Territorial Programs Research Articles

The evolution and causes of the change in the demographic model of Russia. Message 1. General assessment of historical, medical, social and demographic events

The demographic situation in different periods was determined by the general patterns of childbearing, epidemics and the state of society. In Russia, even against the background of great upheavals, population growth has been observed for several centuries with a high birth rate, which exceeded the total mortality rate. Epidemics, wars and political events of the twentieth century, as well as the change of priorities in the 1990s, left their mark and led to a decrease in the population. This analytical review is devoted to the evolutionary changes in the Russian population model. The main historical, medical, social and demographic events that dynamically affect the demographic situation in our country are considered. Special attention is paid to the factors influencing the decline in the population in the country, which must be taken into account when planning and implementing state and territorial programs to stimulate the birth rate, taking into account the main political and economic changes.

Improving the organization of medical care for patients in the specialty of medical rehabilitation in the Tomsk oblast

More than a third of the total population of the planet needs medical rehabilitation and the need will increase in the future. The prospective increase in life expectancy by the middle of the 21st century will be accompanied by an increase in the share of malignant neoplasms and diseases of the circulatory system in the morbidity structure, and the level of injuries will remain unchanged. These factors will negatively affect a person’s functional capabilities and will contribute to an increase in disability, increasing the relevance of medical rehabilitation. In Russia, according to the current procedure, there is a three-stage organization of medical rehabilitation. The implementation of these stages is carried out within the regional territorial programs of state guarantees (TPSG) of free medical care to citizens, which limits the financial accessibility of the completed cycle of medical rehabilitation for patients, due to budgetary allocations and the compulsory health insurance program, negatively affecting the quality of care provided. The article assesses the volume of medical rehabilitation provided in inpatient settings in the TPSG of the Tomsk oblast for the period of 2019–2022. Currently, three medical organizations in the region of different forms of ownership provide medical rehabilitation. In total, over a four-year-period, 8,804 cases in the specialty of medical rehabilitation were completed in the amount of 378.9 million rubles. An underfulfillment of the volume and costs of medical care during medical rehabilitation approved by the TPSG was recognized, as well as an outflow of patients for treatment to other regions (1,864 people during the study period). The most popular clinical and statistical groups (CSG) for which residents of the Tomsk oblast need rehabilitation measures have been identified, and organizational ways to improve the profile of this medical care have been substantiated.

AUDIT OF THE EFFECTIVENESS OF THE IMPLEMENTATION OF TERRITORIAL DEVELOPMENT PLANS

The article focuses on the disparities between regions that slow down economic growth. The article emphasizes that, despite the state creating regulatory and legal conditions to eliminate uneven development, practice shows the ineffectiveness of current approaches in achieving the goals of eliminating regional differences. In this regard, there is a need to modernize policies based on new principles and approaches, especially at the regional level, in order to cope with existing challenges. The main goal of the study is to develop proposals for improving mechanisms for the implementation of territorial programs that could contribute to a more balanced and effective development of all regions. The study uses various methodologies, including clarification and abstraction to define key terms, retrospective analysis to study historical data, comparative analysis to evaluate implementation of programs, a descriptive method for studying international and local experience, as well as documentary analysis for the development of regulations. At the same time, statistical methods are used to systematize data and scientific analysis to study the relationships between different levels of planning. Moreover, the article notes the need to improve performance assessment as a tool for optimizing and adjusting programs and plans for territorial development, methods and approaches to conducting audits, based on the analysis of current strategic documents and statistical data. It is recommended to improve the planning and development of territorial programs through economic diversification, increasing tax potential, the level of human capital and reducing bureaucratic processes. Special attention is paid to optimizing the selection of indicators for a more accurate and timely presentation of results. These proposals are aimed at creating a more balanced and targeted approach to regional development, ensuring more efficient use of resources and improving the quality of life of the population.

The compliance of specialized medical care of patients with glaucoma to clinical recommendations (CR 96/1 “Primary open-angle glaucoma”) in Russian Federation regions

The high prevalence of primary open-angle glaucoma, its leading role in the structure of visual disability, and insufficient effectiveness of treatment, prevention and rehabilitation measures require new approaches to providing quality care of patients with glaucoma. It is important to analyze the epidemiological situation, human and technological resources in various regions of the Russian Federation. The paper evaluates the compliance of specialized medical care of patients with glaucoma with the approved clinical guidelines CR 96 “Primary open-angle glaucoma” in the regions of the Russian Federation monitored by the Helmholtz National Research Center for Eye Diseases, based on the material of on-site data collection visits. The epidemiological situation relating to glaucoma, the structure and performance indicators of ophthalmological service departments, preventive measures, human and material resources, and the correctness of statistical accounting and reporting were studied. In most regions, the times of examination and treatment correspond to the regional territorial programs covered by state guarantees. The cases when primary specialized care lags behind is associated with staff shortage at the outpatient level. Practically in all regions of the Russian Federation, diagnostic methods and conservative/surgical treatment techniques with proven high efficiency conform to CR 96/1 “Primary open-angle glaucoma”. Some of the regions, however, are insufficiently equipped for early diagnosis of glaucoma and monitoring its course.

Assessment of the Economic Accessibility of Forest Wood Resources

The article is devoted to the development and approbation of methodological tools for assessing the economic accessibility of forest wood resources. According to the authors, the assessment of forest wood resources by the criterion of their economic accessibility can become the most effective tool for intersectoral forest planning. The purpose of this article is the theoretical substantiation and development of methodological tools for assessing the economic accessibility of forest wood resources in the system of rational forest management, as well as the formation of directions for including its results in the mechanism of regional forest planning. As a result of the conducted research, the authors have formed a theoretical basis for the concept of assessing the economic accessibility of forest wood resources, including the introduction of a categorical apparatus («economic accessibility of forest wood resources», «accessible», «conditionally accessible/inaccessible» and «inaccessible» forest wood resources) and substantiation for the feasibility of including an assessment of the economic accessibility of forest resources in the forest management planning system. The results of the study can be applied by public administration bodies in the formation of territorial programs for the development of the forest sector of the economy, taking into account the market conditions of forest regional markets. Methodological approaches and tools for assessing the economic accessibility of forest wood resources can be used to determine the amount of payments for forest resources, ensuring a balance of economic interests of the state, forest users and other stakeholders.

Analysis of tariff agreements of the constituent entities of the Russian Federation: form and completeness of data presentation

Background. Each constituent entity of the Russian Federation (RF) on the basis of the territorial programme of state guarantees of free medical care for citizens forms a tariff agreement (TA) on payment for medical care. Despite the list of requirements to the content and structure of the tariff agreement established by the decree of the Ministry of Health of the RF, there are significant differences among the regional tariff agreements in terms of content and completeness of the information provided.Objective: a comparative analysis of TA of the RF constituent entities and additional agreements to them to identify differences in their structure and content.Material and methods. To carry out the analysis, the data of TA for the full calendar year 2022 were systematised into a single database with the allocation of the main parameters regulated by legal documents. On the basis of the database, the availability and form of information presentation in the TA were analysed.Results. The differences were revealed, which can be divided into two groups. In the first group, they relate to the content and structure of TA; in the second group, to the presentation of TA in public domain. The differences are related to the information content of TA, details of tariffs for medical services, the presence or absence of tariffs for separate medical services, as well as the presentation and formats of TA files on the websites of territorial compulsory health insurance funds.Conclusion. To date, there are still a significant number of differences between TA of the RF constituent entities. The lack of unification in data presentation in the regions increases the risk of errors in comparative analysis, which may ultimately affect the correctness of its results presented to the authorities for decision-making in the health care sector. The new unified form of TA will make it possible to eliminate the above-mentioned differences in content and presentation by bringing the data to a single format.

Анализ финансирования государственной и территориальной программ по оказанию бесплатной медицинской помощи

The article analyzes and compares the financing of expenditures of various types of medical care within the framework of the “Program of state guarantees of free provision of medical care to citizens for 2022 and for the planning period of 2023 and 2024” and the “Territorial program of state guarantees of free provision of medical care to citizens in the Rostov region” for the same periods. Some types of costs for the implementation of state programs in the field of healthcare are considered, due to the implementation of the national project “Healthcare” in the Rostov region and shortcomings in the healthcare system of this region. The growth rates of expenditures of the federal and regional budgets of the Rostov region, as well as the health insurance fund for financing various types of medical care have been determined. The most significant problems in the region that hinder the implementation of state programs included in the national project “Healthcare” have been identified. The budget for healthcare in the region according to regional experts, is not getting bigger, which is an incentive to search for other financing models, in particular, the perspective of the experience of the Rostov region in the field of organization of medical management is noted. In recent years, the municipal authorities have made a decision and transferred all municipal medical institutions to the ownership of the regional government, explaining this by the need to centralize management. The transition of municipal medical institutions to the category of state ones will simplify the routing of patients, make medical care more qualitative and affordable, and also provide an opportunity for more efficient use of all types of resources directed to the field of health care in the region. The results obtained can serve as a basis for adjusting the health policy of the Rostov region.

Ryan White HIV/AIDS Part B and AIDS Drug Assistance Programs during COVID-19: safety net public health programs' challenges and innovations.

We characterized the challenges and innovations of states' Ryan White HIV/AIDS Program (RWHAP) Part B programs, including AIDS Drug Assistance Programs (ADAPs), during the COVID-19 pandemic. In the United States, these are important safety net programs for HIV healthcare, providing essential medical and support services, and medications, to people with HIV with low incomes who are uninsured/underinsured. Data were collected via the 2021-2022 NASTAD National RWHAP Part B and ADAP Monitoring Project Report, a cross-sectional survey of state, district, and territorial programs through a mixed method study design. For quantitative data, we used descriptive statistics. Qualitative responses were coded and analyzed using content analysis. Forty-seven RWHAP Part B and ADAPs responded (92% response rate). The majority of respondents reported that maintaining client eligibility (78%) and working remotely (70%) were the most challenging aspects of the pandemic, particularly in regards to implementing new telehealth and e-certification platforms. In response to COVID-19, programs introduced enrollment "grace periods" (19%), bolstered client outreach (11%), allowed more than a 30 day supply of medications (79%), and supported medication home delivery for clients (80%). Despite the challenges of the COVID-19 pandemic, RWHAP Part B and ADAPs implemented several operational innovations in order to continue providing essential medicines and services. Other public health programs may adopt similar innovations, including digital innovations, for greater public health benefit. Future studies should assess the retention of policy innovations over time, their impact on the individual client level satisfaction or health outcomes, and what factors may improve the acceptability of telehealth and e-certification platforms.

Digital healthcare environment: requirements and limitations

Systemic changes in the digital environment of domestic healthcare are considered, in particular, explanations approved by the Order of the Ministry of Health of the Russian Federation dated March 10, 2023 No. 99n on the application of the Decree of the Government of the Russian Federation “On additional state social support for medical workers of medical organizations included in the state and municipal health systems and participating in the basic program of compulsory medical insurance or territorial programs of compulsory medical insurance” dated December 31, 2022 No. 2568. The analysis of new approaches to ensuring the interests of medical workers of scarce specialties, restrictions established in accordance with the norms of the Labor legislation of the Russian Federation and the requirements of the digital healthcare environment is carried out.

Transformation of priorities in the social security of medical workers: a note to the accountant

The novelties of legislation in force since January 1, 2023, provided for by the decree of the Government of the Russian Federation “On additional state social support for medical workers of medical organizations included in the state and municipal health care systems and participating in the basic program of compulsory medical insurance or territorial programs of compulsory medical insurance” are considered. The analysis of the development of legislation regulating the remuneration of public sector employees, including differentiated approaches to remuneration and social support for certain categories of medical workers, which is due to the need to consolidate the scarce staff of doctors, specialists with secondary medical education and junior medical personnel in primary health care, including in rural areas, in the emergency care system.

The analysis of application of telemedicine technologies in the Russian Federation in 2019-2022

Over the past five years, development of telemedicine was accompanied by many changes. Despite the need for remote medical care, development of telemedicine technologies was not uniformly intensive, both in different countries and in regions of a single state (such as Russia). The purpose of the study is to evaluate dynamics of volume of medical care and number of types of services using telemedicine technologies in regions of the Russian Federation. The retrospective analysis was applied to data retrieved from the Form of the Federal Statistical Observation № 30 of 2019-2021, from documentation of territorial programs of state guarantees of free medical care of population and tariff agreements in regions of the Russian Federation in 2021-2022 and from the Federal Telemedicine System in 2021. The study established that total number of telemedicine consultations increased in 2021 by 23% as compared with 2020. The percentage of consultations financed by the Compulsory Health Insurance Fund also increased from 6.95% in 2020 to 11.72% in 2021. The number of patients being on remote monitoring increased in 2021 up to 44% as compared to 2020. In addition, percentage of patients receiving medical care through remote monitoring and financed by the Compulsory Medical Insurance Fund increased from 6.55% in 2021 to 19.96% as compared with 2020. In the territorial programs of state guarantees for seven regions of the Russian Federation the number of types of telemedicine services fixed in tariff agreements increased in 2022 as compared to 2021. However, it decreased in ten regions. The most common medical care profiles for which telemedicine consultations in the "physician-physician" format were provided by Federal medical organizations in 2021 were: oncology (55 regions of Russia requested consultations on this profile), pediatrics (45 regions), and intensive-care medicine (39 regions). The telemedicine solutions are in high demand, as it is demonstrated by increasing both of volume of remote medical care and of percentage of consultations financed by the Compulsory Medical Insurance Fund. The COVID-19 pandemic had rather strong impact on development of telemedicine. The alignment of market for telemedicine services in public health sector began in 2021 and it is confirmed by decreasing of total number of consultation types in tariff agreements in 2022. In terms of remote interaction in "physician-physician" format, situation continues to be stable. In the nearest future one should expect more gradual development of telemedicine in Russia with appearance of individual initiatives in terms of pilot projects and experimental law modes.

Current state of legal regulation of self-employment in Ukraine

The work analyzes the current state of legal regulation of self-employment in Ukraine. It is noted that self-employment of the population is an alternative way out of the crisis situation on the labor market, for a certain part, a way of survival in a difficult life situation. Thanks to it, additional jobs are created, there is an opportunity to show one's own initiative and receive income. At the same time, it does not require state capital investments, has a mobile organizational structure, is based on strong labor motivation, focuses on consumer needs and promptly satisfies them. The basis of the legal regulation of this form of employment in Ukraine is the Constitution, special normative legal acts that regulate the procedure for the employment of self-employed persons. It is noted that the non-regulation of this form of population employment by the main acts of labor legislation has a negative consequence for the regulation of these legal relations. Attention is focused on the importance of self-employment as a separate type of employment, especially today, when the country is in a state of war. Currently, the processes of formation and development of the labor market of Ukraine and its regions are under the significant influence of the socio-economic crisis, the systemic nature of which produces the growth of labor migration, a high level of unemployment, an existing imbalance in the structure of labor supply and demand, the imperfection of the wage system, the development of shadow labor socio-economic and contractual relations, as well as the underdevelopment of incentives to improve labor efficiency. Therefore, aspects of effective employment of the population, creation of an effective labor market, prevention of mass unemployment and labor migration are of particular importance. The state should pay special attention to the issue of self-employment of the population in Ukraine, in particular by introducing regional strategies to support employment; improvement of the organizational and economic mechanism of interaction of the self-employed with local authorities. The implementation of the mentioned measures should lead to the development of territorial programs to promote the development of micro-businesses, the development of regulatory documents, the optimization of tax payments, the construction of a system of social protection and social benefits for the self- employed.

ОКАЗАНИЕ МЕДИЦИНСКОЙ ПОМОЩИ СВЕРХ УСТАНОВЛЕННОГО ОБЪЕМА: ВЫПОЛНЕНИЕ ОБЯЗАТЕЛЬСТВ ПО ДОГОВОРУ ОБЯЗАТЕЛЬНОГО МЕДИЦИНСКОГО СТРАХОВАНИЯ ИЛИ С ПАЦИЕНТОМ

Significance. The issue of medical care delivery in excess of the established volume, including by private health sector operating under compulsory health insurance remains a challenge to the medical community. The subject of the study, on the one hand, was the overview of the current situation regarding medical organizations that submit registers of bills and invoices for medical services provided to the insured under the territorial program and insurance medical organizations that refuse to reimburse services in excess of the established volumes. On the other hand, the inability of a medical organization to refuse to provide medical care to citizens who have applied for care. The purpose of the study was to analyze the normative and legal acts that regulate legal relations between participants and subjects of the compulsory health insurance, indicating impossibility or difficulties for the parties to fulfill their obligations to ensure care delivery to the insured under the compulsory health insurance program. Material and methods. Material and methods of the study included an analytical review aimed at studying and analyzing the legal policy, current legal practice, current situation regarding place in the medical service market, including the private health sector, in order to answer the research question. Results. The conducted analysis shows that the main function of medical organizations is to provide medical care to the insured. At the same time, territorial funds are responsible for providing medical care to the insured under the federal compulsory health insurance program, and are to create all conditions to ensure availability of services. The federal legislation does not make the provision of free medical care to a citizen under the compulsory health insurance program dependable upon the planned total volume of services and guarantees the provision of free medical care to the insured in the compulsory health insurance system. When the planned volumes of medical care under the program of compulsory health insurance do not correspond to the actual demand, the excess of these volumes provided by a medical organization cannot be attributed to the financial results of its performance. Conclusion. The foregoing confirms the conclusions that medical services provided in excess of the established volumes are to be considered as insured events and are subject to reimbursement in the stated amount. Accordingly, they cannot be a restriction to realizing the powers to provide medical care to citizens under the program of state guarantees in cases where the volume of medical services provided exceeds the planned one, envisaged by the compulsory health insurance contract. This position will help avoid risks, including reputational ones, and prevent the organizations from filing a lawsuit.

Планирование медицинской помощи пациентам с онкологическими заболеваниями в субъектах Российской Федерации

National project “Fight against oncological diseases 2019 - 2024” implemented for the fourth year. During this time, experience has been gained in planning the volume of medical care, including diagnostic tests, and financial support in the system of compulsory medical insurance, but there is no systematic analysis of planning problems. The purpose of this study was to study the planning by the subjects of the volume of medical care and their implementation of the target indicators of the territorial programs of state guarantees of free medical care (TPGG) and to identify planning problems. We analyzed the territorial programs of state guarantees of some subjects of the Russian Federation. Also, from the territorial CHI Funds (TFOMS) we received information on the performance of TPSG indicators: the volume of care in round-the-clock and day hospitals, planned and actually performed molecular genetic studies and cases of positron emission tomography combined with computed tomography in 2021 and the first half of 2022 of the year. We found significant problems, some of which have causes at the federal level, others are purely regional in nature, which lead to significant differences in planning the volume of medical care between the subjects of the Russian Federation. Conclusion. Planning the volume of medical care in the field of “Oncology” varies significantly between the subjects of the Russian Federation and has systemic difficulties, control over the effective use of funds is insufficient. We consider it necessary when planning medical care for the oncology profile in the Program of State Guarantees of Free Medical Care to take into account the standardized incidence rate per 100,000 population, and not the number of insured persons in the subject.

Health care delivery above the established level: obligatory medical insurance contract performance or to the patient

The imperfection of the normative legal acts regulating legal relations between participants and subjects of compulsory medical insurance inevitably leads to the impossibility or difficulties for the parties to fulfill their obligations to ensure the provision of medical assistance to insured persons under compulsory medical insurance programs. Medical organizations included in the unified register of medical organizations operating in the field of CHI are limited in exercising their powers to provide medical care to citizens under the state guarantees program in the event that the volume of medical services provided exceeds the planned services provided for in the CHI agreement. The "forced" provision of medical care "in excess of the volume", in the first place, is aimed at meeting the actual needs of patients in this service. And ignoring this circumstance by medical organizations contradicts the basic principles of protecting the health of citizens, namely, the priority of its provision in the field of health protection.The inadmissibility of refusal to provide medical care and the revision of legal instruments for its provision in order to avoid a negative impact on patients, and on the performer represented by a medical organization, is the topic of this discussion.Presentation by the contractor in the person of a medical organization for payment of medical services in excess of the distributed volume and (or) financial security established by the medical organization in accordance with the legislation on CHI should not be a reason for refusing to provide medical services at the time of the consumer's request and when planning treatment. At the same time, based on the results of examinations conducted by insurance medical organizations for monitoring the volume of medical care for identified cases of medical care in excess of the distributed volume established by the decision of the commission for the development of the territorial program, acts of medical and economic control were drawn up.Non-payment by the insurance medical organizations of the subject of bills for the rendered medical services, motivated by the excess of the volumes and financial support established by the territorial CHI program, served as the basis for the medical organization to file a lawsuit.

Acute Cerebrovascular Accident during the pandemic of a new coronavirus infection in the Ural Federal District

Introduction. Acute cerebrovascular accidents are among the leading causes of death and disability in the population. The study of regional features of the incidence of acute disorders of cerebral circulation in the context of a pandemic of a new coronavirus infection COVID-19 is an urgent task. Purpose - to conduct a comparative analysis of the primary incidence of acute disorders of cerebral circulation, including transient ischemic attacks, in the adult population of Russia, the Urals Federal District and the constituent entities of the Russian Federation as part of the Urals Federal District. Materials and methods. A comparative analysis of the primary incidence of acute cerebrovascular accidents in the adult population in the Urals Federal District and in individual subjects of the district during the 2020 pandemic was carried out relative to the average long-term indicators for 2015-2019. Transient transient cerebral ischemic attacks, intracerebral and other intracranial hemorrhages, cerebral infarctions and strokes not specified as hemorrhage or infarction were taken into account. Average long-term levels of primary morbidity, standard deviation, coefficient of variation were calculated. Statistical data analysis was carried out using Microsoft Excel software products. Results. During the COVID-19 pandemic, the levels of primary incidence of certain acute cerebrovascular accidents in the Russian Federation and the Urals Federal District as a whole decreased compared to the long-term averages of 2015-2019. Conclusions. Indicators of primary morbidity of the adult population of the Ural Federal District with certain acute cerebrovascular accidents, including transient ischemic attacks, in different subjects of the district have pronounced regional features. Regional peculiarities of morbidity should be taken into account when planning the volume and financial parameters of territorial programs for the provision of free medical care to citizens. Significant differences in morbidity rates should be in the focus of attention of the chief neurologists of the Ministry of Health of the Russian Federation and the constituent entities of the Russian Federation.

Chronic vein diseases in the population in the Ural Federal District. Statistics and trends

Introduction. There are practically no publications on the study of epidemiology of chronic venous diseases (CVD) in residents of the Urals, although the incidence of CVD is one of the significant components in assessing the health of the adult population. The aim of the work is to evaluate the indicators and determine the epidemiological trends of the primary incidence of chronic diseases of the veins of the lower extremities in the population of the Ural Federal District over the past 11 years. Materials and methods. A retrospective analysis of official statistical data on the morbidity of the adult population of the Ural Federal District (UFD) with varicose veins of the lower extremities (VVLE) was performed with a diagnosis established for the first time in his life for the period from 2010 to 2020. The ranking of all subjects of the Russian Federation as part of the UFD according to the level of primary morbidity was carried out. The statistics of the largest private regional phlebological center are summarized for a comparative assessment of the patients' appeal to the public and private sectors of the health care system of the Sverdlovsk region. For this article, it is postulated that VVLE in statistical reports and CVD are equivalent concepts. Results. Absolute and relative indicators of the primary incidence of VVLE (CVD) of the adult population in the subjects of the UFD have been investigated. A high variability of morbidity rates was revealed depending on the region of the UFD. A sharp decrease in morbidity was recorded in 2020 in relation to the median level of 2010–2019 in the whole of the Russian Federation and the UFD region, as well as in most regions of the district. With a decrease in the level of morbidity registered in public institutions over the years, the number of requests for phlebological care increases in the private healthcare sector. Discussion. The revealed significant regional differences in the figures of the primary incidence of VVLE (CVD) require the introduction of uniform methodological documents for the diagnosis, treatment and registration of patients with CVD. Similar epidemiological trends have been obtained by a number of other researchers, only in relation to other nosologies. Conclusions. The primary morbidity of the population of the Ural Federal District of VVLE (CVD) as a whole is statistically significantly higher than the average in Russia. Morbidity rates in individual subjects of the district have significant differences. The morbidity rates of the adult population should be taken into account when developing territorial programs of state guarantees of providing free medical care to citizens.

Health technology assessment and price negotiation alignment for rare disorder drugs in Canada: Who benefits?

BackgroundSince 2014, the Canadian Agency for Drugs and Technologies in Health (CADTH), which performs health technology assessments for all federal, provincial and territorial government drug programs (except Quebec’s) and the pan-Canadian Pharmaceutical Alliance (pCPA), which conducts price negotiations with manufacturers for all government drug programs, have been aligning their processes.ObjectiveTo examine trends in CADTH recommendations for non-oncology drugs for rare disorders (DRDs) released between 2014 and 2021, results of pCPA negotiations for the same drugs, and listings in government drug plans to assess who benefits from the alignment.ResultsRecommendations were positive in 87% of the reviews, although all included clinical criteria for use and/or economic conditions. Almost 90% of the DRDs with a positive recommendation had a successful price negotiation and 71% of those with a negative recommendation had no negotiation. Although no recommendation published before mid-2016 had a specified price reduction, almost 95% of those issued afterwards included the price reduction required to achieve a specific low cost-effectiveness threshold. The median time between the DRDs receiving marketing approval and a completed price negotiation was 663 days. Negotiations for DRDs completed after 2017 generally had fewer listings in government drug plans, but there was no distinct trend. The drug’s price likely played a role in listing decisions. When DRDs were listed, drug plans had access criteria consistent with CADTH’s or stronger for all the DRDs.ConclusionsThe governments who own, fund and manage CADTH and the pCPA benefit from their alignment. The alignment is less beneficial for patients waiting for access to the DRDs. The time taken by CADTH and pCPA actions and individual government drug plans to make listing decisions delays access. CADTH’s clinical criteria have become more extensive and are applied rigorously by drug plans which restricts patient access to DRDs. Canadians with rare disorders urgently need their governments to implement a long-overdue, comprehensive rare disease strategy to ensure DRDs are reviewed and reimbursed quickly and equitably to provide adequate health care to all who need them.

REGIONAL PUBLIC POLICY IN MOROCCO IN THE LIGHT OF THE CONSTITUTION 2011 AND ORGANIC LOW NO. 111-14 CONCERNING THE REGIONS

The study discusses Morocco's regional public policy in the light of the Constitution 2011 and Organic law No. 111-14 concerning the regions, the importance of research is to study and analyze the constitutional and legal framework of Morocco's advanced region, in accordance with a legal methodology. What are the framed constitutional principles of Morocco's advanced region? How to organize and distribute regional competencies? To take note, it was divided into two axes: The first addresses Morocco's regional policy under the Constitution 2011 and the question of the basic terms of reference on which regional perception is built; The second focus deals with the competence of the entity in the light of the Organic law concerning the regions. The study concludes the importance of the principle of free governance, and giving the power to authorities to implement their decisions. Adopting a direct election of members of regional councils, and elaborating on their management choices in accordance with a democratic methodology. The importance of a participatory approach the regional management through the inclusion of new actors in the development process, such as consultative entities and the mechanism for submission of petitions to regional councils. The need to define clearly the terms of reference, to adopt contracts as a mechanism consistent with territorial programs. To give effect to the principle of arty in determining the scope of competence between the State and the regions, to redrawn the relationship between the State and the regions by defining the respective powers of the Chairman of region and the representative of the central authority. and to review the logic of administrative control of the authorities. Key words: Advanced Regional; Moroccan Regional Public Policy; Morocco; Constitution; Organic Law.

Urban Agglomeration: Transforming the Economic Space Based on the Concept of Sustainable Development of the Territorial Land Resource System

Regional strategies for sustainable development of territories are a priority in the Russian Federation. In the context of these strategies, the modernization of the country's regions' economic space is inextricably linked to agglomeration tendencies. The article determines that to solve the important social and economic problem of providing affordable housing for the Russian population and the making of comfortable urban environment it is advisable to focus on the project approach with the use of environmental, technical and legal tools to improve the environmental, economic and cost efficiency of land resources of urban agglomeration systems. Urban agglomeration is a highly developed spatial form of integrated cities, via a shift from competition to cooperation. Agglomerations have certain attributes, described in detail in the article, that make urban agglomeration one of the most important agents of global economic development. The author systematizes technologies of agglomeration development spatial planning in terms of managerial concept of territorial land resource system as the basis for housing development. In addition to the existing structure-planning, functional, compositional factors of territorial development, through the formation of agglomeration the efficiency of using territorial land resources in suburban areas as a tool used by investment and construction companies in the implementation of territorial programs, with predominantly low-rise development, ensuring a high level of integrated development of territories and energy efficiency class is proved. In addition to existing structural-planning, functional, compositional factors of territorial development, the author proves, through the making of agglomerations, the efficiency of use of land resources of territories in the suburban areas as a tool used by investment and construction companies in the implementation of territorial programs, with mainly low-rise buildings, providing a high level of comprehensive development of territories and high energy efficiency class. As a result, this will allow the formation of an urban agglomeration as an «economic funnel», which will be the core for the social and economic resources of the region and will enable the transformation of the economic space.