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COMPARISON OF HEALTHCARE SYSTEM IN RUSSIA AND SLOVENIA
PANKOVA E.D.1, PANIC A.2 1 FSBEI HE SUSMUMOH Russia, Chelyabinsk 2 Univerza v Ljubljani, Ljubljana Slovenija e-mail: katerinachelsma@yandex.ru, aleksandra.panic.ap@gmail.com
Abstract
One of the main tasks of any country is to provide timely and quality medical care. This article analyzed organization of healthcare system (public and private health network; organization of system on different levels) and organization of insurance /payment system in Slovenia and Russian Federation. This article also provides information about important demographic and main healthcare indicators in order to compare healthcare systems in both countries.
Keywords: health care system, Slovenia, Russian Federation.
Introduction. Health system includes by the definition all the activities whose primary purpose is to promote, restore or maintain health [16]. Considering this, health care is an important public service and is one of citizen's rights, written in the Constitution of the Republic of Slovenia and Russia.
Organization of health care system in Slovenia and Russia. Russian Federation has three health care systems: state, municipal and private. The state health care system includes institutions and organizations in state ownership. The municipal health care system includes medical, pharmacy and pharmaceutical institutions in municipal ownership. The private health care system includes private medical institutions [3, 4].
At the same time, the Russian Federation has a unified health care system. The unified health care system consists of three regulated subsystems: health care at the Federal level, the level of subjects of the Russian Federation, the level of municipal institutions. Each level has own governing body [1, 2, 6, 12].
Slovenia has a democratic political system with a parliamentary form of state power. The system is based on a tripartite division of powers between the legislative, executive and judicial branches.
There are approximately 36 medical centers across the country, which provide a range of services, including outpatient care, GP services and a range of specialists, known locally as consultants. Hospitals and emergency clinics are available in the main cities and towns, and provide emergency medical services. Hospitals will treat everyone on arrival but will ask for payment later if you do not
have health insurance or are not covered by the state system [9].
In Slovenia, health care system consist of two main networks, public and private health service network. Healthcare is provided by public health institutions and private physicians on the basis of concessions.
Public health service network is organized on three different levels: primary (health centers, private health professionals with concessions and other institutions) secondary (general and specialized hospitals, spas and blood transfusion centers) and tertiary (clinics combined in clinical centers, independent clinics, clinical institutes) [18].
The public system covers most medical services, including GP visits, emergency and outpatient hospitalization, prescription medicine costs, prenatal and childbirth care and other specialist services [9. 11].
Private health service network was introduced in 1992. Private physicians can also operate in public healthcare network, if they have special permission called concession. They are given by municipality or Ministry of health, according for which level of service - primary, secondary or tertiary [18].
Dental services are usually only available with private insurance, and out-of-pocket costs can be higher for dental care than medical care [11].
Health care institutions of the Russian Federation and Slovenia provide the population with various types of medical care. Medical care is provide in different conditions:
1. Outside the medical organization on the place of the call of the emergency medical service team.
2. On an ambulatory basis and home
3. On day patient facility
4. In hospital
There are several types of medical care in Russian Federation and Slovenia. In both countries, here are:
1. Primary medical care - pre-hospital and hospital
2. Specialized, including high-tech medical care (VMP)
3. Emergency medical care, including specialized emergency medical care
Russian Federation has too a palliative medical care [12].
Firstly and most importantly, emergency care is always accessible to all citizens of the Republic of Slovenia and includes the cost of the ambulance and supply of essential medicines. Emergency care is one of the tasks of primary health care level [18].
Medical specialists of Russian Federation and Slovenia provide emergency medical care in urgent form in conditions requiring urgent medical intervention outside the medical organization [9, 13].
The basis of the system of medical care of citizens in Russia - primary medical care. This type of assistance is provided to citizens in outpatient departments and in a day hospital.
Primary health care in Slovenia in mostly performed by health centers, spread across whole country. They have organized preventive health care for different target groups, general medicine, dentistry, and laboratory and other diagnostics (radiology ...), gynecology. Good organization of the primary health care system shows on many different levels, for example, everyone can choose personal doctors (general practitioner, gynecologist and dentist), free electronic health insurance card is provided to patients (if they have compulsory health insurance), prescriptions and referrals are issued electronically, etc. Primary health care is much better than in many neighboring countries, and it's interesting that in 2013, 99,8% of the population stated that they do not have unsatisfied health needs. This is just one of indicators of strong and quality system of care. The public health service network at the primary level is provided by the municipality, at the secondary and tertiary level provides by the Republic of Slovenia [9, 18].
Medical specialists in hospital provide specialized medical care. Specific methods and complex medical technologies are used.
High-tech medical care includes the use of new complex and (or) unique methods of treatment with scientific-based effectiveness.
Palliative care of Russian Federation is direct to improve the quality of life of terminally ill citizens. Medical specialists in outpatient and inpatient conditions provide it [12].
Healthcare insurance system in Slovenia and Russia. The foundations of medical insurance in both countries includes:
1. Total nature of participation of citizens in programs of compulsory medical insurance
2. Warranty volume and conditions of assistance to the population
3. Free provision of medical services within the framework of compulsory medical insurance
4. Combination of compulsory and additional health insurance
5. Voluntary health insurance provides citizens with services in excess of the compulsory health insurance program
6. Securing and protecting the rights of insured persons in the health insurance system.
Citizens have the right:
1. The choice of medical insurance company and medical institution, and doctor
2. To receive medical assistance everywhere in Russia
3. Material compensation of damage caused by the fault of the insured
4. Restitution of part of insurance contributions in case of voluntary medical insurance
The foreign citizens permanently residing in the country also have these rights in Russian Federation [12].
In both country, every citizen has the right to receive free medical care and health protection. If you want to get free medical care, you need a certificate of insurance.
There are two health insurance systems: compulsory and voluntary.
Healthcare insurance system in Slovenia is organized and based on the Bismarck model of health care system. It was established in the 1992 and it is defined in the Health Care and Health Insurance Act from the same year. In this social model, the healthcare system is funded by compulsory health insurance, which is in fact the largest public funding source (the other sources are state budget and budget funds of municipalities). The sole provider of compulsory health insurance is Health Insurance Institute of Slovenia (HIIS), based in Ljubljana. This kind of system of funding is paid by employers and employees on the principle of solidarity and covers the entire population of Slovenian citizens (employed family members, their
dependent family members and self-employed who also contribute) [9, 10, 18].
The goal of compulsory health insurance of both country is to provide all members of society with equal access to quality health services.
Some services in Slovenia are financed from compulsory health insurance in full scope (100%), while others are only covered to a certain percentage of the total value of the service. For example, compulsory insurance usually covers most medical services, like GP visits, emergency and outpatient hospitalization, some prescription medical costs, etc [9].
The basic program of compulsory health insurance of Russian Federation includes primary health care, medical examination and preventive medical examinations of citizens, emergency medical care, specialized medical care, the use of bridging reproductive technologies and medical rehabilitation [12].
Certain special groups, like children and adolescents until the end of schooling/studying, pregnant women, unemployed, patients with specific diseases (Diabetes, cancer, tetraplegia) have full coverage under the compulsory insurance.
As mentioned, not all healthcare costs are included in compulsory insurance, and the difference to the full value must be paid by insured persons from their own funds. They can also pay voluntary health insurance (VHI), provided by different competitive insurers. Monthly paid premium is equal regardless of the insured income.
Voluntary health insurance provides additional medical services and effected on account of personal contributions of citizens and the employer. The contract is concluded between the policy holder and the insurance company [9, 12].
Comparison of demographic and health care indicators. Slovenia ended 2017 with a population of 2,066,880 people and Russian Federation with a population of 146 450 019 people, which represents an increase of 985 people compared to 60 020 people in Russian Federation.
Demographic indicators of Russia and Slovenia in 2017 year given below (tabl. 1) [5, 14, 15].
The aging population in Russia Federation and Slovenia is growing, and this, combined with low birth rates, is placing a demographic burden on the systems.
Life expectancy in Slovenia - 81,1 years old; in Russian Federation - 72,7 years old
The share of employed persons in Slovenia is 52,7% of people. The same share in Russia Federation is 59,6% of people [5, 15].
Table 1
Demographic indicators of Russia and Slovenia in 2017 year___
Slovenia Russian Federation
births 20 241 1 860 617
deaths 20 509 2 028 965
Natural increase -268 -168 348
positive migration balance 1 253 people 871 people
Males 1 027 041 67 831 800
Females 1 039 839 78 618 219
Table 2 The main indicators and health care resources (in brackets are years for comparing data)
Slovenia Russia Federation
infant mortality (per 1000 live-born) 1.8 (2016) 6.6 (2016)
stillbirth rate (per 1000 births) 4.9 (2015) 6 (2015)
neonatal mortality (per 1000 live-born) 3.1 (2005) *1.4 (2015) 6.4 (2005)
perinatal mortality (per 1000 births) 2.9 (2015) 5.8 (2015)
Average number of absence from work due to illness per one worker in year (days) 11.6 (2013) 6.3 (2013)
Number of hospitals (per 100,000 population) 1.4 (2013) 3.5 (2013)
Number of primary health care facilities (per 100,000 population) 3 (2006) 9 (2006)
Number of hospital beds (per 100,000 population) 455.39 (2013) 817.53 (2013)
Number of doctors (per 100,000 population) 276 (2014) 331 (2014)
Average length of hospital stay (days) 6.9 (2014) 11.6 (2014)
Average bed occupancy in acute care hospitals (%) 68 (2014) 87 (2014)
The main causes of mortality in Russia Federation and Slovenia are cancer, cardiovascular disease, injuries and poisoning.
The number of deaths from cancer in Slovenia is higher than in the Russian Federation at 100,000 population in 2013 year (in Slovenia is 188 people against 169 in Russia Federation).
However, cardiovascular death, trauma-related mortality and poisoning is higher in the Russian Federation at 100,000 population in comparison
with Slovenia in 2016 year (cardiovascular death in The health care resources such as number of Russia Federation is 547 people, in Slovenia is 198; hospitals, number of primary health care facilities, trauma-related mortality and poisoning in Russia number of hospital beds, number of doctors, and Federation is 118 people against 48 in Slovenia) [5, average length of hospital stay, and average bed 7. 8, 17]. occupancy in hospitals is too higher in Russian
The main indicators and health care resources of Federation. the health care system in Russia and Slovenia have According to statistics, Russia occupy pride of some differences (tabl. 2) [5]. place among developed countries in the number of
Results and conclusion. Therefore, the main doctors and hospital beds per 1,000 people [12]. indicators such as infant mortality, stillbirth rate, It can be concluded that due to the low mortality neonatal mortality, perinatal mortality is higher in rates Slovenia has a better quality of health services. Russian Federation than in Slovenia. Reducing The state investment in Slovenia is higher than in infant mortality is an important factor leading to an Russian Federation (71% from general spending per increase in natural increase. health care system in Slovenia against 63.8% in
Russian Federation).
Reference list
1. Белова С.А. Маршрутизация пациентов с болезнями системы кровообращения при оказании высокотехнологичной медицинской помощи на примере Челябинской области / С.А. Белова, М.А. Медведева, Е.А. Белова и др. // Вестник совета молодых учёных и специалистов Челябинской области. - 2017. - Т. 1. № 4 (19). - С. 12-17.
2. Белова С.А. Особенности маршрутизации пациентов с ишемической болезнью сердца в Челябинской области / С.А. Белова, О.П. Лукин, Д.В. Белов и др. // Вестник совета молодых учёных и специалистов Челябинской области. - 2017.
- Т. 2. № 3 (18). - С. 46-50.
3. Белова Ю.К. Отдельные характеристики частной медицинской помощи в г. Миассе Челябинской области / Ю.К. Белова, Е.С. Матвеева, О.В. Пешиков / Вестник совета молодых учёных и специалистов Челябинской области. - 2017.
- Т. 2. № 3 (18). - С. 51-53.
4. Горлова Н.В. Управлению здравоохранения администрации г. Челябинска 90 лет: прошлое и настоящее / Н.В. Горлова, А. С. Шуляковская, И.А. Киреева и др. // Вестник совета молодых учёных и специалистов Челябинской области.
- 2017. - Т. 2. № 3 (18). - С. 6-23.
5. Европейская база данных "Здоровье для всех": [электронный ресурс]. URL: https://gateway.euro.who.int.ru. (Дата обращения: 20.10.18)
6. Емельянов В.А. Об организации медицинской помощи в городе Магнитогорске в современных условиях / В.А. Емельянов, Е.С. Матвеева, О.В. Пешиков //Вестник совета молодых учёных и специалистов Челябинской области. -2017. - Т. 2. № 3 (18). - С. 95-98.
7. Пешиков О.В. Организационные принципы здравоохранения Челябинской области в части реализации программы родовых сертификатов приоритетного национального проекта "Здоровье" / О.В. Пешиков, Н.П. Петрушкина, А.Ю. Шаманова // Материалы 4 областной научно-практической конференции "Актуальные проблемы восстановительной медицины" - Челябинск: изд-во УралГУФК. - 2009. - с. 78-81.
8. Пешиков О.В. Роль министерства здравоохранения Челябинской области в реализации программы родовых сертификатов / О.В. Пешиков //Научно-медицинский вестник Центрального Черноземья. - 2009. - №36. - С. 52-57.
9. Albreht T.A. Slovenia: Health System Review / T.A. Albreht, R. Pribakovic, D. Josar et al. //Health Systems in Transition. -2016. - Vol. 18 (3). - p. 1-207.
10. Cylus J. Health system expenditure review / J. Cylus, V. Kovacic-Mezek, E. Zver //European Observatory on Health Systems and Policies. - 2015. - p. 1-43
11. Gobec M. Health care system in Slovenia / M. Gobec // Public Health and primary healthcare Study visit. - 2014. - p. 6-16
12. Popovich L. Russian Federation. Health system review / L. Popovich, E. Potapchik, S. Shishkin et al. // Health Systems in Transition, 2011. - p. 1-217
13. State of health in the EU: country profile 2017 - Slovenia // OECD /European Observatory on Health Systems and Policies.
- 2017. - p. 1-20
14. Statistical office of republic of Slovenia: [internet reference resource]. URL: https://www.stat.si/StatWeb/en/Field/Index/17 (data taken: 21.10.18)
15. The demographic yearbook of Russia 2017 // Statistical handbook. Rosstat. - M, 2017. - p. 263
16. World health report 2000: Health systems: Imrpoving Performace // World health organization, 2000. - p. 5
17. World health statistics 2017: monitoring health for the SDGs, Sustainable Development Goals // World health organization, 2017 - p. 1-116
18. Zaletel-Kragelj L. Zdravje in okolje /L. Zaletel-Kragelj, I. Erzen, A. Kukec et al. // Studijsko gradivo, 2017 - p. 114-145
СРАВНЕНИЕ СИСТЕМ ЗДРАВООХРАНЕНИЯ РОССИИ И СЛОВЕНИИ*
ПАНКОВА Е.Д.1, ПАНИКА.2 1 ФГБОУВО ЮУГМУМинздрава России, Челябинск, Россия 2 Университет Любляны, Любляна, Словения e-mail: katerinachelsma@yandex. ru, aleksandra.panic. ap@gmail. com
Аннотация
К одной из главных задач любой страны относится оказание своевременной и качественной медицинской помощи. В данной статье проанализирована организация системы здравоохранения (государственная и частная структура здравоохранения; организация системы на разных уровнях) и организация системы страхования /оплаты в Словении и Российской Федерации. В статье также представлена информация о важных демографических и основных показателях здравоохранения с целью сравнения систем здравоохранения обоих стран.
Ключевые слова: система здравоохранения, Словения, Российская Федерация
* Научные руководители: к.м.н, доц. Пешиков О.В., к.м.н, доц. Матвеева Е.С.
