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19DIGITAL TRANSFORMATION PROCESSES AND ASSESSMENT OF THE RUSSIAN HEALTHCARE SYSTEM FINANCING
Kislinskaya M.,
Candidate of Science (Economics), Docent, Associate Professor, Department of Economics of enterprises
and organizations
Lobachevsky State University of Nizhny Novgorod (UNN)
Chemodanova J.
Candidate of Science (Economics), Docent, Associate Professor, Department of Economics of enterprises
and organizations
Lobachevsky State University of Nizhny Novgorod (UNN)
Kornilova H.
Candidate of Science (Economics), Docent, Associate Professor, Department of Economics of enterprises
and organizations ННГУ им. Н.И. Лобачевского Lobachevsky State University of Nizhny Novgorod (UNN)
Abstract
This article is devoted to topical issues of digitalization. The analysis of the existing mechanisms of healthcare assessment and processes of its financing is carried out in the article. To improve the efficiency of the healthcare system and the formation of the society of the future, the application of technologies of the balanced scorecard and lean production is justified in the article.
Keywords: digital economy, performance assessment, financing processes, health system, society 5.0
Currently, the world is undergoing global transformations. They are related to the transformation of social communications, production technologies, the use of Big Data, the Internet of things, artificial intelligence, the formation of cryptocurrencies, the development of block chain technologies and many others. Before our eyes, the energy network economy is forming. A global system of exchange of not only information and knowledge, but also goods and finance is creating. Countries are becoming increasingly interdependent. The real world and cyberspace are becoming very integrated. Modern science and technology, especially information and communication technologies, are rapidly changing economic and social rules and values. They affect the way of life of the world's population.
At this moment, many countries are already on the path of digital transformation. It is called differently in different countries. In Germany, it is called "Industry 4.0", in the USA - "Industrial Internet consortium", and "Digital economy" in Russia.
Japan is proposing a more comprehensive strategy - "Society 5.0". It is aimed at the development not only of the industrial, but also of the social sphere, at the socio-economic transformation of society as a whole. The government of Japan with the active participation of the Japanese Association of large business "Keidanren" in 2016 developed it [5].
"Society 5.0" is the society of the future. According to this strategy, digital technologies will take a leading role in transforming the whole society, all its spheres, including agriculture, energy, financial sector, education, health, etc.
It is obvious that the problem of diversification of the economy and development of the production sector is particularly relevant for Russia now, because the solution to this problem will help to reduce dependence on the export of resources.
However, issues related to health and healthcare are just as relevant. The health of the nation is one of
the most important areas that determines the quality of life of the population. The health of the nation is among the priorities of the socio-economic policy of the Government of the Russian Federation. The health care system is an integral part of the socio-economic policy of the state.
In today's complex political and economic situation, not only at the international level, but also at the state level, Russian healthcare must solve the problem of effective and equitable distribution of available resources to improve the quality of medical care. In addition, it must address the related problem of assessing the effectiveness of financing the health system.
According to the article 41 of the Constitution of the Russian Federation, medical care is free for the population [1].
In this regard, the problem of identifying the sources and amounts of financing of health system expenditures, as well as the issues of identifying their effectiveness become relevant.
According to article 10 of the Law of the protection of health of citizens, the sources of financing of health protection of citizens are [2]:
1) Budget funds at all levels;
2) Funds allocated for compulsory and voluntary health insurance;
3) Funds of the trust funds intended for protection of health of citizens;
4) Funds of state and municipal enterprises, organizations and other economic entities, public associations;
5) Loans from banks and other lenders;
6) Gratuitous and charitable contributions and donations;
7) Other sources not prohibited by the legislation of the Russian Federation.
There should be enough data sources not only to maintain the current functioning of the health sector, but also for its development. Budget deficits and the
compulsory health insurance system lead to an increase in private spending on healthcare, and in unfavorable economic conditions, the deficit stimulates the growth of the shadow economy in this sector.
As for the share of expenditures of the consolidated budget on healthcare, it is constant and makes 3,2-3,6% of gross national product [8]. This is significantly less than the real need and less than in developed countries, where the figure exceeds 10%.
3,2
Based on statistical data [8] the authors of the article compiled the dynamics of health spending from consolidated budgets for the period from 2010 to 2020 (taking into account the forecast). It is presented in figure 1. As we can see, there is a small but steady tendency to increase the allocated funds.
3,035 3,015
3,044
2,861 2,864
2,8
2,6
2,4
2,2
2
2,533
2,187
I
2010
2,283 2,318
2,212 2,212
2011
2012
2013
2016
2017
2018
2019
2020
2014 2015
Figure 1.
Dynamics of expenditures of the consolidated budget of the Russian Federation on healthcare, trillion RUB
The authors of this article believe that it is inappropriate to assess the effectiveness of these funds in the healthcare system to use the standard criteria used in theory and practice to assess the effectiveness of financial processes and investment projects (net discounted income, internal rate of return, etc.).
This is due to the social orientation of health systems. The choice of programs to minimize the reduced (discounted) costs can lead to negative social consequences. Therefore, the authors of this article suggest focusing on a comprehensive indicator that combines the assessment of financial processes and social performance.
There are different approaches to the definition of this indicator in theory and practice.
73 72 71 70 69 68 67
70,2
69,8 _
68,9
Therefore, the world health organization considers that it is enough to have 3 indicators to assess the results of the healthcare system/ they are [6]:
1) the overall level of health;
2) access to health care;
3) satisfaction of the population with the quality of services provided.
Russian President Vladimir Putin in his address to the Federal Assembly stressed that "everything is based on the preservation of the people of Russia and the well-being of our citizens... and the most important basic indicator of the well - being of citizens and the country is, of course, life expectancy" [3]. The dynamics of this indicator is shown in Figure. 2. Even with the naked eye, we can see a connection: the costs increase-the life expectancy of the population increases.
72,45 72,6 72,7
72,2
71,9
71,4
72,2
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Figure. 2. Dynamics of average life expectancy of the population of the Russian Federation
3
Minister of healthcare of Russia V. Skvortsova noted that "the main concept of the development of Russian healthcare is the creation of a national patient-oriented system that unites all medical facilities of the country, regardless of ownership and departmental affiliation, on the basis of uniform requirements for the availability and quality of medical care and qualification of medical workers" [7].
Currently, according to the order of the Ministry of healthcare of the Russian Federation dated on May 10, 2017 No. 203n "On approval of criteria for assessing the quality of medical care", criteria for assessing the quality of medical care have been developed and are in effect [4]. However, they characterize and evaluate the care provided by medical professionals to patients and the compliance of their work with accepted standards.
As a whole, the assessment of the effectiveness of expenditures in health care can be divided into 3 levels:
- Social efficiency (it is characterized by indicators of public health-mortality from controlled causes, primary disability, temporary disability due to illness, etc.). The Executive and legislative authorities conduct macro level assessments with the participation of public organizations and the population;
- Structural efficiency (it is characterized by indicators of the program of state guarantees by types of medical care - emergency, inpatient, outpatient, inpatient replacement). Health authorities carry out an assessment at the level of the health sector municipality or region as a whole;
- Medical and economic efficiency (it is characterized by indicators of achievement in the treatment of certain diseases with the use of various methods and treatment regimens). Health facility management bodies conduct assessments at the health facility level.
One of the three practical methods of cost effectiveness analysis can be used at each of these levels:
- the cost minimization method;
- the method of "cost - effectiveness";
- the method of "cost - utility".
The authors of the article state that the process of reforming the budget process in the Russian Federation is still ongoing. The transition to the model of public and municipal finance management - results-based budgeting is still ongoing. However, much has already been done in this direction, including at the legislative level. The system "Electronic budget" was launched, designed to form a single information space and use information technologies in the management of state and municipal (public) finances.
Budgeting as a tool to improve the quality of budget management has been successfully used in the USA, UK, Australia and other developed countries for a long time.
International experience shows that using the results-based budgeting really allows to count on improving the efficiency and transparency of the management of public financial resources, when the distribution of budget funds is ensured not by items of expenditure, but by strategic goals and tactical tasks, which provide for the achievement of certain final results. At the same time, budget decisions are based not on the amount of
costs for individual items of economic classification or the cost of performing certain functions (education, health, law enforcement), but on a set of budget programs focused on ensuring a specific result.
Of course, effective, responsible and transparent financial management, especially in the field of healthcare, is an essential condition for improving the level and quality of life of the population, and, as a consequence, economic growth and socio-economic development of the country, as a whole.
For the further development of existing trends, the authors of this article propose to put into practice the balanced scorecard and the concept of lean production into the practice of assessing and analyzing the effectiveness of the Russian healthcare system.
It should be noted, that the balanced scorecard was created as a tool that allows us to coordinate the actions of departments and employees to achieve the main goal facing the organization. Execution of strategic plans becomes the most serious test for every organization, including a medical institution. Managers should coordinate individual activities and actions of employees in such a way as to achieve the goals. It is good if the goals are achieved at the lowest cost and in the shortest possible time. The balanced scorecard allows to make it.
This system pays equal attention to traditional financial and non-financial performance indicators. Thanks to this system, managers can make the implementation of the strategy a regular activity of all departments. The strategy becomes manageable through planning, accounting, monitoring and analysis of the score-card. Motivation of staff to achieve such indicators also plays an important role in the balanced scorecard.
In general, using the balanced scorecard in the practice of assessing the healthcare system will contribute to its reorientation from the process of ensuring the functioning, survival to achieve important, socially significant goals and results.
As for the concept of "Lean production", initially it was the management of a production enterprise, which is based on a constant desire to eliminate all kinds of losses. However, we can consider this concept a universal approach to management, regardless of ownership and activities of organizations. "Lean production" includes the whole set of tools and techniques that can reduce losses, simplify and reduce the cost, accelerate the processes of various organizations.
Within the framework of healthcare in Russia, there is already a positive experience in implementing the concept of "Lean production". The project "Lean polyclinic" was launched in November 2016 in Yaroslavl, Kaliningrad regions and in Sevastopol. Currently, 99 polyclinics from 37 regions of Russia are already involved in this project.
On October 15, 2018 JSC "VNIIS" issued the first Russian certificate for the lean production management system in the voluntary certification system "LINSERT" to the city polyclinic in Izhevsk (Udmurt Republic) [9].
The fact that in 2019, during his address to the Federal Assembly, Vladimir Putin instructed to approve the regulation on "lean polyclinics" characterizes the special importance of introducing "lean production"
technologies into the healthcare system [3]. First of all, by 2021 it is planned to transfer all children's polyclinics to new standards. The Russian leader also noted that in three years electronic interaction between all poly-clinics, pharmacies and other medical institutions will be established.
The authors of the article emphasize that it is necessary to develop this trend. If Russian polyclinics follow to the principle of thrift, it will allow patients to reduce the time of appointment to the doctor by five times and get help without queues. In general, it can increase patient satisfaction by 10-15% without significant financial resources due to the normalization of logistics and organizational processes.
The integration of the lean production model and the Russian Government's quality Award will help to improve the efficiency of Russian organizations. Thanks to the initiative of the Ministry of industry and trade of Russia in 2018, it was happened. Now all organizations that implement quality management systems and submit applications for participation in this competition must additionally be evaluated according to the criteria of lean production.
In addition, within the framework of cooperation with Japan, experts provide training to leading Russian enterprises on the implementation of the Kaizen strategy and the Lean system in business.
In order to create "lean", digital and smart healthcare facilities, appropriate staff is needed. Realizing this fact, the leading universities of Russia are beginning to open centers for training medical personnel in lean production technologies. Specialists of such centers should train personnel for medical institutions that are trying to optimize their business processes. These centers should use innovative interactive forms of training, such as, for example, process factories, involving simulation of the real workflow occurring in the clinic. Naturally, in the process of learning, practical training of lean production tools and evaluation of their real effectiveness should have to be done.
All of the above will not only enhance the overall productivity and efficiency of Russian medical institutions, but also will create a "lean" healthcare system in Russia and will improve the population life quality. Moreover, consequently, formation of the foundations
for the development of a new quality and a new level of society will occur. This will stimulate the development of the digital economy and the Russian version of "society 5.0".
References
1. Constitution of the Russian Federation. [Electronic resource]. Access mode: http://www.constitu-tion.ru/
2. Federal law No. 323-FZ of 21.11.2011 "On the basis of public health protection in the Russian Federation". [Electronic resource.]. Access mode: http ://www. consultant.ru/document/cons_doc_ LAW_121895/
3. Presidential Address To The Federal Assembly. [Electronic resource]. Access mode: http://krem-lin.ru/events/president/news/56957
4. Order of the Ministry of healthcare of the Russian Federation No. 203n of May 10, 2017 "On approval of criteria for assessing the quality of medical care". [Electronic resource]. Access mode: http ://www. garant.ru/products/ipo/prime/doc /71575880/
5. "Society 5.0": Japanese technologies for the digital transformation of the Russian economy: interview with the General Director of Mitsubishi Electric (RUS). [Electronic resource.]. Access mode: https ://www.forbes.ru/partnerskie -materialy/367837-obshchestvo-50-yaponskie-tehnologii-dlya-cifrovoy-transformacii
6. Official website of the world health organization. [Electronic resource] Access mode: https://www.who.int/topics/health_systems/ru/
7. Official website of the Ministry of healthcare of the Russian Federation. [Electronic resource]. Access mode: https://www.rosminzdrav.ru/ru
8. Official website of the Ministry of Finance. [Electronic resource]. Access mode: https://www.min-fin.ru/ru/perfomance/budget/
9. Official website of the Russian research Institute of certification. [Electronic resource.] Access mode: https://www.vniis.ru/vniis-vydal-pervyj-v-ros-sii-sertifikat-na-sistemu-menedzhmenta-berezhlivogo-proizvodstva-gorodskoj-poliklinike-izhevska/
