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РАЗДЕЛ 1 МОДЕЛИ, СИСТЕМЫ, СЕТИ В ЭКОНОМИКЕ И УПРАВЛЕНИИ
УДК 330.1
PROJECT-BASED APPROACH IN THE MODERNIZATION OF THE HEALTH CARE SYSTEM IN THE REGION
I. A. Pitaikina, V. V. Udalova
ПРОЕКТНЫЙ ПОДХОД В МОДЕРНИЗАЦИИ СИСТЕМЫ ЗДРАВООХРАНЕНИЯ РЕГИОНА
И. А. Питайкина, В. В. Удалова
Abstract. Importance and high priority development of health care system in the region are considered in this article. Particular attention is given to the modernization of the health care system and the use of project-based approach in the Penza region.
Key words: modernization, health care system, project-based approach, development of a region.
Аннотация. В статье рассматриваются значимость и приоритетность развития системы здравоохранения в регионе. Особое внимание уделяется использованию проектного подхода в модернизации системы здравоохранения в Пензенской области.
Ключевые слова: модернизация, система здравоохранения, проектный подход, развитие региона.
Institutional transformation trends, taking place in Russia now, primarily aim at the formation of post-industrial society being the present stage of economic and social development, which was reached by the industrialized countries of the West and Japan in the last quarter of the XX century. The «demographic cross» (the intersection of the curves of mortality and fertility) of 1993 and the widening gap between the curves before 2006 emphasize the problem of saving the population, not only as an economic resource, but the ultimate goal of all major reforms.
According to the World Health Organization (WHO), health is a state of complete physical, mental (psychological) and social well-being and is not merely the absence of disease and disability, that is an indicator of socio-economic state development.
Russian healthcare reforms related to health insurance, restructuring, efficiency, quality of care, developed in the 1990s, were overshadowed by health problems of regions that are particularly aggravated by the beginning of the XXI century. Disadvantages in health care to country folk were not only a consequence of national problems, but also a serious underestimation of the importance of this work by the individual heads of municipalities, the lack of coordination in
the field of public health in rural municipalities between medical institutions and agricultural producers.
Now to analyze the problem of regional health should consider factors such as the demographic situation in the region, the level of morbidity, the available resources of the health system, quality of care and efficiency of health care utilization, satisfaction of medical care. For example, according to a public opinion people, using healthcare services in Penza region, have low satisfaction with the quality of hospital services [1].
It's worth mentioning that the health status of rural municipalities is traditionally worse than in the city. There are both objective (older population) and subjective (the worst access to health care) reasons. In Penza region (for example, Ser-dobsky and Kuznetsk areas) people go to the nearest regional centers to have health services, where the detection and registration of diseases is lower than in Penza. Moreover, the number of treatments for primary care is lower than the periodicity of diseases. During the research we distinguish a number of factors influencing on few treatments of people for medical assistance in health care facilities.
The main problem is the transport problem. On the one hand, the government reduces the number of ambulances, which serving people in the region. On the other hand, it is very difficult to go to the hospital from the country to the city. According to information from the Ministry of Health Care in Penza region, now there are 22 emergencies and 19 specialized teams (cardiac, neurological, surgical trauma, pediatric, psychiatric, resuscitation).
By the middle of 2014 in connection with the order of the Ministry of Health Care on 20.06.2013 № 388n «On approval of emergency ward, including the specialized emergencies», which came into force on 01.01.2014, the government decided to reduce the number of emergencies in Penza region. It will be only two emergencies - psychiatric and obstetric. The opportunity to people to get to central hospitals themselves is significantly reduced due to undeveloped transport infrastructure, road conditions, the availability of cars, inability to drive when you feel yourself bad. In some villages of Penza region, people are forced to stop the train to get to the hospital. There are not any bus stops between the villages [2].
The next problem is the fact, that rural institutions have not enough hightech medical equipment and highly qualified medical personnel. For example, in the village Sokolniki in Serdobsk region only one doctor and nurse from GBUZ «Serdobskiye MRB» by A I Nastina serve about 650 villagers. This is due firstly to the lack of personnel in central hospital in Serdobsk. Hospital management decides the problem by offering potential employees new flats in new buildings, payment in the amount of 375,000 rubles to increase staff [3].
On the background of developing demographic crisis, the solution of these problems by regional government was taken under special control. In Penza region there was a pilot project to modernize health care in two ways [4]:
- health care is funding through the compulsory health insurance;
- improving accounting volumes of medical care (introduction of personalized accounting) in the compulsory health insurance.
In order to realization the pilot project the Government of Penza region accepted a document called «About a single-channel financing of health care» on the 26 of March in 2007 № 189. The Government concluded agreements between Territorial funds of the compulsory health insurance, the Ministry of Finance, the Ministry of Health Care and Social Development about the transfer the budgets for health care in the compulsory health insurance.
Penza joined the seven regions, that fully completed the implementation of the regional health program. These news were discussed during the meeting on 12 of July in 2013 on videoconference by Prime Minister of Russian Federation Olga Golodets [5].
During the period since 2008 till 2012 in Penza region was accepted the following Federal target programs:
2008 - development of blood service;
2009 - oncology and healthy lifestyles;
2010 - vascular program and program of the accidents;
2011 - tuberculosis and drug and alcohol abuse;
2012 - a healthy lifestyle, drug and alcohol abuse [6].
The results of the health system reform in the Penza region were:
- supplement new centers and clinics of general practitioners;
- repaired all structural units of the central district hospitals;
- optimized bed space;
- since 2005 there are 5 municipal health centers;
- presented the information about deadly diseases;
- organized high-tech care in regional and urban medical facilities [7].
According to GTRK «Penza» in the press service of the regional government, healthcare modernization program was realized in the Penza region since 2011 till 1 July 2013. Total funding amounted 5 billion 686.1 million rubles, including:
- grants from the Federal Health Insurance Fund - 3 billion 903.2 million rubles;
- budget of the Penza region - 1 billion 250.0 million rubles;
- budget of Territorial Health Insurance Fund - 532.9 million rubles [8].
According to the information from the Ministry of Health Care the finance
of program were spent fully.
Table 1
Regional healthcare modernization program: the main events (based on the official website of the Ministry of Health Care of the Penza region [8])
The main events Results
Improvement of material and technical base of medical institutions • completion of the pre-existing objects (a savings of $ 496.3 thousand rubles directed by retrofitting equipment surgical case Kamenka's hospital in 2013); • repair in medical institutions (work on the creation of high-speed channels and Internet connection); • purchase of medical equipment.
Introduction of modern information systems in health care • provision of computer equipment; • introduction of «Electronic Registry».
Implementation of standards of health care, increasing the availability of outpatient care • health care based on medical standards for more than 38 thousand people; • conduct clinical examination more than 22 thousand young people; • providing hospice care for 18 children with cancer; • making payments to specialist doctors and nurses
At that moment in the Penza region 54 health facilities operate, where there are 3,605 doctors and 11,061 nurses. The average salary of doctors is currently 29,479 rubles, nurses - 15,976 rubles.
Monitoring of the quality of medical services by others specialists in health care revealed a deficit of the following specialties: anaesthetist, pathologist, clinical laboratory diagnostics, neonatologist, radiologist, geneticist, bacteriologist and clinical pharmacologist. Also, hospitals need specialists for emergency assistance and pediatric and psychiatric profile.
To solve this problem, the Ministry of Health Care and regional governments of the Penza region provide special measures to support young professionals. So, government provides monthly surcharges to scholarships from the budget of the Penza region for students (4 to 6 class) to the tune of 2,500 rubles. Government provides incentive allowances for medical professionals (to the tune of 10,000 rubles for doctors with scarce specialties, 5,000 rubles - for rentgenlaborants, operating nurses, etc.) and payments for young professionals, paediatricians and medical staff, which is employed by the central district hospital.
It is also worth mentioning, that in the concept of lifelong learning as a factor of moving to sustainable regional development there is the organization of postgraduate training of health workers in the Penza region. So, there are Penza Institute of Advanced Medical in our region, where more than 1,500 people pass the annual postgraduate training. Here also there is a possibility of free training for physicians in internship / clinical internship. The government provide to the interns granted residence and monthly scholarship.
So, an integrated approach to solve the problem of the quality of the health care system will increase the efficiency of solid state investments. So in 2013 the indicator «maternal mortality» was 0 cases on 100 thousand live births, and the rate of «infant mortality» was 5.3 cases on 1,000 live births, which decreased almost in 2 times compared to the previous year.
The rate «all-cause mortality» for 2013 was 14.8 cases on 1,000 population, the rate of «mortality from neoplasms (cancers, heart attacks)» was 208.1 cases on 100 thousand population [9]. For comparison, these figures for 2012 amounted 20.1 cases on 100 population and 211.5 cases on 100 thousand populations.
So, despite the serious problems in the Penza region there is a trend for improvement, and also for the formation of a new quality of medical services, which, in turn, contributes to the implementation of strategies of sustainable socioeconomic development of our region as a whole.
List of reference links
1. URL: http://vpenze.ru/news/view/71614
2. URL: http://medportal.ru/mednovosti/news/2013/09/13/187penza/
3. URL: http://serdcrb.ru/
4. URL: http://www.rae.ru/monographs/182-5732
5. URL: http://www.vesti.ru/doc.html?id=1104948
6. URL: http://minzdrav.pnzreg.ru/
7. URL: http://minzdrav.pnzreg.ru
8. URL: http://health.pnzreg.ru/moderniz/modern_monotor/oper_info
9. URL: http://health.pnzreg.ru/Dolgosrochnye_celevye_programmy
Питайкина Инна Анатольевна
кандидат экономических наук, доцент, кафедра экономической теории и мировой экономики, Пензенский государственный университет
Pitaikina Inna Anatoljevna candidate of economic sciences, associate professor, sub-department of economic theory and world economy, Penza State University
Удалова Валерия Вадимовна
студентка,
Пензенский государственный университет E-mail: persey_@bk.ru
Udalova Valeria Vadymovna student,
Penza State University
УДК 330.1 Питайкина, И. А.
Проектный подход в модернизации системы здравоохранения региона /
И. А. Питайкина, В. В. Удалова // Модели, системы, сети в экономике, технике, природе и обществе. - 2014. - № 3 (11). - С. 7-11.
