CC BY
2UDC: 614.2:369.22(478) RESEARCH ARTICLE SOME WAYS TO ANALYZE THE MEDICAL INSURANCE SYSTEM: REFLECTIONS
AND SUGGESTIONS
EFIM ARAMA
Department of Human Physiology and Biophysics, Nicolae Testemi^anu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
EMIL CEBAN
Department of Urology and Surgical Nephrology, Nicolae Testemi^anu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
NATALIA GASITOI
Department of Mathematics and Informatics, Alecu Russo State University of Balti, Republic of
Moldova
VALENTINA PiNTEA
Department of Physics, Tehnical University of Moldova, Chisinau, Republic of Moldova.
Corresponding author: EFIM ARAMA, PhD, university professor Department of Human Physiology and Biophysics, Nicolae Testemi^anu State University of Medicine and Pharmacy,
Chisinau, Republic of Moldova
What is not yet known about the issue addressed in the submitted manuscript?
Application of the mathematical calculation method through regression equations for forecasting the birth-mortality correlation and the redistribution of medical insurance funds. The research hypothesis
The regression equations are relevant for the redistribution of medical insurance funds. The novelty added by the manuscript to the already published scientific literature
Evidencing the factors with a negative impact on human health and applying the mathematical calculation method through regression equations for forecasting the birth-mortality correlation and the redistribution of medical insurance funds.
Cite this article: Arama E, Ceban E, Gasitoi N, Pintea V. Vital statistics: reflections and
suggestions
Introduction. Health insurance policymaking must take into account several factors, including the predictability of the birth-mortality correlation for an efficient distribution basic fund by types of medical activities.
Purpose: Calculation of the birth-mortality correlation, using regression equations for the anticipation and more efficient distribution of the basic fund on medical activities. It is being suggested to take into account various risks to the health of the population for its improvement, using advanced technologies and mathematical methods.
Materials and methods. The statistical data of the National Bureau of Statistics served as materials. The logical, comparative method, the method of mathematical calculation of the parameters of the regression equations and the correlation coefficient were used in the study process.
Results. Are listed and analyzed: birth-mortality balance per 1000 inhabitants in the Republic of Moldova is analyzed; statistics distribution of basic funds by types of medical activities is characterized; components of the health care system in the Republic of Moldova, including information, medical, managerial system are identified. In the article, correlative dependencies are
quantified, the algorithm for calculating the parameters of regression equations is proposed based on statistical data.
Conclusions. The birth-mortality balance was negative in the Republic of Moldova in the period 2003-2018, i.e. the birth rate per 1000 inhabitants is exceeded by mortality. The problem of this balance, to a certain extent, could be solved by optimizing the distribution of basic funds by types of medical activities. For this purpose, the dependencies of mortalities on the types of medical activities are necessary. The development of a system of regression equations could contribute to the redistribution of some funds in order to reduce the level of mortality. The proposed material is of interest for public health specialists.
Keywords: health care system, health insurance system, medical services, scientific efforts, death rate, birth rate.
Introduction
Health is a vital value for every person, far superior to all the values of goods. Health occupies the highest rung in the hierarchy of all values. Health is a necessary asset that allows man to increase his physical and intellectual potential, creative, innovative potential throughout his life. Health allows man to cope with dangerous situations, economic shocks, and natural disasters. The right to health is a social right, to which every member of human society must have access.
The ratio effects - efforts, determine the effectiveness of any process, including the medical treatment activity of the population. Treating a sick person cost. However, if preventive efforts are made, that is, efforts to prevent some risk factors, efficiency will increase [1-8]. As it is difficult to list the totality of diseases affecting the health of the population of the Republic of Moldova, we can limit ourselves, for example, to cardiovascular diseases. Medical treatments are not always accompanied by success. Some of the negative outcomes (premature deaths) could have been prevented by creating and promoting a healthy lifestyle, promoting fair healthcare, expanding and improving the medical surveillance system, reducing the consumption of alcohol, tobacco, sodium, counseling the population and promoting a healthy lifestyle [9]. Eliminating risk factors for the health of the population can help reduce the cost of treaeating potential paatients. Many diseases (hypertension, hyperglycemia, hypercholesterolemia) are generated by the use of tobaacco, alcohol, unhealthy diet. Therefore, the medical insurance system of the Republic of Moldova must orient some financial resources aimed at initiating the population in elementary knowledge about health.
Materials and methods
The health and disease can be interpreted as biological, psychic, social states of man: basically, it has been shown that people with a certain intellectual training, intelligent ones, have a relatively higher life longevity than people with low intellect. Health is dependent on the specifics of work, the quality of life, the quality of the medical system. We distinguish factors that strengthen health and factors with negative impact on health (alcohol consumption, tobacco, narcotics, harmful environment, etc.). Man must avoid or do not accept risk-generating activities. The system of medical health insurance is a form of overcoming some risks.
Since 01.01.2004 in the Republic of Moldova, insurance has become mandatory, as a result of which the degree of financial stability of the medical system has increased, the access of the population to basic medical services has improved. The mandatory health insurance (MHI) has contributed to increased demand for healthcare. Under these conditions, the situation requires the medical system to be optimized and to increase the efficiency of its activities. Using the method of analyzing the works of local authors who studied factors with a negative Impact on Human Health and data from the National Bureau of Statistics we classify the factors on which the state of human health depends, including: 1) the behavior of man in various situations during life; 2) technological progress, innovation at global level; 3) the care of his own health; 4) the scientific, practical, innovative achievements of the National Medical System; 5) the living and working environment; 6) the quality of life; 7) the biology of man; 8) the level of intellectual development of man (fig. 1).
Fig. 1 The state of human health.
Currently, the possibilities of treating many diseases are limited. In the Republic of Moldova efforts, the share of expenditures for health care exceeds 5.5% of GDP; the MHI system covers over 90% of the population; about 50% of the expenditure comes from budgetary sources. But the health spending per capita is far below the level of highly developed industrial countries. Efforts to create conditions for man to be healthy are necessary, firstly, on his (man) part and secondly - on the part of the medical insurance system.
It is natural that family doctors can also contribute to increasing the level of health of the society. Currently, family doctors are predominantly (70%) occupied with curative medical care. Preventing potential diseases by promoting a healthy lifestyle could contribute to considerable reduction in spending on treating diseases. The identification of risk factors for the health of potential patients must become the activity of first importance for family doctors.
We are now witnessing the Fourth Industrial Revolution. Information technologies, for sure, will also invade medicine. From the perspective of using new technologies in the Health Care System in medical activities it is necessary to formulate and solve a number of problems, including: planning medical services provided by outpatients in territorial profile; identifying optimal reserves of various materials; ensuring potential patients with access to telemedicine; studying diseases specific to hum an activities, areas, professions; creating databases, information systems about the evolution of some diseases of patients taken into evidence by the doctor. Broadly speaking, the health care system (HCS), in our view, is made up of a lot of medical services and efforts aimed at protecting human health.
Using statistical calculation method, it is possible to forecast the birth-mortality balance.
Results
To improve the Health Care Insurance are necessary to develop the scope of medical services provided free of charge (communicable diseases, socially dangerous diseases), that is by the MHI. Thanks to MHI, life expectancy in the Republic of Moldova has increased over the last 30 years by over 6.7 years. The Human Development Index of the Republic of Moldova exceeds this index of the group of countries with an average human development by 1.1 times, but constitutes only 92.6% of the index of European states. According to the National Bureau of Statistics (NBS) data, the birth-mortality balance per 1000 inhabitants is negative (tab. 1).
Ta jle 1. Birth-mortality balance per thousand inhabitants.
Year 200 3 200 4 2005 200 6 200 7 200 8 200 9 201 0 201 1 201 2 201 3 201 4 201 5 201 6 201 7 201 8
Natality 10.1 10.6 10.5 10.5 10.6 10.9 11.4 11.4 11.0 11.1 10.6 10.9 10.9 10.8 10.7 10.6
Mortalit y 11.9 11.6 12.0 4 12.0 11.5 11.8 11.8 12.3 11.0 11.1 11.7 10.9 11.2 11.1 11.2 11.8
Natural growth -0.8 -1.0 -1.9 -1.5 0.99 -0.9 -0.4 -0.9 0 0 11.1 0 -0.3 -0.3 0, 5 -1.2
Note: Relative value per 1000 inhabitants
Analyzing statistical data, we find causes of death: 57.8% - diseases of the circulatory system; 15.3% - tumors; 9.4% - diseases of the digestive system; 6.9% - accidents, poisoning; 4.6% -diseases of the respiratory system; 6% - other causes.
Knowing the causes of deaths and forecasts of potential diseases, the medical insurance system can schedule its expenses for purchasing devices, techniques for treating these diseases. The financial means of the SHI need to be used not only for current medical services, for medical assistance, for the administration (regulation) of the system, but also for the prevention of potential diseases generated by certain risks, the modernization of treatment methods, high performance medical services.
At macro level, the HCS consists of subsystems: 1) specifics of the HCS problems; 2) methods of operational, mathematical research in the HCS; 3) the HCS system planning; 4) the HCS operation in telemedicine conditions; 5) ways of distribution of funds (finances) in the HCS (fig. 2); 6) ways of improvement of the HCS.
The distribution of the basic fund by types of medical care can be carried out using statistical data, or based on the recommendations of notorious doctors. However, statistical data reflect the structure of medical services (tab. 2). In the medical insurance system of the Republic of Moldova, the maximum expenses are those related to hospital medical care; the minimum expenses -community medical care. Total medical expenses, for example, in 2017 amounted about 6 billion lei. One way to reduce hospital healthcare expenditure is primary healthcare (fig. 2).
Fig. 2 Distribution of the basic fund by types of medical activities.
The medical insurance system, increasing the expenditures for primary medical assistance, solves two problems: 1) it contributes to reducing the number of potential diseases; 2) it increases its financial potential, intended for other necessary medical activities. Preventing diseases costs cheaper than treating them. The distribution of the basic fund by types of medical activities in the profile of the years 2004-2015 can be transcribed in relative quantities, in weights that are determined after the calculation relationship:
p = 4^-; f = 1; 2;...;14
IX,
t=1
These shares are given in table 2.
Table 2. Distribution in % of the basic fund by type of medical activities.
Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Emergency medical care 10.9 10.3 9.0 8.6 9.3 9.1 9.1 8.8 8.6 8.4 8.5 8.3 8.5 8.7
Primary healthcare 25.1 29.8 30.9 30.1 30.6 31.1 30.1 30.0 30.0 30.1 30.1 32.2 33.6 35.2
Specialized medical assistance 4.3 5.2 6.5 6.7 7.4 7.7 7.1 7.5 7.4 7.4 7.3 7.3 7.4 7.5
Hospital healthcare 59.7 53.1 52.1 52.1 50.1 49.8 50.7 51.0 50.4 50.4 50.5 48.7 46.6 44.3
High performance med. services - 1.6 1.4 2.3 2.5 2.2 2.3 2.5 3.5 3.5 3.5 3.3 3.8 4.2
Community med. facilities - - 0.07 0.2 0.1 0.1 0.7 0.2 0.1 0.2 0.1 0.2 0.1 0.1
Total expressed in % 100 100 100 100 100 100 100 100 100 100 100 100 100 100
The process of providing medical services consists of two stages: 1) prophylactic control, regarding the level of health of the population; 2) adoption of medical treatment decision in case of identification of deviations from the normal state. In the process of treating a disease, the individual (patient) and the means of treatment are biologically important; the process of treating that disease turns into a complex process that evolves over time (usually for the better). In the Republic of Moldova, the HCS is to be optimally located in the profile of districts, localities. This location can be achieved with the help of mathematical methods, operational research [10-12]. The HCS in the territorial profile assumes the existence of certain infrastructure. Moreover, as the HCS includes the interests of the state and society, it is of particular social importance to locate medical structures in the localities of the Republic of Moldova, which should not start from economic considerations. The health of the population cannot be transformed into a form of business. The rural population must be provided with all medical infrastructure. The medical services provided by outpatient clinics generate two effects: 1) protecting the health of the population; 2) reducing the number of risks causing diseases and thus reducing the potential expenses from the HCS. In this case, financial resources can be aimed at increasing the quality of medicacal services, equipping outpatient clinics with vaarious devices and medical technologies. The HCS can streamline its functioning, using some economic and mathematical methods of optimal territorial location of outpatients and optimal distribution of
financial resources in the process of prococurement of medical techniques, technologies [13, 14]. A separate issue is Hospital Medical Services. The reduction in the number of hospitals in the rural area of the Republic of Moldova, in our view, remains questionable. In the current conditions, when remote information systems can be made available to doctors in rural areas, hospitals must be equipped with equipment and techniques for collecting patient analyzes; the number of doctors can be reduced to the minimum level. Rural hospitals can be provided with benefits from doctors from outside, including from other states. The emphaasis in this case is on equipping hospitals with medical equipment. The presence of a minimum number of medical personnel can contribute to providing the rural population with high-performance medical assistance [15].
The HCS can work effectively if planned. The system must be equipped with various medical techniques, with medical personnel specialized in various medical fields. The need for personnel, technologies, medical devices is determined by the demand created by potential patients. In this context, the disease statistics becomes of primary impoortance for the HCS. Economic problem: to identify the available finances; the need for medical activities; to establish the optimization criteria; to formulate the problem in the economic-mathematical language; to identify or develop the algorithm for solving the problem [15]. Medical problem: to identify the trend, the evolution of diseases; to identify the appearance, disappearance of diseases; to establish the need for techniques, technologies for treating patients in the profile of diseases. The HCS problem is complex, its solution requires the efforts of a group of medical experts, who know the successes of national and other country medicine, experts in economics, Information Technologies.
Regression equations in the health care system support
The evolution (trend) of diseases can be identified using statistical methods of calculation. For example, birth and death rates in the Republic of Moldova are subj ect to statistical analysis. In tables 3-6 based on the initial data, the algorithm for calculating the parameters of the regression equations is presented; determination of correlation coefficients.
Table 3. Determination of dispersion in relation to the arithmetic mean, for birth rate.
Anul t Natality Arithmetic Deviation from Deviation from the Arithmetic mean
Y mean Y the arithmetic mean arithmetic mean squared of the squared deviation
2015 1 10.9 10.75 10.9-10.75=0.15 0.0225 0.0125
2016 2 10.8 10.75 10.8-10.75=0.05 0.0225 0.0125
2017 3 10.7 10.75 10.7-10.75=-0.05 0.0225 0.0125
2018 4 10.6 10.75 10.6-10.75=-0.15 0.0225 0.0125
Algebraic sum deviations The sum of squared deviations S ^ = 0.0125
0.15+0.05-0.05- 0.05
0.15 = 0
Note: t- years; Y- arithmetic mean; g2 -dispersion.
The birth forecast can be calculated from the regression equation of the form Y = a0+a1t, where a0; a1 - parameters that need to be determined. Based on the data from Table 1 and the system of normal equations:
4
4a0 + a S t = 10.9 + 10.8 + 10.7 + 10.6 = 43
t=1
4
a S t + (12 + 22 + 32 + 42); a = 10.9 1 + 10.8 - 2 + 10.7 - 3 + 10.6 - 4 = 107
t=1
Or 4a0+10a1 = 43 10a0+30a1 = 107
ОФ "Международный научно-исследовательский центр "Endless Light in Science"
from where we determine the parameters of the regression equation: ao = 11.0 ai = 0.1
The regression equation that can be put at the basis of forecasting the birth rate for the next year (t = 5) has the form:
Y = 11-0,1t
The birth rate for 2019 will be Y2019 = 10.5.
Table 4. Determination of corre ation coefficient for birth rate.
Year t Natality, Natality Y Squared deviations
2015 1 10.9 l = 11-0.1-1 = 10.9 0
2016 2 10.8 l2 = 11-0.1-2 = 10.8 0
2017 3 10.7 l = 11-0.1-3 = 10.7 0
2018 4 10.6 l = 11-0.1-4 = 10.6 0
Si =0
Note: t- serial number of the year; Y- natality.
Correlation coefficient
S[-Sl_ _ /0.0125-0 _ 1
r S72 "V 0.0125 ~ 1
In this case the correlative dependence is in functional dependence.
Table 5. Determination of dispersion in relation to the arithmetic mean for mortality.
Year t Mortality Yi Arithmetic mean Y1 Deviation from the arithmetic mean Deviation from the arithmetic mean squared Arithmetic mean of the squared deviation
2015 1 11.2 11.325 -0.125 +0.15625 0.076875
2016 2 11.1 11.325 -0.125 +0.050625 0.076875
2017 3 11.2 11.325 -0.125 +0.015625 0.076875
2018 4 11.325 11.325 0.475 0.225622 0.076875
Note: t- serial number of the year; Yi- mortality
S^ = 0,076875 - called dispersion in relation to the arithmetic mean;
Sy 076875 « 0,277 - arithmetic mean- of the squared deviation.
The mortality prognosis can be calculated from the regression equation of the form Yi = mo+miti, where mo and mi-the parameters that need to be determined. Based on the data in the table and the system of normal equations:
4m + m (1 + 2 + 3 + 4 ) =112 +111 +112 +118
m(1 + 2 + 3 + 4) + (12 + 22 + 32 + 42 ) m = 112 1 + 11.1- 2 + 11.2 - 3 + 11.8 - 4 Or
4m + 10m = 45.3
where m0 = 10.85 and m1 = 0.19
10m +30m = 114.2
The regression equation for mortality has the form: Y1 = 10.85 + 0.19t
Mortality for 2019 (t = 5) will be: Y1 (2019) = 10.85+0.19-5=11.8-at the level of 2018
Balance: 10.5-11.8 = -1.3 (in 2018 it was (-1.2)).
Table 6. Determination of correlation coefficient for mortality.
Year t Mort ality Yl Calculated mortality Y = 10.85+19t Deviation of the calculated value from the real one Deviation from the square Arithmetic mean of the squared deviation
2015 1 11.2 Y = 10.85+19-1 = 11.04 11.2-11.4 = 0.16 0.162 = 0.0256 0.03175
2016 2 11.1 Y = 10.85+19-2 = 11.23 11.1-11.23 = -0.13 (-0.13)2 = 0.0169 0.03175
2017 3 11.2 Y = 10.85+19-3=11.42 11.2-11.42 = -0.22 (-0.22)2 = 0.0484 0.03175
2018 4 11.8 Y = 10.85+19-4 = 11.61 11.8-11.61 = 0.19 0.192 = 0.0361 0.03175
Note: t- serial number of the year; Y - calculated mortality
called dispersion in relation to the value calculated by the regression value
Sz = 0.0з175
S
SYt=0.178
We calculated the coefficient of determination
2 SYi -Slt 0.076875 - 0.03175 0.045125
r =--—- =-=-= 0.587
S2 0.076875 0.076875
Correlation coefficient Z =0.58699186991 = 0.766
The dаtа of the National Bureau of Statistics confirmed the veracity of our results, so the method of mathematical calculation and regression equation determining the correlation coefficient can be used in forecast the birth-mortality balance.
ОФ "Международный научно-исследовательский центр "Endless Light in Science"
Discussions
As part of the discussions, we are analyzing some proposals, for example, E. Raevschi (Management of risk factor surveillance in reducing premature cardiovascular mortality of the population of the Republic of Moldova, dissertation) propose a "flow chart of identification of respondents' eligibility for particiapation in telephone interview on monitoring risk factors for cardiovascular diseases" [16]. It is a proposal, in our view, questionable. An alternative would be under the conditions of the development of new technologies: the work activities of each family physician are printed in their (physician's) database. These (data) are automatically transmitted to be recorded and processed in the full database. Data on the evolution of health, the impact of risk factors must be truthful, resulting from the analyses of specialists, experts. In addition, in the Republic of Moldova the analysis, for example, of the standardized mortality rate from ischemic heart disease according to age and gender per 100 thousand inhabitants, needs to be analyzed simultaneously with the emergence of new technologies and drugs in the endowment of doctors. At the basis of the efficiency of the functioning of the medical insuranccee system, efforts must be made to identify organizational, managerial reserves, surveillance of risk factors for any disease, including cardiovascular ones. Risk factors require constant monitoring. These are the most different ones: the quality of drinking water, agriculture food products, household products, and the quality of the air breathed by the population of the Republic of Moldova. The researcher E. Jardan (Hygienic estimation of lead content in risk factors and possibilities of reducing the associated risk to health, dissertation) refers to the estimation of lead content in environmental factors in the Republic of Moldova and elaboration of measures to reduce the negative impact on the health of the population [17]. To achieve this goal, the author recommends the central public authorities general measures like: strengthening the legal support regarding the protection of the population's health and the protection of the environment; strengthening the capacities of the competent authorities empow ered with quality control, import authorization and marketing of high-risk products etc., as well as concrete measures, like checking the quality and compliance within the legislation by the economic agents active in the given field; paying greater attention to the surveillance of the content of toxic substances, conducting regular selective tests of the content of lead in the environment and in some products etc. Public health institutions, research and medical-sanitary institutions must updating the permissible norms for lead in environmental factors and non-food products intended for children; monitoring and regulating the exposure of the population to lead sources; implementing in practice the recommendations of international institutions; monitoring the concentration of lead in the blood in order to prevent poisoning. It is necessary to inform the population about the danger of lead. All these mentioned before allow us to coonclude: the potential risks need to be detected, identified; the risks can be eliminated through the behavior of the population and the elaboration of certain normative acts at macro and micro level; the risks of people becoming patients generate costs from the medical insurance system. Ensuring a person's health can be interpreted as "selling" potential risks that can affect that person's health. The insurer, "buying" the risks, assumes free medical treatments. Risks can be active and passive. Active risks can be prevented, bypassed, "traded". The passive ones (earthquake, for example) can neither be prevented nor bypassed.
Frequently some authors talk about risk management, which is debatable. If risks could be "driven", then they shoould not be called risks. Selling, trading risk does not mean its potential disappearance. The risk with the same probability will be realized, only the losses of goods, the costs of health treatment will be borne already by the insurer. Can the insurance company of all kinds be dispensed with or not? We admit the answer "yes". In this case, if the potential risk becomes reality, the affected person must financially bear all the ailments generated by that risk. In this case, the costs could exceed the financial possibilities of the patient. Treating a disease is not just down to the cost of the services provided by the doctor. These include the cost of equipment, technologies used in the process of treating the disease. The enormous costs of medical treatment can only be covered with everyone's contribution. As the number of insured persons increases, the capacities to improve the medical system increase, contributions per person can be reduced. In the situation when the entire
population is insured, the healthy ones pay the cost of treatment for the sick. In principle, the health care system in the Republic of Moldova can forecast the number of potential patients. Based on such forecasts, strategic programs for the functioning of the medical system can be developed. Some ailments are well known to the population of the country, others remain in the "shadow". A complex and scientifically managed analysis of the diseases of the "shadow" can be found in the work of author S. Virlan (Risk assessment of exposure to natural urges of ionizing radiation among the population of the Republic of Moldova) [18]. In order to streamline the activities of the medical insurance system, scientific and practical efforts are needed to identify the risks generating the most diverse diseases, including studying the variations of radon concentrations in the indoor air of homes and buildings in the Republic. In this context, scientific and practical studies are needed to identify in territorial profile the types of ionizing radiation; the risks of exposure of the population to ionizing radiation, which can generate different types of cancer. In the Republic of Moldova, the following researches are carried out: sanitary-hygienic assessment of radionuclide concentrations in building materials, soil, water, indoor air in residential and production rooms. Separately, the structure of morbidity profile caused by oncological diseases in the North, Center, and South is identified. In this context, it is necessary to identify the correlation between the level of radionuclide concentration and the structure of morbidity in territorial profile; to identify the elasticity of morbidity in relation to the level of radionuclide concentration. Applying the method of quantitative structuring of the dynamics of radionuclides, the dynamics of radionuclides, and the dynamics of morbidity caused by oncological diseases can be identified. Such information can be useful for the medical insurance system, which can streamline its activities by equipping the medical system with technologies, devices, by preventing some oncological diseases, therefore, by reducing some potential expenses, by contributing to the increase of life expectancy.
Conclusions:
1. The efficiency of any system, including the medical insurance system, is represented by the ratio of effects to efforts, the managerial mastery to distribute optimally the efforts made by doctors, the material, financial, organizational efforts to achieve the effects sucked in the treatment processes of the most diverse diseases.
2. The present bibliography aimed at streamlining the medical insurance system is an argument that the topic is current and intellectual efforts are made by a number of authors to solve the problems in the medical system.
3. The birth-mortality balance was negative in the Republic of Moldova in the period 2003-2018, i.e. the birth rate per 1000 inhabitants is exceeceeded by mortality. The problem of this balance, to a certain extent, could be solved by optimizing the distribution of basic funds by types of medical activities. For this purpose, the dependencies of mortalities on the types of medical acactivities are nessceary. The development of a system of regression equations could contribute to the redistribution of some funds in order to reduce the level of mortality.
4. The problems will be successfully solved, if Information Systems and software are created in the profile of these subsystems, if negative trends are identified systematically, if correlative dependencies are quantified. The health care system must be in the attention of scientific and practical research, in the attention of the governors and the population.
Competing interests
None declared.
Contribution of authors
EA - substantial contribution to conception and design of the work, EC - approved the article, NG, VP - drafting the article. All the authors contributed to the acquisition of data, reviewed the work critically, and approved the final version of the manuscript.
Ethical statement
No approval was required for this study.
Funding
The study had no external funding.
Authors' ORCID IDs
Efim Arama - https://orcid.org/0009-0005-8606-6266 Emil Ceban - https://orcid.org/0000-0002-1583-2884 Natalia Gasitoi - https://orcid.org/0000-0002-5895-286X Valentina Pintea - https ://orcid. org/0000-0003-0137-4699
REFERENCES:
1. Guvernul Republicii Moldova [Government of the Republic of Moldova]. Hotararea nr. 1128 din 14.10.2004, cu privire aprobarea Conceptiei Sistemului Informational Medical Integrat [Decision no. 1128 of October 14, 2004, on the approval of the Concept of the Integrated Medical Information System]. Monitorul Oficial al Republicii Moldova. 2004 Oct 29;(193-198): art. 1333. Romanian.
2. Republica Moldova, Parlamentul. [Republic of Moldova, The Parliament]. Legea nr. 278 din 14.12.2007 privind controlul tutunului [Law no. 278 of 14 December 2007 regarding tobacco control]. Monitorul Oficial al Republicii Moldova. 2007 March 7;(47-48): art. 139. Romanian.
3. Ciocanu M. Strategia de dezvoltare a asigurarilor obligatorii de asistenta medicala in Republica Moldova [The strategy for the development of mandatory medical assistance insurance in the Republic of Moldova]. Chisinau: Epigraf; 2009. 320 p. ISBN 978-9975-947-72-5. Romanian.
4. Raevschi E, Obreja G. Considera^ii asupra dezvoltarii functionalitatii sistemului de supraveghere a factorilor de risc pentru bolile netransmisibile in Republica Moldova = Considerations of the development of functionality of noncommunicable diseases surveillance system in the Republic of Moldova. Mold J Health Sci. 2018;(2):73-81. Romanian, English.
5. Raevschi E, Ababii I, Obreja G. Suggestions on strengthening of noncommunicable diseases risk factors surveillance management in the Republic of Moldova. Acta Medica Transilvanica (Sibiu, Romania). 2017;22(4):1-5.
6. Penina, O. Cardiovascular mortality in Central and Eastern Europe: differences and similarities. In: Romanian Medical Journal. 2022, nr. 69(2), pp. 50-56. ISSN 1220-5478. BDI:
7. Ciocanu M, Buga M, Etco C. Preocuparile importante in elaborarea politicilor in cadrul asigurarilor sociale de sanatate in tarile din Europa de Vest [Important policy-making concerns in social health insurance in Western European countries]. [Public Health Econ Manag Med] (Chisinau). 2007;(6/21):35-42. Romanian.
8. World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva: WHO; 2013. 102 p.
9. Penina, O. Regional mortality disparities in the Republic of Moldova. Chisinau: CEP Medicina, 2022. 116 p. ISBN 978-9975-82-234-3. https://library.usmf.md/ro/library/mgdicint L2. monograJii colective I.2.L
10. Penina, O., Mesle, F., Vallin, J. Mortality trends by causes of death inthe Republic of Moldova.Chisinau: CEP Medicina, 2022. 277 p. ISBN 978-9975-82-233-6.
11. Ababii I, Vataman E, Raevschi E, Pautz L. Pilot cross-sectional telephone survey test mainley based on the - U.S. BRFSS's protocol conducted in the Republic of Moldova: challenges of the surveillance quality. Int J Humanit Soc Sci. 2016;5(6):73-81.
12. Bogatyrev ID. O kriteriiakh effektivnosti dlia matematicheskogo modelirovaniia razlichnykh vidov meditsinskoi pomoshchi naseleniiu [Evaluation criteria for mathematical modelling of various form of medical care]. [Soviet healthcare]. 1969;(5):8-13. Russian.
13. Bodenham KE, Welmann F. Foundations for health services management: a Scicon report for the Scottish Home and Health Department on the requirements for a health service information system. London: Oxford University Press; 1972.
14. Barnett GO. The use of computers in clinical data management: the ten commandments, in committee on computer system in medicine. In: Symposium on Computer Systems in Medicine. Chicago: American Medical Association; 1971. p. 85-89.
15. Arama E, Maximilian S, Rotaru L, Vovc V. Telemedicine - advanced technology at the service of society. In: Tiginianu I, Sontea V, Railean S, editors. 4th International Conference on Nanotechnologies and Biomedical Engineering. ICNBME 2019: IFMBE Proceedings. Vol. 77. Cham: Springer; 2020. https://doi.org/10.1007/978-3-030-31866-6_116.
16. Raevschi E. [Management of risk factor surveillance in reducing premature cardiovascular mortality of the population of the Republic of Moldova] [dissertation]. Chisinau: Nicolae Testemitanu State University of Medicine and Pharmacy; 2019. 249 p. Romanian.
17. Jardan E. [Hygienic estimation of lead content in risk factors and possibilities of reducing the associated risk to health] [dissertation]. Chisinau: National Public Health Agency; 2018. 162 p. Romanian.
18. Virlan S. [Risk assessment of exposure to natural sources of ionizing radiation among the population of the Republic of Moldova] [dissertation]. Chisinau: National Public Health Agency; 2018. 214 p. Romanian.
