Health Development Concepts of the Russian Federation. Health Development Concept in the Russian Federation. Implementation of the program of state guarantees to citizens of the Russian Federation of free medical care

Based on the analysis of the situation in the country, Putin V.V., being president, and then the Prime Minister, signed two fundamental documents:

On approval of the concept of demographic policy of the Russian

The concept of long-term socio-economic development of the Russian

Federations for the period up to 2020 . (Order of the Government of the Russian Federation No. 1662-p of November 17, 2008).

All calculations of the "Health Development Development Concept until 2020" are considered, based on the parameters for which the concept of the long-term socio-economic development of the Russian Federation is considered until 2020, because these are interconnected documents.

Objectives of the Health Development Concept

1. Exceeding health financing by 2020 5% of GDP.

2. Stop loss of the population by 2011 and bringing the number to 145 million people by 2020.

3. Increase the expected life expectancy of the population up to 75 years.

4. Reducing the total mortality rate of up to 10 (the total mortality rate is the number of died of all reasons per 1000 people per year).

5. Formation of a healthy lifestyle of the population, including a decrease in the prevalence of tobacco use to 25% and reduced alcohol consumption to 9 liters per year per capita.

6. The main goal is to provide a population of a free, guaranteed state, high-quality medical care.

Problems of Health Development Concept

In the semantic part of the concept, two large partitions are highlighted. The first section is the preservation of public health based on the formation of a healthy lifestyle. The second is the guaranteed provision of the population with high-quality medical care, and for this it is necessary:

Creating conditions, opportunities and motivation of the population to keep

healthy lifestyle.

Improving the system of organization of medical care.
Specification of state guarantees for citizens free

medical care.

Creating an effective financial resource management model

programs of state guarantees.

Improving drugs of citizens in outpatient conditions

within the system of compulsory medical insurance (OMS).

Training medical workers and the creation of the system

motivation them to quality work.

Development of medical science.
Health informatization.

All activities aimed at implementing the concept will be carried out in several stages - running in the "pilot" regions (2010-2015) and subsequent replication on the entire territory of the country (2016-2020) with access to the necessary, in terms of efficiency, activities for events for Achievement of target values.

In our country, health care has always been funded by the residual principle, but 10 years ago, at the highest political level, it was announced that the health of the population is one of the priorities public Policy.

And it is very good that this understanding does not leave the site of state priorities. As Mrs. Gru Harlem Brutlan, who served as Director General of WHO from 1998 to 2003, "... The Presidents and the Prime Minister's president ...".

The current state of health in Russian FederationDemographic situation

At the end of the last century, the fall in the birth rate and the increase in mortality began to be observed in the countries of the former USSR. This demographic phenomenon was called "Russian Cross" (or "Slavic Cross").

Reducing the population, which began in the 90s, continues, but its rates decreased significantly. A decrease in the number of population reduction is ensured mainly by increasing fertility and decrease in mortality.

Measures were taken to stimulate fertility:

One-time allowance at the birth of a child (10 988,85 rub.)
Certificate (entered into force since 2006) secured the right

patients to choose a female consultation and maternity hospital. And the institutions that assist future mothers began to receive an additional payment from the state for each of them in their accounting of a pregnant (attempt to materialize physicians and create a competitive environment).

Certificate for maternity capital (from January 1, 2011 - 365,698.4 rubles),

which can be directed to improving housing conditions, obtaining education by children or the formation of a sauming part of a woman's labor pension.

Help childless pairs - Extracorporeal fertilization included

the list of high-tech medical care types is carried out at the expense of the federal budget in 11 federal medical institutions.

Crisis centers in which psychologists convince women to refuse

intentions to make an abortion.

The main cause of death in our country is diseases of the circulatory system (56.6% of the dead), neoplasms (13.8%), injury and poisoning (11.9%).

Mortality from blood circulation disease is one of the highest in the world. Moreover, the share of mortality from strokes in Russia is almost half (46%) in mortality from diseases of the circulatory system, which indicates the poor quality of the treatment of arterial hypertension (both from patients and doctors). According to the World Bank, GDP loss in the Russian Federation is about 30 billion dollars due to premature death from heart attacks and strokes.

Oncological diseases in Russia are characterized by a high share of deaths during the first year after diagnosis. This indicates the late diagnosis of these diseases. Men able-bodied age die from cancer almost 2 times more often than women, although the incidence among women is higher.

The external causes of death have a significant impact on the formation of mortality rates in working age. Mortality from external reasons in the overwhelming majority of cases is associated with excessive consumption of strong alcoholic beverages. Our country is ranked first in the world around the road accident, the cause of which drunk drivers often are. It should be borne in mind that the number of cars per capita in Russia is twice as fewer than in the EU countries (EU).

The incidence of the population is constantly growing, which is due to the one hand, with an increase in the share of the elderly population and with more effective diagnosis of diseases, on the other hand, with the ineffectiveness of the system of prevention and prevention of diseases.

It is believed that the level of health of the population depends on the number of interests allocated for health care from internal gross Product (GDP). However, studies of recent years show the inverse dependence. Mathematical calculations of WHO suggest that improving the state of health contributes an adequate contribution to an increase in the economic potential of the country. For example, in Russia, on average due to diseases, up to 10 working days is lost per working, which per year is losses in the amount of about 1.4% of GDP.

The most important indicator of the effectiveness of health care of any country is the average life expectancy of persons suffering chronic diseases. In Russia, it is 12 years old, and in the EU countries - 18-20 years.

Another major indicator of the quality of life and public health is an indicator of the expected lifespan. In 2006, the life expectancy of the population began to increase. Nevertheless, it is 12.5 years less than in the "old" (entered into the EU until 2004) EU countries.

A key role in the low life expectancy of the population is playing high mortality People of working age, mainly men. In lifetime, 1 women dies 2.7 men aged from 15 to 60 years.

For our country, the phenomenon of supercursion of men is characterized in the fact that the life expectancy of the men's population during the entire post-war period was less than female for 10 years, and in the past two decades this difference was completely frozen at a mark at 13-13.5 years. This is an unprecedented phenomenon. That is, there is no analogues in any country of the developed world. The average man does not live to retirement age.

Formation of a healthy lifestyle

For the first time in the history of not only the Russian Federation, but also the Soviet Union, the state undertakes to the formation of a healthy lifestyle among the population and actively allocates funds for it.

Preservation and promotion of health is possible only when compliance the following conditions:

formation of health priority in the value system of society,
creation of the population of motivation to be healthy,
providing a state of legal, economic, organizational and infrastructure conditions for conducting a healthy lifestyle.

The main directions of the program are as follows:

1. Improvement of medical and hygienic education and upbringing

Education of the population through the media.
The introduction of educational programs in educational institutions.
Training in hygienic skills to comply with the regime and recreation,

conditions and nutritional structures and other behaviors supporting health.

Maintaining explanatory work on the importance and necessity of regular

dispensarization of citizens, timely appeal to medical care.

2. Creating an effective system for combating bad habits

Sanitary education and public informing about the consequences

tobacco use and alcohol abuse.

In 2001, the FZ-87 was adopted "On the restriction of tobacco smoking" - assistance

reducing tobacco and alcohol use (places and hours of sale, age, price measures), protection of non-smoking on the effects of tobacco smoke, restriction of alcohol consumption in public places.

In 2010, the provision of technical regulations on the new

the form of warning inscriptions on tobacco packs. The main warning inscription "Smoking kills" takes up at least 30% of the main part of the consumer packaging (previously only 4%), for another preventive inscription - at least 50% on another larger side of the pack.

3. Ensuring healthy nutrition

In 2010, it was approved:

"The Doctrine of Food Safety of the Russian Federation."
"Fundamentals of the State Policy of the Russian Federation in the region

healthy eating for the period up to 2020 "(Order of the Government of the Russian Federation of 10/25/2010 No. 1873-P).

Order of the Ministry of Health and social Development RF OT.

4. Development of mass physical education and sports

5. Reducing the risk of exposure to adverse external factors

Sanitary and epidemiological supervision of the habitat and conditions

caution will continue to be paid to controlled infections whose prevalence directly depends on the vaccine-philatics, improvement and implementation of the national calendar of preventive vaccinations and the calendar of preventive vaccinations on epidemic indications, as well as the prevention, diagnosis and treatment of HIV infection and viral hepatitis B and C.

6. Changing the regulatory framework for creating a system for motivating employers to participate in the health of employees.

7. Creation of a system of motivation of citizens to the maintenance of zoom and participation in preventive measures:

Popularization of text and lifestyle, promoting conservation and

health promotion, formation of fashion for health especially among the younger generation.

It is enough to remember various television projects (for example, dances on ice, dancing with stars), in which famous people prove that anyone can learn to own their body. An example of a healthy lifestyle show the first persons of the state (Medvedev, Putin). Unique is the introduction of a health care system of healthy and practically healthy citizens - the creation of health centers in Russia (order of the Ministry of Health and Social Development of the Russian Federation No. 597N of 19.08.2009). Centers are equipped with health-express complexes for screening assessment of health and organism reserves. The patient receives specific recommendations on the predisposition to one or another diseases with the formation of an individual preventive program.

8. Mass prevention of risk factors noncommunicable diseases

This is primarily about cardiovascular and oncological diseases that occupy the first places in the mortality structure.

Implementation in primary ambulatory-polyclinic institutions

the level of automated risk assessment of vascular diseases (1st place by mortality, 2nd in incidence) and primary prevention of stroke and myocardial infarction. Assessment of the patient on the Score scale (floor, age, smoking, level of blood pressure, cholesterol) allows you to predict the risk of death for the next 10 years.

The introduction of total screening of oncological diseases (2nd place by

mortality, 15th in incidence). Analysis on fibrinogen can be used as the simplest laboratory screening method. Fibrinogen is reduced: the cancer of the prostate, pancreas, lung. Fibrinogen is elevated: stomach cancer, breast, kidney.

Accessibility and quality of medical care

Special significance in the concept has a section on guaranteed to ensure the population of high-quality medical help. Qualitative medical help is that the help that provides the best results based on the modern level of knowledge and technologies with minimally necessary spending on this help.

In this definition, everything is important: efficiency, evidence, efficiency.

The effectiveness of the functioning of health care depends on several interrelated factors:

organizational system,
providing resources (financial unit, informatization unit, block

legislative and legal support).

availability of medical personnel in sufficient quantity and properly

prepared to solve the task assigned to health.

Improving organizational system

All principles (district accommodation, publicity, free for all godliness payers, dispensarization) were developed back in the XIX century. Zemskie doctors were first developed and implemented individual patient maps, later recognized as the most advanced form of collecting data on incidence in outpatient conditions.

Initially, a traveling system was tested, in which the Zemstvo doctors consistently parted in the land of settlements and provided the necessary assistance at the place of residence of patients. But at the same time he wasted a lot of time on moving a doctor from one village to another. Therefore, there was a replacement of a traveling system for medical sites, which continue to exist in Russia to the present.

On the foundation of the Zemsky Health and formed our modern two-level system The provision of medical care (or the Semashko model, as they call it abroad) - two little integrated structures: an outpatient polyclinic stage (polyclinic, ambulance) and hospital.

Physician first contact - This is a precinct therapist (pediatrician). Sickwall, a person turns to the clinic, and is treated at home for the appointments of a precinct therapist or a narrow specialist of the polyclinic. Part of the patients in the direction of the Polyclinic doctors or independently through the ambulance service falls into the hospital, where he holds an average of 2-4 weeks. Then the patients return home allegedly under the observation of the precinct therapist (in fact - under their own observation).

Abroad, the first contact doctor is a general practitioner (or family doctor). In 2005, a course was taken to a gradual transition from the principle of patient service through a polyclinic network to the creation of common medical practices, but it turned out that the clinic early to write off the clinic:

At the present level of development of medicine, a general practice doctor cannot

to independently maintain a high level of patient service, it needs to constantly master new techniques. Therefore, abroad and there was a trend towards the organization of service based on collective action (group practices).

The polyclinic has a lot of advantages: rational concentration

material and personnel resources (due to this concentration, the cost of service is reduced), a complex of laboratory and diagnostic services, the reception of narrow specialists, the presence of a day hospital, the interchangeability of personnel, etc.

Therefore, it came to the conclusion that the system of general medical practice is the most convenient form of servicing residents of small-populated areas. And it is in remote areas and in rural areas it is planned to develop this system.

Otherly organized abroad and emergency scheme. In the event of an emergency organization or injury, the patient appeals to a single telephone emergency telephone (911 for the US or 112 for Europe) and the Paramedikov Brigade (delivery service), not dealing, delivers it to the ambulance department. When entering the patient, surveys are carried out to clarify the diagnosis, stabilize the state. Further, some of the patients are discharged home with specific recommendations for a family doctor, others continue treatment in the mode of active patronage in the hospital at home.

Some patients (in more complex cases or with the impossibility of rapid correction of the state) come to the hospital bed, where within a few days (the average duration of stay in the hospital - 4.7 days) is carried out intensive treatment. After that, a part of the patients is translated into the rehabilitation department, in the hospital mode at home, someone in the hospice or other medical and social beds.

The liberation of the hospital bed in favor of treatment in the "hospital at home" has great advantages. The patient is in the usual home setting, as a rule, it is better resting and falling out. A pattering sister regularly comes to him (in fact, it is the patient who leads), periodically - the doctor who makes all the necessary procedures, injections, dressings, tests, etc. And at the same time there are no additional costs for food, water and power supply, heating, bed linen, repair, etc. No need to contain anemone, spend money on disinfection of chambers, toilets, foodstocks, fighting hospital and respiratory infections, etc.

Improving the organization of medical care in our country will be based on three blocks:

First of all, that the patient can get as quickly as possible to the institution that can provide medical care according to Standard. That is, it should be equipped with prepared personnel, provided with drugs and is equipped with medical products in the required quantity.

The second is a very important unit - the stratitude of medical care according to Order. At the same time, ensuring continuity between different stages is an important condition for providing quality medical care.

The third important unit is the introduction of work targets reflecting not only the types and volumes of medical care produced, but also Quality. The quality management systems for medical care based on orders and standards of its provision will be introduced, including the implementation of an independent audit. The use of quality indicators will allow every month to evaluate the effectiveness of the work of medical personnel, depending on the completeness and correctness of the implementation, approved procedures and the standard for the provision of medical care with the appropriate pathological state. The same information will be allowed to rank money payments not only on the basis of the type and volume of medical care provided, but also depending on its quality.

In addition, a three-level health system will be created in Russia:

Level 1. Primary health care

Primary health care, organized by the territorial-precinct principle, was and remains a priority direction of domestic healthcare due to the tremendous size of the country and uneven population density.

Liquidation of frame shortages due to intra-separable migration

redistribution.

Disagruption of sections: reducing the number of attached adult

population from 1700-2500 people up to 1.2-1.5 thousand people per 1 plot (it will be possible when the personnel deficit will be eliminated).

Creating comfortable conditions for the work of the doctor - Improving the standard

time paid per adult patient up to 20 minutes.

Reducing the load due to the transfer of the average medical staff of the row

events: Proponial assistance in acute pathology, dispensary observation of patients with chronic pathology, etc.

Returning of the primary link to the hospital technologies -

development of "hospitals at home" and active patronage.

Transition to other targets for working with an emphasis on

preventive activity.

2 level. Stationary help

The main point is the intensification of the work of the bed. It will be possible with

one side, if substitute hospital technology will be introduced into the primary link, and the network of compartments for fake and rehabilitation will be deployed. Stationary medical care should be intended only for patients requiring round-the-clock observation.

Creating a routing service in each hospital through which

there will be an extract of patients from the hospital. This service will provide the organization of phased rehabilitation and rehabilitation, continuity under the patient at all stages, the transfer of information on patient and medical and social recommendations to the district patronage division at the place of residence of the patient.

Phased creation of tin regional centers coordinating all

the volume of preventive, diagnostic and medical measures for social and meaningful medical problems.

Improving the targets of the work of stationary institutions

level reflecting the quality of medical care (mortality, degree of recovery of disturbed functions).

3 level. Rehabilitation

Not in one of the previous concepts of health development, including the Soviet period, this stage was not included. Instead of a two-level, a three-level health system is created: primary health care, inpatient care and rehabilitation service (rehabilitation).

Creation and expansion of a network of institutions of restoration

treatment (fake), rehabilitation, medical care by reloading part of working hospitals and sanatorium-resort institutions.

Determine the target performance indicators reflecting the quality

medical care (degree of restoration of disturbed functions, indicators of primary disability and weightlifting of disability).

4 level. Paralegal service

It's just pilot projectwhich will be launched in those regions that have achieved good development by 2014-2015.

The essence of the project: The organizational structure is created, into which the hospital selection department and ambulance station are combined, plus the deposit and routing services of patients, patronage primary service and fill service.

This service will be designed for:

ensuring the population of ambulance and emergency medical care

(for the first time sick and faces with the exacerbation of chronic disease);

determine the need (or lack of need) in

hospitalization of the patient in the hospital;

carrying a complex of diagnostic and medical events when

pathological states that do not require continuous round-the-clock observation;

organizations of the optimal stratification of the patient ("home

hospital ", separation of rehabilitation and rehabilitation, hospice) and the implementation of active or passive patronage.

Affordable and high-quality medical care is not possible without resources, including three providing infrastructure blocks:

1. Economic unit (how much medical care should cost and how

to spend money);

2. Block information (electronic health);

3. A block of legislative and legal support concept.

The economic unit where it is determining about dnochanal financing.Any service costs money. In Soviet times, the state paid for medical care. In 1993, in addition to the budget health system, a system of compulsory medical insurance was created, as a result, a unique budget and insuring model of funding for the state health care system was developed in Russia. The number of sources from which health care began to receive money, increased (multichannel financing).

As part of the Health Development Concept from January 1, 2012, the transition to predominantly single-channel funding for medical care - through a compulsory health insurance system, which is governed by Federal Law No. 326 of November 29, 2010, "On compulsory health insurance in the Russian Federation". For one-channel financing, the following steps are taken:

Transition from the system of a single social tax on insurance premiums. Insurance principles of payments in terms of establishment

of all the types of stimulating modes, for example, to a healthy lifestyle, much closer to insurance than to taxation. The insurance premiums of employers are established in the amount of 5.1% of the wage fund, while the limit value of the annual wage foundation, over which the payment of insurance premiums is not produced.

Transition to uniform methods for establishing payments for non-working

population (Previously, the decision to establish payments for the non-working population always lay on the subject of the Russian Federation, but the regions preferred to allocate less (that is, to declare a deficit) to receive subsidies from the federal budget).

State guarantees

Since 1998, the Government of the Russian Federation has been adopted annually a program of state guarantees for citizens of the Russian Federation of free medical care, which is ensured by funds budget system The Russian Federation and funds of the OMS system. At the same time there were two big problems:

Underfunding, both at the expense of budget and financial

providing OMS programs. Employer paid for working, paid with white salary; The regions that have paid for non-working, deliberately underestimated calculations to create a deficit and get subsidies from the center.

A great difference among the constituent entities of the Russian Federation in

implementation of territorial programs of state guarantees of free medical care.

For example, a state of financial support for 1 resident in Ingushetia is about 2.5 thousand rubles, and in the Chukotka Autonomous District he reaches 30 thousand rubles. It is clear that this is a very significant restriction in the availability of medical care. So, in 58 regions, the fare of the program of government guarantees is lower than those established on average in the Russian Federation.

To correct the situation, it is proposed:

Specify the system of formation of state guarantees,

legally decompose "Who for whom and how much pays", introduce criteria and procedure for evaluating effectiveness and, which is important, to establish responsibility for non-fulfillment of state guarantees of free medical care.

Adopted by the Government a financial support standard should be

provided throughout the Russian Federation. This is the most important innovation. That is, the minimum should be provided throughout the Russian Federation. At the same time, the pillow of the standard, which is established by the government, must be counted, taking into account the standards of medical care. This is the basic minimum package of state guarantees.

Also for the first time the federal financial Fund, which the

specially designed to level financial situations between the regions (federal surcharges of deficient regions).

Pay extra for the treatment that will go beyond the scope of state guarantees

citizens. But now - at the cashier, and quite officially. For this introduced new organizational and legal forms of medical organizations (autonomous organizations).

These innovations and in the press, and in the speech General Director

WHO is noted as advanced experience in the world. The Americans are so interested in what they themselves translated our concept and used some provisions for plans to reform their health care.

Standardization of medical care

Of course, the key to high-quality medical care is its unification on the basis of uniform countries of the country and standards for medical care. The obligation of execution and a single content guarantees available high-quality medical care in the country. Currently, 1041 standards and 44 of the procedure for providing medical care have been developed and adopted.

The procedure for providing medical care Presents organizational requirements. For example, how to be equipped with a medical institution, an emergency room or an ambulance; how many people should work in a particular unit, which is the load rate; What should be the sequence of medical and diagnostic measures, where and when to transmit patient, etc.

Medical Care Standard Includes the necessary medical manipulations, the use of specific drugs, the possibility of operational intervention and other methods of treatment, etc. Standards are created on the basis methodical recommendations (Gaidlanov, manuals), which are developed by international / domestic professional communities (associations) and contain information on the prevention, diagnosis, treatment of specific diseases and syndromes.

Standards and orders are the foundation of the program guarantees. On the basis of these documents, a list of vital drugs is created, which does not live separately from these documents, it is formed from them.

In addition, standards and orders allow for each completed case to evaluate the quality of medical care. On this basis, a system of ranked remuneration of medical personnel is produced.

Thus, medical standards themselves, without financial documents, acquire an economic component and become medical and economic standards.

Informatization

Today, the patient information can be entered once and stored throughout life, to be used repeatedly, transmitted at any distances. Moreover, two types of information can be stored: "biological" and "nebiological" (bed-days, treatment costs, etc.).

Modern medical information technologies can:

Have a significant impact on improving quality and accessibility

medical services to the population (for example, record via the Internet at the reception, obtaining results of analyzes, on-line consultation, etc.).

Increase the efficiency of planning and management of system resources

health.

Save costs. According to expert estimates, the transition to

electronic health care leads to cost savings up to 30% of the costs available. For example, due to the introduction of electronic recipe technology (reduction of expenses related to the choice of an incorrect treatment method), identifying and preventing insurance fraud.

Many countries have begun to implement programs for creating a single information space in the areas of health and social development. Russia is lagging behind in this direction, despite the fact that the development and implementation of domestic health informatization programs has been conducted since 1992.

To date, exist the following problems:

Heterogeneous level of equipment. Most often it is some autonomous

(not related to a single network) of automated jobs.

No unification leads to the absence of a single information

spaces (electronic data exchange between cabinets, divisions, institutions, regions is difficult).

The concept of two interconnected directions for the development of informatization are planned. The first thing is the formation of uniform reference information databases. And the second block is a block of personalized medical care consumers, which is needed to plan the volume of assistance, collecting better statistics and reporting.

For these purposes, a state information system for personalized accounting for medical care, which will ensure operational accounting Medical care, health and medical facilities and will create a reliable basis for solving key management tasks in the industry. It is assumed that medical institutions should become sources of primary information to form the system elements of the system, as well as territorial funds of compulsory medical insurance.

By 2016-2020 should be implemented:

Entering the State Information System in Industrial

operation.

The introduction of a unified system for identifying recipients of medical services

based on the use of a single social card of a citizen.

Creating a system of centralized maintenance and actualization of scientific

reference information, including reference books, classifiers, medical and economic standards.

Creating a unified federal electronic collection and storage system

disease stories based on national standards.

Legal support

Out of the framework of the legal field, no concept can be implemented.

The regulatory support of the concept provides for both improving the current legislation and the publication of new laws. Thus, it is planned to develop the Federal Law "On State Guarantees for Citizens of Free Medical Aid". Evaluable legislation does not provide a clear distinction between the procedure for obtaining free medical care and paid medical services, does not contain provisions governing pricing issues for medical services provided to citizens for fee. Therefore, this bill is paramount, because aims to implement Art. 41 of the Constitution of the Russian Federation and must determine the procedure, conditions and standard of volume of providing citizens of free medical care, the procedure for financial support.

Federal Law No. 326-FZ "On Compulsory Medical Insurance in the Russian Federation" was adopted on November 29, 2010, entered into force on January 1, 2011. This is basic

I. Introduction

IN last years There is a deterioration in the health of the population. Crisis activities medical institutions Approaches the feature for which the disintegration of the entire health care system.

The amount of health financing from budgets of all levels and at the expense of compulsory medical insurance do not provide the population with free medical services. At the same time, the existing financial and material resources are used inefficiently, imbalances in providing medical care. Social tensions are growing in the industry. The shadow side of the payment of medical services is becoming increasingly distribution.

In this regard, a well-thought-out health care reform strategy is necessary.

II. The main directions of development of the health care system

The purpose of the Health and Medical Science Development Concept in the Russian Federation (hereinafter referred to as the concept) is to preserve and improve the health of people, as well as the reduction of direct and indirect losses of the Company by reducing the incidence and mortality of the population.

The main tasks of the concept are:

increase in the amount of measures for the prevention of diseases;

reduction of the timing of the restoration of lost health of the population by introducing modern methods of prevention, diagnosis and treatment to the medical practice;

improving the efficiency of use of resources in health care.

The implementation of the concept is based on the following principles:

universal, social justice and the availability of medical care to the population, regardless of the social status of citizens, the level of their income and place of residence;

preventive orientation;

economic efficiency of the functioning of medical institutions;

unity of medical science and practice;

the active participation of the population in solving health issues.

In the current conditions are important:

the formation of state policy in the field of health and medical science and increasing the responsibility of all authorities for its implementation;

ensuring the adequacy of financial resources to state guarantees in the field of health, a phased increase in the share of funds to finance health care, up to 6-7 percent of the internal gross product;

development of the non-state sector in health care;

perfection legal regulation health care activities;

development and implementation of advanced forms and methods for organizing state sanitary and epidemiological supervision, hygienic and epidemiological examination, monitoring of human health and human habitats;

investment policy providing high effectiveness of investments - maximum medical, social and economic effect per unit cost;

raising the level of qualifications of medical workers, improving the system of their preparation, retraining;

increasing the social security of medical workers, including wage raising;

attracting professional medical associations to the implementation of state policy in the field of health and medical science;

perfection state regulation in the field of providing medicines, medical products and medical equipment;

increasing the interest of citizens in preserving and strengthening their health.

III. Improving the organization of medical care

The main areas in improving the organization of the provision of medical care are the development of primary health care based on municipal health care, the redistribution of part of the amount of assistance from the stationary sector into the outpatient.

Primary health care is the main link when providing medical care to the population.

A special role is assigned to the development of the institution of a general (family) practice. Polyclinics should develop consultative and diagnostic services. The branch of medical and social rehabilitation and therapy, care services, day hospitals, outpatient surgery and medical care centers can be deployed on their base, etc.

Reorganization of inpatient care will reduce the duration of the hospital stage. For this, it is necessary to provide for the distribution of the number of beds, depending on the intensity of therapeutic and diagnostic process as follows:

intensive treatment - up to 20 percent;

recovery treatment - up to 45 percent;

long-term treatment of patients with chronic diseases - up to 20 percent;

medical and social assistance - up to 15 percent.

Wider use daily forms of patients in hospitals.

It is necessary to revive interregional and interdistrict specialized medical centers.

For high-quality medical care, it is necessary to ensure the continuity of therapeutic and diagnostic process at all stages of treatment. It acquires a clear separation of functions at each stage of medical care, as well as between different types of medical institutions. This involves creating a higher level of funding and managing healthcare facilities.

Improving the quality of medical care will contribute to the implementation of the standards of diagnosis and treatment of patients both in outpatient polyclinic and hospital institutions.

Adoption of effective measures to develop the Maternity and Childhood Protection Service at the concentration of efforts to improve primary health care for children and adolescents, the development of family planning services and safe maternity integration of general institutions with a common treatment network.

Comprehensive measures need to be carried out on the further development of psychiatric and narcological assistance to the population, the fight against tuberculosis, sexually transmitted diseases.

Require state support measures to introduce modern technologies in intensive treatment units, cardiology and cardiac surgery, oncology, diagnosis and treatment of socially significant diseases.

It is necessary to strengthen the emergency medical care service, make it more mobile and equipped with modern means to provide emergency medical care and emergency hospitalization of patients.

It is required to increase the role of scientific centers and research institutes in the development and implementation of effective medical technologies, the use of unique diagnostic and treatment methods.

The adoption of state support measures to improve rehabilitation assistance, the development of sanatorium-resort organizations of the health care system, health facilities and organizations.

To improve the quality and availability of medical care rural population It is required to form medical diagnostic complexes on the basis of central district hospitals, including municipal rural medical institutions, develop mobile forms of medical and diagnostic and advisory assistance, to create interdistrict clinical diagnostic centers.

It is necessary to integrate departmental medical institutions into the general health system at a single regulatory framework, taking into account their industry features and locations.

When maintaining the dominant role of state and municipal health, the emerging private sector will play an important role. Creating conditions for its development is an essential element of structural transformations in health care.

It is necessary to provide medical organizations, individuals carrying out private medical activities, state and municipal organizations equal rights to work in the system of compulsory medical insurance and participation in the implementation of state and municipal targeted programs. The participation of medical organizations of various shape of ownership in the implementation of state health programs, municipal orders should be carried out on a competitive basis.

State and municipal medical and prophylactic institutions that perform functions that are not related to the framework of a single technology for providing medical care should have broad powers in the use of property, personnel wages.

In accordance with the Constitution of the Russian Federation, the health protection of people is one of the foundations of the constitutional system of Russia. Everyone has the right to protect health and medical assistance to the Constitution of the Russian Federation / adopted by a popular vote on December 12, 1993, Novosibirsk 2009.

This right is ensured by providing citizens with free medical care in state and municipal healthcare institutions, financing federal programs for the protection and promotion of public health, the implementation of measures for the development of state, municipal, private health care measures, promoting activities that promotes the development of physical culture and sports, environmental and sanitary -Epidemiological well-being.

There is a concept for health development in the Russian Federation until 2020, which is based on the following fundamental documents regulating the social structure in the Russian Federation, including the organization of health care: the Constitution of the Russian Federation, federal laws "On the General Principles of Legislative Organization (Representative) and the Executive Bodies of the State the authorities of the constituent entities of the Russian Federation "No. 95-FZ dated 04.07.2003; "On the general principles of organizing local governments in the Russian Federation" No. 131-FZ dated 06.10.2003.

To competently and effectively solve problems of cardinal improvement in public health and health care, it is advisable to determine and clarify the concepts, without which it is difficult to reasonably talk about the concept and its implementation.

First of all, the concept of "concept". In the dictionaries, the directories, this term is explained as a "definite way of understanding", "the main point of view for the subject", "explanation of the leading plan" or as "the process of forming the main idea", even in short - "intent."

The purpose of the health development concept is to ensure reasonable accessibility for the population of the medical care of good quality, regardless of the social status of citizens, the level of their income and residence on the basis of improving the efficiency of healthcare agencies through the rational use of resources and the implementation of activities aimed at optimizing the health system. Expert platform of open discussion of the concept of health development until 2020; Finchenko Evgeny Aleksandrovich, expert; 04/22/2008

The focus of health care should be the adequate needs of each person in medical care and, based on this priority, a health care system is being built, and the main mechanisms for the involvement of a person in the health care system are becoming compulsory medical insurance (OMS) and voluntary medical insurance (DMS) 2 Fatullaev, G .G. On the competence of municipal health authorities // Bulletin of Volzhsky University. V. N. Tatishchev. Series "Jurisprudence". - Tolyatti: Publishing House Wuit, 2006. - No. 60..

The basis for the concept of health development is the improvement of regulatory legal regulation in the health sector:

Legislative approval of social standards for providing the population with medical care under the program of state guarantees of free medical care - ensuring the population of primary health care, including emergency medical care; medical care for infectious and mental illness;

Development and legislative statement of the procedure and provision of medical care in medical organizations;

Reorganization of municipal and state medical institutions in autonomous institutions;

Creating a system of restrictive measures in activities commercial organizationsfocused on making a profit in the provision of medical services;

Legislative restriction of the non-receptible sale of medicines to the population;

Introduction into medical organizations of national protocols (standards) of medical care;

Determination of the management of the management and medical organizations that finance organizations of all levels for achieving the results provided by the strategic and current plans, as well as for the efficient use of resources;

Ensuring the possibility of replacing any guidance in health care exclusively on a competitive basis.

It is fundamentally important to identify the goals, objectives and regulations of the medical care of the population in medical organizations of various organizational and legal forms and levels of service of the population; Based on this, determine the testimony for one or another kind of medical care and develop national protocols for the provision of medical care Fatullaev, G.G. Perfection organizational structure Functional function Municipal health authorities // Modern Right 2006, No. 10.

The competence of the state remains:

The definition of goals, objectives and regulations of the medical care of the population (both community and inpatient) in medical organizations of various organizational and legal forms and levels of service of the population;

Development of national protocols (standards) of medical care;

Regulation of the system of compulsory health insurance;

Licensing of medical services and accreditation of medical institutions.

The concept provides for the implementation of a set of measures for the main areas of health development.

The main directions of medical education and science policies suggest:

Translation of medical universities, research institutes of federal subordination in the subjects of the Russian Federation, to the management of the subjects of the Russian Federation (with the possibility of financing for federal order for training and scientific research);

Priority training of general practitioners;

Postplomal training of doctors and medium-sized medical professionals on the basis of regional medical organizations;

Termination of the practice of training managers of health and managers of medical institutions from among doctors;

Introduction of a state order system for the development of new medical technologies (grants). Expert platform of open discussion of the concept of health development until 2020; Samoshkin Alexey Anatolyevich, the answer Secrets. Associations of doctors; 04/22/2008

The main directions of personnel policies suggest:

Creation of a system of examinations when receiving medical personnel to work and annual certification of specialists;

Changing the nomenclature of senior positions in medical institutions: Heads the Director, which is the manager, and the chief physician is engaged only by medical issues, in the traditional understanding is the deputy chief physician for medical issues;

Objectification of the procedure for verifying the level of knowledge and skills of health manifeships;

Termination of the practice of appointing health managers of all levels without the appropriate training and passing of certain administrative steps.

Legal regulation policy suggests:

Implementation of antimonopoly legislation in the field of insurance medical services, including compulsory health insurance;

Ensuring the protection of medical institutions by state administration authorities of all levels from any interventions into their activities of OMS territorial funds.

Financial policy suggests:

The creation of a single-channel system for financing a medical organization, regardless of the organizational and legal form in terms of the provision of medical services in the OMS system;

Bringing tariffs in the OMS system in accordance with the actual costs of a medical organization for the provision of medical services;

Separation of utility payments (water, light, heat, garbage collection, etc.), other economic expenses of the medical institution and medical rates of OMS;

It should be noted that the key areas of the development of public health are: ensuring the safety of the population (physical, sanitary and epidemiological, etc.), ensuring the provision of urgent medical care to the population (rescue of life) and providing opportunities for each citizen to conduct health capacity conservation activities .

The proposed health reform concept is not based on an increase in health financing, but on rational use of existing funds. At the same time, as an option, even a possible significance decrease in health financing is assumed to the negative development of events. Tkachenko Yu.A. Health care reform project in the Russian Federation www. duma.tomsk.ru.

Nevertheless, even with such developments, the obligatory consequence of the proposed reform will be to promote public health, including an increase in the duration of active life, withdrawal or a significant reduction in social tensions.

The current healthcare models adopted in most countries of the world are based on a market principle: the need - the need for a profit is a profit - the need for needs is a need. Thus, modern medical, pharmacological industry and other associated sectors of the economy as economic subjects Directly interested in increasing the need for medical care.

At the same time, the greatest distribution, including in Russia, was incentive to stimulate the need for medical services, not as in preventive measures, what the great doctors dreamed of the past - "The future belongs to medicine of preventive" - \u200b\u200bN.I. Pirogov, and conscious or unconscious modeling of the situation : Formation of the disease - pain or other symptom - the patient's appeal to the medical institution - diagnosis - therapy. This is an unlawful, but really dominant today, will, will or unillets performed by almost every doctor using standard methods of therapy. Any other interpretation of the current health situation is artificially, absurd and manipulatively, as it should be based only on logic, on the principles of the market and most importantly - on real facts.

Further, both the media, as well as established stereotypes among the population, which has formed their views during the times of free and developed Soviet health, is clearly exaggerated by the role of medicine actually in maintaining health. Medicine as a smallstorm is only responsible for the health of the population. The long-known data of the World Health Organization on the degree of importance of various factors in public health are not popularized (lifestyle - 50%, condition ambient- 20%, genetic factors - 20%, the quality of functioning of the health system - 10%) TBES brigade. Right to health. Theory and practices. Moscow, 2009

Today's, quite prosperous, the situation with the dynamics of life expectancy in recent decades in economically developed countries is significantly due to the successes of medicine as such. This is due to rigid and effective measures of government bodies in more important areas (unprecedented and success, the formation of the mass media of a stereotype of health, as a compulsory component of the prestigious life, as a result - a sharp decrease in harmful and increasing useful habits among the population, intensive growth of paramedicine Business based on the idea of \u200b\u200bphysical beauty and, as a result, promoting a healthy lifestyle, severe environmental measures, the formation of radical environmental thinking in society). The next global step in this direction in the coming years will be a fundamental change in the health care market associated with the development of genetic engineering.

Implementation of the concept is carried out in stages:

In the first stage (2009-2015), the state guarantees of the provision of free medical care to citizens of the Russian Federation are concreted, a predominantly single-channel model of funding for medical care through a system of compulsory medical insurance will be carried out, the development of standards and procedures for the provision of medical care will be developed; information system Personalized accounting of medical care provided to citizens.

As part of the first stage of implementation, preparatory activities will also be implemented for the subsequent transition to the new system of medical care, including the creation of a medical care control system with its subsequent integration into the quality management system, the modernization of the material and technical base of health care facilities has begun and will begin to be implemented The system of continuous training, based on a single personnel policy, will also be determined priorities for innovative health care development, interdepartmental target scientific programs for the development and implementation of new highly efficient technologies for the prevention, diagnosis and treatment of social and significant diseases and pathological conditions are formed. Health Development Concept of the Russian Federation until 2020

In addition, at the first stage, the implementation of the Priority National Project "Health" will continue in the following areas:

· Formation of a healthy lifestyle;

· Development of primary health care and medical prevention;

· Improving specialized, including high-tech, medical care for socially significant diseases, including cardiovascular, oncological, combined injuries in road traffic accidents;

· Development of blood service;

· Improving medical care mothers and children.

At the second stage of the implementation of the concept (2016-2020), a phased transition to a self-regulating medical care system based on the established infrastructure and personnel resource of health and informatization of the industry, the further introduction of new technologies developed taking into account the priorities of innovative health care, including high-tech and emergency medical care The system of compulsory health insurance, the integration of budget investments in tariffs for medical care, the creation of a system of drugs for citizens in outpatient conditions within the framework of compulsory health insurance.

The effective functioning of the health care system is determined by the main system-forming factors. These factors are interdependent and mutually definitions, in connection with which the modernization of health requires the harmonious development of each of them and the entire system as a whole.

The trend of the population reduction in recent years is ensured by an increase in fertility and a decrease in mortality. "The concept of health development in the Russian Federation up to 2020", which discusses and regulating issues related to a healthy lifestyle, is not just relevant, but is extremely important for today.

In general, the implementation of all directions of the concept will ensure by 2020 the formation of a healthy lifestyle of the population of the Russian Federation, and will also create a health care system that allows accessible and high-quality medical care based on uniform requirements and approaches, taking into account the advanced achievements of scientific and technological progress, which will be The key to the sustainable socio-economic development of the Russian Federation in the long run.

* clarify the concept of "transition to modern system medical care organizations ";

* add "Creating an effective (single for regions and districts) a model of financial resources management of state guarantees";

* add "Improvement of drugs to citizens in outpatient conditions within the compulsory health insurance system" by expanding the restrictive list formed on the basis of the analysis of clinical and economic efficiency;

* modify "Improving the qualifications of medical professionals and the creation of a system of continuous medical education with motivation to high-quality labor";

Paragraph 4.1 "Forming a Healthy Lifestyle" to supplement and offer as follows:

To form a healthy lifestyle, it is necessary to introduce a system of state and social measures by:

Subparagraph 1) "Improvement of medical and hygiene education and education of the population, especially children, adolescents, youth, through the media (including through commercials) and the mandatory introduction of relevant educational programs in preschool, secondary education institutions.

Subparagraph 4) "Creation of a system of materially interested motivation of citizens to conduct a healthy lifestyle and participation in preventive measures, forming a fashion for health, especially among the younger generation, making explanatory work on the importance and need to regular prevention and dispensarization of citizens at the place of residence; Selection and introduction of health care systems of healthy and practically healthy citizens in the ambulatory-polyclinic LPU "Halfin R.A. Priority National Health Project: Results and Prospects // Health Economy 2009, №11.

It can be concluded that in general, the scrupulous implementation of all directions of the concept should provide for 2020 the formation of a healthy lifestyle of the population of the Russian Federation. And if we talk about the long run, a health care system should be created, which allows accessible and high-quality medical care based on uniform requirements and approaches, taking into account the advanced achievements of scientific and technological progress, which will be the key to the sustainable socio-economic development of the Russian Federation.

healthcare Municipal Self-Government

Act Editorial 05.11.1997

Name Document	Decree of the Government of the Russian Federation of 05.11.97 N 1387 "On measures to stabilize and develop health and medical science in the Russian Federation"
Document type	resolution, concept
Accepted by	government of the Russian Federation
Document Number	1387
Date of adoption	01.01.1970
Date of editorial	05.11.1997
Date of registration in the Ministry of Justice	01.01.1970
Status	act
Publication	Document B. in electronic format FAPSI, NTC "SYSTEM" "Russian newspaper" on November 19, 1997 N 223
Navigator	Notes

Decree of the Government of the Russian Federation of 05.11.97 N 1387 "On measures to stabilize and develop health and medical science in the Russian Federation"

Health and Medical Science Development Concept in the Russian Federation

I. Introduction

In recent years, there is a deterioration in the state of public health. The crisis of medical institutions is approaching the feature for which the disintegration of the entire health care system.

In this regard, a well-thought-out health care reform strategy is necessary.

II. The main directions of development of the health care system

The main tasks of the concept are:

increase in the amount of measures for the prevention of diseases;

reduction of the timing of the restoration of lost health of the population by introducing modern methods of prevention, diagnosis and treatment to the medical practice;

improving the efficiency of use of resources in health care.

The implementation of the concept is based on the following principles:

universal, social justice and the availability of medical care to the population, regardless of the social status of citizens, the level of their income and place of residence;

preventive orientation;

economic efficiency of the functioning of medical institutions;

unity of medical science and practice;

the active participation of the population in solving health issues.

In the current conditions are important:

the formation of state policy in the field of health and medical science and increasing the responsibility of all authorities for its implementation;

development of the non-state sector in health care;

improving legal regulation of health care activities;

carrying out an investment policy that ensures the high efficiency of investments - the maximum medical, social and economic effect per unit cost;

raising the level of qualifications of medical workers, improving the system of their preparation, retraining;

increasing the social security of medical workers, including wage raising;

attracting professional medical associations to the implementation of state policy in the field of health and medical science;

improvement of state regulation in the field of providing medicines, medical products and medical equipment;

increasing the interest of citizens in preserving and strengthening their health.

III. Improving the organization of medical care

Primary health care is the main link when providing medical care to the population.

recovery treatment - up to 45 percent;

long-term treatment of patients with chronic diseases - up to 20 percent;

medical and social assistance - up to 15 percent.

Wider use daily forms of patients in hospitals.

It is necessary to revive interregional and interdistrict specialized medical centers.

Improving the quality of medical care will contribute to the implementation of the standards of diagnosis and treatment of patients both in outpatient polyclinic and hospital institutions.

Comprehensive measures need to be carried out on the further development of psychiatric and narcological assistance to the population, the fight against tuberculosis, sexually transmitted diseases.

Require state support measures to introduce modern technologies in intensive treatment units, cardiology and cardiac surgery, oncology, diagnosis and treatment of socially significant diseases.

It is necessary to strengthen the emergency medical care service, make it more mobile and equipped with modern means to provide emergency medical care and emergency hospitalization of patients.

The adoption of state support measures to improve rehabilitation assistance, the development of sanatorium-resort organizations of the health care system, health facilities and organizations.

To improve the quality and accessibility of medical care to the rural population, medical diagnostic complexes on the basis of central district hospitals are required, including municipal rural medical institutions, develop mobile forms of medical and diagnostic and advisory assistance, to create interdistrict clinical diagnostic centers.

It is necessary to integrate departmental medical institutions into the general health system at a single regulatory framework, taking into account their industry features and locations.

IV. Improving health financing system

Improving the health financing system involves the close dependence of the amount of financing of medical institutions from the amount and quality of services provided by them.

The financing system should ensure an increase in the efficiency of resource use and quality of medical care.

To this end, it is necessary:

develop legal mechanisms that ensure unconditional compliance with the compliance and conditions of compulsory medical insurance of the population in financial support;

establish the procedure for the distribution of federal budget funds sent to align the conditions for financing compulsory health insurance programs in the constituent entities of the Russian Federation;

improve methods for setting tariffs for medical services;

introduce a unified system of calculation for the provision of medical care provided within the framework of the program of state guarantees to ensure citizens of the Russian Federation free medical help;

determine the mechanisms of financially covering part of the cost of providing medical care to citizens based on the development of voluntary health insurance;

promoting the creation of a competitive environment in the medical services market.

The existing procedure for compulsory medical insurance needs to be improved. Two financing schemes for medical organizations in the system of compulsory medical insurance are possible:

financing through insurance medical organizations carrying out compulsory medical insurance;

financing medical organizations by branches of territorial compulsory health insurance funds.

The application of the second scheme is suitable for countryside and areas with a small population density, where the activities of insurance organizations and their competition with each other are objectively difficult.

To ensure the target and efficient use of funds allocated by the state for health care, it is necessary:

supplement the current health protection legislation with regulations ensuring more strict control over their spending, as well as the financial and economic activities of institutions and health organizations;

improving the accounting system received by healthcare institutions, including for the provision of paid medical services, as well as their use;

improving the competitive system for purchasing medicines, medical products and medical equipment, widespread use financial leasing To equip healthcare facilities with medical equipment;

improving the responsibility of compulsory health insurance funds for the results of their activities;

executive and local self-government bodies, compulsory medical insurance funds, insurance medical organizations, medical facilities to publish obligatory Annual reports on the expenditure of compulsory medical insurance and funds of budgets.

In 1998, to align the conditions for funding for compulsory health insurance programs in the constituent entities of the Russian Federation, it is planned to establish the distribution of insurance premiums in the following relation: The Federal Medical Insurance Fund - 0.5 percent, territorial funds of compulsory medical insurance - 3.4 percent or 2 percent of the Fund wages if the income of citizens will respectively more or less than 60 million rubles per year.

In the future, it is envisaged to combine funds intended for social and compulsory health insurance to ensure more efficient use within a single system of compulsory medical and social insurance.

V. Organization of health

In order to improve the provision of medical care, it is necessary to adopt the priority of federal laws on state, municipal and private health. This will ensure the implementation of public health policies at the present level.

For the implementation of the Unified State Policy in the field of healthcare should be modernized by the Industry Management Structure.

The main tasks of the health organization at the federal level should be considered:

determination of the health development strategy in the country;

development and execution of federal healthcare targeted programs;

development of the legislative and regulatory and methodological base of health care;

coordination of the activities of state authorities to address health issues;

development of mechanisms for the activities of the control and permits in the field of drug circulation.

At the subject of the constituent entity of the Russian Federation, the main tasks of the organization of health care should be:

health care taking into account regional peculiarities;

development and execution of territorial health care and state guarantee programs to ensure citizens free medical care in the territory of the constituent entities of the Russian Federation.

The main task of the health organization at the municipal level should be considered the formation and implementation of municipal health programs.

The main direction of improving the organization of health care is to ensure its integrity due to the uniform approaches to planning, normalization, standardization, licensing and certification. At the same time, a compulsory health insurance system should have a positive impact as a basis for funding for medical care under state guarantees.

The basis of the planning will be federal health development programs that implement the goals and objectives of public policy for a certain period and include:

federal Health Development Target Programs;

programs of state guarantees to ensure citizens of the Russian Federation free medical help.

These federal programs should be approved simultaneously with the allocation of relevant financial resources to their implementation.

To ensure a single (basic) level of state guarantees in health care at the federal level, medical and social standards should be approved, including:

the main indicators of the population of hospital and outpatient polyclinic institutions, as well as doctors and middle medical personnel;

regulatory health care financing.

In addition, at the federal level, the methods of calculating the regulations for ensuring health institutions with material, labor and financial resources are approved.

Health programs of the constituent entities of the Russian Federation include programs for state guarantees to ensure citizens of free medical help, in which:

health status indicators that must be achieved as a result of improving the health system;

funding amounts at the expense of the health and compulsory health insurance budget, ensuring the implementation of state guarantees;

general principles of financing and indicators of public health institutions;

events to improve the efficiency of health institutions;

the main directions of preventive activity.

In the constituent entities of the Russian Federation, standards for costs of outpatient and inpatient treatment should be approved. Based on these standards and incidence rates, the structure of medical care to the population is determined.

Health programs of the constituent entities of the Russian Federation serve as the basis for the formation of municipal programs containing indicators of the activities of health institutions and their funding at municipal levels.

The executive authorities of all levels control the execution of relevant programs, which will increase the effectiveness of the health organization.

In order to more rational use of financial and material resources in health care, it is necessary to establish that the largest investment projects on which budget funds are sent to be subject to mandatory examination of the Ministry of Health of the Russian Federation.

In the conditions of insufficient health financing, the duplication of the work of the medical institutions of the public sector, especially departmental healthcare agencies should be excluded. It is necessary to attract departmental medical institutions to implement the program of state guarantees, which will effectively use financial and material resources, to implement the principle of equal state relations to all citizens, regardless of their place of work, reduce the financial burden on budgets of departments. Separate health facilities should be transferred to the ownership of the constituent entities of the Russian Federation or to municipal property.

The priorities of international cooperation are the expansion and deepening of cooperation with the CIS participating States, support for compatriots abroad (primarily on the provision of medical care) both at the intergovernmental level and by providing humanitarian aid.

To ensure gradual integration into the world community on an equal basis, it is necessary to continue cooperation with international health organizations in the following areas:

protection of national interests in the implementation of international health and health projects;

expansion of participation in such international projects;

participation in medical care programs to citizens of individual countries;

adaptation of international criteria for the classification of diseases and standards of medical care for the Russian Federation;

international examination of Russian bills in the field of health care;

the study and application of international legal regulation experience in the field of health care;

expansion of medical care to citizens of Russia abroad and foreign citizens in Russia.

Vi. Ensuring sanitary and epidemiological well-being

The development and improvement of the State Sanitary and Epidemiological Service of the Russian Federation (hereinafter referred to as the Service) is the most important condition for improving the health of the country's population.

Ensuring the effective functioning of the service is to develop and implement the state program of development, providing for the leading organizational structure, management, resource and scientific service, the organization of its activities in accordance with the tasks and functions.

It is required to continue the reorganization of the structure of service institutions in accordance with the previously approved concept of restructuring of the centers of state sanitary and epidemiological surveillance through the formation of departments (offices) to study the impact of environmental factors on the health, offices of hygienic education and education of the population.

It is necessary to ensure:

a clear distinction between the functions of state sanitary and epidemiological supervision and sanitary and epidemiological activities between the organizations of the service and therapeutic and preventive institutions;

the protection of the territory of the Russian Federation from the importation and distribution of specially dangerous infectious diseases of people, animals and plants, as well as toxic substances;

introduction of new scientific developments;

strengthening interaction with other control and supervisory authorities;

improving the economic mechanism of activity and the development of criteria for regulatory financing institutions;

improvement of the legislative framework in the field of state sanitary and epidemiological supervision, strengthening the organizational and legal status of the service;

the reorganization of the system of hygienic education and education of the population, the formation of a system of self-treatment of the population.

VII. State guarantees for the provision of free medical care and protection of patient rights

State guarantees for the provision of free medical care should be provided at the expense of the relevant budgets, payments on mandatory health insurance and other revenues. To do this, it is necessary to adopt a program of state guarantees to provide citizens of the Russian Federation of free medical care, which should contain:

a list of appropriate types of medical care;

amount of medical care;

basic compulsory medical insurance program as an integral part of the government guarantees;

popular health financing standards providing guaranteed medical care.

In order to ensure the rights of citizens to health protection, the adoption of the Patient Rights Act is required.

VIII. Development of medical science

The main tasks of medical science should be:

formation of the strategy of preserving and promoting public health, the development of scientific foundations in combating the most common diseases;

getting based on fundamental studies new and deepening knowledge of the healthy and sore human body, its livelihoods and adaptation to environmental conditions;

development of new methods of prevention, diagnosis and treatment of diseases, restoration of lost health, increasing the duration of a person's active life;

development of new medical care and health management schemes.

The development of medical science will be carried out on the basis of the following principles:

concentration of scientific and technical potential and resources in priority areas of medical science;

the increase in the role of program-targeted planning, improving the quality of examination of scientific research, ethical control over their conduct;

budget financing of fundamental and applied research on a competitive basis;

state support of scientific teams that make a great contribution to the development of domestic and world medical science, the use of extrabudgetary sources of financing (international projects, funds, etc.);

development of regional scientific and practical units, development of programs and research;

expansion of ties between science, technology and production;

legislative consolidation of legal mechanisms for the development of medical science;

development of scientific and technical entrepreneurship, the creation of small implementing enterprises and experienced industries;

protection of intellectual property rights researchers on the results of scientific activities.

Budget financing of scientific developments should be carried out on the basis of the competitive allocation of grants, creating interdepartmental competition commissions for this. To implement the development of theoretical and practical direction, it is necessary to use a multi-channel financing system with the involvement of extrabudgetary sources.

Special attention should be paid to research and development work, which requires support from the state aimed at financing research that will ensure import substitution and will contribute to the development of the domestic medical industry.

The Russian Academy of Medical Sciences will implement functions to identify and develop the most important areas of fundamental and applied research, their organization and coordination in the Russian Federation, the preparation of highly qualified scientific personnel, as well as to participate in the development and implementation of the scientific sections of federal and other programs.

The Ministry of Health of the Russian Federation should determine priorities in applied scientific developments and coordinate federal programs in terms of scientific support for the health of people and state sanitary and epidemiological surveillance.

The Ministry of Health of the Russian Federation and the Russian Academy of Medical Sciences must jointly carry out a comprehensive expertise of federal and other scientific programs, to submit their recommendations on the implementation of medical science in practice and the effective use of achievements.

Ministry of Health of the Russian Federation together with the Ministry of Science and Technologies of the Russian Federation and with the participation of the Russian Academy of Medical Sciences will coordinate cooperation government agencies Executive and local government bodies with research institutes, institutions and organizations of the medical and biological profile, develop and implement a system of measures to strengthen international relations in order to solve topical problems of national science.

IX. Improving medical education and personnel policy

Personnel policies should be resolved taking into account changes occurring in all areas of health. It is necessary to develop a program for reforming a medical education system, which provides for a reduction in the preparation of medical professionals in traditional specialties, revising the structure of training of specialists. It is necessary to improve the planning system, forecasting and monitoring the training of health care professionals, including such new areas as a general practice doctor, a clinical pharmacologist, a medical psychologist, a medical sister with higher education, a specialist in social work, an economist of health care, a health manager.

The system of the total state certification of graduates of medical and pharmaceutical educational institutions, as well as certification of health professionals is necessary.

In international relations in the field of training follows:

restore professional medical connections with CIS member states;

develop work on the conclusion of international agreements

Of the Russian Federation on the mutual appeal of medical diplomas and other vocational training documents, as well as internships of specialists, training doctors and nurses abroad on the principle of exchange.

A system of planning and distribution of personnel potential is subject to reorganization, which should change the ratio of the doctor - a medium-sized medical worker towards increasing the number of the latter.

The practice of formation by the management bodies of the target orders for the preparation of specialists with the conclusion of relevant contracts with educational institutions and applicants will be applied.

In order to include health care professionals, health care reform:

improve the labor remuneration system of health workers, taking into account the harmful working conditions, complexity, volumes and quality of medical and preventive work;

establish and index the salary of health workers in size not lower than the subsistence minimum;

regularly review the size of tariffs for medical services based on tariff agreements with professional medical unions;

expand the list of categories of health workers regardless of the departmental affiliation of institutions in which they work with the right to a retirement for serving years working with a special risk for their health.

In the field of ensuring the labor protection of medical workers, it is necessary:

develop regulations on labor safety in health facilities;

organize training on labor protection of managers of government and healthcare agencies, medical educational institutions;

carry out a single policy to establish compensation and benefits for special conditions Labor medical workers.

H. Improvement of medicinal support, warranty in the field of medicinal assistance to the population

The state policy of providing the population by drugs and medical products is aimed at providing them with consumers in sufficient high-quality assortment and volume at affordable prices.

The implementation of this policy should be carried out by developing the pharmaceutical services market.

In order to ensure the safe use of drugs and medical products, it is necessary to improve the existing control and permitting system of expertise, standardization and state control both at the federal level and at the level of the constituent entities of the Russian Federation.

The main direction of the implementation of state policies in the field of drugs to citizens should be a drug, including preferential, providing the population in the provision of medical assistance under government guarantees.

At the stage of outpatient treatment:

formation within the framework of state and municipal orders of the list of medicines and medical products for preferential support of citizens;

formation within the framework of state and municipal orders of lists and volumes of medicines and medical products for the treatment of socially significant diseases.

At the stage of stationary treatment - free medicinal support in the framework of species, volumes and conditions for the provision of medical care provided for in government guarantees.

In order to effectively spend the consumption of public funds sent to preferential provision of citizens with medicines and medical products, the development and implementation of a system of accounting and control of these funds, creating conditions that ensure the interest of citizens in the rational use of drug benefits are envisaged.

In the field of wholesale purchases and retail sale of drugs follow:

carry out these purchases and sales on a competitive basis and provide publicity in choosing wholesale drug suppliers;

ensure safety, efficacy and quality of drugs by selecting, standardization and monitoring the compliance of standards;

provide a wide range of drugs in retail, in a stationary network - according to government guarantees.

In order to ensure the availability and adequacy of medicinal assistance to the population, it is necessary:

improve the mechanisms of state regulation of medicinal support;

provide state support for domestic medicines;

improve the organization of providing medicines and the management of pharmaceutical activities.

Xi. Expansion of the Social Healthcare Base

The work on the health of citizens and the provision of medical and social assistance it is necessary to involve non-professional public organizations and professional medical and pharmaceutical associations, as well as individual citizens, which will increase the efficiency of preventive work, including with socially protected population layers, facilitate rehabilitation work with Groups of patients, develop the principle of mutual assistance and the skills of solving medical and social problems by patients themselves.

Work on the expansion of the social base of healthcare should be carried out in the following areas:

search for valid forms of cooperation with public, charitable and religious organizations;

attracting the attention of the population to health issues, promoting the creation of public associations of patients in medical interests;

creation of a medical education system and medical information, cooperation with the media in popularizing a healthy lifestyle, strengthening control over the advertising of products of the medical industry and medical services;

assistance in the implementation of state and public events aimed at preserving and protecting the moral health of society;

work among the population on family planning in order to form a conscious relationship to family, motherhood and paternity;

creating a system for training employees of the Ministry of Internal Affairs of the Russian Federation, the Ministry of the Russian Federation for Civil Defense, Emergency Situations and Elimination of Disaster Consequences and other special services to provide first aid.

XII. Mechanisms and stages of the implementation of the Concept

To ensure the sequence in fulfilling the provisions of the Concept, the work on its implementation will be performed in 2 stages.

Stage I (1997-2000)

The implementation of the activities set forth in the Program of the Government of the Russian Federation "Structural Perestroika and Economic Growth in 1997-2000."

Taking measures to ensure the stable work of health care institutions to increase the amount of industry financing and improving the efficiency of use of resources in health care.

To this end, the provision of medical care to the population since 1998 will be conducted within the framework of programs of state guarantees to ensure free medical care. At the same time, the amounts of financial resources sent to the implementation of these programs must comply with state guarantees provided for in them.

Implementation during the 1997-1999 structural transformations in the industry. Conducting restructuring of inpatient assistance with the simultaneous development of outpatient polyclinic institutions and the creation of day hospitals and hospitals at home. An important direction of this work will be the introduction of the Institute of General Medical Practice.

Introduction In 1998, the standardization of medical services, regulation of hospitals and polyclinic drugs, medical products and medical equipment.

Completion by 1999, work on the reorganization and elimination of duplication in the activities of federal healthcare institutions, including departmental.

Development and approval in 1997-1998 federal target programs to combat tuberculosis and sexually transmitted diseases, to develop oncological assistance to the population, prevention and treatment of cardiovascular diseases.

Conducting state anti-alcohol measures, the development and subsequent implementation of the federal target program of combating smoking will contribute to a decrease in the incidence and mortality of the population.

Stage II (2001-2005)

The implementation of federal targeted health care development programs, the implementation of which will create the basis for the implementation of effective methods of prevention, diagnosis and treatment of disease and to provide people with accessible qualified and specialized medical care to the population.

Completion of the structural restructuring of the industry. As a result, the private sector should be formed in health care. In the primary health care system, the main role will be assigned to general practitioners. Large development will receive inter-district and interregional clinical centers of specialized medical care. Actively will be implemented by mobile forms of medical care to the population in rural areas.

Formation of a unified health monitoring information system, the creation of telecommunication ties between clinical centers and doctors of the general (family) practice to advise patients and raising professional knowledge of medical workers.

Approved
decree of Government
Russian Federation
of November 5, 1997
N 1387.