The document discusses Russia's health system, which has undergone significant reforms since the 1990s. It provides statistics on health outcomes and spending. Key reforms included introducing compulsory health insurance, decentralizing governance of health services, and increasing the private sector's role. The system faces challenges like unequal access to care, especially in rural areas. Future reforms aim to improve availability and quality of care through measures like consolidating financing and strengthening provider accountability.
Healthcare in Digital Age
by Assit. Prof. Polawat Witoolkollachit,MD
Present for the 3rd Samitivej Sriracha Medical Symposium 2018 "CQI & Innovation in Healthcare 4.0"
Proyecto y programa educativo de formación a padres, profesores y sanitarios para la integración de niños y adolescentes con diabetes en centros escolares
Healthcare in Digital Age
by Assit. Prof. Polawat Witoolkollachit,MD
Present for the 3rd Samitivej Sriracha Medical Symposium 2018 "CQI & Innovation in Healthcare 4.0"
Proyecto y programa educativo de formación a padres, profesores y sanitarios para la integración de niños y adolescentes con diabetes en centros escolares
The Republic of Korea HiT notes that economic development and universal health coverage through national health insurance has led to a rapid improvement in health outcomes. Overall, the health status of the Korean population is better than that of many other Asian countries. Reducing inequality in health coverage outcomes, strengthening primary health care and improving coordination between hospitals and long-term care facilities to meet the needs of the aged population are the challenges facing the Government.
Presentation at the National Capitalization conference of the Swiss-Ukrainian Mother and Child Health Programme (Kyiv, Ukraine, April 23, 2015)
http://motherandchild.org.ua/eng/event/768
Reviewing the Healthcare Analytics Adoption Model: A Roadmap and Recipe for A...Health Catalyst
Dale Sanders provides an update on the Healthcare Analytics Adoption Model. Dale published the first version of this model in 2002, calling it the Analytics Capability Maturity Model. The three intentions at that time are the same as they are today: 1) Provide healthcare leaders with a clear roadmap for the progression of analytic maturity in their organization. 2) Provide vendors with a roadmap to meet the analytic needs of clients. 3) Create a common framework to benchmark the progressive adoption of analytics at the industry level.
In 2012, Dale co-published a new version of the Model with Dr. Denis Protti, rebranding it the Healthcare Analytics Adoption Model and purposely borrowing from the widespread adoption of the EMR Adoption Model (EMRAM) published and supported by HIMSS. In 2015, Dale transferred the model under a creative commons copyright to HIMSS to create a vendor-independent industry standard that is now widely applied to support the original three intentions. He continues to collaborate with HIMSS to progress the Model.
During this webinar, Dale:
-Reviews the current state of the Health Catalyst Model, including recent changes that advocate a ninth level—direct-to-patient analytics and AI.
-Shares his observations of maturity in the market.
-Provides an update on the current state of the HIMSS Adoption Model for Analytic Maturity.
Japan has made numerous achievements in health most notably the world’s highest life-expectancy in the past two decades, since its founding Universal Health Insurance System in 1961. However, ageing population with low-fertility rates, stagnating economy, increasing burden of NCDs and growing use of expensive technologies pose the critical challenges in service delivery and financial stability in health. Japan HiT reports current health system reforms undertaken and also recent discussion on paradigm shift to the new system as proposed in Japan Vision: Health Care 2035.
The Analytic System: Finding Patterns in the DataHealth Catalyst
Dr. Haughom set the stage for this upcoming discussion in his previous webinar, explaining the key components of an effective analytical system that enables self-exploration and learning. In this session Attendees will learn:
How the distinction between random variation and assignable cause variation is critically important to patient care
Creation and application of Statistical Process Control (SPC) charts to:
Monitor process variation over time
Differentiate between assignable cause and random cause variation
Assess effectiveness of change on a given process
Achieve and maintain process stability
How implementing inlier management and creating a collaborative environment will drive continuous improvement
How to identify patterns in data using a live demonstration of advanced analytical tools.
Slides used to deliver presentation on Korean healthcare system overview. Main topics are: payer, healthcare delivery system, regulation, stakeholders.
Thực trạng giao tiếp của điều dưỡng với người bệnh và một số yếu tố liên quan tại bốn khoa lâm sàng Bệnh viện Đa khoa Vĩnh Long năm 2014.Giao tiếp đóng vai trò quan trọng trong đời sống, đặc biệt trong ngành y tế,giao tiếp giữa người bệnh với thầy thuốc giúp thu thập và chia sẻ thông tin, đáp ứng các
Data Science for Healthcare Graduate Programs, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 2, 2019
The Republic of Korea HiT notes that economic development and universal health coverage through national health insurance has led to a rapid improvement in health outcomes. Overall, the health status of the Korean population is better than that of many other Asian countries. Reducing inequality in health coverage outcomes, strengthening primary health care and improving coordination between hospitals and long-term care facilities to meet the needs of the aged population are the challenges facing the Government.
Presentation at the National Capitalization conference of the Swiss-Ukrainian Mother and Child Health Programme (Kyiv, Ukraine, April 23, 2015)
http://motherandchild.org.ua/eng/event/768
Reviewing the Healthcare Analytics Adoption Model: A Roadmap and Recipe for A...Health Catalyst
Dale Sanders provides an update on the Healthcare Analytics Adoption Model. Dale published the first version of this model in 2002, calling it the Analytics Capability Maturity Model. The three intentions at that time are the same as they are today: 1) Provide healthcare leaders with a clear roadmap for the progression of analytic maturity in their organization. 2) Provide vendors with a roadmap to meet the analytic needs of clients. 3) Create a common framework to benchmark the progressive adoption of analytics at the industry level.
In 2012, Dale co-published a new version of the Model with Dr. Denis Protti, rebranding it the Healthcare Analytics Adoption Model and purposely borrowing from the widespread adoption of the EMR Adoption Model (EMRAM) published and supported by HIMSS. In 2015, Dale transferred the model under a creative commons copyright to HIMSS to create a vendor-independent industry standard that is now widely applied to support the original three intentions. He continues to collaborate with HIMSS to progress the Model.
During this webinar, Dale:
-Reviews the current state of the Health Catalyst Model, including recent changes that advocate a ninth level—direct-to-patient analytics and AI.
-Shares his observations of maturity in the market.
-Provides an update on the current state of the HIMSS Adoption Model for Analytic Maturity.
Japan has made numerous achievements in health most notably the world’s highest life-expectancy in the past two decades, since its founding Universal Health Insurance System in 1961. However, ageing population with low-fertility rates, stagnating economy, increasing burden of NCDs and growing use of expensive technologies pose the critical challenges in service delivery and financial stability in health. Japan HiT reports current health system reforms undertaken and also recent discussion on paradigm shift to the new system as proposed in Japan Vision: Health Care 2035.
The Analytic System: Finding Patterns in the DataHealth Catalyst
Dr. Haughom set the stage for this upcoming discussion in his previous webinar, explaining the key components of an effective analytical system that enables self-exploration and learning. In this session Attendees will learn:
How the distinction between random variation and assignable cause variation is critically important to patient care
Creation and application of Statistical Process Control (SPC) charts to:
Monitor process variation over time
Differentiate between assignable cause and random cause variation
Assess effectiveness of change on a given process
Achieve and maintain process stability
How implementing inlier management and creating a collaborative environment will drive continuous improvement
How to identify patterns in data using a live demonstration of advanced analytical tools.
Slides used to deliver presentation on Korean healthcare system overview. Main topics are: payer, healthcare delivery system, regulation, stakeholders.
Thực trạng giao tiếp của điều dưỡng với người bệnh và một số yếu tố liên quan tại bốn khoa lâm sàng Bệnh viện Đa khoa Vĩnh Long năm 2014.Giao tiếp đóng vai trò quan trọng trong đời sống, đặc biệt trong ngành y tế,giao tiếp giữa người bệnh với thầy thuốc giúp thu thập và chia sẻ thông tin, đáp ứng các
Data Science for Healthcare Graduate Programs, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 2, 2019
Troy Buckner, a private art dealer, operates his own art business in Southampton in New York, NY, where he has sold works by such iconic artists as Andy Warhol. Moreover, Troy Buckner is a fixture of the Southampton, NY, art scene; he participates in such local cultural events as The Mid Summer Gala at the Parrish Art Museum.
Trabalho realizado pela aluna Vanessa Ventura do 11º G da Escola Secundária de Odivelas para a disciplina de História da Cultura e das Artes no ano lectivo de 2008-2009.
Internet is an excellent source for information, you can knew internet search engines, pediatric sites, continuing medical education and evidence based medicine.
THIS PPT IS ABOUT THE HEALTH CARE SYSTEM IN CHINA MOSTLY STUDIED IN ECONOMICS.
THIS ALSO SHOWS YOU ABOUT THE INSURANCE POLICY AND GDP RATE AND MANY MORE
Prof. Dr. Vladimir Trajkovski: HEALTH CARE SYSTEM FOR PEOPLE WITH INTELLECTUA...Vladimir Trajkovski
Prof. Dr. Vladimir Trajkovski presented this topic: HEALTH CARE SYSTEM FOR PEOPLE WITH INTELLECTUAL DISABILITIES IN MACEDONIA at Bristol conference, May 13, 2010
Sri Lanka has achieved strong health outcomes over and above what is commensurate with its income level. The country has made significant gains in essential health indicators, witnessed a steady increase in life expectancy among its people, and eliminated malaria, filariasis, polio and neonatal tetanus. The Sri Lanka HiT review presents a comprehensive overview of the different aspects of the country’s health system, and the background and context within which the health system is situated. The review also presents information on reforms to address emerging health needs such as the growing challenge of noncommunicable diseases (NCDs) and serving a rapidly ageing population
The Solomon Islands HiT determines that the country’s health system has significant weaknesses but also considerable strengths. Despite the range and difficulty of issues facing policy-makers in the Solomon Islands, there have been significant achievements in health, including considerable progress in advancing population health status. The performance of the health system is positive, achieving high coverage, high satisfaction levels, and steady progress on health outcomes. Nonetheless, the country faces important health challenges that could undermine development gains made to date
The Thailand HiT reports that sustained political commitment to the health of the population since the 1970s has resulted in significant investment in health infrastructure, in particular primary health care, district and provincial referral hospitals, and strengthened the overall functioning of the Thai health system. After Thailand achieved universal health coverage in 2002, public expenditure on health significantly increased from 63% to 77% and out-of-pocket expense was reduced from 27.2% to 12.4% of the total health spending in 2011.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
4. Statistics
Total population (2015) 143,457,000
Gross national income per capita (PPP international $, 2013) 23
Life expectancy at birth m/f (years, 2015) 65/76
Probability of dying between 15 and 60 years m/f (per 1 000 population, 2013
Total expenditure on health per capita (Intl $, 2014) 1,836
Total expenditure on health as % of GDP (2014) 7.1
٠ Latest data available from the Global Health Observatory WHO .
11. Russia seems to be a good case as the country’s health system
is undergoing great changes switching from budget (Semashko
model), to basic (limited) social insurance with a strong emphasis
on individual responsibility. However, but Russian health care
has not improved much
The Russian case stresses the importance of health policy
formulation in the course of health Reforms. Though the
strategic aim of securing good health for all is declared by
Russian politicians, the health system model that is emerging in
the course of the reforms is unlikely to reach this aim.
In fact health policy not only fails to solve the old problems but
creates new ones, like widening the inequality in health status
and access to health service.
12.
13. Healthcare reform in the federation 1990 :-
1- Introduction of compulsory health insurance (CHI);
2-Decentralization of governance, administration and provision of health
services;
3-Development of welfare mix in health care with the emphasis on
private sector.
The Soviet Union has budget medicine usually referred to as Semashko
model.
In the beginning of 1990s new financing and management mechanisms
have been introduced -:
Compulsory health insurance (СНI) and decentralization of health саге
financing and management became the strategic course of the reforms.
in The1991 law on chi introduced; universal coverage through CHI;
Compulsory health insurance contributions paid by employers for the
employed and by local administration for the employed;
14. Social determinants of health
Migrant health and health matters associated with migration are important
public health challenges for the Russian Federation. Since the 1990s,
there have been major population movements in the Russian Federation,
with economic migrants from neighboring states seeking job opportunities
and internal movements between rural and urban areas, particularly to
Moscow.
Women in the Russian Federation bear a heavy burden of chronic
diseases. This is due mainly to the poor quality of preventive care and
sexual education for women, relatively high rates of adolescent
pregnancies and abortions, exposure to risk factors, like tobacco alcohol
and unhealthy diets.
While general poverty levels have fallen . relatively high vulnerability to
poverty remains a concern. Poverty rates in the poorest regions are 45
times those in the richest.
15. Unequal access to health services, particularly for people in rural areas, for peop
Rapid modernization of this large emerging economy has not been uniform, with
17. The aim of “Health care development”, approved by Government
Resolution No. 294-r of 15 April 2014 :
, is to make medical care more accessible and more efficient, with the
volume, quality and types of care commensurate with disease incidence
rates and the needs of the population, consistent with the latest medical
advances and with the WHO European Health 2020 framework .
The programmes covers the period 2013–2020 and comprises 11
subprogrammers, each with a specific purpose, a major direction,
financial provision, implementation mechanisms and indicators of
effectiveness. The concept of long-term socioeconomic development up
to 2020, approved by Government Directive No. 1662-r of 17 November
2008 .addresses issues of modernization and development of health
care based on a multi-sectorial approach.
18. The demographic policy of the Russian Federation up to 2025 was
passed by Presidential in year 2007 :
. A ground-breaking legislative platform for improving the health
care system was recently created with adoption of Federal laws on
Compulsory medical insurance in the Russian Federation (2010)
and on The basis of public health protection in the Russian
Federation (2011)
A sustainable national policy on the leading risk factors has been
initiated, with approval of a State policy to reduce alcohol abuse
and prevent alcoholism
19. Laws aimed at administrative reform did not fully take into account the
specific features that are characteristic for the provision of health
services or the existing network of health facilities.
In accordance with the Federal Law on General Principles of
Organizing Local Government in the Russian Federation,
the municipalities bore responsibility for the provision of primary and
emergency care, as well as maternity services (including ante-natal
and postnatal care).
This sharing of responsibility envisaged the transfer of municipal
institutions providing secondary care to the regional level. Over 75%
of the inpatient health facilities in the country are at the municipal
level.
The network of municipal health facilities, particularly in large cities,
includes multi-profile hospitals providing inpatient care in areas such
as cardiology, surgery, ophthalmology, and so on.
20. The Russian Federation inherited a large network of primary care
facilities that covers the entire territory. Primary care physicians and
pediatricians work with specialists In outpatient facilities,
while specialized medical care is delivered in hospitals, clinics,
diagnostic and treatment centers and dispensaries.
The infrastructure is largely intact in urban areas, but there has been
a substantial cut in the number of hospital beds, and the number of
health care organizations in order to optimize the public health
infrastructure and to build a three-tier health care system.
New structural reforms are aimed at improving the availability and
quality of health care, especially for people living in remote regions
and rural areas. The Russian Federation ranks first among
developed countries in the number of physicians per 1000
population, which was about 4.1 in 2013.
21. The health service infrastructure delivered care through a hierarchy of
facilities. The basic unit was the ‘uchastok’ and in rural areas this covered
a population of approximately 4000. Their primary care needs were met
by the health post, which was often staffed by nurses or feldshers.
Any problems that required more complex help would be referred to a
rural health centre, which would normally employ a general physician and
a generalist paediatrician in addition to nursing staff.
These centres provided a mixture of primary and routine secondary care
and often had a small number of inpatient beds.
More complex cases still would be referred to rayon polyclinics or
hospitals. These were district level facilities offering specialist secondary
services in either an outpatient setting (polyclinics) or on an inpatient
basis (hospitals). These fed into the oblast or regional polyclinics and
hospitals, which in turn could refer to Republican level or The major
centres of excellence .
22. The models of provision and the services offered are as follows:
Health Posts/Feldsher-Midwife Stations :
cover a population of about 4000 persons and offer immunization, basic
health checks and routine examinations, as well as care during pregnancy and
for the newborn. They are also able to treat minor injuries and make home
visits but cannot prescribe. Staff (i.e. a feldsher/midwife) are normally trained
for two years beyond the basic nurse training and are employed by the local
government body and supervised via the nearest health centre or polyclinic.
There is no patient choice.
Health Centres :
cover a number of uchastoks or "micro-districts" or larger rural conurbations of
7000 persons or above They are staffed by a general physician, a
paediatrician and sometimes an obstetrician or gynaecologist as well as
nursing staff. They offer a range of primary care services, including
immunization, screening, treatment of minor ailments and supervision of
chronic conditions, prescribing, sickness certification and twenty four hour
cover. Health centres tend to have a number of beds and are able to carry out
inpatient deliveries and perform minor surgery. Many of the beds however are
used for social care and tend to be occupied by the frail and elderly rather than
the acutely ill.
23. Urban Polyclinics:
house a number of generalist (uchastok) physicians and auxiliary staff who prov
Special Focus Polyclinics :-
in large towns and cities there is a network of children’s polyclinics where genera
24. Enterprise Polyclinics:
some Medsanchast facilities survive and provide the staff of the
enterprise/s which support them with the same basic package of
primary provision available through residence based general
practitioners, although with an increased emphasis on occupational
health. There are also work-based polyclinics with outpatient
specialists and a very few examples of inpatient beds attached to
industry. These clinics are a legacy of the soviet concern for the
industrial worker.
25. Secondary care and tertiary care (specialized ambulatory care/ inpatient
care)
The network of secondary and tertiary facilities combines hospitals,
hospital outpatient clinics and specialist outpatient centres based in
polyclinics. The infrastructure inherited from the Soviet era remains
largely intact in urban areas, despite some bed and facility closures, but
in rural areas there has been a more substantial cut in the number of
facilities and beds, with the closure of many small village hospitals (see
section 4.1.1). Care is still organized on a territorial basis. The basic units
that provide secondary and tertiary care are as follows:
26. Small rural hospitals (uchastkovye bol’nitsy):
These are small hospitals with average capacity of 30 beds offering fairly
basic inpatient cover, often with a staff team of a surgeon,
District (raionnye) hospitals:
These hospitals serve the population of large rural municipalities. The
average
capacity of such hospitals is about 130 beds.
Central district (raionnye) hospitals:
These hospitals serve the population of rural municipalities at the
administrative
centre for the area. The average capacity of a central district hospital is 200
beds.
City hospitals:
Urban municipalities have multi-profile city hospitals with a capacity of 150–
800 beds for adults and about 100–300 beds for children.
27. Regional hospitals:
Each region has a general hospital for adults (500–1000 beds) and a general
hospital for children (300–600 beds) that accept referrals of complex cases
from district hospitals and polyclinics,
Regional specialized clinics (dispanserii):
Most specialized clinics are integrated facilities with outpatient and inpatient
departments; about one-third have only outpatient departments. Specialist
outpatient services are also provided at the regional level.
Federal hospitals and federal specialized clinics (dispanserii):
These offer the most complex care at large and highly specialized hospitals
or clinics. These are often associated with research institutes in their
respective
Hospitals and specialized clinics in parallel systems :
Parallel systems under ministries other than the MoHSD tend to concentrate
their secondary and tertiary care services to other ministries.
28. Day care:
More often day-care units are established in outpatient departments (60%
of day-care beds are placed in outpatient facilities . Since 2000, the number
of day-care beds in hospitals increased by 26% and the number of patient-
days in both types of day-care units (established in out- and inpatient
facilities) increased by 55%. In 2008, average length of treatment provided
in day-care units was 11.4 days, and the number of operations provided in
these units was 5 per 100 discharged
Rehabilitation/intermediate care:
There are 47 sanatoria and health resorts under the jurisdiction of the
MoHSD, with a total bed capacity exceeding 11 000. In 2009, more than
112 000 individuals received sanatorium–resort care (including 60 344
(53.6%) whose treatment was funded with public money).
29. Palliative care :-
services have evolved out of cancer treatment services, and there is
strong collaboration between the statutory health system and the
international hospice movement. Approximately 90% of palliative care
services are state funded
Mental health :-
Mental health services are organized “vertically” in the same way as
specialist services for other priority diseases such as diabetes, TB,
HIV/AIDS, sexually transmitted diseases, cancer services and vaccine-
preventable diseases. Nevertheless, mental health has traditionally
been a low priority
30.
31. An example pathway in the provision of medical care
In the Russian Federation, a woman in need of a hip replacement because of
32.
33. Decentralization and centralization
Following the break-up of the Soviet Union, almost all forms of
decentralization have been a part of reforms in the Russian Federation. In
the health sector, only the sanitary-epidemiological system was not much
affected by administrative reform and remained more or less centralized
throughout
Devolution :-
oblast- and local-level administrations managed their own medical
services; they appointed heads of territorial health authorities as well as
heads of appropriate medical facilities, and developed programmes for
improving the population’s health and preventing disease without the
approval of the federal ministry.
Delegation:-
Another significant form of decentralization in the Russian Federation is
delegation, prompted by the introduction of health insurance legislation
leading to the establishment of MHI Funds. The rationale was to create a
purchaser– provider split based on competitive market forces that would
promote efficiency but remain under public control
36. Planning
Strategic planning for health and the health system is the responsibility of
the MoHSD (see section 2.3). There have been moves to shift planning
away from input- to output-based criteria, but at present the
implementation of “outcome- oriented budgeting” is limited to the first
stage of budgeting process: budget planning
One of the main planning tools regarding the provision of medical care is
the development of the programme for state guarantees regarding free
medical care.
Health information management :-
The collating of national statistics is the responsibility of the Federal State
Statistics Service (Federal’naya sluzhba gosusardsvennoi statistiki
(Rosstat)). The Federal State Statistics Service gathers a wide range of
statistical information about health including the health status of the
population, resources in the health system and their utilization, the training
of health care providers and labour reimbursement in health, economic
aspects of the system’s activities, the consumption of goods and services
and others. Data collection is by mandatory report forms for national
statistics,
37. Health expenditure
Total health expenditure in the Russian Federation is lower than the average
level for CIS countries and considerably lower than the average for countries
of the European Union (EU) Per capita total health expenditure in the
Russian Federation is also comparatively low .
Public health funding is also quite low in comparison with other countries of
the WHO European Region .In addition, the share of public funding in total
health expenditure fell from 73.9% in 1995 to 64.4% in 2009 .
Most private expenditure is in the form of out-of-pocket payments,
particularly for outpatient pharmaceuticals, which are explicitly excluded from
the guaranteed packages of care
38.
39.
40. Private expenditure on health has been growing since the 1990s and
accounted for 35.6% of total health expenditure in 2009, most of which
(28.8%) was paid directly out of pocket . Although the significance of
private health insurance has grown, it remains a relatively small feature of
the system, particularly outside Moscow and other big cities .
The hybrid funding system means that there are two main types of pool
for prepaid funds: the MHI (through its federal and territorial funds) and
budgets of different levels: federal, regional and municipal . Purchasing
through the MHI takes place at the regional level through the Territorial
MHI Funds on a contractual basis. Most purchasing at the municipal and
regional level from budgetary funds is conducted according to historical
budgeting processes .
43. In 2010, the new Law on Mandatory Health Insurance and the Law
on the Legal Status of Public Facilities were adopted. The Law on
Mandatory Health Insurance envisages mechanisms for transferring
the financing system from its current dual-stream financing to a
single-channelled system and aims to ensure the long-term financial
sustainability of the MHI system. The Law on the Legal Status of
Public Facilities aims to broaden the range of legal forms health
providers can have to strengthen responsibilities for provider
performance results and to grant providers more economic and
managerial flexibibilty .
44. Physical and human resources
Since independence in 1991, the size of the network of medical facilities has de
during the second decade there was a sharp contraction in the size of the netw
The decline in 1995–2000 was the result of both voluntary policies linked to the
45.
46. The reduction in hospital numbers has been accompanied by a reduction
in the number of hospital beds. These reductions have not been evenly
distributed across specialties and the impact of the lack of financial means
on sectors that were not considered a priority is significant;
47. Further implementation of reforms will depend on the government’s
ability to monitor the reform process, critically evaluate the
achievement of goals and targets, and to introduce changes when
needed. Central to the success of future reforms will be the broad
involvement of all the main stakeholders at all levels and obtaining
the support of regional authorities, as well as ensuring the support of
the medical community.
Future strategy
48. References :-
Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A,
and Mathivet B. Russian Federation: Health system review. Health
Systems in Transition .
http://www.euro.who.int/__data/assets/pdf_file/0006/157092/HiT-
Russia_EN_web-with-links.pdf .
Tompson, W. (2007), “Healthcare Reform in Russia: Problems and
Prospects”, OECD Economics Department Working Papers, No.
538, OECD Publishing. http://dx.doi.org/10.1787/327014317703