Accessibility and effective functioning of the rural health care primary link in the rural settlement system is considered in the article as a necessary condition for ensuring the competitiveness of the rural able-bodied population and a component of the social well-being of the rural population as a whole. The aim of the article is to analyze the structural elements of the rural primary health care at various territorial levels, which allows us to draw a scientifically sound conclusion about how similar the elements of the territorial rural health care systems are to each other. Their differences are considered by the author as evidence of the adaptation of primary links to the characteristics of rural settlement. Theoretical scientific provisions are formulated in the framework of the concept of civic-oriented management and the new role of the state as a source of basic social benefits, which have been recognized in the domestic and international scientific community. Basing on general theoretical propositions, a methodology has been developed that allows using the mathematical theory of measurements to identify and compare the structural elements of the primary links of rural health care at various territorial levels. During the study, the method to assess the volume of structural elements in relative terms was used. We used publications of foreign and domestic authors, indicators shown in materials and collections of state and departmental statistics as sources. As a result of the study, it was proved that at the level of the Russian Federation, the structures of the primary rural health care consist of: outpatient clinics - 11.1%, local hospitals - 3.2%, feldsher-midwife centers - 80.6%, feldsher (rural paramedic) stations - 5.1%. Similar primary link structures were identified in most federal districts of the Russian Federation. An exception is only a few districts located in specific climatic conditions. A study of the structure of the rural health care system at the territorial level of a constituent entity of the Russian Federation, using the example of the Saratov Region, did not reveal significant deviations from the all-Russian standard. In the structure of the regional primary link of rural health care, outpatient clinics account for 9.0%, local hospitals - 1.3%, feldsher-midwife stations - 89.7%; feldsher stations are absent. The undertaken research and comparison of the structural elements of rural health care, carried out at the level of the Russian Federation, federal districts and constituent entities of the Russian Federation, allowed to gain new knowledge about the structural homogeneity of the primary links of the rural health system at all levels. The hypothesis formulated by the author about the structural uniformity of the primary links of the territorial systems of rural health care in most federal districts is confirmed, which indicates their inconsistency with the characteristics of rural settlement. The practical result of the study, which can be used to develop managerial decisions in the process of forming the primary links of territorial rural health systems that correspond to the characteristics of rural settlement, are the proposed in the article indicators that characterize the type of settlements in the rural settlement system. The priority of theoretical and methodological studies as the basis for developing managerial decisions in the field of rural health policy is justified; this involves the formation and support of primary structures of territorial rural health systems, including traditional and innovative types of medical services, corresponding to the peculiarities of rural settlement and scientifically based criteria that ensure the full functioning of medical primary health care organizations in rural health systems.
DEVELOPMENT OF THE OUTPATIENT NETWORK OF RURAL HEALTH CARE IN THE RUSSIAN FEDERATION
