ANALYSIS OF THE QUALITY OF MEDICAL CARE PROVIDED BASED ON INSURANCE SUPERVISORY

2020 ◽  
pp. 160-170
Author(s):  
Ольга Игоревна Муратова ◽  
Наталия Андреевна Матвеева
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Medical Insurance ◽  
Insurance Companies ◽  
Medical Services ◽  
Medical Organization ◽  
Medical Institutions ◽  
Quality Of Medical Care ◽  
The Russian Federation

Статья посвящена анализу качества медицинской помощи, оказываемой населению в рамках системы обязательного медицинского страхования (ОМС), на основе мероприятий страхового надзора над медицинскими организациями. Полис ОМС гарантирует пациентам доступность, качество и своевременность предоставления медицинских услуг. Проверка качества медицинской помощи производится путем осуществления экспертиз и контроля уполномоченными органами РФ по направлениям: законности работы медицинской организации, системности оказания медицинской помощи, результативности и своевременности проводимых мероприятий в рамках оказания медицинской помощи. Таким образом, страховой надзор за медицинскими организациями осуществляется путем соблюдения объема, сроков и условий оказания медицинской помощи, контроля качества медицинской помощи фондами обязательного медицинского страхования и страховыми медицинскими организациями в соответствии с законодательством Российской Федерации. Страховой надзор над медучреждениями осуществляется в рамках ОМС и включает следующие виды страхового надзора: медико-экономический контроль, медико-экономическая экспертиза и экспертиза качества медицинской помощи. Отличительной особенностью современного состояния системы страхового надзора за качеством оказываемой медицинской помощи в системе ОМС является его совершенствование на основе анализа удовлетворенности потребителей медицинских услуг, что позволяет выявить нарушения, которые допущены при оказании медицинской помощи. Причем эти мероприятия способствуют как повышению качества обслуживания застрахованных лиц, так и улучшению репутации медицинских организаций, что серьезно влияет на решения участников программы обязательного медицинского страхования. Повышение ответственности страховых компаний становится важным элементом модернизации системы ОМС. В этой связи актуальным является обеспечение эффективной работы страховых медицинских компаний и медицинских учреждений на принципах конкурентоспособности и повышения качества медицинской помощи, реализуемое с помощью механизмов ориентации на требования потребителей медицинских услуг The article is devoted to the analysis of the quality of medical care provided to the population within the framework of the system Compulsory health insurance (CHI), based on the measures of insurance supervisory over medical organizations. The CHI guarantees patients the availability, quality and timeliness of medical services. Quality control of medical care is performed by carrying out examinations and control by the authorized bodies of the Russian Federation in the following areas: the legality of the work of a medical organization, the consistency of medical care, the effectiveness and timeliness of measures taken within the framework of medical care. Thus, insurance supervisory of medical organizations is carried out by observing the scope, terms and conditions of medical care, and monitoring the quality of medical care by mandatory medical insurance funds and insurance medical organizations in accordance with the legislation of the Russian Federation. Insurance supervisory of medical institutions is carried out within the framework of the CHI and includes the following types of insurance supervisory: medical and economic control, medical and economic expertise and examination of the quality of medical care. A distinctive feature of the current state of the system of insurance supervisory over the quality of medical care in the CHI system is its improvement based on the analysis of satisfaction of consumers of medical services, which allows you to identify violations that have been committed in the provision of medical care. Moreover, these measures contribute both to improving the quality of care for insured persons and to improving the reputation of medical organizations, which seriously affects the decisions of participants in the compulsory medical insurance program. Increasing the liability of insurance companies is becoming an important element of the modernization of the CHI system. In this regard, it is important to ensure the effective operation of medical insurance companies and medical institutions based on the principles of competitiveness and improving the quality of medical care, implemented through mechanisms of orientation to the requirements of consumers of medical services

scholarly journals Evaluation of the Quality of Medical Care to the Population at the Level of Day Stations and Emergency Stations

2022 ◽  
Vol 8 (1) ◽  
pp. 114-121
Author(s):  
B. Niyazov ◽  
S. Niyazovа
Keyword(s):  
Medical Care ◽  
Emergency Medical Services ◽  
Chronic Diseases ◽  
Emergency Care ◽  
Rural Population ◽  
Medical Services ◽  
Emergency Medical ◽  
Medical Institutions ◽  
Quality Of Medical Care

Insufficient availability of emergency medical services to the rural population is noted. The dynamics of the growth of calls to emergency medical services testifies to the fact that emergency medical institutions have taken over part of inpatient services for the provision of emergency care to patients with chronic diseases and acute colds.

scholarly journals The problem of unreliability of information in the system of compulsory medical insurance in the context of the implementation of the constitutional right to free medical care

2021 ◽  
Vol 21 (2) ◽  
pp. 206-214
Author(s):  
Veronika A. Fadeeva ◽  
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Medical Insurance ◽  
Relevant Information ◽  
Medical Services ◽  
Legal Analysis ◽  
The Russian Federation ◽  
Constitutional Right ◽  
The Right ◽  
The Cost

Introduction. The addition of the section “Information on the cost of medical services rendered” to “Public Services”, the state information system, allowed the citizens of the Russian Federation to receive relevant information promptly. This possibility soon exacerbated the problem of unreliability of information about the medical services provided to the insured persons under compulsory medical insurance. The article defends a position based on the legal analysis of the legislation of the Russian Federation in the sphere of compulsory medical insurance. According to this position, the problem can be overcome by appropriate changes in the regulatory documents governing the control powers of the territorial funds of compulsory medical insurance, health insurance organizations. Theoretical analysis. The right to reliable information is enshrined in a number of regulatory legal acts of the Russian Federation, the analysis of which allows us to investigate the problem of unreliability of information in the system of compulsory medical insurance (“medical prescriptions”). Empirical analysis. Identification of unreliability of information about the provided medical services can be carried out both by the insured persons under compulsory medical insurance and through the control of the competent authorities. In this regard, the article analyzes the control powers of the territorial funds of compulsory medical insurance, medical insurance organizations. Results. The result of the author’s analysis of the problem of unreliability of information in the system of compulsory medical insurance (“medical attributions”) is a proposal to improve the procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care for compulsory medical insurance.

REVISITING THE QUESTION OF COMPLIANCE WITH DEPARTMENTAL REGULATORY LEGAL ACTS OF THE PENAL SYSTEM OF RUSSIA, REGULATING THE PROCEDURE OF RENDERING AND QUALITY OF MEDICAL ASSISTANCE TO PENAL STAFF AND THE REQUIREMENTS OF FEDERAL LEGISLATION

2020 ◽  
pp. 77-84
Author(s):  
Олег Алексеевич Свидерский
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Medical Service ◽  
Legal Regulation ◽  
High Tech ◽  
Medical Assistance ◽  
Quality Of Medical Care ◽  
The Russian Federation ◽  
Correction System

В статье поднимаются отдельные вопросы правового характера оказания медицинской помощи сотрудникам УИС в лечебно-профилактических учреждениях ФСИН России, МВД России, Минобороны России, а также в учреждениях государственной или муниципальной систем здравоохранения. Проведен анализ нормативных баз Минздрава России и Минюста России, в которых осуществляется регламентирование вопросов оказания медицинской помощи. Показано, что в федеральных и ведомственных нормативно-правовых актах Минюста России законодательно не закреплен порядок оказания высокотехнологичной медицинской помощи по перечню видов, которые не включены в базовую программу ОМС. В целях устранения пробела в законодательстве предлагается медицинской службе ФСИН России разработать соответствующий регламент, в котором прописать перечень необходимых документов и порядок направления на лечение нуждающихся сотрудников. Проведенный опрос сотрудников УИС показал, что более 2/3 респондентов недовольны не только условиями, в которых оказываются медицинские услуги, но и качеством оказанной им медицинской помощи. Рассмотрены права и возможности сотрудников УИС по предъявлению претензий к лечебному учреждению в случае неудовлетворенности качеством оказанной медицинской услуги (помощи). Анализируются проблемы правового регулирования и практического решения вопроса, оценки качества оказанной медицинской услуги (помощи). Предлагается сформировать в системе ФСИН России институт экспертов по оценке качества медицинской помощи. The article raises certain issues of the legal nature of the provision of medical assistance to the penal correction system in medical institutions of the Federal Penitentiary Service of Russia, the Ministry of Internal Affairs of the Russian Federation, the Ministry of Defense of the Russian Federation, as well as institutions of the state or municipal health systems. The analysis of the regulatory framework of the Ministry of Health and the Ministry of Justice, which regulates the provision of medical care. It is shown that the federal and departmental regulatory legal acts of the Ministry of Justice do not legislatively regulate the procedure for providing high-tech medical care according to the list of species that are not included in the basic program of compulsory medical insurance. In order to fill the gap in the legislation, it is proposed that the medical service of the Federal Penitentiary Service of Russia develop an appropriate regulation in which a list of necessary documents and the procedure for referring treatment to needy employees are prescribed. A survey of employees of the penal correction system showed that more than 2/3 of respondents are dissatisfied not only with the conditions in which medical services are provided, but also with the quality of medical care provided to them. The rights and possibilities of the penitentiary system staff to make claims to a medical institution in case of dissatisfaction with the quality of the medical service (assistance) provided are examined. The problems of legal regulation and practical solution of the issue, assessing the quality of the medical service (assistance) provided are analyzed. It is proposed to form an institute of experts in the FSIN system for assessing the quality of medical care.

scholarly journals THE LEGISLATIVE FOUNDATION OF EXPERTISE OF MEDICAL CARE QUALITY ACCORDING CASES OF LETHAL OUTCOMES

2019 ◽  
Vol 62 (2) ◽  
pp. 95-102
Author(s):  
Konstantin V. Polyakov ◽  
N. M. Gayfullin ◽  
Zh. A. Akopyan ◽  
P. G. Mal'kov
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Quality Evaluation ◽  
Evaluation Criteria ◽  
Care Quality ◽  
Icd 10 ◽  
Quality Of Medical Care ◽  
The Russian Federation ◽  
Care Support

The article presents analysis of national and foreign legislative documents concerning issues of expertise of quality of medical care according cases of lethal outcomes (Universal Declaration of Human Rights, the Constitution of the Russian Federation, ICD-10, Federal laws and sectoral orders). It is established that key elements of system of medical care quality control (levels of control, authorized authority, forms of control, sources of development of criteria of quality evaluation, criteria of quality evaluation) are determined legislatively and reflect main requirements of international documents. The criteria of medical care quality evaluation are developed by groups of diseases of conditions on the basis of corresponding of medical care support Procedures, medical care Standards, Rules of implementation of laboratory, instrumental, pathologico-anatomic and other forms diagnostic analysis and Clinical Recommendations (records of treatment) related to issues of medical care support. The shortcoming of the Russian Federation legislation is an inadequate reflection of sources of development of criteria of medical care quality evaluation and relevant incompleteness of the very criteria of medical care quality evaluation. Therefore, their application by experts to issues of evaluation of medical care quality is complicated that effects formation of expert conclusion and negatively affects detection and prevention of possible violations during medical care support. The outdated normative regulation of clinical pathologic anatomic conference is noted as an important form of control of medical care support according cases of lethal outcomes. The necessity of alterations and additions in particular currently in force documents concerning issues of expertise of medical care quality, including according cases of lethal outcomes.

scholarly journals JUSTIFICATION FOR ESTABLISHING THE PRIMARY AND CLINICAL DIAGNOSIS IN THE GROUP OF DISEASES – ACUTE PSYCHOTROPIC DRUG POISONING

2020 ◽  
Vol 26 (4) ◽  
pp. 10-15
Author(s):  
Pavel Pavlovich Gavrikov ◽  
◽  
Boris Borisovich Yatsinyuk ◽  
Vyacheslav Aleksandrovich Zhidkov ◽  
Ekaterina Alekseevna Barats ◽  
...  
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Psychotropic Drugs ◽  
Clinical Symptoms ◽  
Acute Poisoning ◽  
Clinical Observations ◽  
Clinical Diagnoses ◽  
Quality Of Medical Care ◽  
The Russian Federation

The study, based on clinical observations of a group of specialists (toxicologists, anesthesiologists, resuscitators), reflects the course of clinical symptoms that occur in acute poisoning with new psychotropic drugs (alpha-pyrrolidinopentiophenone). The article provides a rationale for establishing primary and clinical diagnoses that reflect the quality of medical care in patients in this nosological group of diseases, evaluated on the basis of Federal clinical recommendations and orders of the Ministry of health of the Russian Federation.

scholarly journals Assessment of organization of medical care and drug provision for patients with rheumatic diseases, and the socioeconomic burden of these diseases in the Russian Federation

2018 ◽  
Vol 12 (3) ◽  
pp. 112-119 ◽  
Author(s):  
A. M. Lila ◽  
R. О. Dreval ◽  
V. V. Shipitsyn
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Legal Regulation ◽  
Drug Supply ◽  
Quality Of Medical Care ◽  
The Russian Federation ◽  
Socioeconomic Burden ◽  
Drug Provision ◽  
Local Levels

This article reviews data on the assessment of the incidence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA, arthropathic psoriasis), as well as related disability and the economic burden of these nosological entities, including their therapy with biological agents. It considers the issues of organization and quality of medical care, drug supply, normative and legal regulation. The paper also shows the important epidemiological and socioeconomic importance of RA, AS, and PsA in Russia, points out the regional peculiarities of medical care and drug provision, and proposes solutions for their optimization at the federal and local levels. In preparing this investigation, the authors have taken into account the opinions of many specialists and experts in this field from different subjects of the Russian Federation.

The quality of working life and its influence on the efficiency of the activities of nursing specialists

2021 ◽  
pp. 50-60
Author(s):  
Irina Evgenievna Misko ◽  
Larisa Arkadyevna Karaseva
Keyword(s):  
Russian Federation ◽  
Medical Science ◽  
Working Life ◽  
Medical Organization ◽  
Quality Of Working Life ◽  
Quality Of Medical Care ◽  
The Russian Federation ◽  
Required Quality ◽  
Labor Potential

The aim of the study is to determine the value of the quality of working life as a stimulus for the growth of the efficiency of nursing personnel. Results. On the basis of the development of the system of the quality of working life, the fundamental conditions have been formulated that ensure a more complete realization of labor potential, without which it is impossible to maintain a high and stable level of production and ensure the required quality of medical care. Conclusion. The labor collective of a medical organization is a social group of interaction and mutual assistance, in which conditions are created in which a specialist can develop as a person in cultural, national, moral and everyday aspects. The personnel policy of the top management of a medical organization is developing in accordance with the Concept for the development of healthcare and medical science in the Russian Federation.

The achievements of pulmonology and the main directions of further improvement of medical care in the Russian Federation

2021 ◽  
Vol 31 (6) ◽  
pp. 782-791
Author(s):  
Tatiana N. Bilichenko ◽  
Alexey A. Shutov
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Primary Care Physicians ◽  
Scientific Research ◽  
Scientific School ◽  
Treatment And Prevention ◽  
Quality Of Medical Care ◽  
The Russian Federation ◽  
Research Institute

The development of pulmonology in Russia is linked with the creative activity of the Scientific Research Institute of Pulmonology of the Federal Medico-Biological Agency (Research Institute of Pulmonology of the FMBA) and its scientific school.The aim of the analytical review was to assess the role and contribution of the research team of the Research Institute of Pulmonology in improving the quality of medical care to the population of Russia.Methods. The data of medical statistics of the Ministry of Health of the Russian Federation on morbidity and mortality of the population due to respiratory diseases (RD) from 2004 - 2018 are analyzed. The publications on scientific research conducted with the participation of employees of the Research Institute of Pulmonology for the period from 2005 to 2020 were studied.Results. Over the past 30 years in Russia, with the participation of the staff of the Research Institute of Pulmonology, the state task of creating a system for organizing medical care for the population with RD has been successfully solved. The study and implementation of modern innovative approaches in the diagnosis, treatment and prevention of RD, the training of primary care physicians allowed to improve the quality of medical care to patients to the level of world standards. For the period from 2004 - 2018 the mortality of the population from RD 35.6% decrease was registered. During the pandemic of a new coronavirus infection, the use of pulmonology achievements in clinical practice contributed to a decrease in the frequency of deaths in people with COVID-19.Conclusion. Currently, the Research Institute of Pulmonology of the FMBA of Russia retains a leading position in the country in the field of fundamental scientific research, innovative methods of diagnosis and treatment of RD, educational activities and training of specialists in the field of pulmonology.

Study of temporary losses of patients when receiving medical services in ambulatorypolyclinic conditions

2021 ◽  
pp. 37-44
Author(s):  
T. V. Pozdeeva ◽  
◽  
N. V. Pchelina ◽  
Keyword(s):  
Medical Care ◽  
Statistical Processing ◽  
Medical Services ◽  
Special Technique ◽  
Medical Organization ◽  
Patient’S Satisfaction ◽  
District Center ◽  
Quality Of Medical Care ◽  
Microsoft Office

The study of the patient’s temporary losses when receiving medical services in an outpatient clinic and their minimization contribute to an increase in patient satisfaction with the quality of medical care. Objective of the stud y: to assess the temporary losses of patients when visiting outpatient clinics of the city municipality. Methods and materials. The temporary losses of patients were studied by analyzing route maps compiled using a special technique. The analysis of the questionnaires made it possible to assess the patient’s satisfaction with the conditions of providing medical services, the information received in the healthcare institution and the attitude of the nursing staff to the visitor. Statistical processing of the results was carried out using the programs Statistica 5.0 and Microsoft Office Excel. Results. As a result of the conducted research, significant time costs of patients were identified when receiving medical care in polyclinics of the district center: when visiting a district doctor, a registry, a treatment room and a laboratory, which directly affected the results of assessing their satisfaction with the temporary criteria for visiting a medical organization. Scope of the results. The data obtained during the study can be used as basic information when developing measures to optimize key processes in outpatient health care institutions.

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