Organization of medical and economic control of the volume and cost of medical care in the system of compulsory health insurance in 2021

The article is devoted to the current problem of interaction in fulfilling the obligations of all participants of compulsory health insurance to pay for and provide medical care in accordance with the amendments made to Federal Law No. 326-FL of 29 November 2010 (as amended on 08 December 2020) «On Compulsory Health Insurance in the Russian Federation» and entered into force on January 1, 2021. The authors focus on the issue of granting of the territorial compulsory health insurance fund new powers to conduct medical and economic control and abolishing these powers from medical insurance organizations. According to the amendments, all volumes of medical care provided to the insured population of the subject of the Russian Federation, both on the territory of insurance and outside it, as well as medical care provided outside the territory of insurance, are the subject of medical and economic control by the territorial fund. Starting from 2021, the form of the contract for the provision and payment of medical care for compulsory health insurance, approved by Order of the Ministry of Health of the Russian Federation No. 1417n of 30 December 2020, has also changed. Unlike the previous form of contract concluded between an insurance medical organization and a medical organization, the current document provides for the participation of three parties in contractual relations: the territorial fund, insurance medical organizations, medical organizations. The agreement contains provisions providing for the obligation of the territorial fund to carry out medical and economic control of registers of accounts and accounts submitted by medical organizations to pay for medical care provided within the framework of the basic and territorial compulsory health insurance programs. The article presents the results of the control carried out with the analysis of the identified violations in the provision by medical organizations of the Ryazan region of invoices and registers of invoices for payment of medical care provided for January 2021, identifies problematic points in the information interaction between participants of compulsory insurance in the implementation of this function of the territorial fund.

Assessing the sustainability development of an organization

Introduction. The article presents a review of scholarly literature and the author's assessment of the potential for sustainable development of a medical organization. The purpose of the article is to describe the author's methodology for assessing the potential for sustainable development, and to evaluate the effectiveness of its application in a medical organization. Materials and Methods. The study used the following research methods: comparative analysis, T.L. Saati, and the author’s methodology for assessing the potential for sustainable development of a medical organization. Results. In the process of analyzing the methodology for self-assessment of the maturity on the way to achieving the sustainable development of the ISO 9004 standard organization, the author revealed a number of problems. They include low sensitivity to individual assessment of processes, the lack of a mathematical expression of the level of development for certain areas of activity, and the absence of an integral indicator sensitive to minimal changes. The author describes in detail process of developing her methodology for assessing the potential for sustainable development of an organization and illustrates the application of this methodology within a medical organization for evaluating sustainable development in statics and dynamics. Conclusions. Finally, conclusions are drawn about the ways of applying the author's assessment methodology by the head of the medical organization.

DEFINING THE ONTOLOGICAL STATUS OF LABOUR PRODUCTIVITY IN HEALTH CARE

he present research touches upon the problem of comprehension of the concept «labor productivity» as applied to the field of healthcare in comparison with other categories and the corresponding indicators, used in the assessment of the medical organization personnel activity. As methodological basis the ideas in the field of labor economics, conceptual apparatus and theoretical bases of which have proved their efficiency in the solution of the tasks of development of the organizations of different branch affiliation act. The statement that labor productivity in public health services is connected with the transfer of knowledge and technologies from industrial sphere to medicine, requiring the interpretation of concepts and conceptual apparatus in relation to the considered branch is taken as the basis. In modern conditions of high intensity of work of medical organizations at simultaneous necessity of observance of obligatory requirements to quality and safety of medical aid, rational use of resources, the demand for formation of scientifically grounded approaches to labor productivity estimation in healthcare is realized by authors by means of development of an integrated index of labor productivity estimation. The present research can be considered in the development of the theory of labor productivity as applied to the branch of health care taking into account its orientation on rendering qualitative and safe medical aid. The offered by the author approach to the estimation of the given indicator allows to reflect not only quantitative (output, labor input) or cost estimation of labor productivity, but also takes into account complexity, intensity of work of the employees, and also an estimation of a degree of achievement of productivity (quality) of their activity. Its novelty is seen in the mutual conditionality of medical, social and economic evaluation of the effectiveness of the use of labor resources of the employees of medical organizations.

Current approaches in providing medical care for patients with corneal diseases in a large city

Objectives to analyze the aspects of the specialized ophthalmological medical care for patients with corneal diseases on the example of St. Petersburg. Material and methods. The data of the patients with corneal diseases treated in hospitals of St. Petersburg were copied onto specially developed cards from the official reporting forms and medical records of inpatients for the period of 5-year follow-up. To analyze the characteristics of patients with a continuous method of observation, we studied data on 2200 patients hospitalized in large ophthalmological hospitals in the city. We also interviewed 840 ophthalmologists in order to identify the main problems. The obtained data were statistically processed with the calculation of statistical series, extensive and intensive indicators. To assess the statistical significance of the differences in indicators in individual years of the observation, we used Student's t-test. Results. The analysis of statistics revealed an increase in the number of patients hospitalized with corneal diseases in the period from 2015 to 2019. The following problems were identified: nonavailability of keratoplasty in the regions (28.6 per 100 respondents), imperfection of the regulatory basis for corneal transplantation (26.2 per 100 respondents), long waiting list for surgery (22.6 per 100 of respondents), lack of modern medical equipment in a medical organization (20.2 per 100 respondents) and an insufficient number of quotas for operations (20.2 per 100 respondents). Conclusion. The availability of a sufficient amount of donor material will reduce the waiting time for specialized ophthalmic medical care for patients with severe corneal diseases, and will help create conditions for their satisfaction with the medical care provided to them.

Secure Health Monitoring Communication Systems Based on IoT and Cloud Computing for Medical Emergency Applications

Smart health surveillance technology has attracted wide attention between patients and professionals or specialists to provide early detection of critical abnormal situations without the need to be in direct contact with the patient. This paper presents a secure smart monitoring portable multivital signal system based on Internet-of-Things (IoT) technology. The implemented system is designed to measure the key health parameters: heart rate (HR), blood oxygen saturation (SpO2), and body temperature, simultaneously. The captured physiological signals are processed and encrypted using the Advanced Encryption Standard (AES) algorithm before sending them to the cloud. An ESP8266 integrated unit is used for processing, encryption, and providing connectivity to the cloud over Wi-Fi. On the other side, trusted medical organization servers receive and decrypt the measurements and display the values on the monitoring dashboard for the authorized specialists. The proposed system measurements are compared with a number of commercial medical devices. Results demonstrate that the measurements of the proposed system are within the 95% confidence interval. Moreover, Root Mean Squared Error (RMSE), Mean Absolute Error (MAE), and Mean Relative Error (MRE) for the proposed system are calculated as 1.44, 1.12, and 0.012, respectively, for HR, 1.13, 0.92, and 0.009, respectively, for SpO2, and 0.13, 0.11, and 0.003, respectively, for body temperature. These results demonstrate the high accuracy and reliability of the proposed system.

PROBLEMATIC ISSUES OF INFORMATION SUPPORT FOR MANAGEMENT DECISION-MAKING IN HEALTHCA

— The purpose of the work is to analyze the main problem areas and the possibilities of introducing an information support system for making management decisions (controlling) in the activities of managers of modern medical organizations. The work used bibliographic, descriptive-analytical, general scientific, methods of system and content analysis. As a result of the study, the prospects for the use of controlling tools in preventive and clinical medicine, including in activities directly related to the treatment of patients, have been substantiated; a number of indicators have been proposed for monitoring and assessing the health status of the population; an assessment was made of the possibilities of using the decision-making information support system in the management of a medical organization; the main directions of further implementation of IT-technologies in healthcare practice are presented. The results obtained in the course of the study will significantly improve the quality of management decisions made and the effectiveness of the activities of modern medical organizations.

Modern Management: Methods of Managing the Clinical and Diagnostic Center «Med-Art» with a Patient Orientation and Resource Saving

In modern conditions, the effectiveness of the functioning of any medical organization is determined not only by the availability of the latest equipment and qualified personnel, but also by the introduction of innovative technologies in medicine and management

ANALYSIS OF THE IMPLEMENTATION OF A NEW MODEL OF A MEDICAL ORGANIZATION PROVIDING PRIMARY HEALTH CARE IN CHILDREN'S STRUCTURAL UNITS

Вопросы улучшения оказания первичной медико-санитарной помощи детскому населению всегда выступали в качестве приоритетных при оптимизации деятельности службы охраны материнства и детства и вызывали особое внимание организаторов здравоохранения. Одним из значимых решений по повышению качества оказания медико-санитарной помощи, в том числе и детям, является проект по реализации «Новой модели медицинской организации, оказывающей первичную медико-санитарную помощь» в детских структурных подразделениях. Одной из основных задач педиатрической службы Воронежской области является реализация мероприятий региональной программы «Развитие детского здравоохранения Воронежской области, включая создание современной инфраструктуры оказания медицинской помощи детям», которой предусмотрено достижение целевых показателей и выполнение определённых задач. В данной статье рассматриваются вопросы организации деятельности педиатрической службы Воронежской области в плане реализации новой модели медицинской организации, оказывающей первичную медико-санитарную помощь в детских структурных подразделениях. Определяются направления развития детского здравоохранения, включая создание современной инфраструктуры оказания медицинской помощи детям. Приводятся данные по достижению в детских поликлиниках и детских поликлинических отделениях Воронежской области организационно-планировочных решений внутренних пространств, создание условий для внедрения принципов бережливого производства и комфортного пребывания детей и их родителей при оказании первичной медико-санитарной помощи, с акцентом на воплощении идей оптимизации первичной медико-санитарной помощи путем использования принципов и методов бережливого производства в части реализации регионального проекта «Развитие системы оказания первичной медико-санитарной помощи» Нацпроекта «Здравоохранение» в рамках создания и тиражирования «Новой модели медицинской организации, оказывающей первичную медико-санитарную помощь» The issues of improving the provision of primary health care to the children's population have always been a priority in optimizing the activities of the maternal and child health care service and have caused special attention of health care organizers. One of the significant decisions to improve the quality of health care, including for children, is the project to implement the "New model of a medical organization providing primary health care" in children's structural units. One of the main tasks of the pediatric service of the Voronezh region is the implementation of the activities of the regional program "Development of children's health care of the Voronezh region, including the creation of a modern infrastructure for the provision of medical care to children", which provides for the achievement of targets and the implementation of certain tasks. The article deals with the organization of the activities of the pediatric service of the Voronezh region in terms of implementing a new model of a medical organization that provides primary health care in children's structural units. The directions of development of children's health care, including the creation of a modern infrastructure for the provision of medical care to children, are determined. The data on the achievement in children's polyclinics and children's polyclinic departments of the Voronezh region of organizational and planning solutions of internal spaces, the creation of conditions for the introduction of the principles of lean production and a comfortable stay of children and their parents in the provision of primary health care, with an emphasis on the implementation of ideas for optimizing primary health care through the use of principles and methods of lean production in terms of implementation regional project "Development of the system of primary health care" of the National Project "Healthcare" in the framework of the creation and replication of the "New model of a medical organization providing primary health care"

Dynamics of labor motivation of medical employees in the process of professional activities

The aim of the study is to study the structure and dynamics of changes in the labor motivation of medical workers at the stages of professional activity and to suggest ways to improve the labor motivation management system in a medical organization. Results. Based on the theoretical conclusions and the research conducted, recommendations were developed to improve the system for managing the labor motivation of the personnel of a medical organization, which, on the one hand, take into account the features of the motivational complex specific to each group of medical workers, and on the other hand, changes in the structure of motivation that occur as the acquisition of professional experience by specialists. Conclusion. The study showed that as medical workers accumulate work experience, their motivational spectrum shifts towards external motives, thus, their internal motivation decreases.

Entering a medical clinic on the stock exchange: reflection in accounting and reporting

Medicine in modern Russia is as profitable business as any other. Of course, we are talking about private medicine. Therefore, medical organizations need to be able to plan their income and expenses, as well as be able to manage them. Many Russian private medical organizations adopt foreign experience, transferring to the “medical soil” the idea of “effective management”, which consists in the ability to increase revenues, reduce costs, and generate such a volume of profit that suits the shareholders. According to the market law of capital flow, shareholders who own shares of companies in one industry sell these shares (at the time when this can be done with the maximum possible profit) and acquire shares of companies in another industry that are more attractive for investors. It is possible to sell shares “from hand to hand” — from the previous owner to a new one, but the transaction in this case is carried out at a negotiated price that will not meet the criteria of the so-called fair price. A completely different matter is the sale of shares on an exchange, an observable (transparent) market. The transaction is reflected in the accounting and reporting, the only question is whether the profit from the transaction is reflected on the balance sheet of the medical organization in respect of the shares of which the transaction is being made.