Modern high technology. Problems of healthcare and ways to solve them Kolesnikov S.I. Deputy Chairman of the Health Protection Committee, Member of the Presidium of the Russian Academy of Sciences, Academician of the Russian Academy of Medical Sciences, Foundation for the Use and R. Problems of Russian healthcare and ways to solve them

Data from 2014 to 2018, the upper dotted line is plotted according to forecasts (if the situation does not improve), and the lower one – according to forecasts of the State Program “Health Development” “New” EU countries include the Czech Republic, Estonia, Hungary, Poland, Slovakia, Slovenia ( close to the Russian Federation in terms of GDP - 23–25 thousand $PPP per capita per year). Sources: Rosstat database – EMISS; WHO Health for All database; OECD database “OESD.StatExtracts”; Demographic Yearbook of Russia (2014).

The most important lesson of these periods is the improvement of the socio-economic situation of citizens, an increase in government funding for health care, the implementation of targeted health programs and the political will of the country's leaders - which allows us to achieve a noticeable improvement in demographic indicators in the country. Standardized mortality rate (SMR).

Standardization of mortality taking into account the age structure of the population will give an even greater difference in values ​​with EU countries than comparison by ACS. The SDR from all causes in the Russian Federation is 1.5 times higher than in the 6 indicated “new” EU countries, and 2.1 times higher than in the “old” EU countries (1109, 755 and 523 cases per 100 thousand, respectively). population). At the same time, the SDR from diseases of the circulatory system is 1.7 times higher than in the “new” countries and 3.6 times higher than in the “old” EU countries (570, 345 and 160 cases per 100 thousand population, respectively) .

Morbidity of the population. Over the past 16 years, the overall morbidity rate of the population of the Russian Federation has been constantly growing, which is explained, on the one hand, by the growing proportion of the elderly population and more effective detection of diseases using new diagnostic methods, and on the other hand, by the deterioration of public health and the ineffectiveness of the system for the prevention and treatment of diseases.
In 1990, 158.3 million cases of diseases were registered (identified), in 2013 – 231.1 million, i.e. the increase was 46% (and in terms of 100 thousand population, the incidence increased by 51%) (Fig. 4). The observed increase in morbidity correlates with the increase in population mortality over this period.

In Fig. Table 4 shows that from 1990 to 2013, the number of cases of diseases leading to death increased, for example, the number of diseases of the circulatory system increased by 2.3 times, oncological diseases - by 2 times. The frequency of disabling pathologies of the musculoskeletal system and connective tissue– 2.3 times, as well as complications of pregnancy, childbirth and the postpartum period increased by 2.2 times. It should be noted that the actual incidence requiring medical intervention may be even higher than the recorded one. This is due to the fact that part of the population, due to the low availability of medical care, especially primary health care, simply does not go to medical institutions. This is confirmed by the results of the clinical examination carried out in 2013, when 34.6 million people were examined and the number of people under medical supervision doubled.

Figure 4. Dynamics of overall morbidity in the Russian Federation per 100 thousand population (total population and by disease class) from 1990 to 2013.

Basic problems of the Russian healthcare system are growing

Figure 5. Availability of practicing doctors in the Russian Federation (2013) and developed countries (2012)

“New” EU countries include the Czech Republic, Estonia, Hungary, Poland, Slovakia, Slovenia (close to the Russian Federation in terms of GDP - $23-25 ​​thousand PPP per capita per year).
Sources: Rosstat database – EMISS; WHO Health for All database; OECD database “OESD.StatExtracts”; Federal Statistical Observation Form No. 17 “Information on medical and pharmaceutical workers in the Russian Federation for 2013”, TsNIIOIZ.

Figure 6. Insufficient drug supply to the population in outpatient settings - in the Russian Federation 4.2 times lower than in the “new” EU countries

Low volumes of HFMP – 3–5 times lower than in the “new” EU countries. For example, revascularization operations are performed 3 times less (89.4 and 253.2 per 100 thousand population, respectively), knee replacement operations and hip joints– 3.8 times less (58 and 220 per 100 thousand population, respectively).

The quality of medical care remains unsatisfactory. Indicators of the quality of medical care in the Russian Federation are worse than in EU countries, which is caused by a critical weakening of the personnel training system in medical universities and insufficient implementation modern system continuing medical education. For example, the in-hospital mortality rate of patients with myocardial infarction in the Russian Federation is 2.4 times higher than in the EU countries on average (17 and 7%, respectively). In the Russian Federation, non-compliance of the medical care provided with established standards and rules, according to the Compulsory Medical Insurance Fund, occurs in every sixth case of treatment (17%), in developed countries, adherence to established treatment standards and clinical recommendations) is 90% (and only in 10% of cases there are facts of deviations) , i.e. Our figure is almost 2 times worse.

The already insufficient government funding for the health care system is being reduced. In 2013, government spending on health care was 1.5 times lower than in the “new” EU countries (US$910 and US$1,410 per capita per year, respectively, Fig. 7). In 2014, compared to 2013, government spending in constant prices decreased by 9%, and in 2015 there was a deficit of funds taking into account inflation (12.2%), ruble devaluation (60%) and additional expenses already declared by the Ministry of Health compared to 2014 will be almost 30% (without taking into account the need to increase wages medical workers- 20%). Additional expenses consist of funds needed to increase the volume of high-tech medical care (HTMC) for 162.5 thousand citizens, to provide guarantees of free medical care to new citizens of the Russian Federation - 2.3 million people, to increase wages for medical workers in accordance with the Decree President of the Russian Federation No. 597 of May 7, 2012, as well as to cover the accumulated deficit of 2014. Together, these expenses amount to 873 billion rubles. (without increasing wages for medical workers - 645 billion rubles). And the planned increase in spending on the State Guarantees Program (SGP) in 2015 compared to 2014 is only 173 billion rubles. The difference (deficit) is 700 billion rubles. (873 – 173), this is 30% of all expenses for the SGBP in 2015 (RUB 2,205 billion). In other words, they planned 30% less funds than needed.

The efficiency of spending resources in the Russian healthcare system is decreasing. In 2014, healthcare funds are allocated for capital and other non-priority expenses. For example, for the construction of perinatal centers using compulsory medical insurance funds, which reduces costs in the most deficient compulsory medical insurance system. The development of clinical examination in a situation of personnel shortage in primary care is ineffective, since doctors cannot take on the additional workload.

There are significant external challenges until 2020 that need to be taken into account when formulating healthcare development policies

Demographic: reduction in the working-age population by an average of 1 million people. in year; an increase in the number of citizens over working age by 4.3 million; increase in the number of children by 7%. As a consequence, it is necessary to provide special programs to provide medical care to these categories of the population.

Economic: deterioration in the socio-economic indicators of the country’s development in 2015 – a drop in GDP by 3%, inflation up to 12.2%, devaluation of the average annual exchange rate of the ruble against the dollar by 60% (in 2015 compared to 2014), decline real income of the population by 4%.

Main conclusions about the relationship between government funding of healthcare and public health indicators in the Russian Federation and developed countries

An analysis of existing proposals for the development of healthcare shows that their implementation will not improve the health indicators of the population of the Russian Federation by 2018.

On May 7, 2012, the most important decrees for the industry of the President of the Russian Federation (No. 596, 597, 598 and 606) were adopted, aimed at increasing the wages of medical workers and teaching staff of medical universities, increasing the drug supply to the population and developing prevention. They also set a goal for healthcare – achieving a life expectancy of 74 years by 2018. However, the measures to implement these decrees proposed in the “road maps” will not improve the quality and accessibility of medical care and improve the health indicators of the population of the Russian Federation.

Thus, the “road maps,” on the contrary, provide for a reduction in the volume of emergency and inpatient medical care under the SGBP, a reduction in medical personnel, and an increase in paid medical services in state medical organizations.

Managerial and budgetary maneuver in the development of the Russian healthcare system until 2018.

Figure 8. Two scenarios for financing healthcare in the Russian Federation until 2020 – “survival” and “basic”

• Implementation of Presidential Decrees to increase wages for employees of state and municipal medical organizations.

• Providing benefits to primary health care workers for the purchase of housing.

• Indexation of wages for rural medical workers (coefficient of 1.4 to the average payment of medical workers in the country).

• Personnel training in medical and pharmaceutical universities: to increase the wages of teaching staff (coefficient of 2.0 to the average wage of doctors in the country), to improve their qualifications (10% of the wage fund (payroll) of the teaching staff), for subsidies to medical organizations for the placement of clinical bases of universities, as well as for the material and technical equipment of universities.

• Development of a system of continuous medical education and advanced training (1% of the payroll of medical workers, as is customary in most developed countries).

• Inclusion in the tariff for payment of medical care the cost of depreciation and Maintenance expensive equipment and maintenance of the software and hardware complex (SHC) of medical organizations.

• Drug provision for children aged 0 to 15 years in an outpatient setting.

• Drug provision in outpatient settings for citizens of working age suffering from diseases of the circulatory system.

Consequences of a decrease in the volume of government funding for healthcare in the Russian Federation

The funds provided by the Ministry of Health for healthcare in constant prices (2013 - 100%) in 2015 are reduced by 13% (excluding declared additional expenses in 2015 and the devaluation of the ruble), in 2016 - by 17%, in 2017 - by 16%, in 2018 - by 15%. This means that the guaranteed volumes of medical care will also decrease. All this, in a situation of declining real incomes of the majority of citizens of the Russian Federation (by 4% in 2015, according to forecasts of the Ministry of Economic Development), will lead to a decrease in the availability and quality of medical care for the population of the Russian Federation, and therefore to a deterioration in the health indicators of the population.

The deterioration of the socio-economic situation of citizens, the growing funding gap and the reduction in the capacity of the healthcare system in 2015 have already led to an increase in mortality by 5.2% in the first quarter. In subsequent years, if the basic problems of the industry are not resolved, instead of the planned decrease, mortality will increase. According to the most optimistic forecasts, in 2018 it will increase to 13.9 cases per 1000 population (see Fig. 3). It follows from this that by 2018, instead of reaching life expectancy of 74 years, this figure will fall from the current 71 years to the level of 69–69.5 years. This means that the Russian Federation will no longer be included in the list of 50 developed countries in the world whose life expectancy is more than 70 years. And we were so proud of this achievement in 2013–2014!

It should be noted that the implementation of the basic program will require the political will of the country's leadership. The key to successful implementation of programs is accelerated and massive advanced training of management personnel in healthcare, as well as formalization and tightening of requirements for their appointment to management positions
Thus, in order to save the lives of Russian citizens, and therefore to ensure the national security of our country, it is necessary to increase public funding for healthcare and focus on solving the basic problems of the industry.

The healthcare system is characterized by the presence of a complex of deep economic problems that have been reproducing over the past ten years:

– financial insecurity of state guarantees of medical care to the population;

– incomplete introduction of the compulsory health insurance system;

– significant territorial inequality in financial provision of citizens’ rights Russian Federation to receive medical care;

– lack of economic mechanisms that encourage participants in the health care system to increase the efficiency of using public resources.

The amount of government funding for health care, which decreased by more than a third in the 90s, began to increase since 2000, but has not reached the level of fifteen years ago. There was a gap between the declared and real economic conditions for receiving medical care. Financing of medical care is largely transferred to the citizens and employers themselves. Population expenditure on medicines and medical services is steadily growing at a high rate. The increase in payment for medical care is intensifying, despite the increase in government funding in last years. There is an unregulated replacement of public spending with private ones, and a decrease in the quality of free medical care. Low-income groups of the population suffer the most from this. Inequalities in the opportunities of different social groups to receive quality medical care are increasing.

The problem is aggravated by the fact that approaches to financing state guarantees for the provision of medical care to the population do not clearly define the relationship between payment and quality of care, which should be provided free of charge to citizens. References to the insufficient state funding of health care and the unenforceability of declarative rules of free medical care are used by medical workers and health care managers as a justification for reducing the quality of medical services and providing for a fee services that should really be provided to citizens free of charge. Therefore, without specifying state guarantees of medical care and distinguishing medical care into free and paid medical services, one can no longer count on the fact that the problem of the gap between guarantees and their financial support can be solved only by increasing the amount of state funding for health care.

The existing system of compulsory health insurance (CHI) has a number of serious flaws, overcoming which requires changes in the very model of its existence.

The main flaw is the imbalance of compulsory medical insurance programs with the amount of insurance payments. The compulsory medical insurance system accumulates only 41.9% of the total volume of government funding for healthcare.

This problem is generated primarily by the failure of the constituent entities of the Russian Federation and local governments to fulfill their obligations to pay insurance premiums for the non-working population in full. True, in recent years there has been a tendency to increase the size of contributions for the non-working population, but this does not fundamentally change the situation.

The existing compulsory medical insurance model did not have a significant impact on the efficiency of using healthcare resources. Initial expectations of the emergence of competition between insurers, stimulating their activity in protecting the rights of the insured and optimizing the placement of orders among medical organizations, did not materialize.

Thus, a serious problem of ensuring the rights of citizens to receive medical care is the significant differentiation in the amount of government funding for health care. Existing economic mechanisms in the healthcare system do not create incentives for its participants to increase the efficiency of using public resources.

Modernization of the healthcare system is inevitable. The main thing in modernization Russian healthcare– systematic transformations and gradual implementation. The ultimate goal is to increase the availability and quality of health care for the general population.

Reforming health care systems and compulsory health insurance is impossible without progressive economic management methods, including analysis of the efficiency of using available resources.

In the difficult conditions of reform in healthcare, the principles of program-targeted planning and financing of the industry are of paramount importance:

– compliance of the powers (functions) performed with their financial content at each level of management;

– ensuring continuity and succession of powers;

– optimization of budget expenses;

– results-oriented budgeting;

– restructuring of subordinate institutions in order to effective use available resources.

The implementation of these principles is possible only with an increase in health care spending.

Increasing health care spending will ensure:

– overcoming the gap between the average wages of healthcare workers and the regional average (it is necessary to increase labor costs by 2.4 times, which will increase real wages by 1.6 times);

– compliance with state guarantees of free drug provision for citizens.

As a result, it will be possible to provide free medicine to patients in hospitals and significantly improve the medicine provision to certain categories of citizens in outpatient settings;

– replacement of worn-out medical equipment, repair of buildings and structures, priority acquisition of the necessary equipment for primary care (primarily for general medical practice) by increasing investment costs in real terms by 2.4 times;

– increase in expenses for therapeutic nutrition patients in hospital in real terms by 2.9 times (from 34 rubles in 2004 to 100 rubles per patient per day in comparable prices).

This version of the optimization forecast provides for an increase in costs per one bed-day of inpatient treatment for one patient on average.

CONCLUSION

From this course work It is clear that the healthcare system is a socio-economic institution of the state for providing medical care to the population and carrying out medical and preventive measures.

The strategic goal of the healthcare system is to protect and improve the health of every citizen of the Russian Federation.
The main task of healthcare is to provide qualified medical care available to the entire population of the Russian Federation.

Problems of healthcare and ways to solve them KOLESNIKOV S.I. Deputy Chairman of the Health Protection Committee Member of the Presidium of the Russian Academy of Medical Sciences ACADEMICIAN OF THE RAMS Foundation ISP and R (Fedorova) Moscow,

CONDITIONS OF PROGRESS IN RUSSIA 1. Political will of state leaders and consent of bureaucrats 1. Political will of state leaders and consent of bureaucrats 2. Stable financing and predictable tax policy 2. Stable financing and predictable tax policy 3. Consent in society 3. Consent in society 4. Management and training 4. Management and training 5. Interaction with advanced partners and exchange of experience 5. Interaction with advanced partners and exchange of experience 6. Public-private partnership 6. Public-private partnership

Efficiency of the Russian healthcare system Per capita budget expenditures on healthcare place in the world. Per capita spending budgets on health care place in the world. In terms of efficiency of the healthcare system - 130th place (WHO) In terms of efficiency of the healthcare system - 130th place (WHO) Dissatisfaction of the population and doctors with healthcare is more than 60%. Dissatisfaction of the population and doctors with healthcare is more than 60%.

Healthcare reform is an urgent need: increasing the level of health of the nation increasing the level of health of the nation maintaining social stability in society maintaining social stability in society improving the quality of medical care to the level of developed countries improving the quality of medical care to the level of developed countries optimizing government spending while increasing the efficiency of investments optimizing government spending while increasing the efficiency of investments reducing structural imbalances (restructuring) reducing structural imbalances (restructuring)

1. There is no unified health care system - 3 autonomous systems and different types of institutions (addressed without sufficient funding). 1. There is no unified health care system - 3 autonomous systems and different types of institutions (solved without sufficient funding). 2. State guarantees and financial resources for providing free medical care are not balanced; inpatient care is mainly financed, the volume of paid services is increasing (it is not resolved and the prospects are unclear). 2. State guarantees and financial resources for providing free medical care are not balanced; inpatient care is mainly financed, the volume of paid services is increasing (it is not resolved and the prospects are unclear). 3. There is no incentive for investments and payments in healthcare for individuals and legal entities, which does not allow the legalization of payments (not resolved). 3. There is no incentive for investments and payments in healthcare for individuals and legal entities, which does not allow the legalization of payments (not resolved). Health problems:

4. Low motivation of managers and employees to improve the quality of work, and of insurers to ensure the interests of citizens (mechanisms have not yet been created). 4. Low motivation of managers and employees to improve the quality of work, and of insurers to ensure the interests of citizens (mechanisms have not yet been created). 5. Sharp differences in the availability and quality of medical care between the constituent entities of the Russian Federation, municipalities, in the city and in the countryside, the poor and the rich (partially resolved). 5. Sharp differences in the availability and quality of medical care between the constituent entities of the Russian Federation, municipalities, in the city and in the countryside, the poor and the rich (partially resolved). 6. There is no single information space (register of insured, sick, capacity, medicines, telemedicine, etc.) - to be solved 6. There is no single information space (register of insured, sick, capacity, medicines, telemedicine, etc.) - to be decided

7. Lack of elements of professional self-regulation (not resolved) 7. Lack of elements of professional self-regulation (not resolved) 8. Public-private partnership is underdeveloped (not resolved). 8. Public-private partnership is underdeveloped (not being resolved). 9. Underdevelopment of public institutions for control over the healthcare system (solved slowly and ineffectively). 9. Underdevelopment of public institutions for control over the healthcare system (solved slowly and ineffectively). 10. The participation of citizens in maintaining their health is minimal. There is no effective system of education, propaganda and incentives healthy image life (decided poorly). 10. The participation of citizens in maintaining their health is minimal. There is no effective system of education, propaganda and stimulation of a healthy lifestyle (it is poorly resolved). 11. Lack of real responsibility of the authorities for the state of public health. 11. Lack of real responsibility of the authorities for the state of public health.

Resource support The outdated system of personnel training, both for doctors and especially for managers (managers) working in the social sphere (who do not have a medical education), is not being addressed. The outdated system of training personnel, both doctors and especially managers (managers) working in the social sphere (who do not have a medical education) is not being resolved. There is no developed modern domestic pharmaceutical and medical industry (partially being resolved) There is no developed modern domestic pharmaceutical and medical industry (partially being resolved)

Solutions to overcome the crisis in healthcare () 1. DLO 2. Monetization of benefits 3. National priority project “Health” 4. Reform of legislation and regulatory framework. 5.Increasing insurance premiums and modernizing healthcare

RESULTS OF PNP “HEALTH” An additional 825 thousand lives of citizens of the Russian Federation (0.6% of the population of the Russian Federation) were saved. But in the dynamics in improving the health status of the population of the Russian Federation has slowed down

Reasons for the slowdown in improving the health status of the population of the Russian Federation Reduction in the growth of healthcare costs in constant prices Unsatisfactory response of the healthcare system to abnormal weather and environmental conditions in the summer of 2010 Unresolved key healthcare problems

Problems that need to be solved (before the emergence of social protests) Oblige all levels of government to restore order (queues, paid services, rudeness, etc.) in medical organizations, up to and including the removal of municipal and regional level managers, managers, and doctors from their positions. Oblige all levels of government to restore order (queues, paid services, rudeness, etc.) in medical organizations, up to the removal of municipal and regional level managers, managers, and doctors from their posts. Urgently organize equipped offices instead of FAPs family doctors(paramedics) bringing help closer to the population by allowing the circulation of medicines at these points without obtaining a pharmaceutical license. Urgently organize, instead of FAPs, equipped offices of family doctors (paramedics) to bring assistance closer to the population, allowing the circulation of drugs at these points without obtaining a pharmaceutical license. Urgently increase funding for the system and transfer all organizations to sectoral (incentive) wage systems, using both modernization and a direct increase in the wage fund. Urgently increase funding for the system and transfer all organizations to sectoral (incentive) wage systems, using both modernization and a direct increase in the wage fund. Introduce social and other benefits for well-performing medical workers (bonuses, payment of utilities, wider use of honorary titles and social incentives). Introduce social and other benefits for well-performing medical workers (bonuses, payment of utilities, wider use of honorary titles and social incentives). Conduct clinical examination of the working population using city and regional medical organizations. Conduct clinical examination of the working population using city and regional medical organizations.

Key problems that need to be consistently addressed Increase in budget funding to US$ 1000 per capita per year (WHO recommendation). Do not reduce the budget component (!!!). Increase in budget funding to US$1000 per capita per year (WHO recommendation). Do not reduce the budget component (!!!). Careful introduction of standards and rules (do not close regional medical organizations). Careful introduction of standards and rules (do not close regional medical organizations). A sharp increase in incentive mechanisms depending on the quality of work. A sharp increase in incentive mechanisms depending on the quality of work. Create a system of training and continuous education for critically needed personnel, including managers. Create a system of training and continuous education for critically needed personnel, including managers. Training of social managers for municipalities and subjects of the Federation, competent in the field of state policy and the consequences of making management decisions. Training of social managers for municipalities and subjects of the Federation, competent in the field of state policy and the consequences of making management decisions. Introducing strict responsibility of regional authorities for the indicators of medical care of the population. Introducing strict responsibility of regional authorities for the indicators of medical care of the population.

17 Billion RUR Billion rub 2010 2011 2012 2013 % to 2010 % to 2011 % to Education, 451699.7 Healthcare, 343389.9 Social policy, 9 Physical Culture and sports,02967,82690,1

LAWS (AMENDMENTS) Federal Law 94 On procurement for state and municipal needs (auctions and quotations) Federal Law 217 On the creation of innovation companies in research institutes and universities for the commercialization of IP On concession agreements in Healthcare (Government Decree) Transition to Insurance Payments in the Compulsory Medical Insurance Fund, FSS and Pension Fund About self-regulatory organizations (SRO) (Unified Medical Community)

NEW LAWS, amendments () On liability insurance of medical organizations On health protection of Citizens of the Russian Federation On State. (municipal) institutions Law On Compulsory Medical Insurance On the circulation of medicines and amendments to a number of laws On special economics. zones

Interference of new laws () Federal Law 83 “On ... budgetary institutions» On the circulation of medicines On education The law “On compulsory medical insurance” (+ on drug insurance?) Laws on the distribution of powers (local self-government and subjects of the Federation) “On the fundamentals of protecting the health of citizens of the Russian Federation”

The increase in the amount of insurance premiums for compulsory medical insurance will be 2% in 2011 and 2012. 230 billion rubles per year According to the Accounts Chamber of the Russian Federation, the deficit in financial support for territorial state guarantee programs (current financing of free medical care for citizens) in 2009 alone amounted to about 385 billion rubles and, according to preliminary estimates, the situation did not improve in 2010. RISK: possible even more significant failure to fulfill social obligations to implement the constitutional rights of citizens to free medical care

Prospects for financial changes Increase: Irreducible insurance premiums for the non-working population (proposed 5, but 10 thousand rubles are needed) Minimum insurance premiums for the non-working population (proposed 5, but 10 thousand rubles are needed) Increase in these payments annually from 2013 by 25% until 2015 An annual increase in these payments from 2013 by 25% until 2015. Decrease: Inclusion in compulsory medical insurance (without provision) of ambulances, high technologies, federal clinics and the National Health Project. Inclusion in compulsory medical insurance (without provision) of ambulances, high technologies, federal clinics and the National Health Project

Article 15. Transfer of the exercise of powers of the Russian Federation to the subjects of the Russian Federation 1. The Russian Federation transfers to the subjects: 1. The Russian Federation transfers to the subjects: 1) licensing of: a) medical organizations of municipal and private systems healthcare (except for VMP); b) pharmaceutical activities (except for the activities of wholesale trade organizations and pharmacies of federal organizations); 1) licensing of: a) medical organizations of municipal and private health care systems (with the exception of VMP); b) pharmaceutical activities (except for the activities of wholesale trade organizations and pharmacies of federal organizations); c) trafficking in narcotic, psychotropic drugs and precursors; c) trafficking in narcotic, psychotropic drugs and precursors; 2) organizing the provision of medicines for “seven nosologies”. 2) organizing the provision of medicines for “seven nosologies”.

Article 15. Transfer of the exercise of powers of the Russian Federation to constituent entities of the Russian Federation 2. Funds for the exercise of powers transferred in accordance with Part 1 are provided in the form of subventions from the federal budget. 2. Funds for the implementation of powers transferred in accordance with Part 1 are provided in the form of subventions from the federal budget. 3. The total amount of funds is determined on the basis of methods approved by the Government of the Russian Federation. 3. The total amount of funds is determined on the basis of methods approved by the Government of the Russian Federation. 5. Funds are targeted and cannot be used for other purposes. 5. Funds are targeted and cannot be used for other purposes.

Article 15. Transfer of the powers of the Russian Federation to the constituent entities of the Russian Federation 8. The Federal Register of persons with hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, malignant neoplasms of lymphoid, hematopoietic and related tissues, multiple sclerosis, after transplantation of organs and (or) tissues is maintained by an authorized federal organ. 8. The Federal Register of persons with hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, malignant neoplasms of lymphoid, hematopoietic and related tissues, multiple sclerosis, after organ and (or) tissue transplantation is maintained by an authorized federal body.

Article 15. Transfer of the exercise of powers of the Russian Federation to the constituent entities of the Russian Federation 7. federal authority: 7. federal authority: 2) issues methodological guidelines and instructions on the transferred powers that are mandatory for execution by the authorities of the constituent entity of the Russian Federation; 2) issues methodological guidelines and instructions on delegated powers that are mandatory for execution by the authorities of a constituent entity of the Russian Federation; 3) coordinates the appointment (dismissal) of heads of executive authorities of constituent entities of the Russian Federation exercising delegated powers; 3) coordinates the appointment (dismissal) of heads of executive authorities of constituent entities of the Russian Federation exercising delegated powers;

Article 44. Medical care for those suffering from rare (orphan) diseases 1. Rare (orphan) diseases are diseases that have a prevalence of no more than 10 per population. 1. Rare (orphan) diseases are those that have a prevalence of no more than 10 per population. 2. The list of orphan diseases is compiled by the authorized federal executive body on the basis of statistical data and is posted on the official website. 2. The list of orphan diseases is compiled by the authorized federal executive body on the basis of statistical data and is posted on the official website. 3. The list of orphan diseases is approved by the Government of the Russian Federation 3. The list of orphan diseases is approved by the Government of the Russian Federation

Article 83. Financial support for the provision of medical care and sanatorium-resort care 9. Financial provision of citizens with medicines for the treatment of diseases included in the List of life-threatening acute and chronic progressive rare (orphan) diseases leading to a reduction in the life expectancy of a citizen or his disability (with the exception of diseases , specified in paragraph 2 of part 1 of Article 15), is carried out at the expense of the budgets of the constituent entities of the Russian Federation. 9. Financial provision of citizens with medicines for the treatment of diseases included in the List of life-threatening acute and chronic progressive rare (orphan) diseases leading to a reduction in the life expectancy of a citizen or his disability (except for the diseases specified in paragraph 2 of part 1 of Article 15) is carried out for account of funds from the budgets of the constituent entities of the Russian Federation.

Article 74. Restrictions imposed on medical and pharmaceutical workers (“medreps”) 1. Medical workers and managers do not have the right to: 1. Health workers and managers do not have the right to: 1) accept from organizations involved in the development, production and (or) sale of medicines, medical products, or with rights to the trade name of a medicine, drug wholesale trade organizations, pharmacy organizations, gifts, money (except for remuneration under contracts for conducting clinical studies or tests, in connection with pedagogical and (or) scientific activities), incl. to pay for entertainment, recreation, travel to a place of recreation, as well as to take part in entertainment events, at the expense of companies (representatives); 1) accept gifts, money from organizations engaged in the development, production and (or) sale of medicines, medical devices, or with rights to the trade name of medicines, medicine wholesale organizations, pharmacy organizations (with the exception of remunerations under contracts for conducting clinical studies or tests, in connections with pedagogical and (or) scientific activities), incl. to pay for entertainment, recreation, travel to a place of recreation, as well as to take part in entertainment events, at the expense of companies (representatives);

Article 74. Restrictions imposed on medical and pharmaceutical workers (“medreps”) 2) enter into agreements with the company on prescribing or recommending drugs and medical devices to patients (except for clinical trials); 2) enter into agreements with the company on the prescription or recommendation of drugs and medical devices to patients (except for clinical trials); 3) receive samples from the company for delivery to patients (except for clinical studies); 3) receive samples from the company for delivery to patients (except for clinical studies); 4) when prescribing a course of treatment to a patient, provide unreliable, incomplete or distorted information about the medications and medical devices used, incl. hide information about the availability of similar medicines and medical products in circulation; 4) when prescribing a course of treatment to a patient, provide unreliable, incomplete or distorted information about the medications and medical devices used, incl. hide information about the availability of similar medicines and medical products in circulation;

Article 74. Restrictions imposed on medical and pharmaceutical workers (“medreps”) 5) not to receive representatives of companies, with the exception of clinical studies and trials, to participate in the manner established by the administration of the organization, in meetings of medical workers and other events related to increasing the professional level of medical workers or providing information on side effects; 5) not to receive representatives of companies, with the exception of clinical studies and trials, to participate in the manner established by the administration of the organization, in meetings of medical workers and other events related to improving the professional level of medical workers or providing information on side effects; 6) prescribe medicines and medical devices on forms containing advertising information, as well as on forms on which the name of the medicine or medical device is pre-printed. 6) prescribe medicines and medical devices on forms containing advertising information, as well as on forms on which the name of the medicine or medical device is pre-printed.

Article 74. Restrictions imposed on medical and pharmaceutical workers (“medreps”) 2. Pharmacists and heads of organizations: 2. Pharmacists and heads of organizations: 1) accept gifts, money, including to pay for entertainment, recreation, and also accept participation in entertainment events at the expense of the company; 1) accept gifts, money, including to pay for entertainment, recreation, as well as take part in entertainment events at the expense of the company; 2) receive from the company samples of medicines and medical devices for delivery to the public; 2) receive from the company samples of medicines and medical devices for delivery to the public; 3) enter into agreements with the company to offer certain medicines and medical products to the population; 3) enter into agreements with the company to offer certain medicines and medical products to the population; 4) provide unreliable, incomplete or distorted information about available drugs that have the same INN, medical products, including hiding information about the availability of drugs and medical products that have a lower price. 4) provide unreliable, incomplete or distorted information about available drugs that have the same INN, medical products, including hiding information about the availability of drugs and medical products that have a lower price.

Article 75. Settlement of conflicts of interest in the implementation of medical and pharmaceutical activities - 1. Conflict of interest is a situation in which a medical or pharmaceutical worker, when carrying out professional activities, has a personal interest in receiving personally or through a company representative a material benefit or other advantage that affects or may affect the proper performance of his professional duties due to a conflict between the personal interests of the medical or pharmaceutical worker and the interests of the patient. 1. Conflict of interest is a situation in which a medical or pharmaceutical worker, when carrying out his professional activities, has a personal interest in receiving personally or through a company representative a material benefit or other advantage that affects or may affect the proper performance of his professional duties due to a contradiction between personal the interests of the medical or pharmaceutical worker and the interests of the patient. 2. In the event of a conflict of interest, the employee is obliged to inform the head of the organization about this in writing, and individual entrepreneurs - the authorized federal executive body. 2. In the event of a conflict of interest, the employee is obliged to inform the head of the organization about this in writing, and individual entrepreneurs - the authorized federal executive body.

Article 75. Settlement of conflicts of interest in the implementation of medical and pharmaceutical activities 3. The head of a medical or pharmacy organization is obliged to notify the authorized federal executive body about this in writing within seven days. 3. The head of a medical or pharmacy organization is obliged to notify the authorized federal executive body about this in writing within seven days. 4. To resolve conflicts of interest, the authorized federal body establishes a commission to resolve conflicts of interest and approves the regulations on it. 4. To resolve conflicts of interest, the authorized federal body establishes a commission to resolve conflicts of interest and approves the regulations on it. 5. The composition of the commission must exclude the possibility of a conflict of interest that could affect the decisions made by the commission. 5. The composition of the commission must exclude the possibility of a conflict of interest that could affect the decisions made by the commission.

Belovodsky A.A.

This article discusses the problems of the Russian healthcare sector. Given brief analysis main problems (low efficiency of healthcare, stagnation of the pharmaceutical industry, high prices for medicines for the population). It also describes ways to solve them, proposed by both experts and the author of the article.

Introduction

The wealth of any state is its population. People create the state and are the source and engine of its development and prosperity. But to be active, a person must be healthy. Therefore, one of the most important functions of the state is maintaining the health of its population. This support is provided through the health care system.

Healthcare is a set of political, economic, social, legal, scientific, medical, sanitary and hygienic, anti-epidemic and cultural measures aimed at preserving and strengthening the physical and mental health of each person, maintaining his long active life, providing him with medical care in case of deterioration health.

According to the Constitution of the Russian Federation, “The Russian Federation is welfare state", in which "labor and human health are protected." But in practice, everything is far from being as it is written.

Most experts agree that the healthcare system of the Soviet Union was one of the best in world practice, since it fulfilled all the functions assigned to it in terms of quality, accessibility and provision of medical services, medicines and materials. But after the collapse of the USSR, it entered a phase of stagnation: funding was greatly reduced, highly qualified specialists in the field of medicine went abroad, scientific research in medicine stopped, and the production of drugs and devices for diagnosing and treating diseases was greatly reduced.

In the early 2000s, when the situation in the country began to gradually improve, the authorities turned their attention to the healthcare sector. But there are so many accumulated problems that they cannot be solved at once and in a short period of time.

So, the most important condition further development of the healthcare sector is the transition to an innovative development path, in connection with which the implementation of the following principles must be ensured:

1. government regulation combined with effective competition in the innovation sector;
2. preparation and transition of industry to increase the output of high-tech and knowledge-intensive products that meet the needs of the market and the prospects for its development;
3. creating long-term conditions for increasing labor productivity;
4. concentration of resources on innovations that will ensure positive structural changes in the economy;
5. stimulation of business and investment activity in the field of scientific, scientific-technical and innovative activities through tax, credit and other economic benefits;
6. integration of investment, scientific, technical, educational and production activities;
7. ensuring legal protection of objects intellectual property and copyright in the dissemination of scientific and technical knowledge and information;
8. cooperation of all levels of government, as well as the state, federal subjects and municipalities on issues of modernization and technological renewal of basic sectors of the economy and social sphere;
9. publicity and discussion of priority innovative programs and projects during open competitions.

It is not for nothing that government regulation is placed in first place among the principles. Without it, innovative development will not work, because private business reluctant to participate in the innovation process. Regulation and support in the field of innovation from the state should be as follows:

1. development of regulations in the field of innovation, organization and control over their implementation;
2. determination of priorities in the field of innovation, development and implementation of innovative programs and projects;
3. creation of innovation infrastructure and conditions for innovation activities (stimulation through preferential taxation, subsidies, subsidies from budgets);
4. formation and placement on a competitive basis of state orders for the creation of high-tech products and technologies;
5. protection of the rights of investors and creditors;
6. training and advanced training of personnel engaged in the field of innovation;
7. coordination of actions of subjects of innovation activity;
8. support for creating entities investment activities with the participation of foreign capital, with the provision of appropriate state guarantees for activities.

Thus, the purpose of this abstract is to characterize the problems in the healthcare sector in Russia and ways to solve them.

The following tasks were set:

1) description of problems in the healthcare sector;

2) a description of the measures taken in Russia to eliminate problems;

The abstract used information not only from various sources, but also the observations of the author himself.

1. Problems of the Russian healthcare system

First of all, we should focus on the low efficiency of the entire healthcare system, which gives rise to the low quality of the medical services provided. The reasons for this state of affairs are the following:

1) lack of specialists, medical equipment, and hospital facilities, which creates long queues of patients during reception hours. Doctors have to work in emergency mode, which automatically reduces the quality of services provided;

2) short patient appointment schedule. Office hours often end before 2 p.m. Those who do not have time to get to the appointment are forced to come another day, that is, again ask for time off from work, and therefore fail to fulfill a number of their duties. Such distraction of employees has a negative impact both on the company itself (the degree of negative consequences will directly depend on the employee’s position and the possibility of replacing him) and on the employee of this company (wage reduction);

3) inability to receive the required medical care in a timely manner. This is a consequence of the lack of specialists, equipment, high cost of medicines and medical services;

4) low qualifications of doctors. It often happens that doctors in two different clinics make different diagnoses for the same symptoms. Accordingly, the treatment does not give the expected effect;

5) lack or aging of medical equipment. In most hospitals, examination and treatment of patients is carried out using Soviet equipment. And undergoing treatment or examination using new equipment (if available) often costs a lot of money;

6) low wages and lack of mechanisms to stimulate quality work.

The situation of shortage of specialists and hospital facilities is especially noticeable when comparing cities both within one region and between regions. So, if in the regional center or the capital of the republic most hospitals and clinics are renovated and have new equipment, then in ordinary cities, especially those remote from the center, there are often few clinics in which people cannot get required volume medical services. How often in the hospitals of the capitals of the federal subjects you can see people from other cities and hear about the lack of the necessary equipment or specialist in their city.

The low efficiency of the healthcare system greatly affects the country as a whole, especially its economy.

The next major problem is in the area of ​​drug production. The modern population of most countries cannot live without antibiotics, vaccination, and many different drugs. And if more than 80% of the drugs required for its population are produced within a country, then there are practically no problems. But if a country imports most of its drugs, then a “threat to national biosecurity” arises. Russia is one of these countries: imports of medicines account for about 80% of their consumption. Most domestic drugs are developments from Soviet times (brought to industrial production) or generics (a drug with proven pharmaceutical, biological and therapeutic equivalence with the original, but does not have patent protection; that is, it is a copy of the original drug developed by a third party). New developments in this area are being carried out with their own money by the largest companies in the pharmaceutical market (Pharmstandard, Domestic Medicines, Nizhpharm, Veropharm, etc.), while the rest receive grants from abroad and occasionally government orders.

Also, the reasons for the stagnation of the pharmaceutical industry were:

1) outflow of specialists abroad. The so-called “brain drain” has long been a national problem in Russia. Scientists move to other countries because they are offered high pay, guaranteed orders and provided with all the necessary equipment for research;

2) insufficient investment. Pharmacology is a specific field of healthcare with its own concepts and laws. Few potential investors are able to understand the meaning of the development and evaluate its prospects. Also frightening is the uncertainty of the payback period for investments and the high medical risks of manufactured drugs;

3) the inability of scientists to “sell” their ideas. Russia has always been famous for its people. Today there are groups of enthusiasts developing new drugs. But things don’t progress beyond the idea and initial developments, because they don’t know how to properly present their development to investors for the purpose of further testing it and putting it into production;

4) the high cost of developing new drugs. According to experts, investments in the development of a new drug amount to at least $600 million. Of this, 10-15% goes to the development of the molecule, 25-30% to preclinical tests on animals, 50-60% to clinical trials on humans. If we are talking about the development of a fundamentally new formula, then the costs for the entire cycle (from research to market launch) can reach more than $1 billion;

5) long term. The minimum development period for a new drug is 3 years;

6) lack of protection of intellectual property. This problem is not specific only to the pharmaceutical industry. It is typical for Russia as a whole. Only in 2006 did it begin to take shape the legislative framework on protection of intellectual property. In particular, on December 18, 2006, Part 4 of the Civil Code of the Russian Federation, dedicated to intellectual property, came into force;

7) availability of generics. Large modern pharmaceutical companies have little interest in developing new drugs also due to the large number of companies producing generics. Generics in most cases do not differ in quality and properties from the original, but are much cheaper, which reduces the profitability of the new drug from the developer company.

We should dwell in a little more detail on the problems of financing drug development. The high cost of the full cycle of creating a drug (from idea to production) makes such developments impossible for medium and small companies. But they participate in developments as “idea generators” or the first stage of research (creating a drug formula). In the future, they sell their work, most often, to foreign companies due to the high payment. In addition, according to experts, sometimes domestic companies do not need new developments, which is explained by the lack of Money to continue development, either by the presence of a large number of own drugs, or by the successful release of generics for imported drugs.

Foreign grants are another way for representatives of small pharmaceutical businesses to survive. According to Rosprom estimates, the average grant size is $100 thousand, and 30-50% of Russian companies operate under it. Development is carried out up to the stage of obtaining the formula, then it is sold abroad.

Companies also have a chance to receive the necessary funds by turning to special funds. Now entrepreneurs are helped by the Small Business Support Fund, which issues money provided that the entrepreneur has a patent. The amount of funds allocated at the earliest stage of development is 1 million rubles. In the future, if it is possible to attract an investor, the Fund will allocate another 3.75 million rubles. There are also 3 venture funds operating in the country, with 7 more to be established in the future. Their capital will be formed from private and public funds. Money will be issued to entrepreneurs on the condition of entering into the capital of the company being created and receiving a share of profits in the future.

Another way to solve the financing problem is government procurement of drugs and orders. But so far this mechanism is ineffective, since in government procurement 89% of the required drugs are purchased from foreign companies. But Russian developments should have priority.

The next problem associated with drugs is their high cost for the population. No, there is no malicious intent from drug manufacturers in this (as many people think). There are a number of reasons for this:

1) fluctuations in the ruble exchange rate. Since October 2008, a gradual devaluation of the ruble began in Russia, as a result of which the dollar rose against the ruble by almost 40%, which affected the rise in import prices. And since 80% of the medicines consumed by the country’s residents are imported, end consumers received the brunt of the devaluation;

2) high cost and duration of development. Therefore, all fundamentally new drugs entering the market are available only to a limited circle of consumers (either the rich or those to whom the development company provided them for free). One example is the modern development of a vaccine against “swine flu” by the British company GlaxoSmithKline Plc. The development of the vaccine took 5 years, more than $3.2 billion was spent. The price of the finished vaccine is $10. 50 million doses were given free of charge to the World Health Organization. Now let’s present a few calculations on how much an imported vaccine against “swine flu” will cost for the Russian population:

The dollar exchange rate established by the Central Bank of the Russian Federation as of October 13, 2009 is 29.5 rubles;

The cost of the drug is $10;

The import duty on medicines is 10%;

Thus, the cost of this vaccine when crossing the border is 324.5 rubles. (10*1.1*29.5).

The final cost will consist of retail chain markups, delivery costs and drug promotion costs. It can be assumed that the cost for the population will be about 500 rubles. for 1 dose. It is clear that the majority of the Russian population will not be able to afford such a vaccine due to low incomes, which increases the risk of morbidity and mortality from the swine flu virus.

3) unreasonable prices for medicines. The problems of the high cost of medicines were recently touched upon by V.V. during a visit to Zelenograd. Putin, focusing attention and misunderstanding on the fact that foreign medicines are often sold in Russia at prices many times higher than in other countries.

The population is often afraid to purchase Russian drugs, preferring imported ones, since there is no confidence in the quality of domestic drugs. In addition, most imported drugs have no analogues in Russia.

The same situation (as in the example with cost calculation) is observed in the pharmaceutical market as a whole, which puts the Russian state under serious threat due to the high risk of morbidity among the population and reduced opportunities for its rapid recovery.

2. Ways to resolve problems in the healthcare sector

How can Russia get out of such a deplorable health care situation? The main thing is reforms. But not point-by-point ones based on the principle of “find the decisive link, pull on it, and everything will be resolved.” A set of reforms is needed that addresses all elements of health care. They must be thoughtful and complete, otherwise, as often happens in Russia, they will only make matters worse.

To increase the efficiency of the healthcare sector, experts propose to develop a mechanism for stimulating competition between doctors and medical institutions. It is necessary to create a mechanism that will interest medical specialists in improving the quality of the services they provide. For example :

1) creation of a database of doctors and their patients (who are constantly served by him). Such a system operates abroad, where healthcare is free (USA, Western European countries), and makes it possible to identify highly qualified doctors;

2) provide funding to medical institutions for the effectiveness of the services they provide. That is, the less time a person spent within the walls of the hospital, and if he did not have a relapse of the disease, then the medical institution that helped him will receive more funding than others. This mechanism is used in most developed countries (Great Britain, etc.);

3) it is necessary to adopt a number of laws promoting competition in healthcare;

4) it is necessary to change the organizational and legal form of medical institutions. Today they are all state-owned. This means that emerging financial results from their work they go to the state: excess funds are taken away, debts arising are paid off. This situation demotivates medical institutions to work effectively. They should be given more freedom in their activities;

5) it is necessary to take a differentiated approach to the development of the healthcare sector in different territories of the Russian Federation due to their unequal development. In some places, it is only necessary to increase the efficiency of healthcare by stimulating competition to develop and improve the quality of medical services provided, since the region (city) has the necessary medicines, equipment, and specialists. And somewhere, first it is necessary to resolve the issue of shortages of medicines, medical equipment, and specialists, and only then introduce mechanisms to stimulate competition in the healthcare sector.

Issues of remuneration for medical specialists should be approached from the point of view of regional (city) development, rather than increasing wages by the same amount throughout the country. Due to the strong differences in the level of development of the federal subjects and municipalities, the amount of wage increases will be perceived differently everywhere. So, in Moscow 10 thousand rubles. allowances for a local doctor mean very little, but in Dagestan this same amount is a lot of money.

It is also necessary to create mechanisms through which free medical care would primarily be received by those who have nothing to pay, and those who have money to pay, if there is a shortage (equipment, specialists, medicines), could pay for the medical care they require.

Another way to develop competition is to use modern information advances in the healthcare sector. In particular, experts propose the idea of ​​creating a personalized database of individual accounts. On its basis, it will be possible to scientifically justify the required number of specialized beds in a particular region.

Improving the quality of medical care will also be achieved through the development of intensive care units (resuscitation units of various specializations). In the West, each hospital has 20-25% intensive care beds. In Russia this figure does not exceed 5%.

The next problem in the healthcare sector - tariffs for medical services - must be solved through civilized government intervention. Medical tariffs must include all cost items. They must take into account the required profitability and the level of projected inflation.

To attract funding and stimulate new developments, it is proposed to establish venture funds (with the participation of various capitals) and allocate government grants for research. Business cooperation with universities and science cities begins. Today there are biotechnological laboratories on the basis of Moscow State University, Stavropol State University, and the science city in Pushchin. Their task is the first stage of development. In the future, the resulting formula will be sold to a private company.

The state needs to stimulate the innovative development of the entire economy in general and the healthcare sector in particular. As noted earlier, there are practically no new developments of drugs and medical equipment in Russia. To correct the situation, the state, first of all, needs to develop innovation infrastructure, change tax legislation (increasing tax benefits and introducing tax holidays for companies carrying out new developments). It is planned to soon create several research institutes to conduct scientific research in the field of medicine.

But there are already real progress in this situation. So in 2008, 19.4 billion rubles were allocated from the budget. for the construction of centers for new medical technologies in Penza, Khabarovsk, Astrakhan and other cities. With the support of the state, the medical field is being developed in technology parks (Kurchatovsky, Zelenogradsky, Obninsky), where new treatment methods, medicines, and equipment are being developed.

At the beginning of 2005, the Supplementary Drug Supply program was launched. The essence is free provision of medicines to benefit categories of the population. For these purposes, funds were annually allocated from the budget for the purchase of medicines. 89% of purchases in monetary terms come from foreign companies. In this regard, experts advise shifting the focus to drugs from domestic manufacturers.

All of the above is what experts suggest. In general, the author agrees with their proposals. But after analyzing the problems in the Russian healthcare sector, he proposes an additional series of measures aimed at improving the situation.

The most important thing is innovative development. The state must become the initiator of the innovation process. It should create incentives for businesses to be interested in investing their funds in costly, risky projects. To do this, it is necessary to change legislation regarding the innovative activities of companies. For companies that are developing new drugs or medical equipment, tax incentives should be introduced for the first few years (up to 3 years) of development. In the future, income taxes should be reduced for them at the stage of promoting a new drug (equipment) to the market. As soon as sales volume reaches planned levels and continues to grow, such companies should be transferred to the general tax regime.

On initial stage developments, the state should actively help companies financially, especially young companies with promising developments. To do this, you can use funds from federal target programs, government orders, grants, the creation of joint ventures with private businesses, and the creation of various venture funds.

To stimulate new developments, research centers should be created (at least one in each federal district), under whose roof to gather scientists and provide them with funding for their ideas. In the future, the developments can either be sold to private companies, or their industrial production and promotion on the market can be established within the framework of joint ventures, or a rental or leasing form of implementation of the development can be used. When selling a development, the contract should specify the forms and terms of payment. The optimal option would be a step-by-step payment (down payment, then fixed or percentage deductions from the proceeds from sales of the new drug/equipment). In the lease form, the purchaser (lessee) will only pay royalties for the use of the formula or industrial design of the device without transferring ownership of the leased development. Moreover, this development can be leased to other companies. In the leasing form, the purchaser (lessee) will use all the advantages of the leasing scheme.

To facilitate the transition to an innovative path of development, you can initially create generics based on Western samples, but then produce your own developments based on them. But it is necessary to strengthen control over generics, which will automatically increase public confidence in them and reduce the number of side effects.

In order for innovative development to be possible, highly qualified personnel are needed. Talented students should be sought out and encouraged to participate in research projects. It is also necessary to stop the outflow of domestic scientists abroad. To do this, it is necessary to create for them all the conditions for research activities: provide laboratories, allocate funding. But such measures should be taken in priority scientific areas, as well as promising areas. You should not waste resources on dubious research (of which modern world you can find many).

One of these key areas (in addition to the use of nanotechnology in medicine, the creation of new drugs and medical equipment) should be diagnostics. The development of this area of ​​medicine will make it possible to significantly reduce the treatment time and the number of cases of moderate and high degree severity, since diseases will be able to be identified and treated early stage, when it is much easier to do this than later.

To solve the problem of drug costs, pricing should be monitored throughout the entire chain (from manufacturer to retail). And punish those who unreasonably raise prices.

Conclusion

Based on the results of the work carried out, we can conclude that, despite the huge volume of accumulated problems, changes towards improvement are beginning in the Russian healthcare system.

But there is another serious problem that cannot be solved with new ideas and funding alone. This problem is not identified by experts, but every person faces it. We are talking about consumer trust in Russian medicines, medical equipment, doctors. And the reason for this problem lies precisely in those shortcomings in the healthcare sector mentioned in the work. In addition, since Soviet times, people have had the idea that all imported goods have better quality, characteristics, and are safer than their Russian counterparts (if they exist).

Lost trust is always very difficult to regain. But if all the problems identified in the work are solved, if their solution does not take long term, then people will switch to domestic medicines and medical equipment, and will no longer consider the maximum withdrawal of money from the patient as the main goal of doctors. The number of days spent in hospitals will be reduced. Mortality will decrease and life expectancy will increase. All this will immediately have a positive impact on the country’s economy. Only then can it be said that Russian system healthcare is effective.

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Bibliographic link

The problems that have accumulated in Russian healthcare are causing serious concern in society, and a consensus has almost formed that significant changes are needed in this area. This is evidenced by both objective and subjective indicators characterizing such parameters of the Russian healthcare system as - the state of health of the population; - the state of the healthcare system itself; - the population’s assessment of their health status and their attitude towards the healthcare system in general and reforms in particular.

The population's subjective assessment of their health confirms the statistics. Sociological surveys show low self-esteem of the population's health status. The population's subjective assessment of health care reform is quite wary. This indicates that there has not yet been a significant improvement in the situation in the health care system.

I would also like to draw attention to the global challenges to the healthcare systems that have now formed in developed countries. Health care systems can be organized in many different ways, but health care as a system globally is currently experiencing serious problems, which require a reaction and will obviously determine its organization in the future. Population aging has become the most important socio-demographic problem in developed countries. On the one hand, there is an increase in demand for medical services, and on the other, an increase in the demographic burden on workers, which complicates the problem of financing healthcare. The increase in demand for medical services is also caused by the development modern technologies, which provide new opportunities in the field of treatment various diseases, and accordingly, the ground for the emergence of new expectations on the part of the population.

Growing inequality in access to health services has been noted by many experts, despite the fact that Lately this issue is attracting attention at the highest levels. There is a change in trends in the health status and morbidity structure of the population. Coming to the forefront in developed countries chronic diseases, which require different approaches to organizing treatment and prevention than infectious diseases.

Threats to health arise from human actions, human interactions and environment and accidents and natural disasters. These include the problem with vaccination. The voluntariness of vaccination in many countries and a false sense of security, when in conditions of a high level of vaccination the risk of disease decreases and parents refuse vaccinations, can in turn lead to a decrease in the level of vaccination, an increased risk of morbidity and epidemics. The evolution of viruses and increasing their resistance to appropriate drugs leads to the emergence of new and resumption of already known infectious diseases. Epidemics of infections such as HIV and bird flu have appeared. The other side of risks is related to human activities. The life of society became largely dependent on atomic energy and chemical processes. Therefore, the epidemiological situation depends on the safety of the corresponding capacities and correct use the resulting products.

Paradoxically, the National Project “Health” became a litmus test for the problems of the Russian healthcare system. It turns out that everything latest achievements Russian healthcare comes down to the results that were achieved within the framework of the tasks set in this project. At the same time, it is often stated that some stabilization in the health care system in 2005-2007. was achieved at his expense. However, many demographers and experts directly indicate that the increase in the birth rate in recent years is directly related to the entry into active reproductive age of girls and boys born in the late 80s of the twentieth century. A question also arises about the role of the rest of the health care system, which was not included in the national project, in the ongoing positive changes. Although the latter has brought some positive results, they were achieved not within the existing health care system, but outside it, which actually confirms the fact that it is ineffective and generally unable to implement positive changes without an additional push from the outside, for example, in the form of a national project

Another issue is related to the problem of maintaining and developing the healthcare system. Today, three basic models of organizing and financing healthcare are known, and Russia was the author of one of them (the Semashko model). Specific forms are determined by the specifics of the functioning of the system, which a country can afford depending on the characteristics of its development. New healthcare models arose in the world when there were changes in worldview that changed the formulation and vision of the problem. The proposed options for the development of Russian healthcare, including the draft Concept for the development of healthcare in the Russian Federation until 2020, developed under the auspices of the Ministry of Health of the Russian Federation, or the project proposed by the Public Chamber, are adjusted to the situation in which Russia finds itself today and which was set in the early 90s. s of the twentieth century. But the speed of social change requires that the forecasting function, which determines how a particular system will behave in the long term, become leading. Creating fly-by-night projects under these conditions can be costly to society. It seems that the onset of a crisis is not the right time for global changes. Lessons can also be drawn from the experience of the early 90s, when most of failures in health care reform are due precisely to the fact that the insurance system was introduced in complex economic conditions when the base for insurance premiums is obviously narrowed.

Therefore in modern conditions An integral part of the Russian healthcare development strategy should be the development of adaptation mechanisms to crisis situations.

There are objective factors of a system-forming nature that will potentially cause problems in the development of healthcare in Russia as a system. The success of the measures taken depends on the extent to which they are taken into account when formulating the reform strategy.

One of the threats is related to the volume and method of financing healthcare in Russia. The question of how much money Russia should spend on healthcare remains open. It would seem that rising health care costs should be welcomed. However, a phenomenon arises that can be roughly called a funding growth trap. This means that the option chosen in the context of limited resources allocated by society for healthcare initially turns out to be costly and leads to the need to increase healthcare financing in the future.

The main motive for health care reforms in the 90s was the lack of public funds and the need to mobilize resources from other sources. But the paradox of Russian healthcare policy is that, on the one hand, budgetary medicine has no equal in containing healthcare costs, on the other hand, Russians are constantly being told that there are not enough funds for healthcare, but at the same time they choose an initially costly option (insurance ), ignoring or even openly denying the relatively less expensive (budget) system.

By relatively less expensive we mean that such a system provides equal and relatively better health outcomes for the population as a whole at relatively lower costs. Examples include the UK and the USA. A comparison of health care financing and health outcomes in these countries shows that although the US spends almost twice as much on health care as the UK, with a significant share of private funding, health outcomes in these countries are comparable and some are even slightly better than the UK. For example, maternal mortality in the UK is lower than in the US (11 and 14 per 100,000 live births in 2010, respectively), and the duration healthy life higher at birth (69 years for men and 72 years for women in 2010 in the UK and 67 years and 71 years, respectively, in the USA). Obesity has become a major public health problem in the United States in recent years, affecting nearly one-third of the population, both men and women over 15 years of age.

There are different approaches to determining the share of health care expenditures, taking into account the population’s willingness to finance it. It is possible to establish standards for minimum government expenditures taking into account international experience. However, it is important not only how much money is spent, but also through what financing mechanism the redistribution is carried out. In Russia, we are talking about chronic underfunding and the need to increase healthcare costs, while in developed countries the issue is about curbing the growth of healthcare costs. Taking into account global trends, our country must initially choose a financing system option that will transform the allocated funds into an effective system for providing quality medical care to the population, and not simply increase healthcare costs.

Here it is appropriate to recall such an approach as managerialism, which is widely recognized in the world and argues that improving management and organization is an important reserve for increasing the efficiency of any structure. In this context, we can talk about a wide range of actions, from changing the structure of the health system in favor of primary care and prevention, to “medicine with human face"or "policy of small achievements", implying the use of modern management technologies for organizing work in medical institutions, allowing for the implementation of a humane attitude towards patients at minimal additional costs.

In this regard, the statement that if there is a demand for medical services (implied by high-income groups of the population), then it is necessary to ensure its satisfaction is also controversial from an economic point of view. It seems that the features of medical services as a product, which are widely known and described in the world literature, put in the first place the question of satisfying the need, not the demand. Cost growth will also be facilitated by tying the payment of medical workers to the volume and quality of care provided.

The advantages of government funding are well known: control over funds and ensuring the implementation of national priorities, the main one of which is the population's access to medical care. Centralized systems are quite effective in containing the growth of healthcare costs. It is obvious that the budgetary healthcare system has both advantages and disadvantages, but the analysis various systems healthcare shows that the adoption of other models will lead to the emergence of a number of new problems.

Another threat to the integrity and, accordingly, the effectiveness of Russian healthcare as a system acting in the interests of society is associated with the growth of inequality in society, both its general level and in health status. At the same time, world theory and practice convincingly prove that inequality in health is a serious obstacle to economic growth.

One of important factors Inequality in health is driven by income level. Given the high level of income inequality that currently exists in Russia - in 2006, the Gini coefficient on average in Russia was 0.410 - objectively, significant differences arise in the socio-economic status of patients. In the conditions of fundamental stratification of Russian society, it is already difficult to find the “average patient” - rich and poor have different needs and financial capabilities to receive medical care. The presence of wealthy people able to pay for medical services stimulates the development of the private sector. Moreover, in this regard, it is necessary to keep in mind two aspects. One is related to the profit motive in healthcare, and the other is related to the innovative potential of entrepreneurship.

The goal of any commercial structure is to make a profit. Healthcare in this sense is a very sensitive industry, including due to the special relationship that develops between the doctor and the patient due to the characteristics of the medical service and the process of its provision. On the one hand, the patient will have more trust in a doctor who acts without a profit motive; on the other hand, the doctor has an objective opportunity to “increase the score.” Therefore, strict regulation is necessary, perhaps at the level of profit margins.

Typically, private medicine develops as a complement to more socialized forms. However, the situation is ambiguous, since there is a process of “skimming the cream” or selecting the best clients. For example, in the UK private sector, including voluntary health insurance, quite inexpensive precisely due to the presence of a developed public sector. Most patients make additional use of the National Health Service (NHS), even if they have voluntary insurance, especially if the patient has a complex problem and the private hospital simply does not have the capacity to treat it; Typically, additional insurance is obtained at work by young, healthy and well-paid people, that is, a minimum risk group.

A special role is given to business as a leader of innovations in medicine. The innovative potential of entrepreneurship is well described, but in medicine this process also cannot be assessed unambiguously. The development of medical technologies is an expensive process, which is one of the main drivers of rising healthcare costs in developed countries. Therefore, a contradiction of the following order may arise. For business, from the point of view of making a profit, high technologies are more profitable since they are more expensive, and for society, from the point of view of efficient and fair distribution of limited resources, the development of relatively cheaper primary health care is more profitable. Today in Russia it is proposed to look for compromise options for business development as a provider of medical services along the path of public-private partnership.

For now, the private sector is complementary and serves to expand consumer choice. But if it grows above a certain level, then it is possible that the most demanding consumers will leave the public sector, thereby reducing the pressure on the government to increase health care spending. This will lead to the formation of a two-tier system - high-quality medical care in the private sector for the wealthy and low-quality care in the public system for the rest. This situation risks disrupting the health care system and marginalizing the poor. Therefore, it is currently necessary to choose a healthcare system that will allow Russia to maintain healthcare as a system for providing affordable and high-quality medical care to the population while maintaining the basic principle of social solidarity.

The experience of developed countries shows that, despite liberal reforms, the role of the state in providing the population with social services and redistribution is still on the agenda. Liberal policies led to increased social division and therefore the need for an integration strategy within the framework of a market economy arose. Under these conditions, the state healthcare system can become the basis for social consensus and overcoming social disunity in Russian society.

Thus, at present, the Russian healthcare system is faced with both specific problems caused by the peculiarities of its socio-economic development, and common problems, arising in the field of public health and having a global nature.