LECTURE №5
THEME: PUBLIC HEALTH SERVICES
FINANCING
THE PLAN:
1. POSSIBLE(PROBABLE) STRATEGY OF
REFORMING OF SYSTEM OF THE STATE
OBLIGATIONS IN PUBLIC HEALTH SERVICES.
2. EXCESSIVENESS OF THE STATE GUARANTEES
AND STRATEGY OF MODERATE RE-STRUCTURING
OF PUBLIC HEALTH SERVICES.
3. STRATEGY OF DEEP RE-STRUCTURING, AN
EXCEPTION OF THE PROGRAM OF CERTAIN KINDS
OF MEDICAL AID AND THEIR
TRANSFER(TRANSLATION) INTO A PAID BASIS.
4. ADDRESSEES OF MEDICAL AID UNDER THE
PROGRAM OF THE STATE GUARANTEES.
INTRODUCTION SOPLATEZHEJ CITIZENS AT THE
MOMENT OF CONSUMPTION OR MEDICAL AID.
STRATEGY IS A BASIS OF THE PROGRAM OF
THE STATE GUARANTEES OF
MAINTENANCE(SUPPORT) OF CITIZENS ACCEPTED
BY THE GOVERNMENT MEDICAL AID. THE
PROGRAM CONFIRMS(APPROVES) FOR THE FIRST
TIME A PRINCIPLE OF COORDINATION OF THE
STATE OBLIGATIONS WITH THE EXPECTED SIZE OF
FINANCIAL ASSETS OF SYSTEM OMS AND PUBLIC
HEALTH SERVICES BUDGETS. IN IT(HER)
MAINSTREAMS OF RE-STRUCTURING OF PUBLIC
HEALTH SERVICES ARE DEFINED. THE PROGRAM
PROVIDES REDUCTION ALMOST ON 20 % OF
VOLUME OF THE STATIONARY HELP (KOJKO-DAYS
ON 1000 INHABITANTS) AT THE EXPENSE OF
DEVELOPMENT STATSIONARO REPLACING KINDS
OF THE HELP. GROWTH OF A SHARE OF EXPENSES
OF THE STATE IS PLANNED FOR THE OUT-PATIENTPOLYCLINIC HELP IN TOTAL AMOUNT OF EXPENSES
ON MEDICAL AID.
TO NAME CONDITIONAL THIS PROGRAM IT IS
POSSIBLE STRATEGY OF MODERATE RESTRUCTURING OF PUBLIC HEALTH SERVICES.
UNLIKE RADICAL RE-STRUCTURING, IT(SHE)
DOES NOT PROVIDE A CONCLUSION FROM
SYSTEM OF PUBLIC PUBLIC HEALTH SERVICES
OF FINANCIALLY POOR ESTABLISHMENTS.
TO LOWER VOLUMES OF THE STATIONARY HELP
THERE CORRESPONDS DECREASE IN FINAL
FUND OF HOSPITALS. IT CAN BE REACHED ONLY
UNDER CONDITION OF REFUSAL OF NETWORK
FINANCING (ON A COT) AND TRANSITION TO A
PRINCIPLE ON PER CAPITA FINANCINGS.
RELIABILITY OF ESTIMATIONS OF LEVEL OF
EQUATION OF THE PROGRAM OF THE STATE
GUARANTEES IS INFLUENCED ALSO BY THAT
CALCULATIONS OF ITS COST DO NOT INCLUDE
EXPENSES ON HIGHLY SPECIALISED MEDICAL AID
RENDERED IN FEDERAL INSTITUTIONS AT THE
EXPENSE OF ASSIGNMENTS FROM THE FEDERAL
BUDGET. INVESTMENT EXPENSES ARE NOT
INCLUDED ALSO. THE EXCEPTION OF THESE
COMPONENTS OF EXPENSES IS TO SOME EXTENT
BLOCKED BY THAT IN PROGRAM COST HIGH
ENOUGH CHARGES OF SYSTEM OF PUBLIC
HEALTH SERVICES (APPROXIMATELY 8 % FROM
PROGRAM COST) ARE PUT IN PAWN(PUT).
FOR MAINTENANCE(SUPPORT) OF A FINANCIAL
COVERING OF THE PROGRAM OF THE STATE
GUARANTEES IT IS EXPEDIENT TO
CONSIDER(EXAMINE) MORE RADICAL VARIANTS
OF RE-STRUCTURING CONNECTED WITH A
CONCLUSION FROM SYSTEM OF PUBLIC PUBLIC
HEALTH SERVICES OF A PART OF FINANCIALLY
POOR OR SIMPLY EXCESSIVE
CAPACITIES(POWERS) OF HOSPITALS. IN A
NUMBER OF REGIONS THIS STRATEGY
PARTIALLY IS ALREADY REALISED, BUT SMALL
LOCAL HOSPITALS, AND, AS A RULE, BY THEIR
TRANSFORMATION TO OTHER ESTABLISHMENTS
(MEDICAL AMBULANCE STATIONS, SOCIAL
HOSPITALS, RECEPTION DOCTORS OF THE
GENERAL PRACTICE AND SO FORTH) ARE
CLOSED, MAINLY.
ABUNDANTLY CLEAR, THAT SUCH CLOSING OR
MERGE IS POSSIBLE(PROBABLE) ONLY FOR
HOSPITALS OF ONE LEVEL, AND WITH MORE OR
LESS HOMOGENEOUS STRUCTURE OF THE
RENDERED HELP. AT LEAST, THERE SHOULD BE
TECHNOLOGICAL POSSIBILITIES OF SIMILAR RESTRUCTURING, FOR EXAMPLE, POSSIBILITY OF
EXPANSION OF DIVISIONS OR POSSIBILITY OF
WORK OF THE PERSONNEL IN TWO CHANGES.
BESIDES, CARRYING OUT OF THE BIG
SPADEWORK ON A REGROUPING OF
CAPACITIES(POWERS), PREPARATION FOR IT
MEDICAL AND SUPPORT PERSONNEL IS
NECESSARY, FOR ITS CONVERSION TRAINING.
The world Bank recommends to the developing countries
formation strategy "vitalnogo" a package deal including the
primary medicosanitary help, action for maintenance of
medicosanitary well-being, treatment of infectious diseases
and so forth Thus is recommended to reduce the state
obligations on financing of sectors of secondary and
tertiary medical aid. A possible(probable) variant of this
strategy - an exception of the program of hotel services or a
hook named "service services", that is elements of the
expenses which have been not connected directly with
medical-diagnostic process. First of all, it concerns utilities,
to some extent - a food of patients »a hospital. It is possible
to establish(instal) the size of chamber (number of cots),
given to the patient it is free. Two-three years ago similar
offers became in a number of regions, but, how much(as far
as) to us news, have not been finished anywhere to the
logic end, Probably, it makes sense(is meaningful) to return
now to them.
IN SPHERE OF MEDICINAL
MAINTENANCE(SUPPORT) THE IDEA OF
THE GUARANTEED SET IS REALISED IN
MANY COUNTRIES IN THE FORM OF THE
SO-CALLED BASE PRICE, THAT IS THE
PRICE OF MEDICINES OF IDENTICAL
CLINICAL ACTION. THE DOCTOR CAN
REGISTER AND MORE EXPENSIVE
PREPARATION, BUT THE STATE WILL PAY
IT(HIM) ONLY REGARDING THE BASE
PRICE. THE DIFFERENCE BECOMES
COVERED BY THE PATIENT.
DEVELOPMENT OF VOLUNTARY MEDICAL INSURANCE,
IN OUR OPINION, IS POSSIBLE(PROBABLE) ONLY AT
NARROWING OF SPHERE OF THE STATE GUARANTEES,
THAT IS ON THE BASIS OF A CONCLUSION FROM THE
PROGRAM OR CERTAIN KINDS OF MEDICAL SERVICES
AND MEDICAL PRODUCTS, OR CERTAIN ELEMENTS OF
EXPENSES (FOR EXAMPLE, ON HOTEL SERVICES).
ONLY THEN THE POPULATION WILL SEND, THAT IS A
SUBJECT OF VOLUNTARY INSURANCE. PROSPECTS
DMS ARE DEFINED BY, WHETHER STRATEGY OF
WITHDRAWAL FROM THE PROGRAM OF THE STATE
GUARANTEES OF SOME ELEMENTS AND AS IT(SHE)
WILL BE REALISED WILL BE ACCEPTED. DIFFERENTLY,
DEVELOPMENT DMS HAS DERIVATIVE CHARACTER
AND CANNOT BE RECOGNISED BY INDEPENDENT
STRATEGY OF REFORMING OF SYSTEM OF THE STATE
GUARANTEES.
FOR PRICE CONTROL TO PAID
SERVICES EXPEDIENTLY:
TO PROVIDE GATHERING AND
GRANTING TO THE POPULATION
OF THE INFORMATION ON THE
PRICES FOR PAID SERVICES IN
DIFFERENT ESTABLISHMENTS
FOR SIMPLIFICATION OF A
CONSUMER CHOICE.
Legislatively to fix uniform requirements to the
contract maintenance(content) on rendering of
paid services in the medical organisations of all
patterns of ownership. Physicians should
represent to patients the information on the
expected volume of services, the prices for them
and an approximate total cost of course of
treatment. Are obliged to represent also this
information to controls public health services or
other body which is responsible for regulation of
the market of paid medical services (these
positions contain in last variant of the bill
"About private medical activity").
In the strategic plan price control and volumes of
the paid medical services rendered in LPU, is a
palliative, instead of the decision of a problem of
availability of medical aid for the most requiring. At
all external appeal of strategy of implicit
replacement (it is not necessary to accept any
decisions), it(she) cannot be recognised by
comprehensible. Sooner or later something should
be changed. Therefore already now it is necessary
to search for more comprehensible forms of
attraction of personal means of the population.
QUESTIONS FOR THEME FASTENING:
1. WHAT IS A PRINCIPLE OF PUBLIC
SOLIDARITY?
2. WHAT PROBLEM WAS PUT BEFORE ITSELF
BY(WITH) A PROBLEM OF MODERATE RESTRUCTURING OF PUBLIC HEALTH
SERVICES?
3. WHAT IS NECESSARY FOR REALISATION
OF THE PROGRAMS SET FORTH ABOVE?
4. WHAT POSITIVE SIDES OF REPLACEMENT
OF FREE MEDICAL AID ON PAID, YOU KNOW?
5. PRICE CONTROL TO PAID SERVICES YOU
KNOW WHAT TYPES?