Кыргызстан: обзор системы здравоохранения

В предлагаемом анализе системы здравоохранения Кыргызстана рассматриваются процессы, происходящие в ее организации и стратегическом руководстве и предоставлении услуг, реформыздравоохранения и показатели функционирования системы здравоохранения. В стране действует система обязательного медицинского страхования, при которой Фонд обязательного медицинского страхования(ФОМС) при Министерстве здравоохранения выступает в качестве единого государственного плательщика, оплачивающего почти все услуги больниц и поставщиков первичной медико-санитарной помощи.Пакет медицинских услуг, покрываемых из государственных средств, определяется в Программе государственных гарантий по обеспечению граждан медико-санитарной помощью (ПГГ). Однако многие услуги требуют соплатежей, а в 2019 г. только 69% населения были охвачены обязательным медицинским страхованием. Показатель подушевых расходов на здравоохранение является одним из самых низких вЕвропейском регионе ВОЗ, что объясняется небольшим ВВП страны на душу населения. На долю личных расходов, почти целиком принимающих форму платежей из собственных средств и включающих неформальные платежи, в 2019 г. приходилось 46,3% расходов на здравоохранение. Финансовую защиту подрывают низкие уровни государственных расходов на здравоохранение, и это приводит к тому, что люди, пользующиеся услугами здравоохранения, сталкиваются с финансовыми трудностями. Несмотря на то, что в стране хорошо развита сеть медицинских учреждений, географическое распределение медицинских работников неравномерно и в целом наблюдается нехватка семейных врачей. Сохраняются трудности в доступе к медицинским услугам, и эти трудности усугубила пандемия COVID-19. Хотя в последние годыбыли достигнуты улучшения, инфекционные и неинфекционные заболевания по-прежнему представляют большую проблему, а ожидаемая продолжительность жизни до пандемии COVID-19 была одной из самыхнизких в Европейском регионе ВОЗ.

Croatia: Health system review

This analysis of the Croatian health system reviews developments in its organization and governance, financing, provision of services, health reforms and health system performance. Croatia has a mandatory social health insurance system with nearly universal population coverage and a generous benefits package. Although per capita spending is low when compared to other EU countries, the share of public spending as a proportion of current health expenditure is high and out-of-pocket payments are low. There are sufficient physical and human resources overall, but some more remote areas, such as the islands off the Adriatic coast and rural areas in central and eastern Croatia, face shortages. While the Croatian health system provides a high degree of financial protection, more can be achieved in terms of improving health outcomes. Several mortality rates are among the highest in the EU, including mortality from cancer, preventable causes (including lung cancer, alcohol-related causes and road traffic deaths) and air pollution. Quality monitoring systems are underdeveloped, but available indicators on quality of care suggest much scope for improvement. Another challenge is waiting times, which were already long in the years before 2020 and are bound to have increased as a result of the COVID-19 pandemic.

Living longer, but in better or worse health?

This policy brief in the Observatory’s Economics of Healthy and Active Ageing series explores available information on the health and disability of older people in Europe and how it relates to increases in life expectancy. It considers the main theories on health and ageing, explores the latest evidence on health and disability measures, and considers policy options to support healthy and active ageing. The policy brief argues that the health of older people is best captured by measures of disability or functional impairment. Studies using such measures have found different trends in different countries, with vast differences in the health of older people across and within countries. One overarching finding is that later cohorts of older people have much better cognitive functioning than earlier cohorts. The policy brief concludes that health systems can be important contributors to increases in life expectancies, decreases in severe disability, and better coping and functioning with chronic disease.

Finland: health system review

This analysis of the Finnish health system reviews developments in its organization and governance, financing, provision of services, health reforms and health system performance. Finland is a welfare state with a high standard of social and living conditions and a low poverty rate. Its health system has a highly decentralized administration, multiple funding sources, and three provision channels for statutory services in first-contact care: the municipal system, the national health insurance system, and occupational health care. The core health system is organized by the municipalities (i.e. local authorities) which are responsible for financing primary and specialized care. Health financing arrangements are fragmented, with municipalities, the health insurance system, employers and households all contributing substantial shares. The health system performs relatively well, as health services are fairly effective, but accessibility may be an issue due to long waiting times and relatively high levels of cost sharing. For over a decade, there has been broad agreement on the need to reform the Finnish health system, but reaching a feasiblepolicy consensus has been challenging.

What are the conditions for successful health policy implementation? Lessons learnt from WHO’s regional health policy Health 2020: policy brief

This policy brief explores the conditions that need to be in place for successful health policy implementation in the context of Health 2020. It is based on a scoping review of the literature, as well as semi-structured in-depth interviews with experts in selected WHO Member States. The policy brief identifies six key conditions for successful health policy implementation in the context of Health 2020: 1) ensure contexts are appropriate and receptive; 2) get the timing right; 3) transfer appropriate policies and innovations; 4) ensure good governance; 5) work with other sectors; and 6) move from exploration to full implementation. Identifying how these conditions can be used to maximum effect in specific national contexts and policies will help health policy-makers to increase the chances of success for the policies they develop and aim to implement. Crucially, putting policies in place is only the first step towards full implementation. Successful health reforms generally take several years to prepare and adopt, and they often take far longer to implement. A certain degree of pragmatism will also be needed, using evidence as best as possible and allowing for feedback and refinements throughout the reform process. This includes sticking to principles of good governance. They fulfil a double purpose, ensuring the required leadership for the reform process and allowing for effective implementation to take place. This publication was tabled as a background document during the Sixty-ninth session of the Regional Committee for Europe, Copenhagen, 16–19 September 2019.

Аспекты общественного здравоохранения в Европе

За последние два столетия развитие общественного здравоохранения позволило значительно сократить распространенность инфекционных болезней и их последствий, однако ситуация с неинфекционными заболеваниями, такими как болезни сердца и рак, остается напряженной. В Европейском регионе ВОЗ наибольшая часть бремени болезней приходится в настоящее время именно на неинфекционные заболевания. Авторы данной книги рассматривают общественное здравоохранение масштабно, но вместе с тем детально, и приводят беспрецедентно полный анализ ситуации в Регионе. В книге рассматривается огромное количество ключевых тем охраны общественного здоровья, и в нее вошли главы, посвященные таким вопросам, как: скрининг; укрепление здоровья; воздействие на социальные детерминанты здоровья; оценка воздействия на здоровье; кадровые ресурсы общественного здравоохранения; научные исследования в области общественного здравоохранения. Авторы также анализируют современные структуры, возможности и услуги общественного здравоохранения в ряде европейских стран и перечисляют меры, необходимые для оптимизации деятельности и, в конечном итоге, улучшения показателей здоровья населения. Принимая во внимание огромное географическое разнообразие Европейского региона ВОЗ, авторы приводят примеры из самых разных его стран, тем самым освещая различные подходы к охране общественного здоровья. Книга может стать прекрасным подспорьем в научной работе или практической деятельности в области общественного здравоохранения, в первую очередь – в контексте Европейского региона.

Organization and financing of public health services in Europe

How are public health services in Europe organized and financed? With European health systems facing a plethora of challenges that can be addressed through public health interventions, there is renewed interest in strengthening public health services. Yet, there are enormous gaps in our knowledge. How many people work in public health? How much money is spent on public health? What does it actually achieve? None of these questions can be answered easily. This volume brings together current knowledge on the organization and financing of public health services in Europe. It is based on country reports on the organization and financing of public health services in nine European countries and an in-depth analysis of the involvement of public health services in addressing three contemporary public health challenges (alcohol, obesity and antimicrobial resistance). The focus is on four core dimensions of public health services: organization, financing, the public health workforce, and quality assurance. The questions the volume seeks to answer are: How are public health services in Europe organized? Are there good practices that can be emulated? What policy options are available?; How much is spent on public health services? Where do resources come from? And what was the impact of the economic crisis?; What do we know about the public health workforce? How can it be strengthened?; How is the quality of public health services being assured? What should quality assurance systems for public health services look like? This study is the result of close collaboration between the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe, Division of Health Systems and Public Health. It accompanies two other Observatory publications: Organization and financing of public health services in Europe: country reports and The role of public health organizations in addressing public health problems in Europe: the case of obesity, alcohol and antimicrobial resistance.

Organization and financing of public health services in Europe: country reports

What are “public health services”? Countries across Europe understand what they are, or what they should include, differently. This study describes the experiences of nine countries, detailing the ways they have opted to organize and finance public health services, and train and employ their public health workforce. It covers England, France, Germany, Italy, the Netherlands, Slovenia, Sweden, Poland and the Republic of Moldova, and aims to give insights into current practice that will support decision-makers in their efforts to strengthen public health capacities and services. Each country chapter captures the historical background of public health services and the context in which they operate; sets out the main organizational structures; assesses the sources of public health financing and how it is allocated; explains the training and employment of the public health workforce; and analyses existing frameworks for quality and performance assessment. The study reveals a wide range of experience and variation across Europe and clearly illustrates two fundamentally different approaches to public health services: integration with curative health services (as in Slovenia or Sweden) or organization and provision through a separate parallel structure (Republic of Moldova). The case studies explore the context that explain this divergence and its implications. This study is the result of close collaboration between the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe, Division of Health Systems and Public Health. It accompanies two other Observatory publications: Organization and financing of public health services in Europe and The role of public health organizations in addressing public health problems in Europe: the case of obesity, alcohol and antimicrobial resistance.

Tajikistan: health system review

The pace of health reforms in Tajikistan has been slow and in many aspectsthe health system is still shaped by the country’s Soviet legacy. Thecountry has the lowest total health expenditure per capita in the WHOEuropean Region, much of it financed privately through out-of-pocket payments.Public financing depends principally on regional and local authorities, thuscompounding regional inequalities across the country. The high share of privateout-of-pocket payments undermines a range of health system goals, includingfinancial protection, equity, efficiency and quality. The efficiency of the healthsystem is also undermined by outdated provider payment mechanisms andlack of pooling of funds. Quality of care is another major concern, due tofactors such as insufficient training, lack of evidence-based clinical guidelines,underuse of generic drugs, poor infrastructure and equipment (particularly atthe regional level) and perverse financial incentives for physicians in the formof out-of-pocket payments. Health reforms have aimed to strengthen primaryhealth care, but it still suffers from underinvestment and low prestige. A basicbenefit package and capitation-based financing of primary health care havebeen introduced as pilots but have not yet been rolled out to the rest of thecountry. The National Health Strategy envisages substantial reforms in healthfinancing, including nationwide introduction of capitation-based payments forprimary health care and more than doubling public expenditure on health by2020; it remains to be seen whether this will be achieved.

Узбекистан: обзор системы здравоохранения

Узбекистан – страна в Центральной Азии, провозгласившая свою независимость в 1991 г. после распада Советского Союза. С тех пор страна приступила к реализации ряда крупных реформ в сфере здравоохранения, охватывающих области предоставления, управления и финансирования медицинской помощи, с целью повышения эффективности, при этом обеспечивая равный доступ. Первичная медицинская помощь в сельской местности заменена двухуровневой системой, а специализированные поликлиники в городах трансформируются в поликлиники общего профиля для всех групп городского населения. За основу финансирования вторичной медицинской помощи взяты расходы прошлых лет и затраты на оказание услуг (при этом увеличивается «самофинансирование» за счет взносов пациентов), а для первичной медицины все больше используется модель подушевого финансирования. Налицо также усилия, предпринимаемые для увеличения эффективности распределения ресурсов – доля ресурсов, вовлеченных в реформированную систему первичного здравоохранения, постепенно растет. Предоставление медицинских услуг в основном осуществляется государственными учреждениями, но при этом почти половина всех расходов на здравоохранение поступает из частных источников, в большей части в виде личных платежей граждан. Имеются гарантированные базовые пособия, включающие бесплатные первичные медицинские услуги, неотложную помощь и лечение определенных болезней и категорий населения. Тем не менее, вторичное медицинское обслуживание и лекарственное обеспечение при амбулаторном лечении не включаются в базовые пакеты для большинства населения, и зависимость от частных расходов на здравоохранение приводит к неравенству и катастрофическим расходам у населения. Хотя доля государственных расходов медленными темпами растет, финансовая защита все еще остается проблемным вопросом. Качество услуг здравоохранения является еще одной областью, привлекающей все большее к себе внимание.

Trends in health systems in the former Soviet countries

After the break-up of the Soviet Union in 1991, the countries that emerged from it faced myriad challenges, including the need to reorganize the organization, financing and provision of health services. Over two decades later, this book analyses the progress that twelve of these countries (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine and Uzbekistan) have made in reforming their health systems. Building on the health system reviews of the European Observatory on Health Systems and Policies (the HiT series), it illustrates the benefits of international comparisons of health systems, describing the often markedly different paths taken and evaluating the consequences of these choices. This book will be an important resource not only for those with an interest in health systems and policies in the post-Soviet countries, but also for those interested in health systems in general. It will be of particular use to governments in central and eastern Europe and the former Soviet countries (and those advising them), to international and nongovernmental organizations active in the region, and to researchers of health systems and policies.

Uzbekistan: health system review

Uzbekistan is a central Asian country that became independent in 1991 with the break-up of the Soviet Union. Since then, it has embarked on several major health reforms covering health care provision, governance and financing, with the aim of improving efficiency while ensuring equitable access. Primary care in rural areas has been changed to a two-tiered system, while specialized polyclinics in urban areas are being transformed into general polyclinics covering all groups of the urban population. Secondary care is financed on the basis of past expenditure and inputs (and increasingly “self-financing” through user fees), while financing of primary care is increasingly based on capitation. There are also efforts to improve allocative efficiency, with a slowly increasing share of resources devoted to the reformed primary health care system. Health care provision has largely remained in public ownership but nearly half of total health care expenditure comes from private sources, mostly in the form of out-of-pocket expenditure. There is a basic benefits package, which includes primary care, emergency care and care for certain disease and population categories. Yet secondary care and outpatient pharmaceuticals are not included in the benefits package for most of the population, and the reliance on private health expenditure results in inequities and catastrophic expenditure for households. While the share of public expenditure is slowly increasing, financial protection thus remains an area of concern. Quality of care is another area that is receiving increasing attention.

Building European reference networks in health care: exploring concepts and national practices in the European Union

Under the European Directive on the application of patients’ rights in cross-border health care, the development of European reference networks was promoted as one of the prime areas for cross-border cooperation among Member States. These networks are meant to improve access to and provision of high-quality specialized health care to those patients who need it, and to act as focal points for medical training and research, information dissemination and evaluation, especially for rare diseases. The idea of pooling resources in this way parallels moves to concentrate specialized health care services driven by financial constraints, workforce shortages and growing attention to quality and safety. This book examines the ways in which reference networks have developed in European countries, for what kind of medical conditions or interventions, the motivations behind their establishment, the regulatory and administrative processes involved, and the financial arrangements needed. This study outlines the key policy implications and challenges of developing the concept of reference networks at national and European levels, and will assist policy-makers, health professionals, administrators and others involved in implementing the Directive.