Certain aspects of management of health preservation system.

The trends in development of National health care in Russia are considered. The need in formation of intersectorial system of management of health protection activities is established with priority of preventive direction, including mental prevention, based on systematic observation and participation of both sick and healthy people. The system goal was determined - to improve population health. The main tasks and principles of system functioning are formulated. The reasonableness of application of mechanisms of motivating and stimulating all subjects of health protection system in order to increase their interest, is indicated as one of directions of organizing and introducing intersectorial health protection system. The basic principles of development and implementation of incentive systems of remuneration were formulated. The attention is focused on such aspect related to management of health protection system as legal support. The review of sources of law in the field of health protection revealed that all subjects have duties, and everyone has responsibilities, except citizens and insured persons. To resolve this problem, it was proposed to conclude agreement between the parties, indicating rights and obligations of both parties and responsibility for violation of contractual obligations. The structure is proposed, the main principles of health protection system management are described, designed to provide real shift in achieving settled goals.

[The methodical principles of quality management of medical activities on particular territory].

The article, on the basis of experience of development of the Republic's first territorial system of medical quality management, presents basic organizational systemic principles of building quality management of medical activity and organizational model of system functioning. The listing of criteria and indices of assessing effectiveness of territorial system of managing quality and safety of medical activity is presented too. The purpose of developing such a system is formulated. The evidence base for actuality and feasibility of its organization is presented.

[The evaluation of direct economic loss related to tobacco smoking in 2009 and 2016].

The article presents an assessment of the economic damage associated with smoking for the period of 2009-2016. The obtained data on the prevalence of tobacco dependence for 2009-2016 showed, on the one hand, a decrease in tobacco dependence among the population surveyed, and on the other hand, an increase in the share of consumer spending on tobacco products and of an index of the physical volume of retail sales of tobacco products. The study included an analysis of the incidence of diseases associated with smoking, as well as an analysis of the attendance of medical care for patients with tobacco-related diseases.

[The public opinion about health care: the main factors of increasing satisfaction of population with medical care].

The evaluation of satisfaction of population with medical care has become widespread in practice of medical institutions as an obligatory criterion of assessing quality of their functioning. The study objective is to determine degree of satisfaction of population Russia with health care and role of particular factors in its formation. The study applied questionnaire survey of residents of 9 subjects of the Russian Federation using representative sampling of 1457 observations. The Pearson contingency indicator and the Chuprov-Cramer indicator of association between two nominal variables were determined. The ranking of signs according their influence strength was carried out. The most significant role in evaluation of satisfaction with health system functioning is played by satisfaction with medical care. Among the factors characterizing consumers of medical services, self-assessment of one's health status, social status of respondents, residence demonstrate the most effect. The priority factors in formation of positive public opinion about health care are identified. It is proved that positive opinion about health care depends on quality and accessibility of popular types of medical care, organization of functioning of primary health care medical organizations according expectations of population. The level of satisfaction with health care system is lower than in case of rendered medical services.

[The evaluation of efficiency of medical organizations providing primary medical sanitary care in conditions of capitation financing].

The article analyzes the results of implementing per capita financing mechanism in medical organizations providing primary medical sanitary care. The comprehensive methodology was applied, including analysis and generalization of experience, statistical, analytical, sociological, monographic description, economic, comparative analysis, organizational experiment. The analysis demonstrated that in actual conditions number of subjects of the Russian Federation, being able to include in per capita standard only those volumes of additional medical care that can be directly impacted by primary health care unit decreased significantly.

[The Efficiency of In-Depth Glaucoma Examination within the Framework of Dispensarization of Individuals with Chronic Infectious Diseases].

In Russia, the population aged 60 years and older is the fastest increasing group. This is the reason of augmenting interest to screening programs permitting to timely detect chronic disease, to proceed with treatment and to stabilize condition of patient. At the same time, screening programs require permanent analysis and development that became a foundation for the actual study. The purpose of the study is to evaluate the medical organizational aspects of the second stage (in-depth) of dispensarization exemplified by glaucoma. The retrospective analysis of 392 out-patient records of patients on suspicion of glaucoma was carried out. The questionnaire for ophthalmologists, consisting of 35 questions, was developed. The anonymous questionnaire survey of 62 ophthalmologists was carried out. The analysis of results of survey established that the most significant problem of dispensarization was shortage of time on reception of patient. This problem was resolved through both partial implementation of all needed examinations (21%) and referring all patients to specialized medical centers. All scheduled manipulations are not implemented by 87% of respondents. All respondents mentioned basically needed equipment as available. The extremely low quality of in-depth examination results in redistribution of load to the specialized medical centers and to increasing of waiting time period from establishment of diagnosis to beginning of treatment of disease. It is necessary to provide continuity of medical care during the second stage of dispensarization by the way of implementation of general scheme of out-patient record and notation of particular methods of examination. These measures will both decrease load on specialized medical centers and permit apply resources more efficiently and reduce time period from suspicion of disease to establishment of diagnosis and beginning of treatment of glaucoma.

[The Legal Issues of Conformity of Paid Medical Service with Expectancies of Patient].

The article considers particular aspects of legal regulation of conformity of paid medical service with expectancies of patient. A number of measures related to improvement of legal immunity of all interested sides during interaction with medical organization were proposed within the framework of the study.

[The Efficiency of Screening of Glaucoma within the Framework of Dispensarization of Patients with Chronic Non-Infectious Diseases].

The development of program of dispensarization of individuals with main chronic non-infectious diseases causing premature death and disability in population is one of strategies of health care system. According the rules of dispensarization, glaucoma, the most severe disease of eye resulting in blindness in case of absence of treatment, is included into listing of main chronic non-infectious diseases. The questionnaire including 35 questions for ophthalmologists of primary medical care was elaborated with purpose of evaluation efficiency of screening of glaucoma within the framework of dispensarization of individuals with chronic non-infectious diseases. The anonymous questionnaire survey of 62 ophthalmologists of primary medical care was carried out. the study demonstrated that the dispensarization system is considered as efficient by 37% of respondents and as an ineffective one -- by 63% of physicians. Nowadays, 32% of respondents more often diagnose glaucoma stage I, 63% 0 glaucoma stage I--II and 5% -- glaucoma stage II--III. The glaucoma is diagnosed by 68% of physicians during self-dependent visits of patients and by 32% during dispensarization. The implementation of tonometry within the framework of dispensarization of adult population is considered by 18% of respondents as a measure that increased diagnosing of glaucoma at early stage. The glaucoma is diagnosed more often at later stages is considered by 50% of respondents and 32% of respondents diagnose glaucoma more often at implementation of tonometry within the framework of dispensarization. The study permitted to conclude that nowadays glaucoma is more frequently diagnosed at early stage though predominantly at self-dependent visit of patients. This occurrence indicates on either inadequate dispensarization coverage of population or low quality of its i9mplementation. The alteration of basic principle of glaucoma screening is required meaning transition from mass screening model with application of tonometry providing high percentage of errors to target screening with application of broadened complex of diagnostic techniques.

[The evaluation of economic damage due to premature mortality of population of the Republic of Sakha (Yakutia)].

The evaluation of economic damage was implemented in relation to premature mortality of population of the Republic of Sakha (Yakutia), the region with particular social economic and natural climatic conditions specific to territories of the North. The calculation of economic damage is based on methodology proposed by number of ministries of the Russian Federation and Rosstat in 2012. The presented evaluations and analysis of materials give an idea about total amount of economic damage because of mortality of population of the Republic of Sakha (Yakutia) which is necessary to consider during development of regional programs of decreasing of population mortality.

[The opinion of personnel of medical organizations concerning effectiveness of systems of quality management and international certification].

The sociological study was carried out concerning effectiveness of systems of quality management. The technique of questionnaire survey was implemented in medical organizations with functioning systems of quality management and internationally certified systems. The evaluation by medical personnel impact of system of quality management on their activities based on results of using the given management sub-system was selected as a study object. At that, opinion ofpersonnel concerning time dynamics of indices of activity was served as a study subject. The involvement of personnel, alterations in activities of organization, remuneration of labor, effectiveness of treatment from point of view of organizations' staff members were considered. The conclusion was made that personnel of considered organizations has favorable opinion concerning effectiveness of the given systems. Among particular characteristics ofmedical care, 67% of respondents marked improvement of organization of functioning and 36% out of them marked significant improvement. The most of respondents (69%) felt positive dynamics of activities. At that, personnel of organizations mark no increasing of income in 68% of all cases and only 24% of respondents indicated salary increasing. Among negative outcomes of implementation of system of quality management, the respondents focused on increasing of workload. This trend was marked by 53% of personnel and 30% out of them indicated significant increasing of workload. The absence of alterations was marked by 38% of respondents and decreasing of workload was confirmed only by 9% of respondents.

[The economic aspects of mortality of population in the Republic of Sakha (Yakutiya)].

The article presents data concerning dynamics of level and structure of mortality of population of the Republic of Sakha (Yakutiya) during 1990-2012. The study revealed gender differences and main causes of population mortality. The standardized indicators of mortality due certain causes are presented. The economic losses because of population mortality in 2006-2011 are calculated. It is established that the most input into economic losses because of population mortality was made by diseases of blood circulation system, external causes and neoplasms.

[Legal and social aspects of voluntary medical insurance].

The structure and functions of voluntary medical insurance (VMI) as observed in Orenburg Region are analyzed in the paper. The held marketing research pointed at problematic aspects of VMI as well as at short-comings in information support; besides, potential sectors of the market of medical services were defined, which are rendered on the basis of VMI contracts--they should be considered in the development of complex and individual VMI programs for the purpose of meeting, as full as possible, the demands of potential consumers as well as for the purpose of optimizing the financial and price policy of insurance medical organizations (IMO) in the market etc. Data that were obtained in the course of complex multi-field research served as a basis for elaborating advanced programs for the promotion of VMI in the territory of Orenburg Region as well as for working out proposals targeted at optimizing the VMI performance in the market of medical services.

[Post-graduate medical education in training health care managers]. / Rol' poslediplomnogo meditsinskogo obrazovaniia v podgotovke rukovoditelei zdravookhraneniia.

Contemplations over the training of a modern healthcare manager are reflected in the article; the key organizational and methodological aspects of such training are analyzed; program-based measures related with personnel management are defined; training modules on training the healthcare personnel are designated; the experience and promising trends, as implemented in the above sphere by Semashko's Research Institute of the Russian Academy of Medical Sciences, as well as new program "Head Doctor of the 21st Century", offered by the department of academic educational programs of the People's Economy Academy of the Government of the Russian Federation, are discussed.

[Economic stimulation as a factor of enhancing the effectiveness of health care]. / Ekonomicheskoe stimulirovanie kak faktor povysheniia éffektivnosti meditsinskoi pomoshchi.

How to achieve a higher efficiency in managing the activities of the subjects of the compulsory health insurance (CHI) system is considered in the paper. In the authors' opinion, they are, to a considerable extent, caused by the existing economic levers aimed at optimizing the activities of its main subjects such as medical service producers and purchasers. The results of introduction of economic stimulation mechanisms into practice of the CHI system are given. These mechanisms used on a specific territory may enhance the total level of efficiency of the activities of therapeutical-and-prophylactic institutions and insurers.

[Current problems in advancement of health care of children and adolescents]. / Aktual'nye voprosy razvitiia meditsinskoi pomoshchi detiam i podrostkam

Based on the results of socio-hygienic and medical organization research carried out at N. A. Semashko Institute, the authors discuss transformation of activities of a modern local pediatrician and addition of medical psychologist, adolescent therapist, and gynecologist to the staff of primary pediatric centers. Chronometric studies with evaluation of working time expenditures and estimation of the number of staff members helped determine standard staff for pediatric outpatient clinics.