[The development of the system of medical rehabilitation based at the Russian health resort facilities: investment prospects].

The present work is devoted to the prospects for attracting investments for the maintenance and development of the medical rehabilitation practices based at the Russian health resort facilities. The article describes the prerequisites for the enhancement of the investment attractiveness of the development of the system of medical rehabilitation in the said institutions including the formulation and strengthening of the legal and regulatory framework, the capacity for the organization of the second and third stages of medical rehabilitation in the existing spa and health resort facilities, the attraction of the funds of compulsory medical insurance as an additional source of the financial support. The main legal documents regulating the organization and provision of medical rehabilitation based at the spa and health resort facilities are presented. The results of the implementation of the investment concept of the development of medical rehabilitation in the framework of the system of health resort treatment as exemplified by the experience of JSC «The group of companies «Medsi¼ are discussed. It is shown that the development of medical rehabilitation based at the spa and health resort facilities greatly contributes to the significant expansion of the potential customer base and promotes the further growth of business scale.

BUSINESS PERFORMANCE OF HEALTH TOURISM SERVICE PROVIDERS IN THE REPUBLIC OF CROATIA.

Health tourism can be generally divided into medical, health spa and wellness tourism. Health spa tourism services are provided in special hospitals for medical rehabilitation and health resorts, and include under medical supervision controlled use of natural healing factors and physical therapy in order to improve and preserve health. There are 13 special hospitals for medical rehabilitation and health resorts in Croatia. Most of them are financed through the state budget and lesser by sale on the market. More than half of their accommodation capacity is offered for sale on the market while the rest is under contract with the Croatian Health Insurance Fund. Domestic overnights are several times higher than foreign overnights. The aim of this study was to analyze business performance of special hospitals for medical rehabilitation and health resorts in Croatia in relation to the sources of financing and the structure of service users. The assumption was that those who are more market-oriented achieve better business performance. In proving these assumptions, an empirical research was conducted and the assumptions were tested. A positive correlation was proven in tested indicators of business performance of the analyzed service providers of health-spa tourism with a higher amount of overnight stays realized through sales on the market in relation to total overnight stays, with a greater share of foreign overnights in total of overnights and with a higher share of realized revenue on the market out of total revenue. The results of the research show that special hospitals for medical rehabilitation and health resorts that are more market-oriented are more successful in their business performance. These findings are important for planning the health and tourism policies in countries like Croatia.

The privatization of spa companies in Poland - An evaluation of policy assumptions and implementation.

The aim of this article is to present the course of privatization of spa companies in Poland during the period 2001-2011. We discuss assumptions of the privatization process, as well as actual implementation, having identified the process as chaotic and inconsistent with prior legal provisions. We found that in its applied form the process resulted in limitation of the therapeutic potential of spas, and reduction of the State's ability to implement health policy in a legally determined form. We also found that privatization potentially improved spa infrastructure standards and increases the tourist potential of spa resorts. We recommend that clear eligibility criteria are applied to institutions in the privatization process, as well as the provision of legal guarantees for access to spa services financed from public resources. Such guarantees should be made a public obligation, to ensure the availability of services for insured persons, and there should be an obligation to maintain a specific part of a given institution's potential for the needs of patients funded by public health insurance.

[The necessity of new approaches to the elaboration of the projects for the sanitary (mountainous sanitary) protection districts around the therapeutic and health-promotion facilities, health resorts and their natural medical resources].

The international experience gained during the past two centuries indicates that the most efficient and rational way to ensure the protection of the territories occupied by the therapeutic and health-promotion facilities, spa centres, and health resorts together with their natural medical resources is to set up sanitary (mountainous sanitary) protection districts or zones along the perimeter of these territories. Beginning from 2000, numerous changes and amendments have been annually introduced in the Russian legislation intended to ensure efficacious control over the rational exploitation of the territories of therapeutic and health-promotion value and their natural medical resources. These initiatives have negative effect on the activities of these organizations and the quality of the services they are expected to provide. Taken together these effects lead to the degradation of the spa and health resort business. Bearing in mind the current conditions for economic activities, it is proposed, in contrast to the former global approach, to envisage in the aforementioned projects the establishment of the sanitary (mountainous sanitary) protection districts or zones and determine their borders based on the results of the assessment of their potential for the protection of therapeutic factors and other valuable resources. Equally important is the maximum reduction of the areas of the second and third zones taking into account their relevant objective characteristics. In certain cases, the protective district may coincide with the second zone. As far as the federal health resorts and large territories of special health-promotion value are concerned, some of them may have two or more sanitary (mountainous sanitary) protection districts. Both the owners and the users of these territories should be provided the necessary and sufficient possibilities for the rational nature use at the grounds and in the adjacent water areas suitable for the development of health resort business in the conditions guaranteed by the national legislation.

[The prospects for the development of therapeutic and health-promoting tourism in Gorny Altai].

The present balneological survey made it possible to identify the promising areas with a high potential for the health resort, recreational and touristic activities including the foothill, low-mountain, mid-mountain valleys and hollows of Northern, Northwestern, Central and Eastern bioclimatic provinces of Mountainous Altai. Recommendations have been proposed for the development of therapeutic and health-improving tourism in the Shebalinsk, Ust'-Kansk and Ulagansk districts of the Altai Republic.

[Certain medico-economic prerequisites for the integration of spa and resort facilities into the system of compulsory health insurance].

The involvement of spa and resort facilities in the system of compulsory health insurance is of primary importance for the improvement of medical aid provided to the population. The application of the methods for the calculation of differential expenditures on the spa and resort-based treatment and estimation of their dependence on a variety of factors may facilitate the more rational use of the available resources of compulsory health insurance.

Spinal cord stimulation as treatment for complex regional pain syndrome should be considered earlier than last resort therapy.

BACKGROUND: Spinal cord stimulation (SCS), by virtue of its historically described up-front costs and level of invasiveness, has been relegated by several complex regional pain syndrome (CRPS) treatment algorithms to a therapy of last resort. Newer information regarding safety, cost, and efficacy leads us to believe that SCS for the treatment of CRPS should be implemented earlier in a treatment algorithm using a more comprehensive approach. METHODS: We reviewed the literature on pain care algorithmic thinking and applied the safety, appropriateness, fiscal or cost neutrality, and efficacy (S.A.F.E.) principles to establish an appropriate position for SCS in an algorithm of pain care. RESULTS AND CONCLUSION: Based on literature-contingent considerations of safety, efficacy, cost efficacy, and cost neutrality, we conclude that SCS should not be considered a therapy of last resort for CRPS but rather should be applied earlier (e.g., three months) as soon as more conservative therapies have failed.

[Physiotherapeutic care marketing research: current state-of-the art].

Successful introduction of modern technologies into the national health care systems strongly depends on the current pharmaceutical market situation. The present article is focused on the peculiarities of marketing research with special reference to physiotherapeutic services and commodities. Analysis of the structure and sequence of marketing research processes is described along with the methods applied for the purpose including their support by the use of Internet resources and technologies.

[Efficiency of medical and economic activities of a sanatorium-and-spa facility in the active phase of the public health system reform under macroeconomic instability].

Results of a comprehensive study have demonstrated that the reform of the public health system currently underway in this country provides conditions for the extension of medical care based at sanatorium-and-spa facilities with simultaneous rise in relevant expenses. Bearing in mind the unstable macroeconomic situation, this requires thorough monitoring medical and economic activities of health resorts for the purpose of enhancing cost efficiency. The goal of optimization can be achieved by increasing competitive capacity based on strict control of expenditures and income redistribution for financing the most promising projects.

[Mechanism of strategic management of a sanatorium-and-spa facility under current economic conditions].

The existing system of management of sanatorium-and-spa facilities constitutes a major economic risk factor under current socio-economic situation. One of the most important conditions for the sustainable continuation of activities of a sanatorium-and-spa institution is its adaptability to the changing economic environment. Those health care providers are likely to have an advantage in new conditions that offer a larger scope of specialized services, simultaneously reduces their costs and prices, introduce resource-saving technologies, and stimulate motivation of the medical personnel.

[Clinical and cost effectiveness of rehabilitation programs including physical exercises for patients with ischemic heart disease under conditions of resort and outpatient clinics].

The objective of the present study was to evaluate clinical and cost effectiveness of rehabilitation programs including long-term physical training of moderate intensity intended for the management of patients with coronary heart disease (CHD) who had undergone acute coronary events; the programs were adapted to the treatment under conditions of spa resorts, dispensaries, and outpatient clinics. It was shown that rehabilitation of patients presenting with CDH with the use of moderately intensive physical exercises during a long period enhances the effectiveness of application of the available funds due to improved clinical course of coronary heart disease, tolerance of physical load, and quality of life.

[Approaches to optimization of the organizational and economic management of a sanatorium-and-spa facility].

The main goals of reorganization of sanatorium-and-spa facilities and their activities under current economic conditions should be standardization of services provided to the patients, improvement of their quality, efficacious exploitation of the available resources, and motivation of the personnel.

[Methodology of strategy development for the improvement of efficiency of sanatorium-resort services in the regional healthcare system].

Methodological aspects of the development of the strategy for the improvement of efficiency of sanatorium-resort services in the regional healthcare system based on the experience of "Prokopievsky" sanatorium, Kemerovo region. Different stages in the history of the sanatorium are described with special reference to its role in continuous medico-social rehabilitation of the patients and in the maintenance of continuity of medical care provided by municipal outpatient, inpatient, and sanatorium settings. Transition to new forms of organization and work of sanatorium-resort facilities required in-depth analysis of their day-by-day activities as well as problems and obstacles hindering their further development. After having overcome the crisis of 2001-2006, sanatorium "Prokopievsky" strengthened its position at the market of sanatorium-resort services not only by continuing basic activity but also by developing new lines of medical aid and attracting new categories of patients. In 2007, the share of proceeds from medical and commercial services reached 93.3% and 1.2% respectively compared with 0.12% and 1.32% in 2002.

[Marketing macroenvironment of a sanatorium and spa facility as a study object and a factor of strategic decision making].

Analysis of marketing macroenvironment is an important stage in the formulation of the strategy for the development and operation of a therapeutic and preventive healthcare facility making possible rapid adjustment to sharply changing marketing conditions. The possibility of using expert evaluation for the analysis of the marketing macroenvironment of a sanatorium and spa facility and a concrete medical care service provided (peloidotherapy) is illustrated. The study covers five aspects of marketing macroenvironment, viz. socio-demographic, technological, economic, political and ecological.

Estudio comparativo coste-eficiencia en un dispositivo residencial para enfermos con trastorno mental severo / A comparative cost/efficiency study in a residential unit for patients with severe mental disorder

Funcionamiento de las Residencias para personas con trastorno mental severo, basado en su eficiencia y coste económico (AU)

The functioning of the residential program from Severe mental illness, based on the study of its efficiency and economic cost (AU)

Cost-effectiveness of Spa treatment for fibromyalgia: general health improvement is not for free.

OBJECTIVES: To estimate the cost-effectiveness of an adjuvant treatment course of spa treatment compared with usual care only in patients with fibromyalgia syndrome (FM). METHODS: 134 patients with FM, selected from a rheumatology outpatient department and from members of the Dutch FM patient association were randomly assigned to a 2(1/2) week spa treatment course in Tunisia or to usual care only. Results are expressed as quality-adjusted life years (QALYs) for a 6-month as well as a 12-month time horizon. Utilities were derived form the Short Form 6D (SF-6D) scores and the visual analogue scale (VAS) rating general health. Costs were reported from societal perspective. Mean incremental cost per patient and the incremental cost utility ratio (ICER) were calculated; 95% confidence intervals (CIs) were estimated using double-sided bootstrapping. RESULTS: The data of 128 (55 spa and 73 controls) of the 134 patients (96%) could be used for analysis. Improvement in general health was found in the spa group until 6 months of follow-up by both the SF-6D (AUC 0.32 vs 0.30, P < 0.05) and the VAS (AUC 0.23 vs 0.19, P < 0.01). After 1yr no significant between-group differences were found. Mean incremental cost of spa treatment was 1311 Euro per patient (95% CI 369-2439), equalling the cost of the intervention (thalassotherapy including airfare and lodging), or 885 Euro per patient based on a more realistic cost estimate. CONCLUSIONS: The temporary improvement in quality of life due to an adjuvant treatment course of spa therapy for patients with FM is associated with limited incremental costs per patient.