Public health

doi: 10.25005/2074-0581-2017-19-2-209-213
IMPROVEMENT OF ORGANIZATIONAL FORMS OF WORK OF THE LOCAL MEDICAL ORGANIZATION PROVIDING OUTPATIENT MEDICAL CARE

A.A. Kalininskaya1, I.М. Son1, O.V. Obukhova1, L.A. Balzamova2, D.S. Terentyeva1

1Federal State Budgetary Institution «Central Scientific Research Institute of Health Care Organization and Informatization» of the Ministry of Health of the Russian Federation, Moscow, Russia
2State Budget Educational Institution of Higher Education «Samara State Medical University» of the Ministry of Health of the Russian Federation, Samara, Russia

Objective: Scientific substantiation of the organizational forms of the work of general medical practice in conditions of full fund holding of a medical organization that provides medical assistance on an outpatient medical care (MOOMC).

Methods: The analysis of organizational forms of work and forms of financing of MOOMC was carried out. The following research methods were used: monographic, statistical, organizational experiment, direct observation.

Results: Currently, in the condition of reforming primary health care (PHC), it is necessary to work out organizational and functional models of financing in a new quality under the experimental conditions, making them economically more efficient, sustainable and variable. The experiment of reforming of the outpatient clinic group in the Samara region, which included the transition to the provision of PHC to the urban population according to the principle of general medical practice, should be assessed as positive. At the same time, the general practitioner (GP), who possesses highly professional skills, is fully responsible for the health status of the adherent population and becomes a full fundholder. GP compensates for the volume of medical care that was provided to patients in hospitals, other medical organizations and ambulance teams. The introduction of financing with the full funding of the polyclinic link was accompanied by the improvement of the principles of organization and management of the service, the introduction of resource-saving technologies: day hospitals and inpatient hospitals, the organization of outpatient surgery centers, emergency medical care on the basis of MOOMC. Giving the GP the authority to independently manage financial resources significantly intensified the preventive work and affected the broad introduction of health schools.

Conclusions: A mechanism has been created for the effective use of financial resources with the preservation of accessibility and provided the quality control of the medical care. The financing model in conditions of a full transition of a local polyclinic to a general medical practice with a fund holding should be recommended for implementation in other regions of the Russian Federation.

Keywords: Medical organization providing outpatient medical care (MOOMC), local polyclinic (LP), general practitioner (GP), general medical practice (GMP), fundholding, per capita financing.

Download file:


References
  1. Mikhaylova YuV, Son IM, Dezhurnyy LI, Halmuratov AM. Printsipy sozdaniya i funktsionirovaniya sistemy pervoy pomoshchi v Rossii [Principles of creation and functioning of the first aid system in Russia]. Menedzher zdravookhraneniya. 2008;3:6-9.
  2. Gadaborshev MI, Levkovich MM, Rudlitskaya NV. Organizatsiya otsenki effektivnosti pervichnoy meditsinskoy pomoshchi [Organization of an assessment of the effectiveness of primary health care]. Moscow, RF: INFRA-M; 2013. 424 p.
  3. Starodubov VI, Kalininskaya AA, Son IM. Pervichnaya mediko-sanitarnaya pomoshch’: mekhanizmy sovershenstvovaniya [Primary health care: mechanisms for improvement]. Vienna, Austria: «East West» Association for Advanced Studies and Higher Education GmbH; 2016. 118 p.
  4. Karaylanov MG. Vrach obshchey praktiki v sisteme pervichnoy medikosanitarnoy pomoshchi v usloviyakh krupnogo goroda [General practitioner in the system of primary health care in a large city]. Novaya nauka: Teoreticheskiy i prakticheskiy vzglyad. 2016;75(3-4):70-2.
  5. Denisov IN, Chernienko EI. Sovershenstvovanie organizatsii pervichnogo zvena zdravookhraneniya: Metodicheskie rekomendatsii [Improving the organization of primary health care: Methodological recommendations]. Spravochnik vracha obshhey praktiki. 2008;1:13-46.
  6. Kobyakova OS, Starovoytova EA, Kulikov ES, Kirillova NA, Boykov VA. Optimizatsiya podkhodov k profilakticheskoy rabote vracha obshchey praktiki [Optimization of approaches to the preventive work of a general practitioner]. Spravochnik vracha obshhey praktiki. 2014;5:44-8.
  7. Shevskiy VI, Sheyman IM. Sistema fondoderzhaniya v zdravookhranenii: tipologiya, soderzhanie, usloviya, realizatsii [The system of fundholding in health care: typology, content, conditions, implementation]. Zdravookhranenie. 2008;4:27-41.
  8. Son IM, Kupeeva IA, Nesvetaylo NYa, Leonov SA, Gazheva AV. Podkhody k raschyotu potrebnosti sistemy zdravookhraneniya Rossiyskoy Federatsii vo vrachebnykh kadrakh [Approaches to the calculation of the needs of the health care system of the Russian Federation in medical personnel]. Zdravookhranenie. 2015;1:44-51.
  9. Obukhova OV. Ekonomicheskie mekhanizmy usileniya profilakticheskoy deyatel’nosti meditsinskikh organizatsiy [Economic mechanisms to strengthen preventive activities of medical organizations]. Sotsial’nye aspekty zdorov’ya naseleniya. 2015;44(4):11.
  10. Gridasov GN, Geht IA, Kupaev VI. Osobennosti finansirovaniya obshchey vrachebnoy praktiki. Opyt Samarskoy oblasti [Features of financing general practice. Experience of the Samara region]. Menedzher zdravookhraneniya. 2015;1:23-7.
  11. Lutskan IP, Borisova EA, Timofeev LF. Reformirovanie okazaniya ambulatornopoliklinicheskoy pomoshchi v g. Yakutske v usloviyakh menyayushchegosya finansirovaniya [Reforming the provision of outpatient care in Yakutsk in the face of changing funding]. Problemy i perspektivy sovremennoy nauki. 2016;11:36-41.
  12. Starodubov VI, Kalininskaya AA, Shlyafer SI. Pervichnaya meditsinskaya pomoshch’: sostoyanie i perspektivy razvitiya [Primary health care: status and development prospects]. Moscow, RF: Meditsina; 2007. 261 p.

Authors informations:

Kalininskaya Aleftina Aleksandrovna, Doctor of Medical Sciences, Full Professor, Academician of RANS, Head of the Department of the Organization of Treatment and Medio-prophylactic, FSBI «CSRIOIPH» of the Ministry of Health of Russian Federation

Son Irina Mikhaylovna, Doctor of Medical Sciences, Full Professor, Deputy Director of Science, FSBI «CSRIOIPH» of the Ministry of Health of Russian Federation

Obukhova Olga Valeryevna, Candidate of Political Sciences, Head of the Department of Ecology and Resource Management of Public Health Services FSBI «CSRIOIPH» of the Ministry of Health of Russian Federation

Balzamova Lidia Alekseevna, Candidate of Medical Sciences, Associate Professor of the Department of Public Health of the Samara State Medical University, Vice-president of the Association of Doctors of the Samara Region

Terentyeva Dina Stanislavovna, Research assistant of the Department of the Organization of Treatment and Medio-prophylactic, FSBI «CSRIOIPH» of the Ministry of Health of Russian Federation

Address for correspondence:

Kalininskaya Aleftina Aleksandrovna

Doctor of Medical Sciences, Full Professor, Academician of RANS, Head of the Department of the Organization of Treatment and Medio-prophylactic, FSBI «CSRIOIPH» of the Ministry of Health of Russian Federation

127254, Russia, Moscow, st. Dobrolyubova, 11, apt. 508

Tel.: (+7) 495 618 4388

E-mail: akalininskya@yandex.ru

Materials on the topic: