1

Belovodsky A.A.

The proposed article deals with the problems of the Russian healthcare sector. A brief analysis of the main problems (low efficiency of healthcare, stagnation of the pharmaceutical industry, high prices for medicines for the population) is given. It also describes the ways to solve them, proposed by both experts and the author of the article.

Introduction

The wealth of any state is its population. People create the state and are the source, the engine of its development and prosperity. But in order to be active, a person must be healthy. Therefore, one of the most important functions of the state is to maintain the health of its population. This support is provided through the health care system.

Health care - a set of measures of a political, economic, social, legal, scientific, medical, sanitary-hygienic, anti-epidemic and cultural nature, aimed at preserving and strengthening the physical and mental health of each person, maintaining his long-term active life, providing him with medical care in case of deterioration health.

According to the Constitution of the Russian Federation, "The Russian Federation is a social state" in which "work and human health are protected." But in practice, everything is far from what it is written.

Most experts agree that the health care system of the Soviet Union was one of the best in world practice, since it performed all the functions assigned to it in terms of quality, accessibility and provision of medical services, medicines and materials. But after the collapse of the USSR, it entered a phase of stagnation: funding was greatly reduced, highly qualified specialists in the field of medicine went abroad, scientific research in medicine ceased, and the production of medicines and devices for diagnosing and treating diseases was greatly reduced.

In the early 2000s, when the situation in the country began to gradually improve, the authorities turned their attention to the healthcare sector. But there are so many accumulated problems that they cannot be solved at once and in a short period of time.

Thus, the most important condition for the further development of the healthcare sector is the transition to an innovative development path, in connection with which the implementation of the following principles should be ensured:

1. state regulation combined with effective competition in the innovation sphere;
2. preparation and transition of the industry to increase the output of high-tech and science-intensive products that meet the needs of the market and the prospects for its development;
3. creation of long-term conditions for increasing labor productivity;
4. concentration of resources on innovations that will ensure positive structural shifts in the economy;
5. stimulation of business and investment activity in the field of scientific, scientific, technical and innovative activities through tax, credit and other economic benefits;
6. integration of investment, scientific and technical, educational and industrial activities;
7. ensuring legal protection of objects of intellectual property and copyrights in the dissemination of scientific and technical knowledge and information;
8. cooperation of all levels of state power, as well as the state, subjects of the federation and municipalities on the issues of modernization and technological renewal of the basic sectors of the economy and the social sphere;
9. publicity and discussion of priority innovative programs and projects during open competitions.

It is not for nothing that state regulation is placed in first place among the principles. Without it, innovative development will not work, because private business is reluctant to join the innovation process. Regulation and support in the field of innovation by the state should be as follows:

1. development of regulatory legal acts in the field of innovation, organization and control over their implementation;
2. determination of priorities in the field of innovation, development and implementation of innovative programs and projects;
3. creation of innovative infrastructure and conditions for innovative activity (stimulation through preferential taxation, subsidies, subsidies from budgets);
4. formation and placement on a competitive basis of the state order for the creation of science-intensive products and technologies;
5. protecting the rights of investors and creditors;
6. training and advanced training of personnel employed in the field of innovation;
7. coordination of actions of subjects of innovative activity;
8. support for the creation of subjects of investment activity with the participation of foreign capital, with the provision of appropriate state guarantees of activity.

Thus, the purpose of this essay is to characterize the problems of the healthcare sector in Russia and ways to solve them.

The following tasks were set:

1) description of problems in the healthcare sector;

2) a description of the measures taken in Russia to eliminate the problems;

In the abstract, information was used not only from various sources, but also the observations of the author himself.

1. Problems of the Russian healthcare system

First of all, we should dwell on the low efficiency of the entire health care system, which gives rise to the low quality of medical services provided. The reasons for this state of affairs are as follows:

1) lack of specialists, medical equipment, hospital facilities, which gives rise to long queues of patients during reception hours. Doctors have to work in an emergency mode, which automatically reduces the quality of services provided;

2) a short schedule for receiving patients. Reception hours often end before 2 pm. Whoever did not have time to get an appointment, he is forced to come on another day, that is, to take time off from work again, therefore, not to fulfill a number of his duties. Such distraction of employees negatively affects both the company itself (the degree of negative consequences will directly depend on the position of the employee and the possibility of replacing him), and on the employee of this company (wage reduction);

3) inability to receive the required medical care in a timely manner. This is a consequence of the lack of specialists, equipment, the high cost of medicines and medical services;

4) low qualification of doctors. It often happens that in two different clinics, doctors make different diagnoses for the same symptoms. Accordingly, the treatment does not give the expected effect;

5) lack or aging of medical equipment. In most hospitals, examination and treatment of patients is carried out using Soviet equipment. And the passage of treatment or examination on new equipment (if any) often costs a lot of money;

6) low wage and the lack of mechanisms to stimulate quality work.

The situation of shortage of specialists and hospitals is especially noticeable when comparing cities both within the same region and between regions. So, if in the regional center or the capital of the republic, most hospitals and clinics have been renovated and have new equipment, then in simple cities, especially those far from the center, there are often few clinics where people cannot receive the necessary amount of medical services. How often in the hospitals of the capitals of the subjects of the federation you can see people from other cities and hear about the lack of the necessary device or specialist in their city.

The low efficiency of the healthcare system hits hard on the country as a whole, especially on its economy.

The next serious problem is in the field of drug production. The modern population of most countries cannot live without antibiotics, vaccination, and many different drugs. And if more than 80% of the drugs required for its population are produced domestically, then there are practically no problems. But if the country imports most of the drugs, then there is a "threat to national biological security." Russia also belongs to such countries: imports of medicines account for about 80% of their consumption. Most of the domestic medicines are developments of the Soviet era (brought to industrial production) or generics (a medicinal product with proven pharmaceutical, biological and therapeutic equivalence with the original, but not patent protected; that is, it is a copy of the original third-party drug). New developments in this area are carried out at their own expense by the largest pharmaceutical companies (Pharmstandard, Domestic Medicines, Nizhpharm, Veropharm, etc.), while the rest receive grants from abroad and occasionally government orders.

Also, the reasons for the stagnation of the pharmaceutical industry were:

1) the outflow of specialists abroad. The so-called "brain drain" has long been a national problem in Russia. Scientists move to other countries because they are offered high pay, guaranteed orders and provided with all the necessary equipment for research;

2) insufficient investment. Pharmacology is a specific area of ​​healthcare with its own concepts and patterns. Few potential investors are able to understand the meaning of the development and evaluate its prospects. It also scares away the ambiguity of the payback period of investments and the high medical risks of manufactured drugs;

3) the inability of scientists to "sell" their ideas. Russia has always been famous for its people. Today there are groups of enthusiasts developing new drugs. But the matter does not move further than the idea and initial developments, because they do not know how to properly present their development to investors in order to further test it and put it into production;

4) the high cost of developing new drugs. According to experts, investments in the development of a new drug amount to at least $600 million. Of this, 10-15% goes to the development of the molecule, 25-30% to preclinical animal trials, and 50-60% to human clinical trials. If we are talking about the development of a fundamentally new formula, then the costs for the entire cycle (from research to launch on the market) can reach more than $1 billion;

5) long term. Minimum term development of a new drug is 3 years;

6) insecurity of intellectual property. This problem is not specific only to the pharmacological industry. It is typical for Russia as a whole. Only since 2006 began to take shape the legislative framework for the protection of intellectual property. In particular, on December 18, 2006 Part 4 of the Civil Code came into force Russian Federation dedicated to intellectual property;

7) availability of generics. Large modern pharmaceutical companies have little interest in the development of new drugs also because of the large number of companies producing generics. Generics in most cases do not differ in quality and properties from the original, but they are much cheaper, which reduces the profitability of the new drug of the developer company.

A little more detail should be given to the problems of financing the development of drugs. The high cost of the full cycle of drug creation (from idea to production) makes such developments impossible for medium and small companies. But they participate in development as "generators of ideas" or the first stage of research (creation of a drug formula). In the future, they sell their developments, most often to foreign companies due to high pay. In addition, according to experts, sometimes domestic companies do not need new developments, which is explained by the lack of Money to continue development, either by the presence of a large number of own drugs, or by the successful release of generics for imported drugs.

Foreign grants are another way for representatives of a small pharmacological business to survive. According to Rosprom estimates, the average grant amount is $100,000, and 30-50% of Russian companies work on them. Development is carried out up to the stage of obtaining the formula, then it is sold abroad.

Also, companies have a chance to receive the necessary funds by contacting special funds. Now entrepreneurs are helped by the Small Business Support Fund, which gives out money on the condition that the entrepreneur has a patent. The amount of allocated funds at the earliest stage of development is 1 million rubles. In the future, if it is possible to attract an investor, the Fund will allocate another 3.75 million rubles. There are also 3 venture funds operating in the country, in the future, the establishment of 7 more. Their capital will be formed at the expense of private and public funds. Money will be issued to entrepreneurs on the condition of entering the capital of the company being created and receiving a share of the profit in the future.

Another way to solve the problem of financing is the state purchases of drugs and orders. But so far, this mechanism is ineffective, since 89% of the required drugs are purchased from foreign companies during public procurement. But priority should be Russian developments.

The next problem associated with drugs is their high cost to the population. No, this is not the malice of drug manufacturers (as many people think). A number of reasons contribute to this:

1) fluctuations in the exchange rate of the ruble. Since October 2008, a smooth devaluation of the ruble began in Russia, as a result of which the dollar rose against the ruble by almost 40%, which affected the rise in the cost of imports. And since 80% of the medicines consumed by the country's inhabitants are imported, the end users received the main blow from the devaluation;

2) the high cost and duration of development. Therefore, all fundamentally new drugs entering the market are available only to a limited circle of consumers (either the rich or those to whom the development company has allocated them for free). One example is the current development of a swine flu vaccine by the British company GlaxoSmithKline Plc. The development of the vaccine took 5 years, more than $3.2 billion was spent. The price of the finished vaccine is $10. 50 million doses were donated free of charge to the World Health Organization. And now let's present some calculations on the topic of how much an imported vaccine against "swine flu" will cost for the population of Russia:

The dollar exchange rate set by the Central Bank of the Russian Federation as of October 13, 2009 is 29.5 rubles;

The cost of the drug is $10;

Duty on the import of medicines - 10%;

Thus, the cost of this vaccine when crossing the border is 324.5 rubles. (10*1.1*29.5).

The final cost will consist of markups of retail chains, delivery costs and drug promotion costs. It can be assumed that the cost for the population will be about 500 rubles. for 1 dose. It is clear that the majority of the Russian population will not be able to afford such a vaccine due to low incomes, which increases the risk of morbidity and mortality from the "swine flu" virus.

3) unreasonable prices for medicines. Recently, during a visit to Zelenograd, V.V. Putin, focusing attention and misunderstanding on the fact that foreign drugs are often sold in Russia at prices many times higher than in other countries.

The population is often afraid to purchase Russian drugs, preferring imported ones, since there is no confidence in the quality of domestic drugs. In addition, most imported drugs have no analogues in Russia.

The same situation (as in the example with cost calculation) is observed in the pharmaceutical market as a whole, which puts the Russian state under serious threat due to the high risk of morbidity among the population and reduced opportunities for a quick recovery.

2. Ways to solve health problems

How can Russia get out of such a deplorable situation with health care? The main thing is reforms. But not pinpoint on the principle of "find the decisive link, pull on it - and everything will be resolved." A complex of reforms is needed, aimed at all elements of health care. They must be thoughtful and complete, otherwise, as is often the case in Russia, they will only get worse.

To improve the efficiency of the healthcare sector, experts propose to develop a mechanism to stimulate competition between doctors and medical institutions. It is necessary to create a mechanism that will interest medical professionals in improving the quality of their services. For example :

1) creation of a database of doctors and their patients (who are constantly served by him). Such a system operates abroad, where health care is free (USA, Western European countries), and allows you to identify highly qualified doctors;

2) provide funding for medical institutions for the effectiveness of the services they provide. That is, the less a person spent within the walls of the hospital, and if he did not have a relapse of the disease, then the medical institution that helped him will receive more funding than the rest. This mechanism is used in most developed countries (Great Britain, etc.);

3) it is necessary to adopt a number of laws that promote competition in healthcare;

4) it is necessary to change the legal form of medical institutions. Today they are all government. This means that the resulting financial results from their work go to the state: the surplus of funds is taken away, the arising debts are extinguished. This situation demotivates medical institutions regarding effective work. They should be given more freedom in their activities;

5) a differentiated approach should be taken to the development of the healthcare sector in different territories of the Russian Federation due to their unequal development. Somewhere, it is only necessary to increase the efficiency of healthcare by stimulating competition, to develop and improve the quality of medical services provided, since the region (city) has the medicines, equipment, and specialists necessary for it. And somewhere, first, it is necessary to resolve the issue of a shortage of medicines, medical equipment, specialists, and only then introduce mechanisms to stimulate competition in the healthcare sector.

The issues of remuneration of medical specialists should be approached from the point of view of the development of the region (city), rather than increasing wages by the same amount throughout the country. Due to strong differences in the level of development of the subjects of the federation, municipalities, the amount of wage increases will be perceived differently everywhere. So, in Moscow, 10 thousand rubles. allowances for a district doctor means very little, and in Dagestan the same amount is a lot of money.

It is also necessary to create mechanisms through which free medical care would be received first of all by those who have nothing to pay, and those who have something to pay, in the presence of a shortage (equipment, specialists, medicines) could pay for the medical care they need.

Another way to develop competition is to use modern information achievements in the field of healthcare. In particular, experts propose the idea of ​​creating a personalized database of individual accounts. On its basis, it will be possible to scientifically substantiate the required number of specialized beds in a particular region.

Improving the quality of medical care will also be achieved through the development of intensive care units (resuscitation of various specializations). In the West, each hospital has 20-25% of intensive care beds. In Russia, this figure does not exceed 5%.

The next problem in the healthcare sector - tariffs for medical services - should be solved through civilized state intervention. Medical tariffs must include all items of expenditure. They should take into account the necessary profitability and the level of inflation forecasted.

To attract funding and stimulate new developments, it is proposed to establish venture funds (with the participation of various capitals), to allocate state grants for research. Cooperation between business and universities and science cities begins. Today there are biotechnological laboratories on the basis of Moscow State University, Stavropol State University, science city in Pushchino. Their task is the first stage of development. In the future, the resulting formula will be sold to a private company.

The state needs to stimulate the innovative development of the entire economy in general and the healthcare sector in particular. As noted earlier, there are practically no new developments of medicines and medical equipment in Russia. To remedy the situation, the state, first of all, needs to develop an innovative infrastructure, change tax legislation (increasing tax incentives and introducing tax holidays for companies implementing new developments). The creation of several research institutes for conducting scientific research in the field of medicine is envisaged in the near future.

But there is already real progress in this situation. So in 2008, 19.4 billion rubles were allocated from the budget. for the construction of new medical technology centers in Penza, Khabarovsk, Astrakhan and other cities. With the support of the state, the medical direction is being developed in technoparks (Kurchatov, Zelenograd, Obninsk), where new methods of treatment, medicines, and equipment are being developed.

In early 2005, the Drug Supplemental Program was launched. The essence is the free provision of medicines to privileged categories of the population. For these purposes, funds were annually allocated from the budget for the purchase of medicines. 89% of purchases in monetary terms are accounted for by foreign companies. In this regard, experts advise to shift the focus to drugs of domestic manufacturers.

All of the above is what the experts suggest. In general, the author agrees with their proposals. But after analyzing the problems of the healthcare sector in Russia, he proposes an additional series of measures aimed at improving the situation.

The most important thing is innovative development. The state should become the initiator of the innovation process. It should create incentives for businesses to be interested in investing in costly risky projects. To do this, it is necessary to change the legislation regarding the innovative activities of companies. For companies that are developing new drugs or medical equipment, tax incentives should be introduced for the first few years (up to 3 years) of development. In the future, they should reduce income tax at the stage of promoting a new drug (equipment) to the market. As soon as the sales volume reaches the targets and continues to grow, such companies should be transferred to the general taxation regime.

At the initial stage of development, the state should actively help companies financially, especially young companies with promising developments. To do this, you can use the funds of federal targeted programs, government orders, grants, the creation of joint ventures with private businesses, the creation of various venture funds.

To stimulate new developments, it is necessary to create research centers (at least one in each federal district), under the roof of which to gather scientists and provide them with funding for their ideas. In the future, developments can either be sold to private companies, or their commercial production and promotion on the market within the framework of joint ventures, or a rental or leasing form of development implementation can be arranged. When selling a development, the contract should specify the forms and terms of payment. Stepwise payment would be optimal (initial payment, then fixed or percentage deductions from the proceeds from sales of a new drug / equipment). In the lease form, the acquirer (lessee) will only pay deductions for the use of the formula or industrial design of the device without transferring ownership of the leased development. At the same time, this development can be leased to other companies. With the leasing form, the acquirer (lessee) will use all the advantages of the leasing scheme.

To facilitate the transition to an innovative development path, it is initially possible to create generics based on Western models, but then produce their own developments based on them. But it is necessary to strengthen control over generics, which will automatically increase public confidence in them and reduce the number of side effects.

To be able to innovate, highly qualified personnel are needed. It is necessary to look for and encourage talented students, to attract them to work in research projects. It is also necessary to stop the outflow of domestic scientists abroad. To do this, it is necessary to create all the conditions for their research activities: to provide laboratories, to allocate funding. But such measures should be taken in priority scientific areas, as well as promising areas. Do not waste resources on dubious research (of which there are many in the modern world).

One of these key areas (in addition to the use of nanotechnology in medicine, the creation of new drugs and medical equipment) should be diagnostics. The development of this field of medicine will significantly reduce the duration of treatment and the number of cases of moderate and severe severity, since it will be possible to identify and treat diseases at an early stage, when it is much easier to do this than later.

To solve the problem of the cost of medicines, pricing should be traced along the entire chain (from manufacturer to retailer). And punish those who unreasonably raise prices.

Conclusion

Based on the results of the work carried out, it can be concluded that, despite the huge amount of accumulated problems, changes towards improvement are beginning in the Russian healthcare system.

But there is another serious problem that cannot be solved only with new ideas and funding. Experts do not single out this problem, but every person faces it. We are talking about consumer confidence in Russian medicines, medical equipment, and doctors. And the reason for this problem lies precisely in those flaws in the healthcare sector, named in the work. In addition, since Soviet times, people have been left with the idea that all imported goods are of better quality, characteristics, and are safer than Russian counterparts (if any).

Lost trust is always very difficult to regain. But if all the problems identified in the work are solved, if their solution does not stretch for a long time, then people will switch to domestic medicines and medical equipment, they will no longer consider the maximum withdrawal of money from the patient as the main goal of doctors. The number of days spent in hospitals will be reduced. Mortality will decrease and life expectancy will increase. All this will immediately have a positive impact on the country's economy. Only then can it be said that Russian system health care is effective.

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Bibliographic link

Belovodsky A.A. HEALTH CARE IN RUSSIA: PROBLEMS AND SOLUTIONS // Modern science-intensive technologies. - 2009. - No. 11. - P. 21-27;
URL: http://top-technologies.ru/ru/article/view?id=25977 (date of access: 03/24/2020). We bring to your attention the journals published by the publishing house "Academy of Natural History"

Problems of public health and ways of their solution Kolesnikov S.I. Deputy Chairman of the Committee on Health Protection Member of the Presidium of the Russian Academy of Medical Sciences ACADEMICIAN OF THE RAMS Foundation for ISP and R (Fedorova) Moscow,

CONDITIONS FOR PROGRESS IN RUSSIA 1. Political will of state leaders and consent of bureaucrats 1. Political will of state leaders and consent of bureaucrats 2. Stable financing and predictable tax policy 2. Stable financing and predictable tax policy 3. Consent in society 3. Consent in society 4. Management and training 4. Management and training 5.Interaction with leading partners and exchange of experience 5.Interaction with leading partners and exchange of experience 6.Public-private partnership 6.Public-private partnership

Efficiency of the health care system in Russia Per capita budget expenditures on health care place in the world. Per capita spending budgets for health care place in the world. In terms of the efficiency of the health care system - 130th place (WHO) In terms of the efficiency of the health care system - 130th place (WHO) Dissatisfaction of the population and doctors with health care - more than 60%. Dissatisfaction of the population and doctors with health care is more than 60%.

Reforming health care is an urgent need: improving the health of the nation improving the health of the nation maintaining social stability in society maintaining social stability in society improving the quality of medical care to the level of developed countries improving the quality of medical care to the level of developed countries reducing structural imbalances (restructuring) reducing structural imbalances (restructuring)

1. There is no unified health care system - 3 autonomous systems and various types of institutions (to be solved without sufficient funding). 1. There is no unified health care system - 3 autonomous systems and various types of institutions (to be solved without sufficient funding). 2. State guarantees and financial resources provision of free medical care, inpatient care is mainly financed, the volume of paid services is growing (it is not being solved and the prospects are unclear). 2. State guarantees and financial resources for the provision of free medical care are not balanced, inpatient care is mainly financed, the volume of paid services is growing (it is not being resolved and the prospects are unclear). 3. There is no incentive for investments and payments in healthcare for individuals and legal entities, which does not allow legalizing payments (not solved). 3. There is no incentive for investments and payments in healthcare for individuals and legal entities, which does not allow legalizing payments (not solved). Health issues:

4. Low motivation of managers and employees to improve the quality of work, and insurers - to ensure the interests of citizens (mechanisms have not yet been created). 4. Low motivation of managers and employees to improve the quality of work, and insurers - to ensure the interests of citizens (mechanisms have not yet been created). 5. Sharp differences in the availability and quality of medical care between the constituent entities of the Russian Federation, municipalities, in the city and in the countryside, the poor and the rich (partially resolved). 5. Sharp differences in the availability and quality of medical care between the constituent entities of the Russian Federation, municipalities, in the city and in the countryside, the poor and the rich (partially resolved). 6. There is no single information space (registry of insured people, patients, capacities, medicines, telemedicine, etc.) - being solved

7. Lack of elements of professional self-regulation (not solved) 7. Lack of elements of professional self-regulation (not solved) 8. Public-private partnership is underdeveloped (not solved). 8. Undeveloped public-private partnership (not solved). 9. Underdevelopment of public institutions for control over the health care system (slowly and inefficiently solved). 9. Underdevelopment of public institutions for control over the health care system (slowly and inefficiently solved). 10. Minimum participation of citizens in maintaining their health. There is no effective system of education, promotion and stimulation of a healthy lifestyle (badly solved). 10. Minimum participation of citizens in maintaining their health. There is no effective system of education, promotion and stimulation of a healthy lifestyle (badly solved). 11. Lack of real responsibility of the authorities for the state of health of the population. 11. Lack of real responsibility of the authorities for the state of health of the population.

Resource support The outdated system of personnel training, both doctors and, in particular, managers (managers) working in the social sphere (who do not have medical education) is not being solved. The outdated system of training personnel, both doctors and, in particular, managers (managers) working in the social sphere (who do not have medical education) is not being solved. No developed modern domestic pharmaceutical and medical industry (partially addressed) No developed modern domestic pharmaceutical and medical industry (partially resolved)

Solutions to overcome the health crisis () 1. DLO 2. Monetization of benefits 3. National priority project "Health" 4. Reform of legislation and regulatory framework. 5. Increasing insurance premiums and modernizing health care

RESULTS OF PNP "HEALTH" An additional 825 thousand lives of citizens of the Russian Federation (0.6% of the population of the Russian Federation) were saved. But in the years the dynamics in improving the health status of the population of the Russian Federation has slowed down

Causes of the slowdown in improving the health status of the population of the Russian Federation Reduced growth in health care costs at constant prices Unsatisfactory response of the health care system to abnormal weather and environmental conditions in the summer of 2010 Unresolved key health problems

Problems to be solved (before the emergence of social protests) Oblige all levels of government to restore order (queues, paid services, rudeness, etc.) in medical organizations, up to the dismissal of municipal and regional managers, managers, doctors. To oblige all levels of government to put things in order (queues, paid services, rudeness, etc.) in medical organizations, up to the dismissal of managers at the municipal and regional levels, managers, doctors. Instead of FAPs, it is urgent to organize equipped offices of family doctors (paramedics) with the approach of assistance to the population, allowing the circulation of medicines at these points without obtaining a pharmaceutical license. Instead of FAPs, it is urgent to organize equipped offices of family doctors (paramedics) with the approach of assistance to the population, allowing the circulation of medicines at these points without obtaining a pharmaceutical license. It is urgent to increase the financing of the system and transfer all organizations to sectoral (stimulating) wage systems, using both modernization and a direct increase in the wage fund. It is urgent to increase the financing of the system and transfer all organizations to sectoral (stimulating) wage systems, using both modernization and a direct increase in the wage fund. Introduce social and other benefits for well-performing medical workers (bonuses, utility bills, wider use of honorary titles and social incentives). Introduce social and other benefits for well-performing medical workers (bonuses, utility bills, wider use of honorary titles and social incentives). Carry out medical examination of the working population by city and regional medical organizations. Carry out medical examination of the working population by city and regional medical organizations.

Key issues to be consistently addressed Increase in budget funding to US$ 1000 per capita per year (WHO recommendation). Do not reduce the budget component (!!!). Growth of budget financing up to 1000 US$ per capita per year (WHO recommendation). Do not reduce the budget component (!!!). Careful introduction of standards and rules (do not close regional medical organizations). Careful introduction of standards and rules (do not close regional medical organizations). A sharp increase in incentive mechanisms that depend on the quality of work. A sharp increase in incentive mechanisms that depend on the quality of work. To create a system of training and continuous education of acutely scarce scarce personnel, including managers. To create a system of training and continuous education of acutely scarce scarce personnel, including managers. Training of social managers for municipalities and subjects of the Federation, who are competent in the field of state policy and the consequences of making managerial decisions. Training of social managers for municipalities and subjects of the Federation, who are competent in the field of state policy and the consequences of making managerial decisions. The introduction of strict responsibility of regional authorities for the indicators of medical care for the population. The introduction of strict responsibility of regional authorities for the indicators of medical care for the population.

17 Billion RUB Billion RUB 2010 2011 2012 2013 % to 2010 % to 2011 % to Education,451699.7 Health care,343389.9 Social policy,9 Physical culture and sports,02967.82690.1

LAWS (AMENDMENTS) FZ 94 On Procurement for State and Municipal Needs (auctions and quotations) FZ 217 On Establishment of Implementation Firms in Research Institutes and Universities to Commercialize IP On Concession Agreements in Health Care (Government Decree) FSS and Pension Fund On Self-Regulatory Organizations (SROs) (United Medical Community)

NEW LAWS, amendments () On liability insurance of medical organizations On the protection of the Health of Citizens of the Russian Federation On the State. (municipal) institutions Law on Compulsory Medical Insurance On circulation of medicines and amendments to a number of laws on special economy. zones

Interference of new laws () Federal Law 83 "On ... budgetary institutions" On the circulation of drugs On education The law "On compulsory medical insurance" (+ on drug insurance?) Laws on the distribution of powers (local self-government and subjects of the Federation) "On the basics of protecting the health of citizens of the Russian Federation"

The increase in the amount of insurance premiums for compulsory medical insurance by 2% will be in 2011 and 2012. by 230 billion rubles per year According to the Accounts Chamber of the Russian Federation, the deficit in financial support for territorial programs of state guarantees (current financing of free medical care for citizens) in 2009 alone amounted to about 385 billion rubles and, according to preliminary estimates, in 2010 the situation did not improve. RISK: even more significant failure to fulfill social obligations to implement the constitutional rights of citizens to free medical care is possible

prospects financial changes Magnification: Irreducible insurance premiums for the non-working population (proposed 5, but need 10 thousand rubles) Non-reducible insurance premiums for the non-working population (proposed 5, but need 10 thousand rubles). Increasing these payments annually by 25% from 2013 until 2015 Decrease: Inclusion in compulsory medical insurance (without provision) of ambulance, high technology, federal clinics and the National Health Project Inclusion in compulsory medical insurance (without provision) of ambulance, high technology, federal clinics and the National Health Project

Article 15. Transfer of the exercise of the powers of the Russian Federation to the subjects of the Russian Federation 1. The Russian Federation transfers to the subjects: 1. The Russian Federation transfers to the subjects: 1) licensing: a) medical organizations of the municipal and private healthcare systems (with the exception of VMP); b) pharmaceutical activities (with the exception of the activities of wholesale trade organizations and pharmacies of federal organizations); 1) licensing: a) medical organizations of municipal and private healthcare systems (with the exception of VMP); b) pharmaceutical activities (with the exception of the activities of wholesale trade organizations and pharmacies of federal organizations); c) trafficking in narcotic, psychotropic drugs and precursors; c) trafficking in narcotic, psychotropic drugs and precursors; 2) organizing the provision of medicines for "seven nosologies". 2) organizing the provision of medicines for "seven nosologies".

Article 15. Transfer of the exercise of powers of the Russian Federation to subjects of the Russian Federation 2. Funds for the exercise of powers transferred in accordance with Part 1 are provided in the form of subventions from the federal budget. 2. Funds for the implementation of the powers transferred in accordance with part 1 are provided in the form of subventions from the federal budget. 3. The total amount of funds is determined on the basis of methods approved by the Government of the Russian Federation. 3. The total amount of funds is determined on the basis of methods approved by the Government of the Russian Federation. 5. Funds are targeted and cannot be used for other purposes. 5. Funds are targeted and cannot be used for other purposes.

Article 15. Transfer of the exercise of the powers of the Russian Federation to the constituent entities of the Russian Federation body. 8. The federal register of persons with hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, malignant neoplasms of lymphoid, hematopoietic and related tissues, multiple sclerosis after organ and (or) tissue transplantation is maintained by the authorized federal body.

Article 15. Transfer of exercising the powers of the Russian Federation to the subjects of the Russian Federation 7. federal authority: 7. federal authority: 2) issues methodological guidelines and instructions on transferred powers binding on the authorities of a subject of the Russian Federation; 2) issues methodological guidelines and instructions on delegated powers that are mandatory for execution by the authorities of a constituent entity of the Russian Federation; 3) coordinates the appointment to the position (dismissal from office) of the heads of the executive authorities of the constituent entities of the Russian Federation exercising the delegated powers; 3) coordinates the appointment to the position (dismissal from office) of the heads of the executive authorities of the constituent entities of the Russian Federation exercising the delegated powers;

Article 44. Medical care for those suffering from rare (orphan) diseases 1. Rare (orphan) diseases are diseases that have a prevalence of no more than 10 per population. 1. Rare (orphan) diseases are diseases that have a prevalence of no more than 10 per population. 2. The list of orphan diseases is formed by the authorized federal executive body on the basis of statistical data and posted on the official website. 2. The list of orphan diseases is formed by the authorized federal executive body on the basis of statistical data and posted on the official website. 3. The list of orphan diseases is approved by the Government of the Russian Federation 3. The list of orphan diseases is approved by the Government of the Russian Federation

Article 83. Financial support for the provision of medical care and sanatorium-resort care specified in clause 2 of part 1 of Article 15) is carried out at the expense of the budgets of the constituent entities of the Russian Federation. 9. Financial provision of citizens with medicines for the treatment of diseases included in the List of life-threatening acute and chronic progressive rare (orphan) diseases, leading to a reduction in the life expectancy of a citizen or his disability (with the exception of diseases specified in clause 2 of part 1 of Article 15), is carried out for account of the budgets of the subjects of the Russian Federation.

Article 74 medical devices, or with the rights to the trade name of a medicine, drug wholesale organizations, pharmacy organizations gifts, money (except for remuneration under contracts during clinical research or testing, in connection with pedagogical and (or) scientific activities), incl. to pay for entertainment, recreation, travel to a place of recreation, as well as to take part in entertainment events, at the expense of companies (representatives); 1) accept gifts, money from organizations engaged in the development, production and (or) sale of medicines, medical devices, or with the rights to the trade name of medicines, drug wholesalers, pharmacy organizations (with the exception of remuneration under contracts during clinical trials or trials, in connection with pedagogical and (or) scientific activities), incl. to pay for entertainment, recreation, travel to a place of recreation, as well as to take part in entertainment events, at the expense of companies (representatives);

Article 74. Restrictions imposed on medical and pharmaceutical workers (“medrepas”) 2) conclude agreements with the company on prescribing or recommending medicines and medical devices to patients (except for clinical trials); 2) enter into agreements with the company on prescribing or recommending medicines, medical devices to patients (with the exception of clinical trials); 3) receive samples from the company for delivery to patients (with the exception of clinical trials); 3) receive samples from the company for delivery to patients (with the exception of clinical trials); 4) provide, when prescribing a course of treatment to a patient, false, incomplete or distorted information about the medicines, medical devices used, incl. hide information about the availability of similar medicines and medical devices in circulation; 4) provide, when prescribing a course of treatment to a patient, false, incomplete or distorted information about the medicines, medical devices used, incl. hide information about the availability of similar medicines and medical devices in circulation;

Article 74 or providing information on side effects; 5) not to receive representatives of companies, with the exception of clinical trials and trials, to participate in the manner established by the administration of the organization, in meetings of medical workers and other events related to increasing the professional level of medical workers or providing information on side effects; 6) prescribe medicines and medical devices on forms containing advertising information, as well as on forms on which the name of the medicine or medical device is preprinted. 6) prescribe medicines and medical devices on forms containing advertising information, as well as on forms on which the name of the medicine or medical device is preprinted.

Article 74. Restrictions imposed on medical and pharmaceutical workers (“medreps”) participation in recreational activities at the expense of the company; 1) accept gifts, cash, including to pay for entertainment, recreation, as well as take part in entertainment events at the expense of the company; 2) receive from the company samples of medicines, medical devices for delivery to the public; 2) receive from the company samples of medicines, medical devices for delivery to the public; 3) enter into agreements with the company on offering certain medicines and medical products to the public; 3) enter into agreements with the company on offering certain medicines and medical products to the public; 4) provide false, incomplete or distorted information about available medicines with the same INN, medical devices, including hiding information about the availability of medicines and medical devices that have a lower price. 4) provide false, incomplete or distorted information about available medicines with the same INN, medical devices, including hiding information about the availability of medicines and medical devices that have a lower price.

Article 75 or may affect the proper performance of his professional duties due to the conflict between the personal interest of a medical or pharmaceutical worker and the interests of the patient. 1. Conflict of interest - a situation in which a medical or pharmaceutical worker, in the course of his professional activities, has a personal interest in receiving, personally or through a representative of the company, a material benefit or other advantage that affects or may affect the proper performance of his professional duties due to a contradiction between personal the interests of the medical or pharmaceutical worker and the interests of the patient. 2. In the event of a conflict of interest, the employee is obliged to inform the head of the organization in writing about this, and individual entrepreneurs, the authorized federal executive body. 2. In the event of a conflict of interest, the employee is obliged to inform the head of the organization in writing about this, and individual entrepreneurs, the authorized federal executive body.

Article 75. Settlement of a conflict of interest in the course of medical and pharmaceutical activities 3. The head of a medical or pharmacy organization is obliged to notify the authorized federal executive body of this in writing within seven days. 3. The head of a medical or pharmacy organization is obliged to notify the authorized federal executive body of this in writing within seven days. 4. To resolve a conflict of interest, the authorized federal body forms a commission for the settlement of a conflict of interest and approves the regulation on it. 4. To resolve a conflict of interest, the authorized federal body forms a commission for the settlement of a conflict of interest and approves the regulation on it. 5. The composition of the commission must exclude the possibility of a conflict of interest that could affect the decisions taken by the commission. 5. The composition of the commission must exclude the possibility of a conflict of interest that could affect the decisions taken by the commission.

Protecting the health of the population is one of the most important tasks that the government must solve. The health care system has experienced ups and downs in recent years. This is primarily due to economic crises and ever-increasing inflation. The state of the health system is assessed by such factors as the number and level of medical facilities, the percentage of deaths from diseases and the presence of innovation. For an objective assessment of the situation in the modern healthcare system, we will pay attention to these aspects in this article.

Reducing the number of medical institutions

Many Russian experts agreed that the number of medical institutions in the country will continue to decline in the near future. According to them, by 2021 the number of hospitals in the country may drop to the level of 1913. This is not a mere opinion, but a conclusion based on facts.

According to official statistics (CEPR data), in the period from 2000 to 2015, the number of public medical institutions in the Russian Federation decreased by 2 times (from 10,700 to 5,400). In their report, a group of analysts expressed the opinion that if the government continues to close municipal hospitals at the same pace (today this figure is 353 per year), then by 2022 their number will reach 3,000 institutions, which is comparable to 1913.

The number of rural medical institutions is decreasing at an incredible pace: out of 4.5 thousand, only 400 hospitals remain in the whole of Russia. Thus, the availability of medical care for rural and rural residents has been reduced to almost zero, for 40-60 km not everyone will go to the paramedic and only in an emergency, since there is nowhere to wait for an ambulance.

Also during this period, the number of hospital beds in hospitals decreased to 1,200 thousand (a decrease of 27.5%). The worst situation is in rural areas - here the decline has reached a critical level - 40%. The data is confirmed by the Health Fund and personally by its director E. Gavrilov. He voiced a sad fact: in the last 3.5 years alone, the number of hospital beds has decreased by 100,000.

However, the reduction in hospital beds does not affect the availability and quality of medical care in the country. Experts insist that the key indicator is the number of hospitalizations. He's growing, oddly enough. So, in 2016, almost 100,000 more people were hospitalized in Moscow than in 2015. According to experts, each hospital bed should be at least 85% occupied. If this indicator is lower, it should be disposed of in order to save money. Such a policy seems rational, because the optimization of resources is the key to prosperity.

There is one more nuance. When an epidemic of any disease (even a banal flu) breaks out in a particular region, the number of hospital beds is sometimes not enough. Hence the conclusion - Russia has approached the critical mark of the number of hospital beds per capita. If the dynamics continue, or an epidemic breaks out across the country requiring hospitalization, then citizens will face a shortage of medical care. It will be physically impossible to quickly fill the gap in state medical institutions.

Decrease in mortality from diseases

According to the Russian Research Center, in 2016 the number of deaths from major diseases decreased by 1.2% compared to 2015. This confirms the fact that the level of medical care in Russia, despite all the problems, is at a high level. In 2016, mortality from the following groups of diseases decreased:

• Respiratory organs - by 7.9%
• Digestive organs - by 3.4%.
• Circulatory systems - by 2.6%.
• From malignant neoplasms - by 0.6%
• From external causes - by 6.5%.

Oversupply of managers in the health care system

The Department of Health of the City of Chicago (population 9 million) employs only 8 people. In the same organization in Moscow (population 15 million) - about 2,000 people. A clear numerical superiority of the administrative apparatus is observed in the Russian capital, but does this result in the level of medicine? No. There is a shortage of equipment and free medicines in the country.

The average salary of officials of the Ministry of Health is 100 thousand rubles. If the staff is reduced to 100 people (which, by the way, is still 12.5 times more than in the city of skyscrapers), then a monthly amount of 1900 x 100,000 = 190,000,000 rubles will be saved. With this money, you can buy 12 MRI machines (if we talk about a simple Hitachi Airis Elite 0.3T model worth 16 million rubles).

What else is fraught with an excess of the administrative apparatus in the health care system? First, bureaucratic problems. Doctors spend the lion's share of their time on preparing various reports that the management elite requires. This time they could spend on helping the sick, instead they have to constantly report to their management.

The government does not spare money for the salaries of the leadership, but the state budget does not have enough funds to provide the population with free healthcare. Thus, since 2014, there has been a decline in the financing of the healthcare system:

• 2014 - the budget of the healthcare system amounted to 462 billion rubles;
• 2015 - 406 billion rubles;
• 2016 - 419 billion rubles. In this period of time, there was strong inflation, which covered the increase by 13 billion, so the dynamics is still negative;
• 2017 - 389 billion rubles.

Thus, it can be seen that the financing of the healthcare sector is declining at a rapid pace. At the same time, the Minister of Health of the Russian Federation V. Skvortsova announced on September 28, 2017 that the federal part of the budget in 2018 will increase by 18.3% and amount to 460.3 billion rubles. However, it is not known whether the draft budget will be approved by the State Duma.

Domestic innovations in the field of medicine

Despite the fact that, in general, things in the healthcare system in Russia are not in the best way, this does not affect the level of innovation in any way. The state has always been famous for its great minds, therefore, even in difficult years for the economy, some new discoveries and useful inventions appear in the Russian Federation. The TOP-5 medical innovations in the country in 2017 included:

1. iHematologist.

   This is an expert system that allows you to fully decipher the blood test, thereby diagnosing dozens of types of diseases. To do this, a person does not even have to leave the house. All that is required is to enter the data of your blood test on the site. In return, the service will provide comprehensive information about the state of health.

2. Life button.

   This is a kind of mobile phone, on which there is only one button - emergency assistance. The gadget is equipped with a GPS navigator, which determines the location of a person with high accuracy. The data is sent to a round-the-clock service center, which communicates with the Ministry of Emergency Situations and other services. Such a system is designed to help the elderly and the disabled, who are not properly cared for.

3. Vita Vallis.

   This is an antimicrobial sorption material developed by Akvelit, a Tomsk company. Its main purpose is to protect the body from various infections and viruses. It is a potential alternative to antibiotics. The principle of action is based on the natural mechanism of suppression of microbes inside the dressing. In other words, the infection is destroyed not toxically (under the action of antibiotics) but due to physical processes.

4. oriense.

   This is a device to help people with visual impairments. It is installed on a person's chest in order to analyze the environment. The built-in speech adapter instantly informs a person about the obstacles that are in his way, and how to get around them. Oriense is a resident of the Skolkovo International Center.

5. 3D Bioprinting Solutions.

   A Russian laboratory that has been developing technology for 3D bioprinting for many years. In simple words, this is a technology that allows you to print organs on high-tech 3D printers. The first demonstration of this project in operation was held in the summer of 2017.

As in all developed countries, there are separate clusters in Russia that support high-tech start-ups in the field of medicine. Innovations are being actively implemented not only in various areas of healthcare, but also in the system of interaction between a doctor and patients. For example, the Teledoctor service, recognized as the best startup in 2014, allows you to get a remote consultation from a specialist.

Conclusion

The situation in the healthcare system of the Russian Federation looks twofold: on the one hand, the number of medical institutions is sharply decreasing, on the other hand, mortality from diseases is declining and innovative technologies appear on a regular basis that can change the life of mankind for the better. In general, there is a desire of the government to improve the situation, only the economic factor hinders - an elementary shortage of the budget.

Results of 2005-2011

The performance of any health care system is evaluated in terms of population health and demographic indicators, incl. by life expectancy (LE 1) and total mortality rate (ACS 2). Figure 1 shows the dynamics of the crude mortality rate (CDR) in the Russian Federation in the period from 1980 to 2011 and forecasts until 2020.

Rice. 1. Dynamics of ACS in the "old" and "new" countries of the European Union and the Russian Federation, forecast of ACS in the Russian Federation until 2020

This figure clearly shows that the implementation of the priority national project "Health" in the period 2005-2008. and a certain improvement in the socio-economic situation in Russia reduced the value of the ACS by 9% (from 16.1 to 14.6), which saved the lives of 450 thousand citizens of our country. Even a small annual investment in this project (10% of total government spending on health) in 4 years caused positive changes in the health status of the population.

In the period from 2008 to 2010, the value of TAC practically did not change, the decrease was only 3% (14.6 - 2008, 14.2 - 2009, 14.2 - 2010). This is due to the economic crisis of 2008-2009. and the stagnation of real, inflation-adjusted public health financing during this period. However, in 2011, due to the fact that the country's leadership decided to increase government spending on health care by 14% (or 220 billion rubles annually due to an increase in the rates of insurance contributions to the compulsory medical insurance system by 2%), the mortality rate in 2011 compared with 2010 decreased by 100 thousand people and the ACS decreased by 5% (from 14.2 to 13.5).

The most important lesson of these two periods - the increase in health care funding and the political will of the country's leaders made it possible to achieve a noticeable improvement in the demographic indicators in the country.

It should also be noted that as a result of the implementation of the programs of the Ministry of Health and Social Development of the Russian Federation in the period from 2008 to 2011, the following positive results were achieved in terms of other demographic indicators: life expectancy of citizens of the Russian Federation reached 70 years in 2011; for the first time in many years, an increase in the number of Russians to 143 million people was ensured; mortality from circulatory diseases decreased by 6.2%, from tuberculosis - by 7.4%, from road accidents - by 5.6%, from neoplasms - by 1%. Infant mortality also continues to decline, in 2011 this figure was 7.3 per 1,000 live births, and in 23 regions of the country, infant mortality is comparable to the level of EU countries (data from the report of the Minister of Health and Social Development “On the results of the work of the Ministry Health and Social Development of the Russian Federation in 2011 and Tasks for 2012”).

Figure 1 also shows the value of the GAC - 11.0, which is taken as the target in the Concept of long-term socio-economic development of the Russian Federation for the period up to 2020. If the GAC will decrease along the dotted line shown in Figure 1 (to the level of 11.0), then by 2020, 2.5 million lives of our citizens will be saved. However, this will require a much more intensive development of the health system and a more significant increase in its funding.

Unresolved health problems

Today, in the healthcare system of the Russian Federation, despite some achievements of the past years, serious problems have accumulated that will hinder the solution of the set tasks aimed at improving the health of the population, increasing the availability and improving the quality of medical care. Among them the main ones are:

1. Underfunding of the public health system by at least 1.5 times. There is no sufficient funding - there is no decent salary for medical personnel, there is no sufficient provision of the population with free medicines, there is no way to comply with modern standards of treatment and provide hospitals with modern equipment and consumables. Thus, in the Russian Federation in 2011, government spending on health care (including spending on the program of state guarantees, education, investment in infrastructure and sanitary and epidemiological well-being) amounted to 1.7 trillion rubles, or 4% in the share of GDP, which is 1 .5 times lower than the average in the "new" EU countries (6% of GDP). It should be noted that these countries have a GDP per capita per year close to that of the Russian Federation - about $20,000 PPP3, i.e. as economically developed as Russia.

More funding for health care allows these countries today to have a life expectancy of 76 years and an ADR of 11.0, i.e. even better indicators than those we want to achieve by 2020. It follows from this that further expansion of free medical care will require a 1.5-fold increase in funding, which amounts to about 800 billion rubles. annually.

2. The second important problem is the shortage and suboptimal structure of medical personnel. If there are no doctors, there will be no affordable medical care. It is the doctor who provides the throughput of the health care network. Today, the provision of doctors in the Russian Federation per 1,000 population, excluding sanitary and epidemiological personnel and dentists, in the Russian Federation was 4.5, which is 1.5 times higher than the average in OECD4 countries, where it is 3.1 doctors per 1 thousand population. However, in the Russian Federation, the incidence and mortality of the population is 40-50% higher (see below) than in the OECD countries on average (accordingly, the need for medical care is also higher), so the assertions of some experts about an excess of doctors in Russia are unfounded.

Moreover, in the next 5 years, a significant shortage of medical personnel is predicted in the Russian Federation, associated with low wages for their work - it is 22% lower than the average wage in the Russian Federation. If we compare the level of remuneration for a doctor in the Russian Federation with the same level of remuneration for a doctor in the "new" EU countries, then in these countries a doctor receives 1.5-2.5 times more than the average salary in these countries.

The shortage will also be associated with a high proportion of doctors of retirement and pre-retirement age (about 50%) and a demographic failure. Thus, the number of school graduates in 2011 compared to 2003 decreased by 2 times and, as a result, in 5-6 years the number of university graduates will decrease by 2 times. Attention should also be paid to the extremely low level of remuneration of the teaching staff of medical and pharmaceutical universities, which, of course, does not stimulate an increase in the level of student education. Thus, the salaries of teachers of these universities do not exceed 15-20 thousand rubles. per month, while even secretaries and drivers in commercial firms have significantly higher earnings.

3. The third most important problem is the unsatisfactory qualification of medical personnel and, as a result, the low quality of medical care. No doctor is bad, but no qualified doctor is also bad. Insufficient qualification of medical personnel is manifested in unsatisfactory indicators of the quality of medical care in comparison with developed countries. For example, the survival rate of patients with breast cancer, the in-hospital mortality rate, the proportion of patients who received infectious complications in hospitals in the Russian Federation are 2 times higher than the average in OECD countries.

4. The fourth problem is the backlog of standards for the volume of medical care under the Program of State Guarantees (SGBP) of free medical care to the real needs of the population of the Russian Federation. It is this problem that causes queues in polyclinics, problems with the availability of medicines and high-tech medical care. For example, from 1999 to 2010, the standards for the volume of medical care for the SGBP did not change, and for a number of types of care they even decreased; at the same time, the incidence of the population (which determines the need for medical care) in the period from 1990 to 2010 5 times, and the proportion of the elderly population increased by 4%.

Our population is also insufficiently provided with free medicines on an outpatient basis, by prescription in polyclinics. Thus, in 2010, per capita spending on drugs from public sources in the Russian Federation was 5.6 times lower than in OECD countries (respectively, they amounted to $45 and $250 PPP), and 3 times lower than in the “new » EU countries, and this is at almost the same prices for medicines in our country and in them (Fig. 2) .

Figure 2. Total and government per capita spending on outpatient drugs in different countries

Moreover, today in the Russian Federation, mostly disabled people (about 13 million people) and a number of other few categories of citizens are entitled to free medicines, while in developed countries all the needy population is fully or partially provided with free medicines at the expense of state funds.

5. The fifth problem is the very low volume of high-tech medical care. For example, the number of revascularization operations on the heart (i.e., restoration of patency of the heart vessels), which make up 25% of the volume of quotas for high-tech medical care, is performed in the Russian Federation 5 times less than in the "new" EU countries, on average, hemodialysis procedures - 4 times less, the number of knee and hip arthroplasty operations - 6.5 times less (Fig. 3). Accordingly, the volume of these types of assistance within 5 years will need to be increased by at least 2-3 times.

Rice. 3. Number of knee and hip arthroplasty operations per 100,000 population

6. The sixth problem is the inefficient management of the industry at all levels. For example, in the Russian Federation there is no strategic planning and responsibility of managers at all levels for achieving results (including annual reports) according to indicators adopted in developed countries, for example, indicators of the quality and safety of medical care, performance efficiency. Poor management is manifested in the irrational distribution of public funds. So, the emphasis government programs is spent on poorly controlled investment costs (construction and purchase of expensive equipment) that have a high risk of corrupt payments, instead of developing prevention and human resources. There is an inefficient use of equipment and beds. Also, cost-effective management tools are not used enough, such as competition on the basis of quality when purchasing medical care from health care providers, ratings of health facilities, and the use of economic incentives to achieve planned results.

External challenges to the healthcare system of the Russian Federation until 2020

When developing a health care program, demographic and socioeconomic challenges must be taken into account. The main demographic challenge that will require serious attention to the health of working-age citizens is the annual reduction of 1 million of the working-age population, or 9 million people by 2020.

One should also take into account the expected reduction in the birth rate due to a 15% decrease in the number of women of childbearing age by 2020; the factor of population aging (for example, the proportion of the population older than working age will increase by 5% by 2020). It is also necessary to note the unsatisfactory indicators of children's health (about 40% of children are born sick or fall ill during the neonatal period; in 1990 this figure was 17%) and the constant increase in the incidence of the population; respectively, and the need for medical care. For example, in 2010, 228 million cases of acute and chronic diseases were registered in the Russian Federation, which is 1.5 times more per 100,000 population than in 1990. The citizens of our country also lead an unhealthy lifestyle: the proportion of adult smokers and alcohol consumption per capita per year in Russia is almost 2 times higher than the average in developed countries.

It should also be taken into account that the most important socio-economic challenge is the dissatisfaction of the population with the quality and availability of free medical care (2/3 of those dissatisfied), which is associated both with insufficient funding for free medical care and the inability of the majority of the population to pay for this care on their own (55% population lives on monthly incomes of less than 15 thousand rubles).

New legal framework

The laws “On Compulsory Health Insurance in the Russian Federation” (Federal Law of November 29, 2010 No. 326-FZ) and “On the Basics of Protecting the Health of Citizens in the Russian Federation” (Federal Law of November 21, 2011 No. 323-FZ) will help solve health problems only partially. Thus, the Law “On Compulsory Medical Insurance in the Russian Federation” provides for serious positive norms:

Centralization of financing of the CHI system at the level of the Federal CHI Fund;

Rationing of tariffs for insurance premiums for the non-working population;

Changing the structure of the tariff for CHI - from 2013, the inclusion of expenses for the maintenance of the institution, as well as the inclusion of emergency medical care (2013) and high-tech care (2015) in the CHI system, i.e. organization of single-channel financing;

Increasing the responsibility of the regions for the provision of primary care;

Mandatory implementation of the procedures and standards of medical care within the framework of territorial CHI programs and the formation of criteria for the effectiveness of these programs.

At the same time, there are certain risk factors in the implementation of this law, which will require their solution in other federal laws or by-laws. For example, the centralization of funding with the subsequent redistribution of funds to the regions in the face of a general shortage of these funds may jeopardize the volume of healthcare financing in relatively wealthy subjects of the Russian Federation; consequently, doctors' salaries may suffer. Further, this law focuses on measures to expand the rights of the patient to choose a doctor and a medical organization without taking into account the territorial principle of attachment of the population, stages and levels of medical care to patients, which will entail additional costs in the system. The task is not to give the patient freedom of choice, but to ensure the availability and quality of medical care in most medical organizations (and these organizations, as a rule, are located at the patient's place of residence).

As for the Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”, several positive norms should also be noted.

Transfer of powers to provide primary health care and emergency medical care from the municipal level to the level of the subject of the Russian Federation. This norm is dictated by the fact that most municipalities did not have enough funds to provide these types of medical care. "Poor" health care systems (as in the Russian Federation) should be centralized: it is easier to manage and control them.

Regulations on the provision of medical care according to the precinct-territorial principle, the use of a referral system. These provisions eliminate the risk of reducing the coordination of medical care to the population, introduced by the provisions of the draft law "On Compulsory Medical Insurance", which declare the patient's right to choose a doctor and medical organization.

The law also correctly resolves certain highly specialized health issues: in pediatric transplantation, in the treatment of orphan diseases, in the use of reproductive technologies, etc.

All these issues are important, but the primary goal of the country's main law on protecting the health of citizens is to consolidate the organizational and financial mechanisms for protecting and strengthening the health of all citizens of the Russian Federation, as well as for providing affordable and high-quality medical care to all sick people. Unfortunately, these issues are not properly reflected in the Law "On the fundamentals of protecting the health of citizens in the Russian Federation", it does not solve these problems. Moreover, this law will increase the discontent of the population (due to the risk of reducing the guarantees of free medical care), as well as medical workers, since it does not improve their situation.

Priorities and tasks for the development of health care until 2020

When forming priorities and tasks until 2020, it is necessary to take into account the goals for improving the health of the population set by the Government of the Russian Federation by this date. In accordance with the Concept for the Long-Term Socio-Economic Development of the Russian Federation for the period up to 2020, we must significantly improve the health indicators of the population, namely: increase the life expectancy of the population from the current 705 to 73 years and reduce the crude mortality rate from 13.5 cases to 1 thousand population to 11.0.

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Introduction

1. Health economics

2. Problems of health economics

3. Types of health care efficiency

4. Methodology for economic analysis of the activities of health facilities

5. Problems of pricing for medical services

6. Health planning

7. Health financing

8. Main sources of financing for health care facilities

9. Estimated medical institution

10. Paid medical services

List of used literature

Introduction

In the Russian Federation, health care guaranteed free and publicly available medical care to all citizens. The practice of financing the industry at the expense of funds state budget led to a constant decrease in the share of spending on medicine in the total amount of budget allocations. As a result, insufficient funding, on the one hand, and irrational use of funds, on the other, led the industry to a critical state. The sharp drop in most of the indicators characterizing the level of medical care has made it obvious that there is a need for a fundamental restructuring of domestic health care.

One of the ways the industry got out of the crisis was the introduction of new forms of management, planning and financing into the healthcare system, starting from the early 1990s. During this period, an active search began for optimal forms and methods of management in the new economic conditions.

The practical experience of implementing the reform in health care has shown that the most important issue has not been resolved - the residual principle of health care financing has not been eliminated. In addition, there was no mechanism for reliable control of the required volume and quality of medical care.

It is known that a simple increase in appropriations for any sphere of activity does not allow us to count on a corresponding increase in its efficiency. In conditions economic crisis there were real prerequisites and social need for a radical restructuring of the entire health care system.

In modern conditions, the development and improvement of the optimal model of management and financing of healthcare, which combines social orientation and elements of market relations through medical insurance, is of particular importance.

Medical insurance is a form of social protection of the interests of the population in the protection of health and is a set of types of insurance that provide for the obligations of the insurer to make insurance payments in the amount of partial or full compensation for the additional costs of the insured for medical services included in the health insurance program (guaranteed list of medical services provided all categories of the population and financed from the MHI).

The purpose of health insurance is to guarantee citizens in the event of insured event(diseases) receive medical care at the expense of accumulated funds and finance preventive measures.

Thus, the essence of insurance lies in the creation of a mechanism for financial relationships between subjects of health insurance. Such a mechanism, on the one hand, provides health care with financial resources through compulsory health insurance programs, and on the other hand, expands the list of these programs with additional services, being part of the insurance market.

1. Health economics

The market economy, which is being formed in Russia and gradually more and more covering various fields of activity, has its own principles, which include:

freedom of choice of types and forms of activity;

the generality of the market;

Equality of market entities with different forms of ownership; self-regulation of activities; the principle of contractual relations;

freedom of pricing;

self-financing;

decentralization of management and independence;

economic responsibility;

state regulation;

Competition and mechanisms of social protection.
Health care in the conditions of a modern market economy to some extent uses its laws and principles to solve its problems, therefore, knowledge of the fundamentals of a market economy is so necessary for healthcare professionals. System economic sciences includes political economy, economic theory, branch economic sciences. Health economics is one such economic science.

HEALTH ECONOMY- This is a branch of economic science that studies the problems of efficient use of limited health care resources, managing them to maximize the satisfaction of people's needs for health, goods and services for medical purposes.

The functioning of the health care system, like any other industry, requires a legal, economic, structural or organizational and socio-psychological basis. For the harmonious formation of the foundations of health care in the new conditions, specialists need to have economic thinking based on the study of how rational decisions are made based on a comparison of results (benefits) and costs (costs). When studying health economics, two main categories are considered in detail: cost and effectiveness.

The ultimate goal of all economic activity is to satisfy the diverse needs of people, including needs for health goods and services, for health.

2. Health Economics Issues

The steady rise in the cost of medical services has required many countries to address the problem of efficient use of expensive hospital beds. In this regard, the idea of ​​differentiated care for patients in a hospital has acquired particular relevance, including the creation (re-profiling) of medical institutions for short- and long-term stay of patients, the formation of structural units of hospitals that differ in the degree of intensity of treatment and care in them: divisions (wards) of intensive treatment and care, rehabilitation; deployment of medical and social institutions of nursing care hospitals for the chronically ill, the elderly and the disabled. This redistribution of available beds is based primarily on economic factors. Maintaining one bed in a hospital costs almost 2-2.5 times more than in a nursing home. The economic efficiency of nursing beds is confirmed by the results of numerous foreign and domestic studies.

The intensification of assistance provided to patients and the corresponding reduction in the length of their stay in hospitals, the organization of a wide network of hospitals (departments) of nursing care, the provision of assistance to the population directly at home, provided that nursing personnel are highly qualified, are for this one of the possible ways to maintain the volume of medical and medical and social assistance. population and to a large extent one of real ways solutions to economic health problems.

An analysis of mhoi lent studies carried out in various countries to identify the most needs for nursing care indicates the universal nature and absolute coincidence of these needs in all regions of the world. A highly skilled nursing workforce is critical to the efficient and effective operation of health services in four main areas:

preventive assistance to the population;

treatment and diagnostic care (about 80% of nurses work in hospitals, monitoring the patient's condition, working with modern medical equipment, making professional decisions and providing comprehensive care are a reflection of the quality of medical care in a medical institution);

rehabilitation assistance and medical and social assistance to the chronically ill, the elderly and the disabled; provision of medical and social assistance to incurable and dying patients.

3. Types of health care efficiency

Health economics studies the conditions and factors that ensure maximum satisfaction of the needs of the population in goods and services necessary to maintain, strengthen, restore health, at minimal cost. Economists analyze:

The impact of public health on the economic development of the country, regions, production, etc.;

The economic effect of medical and preventive care, prevention, diagnosis, treatment, rehabilitation, elimination of diseases, reduction of disability and mortality of new methods, technologies, organizational measures, programs, etc.

One of the most important concepts of health economics, the subject of economic analysis is efficiency. In health care, medical, social and economic efficiency are distinguished.

Medical Efficiency- this is the degree (effect) of achieving the goals in the field of prevention, diagnosis, treatment, rehabilitation, i.e. four main types of medical activity. The World Health Organization considers medical efficiency as one of the aspects of the quality of medical care along with adequacy, economy and scientific and technical level.

Social efficiency- has a broader meaning, although it is closely and directly related to medical effectiveness. Social efficiency is characterized by the dynamics of public health, the criteria for social efficiency are indicators of public health.

Economic efficiency- is determined by the ratio of the effect (result) and costs. Cost-effectiveness analysis is necessary for health care management in a resource-limited environment, when the most important problem is to achieve maximum results at minimum cost.

4. Methodology for economic analysis of the activities of health facilities

Evaluation of medical activity is quite reasonably given a central place in the complex of basic management functions. Rational, scientifically substantiated implementation of the evaluation function ensures the fulfillment of the main condition for effective managerial influence - the formation of the information base of the management system. A scientifically based system for evaluating medical activity should have a clearly defined methodological foundation, represented by a general systems theory, a general management theory and its numerous derivatives, qualimetric principles and methods. Exact adherence to the main theoretical provisions and principles that make up the methodological basis of valuation activities is one of the prerequisites for the success of the development and practical application rating systems. It is extremely important to take this circumstance into account when organizing valuation activities at the level of a particular object.

When evaluating health facilities, the following is carried out: evaluation of the efficiency of the use of hospital beds and the efficiency of the staff. For the analysis of the first indicator, the following input variables were selected: the total number of treated patients, the number of beds in health facilities, costs (salary, payroll, food and medicine costs per treated, etc.). The number of treated patients and the average duration of treatment are taken as output variables. After carrying out calculations according to the model, the value is obtained integral indicator the effectiveness of the use of beds in medical facilities. When evaluating the performance of health facility staff, the number of doctors, the number of nursing staff, the number of junior medical staff and the number of other personnel are taken as input variables, and the total number of patients treated and the number of beds in the health facility are taken as output variables.

5. Problems of pricing for medical services

In a market economy, the most important problem is pricing, since real incomes and, consequently, the capabilities of medical institutions depend on its rational solution. Pricing is related to financing, which provides manufacturers of medical services and health products with the opportunity to sell goods and services at appropriate prices. The possibility of normal market pricing in healthcare is determined by the ratio of the cost of goods and services and the possibilities of financing their payment from various sources permitted by law. Price - the monetary expression of the value of the goods, payment. Since Russian healthcare is to function in a market economy, it is necessary to consider the fundamentals of the market pricing mechanism in relation to the possibility of its use in healthcare. The market pricing mechanism does not negate the preliminary calculation of prices based on pricing models. For manufacturers of products, goods and services (which include healthcare institutions), a preliminary estimated price estimate is necessary so as not to "burn out" in the implementation process. According to market economy experts, knowledge of price calculation methods is also necessary because the path Russian economy the market is very long, and on this path prices determined by calculation and imposed from above will not soon give up their positions.

In addition, the inevitable government regulatory impact on prices should also be based on the use of pricing models. The foregoing fully applies to health care, for which the state remains, in accordance with the sources of real financing, the main "buyer" of goods and services. In the health care economy, prices perform accounting, distributive, stimulating functions. In a developed market, certain pricing principles apply:

the price should reflect the necessary labor costs for the production of goods and services, their consumer properties and qualities;

the price should provide compensation for costs and profit for a normally operating commodity producer;

The price should encourage cost reduction;

The price should stimulate the improvement of the quality of products, goods and services.

When paying for medical services and for financing health care institutions in modern Russia used: budget estimates of medical work, list (tariff) prices for ward medical services, tariffs for medical services under compulsory medical insurance programs, contractual prices. The law does not yet provide for the use of free prices in the legitimate market of medical services. The contractual prices that are used in commercial medicine and in voluntary health insurance are closest to free, market prices.

6. Health planning

Top managers (managers) are managers who are responsible for decisions for the organization as a whole or for a significant part of this organization (for example, at the level of health care in the Russian Federation or a constituent entity of the Russian Federation).

Managers in an organization who are directly above the level of non-managerial personnel are called line managers or lower-level managers (for example, heads of offices or departments in medical institutions).

Modern healthcare management is characterized by decentralization, concentration of greater responsibility at low levels of management, and, above all, at workplaces. In this regard, knowledge of the basics of management technology becomes necessary not only for professional managers, but also for ordinary employees. Control technology is a system of operations and procedures performed in a certain sequence. The sequence of actions leading to the goal is called the control algorithm. This sequence can be associated with the main functions of management - planning, organization, leadership and control.

Planning includes the collection, storage, processing, analysis of information (the first part of the management cycle), the development of alternative solutions, the selection and adoption of the optimal decision (the second part of the management cycle). Planning methods: analytical, normative, budgetary, method of ratios and proportions, experiment and modeling, special attention is paid to the system and situational approach and economic analysis in planning. Modern planning is usually called program-targeted, since it should be based on target program, specific reasonable measures to ensure the achievement of the goal at minimal cost. healthcare economic pricing medical

Organization- this is the creation of conditions for the implementation of the adopted management decisions, the implementation of plans and programs, the provision of the necessary financial, logistical, informational and other resources for this.

Management- this is the creation of people who carry out management decisions, motives for their implementation. At this stage, organizational and administrative methods are applied (orders, recommendations, instructions, permissions, authorizations), economic methods, bonuses, economic incentives, various forms of cost accounting (social and psychological methods, encouragement, punishment, formation of public opinion, etc.).

The control- allows feedback, completes the management cycle, current control allows you to adjust decisions and their implementation in accordance with the situation.

Planning and control are associated with information, its collection, storage, processing, analysis. This work can and should be automated.

7. Health financing

The state, by means of laws, determines the sources of financing for health care, depending on the needs of society, the type and real possibilities of the country's economy. According to experts, health care costs as a percentage of GNP (gross national product) or, as they say more often in our country, GDP (gross domestic product) range from 3% to 14%. WHO experts believe that in order to solve the main health problems, society's costs should be at least 6-9% of GNP, and to meet the needs of the population in modern medical care with a high level of quality, at least 12% of GNP. However, the level of public spending on health care does not automatically solve all problems. To solve them, it is necessary to spend funds with maximum efficiency. Currently, the legal basis for financing health care is determined by the Constitution of the Russian Federation, the Fundamentals of the Legislation of the Russian Federation on the Protection of Citizens' Health, and the Law "On Health Insurance of Citizens in the Russian Federation".

In accordance with the Constitution (Article 41), federal programs for the protection and promotion of public health are financed in the Russian Federation, and measures are taken to develop the state, municipal and private healthcare systems. Medical care in state and municipal health care institutions is provided to citizens free of charge at the expense of the relevant budget, insurance premiums, and other revenues.

The sources of funding for health protection are indicated in Article 10 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, they are:

Funds of budgets of all levels.

Funds allocated for mandatory and voluntary health insurance in accordance with the law of the Russian Federation "On medical insurance of citizens in the Russian Federation".

Means of trust funds intended for the protection of the health of citizens.

Funds of state and municipal enterprises, organizations and other economic entities, public associations.

Income from securities.

Loans from banks and other lenders.

Gratuitous and/or charitable contributions and donations.

Other sources not prohibited by law.

The sources of funding for the health care system itself, medical care for citizens are defined in Article 10 of the law "On Health Insurance of Citizens in the Russian Federation.

From these sources, the financial resources of the state, municipal health care systems and the state system of compulsory medical insurance are formed.

8. Main sources of financing for healthcare facilities

The financial resources of the state compulsory medical insurance system are formed at the expense of deductions from insurers for these purposes. All of the above can be represented in the form of a diagram shown in Fig. 1. In general, the financial and economic support of the activities of healthcare facilities is a determining factor in financial stability, solvency, and competitiveness of healthcare institutions. At the same time, of course, financial resources are of paramount importance, as a set of funds (own and borrowed) that are in economic circulation and used in the process of medical and economic activities. To increase volume financial resources interaction with the financial environment of health facilities is necessary. The financial environment is the sphere of interaction between the subjects of financial relations. For health care facilities, such entities are: state budget bodies, banks, foreign exchange funds, insurance and leasing companies, pension funds, territorial compulsory medical insurance funds and medical insurance organizations.

Today, however, health care facilities are also looking for internal financial sources. The latter include:

Income received from paid medical activities;

saving financial resources;

sale of "know-how", methods of treatment, training programs, etc.;

rent, if the rent is authorized by a higher authority;

accumulated reserve funds (for example, a reserve fund, which is created in the context of the development of paid medical care).

All this forms the mechanism of mixed budget-insurance financing of medical care to the population.

	Sources of financing for a healthcare institution
	Budget resources CHI funds VHI funds Charitable funds - loans
	INTERNAL: Income (profit) from paid medical activities; Saving financial resources; Sale of "know-how"; Rent (with permission); Accumulated reserve funds;
CONCLUSION: at present, a multi-channel system of financing health care facilities has developed, however, the main sources are budgetary funds and compulsory medical insurance funds

Rice. 1 HCI financing scheme

9. Estimated medical institution

In Russia, financing of health care institutions from the state budget is carried out according to the cost estimate. The estimate was financial plan institutions where the costs of the institution were recorded under the approved items. Expenses under budget items were determined on the basis of strict standards, funds were used exclusively for their intended purpose, money not used during the year was returned to the budget. Misappropriation of funds that did not correspond to budget items was practically impossible, it was considered a financial crime.

Initially, there were eighteen articles in the estimate, then individual articles were excluded, and by the beginning of economic reforms, the estimate of medical institutions included the following articles:

Article 1. Wages.

Article 2 social insurance workers).

Article 3. Office and household expenses.

Article 4

Article 8 Scholarships

Article 9

Article 10. Acquisition of medicines and dressings.

Article 12. Acquisition of equipment and inventory.

Article 14. Acquisition of soft goods and equipment.

Article 15

Article 16

Article 18. Miscellaneous expenses.

The total funding according to the cost estimate for the year was, as it were, the total price of the work performed by the medical institution, which was paid by the state during the year, mainly on the basis of prepayment, allocating money at the beginning of each quarter strictly according to the estimate of future expenses. With such financing, the principles and formulas of normal market pricing are not used, a distributive system operates, financing is carried out not according to need, but according to the residual principle.

The state, being the only buyer and not having sufficient funds, itself appoints and regulates the conditional price of works, goods and services in healthcare, providing the population, if possible, with free, affordable, qualified medical care in conditions of austerity, setting low wages and low prices for all goods needed by the health care system. When the state distribution of all the resources of the country is canceled, such a health care system becomes unacceptable; it cannot function in a market economy. Formed taking into account the costs of resources (labor, medicines, materials, equipment, etc.), the price according to financial legislation is divided into two components:

not subject to income tax (cost);

subject to income tax (actual income).

When calculating the cost of medical services, the structure of costs included in the estimates of medical institutions is used. The estimate has found a new application in pricing, as it reflects the main costs of producing medical services.

10. Paid medical services

Income from paid medical activities today is becoming an additional source of financing for a medical institution (HCI), along with the funds of compulsory medical insurance (CHI) and budget funds. If income is received, it can be used to stimulate the work of medical personnel, the social needs of the team, and to develop and expand medical activities.

Price-- this is the amount of money for which the patient is willing to buy, and the medical worker is willing to sell this medical service. The price structure consists of two main elements - cost and profit. The cost reflects the costs of providing a medical service, expressed in terms of monetary form. It includes: salaries of medical personnel, the cost of medicines, soft materials, rent, general institution expenses, depreciation of equipment (in rubles), etc.

Today in healthcare there are 5 types of prices:

budget estimates- this is the rationale for financing medical institutions on the basis of adopted regulatory documents;

state prices for paid medical services- these are the prices that are used for settlements between a medical institution and the population when providing medical care on a paid basis in a budgetary medical institution (as a rule, previously owned by the Department of Self-Sustaining Medical Institutions of the Ministry of Health of the Russian Federation);

rates-- these are sums of money intended to reimburse the expenses of a medical organization for the implementation of the territorial program of compulsory medical insurance;

contractual prices - these are prices that are approved by direct contracts between medical institutions and organizations, enterprises, other legal entities for the purpose of medical care for employees;

free market prices-- these are prices formed on the basis of supply and demand and depending on the conjuncture of the medical services market.

Pricing- one of the most difficult medical and economic problems of health care, which is due to a number of reasons:

1) the practice of accounting in health care facilities largely does not meet the requirements of pricing, since there is no separate accounting for many types of costs for services, departments;

healthcare as an industry has a complex structure, so it is impossible to use the same pricing methods for hospitals, outpatient departments, outpatient services, etc.;

the costs of diverse medical institutions affect the final cost of medical services in different ways.

The tariff in the MHI system includes 4-5 types of costs, i.e. not all costs of health facilities. Those costs that are not compensated by the tariff should be compensated by budgetary funds.

The amount of profit of health care facilities in relation to the cost is not legally defined. Moreover, in most regions of the Russian Federation, profit is not included in the calculation of the tariff. This is due to the insufficiency of the collected funds in the CHI system.

Accounting for the deflator is recommended by the pricing methodology in the CHI system. The deflator is an indicator of the increase in prices for the year for all types of goods and services. The inflation rate in the country shows the index of gross national product and the index consumer prices. They have different calculation methods, so they differ as indicators, but the general trends with prices reflect both of these indicators.

The given data is used in pricing in this way. For example, prices are calculated in 2005. Then they do not need to be recalculated in 2006 and 20077, but simply take the price of 2005 as the base price (ie, 100%). Then multiply it by the 2006 consumer price index (CPI) (price 2005 - 1.2). Then the resulting value must be multiplied by the 2007 CPI (2006 price x 1.09). Then we get the deflator-adjusted price of the medical service as of January 1, 2008.

However, prices may vary as it depends on specific economic conditions region (department). The price is always a compromise, it must be flexible and reflect the economic interests of both healthcare facilities and the population.

List of used literature

1. Babich A. M., Pavlova L. N. State and municipal finance. Textbook. - M.: UNITI-DANA, 2002.

2. Vakhrin P. I. Budgetary system of the Russian Federation. Textbook. - Publishing and Trade Corporation "Dashkov and Co", 2002.

3. Pole G. B. The budget system of Russia. Textbook. - M.: UNITI-DANA, 2001.

4. Romanovsky M. V., Vrublevskaya O. V. Budgetary system of the Russian Federation. Textbook. - M.: Yurayt, 2000.

5. Gerasimenko N. F., Kadyrov F. N. “Actual issues of legal regulation of economic aspects of the activities of healthcare institutions” // Healthcare of the Russian Federation, 2004, No. 2.

6. Baranov A.A. Formation of state policy in the field of health care in the Russian Federation: problems and solutions 2006, No. 6

7. Filatov V.B. World health care market: state and development 2006 No. 6

8. Starodubov V.I. Health Development Priorities 2006, No. 5

9. Yamschikov A.S., Popenko I.G. System Aspects of Performance Management in Healthcare 2004, No. 9

10. Odinokova E.S. Features of accounting of fixed assets in budgetary organizations 2004, No. 11-12

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