Goals for the Khabarovsk/KRAI Health Care System: Part2

Goals for the Khabarovsk/KRAI Health Care System: Part 2 of 2

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4.4. To develop programs :

on of health for women and children; on cardiology; on oncology; on diabetes; on health of adolescents and youth; on active longevity.

4.5 Health management

4.5.1. to finish the development of the territorial informational system "Health";

4.5.2. to implement a balanced method to evaluate the results of the activity of health care facilities.

4.5.3. to implement a method for planning health care on the bases of established standards for the health care conditions and the volume of medical services delivered.

4.5.4. to establish a method for planning expenses for ambulatory -polyclinic service, based on a projection of per capita expense per year, including hospital expenses.

4.6. Provision of medicine and medical equipment

4.6.1. to finish the work on the development of a network of insured drug stores.

4.6.2. to supply the health care facilities with the basic medical equipment: diagnostic system - MRI 1 item CAT Scan 2 items apparatus for distant lithotripsy 2 items to upgrade the X-ray equipment of the hospitals in Khabarovsk and Komsomolsk-na- Amure.

4.7. Innovative policy in health care.

4.7.1. to establish a scientific-manufacturing medical corporation, with the Khabarovsk state university, on the base of big multi-profile hospitals in Khabarovsk and Komsomolsk-na-Amure;

4.7.2. to develop and implement programs of international cooperation for health care facilities in the territory on following problems: protection of health for women and children;

vaccine prophylactics; cancer; cardiology; diabetes; psychiatry and addiction.

4.8 Personnel policy in health care

4.8.1. to organize at the Khabarovsk medical university the institute of postgraduate education for those who work in health care.

4.9. Participation of public in their personal health maintenance.

4.9.1. to organize schools in the cities and regional centers of the territory to teach the population methods of basic medical care which can be provided as home care.

4.9.2. to open clubs encouraging healthy life styles.

V. Stage of creative development 2001-2005

5.1. Development of legislative base of health care.

5.1.1. to develop a Law in Khabarovsk territory "About securing the rights of patients in the territory of Khabarovsk"

5.2. Prevention of diseases .

5.2.1. to develop and implement a territorial program of diseases prevention for the population in Khabarovsk territory.

5.2.2. to develop and implement a territorial program for providing high quality water to the public.

5.3. Provide to the population access to quality medical service.

5.3.1. to develop ambulatory -policlinic services: to construct ambulatory-polyclinic facilities in Khabarovsk polyclinic in the region of the Street Bolshaya Vyazemskaya, children's policlinic in Kirov region policlinics for skin-disease and venereal health centers; in Ulch region-a policlinic at the hospital in Bogorod village; in Khabarovsk region-policlinic in Necrasov village; to finish work on the transition to the system of general practice physician.

5.3.2. to develop ambulance medical services: to construct a central sub-post for ambulance medical service in Khabarovsk; to equip departments of ambulance medical service in regional hospitals by purchasing ambulances with the equipment for intensive care; to organize rescue service in Khabarovsk and Komsomolsk -na-Amure.

5.3.3. Development of hospital service: to construct : in Khabarovsk - clinical building of the territorial children's hospital, manufacturing building of the territorial blood transfusion station , morphological building of the territorial bureau of the court-medical expertise, territorial maternity house; in Komsomolsk -na-Amure - children's hospital, laboratory building of the hospital # 2, maternity house; in Nikolayevsk-na-Amure surgical building of the city hospital; in Solnechniy region-hospital in village Hormuly; in the region named after Lazo- holiday hotel on the base of Muhin mineral spring; to finish the structural reconstruction of hospital service introducing stages of intensive therapy and final treatment.

5.4. To develop programs on increasing effectiveness of maintaining of lost health for different groups of the population

5.5. Provision of medicine and medical equipment.

5.5.1. to equip health care facilities with modern basic medical equipment:

- diagnostic system MRI 2 items CAT Scans 3 items

- immunological laboratory 7 items re-equipment of the laboratory of big hospitals in Khabarovsk and Komsomolsk na-Amure

5.6. Innovative policy in health care

5.6.1. to form a territory program of medical science development .

5.6.2. to organize territory medical clinics jointly with foreign partners.

5.7. Personnel policy in health care .

5.7.1. introduce the program of preparing specialists with advanced education at Khabarovsk medical university: in the fields of health management; economics; legal; specialists in management of "main" funds; specialists in preventative medicine, psychologists.

VI. Strategy of health care development in Khabarovsk area during the

period 1996-2005

The direction of the health care development in the territory represents the acting system and planned measures of the state to influence changes in health care and promoting reduction of mortality and morbidity of the population.

The policy of the territorial administration is aimed at the formation and function of such systems of health care, which would be able under market conditions: to realize effective prophylactic measures on preventing infectious diseases and identifying pathology at an early stage of disease; to restore health within a short period of time by providing the population accessible and qualified medical service; to use rationally the manufacturing, scientific and professional potential of health care in the territory; to attract a significant portion of the population to engage in the promotion of their own health.

The success of territorial health care and programs depends to a significant degree on the economic situation in the territorial and state policy of Russia in the field of protection of public health.

An important precondition to the solution of the problems of the health care development in the Khabarovsk area is the success of the Russian Federation Government Federal programs for the long-term development in the Far East through 2005. This program provides for equality of life throughout Russia, including protection of health of the population.

The main measures of Federal state support in the area of health care should be the following:

in the field of diseases prevention: protecting the environment, including water resources from waste harmful to the health of the population; providing resources for the construction of modern water purifying equipment and fluoridation of the water in big industrial centers; provision of means for conducting mass vaccination of the population against infection diseases; provision of means for early identification of infectious diseases.

In the field of development of material-technological base in health care: provision of resources for constructing and equipping the medical facilities in the regions for the native public in Priamurya; provision of resources for construction of the territorial parental center; provision of resources for taking care of new borns: "premature born and weak born" ; provision of resources for finishing the construction of a children's food producing shop in Khabarovsk;

- provision of modern equipment for the early diagnose and effective treatment of cancer, cardiovascular diseases, diabetes, kidney diseases and respiratory diseases.

In the field of developing medical science:

provision of resources for conducting a complex of scientific researches in the field of protection of women and children, protection from natural occurrences of infectious disease, protection of the natural environment; creation of scientific medical center department for Siberia at Russian Academy of medical science in Khabarovsk.

In the field of preparing medical personnel:

provision of resources for annual preparation of not less than 60 clinical interns and 20 post graduate students on the most acute areas of health care problems; -creation of the institute for post graduate teaching of health care personnel at Khabarovsk state medical university;

Realization of the proposed regional policy of the Russian Federation Government which will create a preferable precondition for development of stable health care the territory. Under conditions of economic and political instability and the resulting uncertainty of federal regional policy, the main burden for development and provision of stable conditions for regional medical facilities falls on the territory.

The policy of the territorial administration in the field of health care development should be accomplished through three stages.

At the stage of stabilization 1996-1997 - the key is to keeping the existing scientific and health care personnel in the territory producing. To concentrate the existing resources on solving the current and most important problems of health care in the territory. To encourage an active participation by the population in having healthy lifestyles and maintaining personal health.

In the condition of extremely limited financial resources the accomplishment of the above mentioned measures requires restructuring of the health care system, which consists of the reallocation of services currently provided in the hospitals to the ambulatory-policlinic level. This will permit achieving improved medical service outcomes for the patients with less expenses or achieving better results with the same expenses. In connection with this the work on reinforcing the structure of ambulatory-policlinic facilities is most important in the first plan. Besides improving the base of existing policlinics, establishing there day care treatment programs and departments of home health care, it requires the beginning of the transition of medical services based on the principles of family practice physicians. Khabarovsk medical university has begun preparing physicians of general practice. By the fall of 1996 there is a need to organize the activities in several policlinics in Khabarovsk and in the region named Lazo; in 1997 to start this work in the policlinics of Komsomolsk-na-Amure. An important moment in the development of general physician practice will be the introduction of capitated financing of the policlinics (the wishes of the population

will observed when implementing capitated financing) with consideration of expenditures on treatment at the hospitals.

During the period 1996-1997 it requires the providing a budget 10-12 billion rubles for the change of obsolete ambulances to the posts and departments of ambulance medical services. Health Managing agencies in the territory need to finish the transition to the sectional system of organization the delivery

ambulance medical services.

During the first two years of the plan there is a need to reallocate bed funds in the big hospitals in Khabarovsk and Komsomolsk-na-Amure to establish the treatment-diagnostic complexes of intensive treatment and medical rehabilitation. At the cost of the local budget, hospitals need to continue the equipping of intensive care rooms with modern equipment for conducting intensive diagnostic and treatment measures.

A big and complex need is to achieve improvement in health care management. Insuring common goals and objectives of health management agencies of the territory will allow the activities of medical facilities to be based on the health condition of the population with consideration of priorities for the development of different kinds of medical services.

To achieve rational usage of health care resources and increase the effectiveness of delivering medical services to the population the health administration agencies need to provide structures to manage the resources and medical processes.

The important direction of activity of health administration agencies should become the implementation of modern methods of planning, based on the systematic analysis and standards for delivering medical service.

Under the current acute shortage of health care finances the territorial administration needs to discuss the question of drawing additional resources from the existing "non-budget" funds, to establish the territorial and municipal "non-budget" funds for health care.

Being very pragmatic and with the constant increase in price for medicine, continuing to develop pharmaceutical programs at the medical facilities and a network of insured drug stores is very important. This will permit establishing formularies, to bring order to the list of medicines prescribed and will assist in stabilize the price of medicine and thus the entire cost of medical care.

Under conditions of limited resources, the effective use of new health care technology becomes important to permit treatment of patients in less time and thus reduce expenditures on more expensive hospital services. With this aim, development of the territorial innovative program becomes important and emphasis should be given to the cooperation of the territorial medical facilities with foreign clinics.

During the next two years it is important to increase the provision of highly qualified personnel to the health care institutions in the territory. During the first half of 1996 the program needs to be completed for the period of time 1996- 2001 "Personnel in health care in the Khabarovsk area". The primary focus of the program should be to provide medical personnel, to ambulatory and territorial hospital. With the aim of increasing the quality of medical services Khabarovsk medical university needs to continue the work on preparing physician for general practice, start the training of students on issues of management and quality medical services, start to prepare mid-level medical personnel with advanced education. For the expansion post graduate education, Khabarovsk medical university needs to open the institute of post graduate education. An important moment in fulfilling the measures in health care development during 1996-1997 should establishing laws in the Khabarovsk area regarding health care, medical and pharmaceutical activity and medical insurance. This legislation will establish the legislative base for state regulation of relationship between all individuals and organizations participating in the area of public health.

On the stage of economic raise in 1998-2000

Primary attention should be focused on prophylactic measures. With this aim information needs to be spread widely among the population of the area emphasizing the importance of healthy life styles; programs need to be developed to protect and improve the nature environment; and provisions need to be made so the population will have a safe and secure food supply. At the same time a significant portion of these programs need to be done at the cost of the federal government; at the cost of other budget items; and by the investment of organizations in all forms of property, including foreign. Programs of physical wellness and health maintenance of the population and prophylactics of teeth cavities are important. To achieve early identification of disease and provide access of the rural population to special kinds of medical service, groups of specialty health care providers need to travel to the territorial health care institutions.

With the aim of improving the effectiveness and efficiency of resources utilization and improving the quality of medical service, work needs to be completed on establishing: profile clinic-diagnostic complexes in the territorial health care institutions and multi-specialty hospitals in Khabarovsk and Komsomolsk-na-Amure, enabling them to provide hospital services to the patients the intensive treatment and final treatment stages.

Additional progress should be made on the development of the system of general practice physician, especially in Khabarovsk and Komsomolsk-na-Amure.

All policlinics must organize the department of home health care.

Khabarovsk needs to establish a rescue service based on rural posts of ambulance medical service with participation of agencies of internal (domestic) affairs.

In big hospitals in Khabarovsk and Komsomolsk-na-Amure there is a need to organize departments for treating patients within one day - same day surgery.

The Far East medical center needs to established a program with the technology of aorta-coronary shunt and distance lithotripsy, which will permit significantly reduced mortality of the population from ischemic-heart disease and from severe and complex kidney stone diseases.

For the more balanced development of prioritized directions in health care of the territory, there is a need to develop and implement the programs of protection of the health of women, children, teenagers and youth, and old people.

By drawing on the federal resources, private investments and the territorial budget, the programs in cardiology, oncology and diabetes need to be established and the construction of the 14 medical facilities and renovation of 16 medical institutions in the area needs to be realized.

In improve health management there needs to be establish a common information system "Health" to provide a common method of planning for health care based on standard conditions and objectives for delivering medical service.

With the aim of reducing the time to diagnose disease re-equipment of city hospitals by modern diagnostic systems needs to occur most the funding needs come from federal sources.

For increasing the effectiveness of establishing measures to protect the population's health, integration of medical science and practical health care needs to occur by establishing a scientific-medical cooperation at the big hospitals in Khabarovsk and Komsomolsk -na-Amure, and active participation of health care institutions of the area in the international programs.

The further development requires a legislative base in health care. During the period of 1998-2000 it needs to work out the Laws in Khabarovsk area: about the state, municipal and private systems of health care; about prophylactics of diseases.

This will allow the strengthen of the role of state agencies in increasing the responsibility of employers in protection of the employees health.

At the stage of creative development 2001-2005

effective measures on prophylactics of diseases and rehabilitation need to be conducted. With this aim the territorial program on prophylactic of diseases needs to occur, the primary method of providing these measures are by providing the population with quality drinking water and safe healthy food products. Most of the measures of the program are suggested to be at the cost of the federal budget.

During this period of time the work should be completed on the transition to ambulatory-policlinic services in the area, according to the system of family practitioners. At that time up to 70% of volume of the work of family practitioners should be spent to provide prophylactic measures. Rescue services should be established for the people in Khabarovsk and Komsomolsk-na-Amure.

Work needs to continue on the reequipping of health care institutions with modern diagnostic equipment with an emphasis on labs diagnostics. With the aim of changing the "old main funds" and the development of medical service in modern conditions, there is need for construction of 14 units of health care structures for different purposes.

Further increasing the effectiveness of the delivery of medical services to the population will require conducting territorial programs of medical science and rehabilitation with different groups of the population and the establishment of medical clinic in the area together with the foreign partners.

In the development of the legislative base for health care a law to protect the rights of patients will be needed in Khabarovsk. It should increase the responsibility of people for causing harm to the health of others, promote the development of voluntary medical insurance and insurance for the risk of medical malpractice in the area. A significant role belongs to the professional medical associations, which should participate in increasing the professional knowledge of medical workers and protecting their professions from incompetent doctors and nurses.

Suggested measures of state support in developing health in the territory, both at the federal and area levels, presents conditions for increasing the ability of institutions of preventive health care and rehabilitation. This will protect the labor resources of the area and thus improve their productivity.

Head of the health administration of Khabarovsk area

April 30, 1996

Goals for the Khabarovsk/KRAI Health Care System: Part 2 of 2

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Last Updated: October 10, 1996

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