Close of the Conference - October 17, 1996

Reports from the Sections

Section 1: Professor Astrovskiy, Section on Management and Administration in Health Care

Questions discussed

1. Assessment of quality and quality control.
2. Criteria for outcome evaluation.
3. External expertise on quality control.

Shifting from hospital services to outpatient services requires some structural changes of institutions, changes in general practitioners to specialist ratios, and establishing criteria on how to pay for services provided.

4. Emergency Medicine a) What is an outcome? b) How are outcomes evaluated? c) What is good/bad quality in emergency medicine?

5. Computerization of hospital and outpatient data bases.

6. Do we need HMO's in the Russian Federation?

• a) Need to determine the difference between an HMO and a polyclinic.
• b) Peculiarities of financing of HMO's.

7. The best report was by Professor Kozlov, "Infancy/Maternity Protection". Methodological approaches to quality and quality control were discussed, but the necessary financial resources were not identified.

Section 3: Rector Kogurt, Section on Training Health Care Professionals

Problems mentioned

1. Poor financing.
2. Old curriculums.
3. Lack of psychological motivation in students to become good students.

Six year students are trained to become physicians, but is there a need to train administrators. It was suggested that students be divided into two groups - those who will become physicians and those who will become administrators.

Proposals to the Minister

1. Cut down basic education to four (4) years.
2. Introduce specialization both at the basic and post diploma levels.
3. Choose the Far East Medical University as the pilot university to realize the development of the new educational system.

Section 2 : Section on Financial Resources for the Health Care System

1. Health is an economic good.
2. We need in the structure of both the Ministry of Health and the Regional Funds an Administration Special Economic Councils. These Councils will control expenditures and calculate the economic gain or loss of various policies or programs.

Response of the Minister of Health of the Russian Federation

Many years ago we decided to make the patient the focus of the health care system. I do not believe that their is a need to train non-physician managers and administrators. Many American physicians agree with me.

It will be difficult for non-Russians to understand what Russian's consider a good physician. Russian's want a physician who will listen.

I would like to thank the Governor of the Khabarovsk Territory. The situation in the Khabarovsk Territory is much better than in many other regions. Khabarovsk has become the Medical Capital of the Russian Far East. Hospitals in Khabarovsk are used for the territory and not just the city.

I liked the presentations of the section I attended. The presentations were very good. Many practical workers, physicians and administrators are involved in research. All presentations were excellent. Khabarovsk is in the vanguard of health care reform. It is always pleasant. to places that are not afraid of innovation, but we must not be in a hurry to change without considering what is lost with the implementation of change. Existing systems may be very useful and beneficial and this benefit may be lost with the implementations of innovations.