Features of Financial Resource Management in Healthcare Organizations of Various Forms of Ownership

The dissertation is devoted to the study of the features of financial resource management in healthcare and preventive organizations (LPO) of various forms of ownership in the context of the reform of the Russian healthcare system and the transition to multi-channel financing. The work covers the analysis of the methodology and research base, the legal aspects of the activity of state, municipal, and private LPO, as well as the financial activity of medical organizations in the Noginsk District of the Moscow Region. Special attention is given to the role of financial management and leasing as mechanisms of resource provision for medical institutions.

The research includes the study of public opinion as a source of information for the management of financial resources, a systemic analysis of the use of financial funds in healthcare institutions of the region, and an assessment of the experience of applying new financial management technologies in organizations of various forms of ownership. The work is aimed at developing proposals for increasing the efficiency of financial resource use in healthcare and preventive organizations under market economy conditions and multi-channel financing of healthcare.

Reform of the healthcare system in Russia, the formation of a domestic market of medical services under conditions of weakening state monopolism requires the adaptation of classical methods and the search for adequate methods and forms of management (O.P. Shchepin, 1987, 1990, 1999; V.O. Shchepin, 1993, 1995; V.P. Korchagin, 1997; V.I. Starodubov, 1997, 1999; V.S. Preobrazhenskaya, 1997, 1999; I.N. Denisov, 1998, 2001; Yu.P. Lisitsyn, 1998; A.V. Reshetnikov, 1998; A.I. Vyalkov, 1999; A.M. Taranov, 2000; V.K. Ovcharov, V.B. Filatov, 2000; Yu.L. Shevchenko, 2000; V.N. Denisov, 2001; A.L. Lindenbraten, 2001).

In the Main Directions of the Development of Population Health Protection and the Restructuring of Healthcare for the Period up to 2000, published in 1987, the improvement of healthcare management on a scientific basis using information technologies and economic methods of management was named as one of the six main directions of healthcare reform.

New possibilities and the urgent necessity of using economic methods in healthcare management arose in connection with the adoption of the new Constitution of the Russian Federation, the Fundamental Law on the Protection of Citizens' Health in the Russian Federation, and the Law "On Medical Insurance of Citizens in the Russian Federation."

At the present stage in Russia, against the background of a substantially changed socio-economic situation, the decentralization of the state healthcare system has taken place, and the role of territorial management bodies in organizing the activity of healthcare institutions has increased.

According to N.A. Alekseev (2002), the problems of reform are concentrated in the technologies for implementing transformations, above all, in the basic structural element of the healthcare system — the healthcare and preventive institution. Transformations in the municipal healthcare system are advisable to carry out at the level of multi-profile healthcare and preventive institutions, since they are the minimal structural elements of the system, carry out the main volume of medical care for the urban population, determine the nature of the changes taking place in healthcare, and at the same time contain the main types of medical care — outpatient and inpatient.

The problems of increasing the efficiency of the functioning of both the healthcare system as a whole and individual healthcare and preventive institutions are sufficiently debatable (Petrov P.P., Novikov A.V., 1995; Golov V.I., Kalinin S.A., 1997; Shchepin V.O., 1997, 1999; Shipova V.M., 1998; Kadyrov F.N., 1999, 2000; Groysman V.A., 2000; Kulikov M.P., 2000; Serebrennikov V.A., 2001).

One of the main tasks facing healthcare in the current socio-economic conditions and reflected in economic and social policy is the achievement of sufficient financial resources for carrying out medical assistance programs in accordance with the needs of the population.

Ensuring that healthcare has the necessary economic resources is a complex problem resolved within the framework of economic regulation. Its complexity is compounded by the objective difficulties encountered by the Russian economy during the transition period.

The economic mechanism of domestic healthcare, due to historical circumstances, has for a long period been based almost exclusively on the state budget financing system.

The state, through the budget, provided the healthcare system with the main share of financial resources, the sizes of which ultimately played a decisive role in determining the prospects for the further development of the industry.

The reform of the healthcare system at the current stage is largely associated with the development of compulsory medical insurance, which became the prerequisite for the transition to multi-channel financing of healthcare, the attraction for this purpose of funds from enterprises and the population through voluntary contributions.

During the period of adaptation of the industry to market relations, the share of funds received by state and municipal healthcare institutions from entrepreneurial activity increased significantly. According to the Ministry of Economic Development of Russia, the volume of paid medical services amounted to 19.8 billion rubles in 1999, 27.5 billion rubles in 2000, and 37.8 billion rubles in 2001.

The multi-channel nature of receiving financial resources requires the systematization and accounting of all available sources of financing for the activity of medical organizations.

Under the established conditions, in order to most fully assess the problems of financial support of healthcare and preventive organizations, there is an increased need for scientific analysis of their financial condition.

The reforms and changes that have taken place in recent years in the healthcare system have allowed many medical organizations to more or less transition their activity to the principles of cost accounting, often with the right to receive income from several sources. In the management of medical organizations, economic methods have increasingly been used with the aim of improving the profitability of the production and sale of medical services. The concept of financial management — the adoption of management decisions based on the analysis of financing sources, the optimization of resource utilization, and the achievement of management efficiency — has emerged.

The rational use of financial funds depends, above all, on the effective management of them at the organizational level.

It should be noted that the change in the methods of financing the industry, in turn, has led to the emergence in the market of medical services of treatment organizations of various, including non-state, forms of ownership. The development of the non-state sector of medical services is objectively necessary under current conditions due to the deep differentiation of consumer demand among different groups and strata of the population, the low efficiency of established state service structures, and extremely limited budget financing of the process of medical and diagnostic assistance. The formation of a whole range of non-state medical structures has contributed to the development of competition among healthcare and preventive organizations (LPO). According to Goskomstat, by the mid-1990s there were approximately 800 non-state medical organizations in Russia; in 1998 their number reached 15,385, in 1999 — 17,239, and in 2001 — 18,500.

At present, private medical organizations offer the population services in at least 34 basic medical specialties, with the most widely represented areas being dentistry, surgery (especially aesthetic and plastic surgery), urology, gynecology, cosmetology, neurology, and psychotherapy, as the most commercially attractive areas of specialization. Most medical centers provide narrowly specialized outpatient and consultative care.

At the same time, one must acknowledge that the activity of the non-state sector of healthcare in Russia does not yet have a systematic character and is not prepared to the degree necessary for its stable functioning. Due to the historically established traditions of state healthcare in the country, the development of the private sector cannot proceed without the assistance and participation of the state. For this, institutional reforms, the development of the legal framework, and the formation of a budget and tax policy ensuring the possibility of using non-state healthcare services for a significant part of the population are required. It is also necessary to have corresponding legislation to establish the status of private medical organizations, regulate their relations with state healthcare, and the medical insurance system.

It should also be taken into account that at present, despite the multi-channel nature of financing sources for treatment organizations of various forms of ownership, they possess and utilize entirely different possibilities for managing financial resources. While state healthcare institutions have fairly rigid regulation in the form of itemized expenditure, organizations of other forms of ownership have more free conditions for resource allocation, as well as the ability to direct received profits to various needs.

The resolution of the problem of underfunding, in particular through the introduction of resource-saving technologies, the search for missing financial resources with which it is possible to expand the volume of medical services provided, remains currently relevant for all healthcare and preventive organizations. Modern financial management technologies are increasingly being used, such as leasing.

At the same time, questions related to the optimization of financial resource management in LPO of various forms of ownership under multi-channel financing remain to this day unstudied, which confirms the relevance of the present research.

The purpose of this work was the study of the features of financial resource management and the development of proposals for their more effective use in healthcare and preventive organizations of various forms of ownership.

In accordance with the set goal, the following tasks were solved:

- to study and generalize the experience of using financial management in medical organizations of various forms of ownership;

- to study the interaction of various subsystems of a medical organization and develop proposals for its optimization based on financial management;

- to analyze the legal support for the functioning of LPO of various forms of ownership;

- to study and analyze the sources and volumes of financing for medical organizations of various forms of ownership under current conditions;

- to conduct an economic analysis of the use of financial funds in LPO of various forms of ownership;

- to study the opinions of consumers and physicians on the organization of medical care in LPO of various forms of ownership;

- to develop and test new technologies for managing financial resources in medical organizations of various forms of ownership.

The research was conducted within the framework of the planned topic of the Research Institute of the N.I. Semashko Research Institute of the Russian Academy of Medical Sciences "Management of Financial Resources of a Medical Institution" (theme code 132).

The object of the research were LPO of various forms of ownership, and the subject of the study was their activity.

In accordance with the set tasks, a comprehensive methodology was used in the research, including the following methods: the study and generalization of experience, content analysis, statistical, economic methods, the method of comparative analysis, expert assessments, the sociological method, organizational modeling, and others.

Methodological approaches to financial resource management were tested in organizations of various forms of ownership. The healthcare and preventive organizations selected as research bases are typical for the Russian Federation.

The scientific novelty of the research consists in the following:

- on the basis of generalizing the experience of using the principles of financial management in healthcare and preventive organizations of Russia and foreign countries, a scientific justification is given for the management of financial resources in LPO of various forms of ownership under multi-channel financing;

- an analysis of the legislative framework for the functioning of LPO of various forms of ownership under multi-channel financing and the legal basis for leasing as one of the mechanisms of resource provision for LPO has been carried out;

- the interaction of various subsystems of a medical organization has been examined from the perspective of financial management;

- a comparative analysis of the receipt and expenditure of financial funds in LPO of various forms of ownership has been conducted;

- the experience of using financial management mechanisms in state and non-state medical organizations is presented;

- on the basis of the research results, proposals have been developed for the more effective use of resources in LPO of various forms of ownership under multi-channel financing.

Practical significance.

The conducted comprehensive analysis of the functioning of state and non-state healthcare and preventive organizations makes it possible to develop and implement a system of measures for the more effective use of resources under multi-channel financing. The methodological approaches and management decisions developed during the present research, aimed at further increasing the efficiency of the activity of LPO of various forms of ownership and improving the quality of medical care provided to the population, are used in healthcare and preventive organizations of the Moscow region and can be widely used by medical organizations throughout the territory of the Russian Federation.

The research materials are used in the educational and pedagogical process conducted at the State Institution of the N.I. Semashko Research Institute of Social Hygiene, Economics, and Healthcare Management of the Russian Academy of Medical Sciences and the Department of Social Hygiene and Healthcare Organization of the Russian Medical Academy of Postgraduate Education.

On the topic of the dissertation, 41 work has been published, including a monograph.

The results of the research were reported and discussed at:

- the scientific-practical conference "Healthcare of the Bogorodsk Territory — 170 Years," Noginsk, September 2001;

- the VI scientific-practical conference "Development of the System for Ensuring the Quality of Medical Care Under Current Conditions and Problems of Optimizing the Structure of Healthcare," N.I. Semashko Research Institute of Social Hygiene and Healthcare Management of the Russian Academy of Medical Sciences, Moscow, April 2001;

- the VII scientific-practical conference "Development of the System for Ensuring the Quality of Medical Care Under Current Conditions and Problems of Optimizing the Structure of Healthcare," N.I. Semashko Research Institute of Social Hygiene and Healthcare Management of the Russian Academy of Medical Sciences, Moscow, April 2002;

- meetings of the medical board of the State Institution of the Noginsk Central Regional Hospital: "On the Results of Healthcare and Financial and Economic Activity for 2001" (February 2002), "On Improving the Quality Control of Medical Care for the District Population" (November 2002);

- a meeting of the Administration of the Noginsk District "On Additional Measures to Strengthen the Material Base of Healthcare" (November 2002);

- a meeting of the Presidium of the Moscow Regional Branch of the Russian Medical Association (November 2002);

- an inter-departmental conference of the State Institution of the N.I. Semashko Research Institute of the Russian Academy of Medical Sciences (December 2002);

- a meeting of the Board of the Moscow Regional Ministry of Healthcare "On the State and Measures for the Development of Ophthalmological Care in the Moscow Region" (February 2003);

- the VIII scientific-practical conference "Population Health, Policy, and Technologies of Healthcare Development," N.I. Semashko Research Institute of Social Hygiene, Economics, and Healthcare Management, Moscow, April 2003.

The research materials have been used:

• In preparing decisions of the board of the State Institution of the Noginsk Central Regional Hospital (February and November 2002).

• In preparing the plan of basic organizational measures of the State Institution of the Noginsk Central Regional Hospital for 2001, 2002, and 2003.

• In developing the perspective development plan of the medical center LLC "MEDART."

• In developing the system of programmatic measures for the development of healthcare in the Noginsk District for 2001–2005.

• In preparing the comprehensive program for the socio-economic development of the municipal formation "Noginsk District of the Moscow Region" for 2000–2005.

• In preparing the decision of the Board of the Moscow Regional Ministry of Healthcare (February 2003).

• In developing the main directions of economic policy for ensuring the activity of healthcare institutions in the Moscow Region.

The main positions put forward for defense:

1. Analysis of the legislative framework for the activity of medical organizations of various forms of ownership and the use of leasing as one of the mechanisms for their resource provision.

2. Analysis of the activity of functional subsystems (managing, producing, and supporting) — the basis for financial resource management in healthcare and preventive organizations of various forms of ownership.

3. Results of the analysis of financial support for LPO of various forms of ownership.

4. The possibility of using sociological surveys to obtain information for the purpose of managing financial resources of medical organizations of various forms of ownership.

5. Results of the use of financial resource management methods in healthcare and preventive organizations of various forms of ownership under market economy conditions.