Improvement of the Planning and Normative Base for the Work of Dental Orthopedic Departments

The dissertation is devoted to the improvement of the planning and normative base for the work of dental orthopedic departments. The research focuses on the analysis of organizational and economic aspects of dental orthopedic care, including the study of the volume and nature of care provided, the analysis of referral indicators, the structure of prostheses, and the interrelationship of clinico-statistical parameters in the work of dental orthopedic physicians. Special attention is given to a comparative analysis of the work of departments when receiving patients on a free-of-charge and paid basis, as well as to seasonal fluctuations in workload and production indicators.

The work addresses questions of labor norming in dental orthopedics, including the analysis of existing labor standards and their application in compiling the staffing table and planning the number of medical personnel. Methodological approaches to improving the planning and normative base are proposed, based on correlation analysis of physician activity indicators and financial performance indicators of dental orthopedic departments.

The transition of healthcare to economic methods of management in the early 1990s and the formation of the non-state sector contributed to a sharp increase in the level of dental care provision. This process was also driven by the widespread adoption of the latest materials and medications in dental orthopedics, the application of modern technologies, and the equipping of facilities with high-performance equipment.

Currently, a situation often arises in which, when providing paid medical services, the most modern and therefore the most expensive diagnostic and therapeutic means are sought to be used, and often this service component has no influence on the core professional quality [Alo.M., V.V. Zharov, 2000; V.V. Zharov, 2001; A.Yu. Malyi, 2001]. When determining the method of orthopedic treatment necessary for a specific pathology, the cost factor of fabricating the construction is taken into account, which depends directly on the labor intensity of prosthesis fabrication [P. Koslowski, 1991; Die noetigen Leistungen // Finanztest.-2000; P. Wigge, 2000].

The importance of analyzing economic indicators in dental care was noted by G.N. Trojansky (1993). However, the problem of assessing labor intensity was generally reduced to evaluating the working time expenditures of a dental physician when treating various pathologies [V.N. Koren, V.N. Kuznetsov, G.S. Kuklin, 1978; N.I. Nikitina, V.V. Chistokhvalov, 1980; V.N. Kopeykin, V.I. Samodin, 1997]. An exception is the introduction within the framework of the experiment of working time equivalents (WTE), which were equivalents of labor expenditures for performing therapeutic and preventive measures in providing dental care to the population. An experiment on their implementation was conducted in a number of cities (Leningrad, Moscow, Volgograd, etc.) in the early 1980s; however, they were not developed for dental orthopedics at that time.

In the 1990s, standards for the volume of medical care for various diseases began to be actively developed in domestic healthcare. However, such standards were absent in the field of dental care, and only recently, developments of this type have begun to appear in the form of individual corporate standards.

There are practically no recommendations on treatment methods and types of constructions composed with due regard for the most favorable ratio of effectiveness and cost (the principle of rational therapy), which would reflect the optimal volume of dental orthopedic care.

In the methodological recommendations on the procedures for forming and economic justification of territorial programs of state guarantees for providing free medical care to citizens of the Russian Federation, approved by Resolution of the Government of the Russian Federation No. 550 of July 24, 2001, Appendix 3 presents new WTE developed with consideration of technologies introduced into the practical activities of dental physicians of all specialties over the past 10-15 years, and in Order No. 408 of the Ministry of Health of Russia dated November 15, 2001, "On Approval of the Instruction on Calculations of Working Time Equivalents for Dental Physicians and Dental Surgeons," the time required to perform 1 WTE was established. However, these documents contain a number of contradictions requiring their resolution and improvement of the methodological support for organizing dental orthopedic care.

In the context of dental institutions mastering new technologies for prevention, diagnosis, and treatment of diseases of the oral cavity and maxillofacial region, the introduction of modern materials, instruments, and equipment, and the improvement of work efficiency, the development of approaches to improving the planning and normative base for the work of dental orthopedic departments acquires particular urgency. The relevance and scientific-practical significance of this problem determined the goal of this dissertation research.

The goal of the research was the scientific justification of approaches to improving the planning and normative base for providing medical care to the population in dental orthopedic departments.

To achieve this goal, the following tasks were identified:

- to study the state of dental orthopedic care to the population on the basis of official documents and literature sources;

- to conduct an analysis of the volume and nature of dental orthopedic care provided to the population in a city polyclinic and to study the interrelationships of various indicators of the activities of dental orthopedic physicians and the types of work they perform;

- to analyze the production volumes and financial indicators of the work of dental orthopedic physicians in a city polyclinic;

- to determine the organizational foundations and methodological approaches to labor norming in dental orthopedics;

- to provide recommendations on the use of labor standards in compiling the staffing table, planning the number of medical personnel, and determining cost indicators in institutions and departments providing dental orthopedic care to the population.

Scientific novelty of the research. The research studied the volume and nature of dental orthopedic care provided in a specialized department of a city polyclinic, and conducted a comparative analysis of care provided on a paid and free-of-charge basis. Seasonal fluctuations of various indicators of the department's work, as well as production volumes and financial activities of dental orthopedic physicians over different time periods, were analyzed. A correlation analysis of the interrelationship of various indicators of the activities of dental orthopedic physicians and the types of work performed in providing dental orthopedic care was conducted. New methodological approaches to labor norming in dental orthopedics were developed; the possibilities of using labor standards in compiling the staffing table, justifying the calculation of the required number of positions, and determining cost indicators of dental orthopedic care were demonstrated.

Practical significance of the research and implementation of its results in practical healthcare. The research materials were used both in the work of specific institutions and in the preparation of a number of methodological documents contributing to the improvement of labor norming for medical personnel and the improvement of planning their numbers:

- Methodological Recommendations on Organizing Labor Norming in Healthcare, Moscow, 2004;

- Planning the Number of Personnel of Healthcare Institutions When Compiling the Staffing Table, Moscow, 2004;

- Labor Norming of Medical Personnel in Ambulatory and Polyclinic Institutions, Moscow, 2004.

The obtained results contribute to the scientific justification of rational personnel placement in the dental orthopedic sector and make it possible to determine cost indicators of dental orthopedic care.

The results of the research can be widely used in the educational process in training organizers, economists, and managers of healthcare; they are included in the academic course of the Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation.

Defense of the research

The research materials were reported and discussed at various meetings and conferences, including the scientific-practical conference "Population Health, Policy and Technologies of Healthcare Development," Moscow, April 16-17, 2003, the scientific-practical conference "The Role of Healthcare in Protecting Public Health," Moscow, April 22-23, 2004, the scientific-practical conference "The Role of Healthcare in Protecting Public Health," Moscow, April 19-20, 2005, meetings of the Moscow City Health Department and the Central Administrative District Health Department of Moscow, the interdepartmental conference of the State Institution "National Research Institute of Public Health of the Russian Academy of Medical Sciences," and others.

Publications. On the topic of the dissertation, 43 printed works were published, including a monograph and 3 methodological recommendations.

Main provisions put forward for defense:

1. Results of the clinico-statistical analysis of the main indicators of the work of a dental orthopedic department, reflecting the dynamic changes in the nature of technologies used and the characteristics of patient reception on a free-of-charge and paid basis.

2. A characterization of the interrelationships of various types of work performed and indicators of the activity of a dental orthopedic department.

3. Results of the analysis of the workload and financial indicators of dental orthopedic physicians, reflecting the economic aspects of the activity of dental orthopedic departments.

4. Methodological approaches to labor norming in dental orthopedics and recommendations for their use in improving the planning and normative base for the work of dental orthopedic departments.