Organizational and Economic Aspects of Improving the Efficiency of Use of the Bed Fund of Infectious Hospitals (Departments)

The dissertation is devoted to the organizational and economic aspects of improving the efficiency of use of the bed fund of infectious hospitals and departments of the municipal formation of the City of Yekaterinburg in the Sverdlovsk Region. The work comprehensively examines the epidemiological situation with infectious morbidity, medical-organizational and economic indicators of the activities of inpatient infectious subdivisions for adult and pediatric populations, and also develops methodological approaches to bed capacity planning based on actual hospitalization volumes. The research reflects the processes of transformation of the healthcare system under conditions of reduced financing and restructuring of the hospital network. For the first time in the work, a comprehensive analysis of the medical and economic efficiency of the activities of infectious hospitals for adults and children has been conducted, and the substantiation for preserving the normative provision of infectious beds has been evaluated. New methodological approaches to planning the productive activities of infectious hospitals and departments have been proposed, aimed at optimizing the bed fund. The practical recommendations of the dissertation were used in the development of the Concept for the Development of Healthcare in the City of Yekaterinburg and the program for the optimization of inpatient care for infectious patients.

Relevance of the Problem. The concept of healthcare and medical science development in the Russian Federation identifies "improving the efficiency of healthcare resource utilization" as one of the priority directions. This problem was previously among the most important; however, in the period of radical political changes occurring in the country, the development of market relations, and a sharp reduction in sectoral financing, it has acquired particular relevance. Insufficient substantiation and inconsistency in the conduct of reforms in Russia led to a reduction in revenue portions of budgets at all levels and, as a consequence, to a decrease in budgetary healthcare financing. Therefore, economic relations within the sector itself changed primarily only in the portion of the volumes and types of medical care that are recorded through the line of mandatory medical insurance [95; 36; 37; 50]. The reduction in recent years of the network and capacity of hospital medical institutions, along with changes in their structure, leads to positive results expressed in increasing the intensity of bed fund utilization — lengthening the duration of bed operation during the year, reducing the average length of stay of patients in hospitals, and increasing bed turnover. Contemporary social policy in the sphere of healthcare should be built on objective knowledge of the factors forming population health, scientific substantiation of changes in the organization of preventive and curative institutions, and their resource provision [51]. This significantly enhances the importance of medical-organizational and economic analysis in the activities of healthcare management bodies and medical organizations themselves [58; 22]. At present, domestic medical science and practice have achieved indisputable successes in the field of infectious disease prevention. These include the virtually complete eradication of poliomyelitis, a many-fold reduction in morbidity from infections controllable through specific prophylaxis. At the same time, the last decade in Russia has been characterized by both a rise in "old" infections (diphtheria, tuberculosis, syphilis, hepatitis, and others) and the emergence of new types (HIV/AIDS) [61]. In addition, changes are occurring in the clinical picture of infectious diseases and in the tactics of their treatment. Within the system of Russian healthcare organization, methodological approaches to planning the network of infectious hospitals (departments) are based on principles common to all types of bed fund, and yet the baseline parameters for such planning have traditionally been lower than for other types of beds. To a lesser extent, the processes of intensification of hospital department operations occurring in recent years have been reflected in the work of infectious hospitals (departments). According to the Ministry of Health of the Russian Federation, the duration of operation of infectious beds during the year remains at the level of 240–280 days; however, their resource provision occurs based on existing capacities and current norms [24]. If, during the previously existing centralized system of sector management, when planning bodies deliberately established understated indicators of bed fund operation for the treatment of infectious patients, this problem did not have such an acute character, then in contemporary conditions, given the deficit of financial and material and technical resources that has developed in the sector, the task of determining the substantiation for preserving the normative provision of infectious beds and developing methodological approaches to planning their productive activities becomes highly relevant. Despite the actively ongoing research into the problem of improving the efficiency of preventive and curative institutions as a whole, the division of this problem relating to infectious hospitals (departments) has still been insufficiently thoroughly studied. Goal of the Research. Scientific substantiation of the organization of an optimal network, capacity, and structure of infectious hospitals and departments in a municipal formation. The tasks of the research were as follows: 1. To conduct an analysis and provide an expert assessment of infectious morbidity among the population of the Sverdlovsk Region and the City of Yekaterinburg. 2. To investigate the main trends in the development of infectious hospitals and departments in the City of Yekaterinburg. 3. To conduct a medical-organizational and economic analysis of the efficiency of the existing network of infectious hospitals and departments for adults and children, the principles and methodological approaches to network planning, their bed capacity, and the municipal order for volumes of medical care provided. 4. To develop and scientifically substantiate technologies and regulatory documents for the reorganization of the network of infectious hospitals and departments, a methodology for planning their productive activities based on actual hospitalization volumes and capacity. 5. To develop and implement in the practical healthcare of the City of Yekaterinburg an optimal technological model of medical care organization for infectious patients. Scientific Novelty. It has been demonstrated that since the beginning of the 1990s in the Sverdlovsk Region and the City of Yekaterinburg, there has been a deterioration in the epidemiological situation, and, according to the forecast, a high level of infectious morbidity will be preserved in the near-term perspective. A change in the structure of infectious morbidity among the adult population of the City of Yekaterinburg is occurring. For the first time, a comprehensive analysis of the medical and economic efficiency of the activities of infectious departments for the adult population of the City of Yekaterinburg has been conducted. For the first time, a comprehensive analysis of the medical and economic efficiency of the activities of children's infectious hospitals (departments) in the City of Yekaterinburg before and after the reorganization of the management system has been conducted. It has been established that methods of planning the provision of the population with the bed fund of the infectious profile, alongside the adopted indicators, should be based on an analysis of the actual level of hospitalization. New methodological approaches to planning the productive activities of infectious hospitals and departments have been proposed. Practical Significance and Implementation in Practice. The practical significance of the dissertation research consists in specific methodological and practical recommendations for improving the organizational-technological structure of inpatient care for infectious patients in the City of Yekaterinburg. The materials of the dissertation have been used: in the preparation of the Concept for the Development of Healthcare in the City of Yekaterinburg for 2003–2007; in the preparation of the program for the optimization of the system of inpatient medical care for infectious patients in the City of Yekaterinburg; in the educational process at the Department of Public Health and Healthcare of the Chelyabinsk Medical Academy and at the Department of Economics and Healthcare Management of the Ural State University of Economics. Propositions to be defended: 1. The features of infectious morbidity among the population of the Sverdlovsk Region and the City of Yekaterinburg are determined by the character of the contemporary socio-economic situation and the level of development of preventive technologies. 2. The results of the assessment of the medical and economic efficiency of the work of infectious hospitals (departments) for the treatment of adults and children in the City of Yekaterinburg. 3. A scientifically substantiated model of inpatient medical care for patients with infectious diseases in the City of Yekaterinburg. 4. Methodological approaches to planning the capacity of the bed fund for the treatment of infectious patients.