Scientific Grounds for Improving the Efficiency of the Departmental Dental Service in Modern Conditions

The dissertation is devoted to the scientific grounds for improving the efficiency of the departmental dental service (DDS) of the Ministry of Internal Affairs of Russia in modern socio-economic conditions. The study encompasses a complex of questions regarding the organization of dental care for the attached contingent of employees and workers of internal affairs agencies and military servicemen of the Internal Troops of the Ministry of Internal Affairs of Russia. The work analyzes the organizational structure, financing, production and innovation activities of departmental central preventive clinics (CPCs), the status of dental health of the attached population, the social and hygienic characteristics of medical personnel, as well as the dynamics and quality of dental care provision for the period from 2000 to 2003. Special attention is devoted to questions of staffing, the system of payment for labor under conditions of mandatory medical insurance, the implementation of mechanisms of personalized financial responsibility, and the assessment of the efficiency of activities of dental institutions using out-of-department medical and economic control and questionnaire surveys.

Relevance of the Study

The effective organization of medical care for employees and workers of internal affairs agencies and military servicemen of the Internal Troops of the Ministry of Internal Affairs of Russia plays a significant and integral role in strengthening law enforcement activity, ensuring public order, and combating terrorism. All of this requires clarity and coordinated action among all constituent links of internal affairs bodies.

In this context, particular importance is acquired in the search for effective ways of preserving and strengthening their health, which in turn enables them to improve the effectiveness of performing their service duties, both in peacetime and during the conduct of military operations in the North Caucasus region.

It is precisely these complex tasks facing the employees of the Ministry of Internal Affairs of Russia that constitute the reason why the service of safeguarding their health invariably remains an independent departmental system. At the same time, it possesses all the characteristics of domestic healthcare (accessibility, guaranteed volume of medical care, etc.). The foundation of its activity is laid by legislative acts of the Russian Federation on the protection of public health, conceptual positions on the development of the healthcare system, as well as departmental regulatory acts that confer an unrepeatable individuality upon departmental medicine.

The Concept for the Development of Healthcare and Medical Science in the Russian Federation, adopted in 1997, identified one of the important tasks as the development of departmental healthcare services.

More than 20 ministries, agencies, and organizations currently have their own medical services and institutions [155]. Departmental healthcare, like the entire state healthcare system, developed along an extensive path [72, 156, 160]. And only targeted and rational management using the resources of medical institutions is one of the factors in the transition of the healthcare system to an intensive path of development [83, 85, 124, 126, 179].

At the same time, according to the assessment of the status of the Logistics Service of the Ministry of Internal Affairs of Russia at the present stage, noted in the "Concept for the Development of the Logistics Service of the Ministry of Internal Affairs of Russia for 2003-2010," it is stated that "...actual financing of the units of the Ministry of Internal Affairs of Russia in 2001-2002 amounted to only 55% of the approved indicators." To a greater extent, this concerns subordinate enterprises, institutions, and organizations of special equipment, weapons, etc. However, financing of medical preventive institutions (MPI) of the Ministry of Internal Affairs of Russia is carried out at only 35% of actual need [77].

An integral constituent part of departmental services is the dental service, as the most widespread and in-demand among all segments of the population. At the same time, the dental service of the Ministry of Internal Affairs has its own specificity in the organization of medical care.

Thus, problems associated with the development of the departmental dental service (DDS) of the Ministry of Internal Affairs of Russia: questions of planning, organization of the treatment process, development of the material base of medical institutions, staffing issues, etc., directed toward achieving the ultimate goal - providing high-qualification dental medical care to the attached contingent - have been practically unstudied. Methodological approaches to this problem, as well as the existing regulatory base for it, have not been subjected to deep analysis. In addition, insufficient financing does not allow for the full-scale utilization of the medical and economic potential of the DDS.

It is obvious that the solution of these problems at the present stage is complicated due to the insufficient theoretical elaboration of questions regarding the transformation of the basic methodologies of management and the activity of the dental service of the Ministry of Internal Affairs of Russia in relation to the new economic reality, the transition of financing of medical institutions to economically substantiated norms.

These problems determined the importance, timeliness, and necessity of in-depth research of these questions and the development of their organizational foundations. The relevance and significance of this problem determined the goal and objectives of the study.

The goal of the present study is the scientific grounds for improving the efficiency of the departmental dental service in modern socio-economic conditions.

In order to achieve the goal, the following research objectives were formulated:

1. To study the status and organization of the departmental dental service, the structure, composition, and status of the dental health of the attached contingent to Central Preventive Clinics (CPCs) of the Ministry of Internal Affairs of Russia;

2. To study the social and hygienic characteristics of the medical personnel of CPCs of the Ministry of Internal Affairs of Russia;

3. To conduct an analysis of the status of dental care in CPCs of the Ministry of Internal Affairs of Russia;

4. To determine the directions for improving the efficiency of the departmental dental service of the Ministry of Internal Affairs of Russia in modern conditions;

5. To formulate proposals for further improving the efficiency of dental care for the attached contingent of the Ministry of Internal Affairs of Russia.

The scientific novelty of the study lies in the fact that, based on the obtained data on the status and organization of the DDS, data on the composition and status of the dental health of the attached contingent, the social and hygienic characteristics of the medical personnel, and the analysis of dental care in CPCs of the Ministry of Internal Affairs of Russia, for the first time the directions for improving the efficiency of the DDS in modern conditions were determined, including:

- when making decisions on the improvement of qualifications of medical personnel and when summarizing results at the end of the year for the purpose of awarding (non-awarding) bonuses to medical workers, the application of professional-qualification level coefficients was proposed;

- the necessity of a broader implementation of the first (departmental) level of quality control of medical care delivery in the work of medical institutions was proved, allowing for the evaluation of the work of each specialist, department, and the medical institution as a whole, as well as the prevention of financial losses during the conduct of out-of-department examinations in the future;

- measures for the rational use and placement of medical cadres during the vacation season were developed based on the example of the Central Dental Clinic of the Ministry of Internal Affairs of Russia, with the aim of preventing financial losses (in the form of revenue from dental prosthetics);

- based on the example of the work of the Central Dental Clinic of the Ministry of Internal Affairs of Russia in the mandatory medical insurance system, the influence of material and professional interest of medical personnel in the final results of their activity was established; financial losses of the medical institution associated with insufficient material stimulation of medical workers were calculated, in connection with which a mechanism of personalized financial responsibility for material damage caused to the medical institution as a result of poorly provided dental care was developed and implemented;

- when studying the index of caries prevalence, the level of average daily patient load in different age categories was determined; based on these data, the Index of Assessment of the Status of Dental Care (IASC) in CPCs of the Ministry of Internal Affairs of Russia was calculated, in connection with which an expert assessment of dental prostheses for the contingent attached to medical service at CPCs of the Ministry of Internal Affairs of Russia was conducted for compliance with the requirements imposed on dental prostheses depending on their period of exploitation;

- the information obtained as a result of sociological studies (survey of patients and dentists) highlighted a number of unresolved problems in the organization of dental care.

Based on the above, proposals were formulated for further improving the directions for increasing the efficiency of the DDS in modern conditions.

Scientific and Practical Significance and Implementation of the Results of the Study. Based on the results of the study, the following were developed, substantiated, and implemented:

- a system of payment for medical workers under mandatory medical insurance; a mechanism of personalized financial responsibility in dental medical institutions for material damage caused to the institution as a result of poorly provided dental care;

- methodological recommendations for the preparation of attestation works for the improvement of qualifications of medical workers in the dental profile.

The expediency of the following was scientifically substantiated:

- in-depth conduct of the first level of quality control of dental care delivery in the work of medical institutions, allowing for expert evaluation of the work of each specialist, department, and the medical institution as a whole, as well as the prevention of financial losses during the conduct of out-of-department examinations;

- the conduct of measures for the rational use and placement of medical cadres during the vacation season with the aim of preventing financial losses (in the form of revenue from dental prosthetics);

- the implementation of new for medical practice professional-qualification level coefficients for physicians and average medical workers (Kvp and Ksmp), necessary for making decisions on the improvement of their qualifications and when summarizing results at the end of the year for the purpose of awarding (non-awarding) bonuses.

The practical significance of the results obtained in the course of the present study is confirmed by their implementation in the practice of healthcare of regulatory, administrative, and informational-methodological documents on the improvement of the medical-organizational foundations for the development of dental care for the attached contingent to CPCs of the Ministry of Internal Affairs of Russia. The materials of the dissertation were used in the preparation of the relevant documents by the Medical Administration of the Logistics Service of the Ministry of Internal Affairs of Russia:

- Order of the Medical Administration of the Ministry of Internal Affairs of Russia dated February 18, 2000, No. 29/4-378, announcing the Regulation "On the Use of Funds of Mandatory Medical Insurance in Medical Preventive Institutions Subordinate to the Medical Administration of the Ministry of Internal Affairs of Russia";

- Order of the Medical Administration of the Ministry of Internal Affairs of Russia dated January 20, 2001, announcing the Regulation "On the Use of Funds of Mandatory Medical Insurance in Medical Preventive Institutions Subordinate to the Medical Administration of the Ministry of Internal Affairs of Russia";

- Order of the Medical Administration of the Ministry of Internal Affairs of Russia dated February 1, 2002, No. 29/9-2837, announcing the Regulation "On the Use of Funds of Mandatory Medical Insurance in Medical Preventive Institutions Subordinate to the Medical Administration of the Ministry of Internal Affairs of Russia";

- methodological recommendations "Preparation of Attestation Works for the Assignment (Confirmation) of Qualification Categories to Medical Workers in the Dental Profile - Specialists with Higher and Secondary Specialized Education" (Moscow, 2003);

- Order of the Ministry of Internal Affairs of Russia dated August 28, 2003, No. 680 "On the Approval of the Regulation on the Organization of Medical Service, Sanatorium-Curative Treatment in Medical Institutions, and Organized Rest in Rest Homes within the System of the Ministry of Internal Affairs of Russia" [127] (preferential dental prosthetics).

The Basic Propositions to be Defended:

1. Features of the social and economic characteristics of the medical personnel of the DDS, taking into account staffing, rational use, placement, training and improvement of cadres, payment of their labor under mandatory medical insurance, with the application of professional-qualification level coefficients and a mechanism of personalized financial responsibility as a result of poorly provided dental care.

2. Expert assessment of the activities of dentists of the DDS, the quality of their work, the structure and volume of provided assistance using questionnaire surveys of medical personnel and the attached contingent, as well as departmental and out-of-department medical and economic control using expert programs SKPO-MED of law enforcement agencies.

3. Directions for improving the efficiency of the DDS in modern conditions, based on innovative processes and internal reserves, allowing to obtain a medical-social and economic effect.

Presentation and Publication of the Results of the Work.

The main results of the dissertation were reported and discussed at:

- the Inter-University Scientific Conference "Actual Questions of Hygiene" at the Moscow Medical Stomatological Institute (1996), report on the topic "On the Question of Social and Hygienic Aspects of the Activities of Medical Institutions of the Ministry of Internal Affairs of Russia";

- the Inter-Institute Scientific-Theoretical Conference "Actual Questions of University Medical Science and Pedagogy at the Turn of the Third Millennium," report on the topic "Organization of Medical Care in Departmental Healthcare" and "Medical Institutions in the System of Medical Insurance" (2000);

- the approval council at the Central Scientific Research Institute of Organization and Informatics of Healthcare of the Ministry of Health and Social Development of the Russian Federation (2004).

Seven scientific works on the topic of the dissertation have been published, including methodological recommendations and publications in the central press.

Volume and Structure of the Dissertation.

The dissertation is presented on 154 pages of typed text and consists of an introduction, five chapters, conclusions, proposals, a list of references comprising 227 sources, including 46 foreign ones, and six appendices. The dissertation is illustrated with 27 tables, 21 figures, and 2 schemes.