Scientific Justification for Planning and Organization of Paid Medical and Related Services in the Closed Administrative-Territorial Formation of Zheleznogorsk

The dissertation is devoted to the scientific justification for planning and organizing paid medical and related services in a closed administrative-territorial formation (ZATO) — the city of Zheleznogorsk. The study is based on a comprehensive social-hygienic analysis of the health status of the working population, encompassing medical-demographic, sociological, and economic aspects. The relationships between morbidity and mortality indicators, socio-demographic factors, working conditions, the level of well-being, and the solvency of the population are examined.

A conceptual model of strategic management of the system for providing paid medical and related services was developed, based on the principles of strategic marketing. Financial flows in the healthcare system of the ZATO were studied, and the population's need for paid medical services was determined. The results have been implemented in the medical-sanitary parts of Zheleznogorsk, Severn, and Zelenogorsk, and are also used in the educational process at the organizational-profile departments of the Krasnoyarsk State Medical Academy.

Closed administrative-territorial formations within the subjects of the Federation differ significantly from the territories they geographically belong to in terms of socio-economic development. Numerous studies have been devoted to the health status of the population of closed administrative-territorial formations and specific groups (Mel'nikov T.Ya., 1998, Averchenko E.A., 2001, Melekhov A.A., 2002, Trosheva M.E., 2002, etc.). These studies are primarily aimed at identifying the features of the influence of various occupational factors on health.

Traditional methods of health monitoring (primary and general morbidity, morbidity with temporary loss of working capacity, etc.) do not allow for a complete determination of the health status picture of the population. A significant portion of the population falls outside the field of vision of medical workers, as it ignores diseases or engages in self-treatment. This leads to an undercounting of a large body of pathology that is rather difficult to assess. In this regard, one of the priority tasks of healthcare is the involvement of the population in disease prevention and the preservation of their own health.

A number of authors (Komarov Yu.M., Ivanova N.T., 1977; Tishuk E.A., 1997; Ovcharov V.K., Marchenko A.G., Tishuk E.A., 1990; Aleksandrov O.A., Polonsky M.L., Demchenkova G.Z., 1982; Ovcharov V.K., 1998; Goncharova G.N., Artukhov I.P., 1991, Senchenko A.Yu., 2000, Artukhov I.P., etc., 2003) believe that special attention, alongside traditional methods, should be given to the importance of conducting comprehensive social-hygienic studies aimed at preserving the health of the population and optimizing medical care. In such works, official statistical materials relating to health status are actively used, along with data from sociological studies that take into account both the assessment of citizens' health status and their attitude toward medical care. The materials obtained as a result of such studies serve as the basis for reforms in the healthcare system, particularly at the regional level.

Of fundamental importance in the formation of the modern healthcare system is self-assessment of health (Komarov Yu.M., Ivanova N.T., 1977, Tishuk E.A., 1997, Boyarsky A.P., Chernova T.V., 1993, Tregubov Yu.G., Dmitrieva N.V., Luzan S.G., Mitrofanova N.G., 1996, Lukasev A.M., 1997, Chesnokov P.E., Savinkov Yu.A., 1997, Senchenko A.Yu., 2000, Averchenko E.A., 2001, Artukhov I.P., etc., 2003). Surveys conducted using specially developed questionnaires make it possible not only to determine an individual's health status but also to identify what needs to be done to preserve or improve it, to determine which health promotion methods may have a significant impact on the population, to reveal hidden reserves for improving medical care, and so on. An individual's assessment of their overall and mental health and degree of satisfaction with it, as the basis for their social functions, represents one of the most important components of the concept of quality of life.

Meanwhile, comprehensive social-hygienic studies in interrelation with the actually established healthcare system, financing, the need for paid and related medical services, and the solvency of the population are virtually absent from the literature.

All of the above determined the goal and objectives of the research.

Goal of the research: Based on a social-hygienic study of the health status of the working contingent in the Closed Administrative-Territorial Formation of Zheleznogorsk, to develop organizational and economic mechanisms for planning and organizing paid medical and related services.

To achieve the stated goal, the following tasks were addressed:

1. To study the existing relationships between health indicators, socio-demographic factors, medical activity, and working conditions of the working contingent of the Closed Administrative-Territorial Formation of Zheleznogorsk.

2. To conduct an analysis of financial flows in the healthcare system of Zheleznogorsk.

3. To determine the need of the working population of Zheleznogorsk for receiving paid medical and related services, taking into account the solvency of the population.

4. To develop a conceptual model of strategic management of the system for providing paid medical and related services to the population of the Closed Administrative-Territorial Formation of Zheleznogorsk.

The scientific novelty of the research lies in the fact that for the first time:

- the organizational-functional structure of healthcare in the Closed Administrative-Territorial Formation of Zheleznogorsk was studied in relation to the health status of the working population and the financing system;

- the dependence of a number of health indicators and the demand for medical care on socio-demographic factors, material well-being, and working conditions and their derivatives was established;

- the needs of the population of Zheleznogorsk in the volume of paid medical and related services were determined;

- a conceptual model of strategic management of the system for providing paid medical and related services to the population of the Closed Administrative-Territorial Formation of Zheleznogorsk was presented, based on the principles of strategic marketing.

Main provisions for defense:

1. The contemporary features of the health status of the working population and demographic processes in Zheleznogorsk as a closed administrative-territorial formation are characterized by a shift of negative trends by several years later than regional and all-Russian trends, and by higher morbidity indicators.

2. The need of the population of Zheleznogorsk for paid medical and related services is insufficiently satisfied and is based on changes in the level of well-being and solvency of the population.

3. The model for optimizing the management of the system for providing paid medical and related services to the population of the Closed Administrative-Territorial Formation of Zheleznogorsk, based on the principles of strategic marketing, is universal and can be applied in other closed administrative-territorial formations.

Theoretical and practical significance of the research: The developed approaches to studying the needs of the population for paid medical and related services, taking into account the level of material well-being and solvency of the population, are universal and can be used in other closed administrative-territorial formations of the Russian Federation.

Implementation of research results:

The results of the present research, in the form of methodological recommendations, have been implemented in the work of the medical-sanitary parts of Zheleznogorsk, Severn, and Zelenogorsk. The theoretical and practical provisions set out in the dissertation are used in the educational process at the organizational-profile departments of the Krasnoyarsk Medical Academy.

Acquaintance with the results of the research: at the Medical Council of the Central Medical-Sanitary Part No. 51, 2003; at the scientific-practical conference "Problems of Preserving the Health of Workers Working in Particularly Dangerous Working Conditions," Severn, 2003; at the session of the Scientific and Technical Council of the State Research Center Institute of Biophysics of the Federal Medical-Biological Agency, Moscow, 2004; at the session of the problem commission of the Krasnoyarsk State Medical Academy "Public Health and Healthcare," December 2004.

On the topic of the dissertation, 10 printed works have been published.

Scope and structure of the work:

The dissertation consists of 138 pages of typescript and comprises an introduction, a literature review, research materials and methods, a discussion of the results obtained, conclusions, practical recommendations, and a reference list. The results obtained are illustrated using tables and figures. The reference list contains 168 sources, of which 149 are domestic and 19 are foreign.