Scientific Justification of Priorities for Healthcare Activities of Administrative-Territorial Entities of the Krasnoyarsk Krai

The dissertation is devoted to the scientific justification of the priorities of healthcare activities of administrative-territorial entities of the Krasnoyarsk Krai. The research is aimed at developing a methodology for the selection of indicators and methods for assessing the health status and healthcare activities at the level of cities and districts. The work includes an analysis of the mortality level taking into account demographic characteristics, a comparative assessment of regions by indicators of population health status and healthcare activities, and the development of a healthcare management model based on priorities.

For the first time, the author has scientifically justified and formed a set of indicators for determining the priorities of healthcare activities of ATE of the scale of cities and districts. A comprehensive approach to the determination of priorities has been proposed, employing the comprehensive assessment method and the classification of territories by deviation from the mathematical expectation standard. The obtained results have been applied to the improvement of healthcare monitoring and the preparation of state reports on the health status of the Krai.

Relevance of the Topic.

The last decade has witnessed a state of affairs in the health of the Russian population that gives rise to justified concern and requires the taking of urgent measures [35, 61, 64, 69, 99, 101, 107].

In the report of the World Health Organization (WHO), which reviewed the work of national healthcare services and the state of population health across 191 countries of the world, Russia was ranked 130th in terms of healthcare system efficiency. In other words, the healthcare system that has taken shape today is incapable of making sufficiently productive use of even the resources currently allocated to it.

In the opinion of WHO experts, the quality of a country's healthcare system does not always depend on its size, population size, or state of the economy. Nor does there exist any universal model of healthcare organization that can bring success and prosperity to all states. In the majority of countries that have been successful in this regard, their own, sometimes unique, developments and ideas are employed [126, 133, 166].

The high level of mortality among the working-age population and the unprecedented, for peacetime, gap in life expectancy indicators between men and women, on the one hand, and the deficit of healthcare resources, on the other hand, require the proper prioritization of healthcare activities in Russia [5, 17, 35, 60, 61, 68, 91, 99].

Medical activity, like any other form of activity, is characterized by results and costs; accordingly, a relationship can be established between these categories, its conditions and circumstances can be analyzed for improvement with the maximum achievement of set goals and objectives [71, 123, 136]. However, unlike many other areas of activity, in medicine it is often impossible to guarantee a final result.

The relationship between the quality and efficiency of work is not absolute, since it depends on a multitude of factors, including those that go beyond the responsibility of healthcare workers (lifestyle, working conditions, state of the environment, and others) [69]. In healthcare there are no conditions and factors for improving efficiency such as exist in the production sphere, and it is also extremely difficult to measure all achieved results [135, 139, 141].

Limited possibilities for the quantitative expression of medical characteristics and features substantially complicate, in general, the scientifically grounded selection of healthcare priorities on a permanent basis. Therefore, research into theoretical and methodological problems of efficiency analysis in the field of healthcare is highly relevant. Regarding the prospects of efficiency analysis, there is one question that is not debated in the literature — the necessity of deepening the practical development of this problem [6, 25, 68, 152].

The analysis of medical, social, and economic aspects serves as an instrument that makes it possible to determine, in the process of strategic planning, practically acceptable volumes, accessibility, and quality levels of medical care [61, 79, 104, 112, 113, 114, 115, 118].

Federal Law No. 122-FZ of 22.11.2004 "On Introducing Amendments into Legislative Acts of the Russian Federation and on Recognizing as Invalid Certain Legislative Acts of the Russian Federation" introduces changes into the powers and financial obligations of a subject of the Russian Federation and municipal formations with regard to the healthcare sphere.

Accordingly, the growth of responsibility of municipal formations for the health of the population determines the need for a scientific justification of the priorities of healthcare activities of administrative-territorial entities (ATE).

At the same time, an analysis of domestic and foreign literature has shown insufficient scientific development in the direction of the scientific justification of the priorities of healthcare activities of administrative-territorial entities (ATE) of the scale of cities and districts, since the majority of works are oriented toward the federal or regional level. Fragmentary treatment of the specified question is not always sufficiently scientifically justified, which determined the goals and objectives of the research.

Goal of the Research: Scientific justification of the priorities of healthcare activities in ATE on the basis of indicators of health status and healthcare activities.

Tasks of the Research:

1. Scientifically grounded selection of indicators and methods for assessing the health status and healthcare activities in ATE.

2. Assessment of the mortality level, taking into account demographic characteristics, in ATE of the Krasnoyarsk Krai.

3. Conducting a comparative analysis of ATE of the Krasnoyarsk Krai by indicators of population health status and healthcare activities.

4. Developing a model of ATE healthcare management based on the priorities of its activities and population health status.

Scientific Novelty of the Research:

For the first time, a set of indicators for determining the priorities of healthcare activities of ATE of the scale of cities and districts has been scientifically justified and formed.

For the first time, ranking of ATE of the Krasnoyarsk Krai by the level of age-specific mortality and PPY has been carried out using the method of classification of territories of the scale of cities and districts by deviation from the mathematical expectation standard.

A comparative analysis of ATE of the Krasnoyarsk Krai by indicators of population health and healthcare activities has been conducted using the comprehensive assessment method.

A model of ATE healthcare management based on the priorities of its activities and population health status has been developed.

Practical Significance of the Work:

The results of the research made it possible to determine priority directions in the healthcare activities of ATE of the Krasnoyarsk Krai.

The results of the research have been applied to the improvement of the methodology of "Monitoring the Activities of Healthcare Institutions and the Health Status of the Population of the Krasnoyarsk Krai," carried out by the State Unitary Healthcare Enterprise (SUHE) "Krasnoyarsk Regional Medical Information-Analytical Center," and have been used in the preparation of annual state reports "On the Health Status of the Population and Healthcare Activities of the Krasnoyarsk Krai" in 2001, 2002, and 2003.

On the basis of the conducted research, methodological recommendations "Justification of Priorities in Healthcare" have been introduced into the training process for students, medical interns, residents, cadets of advanced training courses and postgraduate students in the Department of Public Health and Healthcare of the Krasnoyarsk State Medical Academy.

The principal provisions put forward for defense.

The determination of healthcare priorities includes a scientifically grounded selection of indicators and methods for assessing the health status of the population and healthcare activities of ATE.

The complex application of the comprehensive assessment method, age-specific mortality indicators, standardized mortality, life expectancy at birth, and years of potential life lost, using the method of classification of territories of the scale of cities and districts by deviation from the mathematical expectation standard, makes it possible to determine the healthcare priorities of ATE.

The model of ATE healthcare management based on the priorities of its activities and population health status makes it possible to identify territories with the most pronounced healthcare problems for the development of measures for their operational resolution.

Implementation of the Results of the Work into Practice.

On the basis of the research, a teaching-methodological manual "Justification of Priorities in Healthcare" has been prepared, approved, and published, recommended by the Methodological Association for Medical and Pharmaceutical Education of Russian Universities as a teaching aid for the system of postgraduate professional education of healthcare organizers. The teaching aid is used in the educational process at the Department of Public Health and Healthcare of the Krasnoyarsk State Medical Academy.

The results of the research have been introduced into the work of the Department of Strategic Planning of Healthcare Administration of the Krasnoyarsk Krai Administration.

Methods of scientific justification of healthcare priorities in ATE are applied in the activities of the Department of Analysis and Forecasting of the SUHE "Krasnoyarsk Regional Medical Information-Analytical Center."

Presentation of the Results of the Work. The main results of the research were reported and discussed:

- at final collegiums of healthcare administration of the Krasnoyarsk Krai (Krasnoyarsk, 2002, 2003);

- at the All-Russian Scientific and Practical Conference "Problems of Informatization of the Region" (Krasnoyarsk, 2003);

- at the All-Russian Conference "Information-Analytical Systems and Technologies in Healthcare and Mandatory Medical Insurance" (Krasnoyarsk, 2004);

- at a session of the problem commission on public health and healthcare of the Krasnoyarsk State Medical Academy (Krasnoyarsk, 2004).

On the topic of the dissertation and the results obtained in the course of the research, 13 works have been published and 1 teaching aid has been developed.

Volume and Structure of the Work. The work is presented across 136 pages of printed text, consists of an introduction, 5 chapters, a conclusion, findings, practical recommendations, and appendices. The text is illustrated with 17 tables and 36 figures. The bibliography contains 170 sources, of which 60 are by foreign authors.