Scientific Justification of the Effectiveness of New Organizational Technologies in a Municipal Polyclinic

The dissertation is devoted to the scientific justification of the effectiveness of the introduction of new organizational technologies into the work of a municipal polyclinic. The study is based on an analysis of the activity of Polyclinic No. 2 in Mytishchi, Moscow Oblast, for the period 1997–2001, and is dedicated to the improvement of outpatient and polyclinic care within the Russian healthcare system. Structural transformations aimed at improving the quality of primary health care and the redistribution of the volume of medical care from the inpatient sector to outpatient and polyclinic care are considered.

The organizational and functional structure of the polyclinic has been analyzed, including a day hospital, a therapeutic and diagnostic center, a rehabilitation center for outpatient surgery, and a traditional medicine office. The morbidity of the attached contingent has been investigated, the dynamics of indicators of polyclinic activity have been studied, and an assessment has been given of the medical, social, and economic efficiency of the introduction of new organizational technologies, including team contracts of specialist physicians and short-term voluntary medical insurance programs.

The relevance of the concept for the development of medical science in the Russian Federation, approved by the Government of the Russian Federation in 1997 as a primary direction for improving medical care, is determined by the development of primary health care based on municipal healthcare and the redistribution of a portion of the volume of care from the inpatient sector to outpatient and polyclinic care.

The outpatient and polyclinic service currently in operation, which serves the majority of the population, is unable to provide worthy and qualified medical care. Deficiencies in its resource provision and organization have become evident, necessitating reorganization (V.I. Starodubov, 1992; V.I. Starodubov, Yu.V. Mikhailova, Yu.A. Krotkov, 2002).

Significant disparities in the financing of outpatient and polyclinic care and inpatient care, with emphasis on the latter, limit the development of the material and technical base and the implementation of modern resource-saving technologies at the pre-hospital stage, and expand the indications for inpatient treatment (O.P. Shchepin, 1996; Yu.P. Lisitsin, 1999).

The reform of the healthcare management system has led to a significant increase in the responsibility of regions for the state of public health and the level of medical care, transferring the entire burden of decision-making from federal to regional management structures, placing them before the reality of genuinely growing needs of the population in health protection and declining capabilities of the healthcare system (R.A. Khaldfin, 1998).

The Moscow Oblast, which is the largest region of the Russian Federation after Moscow, by per capita healthcare financing belongs to a category below the average level. The Oblast is not among the favorable ones in terms of population health indicators (V.A. Solodkiy, 1999).

The concept for the development of healthcare in the Moscow Oblast for the period up to 2005 envisions the implementation of significant transformations in the organization of polyclinic care for the population. At the first stage (up to 2005), the improvement of polyclinic care provides for the introduction of an intra-institutional contract as a prototype of general medical practice, and the creation of therapeutic and diagnostic centers and outpatient surgery centers in polyclinics.

The practical implementation of structural transformations and the introduction of new organizational technologies in the provision of polyclinic care to the population requires scientific justification and evaluation for the further reform of the healthcare system.

The aim of the study is the scientific justification of the effectiveness of the introduction of new organizational technologies into the practice of a municipal polyclinic.

Research objectives

1. To develop programs for a socio-hygienic study of the effectiveness of the introduction of new organizational technologies into the practice of a municipal polyclinic.

2. To study the morbidity of the population in dynamics for 1997–2001, residing in the service area of Polyclinic No. 2 in Mytishchi, Moscow Oblast.

3. To analyze the organizational and functional structure of the polyclinic, including a day hospital, a therapeutic and diagnostic center, a rehabilitation center for outpatient surgery, and a traditional medicine office.

4. To investigate the dynamics of indicators characterizing the activity of the polyclinic for 1997–2001.

5. To assess the medical, social, and economic efficiency of the polyclinic's activities as a result of the introduction of new organizational technologies.

6. To develop proposals for the further reorganization of the polyclinic service.

Scientific novelty of the study:

For the first time, the organizational and functional structure of a municipal polyclinic has been analyzed, which includes a therapeutic and diagnostic center, a rehabilitation center, an outpatient surgery center, a day hospital, and a traditional medicine department.

The interaction of team contracts of specialist physicians and new organizational structures as the first stage of the transition to general medical practice has been examined.

The use of short-term (1–3 months and longer) voluntary medical insurance programs for traditional and non-traditional medicine has been studied.

A complex of indicators characterizing the medical, economic, and social efficiency of a municipal polyclinic has been defined.

The following theses are proposed for defense.

• The further development of polyclinic care for the urban population should provide for the creation within the polyclinic of a therapeutic and diagnostic center, a rehabilitation center, an outpatient surgery center, and a day hospital, which expands the possibilities of this stage of serving the population and reduces the volume of inpatient care.

• The unification of the main medical personnel of the polyclinic providing specialized therapeutic and preventive care into teams will allow their subsequent transformation into general medical practices.

• The use of short-term voluntary medical insurance programs, having a relatively low cost, combining consultations of specialist physicians, diagnostic examinations, rehabilitation procedures, and methods of folk medicine, has greater demand than long-term programs.

• The combination of team contracts for physicians with broad possibilities for using instrumental and laboratory diagnostics, treatment in a day hospital, and a rehabilitation center has medical, social, and economic efficiency.

Scientific and practical significance consists in the implementation of the results of the study into the practice of Polyclinic No. 2 in Mytishchi, into other polyclinics of the city and the Moscow Oblast. During the study, a methodology for evaluating innovations in the work of a polyclinic through the determination of medical, social, and economic efficiency was developed and implemented; the multifaceted results obtained during the study are used in organizing the educational process at the Department of Management, Healthcare Economics, and Medical Insurance of the Faculty of Advanced Training of Physicians at the Russian State Medical University.

The results of the study are of interest to leaders of healthcare management, medical insurance organizations, and compulsory medical insurance funds.