Scientific Justification of the Efficiency of Resource Base Utilization of Nephrological and Urological Services in a Large Industrial City

The dissertation is devoted to the scientific justification of the efficiency of resource base utilization of nephrological and urological services in a large industrial city of Tolyatti under conditions of healthcare reforms conducted in the Samara Oblast. The research analyzes the dynamics of general morbidity of the population with urogenital system pathology, the coverage under dispensary observation, as well as key indicators of bed fund utilization, efficiency of specialists' labor utilization, and economic efficiency of the aforementioned services in various periods of reforming. The author has developed criteria for the assessment of the development of specialized services and has proposed organizational decisions on the optimization of inpatient medical care for diseases of the organs of the urogenital system.

Relevance of the Topic. In the system of medical and social service of the population, an important place belongs to inpatient medical care. Hospital institutions, as a rule, are called upon to serve the most severe categories of patients, the treatment of which presupposes constant improvement of technology, the use in the process of diagnosis and treatment of the achievements of medical science, modern equipment. This makes this type of medical care the most costly, and the attention of researchers to various questions of inpatient service remains undiminished (Komarov Yu.M., 1997; Shchepin O.P., 1997; Kuchenko V.Z., 1999; Shcherbakov M.V., 2000; Vishnyakov N.I., Kotova G.N., 2003).

In modern socio-economic conditions, paramount importance is retained for the study of the problem of economic efficiency of the work of stationary institutions, the search for reserves of their activity (Pavlov Yu.V., 2002).

The existing organizational model of medical care, in its essence, relies on the most costly inpatient medical care. This, in conditions of sharply limited financial resources, should be assessed as one of the factors of unprofitability and inefficiency of the existing healthcare system. However, at present there appeared a real possibility of more intensive transformation of inpatient medical care, requiring the effective resolution of questions of rational use of hospital beds (Zhukov V.A., 1997; Shchepin V.O., 1997; Pavlov Yu.V., 2002).

The justification of these transformations should be carried out on the basis of a comprehensive analysis of the activity of the inpatient service in the process of reforms of the domestic healthcare system. The Samara Oblast is in a period of economic and structural reforms; since the conduct of the large-scale experiment on the transition of healthcare to new conditions of economic management; at present, in it, the law on mandatory medical insurance is most consistently implemented and certain pioneering projects of the organization of the system are being tested.

Many researchers (Komarov Yu.M., 1998; Korchagin V.P., 1998; Kravchenko N.A., 1998; Polyakov I.V., 1999; Starodubov V.I., 1999; Mikhailova Yu.V., 2002; Dedkov E.D., 2003; Yuryev V.K., 2003) consider that the priorities in the protection and strengthening of the health of the population of Russia should be found in the sphere of economics.

Therefore, the analysis of the influence of healthcare reforms on the economy and efficiency of the utilization of the resource base of specialized services is necessary, and the problem of optimization of the activity of the inpatient service in changing conditions is extremely relevant, which became the basis for the conduct of the present scientific research.

The goal of the present research is the development of scientifically grounded recommendations on the improvement of the model of the service providing inpatient medical care for diseases of the urogenital system.

In accordance with the set goal, the following tasks were solved:

1. To study the dynamics of general morbidity indicators and population coverage with urogenital system pathology under dispensary observation.

2. To conduct a comparative analysis of certain indicators of the utilization of the resource base of nephrological and urological services of Tolyatti in the process of healthcare reforms.

3. To study the efficiency of working time utilization by urologists of inpatient facilities and to provide its economic assessment.

4. To determine the trends in the development of the resource base of nephrological and urological services in a large industrial city in the process of reforming the healthcare system.

5. To develop scientifically grounded recommendations on the optimization of the service providing inpatient care for diseases of the organs of the urogenital system.

Scientific Novelty of the Research. The scientific novelty consists in the fact that for the first time:

• the influence of healthcare reforms on the efficiency of utilization of key components of the resource base of nephrological and urological services in the healthcare of a large industrial city has been studied;

• new economic criteria have been used in the assessment of specialized nephrological and urological services and their changes in the process of reforms have been presented;

• an analysis of the redistribution of patient flows requiring medical care for diseases of the urogenital system between stages and levels of its organization in the process of healthcare reforms has been given;

• an assessment of the trends and nature of development of nephrological and urological services from the standpoint of economic efficiency in various periods of reforms has been provided;

• scientifically grounded proposals on the improvement of the resource base of healthcare institutions providing qualified and specialized care for pathology of the organs of the urogenital system have been presented.

Scientific and Practical Significance of the Research. The results of the dissertation work have been used by the Department of Healthcare of Tolyatti for the development and correction of Programs of State Guarantees of Medical Care for the Population of Tolyatti.

The materials of the dissertation work, by the Ministry of Healthcare of the Administration of the Samara Oblast, have been used in the development of the plan for the optimization of the network of inpatient institutions, Targeted Complex Programs "Health of the Population of the Samara Oblast" (2000–2003).

The materials of the conducted research are used in the educational process of the Department of Public Health and Healthcare of Samara State Medical University and the Department of Public Health and Healthcare of the Institute of Postgraduate Education of Samara State Medical University.

Propositions to be Defended.

1. The influence of healthcare reforms conducted in the Samara Oblast on the efficiency of utilization of the resource base of nephrological and urological services.

2. Scientifically grounded organizational decisions on the optimization of inpatient medical care for diseases of the organs of the urogenital system.

Personal Contribution of the Author to the Conducted Research.

The author independently conducted an analytical review of domestic and foreign literature on the studied problem, compiled a research program, developed and implemented a methodology for determining the average time spent by urologists on performing operations during a working day, conducted chronometric measurements of operations, studied the material reflected in official forms of state medical reporting, conducted its statistical processing and analysis of the results of the research. Personal participation of the author was also realized in the development of:

1. Criteria for the development of a specialized service in the process of healthcare reforms and their point assessment.

2. "Dictionary of Types of Activity and Labor Operations of a Hospital Urologist".

3. "Observation Sheet".

Validation of the Research Results.

The main provisions of the dissertation were reported at the Interregional Working Meeting in Tolyatti in 2002; the Conference of the Samara Oblast Association of Physicians, 2001; the XII International Forum "Medical and Ecological Safety, Rehabilitation and Social Protection of the Population" in Moscow, 2002; the All-Russian Meeting "Improvement of the Quality of Medical Care on the Basis of Development of Informatization of Healthcare" in Tolyatti, 2002–2003; the scientific and practical conference "Modern Problems of Public Health and Organization of Healthcare" in Omsk, 2004.

Publications: The main provisions of the dissertation work are set forth in 9 printed works of regional, Russian, and international levels.

Structure and Volume of the Work: The dissertation is presented on 133 pages of typed text and consists of an introduction, 5 chapters, conclusion, conclusions, practical recommendations, 3 appendices, a list of literature including 176 domestic and 51 foreign sources. The work is illustrated by 5 figures and 15 tables and 1 scheme.