Scientific Justification of the Main Directions for the Development of Healthcare in the Karachay-Cherkess Republic

The dissertation is devoted to the scientific justification of the main directions for the development of healthcare in the Karachay-Cherkess Republic in the context of the healthcare reform processes carried out at the regional level. The research takes into account the socio-economic, demographic, and medico-social specifics of the republic as a subject of the Russian Federation and is aimed at identifying priority directions for improving medical care for the population. The author has conducted a comprehensive multi-factor analysis of the state of population health and the functioning of the healthcare system, developed methodological approaches to assessing the effectiveness of sector reform, and constructed a typology of subjects of the Russian Federation according to the intensity of healthcare reform processes.

The reform of public life in Russia, carried out over the past decade, has significantly strengthened the role of the constituent entities of the Russian Federation in addressing social problems. Regional responsibility for the state of population health, the level of medical care provided, and its accessibility for residents of urban and rural areas has sharply increased.

Limited budgetary financing of the sector, low compensatory capabilities of the compulsory medical insurance system, and the weak development of non-state structures have placed before regional healthcare management bodies two complex and mutually complementary tasks:

- preserving the resource base of the state healthcare system and ensuring its viability under contemporary conditions;

- further developing the system of health protection for citizens and carrying out healthcare reform in accordance with the general state policy on sector reform.

Solving the problem associated with the process of implementing the reform depends to a large extent on the proper use of modern strategic management methods.

The territories of the country found themselves in unequal positions with respect to the possibilities of carrying out reforms. With the beginning of reforms, differences in the socio-economic development of territories began to intensify, which can be explained by two reasons: the presence of territories with different economic structures and a significant weakening of the regulatory role of the state. Territorial inequality is also manifested in the development of healthcare systems of the subjects of Russia. In most subjects that do not possess powerful scientific and managerial potential, reform problems are solved taking into account limited resources, and the results obtained are modest, although they possess practical significance.

In connection with the established socio-economic differentiation of territories, the conduct of a strong state regional policy aimed at smoothing out differences in the level of development of healthcare systems of the subjects of the Russian Federation is of strategic importance for Russia.

For any reform, danger lies both in its unjustifiably rapid implementation, fraught with disrupting the established system, and in slow implementation, which prolongs the period of destabilization. At the same time, obvious stagnation of the reform process, accompanied by declining accessibility of medical care, increasing costs of the population for its receipt, and deterioration of conditions for its provision, elicits a negative reaction from society. The inability to realize expectations associated with increasing remuneration, improving its technical equipment, also elicits a negative reaction from medical workers.

Regional healthcare policy is built on uniform state principles for forming a system of population health protection, which include the following principles:

- ensuring social guarantees in population health protection, in the provision of free medical care, supporting social institutions and unprotected contingents;

- realizing the rights of the patient in the system of medical service of citizens, expanding the possibility to ensure their freedom of choice of various forms of medical care regardless of forms of ownership;

- observing and protecting human rights in the sphere of ensuring ecological and sanitary-epidemiological safety of living conditions, nutrition, work, and study;

- implementing preventive policy in the formation of a healthy lifestyle;

- rational use of healthcare resources on the basis of restructuring the system of medical care provision taking into account the actual needs of the population and the possibilities of their satisfaction;

- strengthening the vertical in healthcare management while expanding the system of interaction between healthcare and society, intersectoral cooperation.

With a large number of constituent entities of the federation, significant socio-economic, ethnographic, and national differences among them, unresolved problems of health protection requiring priority approaches, have much in common and include:

- strengthening reproductive health of the population, leveling the demographic situation, improving the health of children;

- increasing average life expectancy and ensuring active aging;

- reducing the influence of stress on the state of health of the population through increasing resilience and psychological adaptation of individuals;

- taking complex measures to reduce socially significant diseases.

Difficulties with state financing of healthcare, increasing requirements of the population for the quality and accessibility of medical care require conducting organizational and structural transformations of the entire healthcare system and more efficient use of resources.

State support should be targeted at implementing necessary transformations in the territory, which is why it is necessary to evaluate the reforms taking place on the ground in healthcare relative to all-Russian indicators.

In connection with the above, there arises a necessity to study, in a separately taken subject of the Russian Federation, the specifics of the state of population health, the actual needs of the population for medical care and the possibilities of their satisfaction, and the directions for reorganizing healthcare in accordance with the actual socio-economic situation. A comprehensive assessment of the problems of health and healthcare in the Karachay-Cherkess Republic is the subject of this research.

The goal of the research is the scientific analysis of the state of population health and the scientific justification of the main directions for the development of healthcare in the Karachay-Cherkess Republic.

In order to determine the priorities for healthcare development aimed at preserving and improving the health of the population of the Karachay-Cherkess Republic, the following tasks were set in the research:

1) to analyze the current state of the healthcare system at the regional level;

2) to develop methodological approaches to studying the state of population health and directions for reforming healthcare in the KCR;

3) to conduct a comprehensive assessment of the position of the KCR in the Southern Federal District and in the Russian Federation based on economic-geographic, medico-demographic, and socio-economic characteristics of the KCR;

4) to study the specifics of the state of population health in the KCR;

5) to conduct a sociological study among the population, physicians, heads of institutions, and healthcare bodies on problems of population health, medical provision, and directions for reforming healthcare in the KCR.

Scientific novelty. For the first time, based on a comprehensive multi-factor analysis, an in-depth study of the economic-geographic, medico-demographic, and medico-social situation in the territory of the Karachay-Cherkess Republic over a 15-year period in conditions of socio-economic reforms has been conducted.

Methodological approaches to studying the state of population health and directions for reforming healthcare in a subject of the Russian Federation have been developed.

Criteria for constructing a typology of subjects of the Russian Federation according to the development of structural-functional transformations of the healthcare system have been determined.

The specifics of the state of population health in the KCR, problems of medical care, and prospects for its development have been identified based on the analysis of official statistics and sociological research. For the first time, a comparative analysis of the health of the population and healthcare in the KCR has been conducted at regional, interregional, and federal levels.

An integral assessment of the processes of healthcare reform in the KCR has been given based on evaluations of the progress of reforms in the main healthcare services — ambulatory-polyclinic care, inpatient care, and emergency medical care.

A typology of subjects of the Russian Federation according to the intensity of healthcare reform processes has been constructed. A comparative analysis and assessment of subjects of the Russian Federation according to the level of development of healthcare reform processes has been conducted. The main directions for structural-functional transformations in healthcare in the KCR have been justified in order to improve the system of medical care provision to the population of the Republic.

Scientific and practical significance.

The results of the comprehensive analysis of the state of population health in the KCR, trends, and features of its change are relevant information for making managerial decisions aimed at developing and improving medical care for the population of the KCR.

The sociological monitoring of problems of health and healthcare and the database created on its basis contributes to the identification of problematic medico-social situations and the adoption of timely targeted decisions at various levels of management.

A comparative analysis of healthcare problems in the KCR at regional and interregional levels makes it possible to evaluate the Republic's own experience through the prism of achievements in other regions, obtain a picture of the situation in the country, and select territories for further cooperation.

The results of the assessment of sector reform processes at the republican and interregional levels can serve as an information base for developing proposals on the main directions of healthcare policy in the KCR with the aim of overcoming the lag in sector development.

Implementation of the research results

1. The materials of the research are used in the work of the Ministry of Health and Resorts of the KCR for monitoring the situation in healthcare in the Republic and supporting the making of managerial decisions.

2. The results of the medico-social monitoring are used in the practice of the Pyatigorsk Research Institute of Balneology, specialized sanatoriums of the North-Caucasian Zoneal Management of the Federal Agency for Healthcare and Social Development of the Russian Federation.

3. The data obtained in the course of the research are used in the educational process at the Department of Balneology of the Institute of Postgraduate Education in the city of Pyatigorsk.

Main provisions to be defended

1: A comprehensive analysis of the dynamics and trends of change in the medico-demographic and medico-social situation in the Karachay-Cherkess Republic is necessary for increasing the effectiveness of healthcare management.

2. A scientific assessment of the main problems of the state of population health in the KCR as an information base for forming adequate healthcare policy.

3. Sociological monitoring on questions of the state of health and healthcare as important informational support for determining the directions of structural-functional transformations in the system of population health protection.

Validation of the research results

The main provisions and results of the research were reported and discussed at scientific-practical conferences "Zdravnitsa 2004" (St. Petersburg, 2004), "Zdravnitsa 2005" (Moscow, 2005), the Academic Council of the Pyatigorsk Research Institute of Balneology (Pyatigorsk, 2005), the conference "The Role of Healthcare in the Protection of Public Health" (State Unitary Enterprise National Research Institute of Public Health of RAMN, Moscow, 2006), and at the interdepartmental conference of the State Unitary Enterprise National Research Institute of Public Health of RAMN (2006).

Three scientific works have been published on the topic of the dissertation.

Structure and volume of the dissertation. The work consists of an introduction, a literature review, a chapter devoted to materials and methods of research, three chapters of original research, conclusions and proposals, a list of used literature containing 148 sources, including 12 foreign ones. The work is presented on 200 pages of typed text and contains 67 tables and 11 figures.