Scientific Substantiation of Material Incentive for Workers of a Multidisciplinary Hospital in the Conditions of Organizing Paid Medical Services

The dissertation is devoted to the scientific substantiation of a system of material incentive for workers of a multidisciplinary hospital in the conditions of organizing paid medical services. The study is based on a comprehensive socio-economic analysis and relies on the methodological positions of the theory of active systems, applied to the formulation of the tasks of functioning of medical institutions.

The Samara Regional Clinical Hospital named after M.I. Kalinin served as the basic object of study. In the work, a comparative analysis of actual and planned income and expenditure of the institution was conducted, models of material incentive for medical workers were developed, taking into account the interests of the administration, staff, and patients. The proposed models and compensation system were implemented in the departments of the hospital and used to optimize the organization of medical care. The results have also been applied in the pedagogical process of the Samara State Medical University.

Relevance of the topic. Questions of healthcare reform in our country have received considerable attention in the works of domestic scientists (Vishnyakov N.I., 2000; Lisitsyn Yu.P., 2000; Luckevich V.S., 2000; Polyakov I.V., 2001; Shevchenko Yu.L., 2002; Sheyman I.M., 2002; Vyalkov A.I., 2003; Shchepin I.V., 2004; Reshetnikov A.V., 2004; Kucherchenko V.Z., 2005; Starodubov V.I., 2005). The implementation of research results made it possible to substantiate a number of practical measures, the first of which should be the attempt to finance the activity of medical institutions through the mechanism of compulsory medical insurance (OMI). This direction of reform belongs to the macroeconomic level of management. In addition, attempts have been made to transform the activities of healthcare organizations at the microeconomic level. It should be noted here that the experiment, known in the history of healthcare as the "new economic mechanism" (Leningrad, Kemerovo and Kuibyshev regions), was aimed at improving the efficiency of resource utilization by hospitals, decentralizing management, and expanding the rights of the administration of institutions and labor collectives. The aforementioned measures undoubtedly played a positive role, but at the same time did not ensure the realization of the original target objectives. Thus, the volume of financing of healthcare institutions for 2004 under the OMI was only 75%. The need to attract additional financial resources to "cover" the costs of medical institution activities led to the creation of a sphere of paid medical services. The regulation of this new form of activity was supported by a series of normative acts of the Ministry of Health of the Russian Federation. However, the implementation of economic management methods requires the development of new approaches to organizing intra-firm interactions among performers.

The lack of experience in building such interactions predetermines the problems faced by the management of medical institutions. In domestic scientific literature there are publications and works dedicated to questions of organizing intra-firm, intra-hospital economic interactions. Publications in this direction are reflected in the works of Burkov V.N., Gubko M.V., Germeyer Yu.B., Grishanov G.M., Novikov D.A., Enalieva A.K., Kondratiev V.V., Tsvetkov V.A., Chkhartishvili A.M., the analysis of which shows that the most effective tool for solving the tasks of organizing economically coordinated interactions of elements (performers) is the theory of active systems, used in our work.

Therefore, the emergence of new (paid) forms of medical service, combined with the lack of experience in organizing these forms and the scientific and methodological support for solving tasks of stimulating the activity of medical institution workers under new conditions, determined the relevance of the present scientific research.

Goal of the study.

Based on a comprehensive socio-economic study, to develop and scientifically substantiate a system of material incentive for workers of a multidisciplinary hospital in the conditions of organizing paid services, aimed at improving the efficiency and quality of medical care for the population.

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

1. To study the socio-economic problems of healthcare in the conditions of organizing paid services in the Russian Federation.

2. To conduct a comparative analysis of economic indicators of the Samara Regional Clinical Hospital named after M.I. Kalinin.

3. To develop models of material incentive for medical workers in the conditions of organizing paid services.

4. To study the opinions of patients on the quality of paid services received and the opinions of medical workers on job satisfaction in the conditions of organizing paid services.

5. To implement the proposed directions for improving material incentive in the departments of the multidisciplinary hospital.

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

- the socio-economic problems of healthcare in the conditions of organizing paid medical services in the Russian Federation have been studied;

- a comparative analysis of economic indicators of the Samara Regional Clinical Hospital named after M.I. Kalinin has been conducted, which made it possible to formulate tasks for improving the management of medical institutions;

- models of material incentive for medical workers in the conditions of organizing paid medical services have been developed, ensuring high quality of medical care;

- the opinions of patients on the quality of paid medical services received, as well as the opinions of medical workers on job satisfaction in the conditions of organizing paid services, have been studied.

Practical significance and implementation of research results.

The presented material incentive models and the compensation system built on their basis are used at the Samara Regional Clinical Hospital named after M.I. Kalinin for the purpose of optimizing the organization of medical care for the population of the Samara region during the reform of the sector.

The results of the study have been applied in the pedagogical process of the Department of Public Health and Healthcare of the Samara State Medical University, in the training and advanced training of physicians at the Department of Public Health and Healthcare of the Postgraduate Institute of the Samara State Medical University.

The materials of the conducted study are used by the management of the Samara Regional Clinical Hospital named after M.I. Kalinin in the development and improvement of Regulations on the compensation of workers of the departments.

Defended regulations:

1. An approach to analyzing the state of healthcare objects based on the methodological positions of the theory of active systems, which allows formulating the tasks of functioning of medical institutions in the conditions of organizing paid services.

2. A model of material incentive for medical workers in the conditions of organizing paid services, ensuring the reconciliation of the interests of producers and consumers of medical services.

Personal contribution of the author to the conducted research.

The author developed an independent approach to analyzing the state of medical institutions, based on the combination of traditional research methods with the positions of the theory of active systems (personal participation share 100%). The author independently carried out all the work on collecting and analyzing experimental material, its critical evaluation, and identifying the main directions for improving the efficiency of medical institution functioning (personal participation share 100%). The conducted review of literature data allowed the author to develop a scientifically substantiated system of material incentive taking into account the specifics of the functioning of a multidisciplinary hospital (personal participation share 90%). The author conducted a sociological study that made it possible to study the opinions of patients on the quality of paid services received and the opinions of medical workers on job satisfaction in the conditions of organizing paid services (personal participation share 100%). The author personally carried out the generalization and economic-mathematical modeling of the proposed solutions in the work on the selection of scientifically substantiated methods of material incentive (personal participation share 100%).

Defense of the work.

The main provisions of the dissertation were reported at:

- the Inter-regional Congress of Physicians of the Samara Region "Innovations in Medicine," in Tolyatti, in 2005.

- the International Scientific and Practical Conference "Public Health: Innovations in Economy, Management and Legal Issues of Healthcare," in Novosibirsk, in 2005.

- the International Scientific and Practical Conference "Theory of Active Systems," in Moscow, in 2005.

Publications: The main provisions of the dissertation work are presented in 9 printed works of regional and national levels.

Structure and volume of the work:

The dissertation is set out on 121 pages of typescript and consists of an introduction, 5 chapters, conclusion, findings, practical recommendations, a list of references including 104 domestic and 57 foreign sources. The work is illustrated with 14 tables and 41 figures.