The Role of Economic Management Methods in the Activity of a City Multiprofile Hospital

The dissertation is devoted to the study of the role of economic management methods in the activity of a city multiprofile hospital. The author has substantiated conceptual approaches to the application of these methods, analyzed the possibilities of their use in modern healthcare conditions, and developed methodologies for activity planning and differentiated compensation of medical personnel. The research is based on materials from a city clinical hospital No. 67 of Moscow and is aimed at the scientific substantiation and implementation of managerial decisions for optimizing the work of a multiprofile medical institution.

Reorganization of the healthcare system, decentralization of financial provision, formation of the market for medical services, and the emergence of competitive relations among various medical organizations make it urgent to apply adequate methods and forms of management that ensure the restoration of the weakened management vertical in the industry with the aim of ensuring the implementation of state policy in the field of healthcare, as noted in the works of many domestic specialists (Vyalkov A.I., Kuchenko V.V., Lysitsyn Yu.P., Ovcharov V.K., Starodubov V.I., Filatov V.B., Khalfin R.A., Shevchenko Yu.L., Shchepin O.P., Shchepin V.O. and others).

One of such methods are economic management methods, increasingly being introduced into the practice of medical preventive institutions and organizations of various forms of ownership.

Economic methods are methods of impact on the system subjects using material resources, as well as on the management of these resources, that is, on the economic relationships of individual subjects of the system.

In the "Concept for the Development of Healthcare and Medical Science in the Russian Federation" (1997), the necessity of improving healthcare management on a scientific basis through the use of new information technologies and economic management methods is emphasized.

Economic methods of managing resources of medical preventive institutions can be represented as a unified system comprising activity planning taking into account available financial resources, revenue forecasting, as well as the application of financial and administrative levers.

In recent years, the impact of financial-economic mechanisms of functioning of the healthcare system on medical preventive institutions has undergone a fundamental change: targeted sources of financing regulate the types and volumes of medical care provided to the population within the framework of the State Order — the Program of State Guarantees for Providing Citizens of the Russian Federation with Free Medical Care (PGG); the process of calculating the cost per unit of medical service is being regulated; expenditure of financial funds is carried out for targeted purposes in accordance with the codes of the economic classification of budget expenditures and strictly within the limits of budget obligations; budgetary planning of institutional activity is conducted separately by source of financing, etc.

Particular attention in recent years has been paid to planning the activity of medical preventive institutions. The use of planning as a powerful instrument of management of medical preventive institutions can serve as a basis for selecting the optimal solution to an entire complex of problems, creating coordinating links between subjects of the healthcare system based on economic relationships.

The essence of planning lies primarily in the well-founded determination of the main directions and proportions of development of medical preventive institutions, taking into account the material sources of their provision and the demand in the market for medical services.

At present, in domestic medical preventive institutions, current, operational planning is encountered more often than strategic planning, whereas it is precisely the latter that determines the general strategic goals and directions of activity of medical preventive institutions, the resources necessary for this, and the stages of solving the set tasks, and is the main factor in the competitive struggle for survival.

In this connection, measures to streamline the planning-financial and organizational-technical structure of medical preventive institutions are being activated, which require the compilation of a comprehensive program for their strategic development, the resolution of issues related to business planning.

It is known that rational use of financial funds depends, first and foremost, on their effective management at the institutional level. Under the prevailing conditions, particular importance in solving planning questions, as well as for the most complete assessment of problems of financial provision of medical preventive institutions, is acquired by economic analysis using financial-economic indicators of activity of multiprofile medical preventive institutions, with the role of financial management being strengthened.

One of the most important elements of the use of economic methods in management is material stimulation of productive and high-quality labor.

Before the introduction of mandatory medical insurance, a potentially possible source of additional material stimulation of medical workers was budget funds, the use of which was possible only through savings in the payroll fund. The appearance of extra-budgetary sources of financing of medical preventive institutions at present makes it possible to strengthen the stimulating function of wages, provided there is a rational economic mechanism and an adequate assessment of individual labor contribution.

In recent years, sufficient attention has been paid to the scientific substantiation of the introduction of mechanisms of economic stimulation of various subjects of the healthcare system and mandatory medical insurance, as well as of medical personnel. At the same time, these questions were considered both at the level of the system of payment for medical services and within the framework of compensation of medical workers (Kadyrov F.N., 1998; Lindenbraten A.JL with co-authors, 1998; Gaidar G.M. with co-authors, 1999; Tretyakov A.E., 1999; Aleksandrov V.A., Isakov G.N., 2000; Lebedeva I.V., Kudrin B.S., 2000; Panov S.N., 2000; Andreeva O.V., 2002 and others). However, this problem continues to remain a subject of discussion and in this regard many questions still evoke interest among leaders of various levels and medical workers.

Overall, the practice of functioning of the system for providing medical care to the population in modern socio-economic conditions, as well as available sources of literature, testify that questions devoted to improving the efficiency of the use of economic management methods in the activity of medical preventive institutions are sufficiently relevant and require their comprehensive consideration at the level of a multiprofile medical preventive institution, which is the main link in the implementation of reforms in healthcare.

The goal of the research is the scientific substantiation of the use of economic management methods in the activity of a multiprofile hospital.

The tasks of the research:

- to study and generalize the experience of applying modern management methods in the activity of medical preventive institutions;

- to substantiate conceptual approaches to the application of economic management methods;

- to analyze the possibilities of using various management methods in the activity of a city multiprofile hospital;

- to conduct an economic analysis of the use of the bed fund of a multiprofile hospital;

- to develop technologies for planning the activity of a multiprofile hospital;

- to develop a methodology for differentiated compensation of hospital personnel;

- to develop and pilot-test proposals for the use of economic management methods in the activity of a hospital.

The object of the research was a city multiprofile hospital, and the subject of study — its activity.

In accordance with the set tasks, a complex methodology was used in the research, including the following methods: study and generalization of experience, statistical, mathematical, sociological methods of economic and comparative analysis, expert assessments, organizational experiment.

As a specific research base, a city clinical hospital No. 67 of Moscow was selected.

The scientific novelty. The experience of using modern management methods in the activity of medical preventive institutions has been generalized.

The possibilities of using various management methods have been analyzed and conceptual approaches to the application of economic management methods in the activity of a multiprofile hospital have been scientifically substantiated.

A technology for planning the activity of a city multiprofile hospital based on financial-economic indicators has been developed.

The role of the use of result-factor analysis in multiprofile medical preventive institutions has been determined.

The basic principles and methodological approaches to material stimulation of medical personnel of a hospital institution have been developed. An experience of using mechanisms of differentiated compensation of physicians has been presented.

Scientifically substantiated proposals for a more efficient use of priority economic management methods in the activity of a multiprofile hospital have been developed.

The practical significance.

The results of the conducted research made it possible to scientifically substantiate specific proposals and implement a whole complex of managerial decisions on optimizing the management of a multiprofile hospital using economic management methods.

The principles and methodological approaches to economic stimulation of medical personnel of inpatient facilities of medical preventive institutions developed in the course of the work can be used in various types of hospital institutions for motivating the activity of medical workers, improving medical effectiveness and the quality of medical care provided to the population.

The materials of the present research have been reported at various regional and All-Russian scientific-practical conferences, meetings of chief physicians, the Collegium of the Ministry of Health of the Russian Federation, and have been used in the preparation of normative and methodological materials for medical workers, health authorities and institutions.

The results obtained are used in the educational process at the Department of Social Hygiene and Organization of Healthcare of the Russian Medical Academy of Postgraduate Education.

34 works have been published on the topic of the dissertation, including 1 monograph.

The results of the research have been reported and discussed at:

- conference of chief physicians of the SZAO. Moscow, April 18, 2001;

- VI scientific-practical conference "Development of the System for Ensuring Quality of Medical Care in Modern Conditions and Problems of Optimizing the Structure of Healthcare" NII of Social Hygiene, Economics and Management of Healthcare named after N.A. Semashko RAMN. Moscow, April 24-25, 2001;

- conference of chief physicians of the SZAO. Moscow, October 16, 2001;

- VII scientific-practical conference "Development of the System for Ensuring Quality of Medical Care in Modern Conditions and Problems of Optimizing the Structure of Healthcare" NII of Social Hygiene, Economics and Management of Healthcare named after N.A. Semashko RAMN. Moscow, April 18-19, 2002;

- Collegium of the Committee on Healthcare of Moscow "Economics of Healthcare of Moscow" (1st session), January 16, 2003;

- Collegium of the Committee on Healthcare of Moscow "Economics of Healthcare of Moscow" (2nd session), March 20, 2003;

- VIII scientific-practical conference "Health of the Population, Policy and Technologies of Healthcare Development" NII of Social Hygiene, Economics and Management of Healthcare named after N.A. Semashko RAMN. Moscow, April 16-17, 2003;

- at a scientific conference of the Department of Economic Research in Healthcare of NII of Social Hygiene, Economics and Management of Healthcare named after N.A. Semashko RAMN, Moscow, June 10, 2003;

- at an interdepartmental conference of GU NII named after N.A. Semashko RAMN, Moscow, September 19, 2003.

The main provisions put forward for defense:

- substantiation of priority economic management methods in the activity of a city multiprofile hospital;

- modern approaches to analysis and planning of financial-economic indicators of activity of a multiprofile medical preventive institution;

- results of the economic analysis of activity of a city multiprofile hospital;

- mechanisms for assessing the activity of medical personnel of a hospital institution and their economic stimulation.