[The problems of population health and creation of health service programs].
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Biomedical subjects
Publications and source records attributed to E P Kakorina.
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The article defines the prevalence of paraclinical procedures and drug therapy among different groups of population. The data might be used for assessing the problems of health care delivery and also as a basis for dynamic evaluations in the light of multiaspect influence of medicine on the formation of population's health.
The article contains age-and-sex regularities in the development of circulatory diseases including the development of accompanying diseases. Local peculiarities of morbidity characteristic for different territories are described; the amount of medical care provided to this contingent is defined.
The presented data reflect deep and complex processes of biological rearrangements of populations in the current conditions, which are not simple to evaluate but should be taken into account in the analysis of population's health changes and in detection of the factors that are responsible for. With heterogeneous changes in various pathological processes and morphofunctional characteristics of the population, the concept of providing an opportunity for realisation of the age- and sex-specific biological and social functions by a population in certain socioeconomic conditions, with regard to the pathomorphosis, might be used as an approach to the assessment of the health status. Evaluation of dynamic shifts caused by sufficiently inert processes may be included into the range of wide-scale measures for determining the composition and numbers of population, as are regular census.
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Time course, tendencies, and sociohygienic characteristics of population morbidity and mortality with regard to the major diseases have been evaluated by investigation of population morbidity carried out in association with censuses and analysis of official statistical data and interviews of physicians and populations in 1991-1998. Differences in the health status of individual population groups, quality and level of their life are analyzed.
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Discusses obviously limited potentialities of obtaining systematized analytical data by organs and institutions of social sphere. Such potentialities are particularly low in public health, specifically pediatric research and practice, where analytical materials would help improve the development of strategic programs of maternity and childhood protection and adopt adequate managing solutions at all levels. One of the constructive decisions aimed at the formation of a system of sociohygienic monitoring of children's health and ensuring integration of efforts of all responsible organs is creation of Federal Center of Social prevention for Children and Adolescents. The Center will ensure economy and rational utilization of finances and staff at the state and territorial level. Its purpose is to unite the interests of all profile organs and institutions for ensuring social well-being of children and adolescents.
Main trends in the time course of resource provision and volume of activities of hospitals in Russia and their specific regional features are analyzed. Comparison of the main parameters with those in the USA helped disclose the reserves of improving the efficiency of hospital treatment, an expensive type of medical care.
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Although there is a huge variety of medical drugs, the practitioner finds it sometimes difficult to choose an appropriate drug for his patient; the insurance companies, striving for maximal profits, do their best to make the treatment as cheap as possible and to limit the doctor in his choice of preparations; and the manufacturers, seeking to reduce the production costs and make as much profit as possible, give up the research projects and purchase lower-quality substances abroad, facilitate the technologies and neglect the stage-by-stage quality control. However, the inaccessibility of medical drugs due to their high prices (not all patients can allow buying the needed drugs, and there is also a danger that one can buy a counterfeit) still persists to be the key problem. The above stated leads to a poorer treatment quality and a lower status of the national health as a whole.
Present-day medical facilities for treating patients with cancer of the urinary bladder in the Russian Federation (RF) are insufficient. In 1998, urological cancer in RF was managed only in 31 specialized departments working in 24 of 89 (27%) administrative units of the RF. In the other 65 (73%) units only urologists deal with diagnosis and treatment of urinary bladder cancer. These nonspecialized departments lack special equipment and personnel. Therefore, effective management and organization of medical care for urinary bladder cancer can be achieved on the basis of standardization of diagnostic and therapeutic methods and definition of stages in treatment policy. This helps to outline priorities in financing health services.
The results of a sociological inquiry held at 7 Moscow inpatient facilities on the basis of "a questionnaire designed for studying the social-and-hygienic life conditions of artificial-kidney patients" are described in the paper. They are indicative of that a majority of patients have a sufficiently high assessment of their life quality although they experience a constant need in hemodialysis and their vital activity is significantly limited in view of such severe pathology as chronic renal insufficiency. This can be regarded as a positive factor within a system of measures undertaken in the treatment of the above disease.
There are only as many as 31 specialized oncourological departments in 24 of 89 (27%) Federation Subjects in the Russian Federation that can render the oncourological care at the municipal and federal levels. As for other remaining 65 (73%) Subjects, the urologists are preoccupied with diagnosis and treatment of urinary-bladder cancer in them. Russian patient-care facilities have presently differing opportunities in the sphere of diagnosis and treatment of the mentioned pathology. Their related outfit for this purpose is on the whole unsatisfactory. An optimal management of medical care rendered to the discussed category of patients and targeted at promoting its quality and efficiency is possible only on the basis of standardization of diagnostic and treatment approaches. The stage-nature of medical care rendered to such patients is closely related the standardization issues. An accurate definition of stages and of patient-care facilities, which would be in charge for the above stages, would, in the end, clearly depict a sequence of steps for the diagnostic-and-therapeutic schemes applicable to patients with cancer of the urinary bladder. This, in its turn, would optimize the diagnostic-and-therapeutic process and outline the priority spheres in healthcare financing.
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Analyzed in the paper are volumes and structure of surgery in 1993-2002. It is shown that the fluctuating and mismatching nature of surgical up trend observed both in hospitals and outpatient clinics contradicts the redistribution of scope of medical care in favor of its primary stage, which is not supported up to now by an appropriate personnel policy.
Index, based on official statistic data, revealing regional differences and dynamics of medical care input into death rate is proposed. Its enhancing potential for health programs in ambulatory care is proved.