Article
Модернизация российского здравоохранения: вызовы, ожидания и реальность
The paper highlights the agenda of the modernization of the Russian health care and related problems. The author concentrates on the main directions of modernization, draws attention to its public interpretation, reveals mechanisms of social and cultural innovations employed in its implementation.
Based on official statistics, the author tries to address the question of why the infant mortality rate in Russia is significantly higher than might be expected given the measures taken to protect the health of pregnant women and newborns. In the introduction, the author explains the relevance of studying inequality in the level of infant mortality among the population of modern Russia as a factor holding back the positive downward trend.
After presenting the latest history of the evolution of the information and statistical base for population studies on the subjects under review, the author confirms the approach according to which it is advisable to work with data for real generations when analyzing the differentiation of infant mortality and generations born in 2014-2016 are chosen as the object of analysis.
To determine the relevance of individual factors contributing to infant mortality, the author cross-tabulated raw data. Data on such initial characteristics (factors) as the birth order of the child, whether a mother is in a contracted civil marriage or not, mother’s level of education, were grouped by age groups of mothers. The use of cross-tabulation allowed to affirm not only the influence of individual factors on the level of infant mortality but also a quantitative differentiation between them. The article concludes the extent to which the overall level of infant mortality is determined by mortality rates from individual causes of death.
A significant part of the article is presented in the format of author generalization using statistical methods regarding the educational differences of mothers, which have become differentiation factors in infant mortality rates.
The socio-demographic analysis based on official statistics has confirmed not only some hypotheses as to why, despite the relatively rapid decrease in infant mortality in Russia in recent years, its level remains higher than in almost all European countries with reliable demographic statistics, but also to reveal the extent of the inequality of infant mortality in our country.
The author argues that the reason why Russia lags behind many countries with the positive downward infant mortality trend is strongly associated with causes of death from conditions arising in the perinatal period as well as congenital disorders. This suggests that the level of medical care for pregnant women and newborns in Russia is still lower than in developed European countries. It also has to be assumed that different educational groups have unequal access to quality health care. А proactive approach to life as well as a progressive achievement of the right to choose a medical institution and a doctor - is one of the important directions for resolving a whole set of national health care issues.
Fragmentation in organization and discontinuities in the provision of medical care are problems in all health systems. A major challenge is to strengthen integration in order to enhance efficiciency and health outcomes. This artickle assesses issues related to fragmentation and integration in concptual terms and argues that key attributes of integration are teamwork, coordination and continuity of care. It then presents a summary of service integration problems in Russia and the results of a large survey of physicians concerning the attributes of integration. It is argued that characteristics of the national service delivery model don't ensure integration. Teh Senashko model is not an equivalent to the integrated model. Big organizational forms of service provision, like polyclinics and integrated hospitals-polyclinics don't have higher scores of integration indicators than smaller ones. Proposals to improve integration in Russia are presented with the focus on the regular evaluation of integration/fragmentation, regulation of integration activities, enhancing the role of PHC providers, economic incentives.
The paper uses the data of the Russian Longitudinal Monitoring Study to analyze the change in the state of health of the Russian population in the post-Soviet period. Age is regarded as a factor with a potential to influence incidence of chronic disease, disability and self-preservation behavior. The authors stress the importance of such factors of health deterioration as smoking and alcohol consumption.
Several approaches to the concept of fatherhood present in Western sociological tradition are analyzed and compared: biological determinism, social constructivism and biosocial theory. The problematics of fatherhood and men’s parental practices is marginalized in modern Russian social research devoted to family and this fact makes the traditional inequality in family relations, when the father’s role is considered secondary compared to that of mother, even stronger. However, in Western critical men’s studies several stages can be outlined: the development of “sex roles” paradigm (biological determinism), the emergence of the hegemonic masculinity concept, inter-disciplinary stage (biosocial theory). According to the approach of biological determinism, the role of a father is that of the patriarch, he continues the family line and serves as a model for his ascendants. Social constructivism looks into man’s functions in the family from the point of view of masculine pressure and establishing hegemony over a woman and children. Biosocial theory aims to unite the biological determinacy of fatherhood with social, cultural and personal context. It is shown that these approaches are directly connected with the level of the society development, marriage and family perceptions, the level of egality of gender order.