Результативность введения эффективного контракта с медицинскими работниками
The paper presents the results of a study of changes in the salary schemes and working conditions of medical staff, their labor motivation and the compliance of these changes with the objectives of the so-called “effective”, performance-based, contract being introduced. The data from a set of surveys of employees at public medical facilities in 2009–2018 served as the empirical base of the study. It is shown that the introduction of the effective contract had changed the role of factors determining the salary of medical workers. Whereas earlier qualification had been the leading factor, afterwards it was the volume and quality of the work performed as well as the outcomes of a given medical institution or unit. Most doctors had increased the amount of work they do, and the secondary employment of medical staff had slightly been reduced. Survey data indicate quite a stable hierarchy of labor motives among medical workers, the leading ones being earning money, professional interest in work, and altruism. In 2018, the role of the guaranteed employment motive was elevated. Among the positive changes are an increase in the satisfaction of medical workers with the salary, conditions for advanced training, and rules of remuneration. The identified outcomes are generally consistent with the objectives of introducing the effective contract, and they allow one to argue that the new salary scheme has had a positive impact on the labor motivation of medical staff. However, the conclusion of an effective contract was noted by only half of respondents. For the rest, it all boiled down to an increase in salary. These results indicate serious failures in the administration of this reform.
During the first 10 years of post-Soviet development, the healthcare sys tem was severely underfunded, and it wasn’ t until 2006 that total funding from all sources approached even the relatively low levels of 1991. No actual healthcare reform was implemented, however, other than the introduction of compulsory medical insurance (CMI). Even Soviet medical provisions for the presidential administration, with their exclusive healthcare facilities and resorts, were retained. However, there were important developments relat ing to aspects of healthcare regulation, the system of incentives, and medical guidelines. The object of this chapter is to present the major developments in the current system of quality management in the Russian healthcare system, and to consider the lessons learned.
Preface The world of healthcare is very challenging. Resource-constrained services, creeping bureaucratic requirements, new patient populations with greater needs than ever before, demand in excess of supply, clinician overload, major and minor breaches of patient safety, politicized workplaces, and ideology masquerading as systems planning: everywhere you look, the barriers to the provision of high-quality care are considerable, and often daunting. In the midst of all these problems, where can we turn for help? One answer is to change the focus and shift from the negatives to the positives. The very countries in which these types of problems reside always contain examples which have risen above the adversity, and provide solutions to problems. These are success stories that overcome difficulties, surmount obstacles, and deliver an accomplishment worthy of study in its own right. Professor Jeffrey Braithwaite, as health reform series editor, has led a team of internationally renowned scholars to deliver a compendium of work with precisely this focus. Regional experts Professors Russell Mannion (Europe), Yukihiro Matsuyama (South-East Asia), Paul Shekelle (the Americas), Stuart Whittaker (Africa), Samir Al-Adawi (Eastern Mediterranean), and Jeffrey Braithwaite (the Western Pacific) have made a concerted effort to harness the energies, expertise, and analytic ability of 161 authors who have combined to articulate positive messages about healthcare improvement in 60 countries. Rich and poor, northern and southern hemisphere, publicly or privately funded, technologically sophisticated or focused on the basics: the range of health systems examples, and their differing characteristics, is truly impressive. As you will see, each team of authors presents a single case example, which narrates a story of accomplishment in their home health system. The sheer diversity of case examples is testament to the range of things that can go right in healthcare. They provide plenty of lessons for those who want to improve care in their own system. Collectively, they act as a set of blueprints for what success looks like across many settings, sectors, and initiatives. That every country enrolled in the project, no matter how politically, financially, or logistically challenged, could adduce a shining example of success, is a reminder of what can be done by inspiring people who are determined to provide better services to their patient populations. In addition to being inspiring, this volume, the second in the Taylor & Francis health reform series, is instructive and practically relevant. It is jampacked with the expertise of many far-thinking and generous people across the world who take the task of improving the system they work in or on, very seriously indeed. For those of us whose appetite for reform and improvement can occasionally flag, or in cases when we become reform weary, this book is just the tonic needed. In a word, it’ s energizing. As the most extensive anthology of health system success stories ever assembled, we commend this book to you.
Despite the improvement in the material aspects of life in Russia in 21 century, the access to the health care for poor people, rural inhabitants and some othe vulnerable groups is still limited
Market growth of personal medical device comes from a number of factors: • Aging population requiring more attention; • Patients with chronic diseases may measure blood pressure and blood glucose at home; • Reducing the cost of these devices; • Ease of use and availability of medical devices; • Risen cost of a series of medical tests. This article discusses the new challenges that arise in the relationship doctor - patient in the remote Monitoring human healthcare. With the advent of a greater variety of low-cost medical devices, as well as low-cost high-quality mobile communication system will allow the system to tell the Remote Healthcare Monitoring System has also become possible. This system should be as ready to doctors and patients themselves. there is a new quality in the interaction between doctor and patient. Considers a new model of doctor-patient relationship in the light of the transfer of active interaction to the virtual world.
The paper examines the structure, governance, and balance sheets of state-controlled banks in Russia, which accounted for over 55 percent of the total assets in the country's banking system in early 2012. The author offers a credible estimate of the size of the country's state banking sector by including banks that are indirectly owned by public organizations. Contrary to some predictions based on the theoretical literature on economic transition, he explains the relatively high profitability and efficiency of Russian state-controlled banks by pointing to their competitive position in such functions as acquisition and disposal of assets on behalf of the government. Also suggested in the paper is a different way of looking at market concentration in Russia (by consolidating the market shares of core state-controlled banks), which produces a picture of a more concentrated market than officially reported. Lastly, one of the author's interesting conclusions is that China provides a better benchmark than the formerly centrally planned economies of Central and Eastern Europe by which to assess the viability of state ownership of banks in Russia and to evaluate the country's banking sector.
The paper examines the principles for the supervision of financial conglomerates proposed by BCBS in the consultative document published in December 2011. Moreover, the article proposes a number of suggestions worked out by the authors within the HSE research team.
We address the external effects on public sector efficiency measures acquired using Data Envelopment Analysis. We use the health care system in Russian regions in 2011 to evaluate modern approaches to accounting for external effects. We propose a promising method of correcting DEA efficiency measures. Despite the multiple advantages DEA offers, the usage of this approach carries with it a number of methodological difficulties. Accounting for multiple factors of efficiency calls for more complex methods, among which the most promising are DMU clustering and calculating local production possibility frontiers. Using regression models for estimate correction requires further study due to possible systematic errors during estimation. A mixture of data correction and DMU clustering together with multi-stage DEA seems most promising at the moment. Analyzing several stages of transforming society’s resources into social welfare will allow for picking out the weak points in a state agency’s work.