An idea alien to both worlds: why health care rationing is not acceptable in the USA and Russia
The simple idea of rationing appears unacceptable both for the relatively poor “socialist” health care in Russia and for the most expensive USA health care. In Russia the idea of rationing is unacceptable, because the Constitution promises free and unlimited medical care. Therefore, discussion is blocked from the top. In the USA the idea is unacceptable, because citizens are understood as having the right to free choice of legal access to any care, without intervention of a ‘death jury’. We analyse the similarities and differences in the arguments rejecting explicit rationing in health care in the USA and Russia. We describe the legal framework in Russia related to rationing, and theresults of a qualitativestudy of the understanding of the concept of rationing by Russian doctors and of the practices in Russian health care organizations to limit the use of expensive diagnostic and treatment options. While the Russian Constitution promises free medical care, unlimited, legally there are limits imposed by the quota of specific treatments, limited access to care abroad, and problematic access to drugs not included on the essential drug list for inpatient care. Explicit rationing is not rejected by society or by the medical profession. In medical organizations the more explicit techniques are a second opinion by a committee (physicians’ commission), especially in the case of prescription of drugs and diagnostic tests. Physicians tend to behave as medical professionals do: provide more care to people in greater need.
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.
Data management and analysis is one of the fastest growing and most challenging areas of research and development in both academia and industry. Numerous types of applications and services have been studied and re-examined in this field resulting in this edited volume which includes chapters on effective approaches for dealing with the inherent complexity within data management and analysis. This edited volume contains practical case studies, and will appeal to students, researchers and professionals working in data management and analysis in the business, education, healthcare, and bioinformatics areas.
This prototype development explains the challenges encountered during the ISO/IEEE 11073 standard implementation process. The complexity of the standard and the consequent heavy requirements, which have not encouraged software engineers to adopt the standard. The developing complexity evaluation drives us to propose two possible implementation strategies that cover almost all possible use cases and eases handling the standard by non-expert users. The first one is focused on medical devices (MD) and proposes a low-memory and low-processor usage technique. It is based on message patterns that allow simple functions to generate ISO/IEEE 11073 messages and to process them easily. MD act as X73 agent. Second one is focused on more powerful device X73 manager, which do not have the MDs' memory and processor usage constraints. The protocol between Agent and Manager is point-to-point and we can distribute the functionality between devices.
Developed both implementation X73 Agent and Manager will cut developing time for applications based on ISO/EEE 11073.
In the internal medicine wide spectrum the gastroenterology is one of the chapters, less enlightened by the scientific evidence. It does not mean that the practice of the grasntroenterology may ot be improved by the systematic use of the approaches of the evidence based medicine
The article is devoted to the study of the authoritarianism prevalent in the mass consciousness of Russians. The article describes a new approach to the consideration of the authoritarian syndrome as the effects of the cultural trauma as a result of political and socio-cultural transformation of society. The article shows the dynamics of the symptoms of the authoritarianism, which appear in the mass consciousness of Russians from 1993 to 2011. This paper proposes a package of measures aimed at reducing the level of the authoritarianism in Russian society.
This work looks at a model of spatial election competition with two candidates who can spend effort in order to increase their popularity through advertisement. It is shown that under certain condition the political programs of the candidates will be different. The work derives the comparative statics of equilibrium policy platform and campaign spending with respect the distribution of voter policy preferences and the proportionality of the electoral system. In particular, it is whown that the equilibrium does not exist if the policy preferences are distributed over too narrow an interval.
The article examines "regulatory requirements" as a subject of state control over business in Russia. The author deliberately does not use the term "the rule of law". The article states that a set of requirements for business is wider than the legislative regulation.
First, the article analyzes the regulatory nature of the requirements, especially in the technical field. The requirements are considered in relation to the rule of law. The article explores approaches to the definition of regulatory requirements in Russian legal science. The author analyzes legislation definitions for a set of requirements for business. The author concludes that regulatory requirements are not always identical to the rule of law. Regulatory requirements are a set of obligatory requirements for entrepreneurs’ economic activity. Validation failure leads to negative consequences.
Second, the article analyzes the problems of the regulatory requirements in practice. Lack of information about the requirements, their irrelevance and inconsistency are problems of the regulatory requirements in Russia.
Many requirements regulating economic activity are not compatible with the current development level of science and technology. The problems are analyzed on the basis of the Russian judicial practice and annual monitoring reports by Higher School of Economics.
Finally, the author provides an approach to the possible solution of the regulatory requirements’ problem. The author proposes to create a nationwide Internet portal about regulatory requirements. The portal should contain full information about all regulatory requirements. The author recommends extending moratorium on the use of the requirements adopted by the bodies and organizations of the former USSR government.