This article is devoted to identification of a new type of legal responsibility (tubercular responsibility) and her legal treatment.
Compulsory health insurance — one of the most important elements of system of social protection of the population regarding health protection and receiving necessary medical care in a case. The purpose of article is detailed studying and the analysis of model of financing of obligatory medical insurance in connection with adoption of the Federal law upon November 29, 2010 N 326-FZ “About obligatory medical insurance in the Russian Federation”. For achievement of a goal it is necessary to consider the following aspects: the principles and essence of system of compulsory health insurance, participants of the market of obligatory medical insurance and their role in system, financial security of compulsory health insurance and its feature.
Spatial notions’ formedness rating among school age children with schizophrenic spectrum disorders research results are analyzed in the article. Spatial notions’ distortions exposed are specific for the persons with schizophrenic range disorders.
Current study present results of combined treatment with fluticasone propionate and salmeterol in 52 patients with moderate persistent asthma (11 male, 41 female), who received inhaled steroids for more than 3 month before study and/or in combination with different bronchodilators. Efficacy of the treatment (fluticasone - 250 meg, salmeterol - 50 meg) during 9 weeks was evaluated by clinical observation, peak flow and flow-volume measurement with reversibility response to bronchodilators and daily needs to short acting P2-agonists. Obtained results demonstrated that administration of combined therapy with fluticasone and salmeterol the optimal way of treatment of patients according to efficacy and security. This treatment provide stabile and long-term effect on bronchial conductance and daily variability and support its efficacy during whole treatment period. Combined administration of fluticasone and salmeterol doesn't have serious systemic and cardiotoxic side effects.
Keeping pace of development of the Russian health care system requires improving the efficiency of spending. In developed countries, an important role in this task plays a multilevel system of evaluation and control of cost-effectiveness and results of operations of the health system and its individual members, supported by the use of evaluation findings in political and administrative decisions in the health sector, financial incentives and information support of participants in the evaluation. Effective today in Russia, the system for monitoring the effectiveness of the health system is largely a formality and does not meet modern political tasks. The most acute problems in assessing the effectiveness of the country include the lack of evaluation of individual elements, first of all, health technology assessment; the poor quality of data collected, the weak development of mechanisms for the implementation of evaluation results, in particular, the development of public policies promoting health care providers, informing the public about the quality of services provided. The aim of the present work is the development of basic mechanisms for assessing the efficiency and effectiveness of the Russian health care system, taking into account the best international and domestic experience.
In the review there are given current data of theories and neurophysiological aspects of motor control and pathological motor synergies. Attention has been focused on the discussion of certain mechanisms of pathological synergies based on anatomical and physiological upper limb characteristics. Synergistic pattern transformation hypothesis in patients with spastic hemiparesis are described and highlighted. The analysis of modern theories of pathophysiologic backgrounds of pathological synergies formation is based on neuroimaging and non-invasive brain stimulation research data. The problem of pathological synergies correction and transformation in rehabilitation practice has been reviewed. Special attention is paid to clinical and instrumental evaluation of synergies. Data has been proved by clinical scales and instrumental techniques such as movement video analysis, electromyography, magnetic and wireless tracking systems and virtual reality technology.
More than half of all deaths in Russia in 2011-2014 were subjected to pathologic or forensic autopsy, as a result of which the cause of death was not identified for 3.8 percent of the cases. More than 147,000 unproductive autopsies which left the cause of death unknown were carried out. Such a large number of cases cannot be explained by the state of the cadavers at the moment of the autopsy. Another 161,000 deaths (4.1% of autopsies) were classified as events of undetermined intent. This paper attempts to find a rational explanation for such a high proportion of uncertain autopsy conclusions concerning the cause of death. The methods applied include an analysis at the macro-level (regions), with the help of factor analysis and clustering techniques, and multinomial logistic regression at the micro-level, using anonymous individual records. The study is based entirely on Russian state statistics data. There are large interregional differences in the practices of determining the cause of death based on autopsy. Practices of diagnosing external causes also vary greatly by region. In regions where the proportion of unspecified causes is higher, the share of events of undetermined intent is also higher. These differences are not connected with the peculiarities of mortality in each region. The analysis suggests that the large number of cases in which the cause of death remains unknown after an autopsy is due to the lack of incentives to clarify the cause of death after the issuance of the preliminary medical death certificate. Moreover, the existing system of relations between forensic bureaus and law-enforcement agencies makes no provision for apprising forensics experts of the final conclusions concerning the external causes of death. From 2011 to 2014 the number of forensic autopsies of persons who had died from disease increased by 20 percent, but there are doubts that the information obtained as a result of the autopsies is effectively used by the health care system.
The paper addresses the issues of organization of medical care in the Russian Federation and explores the case of specialized medical care restructuring. The new approach towards specialized medical care povision is suggested as an alternative to the prevalent understanding of the restructuring such as reduction of hospital beds, hospitals and their staff for financial reasons. The new approach includes (1) a four-level system of medical aid, (2) the expansion of disease prevention, (3) the introduction of standardized approaches in routine work, (4) a thorough quality control at all levels of medical care.
The pilot project of the restructuring of urologic medical care started in 2010 in Voronezh region. The empirical data were provided by the Institute of Urology (Moscow) and Voronezh Regional Health Department.
The implimentation of a new approach revealed poor performance of the primary medical care provision. The outcomes of the pilot project were an increase in detecting diseases and in the availability of specialized outpatient and inpatient care. The overcoming of the previous system’s flaws caused the need to increase health care costs. However, the introduction of new organizational technologies, providing urological care, resulted in lower unit costs by 21.7% over four years.
Experience of the structural reform presented in the article shows that in cases where inefficiency of the health care system is associated not only with unreasonably high costs for treatment of diseases, but also with insufficient or delayed detectability of diseases, introduction of new approaches to the organization of health care does not lead to saving costs, but to increasing effectiveness and efficiency of health care provision.