To compete on value providers must embrace a series of strategic and organizational imperatives. How can health care providers create more effective strategies and improve their performance? The starting point for strategy is to define the right goal. For every health care provider, the primary goal must be excellence in patient value. Value is the health outcomes achieved per unit of value compared to peers. A provider's size, range of services, reputation, and whether it earns a comfortable operating surplus are secondary. Unless a provider is delivering value to the patients it serves, it is failing at its fundamental mission even if it is financially successful. A provider that delivers superior patient results will be in a position to prosper even in the current system.Patient value can only be measured at the level of medical conditions, and assessed relative to peers. Competence alone is not enough. A provider must be able to achieve results that compare favorably to others that provide similar services.Excellent value in some services does not offset mediocrity in others. Patients, not to mention the entire health care system, are not well served if providers maintain even one service line in which they do not achieve results equal to or better than peers. In value-based competition, excellence, not breadth or convenience, should shape the choice of services by providers and the overall configuration of the health care system. While the goal of patient value may seem self-evident, goal definition in health care delivery has been clouded by a variety of factors. Financial viability often appears as an important goal. But financial results are an outcome, not the goal in and of itself. A comfortable operating surplus cannot offset mediocrity in serving patients. In a value-based system, as we will discuss, excellent results will lead to more patients, greater efficiency, and higher margins.The starting point for developing strategy in any field is to define the relevant business or businesses in which an organization competes. Health care delivery is no different. Health care providers do not think of themselves as businesses, but they are in the business of providing services to patients.
Digital revolution is one of the major global trends resulting in the unprecedented scale and depth of penetration of information and communication technologies into all sectors of national economy, including healthcare. The development of this trend brought about high expectations related to the improvement of quality of medical assistance, accessibility and economic efficiency of healthcare services. However, euphoria of the first steps of digital revolution is passing now, opening doors to more realistic analysis of opportunities and conditions of realization of the true potential hidden in the digital transformation of healthcare. More balanced perception of the peculiarities of innovation processes in the sector is coming together with understanding of the serious barriers, hampering implementation of the new ideas and practices due to complicated interweaving of social, economic, ethical and psychological factors. When taking into account the industry specifics it becomes evident that digital revolution cannot be a quick turnaround but rather would pass a number of phases and is likely to last more than one decade. In this context, the article focuses on the prospects of the new business models, capable of making significant changes in today’s economic landscape of the sector (including uber-medicine,retail clinics, retainer medicine, network models of medical services). The authors also provide assessment of the current situation and perspectives of digital healthcare development in Russia.
The article deals with the problem of the habitual action and routinization of work. Based on the data collected during the study of the implementation of electronic health records in medical practices, the article shows that the widespread view of habitual action as an action in accordance with a preliminary scheme does not describe the actual structure of healthcare activities, a view that forms a basis for the majority of medical information systems. The analysis of how doctors perceive and use electronic health records in their daily practice shows that a situational approach to routine actions is more adequate. For example, the use of so-called “templates” that are created by doctors within the electronic health records system demonstrates the importance of a situational context of professional activities. Doctors, creating and using various “templates,” do this in such ways that allows them to make these health records circumstantially understandable. This work of producing a situational recognizability that does not consist in the use of pre-established schemes can and should be the subject of sociological analysis. The understanding of routine activities as situationally-oriented, concerted achievements not only proves the possibility of a new approach to the desсription of the habitual actions’ role and place in the structure of social action, but can be important for the design and evaluation of professional information systems.
Healthcare professionals’ workforce shortages and recruitment in rural and remote areas continues to be the challenge for all regions in Russia. The aim of the article is to evaluate "Zemsky Doctor" Federal program as well as to identify areas for improvement of current Federal, regional and municipal socio-economic programs and initiatives in order to overcome healthcare professionals’ workforce shortages. Measures of social support and economic incentives for physicians and medical nurses really helps to eliminate medical personnel deficit in rural and remote areas. The authors analyzed experiences of 20 regions with different security characteristics of the budgetary system. The study identified main perspective areas of improvement of regional, local programs and initiatives for healthcare professionals’ recruitment for rural and remote areas. Main perspective areas are target reception, co-financing of professional education and post-university training programs, additional scholarships and benefits, one-time "roll-up" and assistance in solving housing problems, assistance for obtaining postgraduate professional education, additional cash payments on a regular basis for rural physicians and medical nurses, cash prizes for winners of regional, municipal and local healthcare professional competitions, etc. The authors conclude that the administration of regional and municipal programs and initiatives in order to overcome healthcare professionals’ workforce shortages in rural and remote areas should be the separate area of personnel management policy in public health administration.
Today we see the great interest to the field of Software Ecosystems that have been related to products, community of developers around a product and gives the certain advantages to the platform owners and participants of the ecosystem. Mobile healthcare ecosystems – is a new trend, especially in Russia. Nonetheless many big companies see great potential in building the interface between healthcare and the mobile industry. The paper provides a step towards better understanding of background, examples and opportunities for further development of mobile healthcare ecosystems in Russia and all over the world.
The paper deals with the Soviet model and modern organisation of temporary disability examinations, which is one of the most common types of expert assessment within public administration in Russia. A comparative historical approach is used. Three aspects of these examinations are in focus: ideology or the dominant understanding of its tasks and the ‘mission’; the characteristics of the organisation and regulation of procedures; the practices behind these examinations. The key question is whether this institution, which was established in Soviet times, has undergone modifications given the dramatic changes in the state’s attitude to work and employment since the fall of the USSR. A comparative analysis of the regulations of the USSR and the Russian Federation is provided, as well as an analysis of the content of Soviet and contemporary educational literature for physicians. To determine how sick leave provision was organised in practice in the Soviet era, the archival documents of All-Union Central Soviet of Trade Unions over the period 1930–1980 (transcripts of meetings, reports on results of inspections etc.) were examined. Evaluation of modern practices of the examination is based on thirty-one semi-structured interviews with physicians and the representatives of medical centres management and monitoring bodies. Rather than operating as a means of social protection of the citizens, it makes more sense to view the Soviet-era institution of temporary disability examinations as a tool aiming at the rational distribution of labour resources for optimal use in the national economy. Medical providers could not cope with this task of examination and regarded its procedures and rules formally. However, these procedures and rules have influenced and continue to influence the organisation of professional medical practice and therapeutic process, defining routine interactions between medical institutions and patients.
We studied the expression of peroxiredoxin genes (PRDX1, PRDX2, PRDX3, and PRDX6) in human erythroleukemia K652, human breast carcinoma MCF-7, and human ovarian carcinoma SKOV-3 cells during cisplatin resistance development. It was found that drug resistance formation was accompanied by a significant increase in the expression of PRDX1, PRDX2, PRDX3, PRDX6 genes in all cancer cell strains, which confirms the important contribution of redox-dependent mechanisms into the development of cisplatin resistance of cancer cells.
Review of a monograph by G. Carlisle, D. Whitehouse, P. Duquenoy (eds.). E-Health: Legal, Ethical and Governance Challenges. Berlin: Springer, 2013. XIII, 396 pp.
The regional characteristics of the epidemic process and the incidence rates of tick-borne encephalitis (TBE) in the Arkhangelsk region have been examined in the paper. In the period 2005 -2015 the annual TBE incidence rates per 100 thousand population were from 2,0 to 5,4 times higher as compared to the corresponding averages reported for the whole population of the Russian Federation. The most possible causes of the increased incidence rates of tick-borne viral encephalitis in the Arkhangelsk region and temporal trends in its changes as well as potential risk factors of TBE extension have been stated. The vectors of viral encephalitis in the Arkhangelsk region are represented by two types of ixodic ticks: Ixodes persulcatus (the "taiga" tick) and Ixodes ricinus ("forest" tick), the Ixodes persulcatus constitutes over 99 % of their total number. Spring-summer season is typical for TBE cases occurrence which is associated with higher tick activity in this area. The average tick infection rate for the period was 7.8 %. The cases of TBE are reported to occur mainly in urban citizens; and lethality rate due to TBE reached 4.3%. Since 2010 decrease in the TBE morbidity has being observed in the Arkhangelsk region. Reducing morbidity can be connected to the increase in the proportion of vaccinated persons, which reached 6.3 % of the total population of the Arkhangelsk region. The main indices of the acaricide treatment volume which increased since 2005 nearly 6 times, from 128.2 to 740.0 hectares have been stated. Considering the fact that the area of acaricide treatment in the region increases every year, and the number of persons seeking medical advice concerning tick bites remains high it is necessary to control the effectiveness of acaricide treatment regularly. Core measures to decrease the tick-borne viral encephalitis conducted by the Regional Office of Federal Service for Consumers' Rights Protection and Human Wellbeing as well as ways for further research have been introduced.