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The impact of centralization on structural changes in healthcare: when it works
FRONTIERS IN HEALTH SERVICES. 2025. Vol. 5. Article 1484225.
Purpose: After a decade of post-Soviet decentralization of the healthcare in Russia the opposite trend has been dominating. This paper explores the impact of centralization of healthcare governance on the structure of the healthcare system in Russia, including shift in service delivery structure, the institutional organization of healthcare providers, and their interactions.
Methodology: We employ quantitative and qualitative analysis to study how centralization has contributed to restructuring service delivery with instruments of utilization planning, vertical health programs, and centrally determined pathways of patients flows in a multi-level health care system.
Findings: Centralization of healthcare governance has contributed to restructuring the Russian healthcare system, providing positive changes in structure of inpatient/outpatient care utilization, the organizational structure of service providers, and the structure of their activities. Inpatient care is increasingly replaced by outpatient care and day wards. Centralization contributed to creation of new types of medical organizations (perinatal centers, vascular centers, etc.), development of prevention, and strengthening of providers activity integration in a multi-level system of medical care. However, centralization has not been accompanied by the effective interaction of different levels of governance in developing structural reforms and their implementation in the regions. Uniform activities for the entire country do not take into account specific regional and local conditions. Some unified solutions are implemented in regions with negative consequences for the accessibility of care locally. The excessively centralized model of preventive measures does not provide an effective balance between detection of diseases and follow-up treatment. A so-called “new primary healthcare model”, initiated from the top, limits the development of alternative models that are needed in many regions of the country. The analysis concludes with a set of conditions that should be followed in designing and implementing a centralized model of healthcare governance.
Moshkin A., Fedorov M., Arlazarov V. et al., Algorithms 2026 Vol. 19 No. 7 Article 523
Artificial intelligence (AI) technologies, which are being actively developed in modern medicine today, increase the speed and quality of patient care. This article mainly seeks to demonstrate the use of various options of computer analysis of clinical images to solve practical problems of increasing the efficiency of routine diagnostics using retrospective analysis, as well as ...
Added: August 17, 2026
Shartova N., Mironova E., Geo Journal 2026 Vol. 91 P. 1–17
The historical timeline of urban development profoundly shapes the contemporary form and functionality of cities. Traditionally, cities were planned with limited consideration for the promotion of a healthy urban environment. Using Nizhny Novgorod, Russia, a city that has evolved from a medieval market town to an industrial centre and later into a multifunctional city with ...
Added: August 9, 2026
Vlassov V., JAMA - Journal of the American Medical Association 2026 P. 1–6
Importance Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C–related burden is critical for guiding prevention and treatment strategies.
Objectives To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from ...
Added: August 4, 2026
Maghsoohi A., Pavlov V., Rouse P. et al., Health Care Management Science 2026 Vol. 29 No. 37
As the numbers of older people (65 +) rise globally, the pressure on acute hospitals to provide efficient and effective care while addressing resource inequities increases. In this study we introduce Recognising Episodes of Acute Complexity in Health (REACH), a novel Automatic Machine Learning (AutoML)-based predictive model that prioritises older patients and assigns them to complex ...
Added: July 30, 2026
Vlassov V., van der Lubbe S. C., Moberg M. E. et al., The Lancet Public Health 2026 P. 1–6
Background
Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly's proclamation of the Second Decade of Action for Road Safety (2021–30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this ...
Added: July 25, 2026
Авксентьева М. В., Ашихмин Я. И., Ашихмина О. В. et al., М.: ФГБУ "Издательство "Наука", 2023.
Предложены основные направления совершенствования планирования, организации и оплаты медицинской помощи, лекарственного обеспечения, информатизации и оценки технологий здравоохранения. Рекомендованы такие мероприятия, как конкретизация программы государственных гарантий бесплатного оказания гражданам медицинской помощи, создание системы общедоступного лекарственного обеспечения, использование клинико-статистических групп для оплаты медицинской помощи при ряде хронических неинфекционных заболеваний в амбулаторных условиях, формирование механизма привлечения соплатежей при ...
Added: July 16, 2026
Хайлова Ж. В., Омельяновский В. В., Терян Р. А. et al., Опухоли женской репродуктивной системы 2025 Т. 21 № 1 С. 86–105
Цель исследования – определить наиболее целесообразную стратегию скрининга и ранней диагностики рака шейки матки (РШМ) в Российской Федерации с точки зрения клинической (диагностической) и экономической эффективности.
Материалы и методы. Для оценки клинической (диагностической) эффективности различных стратегий скрининга проведен систематический обзор публикаций об исследованиях, оценивающих эффективность применения цитологического исследования и тестирования на вирус папилломы человека (ВПЧ) с целью диагностики ...
Added: July 16, 2026
Иванова А. А., Коган С. А., Горбунова Т. В. et al., Менеджер здравоохранения 2026 № 3 С. 96–105
The research r elev anc e is determined by the demand for telemedicine consultations (TMC) as one of health care digitalization pathways in Russian Federation. Telemedicine, regardless of the field, continues to prove its significant role, saving health resources without losing medical care quality. The TMC is regulated by federal level framework. Each year the ...
Added: July 16, 2026
Sun Z., Khvostikov A., Krylov A. et al., Machine Learning and Knowledge Extraction 2026 Vol. 8 No. 1 Article 8
Whole-slide histology images (WSIs) can exceed 100 k × 100 k pixels, making direct pixel-level segmentation infeasible and requiring patch-level classification as a practical alternative for downstream WSI segmentation. However, most approaches either treat patches independently, ignoring spatial and biological context, or rely on deep graph models prone to oversmoothing and loss of local tissue ...
Added: July 16, 2026
Хайлова Ж. В., Омельяновский В. В., Михайлов И. А. et al., Менеджер здравоохранения 2026 № 4 С. 41–52
The urgency of the problem of organizing effective medical care for cancer patients is determined by the steady trend of increasing incidence of malignant neoplasms, the high proportion of this pathology in the structure of overall mortality, as well as significant medical, demographic and socio-economic losses for society.Purpose of the st udy is to conduct ...
Added: July 16, 2026
Габриелян А. Р., Александрова О. Ю., Михайлов И. А., Здоровье мегаполиса 2026 Т. 7 № 2 С. 7–16
Objective. To evaluate the impact of a series of organizational measures for implementing innovative medical technology in a multidisciplinary hospital on patient quality of life based on patient self-assessments. Results. Patients who received care using innovative medical technology within a systemic organizational approach demonstrated a significantly higher level of overall satisfaction with the quality of care. ...
Added: July 16, 2026
Ахапкина Е. С., Омельяновский В. В., Тулупова О. Н. et al., Медицинские технологии. Оценка и выбор 2026 Т. 48 № 2 С. 70–77
OBJECTIVE
To analyze international approaches to assessing the labor complexity for different specialists with higher medical education (physicians).
MATERIAL AND METHODS
We performed a systematic searching and content analysis of foreign and national studies and documents devoted to labor complexity of different specialists with higher medical education (doctors). A group of experts among the authors of this study discussed and identified significant factors in assessing complexity.
RESULTS
There are 2 main systems to assess physician workload complexity in foreign countries. The first approach is based ...
Added: July 16, 2026
Arina Bukina, Eritsyan K., Antonova N. et al., Frontiers in Psychology 2026 Vol. 17 Article 1824428
Background:
Numerous studies have shown that indigenous populations experience poorer health outcomes compared to people with other backgrounds. However, the interpretation of these disparities remains challenging due to differences in living conditions and social environments, as well as by potential measurement-related biases. Little is known about whether the underlying mechanisms of mental health outcomes differ between ...
Added: July 15, 2026
Ledesma J. R., Zhang M., Liew M. F. et al., The Lancet Infectious Diseases 2026 P. 1–12
Background
Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in ...
Added: July 7, 2026
Liapin G., Vlassov V., DIALOGUES IN HEALTH 2026 Vol. 8 Article 100317
Objectives
Due to the economic growth at the end of the 20th century, people in low-income countries live longer but still spend most of their income on food. These countries, as well as affluent countries, demonstrate a rising prevalence of obesity. The interplay of longevity and obesity at different levels of economic development is not clear.
Methods
We ...
Added: June 29, 2026
Алексашина А. О., Русских С. В., Тырановец С. В. et al., Менеджер здравоохранения 2026 № 4 С. 53–60
Given the increasing prevalence of carbohydrate metabolism disorders in pregnant women, a validated tool is needed to assess the competencies of physicians involved in the multidisciplinary management of this pathology.
Objective. A comprehensive validation of the author’s methodology (questionnaire) «Flowchart “Methodology for assessing the professional potential of medical personnel of endocrinologists, obstetrician-gynecologists, and general practitioners in ...
Added: June 11, 2026
Лебедева Д. А., Вестник Воронежского государственного университета. Серия: Право 2026 № 1 С. 66–77
The article is devoted to the study of problems in the fi eld of ensuring the protection and
portability of patient data in medical information and analytical systems (hereinafter – MIAS). The
purpose of the study is a comprehensive analysis of the legal regulation of the MIAS of the constituent
entities of the Russian Federation. The study identifi ...
Added: June 3, 2026
Biryukova A., Zasimova L. S., Вопросы статистики 2026 Т. 33 № 2 С. 40–57
The paper examines changes in the economic affordability of cigarettes in Russian regions in 2011–2023. Using fixed-effects models, it estimates the impact of prices, incomes, and tobacco affordability (the ratio of per capita income to cigarette price), on three indicators: retail sales of cigarettes per capita, adult population spending on tobacco products, and the share of these ...
Added: June 1, 2026
Helen Selorm Wohoyie, Anikin V. A., Tomsk State University Journal of Philosophy, Sociology and Political Science 2026 Vol. 90 P. 204–211
Menstrual health serves as a critical litmus test for state intervention in contexts where women’s bodily experiences are historically shaped by stigma, cultural taboos, and structural violence. Drawing on Joseph Gusfield’s theory of social problems, this review traces the moral passage of menstruation in Ghana (1992–2025) from a privately managed, stigmatized phenomenon to a matter ...
Added: May 26, 2026
Фандюшин М. В., Вестник юридических исследований 2025 Т. 4 № 4 С. 49–55
The article is dedicated to a comparative analysis of centralized, decentralized, and hybrid management structures for transportation systems, with a focus on their applicability in the Russian Federation over the long term up to 2050. The aim of the study is to identify the most effective management model to overcome historical lag and ensure sustainable ...
Added: May 14, 2026
Klementev I., Скиф. Вопросы студенческой науки 2025 № 2(102) С. 183–190
This article examines the transformation of the Russian model of federalism over the past three decades. The author engages in a debate with scholars who advocate for deep decentralization in Russia and demonstrates the fundamental-both methodological and historical-political-flaws in their position. The author argues that decentralization implemented at any significant depth would inevitably generate risks ...
Added: March 24, 2026
Potapchik E., Профилактическая медицина 2025 Т. 28 № 9 С. 7–14
In just the past few years, digital technologies (DTs) have become from a new experimental concept to an integral part of modern healthcare. There is a change in the paradigm of medical care organization — a shift from the medical care provision within the walls of medical provider (MP) to its delivery at the patient’s ...
Added: March 18, 2026
Maksimov A. G., Telezhkina M., / NRU Higher School of Economics. Series EC "Economics". 2024. No. 271.
The paper examines similarity of models with structural changes among heterogeneous panel data units. We propose applying a cosine metric to compare angles between vectors of weighted coefficients as a measure of closeness of economic models. Testing whether the cosine metric value is zero against nonzero, positive, and negative alternatives enriches traditional testing results. The ...
Added: March 10, 2025
Turovsky R. F., Sukhova M., Функ К. В., Сравнительная политика 2024 Т. 15 № 3 С. 19–45
The article analyzes the recruitment of the heads of law enforcement agencies in Russian regions. The authors collected extensive biographical dataset on all the heads of the prosecutor’s office and the Ministry of Interior in Russian regions in the post-Soviet period, which made it possible to identify the main patterns for the appointments, transfers among ...
Added: December 8, 2024