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THE AVAILIABILITY OF HEALTH CARE . REGIONAL ASPECT 10 November, 2008 Athens

THE AVAILIABILITY OF HEALTH CARE . REGIONAL ASPECT 10 November, 2008 Athens. The structure of state and municipal health care service in the Pskov Region . State system 28 public health institutions The number of hospital beds - 2778, including twenty-four-hour beds – 2673.

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THE AVAILIABILITY OF HEALTH CARE . REGIONAL ASPECT 10 November, 2008 Athens

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  1. THE AVAILIABILITY OF HEALTH CARE. REGIONAL ASPECT 10 November, 2008 Athens

  2. The structure of state and municipal health care service in the Pskov Region  State system 28 public health institutions • The number of hospital beds - 2778, including twenty-four-hour beds – 2673. Municipal system 44 municipal health institutions, including 24 central district hospitals  • There are 18 offices of general practitioners in central district hospitals • 434 first-aid stations • The number of hospital beds - 4979, including twenty-four-hour beds – 4196.

  3. The availability of health care is an inalienable constitutional right of the Russian Federation citizens Social access to health care is based on the following principles: • universality, accessibility, targeting; • the quality of medical care; • effectiveness.

  4. The achieved level of public health funding does not fully meet the requirements for fundingaccording to the territorial program of state guarantees of free medical care provision for the residents of the Region   Targeting of medical care is defined by the Program of Government Guarantees of Free Medical Care for Citizens   The conformity percentage of usedfunds for protection of the Region residents health  from all sources  to the estimated demand (on a program of state guarantees)

  5. Implementation  of the national project «Health» in 2006-2008 made it possible to • increase the availability of primary outpatient - polyclinic aid by 6% (number of visits per inhabitant 1 to 6.9 to 7.6 per year) • improve the accessibility of high-tech medical care by 76% compared with 2005

  6. Improvement of high tech medical care availability through its partial funding from the regional budget in regional specialized medical institutions (endoscopic and rentgen-surgical interventions,computed tomography, etc.) 

  7. Regional program on development ofgeneral practitioners  offices (GPO)In 2007 14 municipalities took part in it,   the amount of funding - 30.0 million rubles. By the end of 2008, the number of GPO will be brought up to 35. In 2009, 11 GPO are planed to be established in 11 areas of the Region, and then, up to 2010, it is scheduled to bring its number up to 50, almost in all parts of the Region

  8. The program allowed to purchase sets of medical equipment  for each General Practitioner Office, designed with a regard to the responsibilities of general practitioner (family doctor) by 50 positions, computer equipment, cars («Niva-Chevrolet»)

  9. Key indicators of demographic and health status of population in the Pskov Region(1)

  10. The key health care problems of the Region remain  unsolved • Staff shortage: indicators of doctors and paramedical workers in the Pskov Region  (per 10.000 people) - 27.7 and 91.2, respectively, the need for medical personnel now - 373 individuals. • Inadequate funding. • Low efficiency of the health system to prevent the spread of several diseases.  • According to opinion polls, satisfaction of population by the quality of medical care is rather low and does not exceed 60%. Disparities in access to health care (depending on domicile , etc.) 

  11. Key indicators of demographic and health status of population in the Pskov Region (2)

  12. The availability of modern means of pharmacotherapy in health care is a critical factor of its quality and efficiency  However, currently in Russia: • as inall countries around the world, needs of population in drug provision face the problem of funds failure to cover the cost of treatment; • there is no any drug provision for citizens in outpatient departments and polyclinics, if they do not fall in any of the preferential categories; • there is an inadequate situation because of the federal law # 94 «About placing orders for goods, works, services for state and municipal needs». Buying medicine at the minimum price by auction, without regard to its quality, proven clinical efficacy and safety, is unacceptable both in terms of the doctors’ and the patients' position. When buying medicines in accordance with the law  # 94,patients compliance to certain drugs, the need in a long-term adjustment (titration) of drug dosage using expensive methods are not taken into account.

  13. Drug provision for federal and regional benefit recipients of the Pskov Region in 2008 • 150patients withhaemophilia, cystic fibrosis, hypophysealnanism, Gaucher disease, Myeloid leukemia, Multiple sclerosis, condition after organ or tissue transplantation.Total funding in 2008 - more than 136 million rubles. The average price of prescription - 80 thousand rubles. • 24,598 people in the regional segment of the federal register of citizens, who eligible to receive a set of social services. In 2008, grants from the federal budget for the Pskov Region amounts to 125.5 million rubles, Additional funding in accordance with the decree # 722 - 41, 7 million rubles. The average price of prescription -387 rubles. 30 154 people- regional benefit recipients, the total amount of funding in 2008 - 55 million rubles. The average price of prescription -541rubles(medicines for citizens are available from commercial inventory pharmacists agencies)

  14. Potential way s to optimize the system of benefit drug provision • Upholding the insurance principle for programs of benefit drug provision. • Involvement of all insured citizens of Russia in the program of guaranteed drug provision. • Creating Federal Target Programs “Bronchial asthma”,”Psychoneurology”, “Programmed hemodialysis”, “Oncology”and “Diabetes mellitus “. • Introduction of drugs co-financing mechanism by people , i.e. reimbursement of difference in the cost of imported drugs to its domestic analogues by citizens (within the International generic names). • Government support and funding for the creation of domestic original drugs and substances, public encouragement of research in development of new drugs. • Formation of a positive attitude to domestic drug producers in mass media, the supply of objective information on the quality of medicines  • The creation of public corporations of drug producers. • Adoption of standards of treatment in the PEDP, equal to every citizen, regardless of his residence. • The purchase of medicines within the program of preferential drug provision for certain categories of citizens according to its trade names, taking into account not only the price aspect, but also the results of clinical and economic (pharmacoeconomic) analysis of alternative proposals (cost / effectiveness, cost / benefit).

  15. Healthcare is seen by most people as the sphere of human life, in which all factors for differentiating accessibility are unjust  …

  16. Thank you for your attention!

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