Sovetskoe zdravookhranenie最新文献

On the basis of physician's logic a questionnaire has been elaborated for identifying the most common diseases of digestive system during mass medical check-ups of rural population. 98 combinations of signs were considered in the diagnostic algorithm for making conclusions regarding 11 diseases. The programme elaborated envisages recommendations on the volume of examinations necessary for verification of diagnoses. The questionnaire and rules governing it were verified for 152 patients. By means of mathematical statistics methods the informativeness of the signs used have been assessed. The analysis showed a great diagnostic value of choosing signs on the basis of physician's logic taking into account their pathogenetic correlation. The efficiency of questionnaires have been demonstrated and sufficient under conditions of automated examinations sensitivity (on the average for diseases 78.1%) and specificity (on the average for diseases 70.0%).

One of the ways to improve measures aimed at population health protection may be the development of insurance medicine in our country. This is a system of curative and preventive measures realized through insurance payments made by citizens and on the basis of target payments by employers, employees and state grants. The international experience of insurance medicine indicates that the existing principle of grouping diseases according to the basic diagnosis no longer provides the effective use of resources and not precisely enough assess to the outcomes of hospital performance. The search of ways to solve this problem led to the necessity of using the method of assessing financial and economic activities of curative and preventive institutions on the basis of diagnosis related groups of diseases (DRG) which unite the cases of similar diseases having approximately the same technology of examination and treatment of patients and consequently the same cost of treatment. This system originated in the USA and is widely used in many countries of Western Europe. With the help of DRG system health institutions can acquire more full information on the results of treatment, costs of treatment and prospects for development. The introduction of DRG system permits to improve the financial and economic performance of institutions and to collaborate with organizations realizing health insurance programmes.

A critical review of some aspects of follow-up examinations and regular check-ups is provided. A criterion of medical and economic advisability of these examinations is suggested which would permit one to substantiate their regional variations and increase their effectiveness.

A unique methodological approach is proposed which is used for the determination of "index of labour efficiency" of medical personnel and such associated with its elements of financial and economic activity as a saving of the number of posts and salary fund, the cost of health services according to their salary-consuming character and the amount of payment for the labour of health workers. The use of this index in the performance of in-patient institutions would facilitate the rational management of personnel, labour and salary.

The results are provided of an in-depth study of the organization, quality and effectiveness of medical care provided at home to persons who referred to medical institutions for cardialgias. It has been shown that the real number of circulatory diseases while considering the complaints such as "pains in the heart area" is considerably less than the number of calls for outpatient home care. The influence is established of the amount and quality of home health care delivery on the effectiveness of outpatient care as a whole in cases of circulatory disease aggravation and of the possibility to reduce the duration of disability in the aggravation cases (and consequently the economic losses) at the expense of improving the medical care quality just at home. The improvement of the organization and quality of home health care is an important reserve for the perfection of outpatient care at large.