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Siburina T.A., Mishina O.S.
Federal Public Health Institute, Moscow
The resume. The aim of this review was to elucidate current world experience in selecting ways of strategic development of national systems of public health. To this end, a few launched strategies are considered here. Main tasks of administers of public health that imply, on the one hand, curbing of expenses for medical services and, on the other, searching for new approaches to ameliorate health condition of the respective populations, are factually the same all over the world, as far as intentions are concerned. The choice of strategy is largely pre-determined by a country’s general conditions, mainly by situation with health of the population, by financial possibilities of the state, by extent of social activity, and by market economy maturity.
The already existing on the globe strategies could be divided into two categories: state level strategies aimed at people’s health preservation in general and administrator level strategies within the format of modernization of public health system, the latter ones being strongly associated with changing mechanisms of funding and of attitudes toward patients’ treatment. Both ones have in common the idea of enhancing efficiency of public health for ameliorating health condition of the population.
Among the state level strategies, the idea of incorporating the interests of people’s health into all visible sectors of economy and social life, being soaked with safeguarding nation’s health as the state’s key social goal, has a prominent position.
Among administrator level strategies, successive development of primary medical care through family practitioners, as well as through diagnosis&treatment centers is of top priority.
The strategy of enhancing the proportion of private sector in providing inpatient medical care is spreading more and more over the world, with private sector becoming a decent competitor to state/municipal hospitals.
In the organization of diagnosis&treatment process, a referral scheme is being actively developed and introduced, and that envisages a choice for a patient between medical centers of different levels - to fit most accurately her/his health condition, and that usually induces an optimization of public health services.
The WHO strategy proclaiming the development of medical care dedicated to a human is distinguished by combination of comprehensive approach with individual-targetted quality of it. This strategy is pursued by primary general practitioners alternating with specialized centers, thus ensuring the whole set of medical services for therapy, rehabilitation, and disease prevention.
Functioning of public health under market conditions for medical services associated with medical insurance, favored introduction of the system of “regulated competition”. To this end, regulatory and control organs of public health try to engage all public health establishments through various regulatory, instructive or mandatory instruments of control: standards, quality control systems, and so on.
Another trend in state guidance of public health was development of various integrative interactions. For example, lining up of medical establishments in profit-bearing nets enables more complete satisfaction of needs of registered population and damping the negative consequences of enhancing competition.
Integration of medical nets and insurance facilities widely spread in USA is dedicated to the idea of guaranteeing stable funding of public health.
The cluster model of interaction of the state, establishments of public health, educational institutions, research centers, and business community is of interest as concerns the tasks of promoting innovative development of public health and enhancing economically stable position of all the participants of such integration.
The strategies for rational employment of labor resources of public health are still an urgent issue, as well as the ones for enhanced efficiency of controlling the public health on the basis of modern information technologies.
Key words: strategy, public health.
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