Guseva S.L.¹, Kondratyev Yi.N.², Puchkov K.G.^3
1Municipal Health Center No.6, city of Samara, RUSSIA
²Clinical Hospital No.8 of Federal Medical Biological Agency, town of Obninsk, Moscow Region
³Federal Research Institute for Health Organization and Informatics of Ministry of Health and Social Development of the Russian Federation, Moscow

Summary. Efficiency of reforming primary care public health largely determines the scale of success in reforming all public health in general. Outpatient clinic is just an establishment of primary level in public health that provides for fulfilling the major amount of diagnostic, therapeutic, and preventive measures. The changes occurred in normative and methodological foundations of public health, as well as certain peculiarities in funding of medical establishments at primary level of public health prompted the necessity of bringing to them certain reforms.

Topical issues here include a transfer from linear functional structure of outpatient clinic to matrix type of organizational structure (which is considered of a more creative nature); reevaluation of role and scope of general practitioners incorporated in modern outpatient clinic; formalization of preventive measures at primary care stage; expediency of developing extra-budget units linked to municipal medical establishment for the purpose of acquiring additional source of funding.

Under the conditions of rigidly limited state funding and administratively fixed scope of provided medical care, stable position of budget-funded medical establishment could be reached only by optimization of expenditure, largely on the way of elevated organizational structural efficiency and also through attracted alternative sources of funding.

Implied by such changes introduction of differential wages aimed at stimulation of labor efforts is quite feasible – just under several different systems of public health funding, though virtually it depends upon personal qualities and the motto of a manager of a medical establishment.

Key words. Municipal public health, reform in medicine, outpatient clinic, funding.

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