Zinchuk Yu.Yu.¹, Patsukova D.V.², Lastovetskiy A.G.³, Fursenko S.N.^3
1 Regional Hospital, city of Kostroma
² Russian insurance national society-Medical Insurance, Moscow
³ Federal Research Institute for Health Organization and Informatics of Ministry of Health and Social Development of the Russian Federation, Moscow
⁴Republican nursing house for disabled children. Neryugrinsk region, Serebryany Bor rural settlement, Republic of Sakha (Yakutia)

Summary. A switch-over to market economy in public health paves its way rather hardly. This propels a search for proper motivation of medical employees to provide high-grade medical care and for certain pathways of organizational and economic nature for activating the presumed motivation.

Under present conditions, medical services are considered to be put into commercial turnover where a hospital and outpatient clinic receive for provided service certain reimbursement from some medical insurance company in accordance with concluded reimbursement contract. Certain searches for improving financial position of a hospital/outpatient clinic under such a system is being conducted nowadays and hence incorporated in organizational and administrative activities of medical establishments.

It is still argued whether activities of a medical specialist should be considered as a kind of productive efforts or as just providing medical services. This argument is only fed more and more with certain extra- and intra-establishment factors, such as current structural alterations in ME, appearance of new service lines, development of novel technologies of medical investigations and medical care, parallel co-existence of self-supporting units inside budget-funded ME – all these moments bring fresh evidence to this issue.

The real nuisance, however, begins with non-owner status of ME as concerns the property of ME which it cannot legally manage or dispose (say, for sale, bail, pawn, mortgage, etc.). This restriction actually means that ME cannot deliberately create or enlarge its means of working capital. As a consequence, ME cannot be considered to be in a position to really control quantitative and qualitative highlights of provided medical care.

Emerging innovative technologies bring slightly new requirements to the professional skills of a physician. Interestingly enough, not only his/her proper knowledge of etiology, pathogenesis, diagnostic and therapeutic means is what really matters, but also capabilities for a specialist for advice, personal communication, training of patients; more emphasis is being made on physician’s commitments to avoid mistakes in diagnosis and treatment, in treatment strategy and tactics, also on devotion to modern or promising new medical technologies.

Scientific evaluation of organizational and applied economical approaches for reaching high efficiency of operation of medical establishments for treatment and prevention (METP) was conducted. These approaches included the implementation of material incentives for medical employees and introduction for this a system of paying wages according to obtained final result which factually implied the given quality of provided medical care.

Amounts of funding envisaged for municipal METPs in Moscow Region to achieve certain highlights on that pathway were considered and reconsidered in this report along the method of additive account of factors that really influence important indicators of individual and team job of medical staff and finally the quality of medical care.

Fundamentally novel foundations of paying for the services of medical staff has been developed and is being cultivated in quite a number of METPs still placed in budget funding which is, however, now guided by final personal results of a set of medical specialists. This new model of funding provides for high-grade process of delivering medical services and also stimulates any medical specialist to reach high quality indicators of his/her job.

Key words. Manufacture of medical services, additive account of manufacturing factors, efficiency of medical care.

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