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Main arrow Archive of previous Issues arrow ╣6 2014 (40) arrow Prospective lines of outpatient care development
Prospective lines of outpatient care development Print
Wednesday, 25 February 2015

Stepchuk M.A.
Medical Information and Analytical Center, Belgorod.

Contacts: Mikhail Stepchuk, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Abstract. The purpose of this review is to study transition of outpatient care and prospective lines of its development.

Main objectives: to evaluate organization of the outpatient care in Russia and abroad; to identify its strengths and reason of its inefficiency. To achieve this goal the author analyzed scientific literature from available sources.

Historical insight into developmental milestones of the outpatient care in Russia showed that outpatient care evolved along with the healthcare. In pre-revolution Russia, the fee-for-service medicine was replaced by county (zemsky) and city (urban) medicine, while in the European countries it was replaced by the solidarity model with free care delivery to the poor and low-income citizens. Medical insurance failed to tighten growth of expenses in the developed countries and as well as solve backlog problems in Russia that were caused by residual principle of healthcare funding and the use of administrative management methods.

Implementation of targeted projects and programs over the last decade had a beneficial effect on some health indicators and development of outpatient care. Current modernization of the Russian healthcare was stated as priority for the next few years. Regional modernization programs have been developed and implemented. At the same time healthcare management and medical society are yet to elaborate a unified position related to modernization, its aims, objectives and approaches towards developing and shaping the modern system of health care and health promotion.

We suppose that modernization is not just strengthening and renovating infrastructure and sound financial management but also system changes in healthcare that are expected to improve its performance even under the conditions of financial and economic crisis.

Performance effectiveness should be achieved through introducing modern organizational, managerial and clinical technologies and methods, latest scientific and technical achievements, and improving primary care ľ the principal element of healthcare system and the most available type of care assuring its quality and efficiency. Primary care is an integral part of the whole process of social and economic development of the society.

Therefore, this review is relevant and suggests the need for detailed elaboration of the stated goal of outpatient care improvement and healthcare system modernization in general.

Keywords: outpatient care; primary care; patronage.


  1. Alekseeva V.M., Reshetnikov A.V., Shamshurina N.G. Ekonomika zdravookhraneniya: uchebnoe posobie [Health care economics: training manual. Reshetnikov A.V., editor. Moscow: GEOTAR-MED; 2012; 272 p. (In Russian).
  2. Doklad o sostoyanii zdravookhraneniya v mire 2008 g. [World Health Report. 2008]. Geneva. 2008; 125 p. (In Russian).
  3. Guseva S.L., Kondrat'ev I.N., Puchkov K.G. Reformirovanie sistemy upravleniya v pervichnom zvene munitsipal'nogo zdravookhraneniya. [Reformation of management system in primary municipal healthcare]. Sotsial'nye aspekty zdorov'ya naseleniya [serial online] 2011 (cited 2014 Feb 12); 20(4). Available from: http://vestnik.mednet.ru/content/view/504/30/lang,ru/. (In Russian).
  4. Guseva S.L. Sovershenstvovanie upravleniya chelovecheskimi resursami kak strategicheskiy imperativ lechebnogo uchrezhdeniya [Improving management of human health recourses as a strategic imperative of health facility]. In: Organizatsionnye osnovy kadrovoy politiki v zdravookhranenii Rossiyskoy Federatsii [Organization basis for human resource policy in health care]. Sbornik nauchnykh trudov FGU źTsNIIOIZ Roszdrava╗. Moscow: RIO TsNIIOIZ Roszdrava. 2012; 30-40. (In Russian)
  5. Egorysheva I.V. Meditsinskie obshchestva v Rossii v kontse XVIII ľpervoy polovine KhIKh veka [Medical societies in Russia in the late XVIII and the first half of XIX centuries]. Zdravookhranenie Rossiyskoy Federatsii 2008; (5): 49-51. (In Russian).
  6. Zhirnova G.M. Reformirovanie ambulatorno-poliklinicheskoy sluzhby v novykh ekonomicheskikh usloviyakh (na primere promyshlennogo goroda Chuvashskoy Respubliki) [Reformation of outpatient service in new economic conditions (by an example of an industry city in Chuvashi Republic]. Cand.Med. Sci. [thesis]. Kazan'. 2004; 21 p. (In Russian).
  7. Ivanov M.V. Nauchnoe obosnovanie sovershenstvovaniya pervichnoy mediko-sanitarnoy pomoshchi na regional'nom urovne [Scientific grounds for improving primary health care at a regional level]. Dr.Med. Sci [thesis]. Moscow. 2011; 48 p. (In Russian).
  8. Kalininskaya A.A., Son I.M., Guseva S.L., Stukalov A.F. Model' reformirovaniya pervichnoy meditsinskoy pomoshchi [Model of reforming primary health care]. Zdravookhranenie Rossiyskoy Federatsii 2008; (5): 6-10. (In Russian).
  9. Komarov Yu.M. Pervichnaya mediko-sanitarnaya pomoshch': kakoy ona dolzhna byt'? [Primary health care: what should it be?]. Zdravookhranenie 2008; (5): 19-28. (In Russian).
  10. Korotkov Yu.A. Nauchnye osnovy reformirovaniya pervichnogo zvena zdravookhraneniya na printsipakh obshchey vrachebnoy/semeynoy praktiki [Scientific grounds for reforming primary health care using the principles of general/family practice]. Dr. Med. Sci [thesis]. Moscow. 1999; 43 p. (In Russian).
  11. Pinkus T.M. Povyshenie strukturnoy effektivnosti sistemy zdravookhraneniya oblasti [Improving the structural efficiency of regional health care system]. Problemy ekonomiki i upravleniya 2009; (4): 181-183. (In Russian).
  12. Stepchuk M.A., Pinkus T.M., Efremova O.A., Bozhenko D.P. Model' organizatsii meditsinskoy pomoshchi naseleniyu Belgorodskoy oblasti [Model of organization of medical care to the population of Belgorod region]. Nauchnye vedomosti. źMeditsina. Farmatsiya╗. 2012; 10 (129). Issue 18: 84-94. (In Russian).
  13. Skvirskaya G.P. Reformirovanie pervichnoy meditsinskoy pomoshchi naseleniyu [Reformation of primary medical care to population]. Zdravookhranenie 1998; (2): 175-176. (In Russian).
  14. Skvirskaya G.P. Sovremennye podkhody k formirovaniyu organizatsionnoy struktury ambulatorno-poliklinicheskikh uchrezhdeniy [Current approaches to forming an organizational structure of outpatient facilities]. Zamestitel' glavnogo vracha 2013; (2): 15-17. (In Russian).
  15. Starodubov V.I., Kalininskaya A.A., Shlyafer S.I. Pervichnaya meditsinskaya pomoshch': sostoyanie i perspektivy razvitiya [Primary health care: current state and prospects for development]. Moscow: Meditsina; 2007; 264 p. (In Russian).
  16. Stupakov I.N. Samorodskaya I.V., Musatov L.I. Novye organizatsionnye tekhnologii v ambulatornoľpoliklinicheskoy pomoshchi [New organizational technologies in outpatient care]. Zdravookhranenie 2004; (5): 30-36. (In Russian).
  17. Tatarnikov M.A. Osnovnye etapy i perspektivy reformirovaniya rossiyskogo zdravookhraneniya [The main phases and prospects for reformation of Russian health care]. Glavvrach 2006; (12): 29-39. (In Russian).
  18. Togunov I.A. Metodika rascheta tarifov v sluchae poliklinicheskogo obsluzhivaniya [Methods of tariff calculation for outpatient care]. Byulleten' NII sotsial'noy gigieny, ekonomiki i upravleniya zdravookhraneniem im. Semashko 1996; (2): 115-119. (In Russian).
  19. Togunov I.A. Problemy standartizatsii meditsinskoy deyatel'nosti v ambulatorno-poliklinicheskom uchrezhdenii [Problems of standardization of medical care in outpatient facility]. Byulleten' NII sotsial'noy gigieny, ekonomiki i upravleniya zdravookhraneniem im. Semashko1996; (3): 87-91. (In Russian).
  20. Togunov I.A., Massimo B.L., Andreeva M.R., Romanova O.V., Lantseva L.A. Ponyatie i traktovka zakonchennogo sluchaya ambulatorno-poliklinicheskoy deyatel'nosti [The concept and interpretation of a completed case in outpatient activity]. Zdravookhranenie Rossiyskoy Federatsii 1997; (4): 39-41. (In Russian).
  21. Trifonova N.Yu. Adaptatsiya meditsinskikh uchrezhdeniy k rabote v usloviyakh rynka [Adaptation of health care facilities to the work in market conditions]. Ekonomika zdravookhraneniya 2008; (9): 16-18. (In Russian).
  22. Trofimov A.C. Analiz kolichestvennykh pokazateley dinamiki ob"emov vnebol'nichnoy meditsinskoy pomoshchi naseleniyu na baze munitsipal'nykh uchrezhdeniy [Analysis of quantitative indicators for dynamics of the volumes of outpatient health care to population on the base of municipal facilities]. Ekonomika zdravookhraneniya 2006; (5): 19-21. (In Russian).
  23. Trubina E.Yu. Metody ratsional'nogo upravleniya uslugami zdravookhraneniya munitsipal'nykh obrazovaniy [Methods of rational management of health care service in municipal facilities]. Cand. Med. Sci [thesis]. Samara. 2010; 22 p. (In Russian).
  24. Ulumbekova G.E. Zdravookhranenie Rossii. Chto nado delat': Nauchnoe obosnovanie źStrategii razvitiya zdravookhraneniya RF do 2020 goda╗ [Russian health care. What should be done?. Scientific grounds for ôStrategy of health care development in the RF up to 2020]. Moscow. 2010; 592 p. (In Russian).
  25. Fadeev A.B. Reforma sistemy zdravookhraneniya SSSR v poslevoennye gody [Reform of health care system of the USSR in the postwar years]. Problemy sotsial'noy gigieny, zdravookhraneniya i istorii meditsiny 2001; (2): 48-50. (In Russian).
  26. Flek V.O., Shil'nikova N.F., Senizhuk A.I., Titova I.A. Sovremennoe sostoyanie i otsenka ispol'zovaniya statsionar zameshchayushchikh tekhnologiy pri okazanii meditsinskoy pomoshchi naseleniyu [The current state and assessment of hospital-replacing technologies for providing medical care to population]. Menedzher zdravookhraneniya 2006; (2): 64-67. (In Russian).
  27. Kutzin J., Cashin C., Jakab M. Reformy finansirovaniya zdravookhraneniya: Opyt stran s perekhodnoy ekonomikoy [Reforms of health care financing. Experience of countries in transition]. Moscow: Evropeyskaya observatoriya po sistemam i politike zdravookhraneniya; 2012; 442 p. (In Russian).

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