ECONOMY of HEALTH CARE — one of sections of social hygiene and the organization of health care, and also the direction of economic science studying manifestations and use of the objective economic laws and the relations developing in health care as one of the industries of the national economy.
Continuous care of party and government of preservation and strengthening of fixed capital of our country — health of the Soviet people, the constitutional obligations of the state before each person cause specific interrelations between health care and economic potential socialist about-va. In Materials of April (1985) Plenum of the Central Committee of the CPSU and in the report of the Secretary general of the Central Committee of the CPSU companion M. S. Gorbachev «The radical question of economic policy of party» at a meeting in the Central Committee of the CPSU on acceleration of scientific and technical progress is specified on June 11, 1985 that at the present stage development of socialist society will be defined generally by high-quality shifts in economy, its transfer into rails of intensive growth, every possible increase in efficiency.
In the Main directions of economic and social development of the USSR for 1986 — 1990 and for the period till 2000 it is noted that steady rise in the material and cultural standard of living of the people was and remains the prime target of economic strategy of party. Implementation of this purpose in the forthcoming period demands acceleration of social and economic development, an every possible intensification and increase in production efficiency on the basis of scientific and technical progress. At the same time it is necessary to strengthen orientation of scientific and technical development to the solution of social tasks, in particular on improvement of management and economy of health care, the state program of prevention.
The underlined concept of acceleration of social and economic development of the country on the basis of scientific and technical progress creates premises for development of the national economy, including for more purposeful solution of economic problems of health care for the purpose of basic change of level of scheduled maintenance, improvement of quality to lay down. - the prof. of service of the population and increase in overall performance of all system of the Soviet health care.
Implementation of these decisions will inevitably cause deep structural shifts in the national economy, including in the field of health care, technical and technological modernization of medical institutions, especially a wedge, the centers, multi-profile BCs and policlinics, modernization of system of planning and management of health care.
Inclusion of expenses on protection and improvement of national health in the general fund of compensation of cost of reproduction of labor, distribution of the public benefits according to quantity and quality of the made work become the defining moments of interrelation of economic laws of socialism (the fundamental economic law, the law of systematic proportional development of the national economy), including health care. This situation was for the first time underlined by K. Marx, to-ry wrote that «... work of the doctor and teacher does not create directly fund from which they are paid though their work is included into costs of production of that fund which in general creates all costs, namely in costs of production of labor» (K. Marx and F. Engels, Soch., 2nd prod., t. 26, p. I, page 150).
It is standard to distinguish the macroeconomic of health care solving problems of the most high levels of managing (economic, cross-industry and industry), and the microeconomics considering the economic nature of the phenomena in the industry of health care. The macroeconomic of health care studies incidence of economic laws in the field of health care; ways and methods of the most rational use of material, labor and financial resources of health care; value of separate actions and all system of the state health care in preservation and reproduction of labor; influence of demographic processes (natural movement of the population, etc.) and incidences on the volume of social production. Thus, point in further development of macroeconomic of health care need of determination of the positive effect rendered by health care on progress of the national economy in general is decisive. The microeconomics of health care studies economic effect of elimination and decrease in certain diseases; economic effect of preventive actions; need of the population for medical aid and degree of its satisfaction, need and the sequence of development of separate types of medical aid taking into account their economic and social importance; the size of a manpower necessary for health care, taking into account expenses of work (standards of need for shots), questions of regulation of vocational structure of shots, their preparation and retraining taking into account economic requirements; volume of capital investments, and also level of the material and financial inputs necessary for ensuring normal functioning of health care; features of the choice of the most effective forms and methods of medical aid (combination of the stationary and extra hospital help), rational creation of network of medical institutions taking into account the amplifying tendency to concentration, specialization and division of labor of medical staff, most economic «technology» of rendering medical aid; charges of healthcare institutions; costs of separate diagnostic and medical actions; reserves of health care and their use for increase in overall performance of healthcare institutions. In other words, one of the main objectives of microeconomics of health care — achievement of an optimum ratio between development of health care, indicators of health of the population and measures for its improvement.
By the main methods applied in E. h., are: analytical, used for assessment of levels and identification of the reasons of change of earlier established levels of economic indicators (see Planning of health care); the comparative method applied at the choice of the most optimum economic indicators received at various candidates solution of tasks in the field of health care; the balance method providing establishment of balance between economic opportunities and the established standards of development of health care; the normative method which is most often applied for optimization and rational use of resources of material and technical resources of health care; the experimental method directed to justification of economic decisions in the field of health care by carrying out the corresponding experiments.
In health care a number of economic experiments is carried already out: on expansion of the rights of heads of bodies and healthcare institutions in use of the approved budgetary funds; to the centralized financing
of activity of institutions a dignity. - epid. services, to use of a teamwork in health care. In a crust, time the experiment on increase in efficiency of use of bed fund, an intensification of work of medical staff and partial change of the existing forms of payment of its work is conducted.
Orientation E. h. on increase in efficiency of use of material, personnel and financial resources in public health care results in need of use of the general for all directions of economic researches a form-. Economic __ the Gained effect ly * efficiency“ Expenses
However should be considered that the health care and medical science are the specific industries of the national economy in which obtaining economic effect is not the defining criterion. In the temporary technique of definition of efficiency of expenses approved by the State Planning Committee of the USSR in the non-productive sphere (1981) it is emphasized that economic results in all industries of the non-productive sphere (including in health care) shall be considered only as additional to the main social results. As justification of the paramount importance of social effect by consideration of economic problems of health care serves the fact that in the conditions of the socialist state health of the population is public property, and its protection and improvement — a subject of continuous care of party and government.
At the solution of economic problems in health care it is necessary to consider that the gained or possible effect can be estimated from social, medical, economic positions. Often division of the specified positions is conditional, and degree of the importance of each position can be various depending on the made administrative decisions.
The social effect of health care can be measured by such indicators as number of the kept lives, change of birth rate (see), mortality (see), a natural increase of the population (see. Demographic statistics), etc. At the same time it is obvious that the social effect of health care in our country is essentially only one of manifestations of numerous positive social and economic changes. It is potentially connected with economic effect since one of its results — reproduction of labor.
Economic effect in health care often decides
in connection with dynamics of indicators of incidence, especially on temporary disability, disability, medical examinations of the population etc.
The medical effect is connected first of all with improvement of quality to lay down. - the prof. of the help, expansion of a dispensary method of service of the population, implementation of the latest developments of medical science in practice of work of healthcare institutions.
In the analysis of economic problems in health care it is also important to define what is subject to assessment: health system (or its some part), separate program or specific type of activity, work of establishment. At assessment of efficiency of health care (social, medical, economic) the choice (and also development is more often) the corresponding criterion or several criteria for its characteristic is essentially important. As an illustration of this situation serves the approximate scheme of assessment of efficiency of programs and actions in the field of health care (table).
At generalization of results of the research which is carried out to the fields of economy of health care, M3 of the USSR in 1983 published «Methodical recommendations about assessment of economic efficiency of the treatment-and-prophylactic help», in a number of the developed and approved techniques including calculation of economic effect of decrease in incidence infectious and a number of noninfectious diseases, disability and premature mortality was recommended-rykh for bodies and healthcare institutions for assessment of economic efficiency; at increase in average life expectancy; at implementation of special medical programs; as a result of costs of medical and recreational actions, and also scientific
research work; at reduction of terms of treatment of patients etc. Use of the unified techniques in the area E. h. increases reliability of the conducted researches, promotes attraction to scientific and practical activities in the field of wide layers of organizers of health care and other categories of medical staff.
Great attention to problems E. h., participation in their permission of all medics brings the positive takes. So, in 1982 incidence with temporary disability in comparison with 1981 decreased by 47,2 working days at the rate on 100 working. In a result in the national economy in addition 200 thousand people daily worked. If at the same time to consider what in 1982 on one working in the national economy of the country in a year was made the national income for the sum more than 4 thousand rubles, then thanks to decrease in temporary disability this year became possible to make in addition products more than on 800 million rubles.
The ratio of the spent means and the gained effect of carrying out to lay down can serve as other example confirming economic efficiency of the Soviet health care. - the prof. of the actions directed to decrease in incidence and separate diseases mortality. As a result of the conducted researches in limited territories of our country it was established that a ratio of the spent means and the gained economic effect at the organization corresponding to lay down. - the prof. of actions makes: on a class of cardiovascular diseases (without costs of scientific research) — 1: 12, on a class of malignant new growths — 1:19, and economic efficiency of elimination in our country polio-
a myelitis is expressed by a ratio
1: 63 that in absolute expression makes apprx. Zmlrd. rub of economy.
Attraction of wide layers of the medical public to the solution of urgent problems of economy of the Soviet health care is promoted by the resolution of the Central Committee of the CPSU, Council of ministers of the USSR, the All-Union Central Council of Trade Unions and the Central Committee of the All-Union Leninist Young Communist League «About further improvement of economic education and education of workers» (1982). In response to this Resolution in a health system and social security the network of the seminars and schools of communistic work operating under the direction of Council for economic education of M3 of the USSR and Methodical council at the Central Committee of labor union of health workers was developed.
Research activity in the area E. h. at the present stage it is conducted in the following main directions.
I. Theoretical aspects: development of the theory of national economic policy in health care, development of criteria and categories of assessment of efficiency of medical actions, development of an economic basis of interrelation of the concepts «health» — «disease» — «social development in the society of the developed socialism»; economic assessment of complex influence on health of the population of environmental factors during the formation of a healthy lifestyle; development of systems approach to assessment of economic interrelation of territorial and program and target planning of health care; economic justification of program and target planning in health care (see Planning of health care, t. 25 and 29, additional materials).
II. The scientific and methodical problems connected with increase in efficiency of use of resources of health care: development of techniques of assessment of social, medical and economic efficiency of actions in activity of healthcare institutions; development of criteria for evaluation of social and economic efficiency; development of techniques of identification of internal resources of health care at the routine and advance planning; studying of the social and economic importance of the best practices in health care (see. Scientific organization of work); studying of experience and efficiency of teaching economy of health care in medical higher education institutions and in-ta of improvement (see Institutes of improvement of doctors, Medical education); studying of economical aspects of demographic processes (see Demography).
III. Economic aspects of the preventive direction of the Soviet health care: development of techniques and criteria for evaluation of economic efficiency of primary prevention; economic aspects of assessment of activity of preventive departments of policlinics; economic assessment of need for primary, secondary prevention and medical examination of all population (see Medical examination, Prevention, Prevention primary); economic justification of medical actions for providing a healthy lifestyle (see. Socialist way of life); economic assessment of preventive activity of medical and support personnel.
See also Social hygiene.
the APPROXIMATE SCHEME of ASSESSMENT of EFFICIENCY of PROGRAMS AND ACTIONS in the field of HEALTH CARE
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