PLANNING OF HEALTH CARE — one of the main functions of management of health care consisting in definition for the set span of optimum volumes of the material, financial and personnel resources necessary for implementation of a complex of the interconnected social and economic and medical actions aimed at providing a high level of health and physical development, increase in working capacity, increase in life expectancy and active longevity of people, the prevention of diseases and satisfaction of needs of the population in all вида^ the treatment-and-prophylactic help. Planning in the USSR plays an important role in implementation of organizing function of the socialist state and social and economic policy of the Communist Party of the Soviet Union. It covers actually development of the plan, the organization of its implementation and control of execution. By means of planning the party and the socialist state manage processes of social and economic development and social activities, provide progressive and proportional development of various industries of the national economy, socialist distribution of material benefits. Objective and evidence-based planning guarantees ensuring economic power of the socialist state, achievement of the prime target of party — the further growth of welfare of the Soviet people. «The plan is a law — comrade L. I. Brezhnev said from a tribune of the XXVI congress of the CPSU — because only his observance ensures harmonious functioning of the national economy» (L. I. Brezhnev, the Report of the Central Committee of the CPSU to the XXVI congress of the Communist Party of the Soviet Union and immediate tasks of party in the field of domestic and foreign policy. In kN. «Materials of the XXVI congress of the CPSU», M., 1981, page 50).
The plan of health care is a component of the nation-wide plan of economic and social development of the USSR representing the evidence-based system of governmental activities coordinating development of all industries of the national economy for fuller satisfaction of material and cultural needs of the people. The high level of health is an important condition of social and economic development of society. Therefore the development plan for health care determining holding governmental activities by improvement of the state of health of the people is connected with the plan of economic and social development of the USSR, unity of the purposes and tasks.
According to nation-wide classification of the industries of the national economy by the industry «the health care, physical culture and social security» are planned the indicators connected with activity of healthcare institutions of the USSR M3 system and other departments, houses nursing homes for aged and disabled people of system of the Ministries of Social Welfare, and also subordinated to many ministries and departments of rest houses, boarding houses, summer and mountaineering camps, sports and sports facilities (stadiums, skating rinks, swimming pools, sports schools, sports and technical clubs, etc.).
the Planned nature of activity and development — the defining principle and distinctiveness Soviet health care (see). In the first years of the Soviet power, despite the heaviest conditions of economic ruin, civil war and intervention, efforts for systematic holding sanitary and anti-epidemic actions, increase in number of medical shots, proportional development of network of medical institutions and distribution of limited resources of health care were made. In the 20th the Soviet social hygienists and a dignity. statisticians developed methods of the analysis of the state of health and studying of incidence, attendance of extra medical institutions and hospitalization of the population. To 20 — to the 30th the first attempts of justification of standards of need for medical aid belong.
Founders of the Soviet social hygiene and organizations of health care (see) — N. A. Semashko, 3. P. Solovyov, M. F. Vladimirsky, etc. considered public health care as the integral function of the socialist state, considered that the health care shall develop in proportion to development of the national economy, growth of economic power of the country.
Speaking at the VI All-Russian congress of zdravotdel in 1927, 3. P. Solovyov indicated the need developments of master plans of development of health care for 10 — 15 years, and also justifications of 5-year plans of health care in communication and according to rates of development of all national economy. The five-year development plan for health care prepared by Narkomzdrav RSFSR in 1930 and approved by the VII All-Russian congress of zdravotdel was made not from departmental positions, and taking into account development of industrialization of the country and collectivization of agriculture as complex system of actions for health protection of workers and peasants in whose implementation various departments had to take part. In the plan medical and recreational actions were closely coordinated. According to the tasks stated in the resolution of the All-Union Communist Party (bolsheviks) of the Central Committee of December 18, 1929. «About medical care of workers and peasants», the plan provided the differentiated approach to medical service of various groups of the population depending on their role in socialist construction. Actions for perhaps fuller satisfaction with the stationary and extra hospital help of industrial working main industrial regions were outlined. For improvement of medical service of country people reorganization and expansion of network of medical institutions in relation to new forms of the organization of agricultural production, preferential service of workers of state farms and the collective-farm peasantry were planned.
In the next years researches in the area P. z. hl were devoted. obr. to development of methods of definition of needs of the population of century different types of medical aid, medical shots * to justification of the planned targets and quantitative characteristics allowing to estimate efficiency of activity of healthcare institutions, to improvement of methods of sectoral planning. In particular, in 60 — the 70th methods are offered forecasting (see) and advance planning of health care on the basis of use of systems approach and modern economic-mathematical methods of adoption of planned and administrative decisions (see. Systems analysis , Management of health care ).
The crucial role which defined planned development of health care of the country at the present stage decisions XXIII, XXIV, XXV and XXVI of congresses of the Communist Party of the Soviet Union, the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of medical care and public health care of the USSR» (1960), «About measures for further improvement of health care and development of medical science in the USSR» (1968), «About measures for further improvement of national health care» had (1977), the resolution of the Central Committee of the CPSU «About further improvement of an economic mechanism and tasks of party and public authorities» (1979) and the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About improvement of planning and strengthening of impact of an economic mechanism on increase in production efficiency and quality of work» (1979).
The accumulated P.'s experience z. in the USSR, its scientific methodology, the principles and methods gained recognition and distribution in other socialist countries. Theoretical bases of P. z. in the countries of the socialist commonwealth are generalized in the document «Main Directions and Perspectives of Further Development of Socialist Health Care» approved at a meeting of Ministers of Health of the socialist countries (1976). The coordinating role in the field of development of health care of the socialist countries is carried out by the Constant commission on health care formed at Council of economic mutual assistance (see. Council of economic mutual assistance ).
Types of plans and structure of the planning bodies
In the report of the Secretary general of the Central Committee of the CPSU comrade L. I. Brezhnev at the XXIII congress accurate classification of economic plans by duration of their action is given. In this regard distinguish long-term plans, to-rye, in turn, share on long-term (calculated on 10 — 15 years) and medium-term (five-year-old), and also flowing — annual plans. The leading place in planning of economic and social development of the USSR, including in P. z.,'zanimat long-term plans. Long-term P.'s need z. follows from the increasing role of large actions in the field of health care which preparation and implementation take decades. Long-term P. z. perhaps only on the basis of forecasting. Planning and forecasting are connected among themselves. At the same time forecasting represents knowledge of objective tendencies of social and economic development and consequently, is scientific and analytical premises of planning. On the basis of forecasts becomes possible to concentrate material and a manpower on those directions, to-rye have crucial importance for decrease in incidence and mortality, improvement of the state of health of the population (see. Forecasting ).
Plans are subdivided also into territorial and industry (departmental). The state plans of economic and social development of the USSR, the federal republic, autonomous republic, edge, area, city, area belong to territorial plans; to industry — development plans for the separate industries of the national economy in general, irrespective of departmental and territorial accessory of objects. Besides, in health care comprehensive plans on separate problems are developed (e.g., plans of recreational actions, fight against infectious diseases, etc.).
Plans of health care usually subdivide into 4 basic groups: the plans which are a part of the general state plan of economic and social development; the plans made by bodies of health care on installations and system of indicators M3 of the USSR (see. Ministry of Health ); the plans of healthcare institutions made on indicators and norms of directive bodies; the plans of activity of bodies and healthcare institutions developed at a discretion and an initiative of their heads.
The plans which are a part of the state plan are developed according to directives and uniform system of indicators and the target figures established by Council of ministers of the USSR. The state plan of economic and social development of the USSR and the state budget made on its basis concern to this group. The plans made by bodies of health care on installations and system of indicators M3 of the USSR are essentially the detailing of the main indicators of the state plan of economic and social development which is carried out according to various and specific character of the tasks facing health care. In them find reflection of a task of party and government on expansion of network of treatment and prevention facilities, development of health care in the certain republics, areas, the cities, to construction, etc. The plans developed by the ministries having departmental medical services concern to the same group (Ministries of Railways, civil aviation, etc.) * The plans of healthcare institutions made on indicators and norms of directive bodies represent the estimate and the list of the main indicators of the plan of economic and social development, and also indicators of specialized types of the help. The plans of activity of institutions and bodies of health care developed at a discretion and an initiative of their heads serve the purposes of operational management and concern various aspects of activity of specific institutions. The plans for various questions of activity of doctors, average medical personnel of that of a pla of other establishment used by the head for internal needs concern to this group.
The state development plans for health care always are complex and represent system of the indicators grouped in several interconnected sections: development of network of healthcare institutions; medical and pharmaceutical shots (requirement, preparation, improvement, specialization); indicators on work (number ра^ body shirts, the wages fund); capital investments (construction, equipment of institutions); logistics; financial plan or budget. All sections of a comprehensive plan of development of health care are closely connected with each other and cannot exist separately neither in territorial plans, nor in plans of institutions. Quality of development of the plan depends on that, its listed sections are how correctly connected among themselves all. At the same time sections of the plan of health care not only shall be connected among themselves and with plans of other ministries, but also enter as a component appropriate sections of the state plan of economic and social development.
Planning of economic and social development of the USSR is carried out within the state system of planning, to-ruyu form the planning bodies and divisions, planned documents and indicators of the plan, an established order of development, representation, the statement and control over the implementation of plan targets. All work on planning of economic and social development in the USSR is headed by the State planned committee of the USSR (the State Planning Committee of the USSR), in federal republics — State Planning Committees of the republics, in edges, areas, the cities and areas — planning commissions at executive committees of the relevant Councils of People's Deputies. In the industry ministries there are departmental services of planning, on to-rye development of plans for the industry, their submission to higher departmental and planned bodies, the management and control of their performance is assigned. In the Ministry of Health of the USSR and a number of the Ministries of Health of federal republics there are planned and financial managements, in some Ministries of Health of federal republics, and also the Ministries of Health of autonomous republics, regional, regional and large city departments (managements) of health care — planned finance departments (sectors), in other bodies of health care — planning inspectors.
Thus, to each planning body in system of the State Planning Committee there corresponds the structural division (or the official) in a health system. Functions of the planning bodies of these two systems (A State Planning Committee and the Ministry of Health) differ a little: the first are invested by the rights of control and information on the course of implementation of plans I correspond-shchekhmu to an operating controls (Council of ministers of the USSR and federal republic, executive committee of Council of People's Deputies); the second — carry out generally methodical functions in relation to subordinate bodies of health care, and also provide the set of the submitted drafts of plans, bring the approved plan targets to performers, exercise departmental control of their execution.
Methodology and the main methods of planning of health care in the USSR.
Development of the Soviet health care, as well as other industries of the national economy of the USSR, is defined by the fundamental economic law of socialism which provides welfare and all-round development of all members about-va by means of the fullest satisfaction of their constantly growing material and cultural requirements, accrescence and improvement of socialist production on the basis of effective use of achievements of scientific and technical progress.
In the field of health care it is expressed in broad implementation of measures prevention (see), in the fullest providing the population with all types to lay down. - professional, the help and sanitary and anti-epidemic service.
P.'s methodology z. is based on the principles of planning of economic and social development developed by V. I. Lenin and developed in the subsequent in resolutions and decisions of congresses, plenums of the Central Committee of the CPSU, a number of directive party and government documents and also in works of the Soviet economists and specialists in the field of the organization and management of various industries of the national economy, including and in the field of social hygiene and the organization of health care. To the fundamental principles P. z. in the USSR party membership, scientific character, reality, a directivity, democratic centralism, a continuity, communication of territorial and sectoral planning belong. P.'s party membership z. is that development plans for health care in the USSR are the specific embodiment of the tasks set by party for the Soviet people at a certain stage of communistic construction, expression of the main directions of social and economic policy of the CPSU. Scientific character assumes that for definition of purposes of the plan and its indicators deep studying of a state and tendencies of development of demographic processes, health of the population, the needs for implementation of preventive actions and different types of medical aid on the basis of use of objective, evidence-based analytical methods is carried out. The reality of planning is provided with profound knowledge of diverse public requirements and economic opportunities of the national economy of the country in general and the industries of health care in particular that defines basic feasibility of plans. Democratic centralism consists in a combination of the centralized planned management to a wide initiative and creative activity of local bodies and workers of masses. Development plans for health care have directive character and, therefore, are obligatory for all performers. Important principles P. z. the continuity and communication of territorial and sectoral planning are. The first provides succession in P. z., the second — an agreement, organic communication of departmental plans with plans of administrative territories at all levels of the state hierarchy. Territorial sectoral planning in our country is successfully applied at the level of federal republics, edges, areas, economical and geographical areas. It consists in development of the system of indicators and volume measuring instruments of the plan on the basis of studying of incidence, attendance and hospitalization - the population; definition of compliance of rates of development of network of healthcare institutions and arrangements of medical shots to growth rates of industrial and agricultural production; evidence-based placement of health care facilities depending on social, economic and demographic factors. At the same time use modern mathematical, economical geografiche-skikh, economical and statistical, architectural and planning and other methods allows to develop plans of the most rational placement of medical institutions, to optimize their power, structure and activity, and also to establish priority of building of the medical and social institutions at a construction of the new cities and working settlements which are again based and the developing industrial complexes.
Item z. represents the continuous process consisting of the profound analysis of a condition of health care, definition of the purposes and problems of its further development; establishments for the planned period of optimum evidence-based standards of need for development of institutions and training for the best satisfaction of needs of the population for medical aid; developments of plan targets; discussions and approvals of the draft of the plan of the interested organizations and departments; approvals by its Supreme Council of the USSR and specification in the republics, regions and areas, bringing plan targets to performers; the organizations of control during implementation of the plan.
During the planning of health care analytical, comparative, normative and balance methods are applied.
The analytical method is used for assessment of a condition of health care at the time of scheduling, the analysis of implementation of plans of the previous periods and identification of the factors significantly influencing performance of plan targets. In the course of the analysis security of the population with medical and average medical personnel, hospital beds is defined. The indicators characterizing the volume of the rendered medical aid are estimated (an indicator of hospitalization of the population in hospitals, a median number of out-patient and polyclinic visits on one inhabitant a year), and also function of a hospital bed (a turn of a bed) and a medical position is analyzed (annual average number of visits to one medical position in policlinics). The state of health of the population, material and financial resources of health care is studied, the analysis of ratios of separate indicators on health care with indicators of development of all national economy is carried out.
The comparative method is a component analytical. Also definitions of rates of overcoming this irregularity use it for assessment (comparison) of the level of development of health care of different administrative territories in dynamics, and also for establishment of the reasons of irregularity of the developed levels of the state of health of the population and health care across the planned territories.
The normative method is used for scoping of different types of medical care, quantity of material, financial and personnel resources at which achievement needs of the population for medical services will be completely satisfied. Development of normative indicators is preceded by profound studying of the developed incidence of the population in the main nosological forms with the subsequent drawing up the predictive hypothesis characterizing the level and structure of incidence of the population for a certain span. On the basis of data of the forecast the volume of the out-patient and polyclinic help to urban and country people, frequency of hospitalization and some other the indicators influencing the size of standards are defined. At the same time norms of load of medical and average medical personnel are considered (reception of patients in 1 hour in policlinic, the number of patients on 1 doctor in a hospital, issue of physiotherapeutic procedures, production of laboratory analyses, carrying out X-ray fluorographic inspections, etc.). Establishment of standards creates possibilities for more rational distribution of network and shots of medical personnel.
In 1979. M3 of the USSR are approved optimum srednesoyuzny normative indicators at the rate on 10 Ltd companies city and villagers: on the stationary help — 136,0 hospital beds, on security with medical shots — 39,8, shots of average medics — 136,0, shots of pharmaceutical workers — 9,1 (including 4,21 with the highest and 4,89 with secondary pharmaceutical education), on a dignity. - hens. the help — 31,1 beds. On security with the extra hospital help the differentiated standards for urban and country people are entered: power of ambulatornopoliklinichesky institutions on 10 Ltd companies of inhabitants shall make 250 visits per shift in the city and 160 — in rural areas; number of medical visits, including v a domiciliary care, on average on 1 city dweller in a year 12,9, on 1 villager a year — 8,2.
At the same time srednesoyuzny standards are indicative only. During the development of long-term and current plans of development of health care in the republics, areas and areas they are specified depending on a demographic situation in this region (birth rate and mortality, level and structure of incidence, age and sex structure, the nature of resettlement and professional structure of the population), and also klimatogeografichesky conditions, national customs and traditions.
The balance method is used for establishment of proportionality between separate sections of the plan of health care, and also between requirements of health care and the state resources; it is directed to achievement of «balance» first of all between development plans for health care and development plans for the industries which are most closely interacting with it. So, e.g., expansion of network of healthcare institutions is balanced with the plan of capital investments for their construction or reconstruction of the buildings transferred to bodies of health care, commissioning of new institutions in volumes not below the planned gain of network, by plans of production of the corresponding materials and the equipment. The balance between the need for medical shots and their preparation for educational institutions planned by actions for health care and volume of the financial means provided in the budget on their performance is established. It is reached by collaboration of bodies of health care with bodies of system of the State Planning Committee of the USSR, the State Committee for Construction of the USSR, State Logistics Committee of the USSR, the Ministry of the higher and secondary vocational education of the USSR, the Ministry of the medical industry, the All-Union Central Council of Trade Unions and other ministries and departments. In plans of economic and social development the balance combination and proportionality of development of the industries provide bodies of the State Planning Committee of the USSR. In that zhz all questions concerning development of network of healthcare institutions and recreational institutions the needs for medical and pharmaceutical shots all ministries and departments coordinate time during the development of the plan for health care with M3 of the USSR as parent organization. Continuous increase in quantity material and a manpower of health care, complication of organizational forms of preventive maintenance and medical aid, implementation of achievements of medical science, scientific and technical and social progress sharply increase number of various options of development of health care, complicate the choice of the most effective of them. P.'s optimization z. in many respects broad use promotes modeling (see), modern economic-mathematical methods, electronic computer facilities. For these purposes the automated control system for health care — OASU «Health care» representing a complex of various function boxes and systems of different level of management is created: allied, republican, regional, city, and also separate institutions (hospitals, research institutes, higher educational institutions). Implementation of this system is carried out by the Main computer center of M3 of the USSR, and in federal republics — republican computer centers. One of function boxes of OASU «Health care» is the subsystem «Planned and financial activity» which main objective is development and deployment in practice of planning of health care of economic-mathematical methods on the basis of use of electronic computers (see. Electronic computer ). At the first stage a subsystem «Planned and financial activity» provides collecting, processing and delivery by means of the COMPUTER of the systematized information necessary for development of the planned and financial performance characterizing the level of development of health care (security of the population with hospital beds and medical shots, level of hospitalization, volume of the ambulatornopoliklinichesky help, etc.), quality and efficiency of use of material and personnel resources of health care (activity of institutions of various type, doctors of different specialties, etc.). Further development of a subsystem «Planned and financial activity» (the II stage) assumes expansion of a circle and character of solvable tasks, development of planned models, use of methods of the multifactorial analysis for assessment of extent of influence of demographic, social and economic, klimatogeografichesky and other factors on the extent of the need of health care for resources.
An operating procedure over the development plan for health care
the Main directions and contents of development plans for health care are defined: program documents of the CPSU and Soviet government, decisions of party and Soviet bodies, indications of higher bodies of health care; programs of the major scientific and technical and social and economic shifts in economic and social development of the USSR; demographic processes and their forecasts, and also forecasts of incidence of the population for the main nosological forms; achievements medical and allied industries of science; the analysis of dynamics of development of health care in 10 — 15 years preceding development of the plan.
Contents of plans of bodies and healthcare institutions, and also tasks which are carried out by them in the area P. z., are various. The USSR M3 functions are especially diverse. It directly develops the main directions and indicators of advance planning of development of health care (network of healthcare institutions, preparation and improvement of medical and pharmaceutical shots, development of medical science) and presents them to Council of ministers of the USSR and the State Planning Committee of the USSR, and also to
the State Committee of the USSR but science and technology (on development of medical science) and to the Ministry of the higher and secondary vocational education of the USSR (on preparation of medical shots); in coordination with the State Planning Committee of the USSR and Councils of ministers of federal republics defines the need for medical and pharmaceutical shots (see. Health care workforce ) also carries out distribution of young specialists between federal republics, the ministries and departments; develops and approves standards of medical aid to the population, regular standards of medical, pharmaceutical, technical, pedagogical personnel of healthcare institutions and (in coordination with the State Planning Committee of the USSR and the Ministry of Finance of the USSR) standard sheets of equipment of healthcare institutions stock and the medical equipment; defines need of the country for medicines and medical devices, devices and other products of medical prescription and carries out distribution them between federal republics, the ministries and departments of the USSR; carries out coordination and advance planning of scientific research in the field of medicine.
The contents of development plans for health care of federal and autonomous republics, edges, areas, on the one hand, correspond to the general purposes of M3 of the USSR for the planned period, and with another — depend on a number of the factors (ekonomi-to-geographical, a demograficha sky, social and hygienic, incidence, etc.) having essential value for this territory.
During the development of plans of separate institutions, determining the power, structure and specialization of an object, are guided by the differentiated standards of need for medical care taking into account the above-stated factors. The made corrections of a long-term plan shall be estimated from the point of view of medical, social and to some extent economic efficiency. So, the current plan of development of separate multi-field or specialized hospital is under construction on the basis of the profound analysis of compliance of need of the serviced population available financial, material and to a manpower, and also the actual use of bed fund. Planning of medical shots of hospital is carried out according to approved by M3 of the USSR the nomenclature of positions and regular standards.
Basic elements of the plan of policlinic are the volume and structure of medical visits (including a domiciliary care). During the scheduling are guided by the differentiated standards of requirement recommended for this administrative territory. At the same time features of age and sex structure of the population and its employment in production, designs and buildings of settlements, level and structure of incidence, etc. are considered. The estimated volume of the planned visits depends also on the number of doctors in general and on specialties, graphics of their work and average norms of loading (number of patients on 1 doctor during hour of work). The plan of medical positions defined thus for specific policlinic depends not only on requirements, but also opportunities of their completion.
At the heart of the plan of the medical and sanitary part consisting of a hospital, policlinic of health centers, sanatoria dispensaries and other divisions the maximum satisfaction of needs of the serviced contingents working at this industrial facility or group of companies lies. A specific place among measures for health protection at the industrial enterprise is held by the organization of control over the implementation of a comprehensive plan which is generally carried out by a medical medical unit and a sanepidstantion in the area of precautionary and current sanitary inspection (see).
In respect of the sanitary and epidemiologic station actions for implementation of precautionary and current state sanitary inspection, and also the prevention of epidemic infectious diseases are of great importance. In this regard on the basis of the regular standards approved by the Ministry of Health of the USSR states of medical, average medical and service personnel taking into account the specific contingents working at the industrial enterprises, children and teenagers and also the planned volume of laboratory researches are planned. A specific place is held in respect of SES by scoping of immunization of the population that is a basis for calculation of allocations for acquisition of bacterial drugs, and also implementation of approximate calculations of means for epidemic fund. The plan of SES unlike plans of other healthcare institutions shall be complex and coordinated with numerous departments, the organizations and the enterprises.
Working on by the long-term and annual plan begins with carrying out the analysis of security of the population with medical care, a condition of material and technical resources of health care, demographic data, incidence, etc. for a number of years, on the basis of the existing statistical reporting (a form 90-regional; 1RIK, etc.). Taking into account analysis findings and proceeding from the main tasks facing the industry the main directions of development of health care for the planned period are developed.
After consideration of the project of the main directions of development of health care by the Government directives to the plan according to which within the target figures established by bodies of the State Planning Committee drafts of the plan are developed are approved.
Designing of the plan of health care on the basis of the received directives and installations begins with a regional link. The chief physician of the area (the manager rayzdravotdely) on the basis of the received drafts of plans from subordinated institutions makes the draft of the development plan for health care of the area and sends it to regional planning department, regional executive committee of Council of People's Deputies and regional public health department.
The regional planning department presents the consolidating plan of development of local economy and cultural development of the area to regional executive committee. It is considered by regional executive committee and after the statement goes to higher administrative and planned bodies. In the same order plans are developed, considered and submitted by the appropriate higher regional and republican authorities. In a final stage the State Planning Committee of the USSR on the basis of the plans received from councils of ministers of federal republics, the ministries and departments of the USSR and after their specification presents the summary draft of the plan of economic and social development of the country in all industries of the national economy to Council of ministers of the USSR. The council of ministers of the USSR after approval submits it for the approval of the Supreme Council of the USSR. The plan approved by the Supreme Council of the USSR becomes the law obligatory for execution by all departments and organizations, and goes consistently to subordinate links for specification and execution.
At each subsequent validation phase of specific plan targets at the sessions of the Supreme Council of federal republics, regional (regional), city (regional) Councils of People's Deputies amendments only towards increase in plan targets can be introduced in indicators of the plan of health care if these administrative bodies have the material and financial resources providing performance of additional tasks.
After bringing specific plan targets to the performer control of the course of their performance will be organized. The control system behind implementation of the plan includes: the analysis of the state statistical reporting (see. Reporting medical ), periodic registration documentation (see. Documentation medical ), control and checks on places, consideration of the course of performance of plan targets on boards of the ministries or medical councils of appropriate authorities of health care.
From additional materials
Indicators of the plan of health care. Perspective and current, territorial and industry development plans for health care are developed on the basis of uniform economical indicators and include both quantitative, and qualitative tasks. In the conditions of the socialist state they have economic and industry value.
Indicators of the plan of health care characterize the main parties of its development. They are complex, provide comparability and reducibility of the plan, reflect proliferation of volume of medical aid and increase in its quality.
Indicators of development of health care happen approved and settlement. The first are approved by Council of ministers of the USSR (republic), have directive character and enter the established forms of development plans for health care at all administrative-territorial levels. The number of the approved indicators of development of health care included in the state plan of economic and social development of the USSR is, as a rule, limited - it is quantity of hospital beds (everything), commissioning of BC and policlinics, power of out-patient and polyclinic institutions, number of the workers occupied in health care, the wages fund, receptions and releases of the highest and average medical and pharmaceutical educational institutions. Detailing of indicators of development plans for health care is carried out from top to down. So, in federal republics the number of the approved indicators of the plan can be big in comparison with the all-union plan. In the area, the city, the area detailing is even more. However irrespective of extent of detailing of indicators at any level their essence does not change that is provided with unity of a methodological basis of their creation. It creates harmonious system of indicators of the plan. All of them — from regional level to allied — have identical contents and can be brought together in the unified state plan. Except the plans approved during the development neut-verzhdayemy (settlement) indicators form. They characterize development of the separate directions of this industry, growth rates of network of medical and out-patient and polyclinic institutions, security of the population with these and other healthcare institutions. Use of settlement indicators for the analytical purposes gives the chance to choose an optimal variant of the decision for the planned period.
In respect of health care treat settlement indicators: number
of beds for mentally sick and suffering from tuberculosis; number of beds in the cities, rural areas (excepting beds for mentally sick); number of beds in sanatoria on the date of the maximum expansion (everything), including year-round; from them number of beds in budget sanatoria, including in sanatoria for TB patients; number of medical positions (including positions of dentists) — only; quantity of drugstores (see the Drugstore) — everything, including in rural areas.
Unlike the approved indicators the nomenclature of settlement indicators extends depending on the tasks solved in planning period. All indicators of the development plan for network of healthcare institutions are established for the end of the planned period except for indicators of development of network of sanatoria, to-rye are defined on the date of their maximum expansion.
In a crust, time planning and financing of network a dignity. - hens. institutions about three channels are carried out: 1) the USSR M3 system (budget children's sanatoria of all profiles and sanatoria for TB patients); 2) the management of resorts of the All-Union Central Council of Trade Unions and republican councils of labor unions, to-rye plan and develop network of the sanatoria (see) which are contained on the terms of self-financing with full or partial payment of cost of permits by the local trade-union organizations; 3) the administration and the trade-union organizations of the industrial enterprises and associations, to-rye develop network of sanatoria dispensaries (see Sanatorium dispensary) according to plans of social and economic development of labor collectives.
The main indicators of the development plan for network of healthcare institutions are: a hospital
bed (see Hospital) — for the fixed network; number of visits per shift — for out-patient and polyclinic institutions; quantity of calls in a year — for stations of emergency medical service (see Emergency medical service); the number of the serviced population and objects of sanitary inspection — for sanitary and epidemiologic stations (see); the number of the serviced contingents of the population — for pre-medical to lay down. - the prof. of institutions (see the Health center, Medical and obstetrical center); the volume of a compounding and goods turnover — for drugstores etc.
Along with the called indicators during the development of the development plan for health care a number of the calculations giving an idea of security of the population with the medical and medicinal care, separate healthcare institutions, medical shots, use of bed fund, etc. is carried out. During the planning of the stationary help such indicators are: percent of hospitalization (see) the population; number of days of use of hospital beds in a year; the average duration of stay of the patient in a hospital (in days); turn of a bed and some other indicators. At the developed structure of hospital network and security of the population with hospital beds in a crust, time for the optimum settlement volume of the stationary help it is considered to be 243 cases of hospitalization for 1000 of the population; the average duration of stay of the patient in a hospital for city BCs is equal 15,4 days at average employment of a bed in a year 340 days, in rural-tsakh respectively 14,5 and 310 days; in-tsakh for chronically sick — 90 and 340 days; in psikhonevrol. institutions — 75 and 350 days. These indicators are unstable and can change depending on character, quality and forms of the organization of medical aid. The main indicators for planning of the out-patient and polyclinic help are: level and structure of the so-called exhausted incidence including primary negotiability of the population in connection with a disease (incidence on negotiability for 1000 of the population) and in addition revealed incidence on professional surveys; median necessary number of visits in a year on one inhabitant (including lechebnokonsultativny, dispensary and preventive visits of doctors in policlinics and at service at home); planned (settlement) function of a medical position on specialties and the actual load of doctors. Optimum requirement and security with medical shots (see) — doctors and paramedical staff are calculated in general and on each specialty on 10 thousand population.
The incidence on negotiability for 1000 zhit. in a year (see. For -
bolevayemost) over the country averages 1000 — 1100 cases, and across certain territories reaches up to 1300 — 1400 and more cases that is caused by distinctions of social and economic, demographic, klimatogeografichesky and medical character.
The average settlement value of 12,5 medical visits on one inhabitant the year (city and rural combined) accepted in a long-term plan for the period till 1990 reflects much the increased possibilities of the Soviet health care on ensuring need of the population not only in the medical, consulting and diagnostic help, but also the bigger volume of preventive visits in connection with phased transition to medical examination of all population (see Prevention primary).
Settlement norms of load of doctors of out-patient and polyclinic institutions (function of a medical position) are established by heads of healthcare institutions in coordination with the trade-union organization and can make various sizes depending on the specific organization of work (see. Scientific organization of work), durations of labor year, volume of loading in an hour and other factors.
A basis of development of health care in general is the plan of optimization of network of institutions, to-ry predetermines the level, rates and proportions of development not only its material and technical resources, but also volume, quality and efficiency of activity of all health system.
Planning of network of healthcare institutions. The main directions of economic and social development of the USSR for 1981 — 1985 and for the period till 1990, accepted by the XXVI congress of the CPSU, provided further increase in level of management and scientific planning. In this regard special relevance is acquired by forecasting of development of system of institutions of the industries of the non-productive sphere, including network of healthcare institutions. Development of the industries of the non-productive sphere shall be guided by the long-term purposes of social development of society, and placement of network of its institutions shall be based on the long-term evidence-based concept of development of system of the inhabited places — the Hookup of resettlement coordinated to the Hookup of development and placement of productive forces of the country, and also to regional schemes of resettlement in territories of federal republics.
On development and improvement of network of healthcare institutions huge impact is exerted by scientific and technical progress, differentiation and integration of medical science and practice of health care, process of an urbanization, concentration of industrial and production potential, its territorial placement, proximity of the large cities to rural settlements, development of vehicles and bonds, structure and reproduction of the population, processes of migration (including pendular), the nature of resettlement of inhabitants — density, a lyudnost (see Demography, the Population), the level and structure of incidence, its geographical prevalence (see. Geographical pathology), state of environment (see), etc.
In «Methodical instructions on development of evidence-based schemes of perspective development and placement of network of treatment-and-prophylactic and pharmaceutical institutions» (M3 of the USSR, 1983) it is indicated the need of use of essentially new systems approach to planning of perspective network of institutions directed to rational use of labor, material and financial resources, and also economy of the budget of free time of the population.
The differentiated regularatory method of formation of uniform functional and organizational structure of network of healthcare institutions for each specific republic, edge, area, the area, the city taking into account a complex not only acting, but also perspective factors of the medico-organizational, town-planning, economical and geographical and social plan shall be the basis for such planning. In this case understand set as network organizationally and functionally related and supplementing each other institutions placed in the specific territory and providing unity of structurally functional interaction in the solution of common goals and problems of a health system. At the same time each healthcare institution takes a certain place in the general system, possesses resursakhm for providing to the population of the corresponding types of the medical and sanitary help in sufficient volume and necessary quality taking into account features of the serviced contingent, etc. Such is optimum criterion function of network of healthcare institutions, edges is a basis of territorial sectoral planning of health care.
Technique of planning and calculation of network of healthcare institutions. Development of network of healthcare institutions is carried out according to the main N and and r and in l e in N and I am m and social and economic development of the USSR, the hosted congresses of the CPSU and «Methodical instructions to development of the state development plans for the national economy of the USSR» approved by the State Planning Committee of the USSR in to-rykh provide the solution of the major problems of this planning period. According to them the M3 of the USSR develops the main installations for drawing up perspective and five-year development plans for health care. Constant growth of network, its modernization and improvement of activity in the conditions of scientific and technical progress provide increase in volume and improvement of quality of medical aid. Control over the implementation of indicators of the plan is exercised by bodies of health care and planned bodies.
Planning of network of healthcare institutions at the republican, regional (regional), city and regional levels begins with the analysis of providing the population with medical aid and a tendency in incidences and demographic processes; optimum need of the population in out-patient and polyclinic, stationary and other types of medical aid is defined. The purposes and problems of development of network of institutions for planning period taking into account the initial level and the forecast of incidence and demographic still zately are outlined.
For receiving optimal variants of the plan of placement of healthcare institutions, determination of their power and structure use methods of operational research (see) — linear programming, statistical tests, the theory of mass service, stockpile management, etc., and also the method of step-by-step planning of specialized types of medical aid to all population of the administrative territory based on use of systems regularatory approach. This method is developed in the All-Russian Research Institute of social hygiene and the organization of health care of
N. A. Semashko. It combines the medico-organizational and town-planning principles of creation of network of healthcare institutions. Use it allows to define structure and functional purpose of each establishment at various stages of the organization of medical aid, to reveal possibilities of the organization of independent full-fledged departments in hospitals and medical receptions in policlinics. At the same time prin the tsipia lyyu important is it a redeleniye of minimum admissible sizes of the departments allowing to render specialized medical aid.
During the development of the plan of perspective development of network to lay down. - the prof. of institutions of the Ministry of Health of the USSR and federal republics are guided by the following philosophy: 1) formation of network of healthcare institutions shall be carried out taking into account perspective systems of resettlement and uniform network of the centers of public service; 2) ensuring functional unity of network of institutions for urban and country people on the basis of uniform perspective standards of need for medical aid and their differentiation at various stages of the organization of medical aid to the population, at the same time a phasing of the organization of specialized types of the out-patient and polyclinic and stationary help, and also interrelation, functional contents, structure and power to lay down. - prof. of institutions are defined by specific conditions of resettlement of the population; 3) the sequence of rendering medical aid is caused by character and complexity of a disease, methods of inspection and treatment, and extent of specialization and integration of medical aid — rational forms of its organization; 4) approach of specialized types of medical aid (see. Specialized medical, the help) and increase in level of satisfaction of need of the population for all its types on the basis of medical division into districts and zoning of the territory.
Creation of specialized departments in hospitals and offices for receptions in policlinics depends on existence of necessary population or the contingent of patients. At insufficiency of the population or contingent of patients various versions of decisions can be applied to creation of independent (full-fledged) specialized divisions of optimum power; 1) planning of this type of the specialized help on higher (on hierarchy) the level of the organization of medical aid; 2) in special cases when specifics of local conditions do not allow to organize this type of medical aid at the higher level (big transport extent, geographical inaccessibility), it is possible to allow formation of uniform highly specialized departments for service of children's and adult population, and also uniform divisions for residents and the visitor of the population; 3) combination of functionally close specialties and profiles of beds in independent departments of the planned power.
The structure of BC shall provide a reasonable combination in each specific establishment of various profiles of departments, departments of hospitals, excluding unreasonable duplication small on power, within the small territory of the area or the city.
The existing network to lay down. - the prof. of institutions dthe olzhna to be a component of perspective network after carrying out necessary reconstruction, modernization and an exception of buildings, unsuitable for further operation.
During the formation of perspective network to lay down. - prof. of institutions are used the general (across the USSR) and the differentiated standards of need of the population for an out-patient polikli-nicheskoy and the stationary help recommended in 1980. M3 of the USSR, and also corrected on their basis of mines - you health care of federal republics of a norkhmativa for certain administrative territories. For an example tab. 1 and 2 are provided.
Starting formation of network to lay down. - the prof. of institutions, it is necessary to carry out preparatory work.
1. To receive materials about perspective system of resettlement in the specific territory (area, edges, the republics), to-rye are presented in schemes and projects of a regional design in the section «Resettlement and System of Public Service» where information on value and function of the public centers, zones of their influence and number of the serviced population contains. Similar information for the cities contains in drafts of master plans of the cities, the section «Architectural and Planning Structure of the City». 2. To correct the differentiated standards of need of the population for all-profile, specialized and highly specialized types of the ambulatornopoliklinichesky and stationary help recommended by the Ministries of Health of the USSR and the federal republic in relation to local conditions. 3. To determine minimum admissible size functional to lay down. units (department, medical reception) by all specialized types of the help taking into account a phasing in the organization of medical care of the population of this territory. For territories where prevail industrial production, dense population and big specific weight of urban population, the recommended power of department shall not be less than 60 beds. Only under special conditions of resettlement, big radius of service department can be the minimum power on 30 — 40 beds. In systems of resettlement with a high density where the number of inhabitants and consequently, and the contingent of patients is sufficient for the organization of separate independent departments for the adult and children's population, is recommended during the calculations of perspectives of development of network stationary and out-patient polikli-nicheskikh institutions to use differentiated (for adults and children) standards of need for medical aid. 4. To establish minimum admissible power of independently functioning various types of medical institutions (rural local-tsa, central regional-tsa, city-tsa, the nursery-tsa, a maternity home, specialized-tsa, a clinic and, etc.).
During the formation of network of stationary institutions on perspective the following sequence of calculations is recommended: 1) the minimum population necessary for the organization of independent department of the planned power for this profile of beds is established; 2) the planned number of beds in the centers of various systems of resettlement is defined. Calculation is carried out on each profile of beds step by step from subordinate system of resettlement to the highest.
Total number of beds in the centers of systems of resettlement of the first level (the central estates of state farms, collective farms, etc.) is defined by summing of beds of those profiles, expansion to-rykh at this stage of medical aid is reasonable from organizational and medical positions.
In the centers of the second level (regional and interdistrict systems of resettlement) the number of beds is determined by each profile also in the beginning, to-rye it is necessary to develop for service of the population of the center and all zone of its influence, and then the corresponding number of the beds planned at the first stage of the organization of the stationary help is subtracted from the received number of beds on each profile. There is a number of beds, to-rye it is necessary to develop in the center of this system of resettlement (the second stage of medical aid).
For the centers of the third level (interdistrict, zone systems of resettlement) calculations are conducted similarly: at first the number of beds is determined by each profile, to-rye can be developed for inhabitants of the center and all zone of its influence (periphery). The sum of the corresponding beds planned to placement in the centers of the second and first levels is subtracted from the received number of beds on each profile. Calculation is in this way carried out until the power and the general functional structure of stationary institutions of the centers of all systems of resettlement at stages of the organization of medical aid is determined.
Thus, each center of system of resettlement will be characterized by a certain quantity functional to lay down. units (departments), their power and settlement total normativokhm the needs for beds, the differentiated standards of requirement for those profiles of beds received as a result of consecutive addition, to-rye can be presented in this or that center of system of resettlement in the form of independent department. The summary standard of requirement reflects dependence of the standard of need on population for the center of system of resettlement and a zone of its influence. Calculation of power and structure of network of out-patient and polyclinic institutions goes a similar way.
As a result of carrying out of this sort calculations at all stages of the organization of medical aid each out-patient and polyclinic and stationary institution receives strictly set quantity of specialized offices and departments with zones of their influence.
Using a method of step-by-step planning of territorial placement to lay down. - the prof. of institutions, creates optimum model of development of network of out-patient and polyclinic and stationary institutions in the conditions of perspective systems of resettlement in the specific territory; the model is compared with the existing network for the purpose of definition of a possibility of its reduction in compliance with a long-term plan. Such comparison allows to determine the planned volume of new construction, and also reconstruction and modernization of the functioning institutions with differentiation of volume indicators by specialized types of the help, types of institutions and stages of the organization of a medpokhmoshcha and to draw up the plan of step-by-step implementation of this task in an optimal variant. During the carrying out this work these incidences of the population and existence of bed fund shall be considered.
Evidence-based planning of providing with medical shots makes an important stage of planning of development of health care. Health care workforce (see) — a manpower of health care, provides performance of tasks and actions in the field of protection and improvement of health of the population. Calculations of need for shots are conducted usually for 10 — 15 and more years, in annual plans tasks of long-term plans are specified and concretized.
The need for medical shots follows from target problems of health care at a certain historical stage of its development. The main objectives defining personnel policy in health care on a crust. vrvkhmya and the subsequent period, are defined by resolutions of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) and «About additional measures for improvement of public health care» (1982).
The general need for specialists with the highest and average medical about-razovaniyekhm represents the size necessary for performance of the health care of volume provided in the development plan to lay down. and a disease-prevention service, and also for providing some other sections of work where work of specialists with the higher and secondary medical education is used. Proceeding from the general need for specialists, norms of requirement, i.e. the average quantitative indices measured by number of specialists on 10 Ltd companies are determined zhit. They share on optimum and limited: optimum — the level of security with doctors for full satisfaction of need for them; limited — the level of security in the set planning period taking into account the available real opportunities. Limited standards call also intermediate since they are a stage on the way of achievement of optimum standards.
Srednesoyuzny standards of need for medical shots are differentiated on federal republics both on total quantity, and on separate specialties taking into account the distinctions caused by influence of a number of factors of social and hygienic, demographic and economic character. On certain areas (edges), the capitals of federal republics and large industrial centers standards of security can be higher, than on average on the republic. It is connected with concentration in them of medical higher education institutions, scientific research institute and a wedge, hospitals allied, republican (regional, regional) values, sanatoria of allied and local value. In other areas (regions, the cities) which do not have such institutions, security with doctors can be below national average level.
For planning of preparation of medical shots it is necessary to define:
1) general need for doctors;
2) additional requirement for doctors; 3) the number of the students admitted to medical institutes (faculties) on medical specialties.
The general need for doctors and specialists with secondary medical education for the planned period is defined by multiplication of the optimum planned standard of need for specialists on predicted (on the end of planning period) population and is estimated on the following formula: d Nm.Pm m — io where Am — the general need for specialists; N — the planned standard of need for specialists (on 10 thousand zhit.); D — population (in one thousand), m — the last year of planning period.
Understand that number of specialists as additional requirement, a cut it is necessary to prepare in planning period in educational institutions to provide achievement of the set size of the general need for these specialists. It consists of two sizes: a necessary gain of number of specialists for increase in level of security of the population with shots according to standards and numbers of the specialists who are required for compensation of their decrease.
The size of additional requirement on a gain of number of specialists is measured by a difference between the general need for them for the end of the planned period (At) and their existence in basic year (Ap).
During the planning of preparation of medical shots year is considered basic year, on to-ry the number of doctors it is predetermined by the forthcoming releases of the young specialists admitted to medical higher education institutions in the previous years, i.e. basic year advances financial year on the number of years equal to duration of training in higher education institution (5 — 6 years).
The additional requirement on a gain of number of doctors depends: from the sizes of a gain of population and the planned development of network of healthcare institutions; extents of lag of already reached level of security from the optimum planned standard.
The size of additional requirement for specialists for compensation of their decrease is measured on the near-term outlook on the average percent of a decrease which developed for 2 — 3 previous years, and is defined on the remote perspective by method statistical peredvizhek age groups of medical shots. Across the USSR in 1975 — 1980 the annual average decrease of doctors
averaged about 1,6%, on specialists with secondary medical education — 2,7%.
The method of calculation of a decrease of specialists consists of several stages: 1) according to the last official report of TsSU USSR on the number of the specialists occupied in the national economy, doctors are distributed on age and sex groups at an interval of 5 years; 2) the number of years is defined, a cut specialists of each age group should work separately for men and women before achievement of a retirement age; 3) years of retirement of persons of each age group separately for men and women are calculated; 4) the absolute size of the forthcoming decrease of doctors is determined by the five-year periods and on average for 1 year.
The size of an estimated decrease of doctors is calculated in absolute values. The percent of a decrease is defined as derivative size from division of the absolute size of an annual average decrease into the expected presence of doctors for the end of the corresponding year.
The sum of additional requirement on a gain of number of doctors and compensation of their decrease defines the number of doctors, a cut shall be prepared in the planned period in educational institutions, it is equal to total release of young doctors for these years. Enrollment of students in medical institutes (faculties) is determined by the level of the annual average release increased by dropout rate of pupils during training in educational institution. During the planning on average across the USSR elimination in in-ta is accepted to all term of training at the level of 10%, and in medical schools — 5%.
During the planning of number on separate institutions the need for specialists is determined by regular normativakhm of medical staff of these institutions approved by M3 of the USSR. At the same time the quantity of the positions provided by regular standards is calculated and the necessary number of personnel is defined, their normative functioning in the current year can provide edges.
STANDARDS of STATIONARY MEDICAL CARE to the POPULATION of the USSR for 1980 (number of hospital beds on 10 000 population)
STANDARDS of the STATIONARY HELP to the CHILDREN'S POPULATION of SOME FEDERAL REPUBLICS for 1980.
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A technique of planning of preparation of medical shots in the USSR, M., 1977.
V. V. Golovteev, W. I. Kant.
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