Вackground In the last two decades, health care systems (HCS) in the European countries have faced global challenges and have undergone structural changes with the focus on early disease prevention, strengthening primary care, changing the role of hospitals, etc. Russia has inherited the Semashko model from the USSR with dominance of inpatient care, and has been looking for the ways to improve the structure of service delivery. This paper compares the complex of structural changes in the Russian and the European HCS. Methods We address major developments in four main areas of medical care delivery: preventive activities, primary care, inpatient care, long-term care. Our focus is on the changes in the organizational structure and activities of health care providers, and in their interaction to improve service delivery. To describe the ongoing changes, we use both qualitative characteristics and quantitative indicators. We extracted the relevant data from the national and international databases and reports and calculated secondary estimates. We also used data from our survey of physicians and interviews with top managers in medical care system. Results The main trends of structural changes in Russia HCS are similar to the changes in most EU countries. The prevention and the early detection of diseases have developed intensively. The reduction in hospital bed capacity and inpatient care utilization has been accompanied by a decrease in the average length of hospital stay. Russia has followed the European trend of service delivery concentration in hospital-physician complexes, while the increase in the average size of hospitals is even more substantial. However, distinctions in health care delivery organization in Russia are still significant. Changes in primary care are much less pronounced, the system remains hospital centered. Russia lags behind the European leaders in terms of horizontal ties between providers. The reasons for inadequate structural changes are rooted in the governance of service delivery. Conclusion The structural transformations must be intensified with the focus on strengthening primary care, further integration of care, and development of new organizational structures that mitigate the dependence on inpatient care.
Background The Russian Federation has introduced a vertical large-scale program of ‘dispensarization’ (Program) that includes health check-ups and screenings for the entire adult population. It is expected to improve the results of medical interventions and ensure health gains at a relatively low cost. The major research question: Does the design and implementation of the program meet the expectations? Methods We analyze regulatory acts and the literature on the design and the outcomes of the Program. Physicians’ surveys and interviews are conducted to understand the capacity of primary care providers to meet the requirements of the Program, as well as the link between the early identification of new illnesses and their follow-up management, administration of the program, the barriers to its successful implementation. Results There is a substantial progress in the coverage of the population and increase in the number of identified illnesses. Some specific instruments of the Program implementation work well, others require more careful design and additional integrative and managerial activities. The capacity of primary care providers does not allow to provide high quality preventive services, as well as to ensure a continuum of preventive and curative work. The pattern of the Program administration facilitates its nation-wide implementation according to the unified rules, but makes it more difficult to account for the local conditions and limits the autonomy of professionals to choose specific population risk groups and a list of services. The interaction of providers in preventive activities is inadequate. Conclusion The expectations of the Program are too high due to the inconsistencies in its design and implementation. The major lesson learnt is that the program like this should meet the capacity of primary care and be designed as a complex of interrelated activities to identify illnesses and provide their follow-up management.
Экспертный центр электронного государства представляет четвертый выпуск сборника «Лучшие практики региональной и муниципальной информатизации». Издание объединяет в себе 37 паспортов проектов, вышедших в финал IV Всероссийского конкурса проектов региональной и муниципальной информатизации «ПРОФ-IT», а также проекты, признанные лучшие в области импортозамещения. Каждый паспорт содержит краткую информацию о региональном проекте, включая перечень решаемых задач, архитектуру системы, используемые платформы и средства разработки, описание функциональных возможностей и перспективы развития. Рассказы о работах, завоевавших первые места, ведутся от имени руководителей органов власти, которые принимали непосредственное участие в разработке и внедрении проектов. Всероссийский конкурс «ПРОФ-IT» организован и ежегодно проводится Экспертным центром электронного государства c 2013 года. Целью конкурса является повышение качества проектов региональной и муниципальной информатизации, реализуемых в субъектах Российской Федерации. С 2016 года «ПРОФ-IT» приобрел статус форума, в рамках которого прошли несколько панельных дискуссий, пленарное заседание, и финал традиционного конкурса с очной защитой проектов.
Background. The Russian Federation has introduced a vertical large-scale program of ‘dispensarization’ (Program) that includes health check-ups and screenings for the entire adult population. It is expected to improve the results of medical interventions and ensure health gains at a relatively low cost. The major research question: Does the design and implementation of the program meet the expectations? Methods. We analyze regulatory acts and the literature on the design and the outcomes of the Program. Physicians’ surveys and interviews are conducted to understand the capacity of primary care providers to meet the requirements of the Program, as well as the link between the early identification of new illnesses and their follow-up management, administration of the program, the barriers to its successful implementation. Results. There is a substantial progress of the coverage of the population and increase in the number of identified illnesses. Some specific instruments of the Program implementation work well, others require more careful design and additional integrative and managerial activities. The capacity of primary care providers does not allow to provide high quality preventive services, as well as to ensure a continuum of preventive and curative work. The pattern of the Program administration facilitates its nation-wide implementation according to the unified rules, but makes it more difficult to account for the local conditions and limits the autonomy of professionals to choose specific population risk groups and a list of services. The interaction of providers in preventive activities is inadequate. Conclusion The expectations of the Program are too high due to the inconsistency in its design and implementation. The major lesson learnt is that the program like this should meet the capacity of primary care and be designed as a complex of interrelated activities to identify illnesses and provide their follow-up management.
Цель исследования – изучение сроков посева сои в погодных условиях Курганской области и их влияние на урожайность культуры. Изучалось три срока посева: 18, 28 мая и 2 июня. Объектом изучения являлись сорта бобовой культуры сои СиБНИИК-315 и Бара. Посев проводился на опытном участке Курганской ГСХА, почвы – черноземы выщелоченные по методике, используемой при полевых исследованиях сельскохозяйственных культур. Всхожесть, выживаемость, сохранность и фенологические фазы определялись в полевых условиях. Структурные показатели были взяты со сноповых образцов и определялись в лаборатории кафедры. Установлено, что посев сои в ранние сроки позволяет получить хорошие всходы за счет влаги, накопленной за весенний период после схода снега, они дружнее прорастают и более устойчивые к неблагоприятным условиям. При посеве сои сорта СиБНИИК-315 18 мая количество растений составило 48,8 шт./м2, что соответствовало 97,6 % всхожести. Оптимальным сроком для сорта Бара было 28 мая, где всхожесть не превысила 96,8 %. Поздние сроки (2 июня) ни по одному из сортов не показали хороший результат. Вегетационный период на сорте СиБНИИК-315 при раннем сроке посева (18 мая) составил 102 дня, при посеве 28 мая – 104 дня, при посеве 2 июня – 108 дней, а из характеристики сои сорта СибНИИК-315 известно, что вегетационный период на юге области составляет 83–106 дней. Сорт Бара ультраскороспелый, период вегетации 90–95 дней. В погодных условиях Курганской области вегетационный период колебался от 97 до 108 дней при июньском способе посева. В расчете биологической урожайности большую роль играет масса 1000 семян. В зависимости от сортовых особенностей и погодных условий она колебалась от 119,5 до 130,4 г. Проводя исследования по срокам посева, можно сделать вывод, что более ранний срок посева обеспечил хорошее развитие элементов структуры урожая. В связи с этим при ранних сроках биологическая урожайность составила 2,5–2,4 т/га, при более позднем сроке – 1,7 т/га на сорте СиБНИИК-315 и 1,9 т/га сорт Бара.
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