Vertical program of screenings and check-ups in the Russian Federation: design, implementation and lessons learnt

Abstract

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.

What next for the polyclinic? New models of primary health care are required in many former Soviet Union countries

“…This small-scale survey doesn't represent all physicians in the country, but it can provide additional evidence to our observations on the limitations of professional autonomy in polyclinics. Some questions from this survey were also used in our recent study of the national preventive program [4].…”

“…While this method of payment motivates physicians to implement the program, it limits their professional autonomy on the choice of preventive services for an individual. They have to provide the entire bundle of services to be reimbursed, irrespective of the actual need of a patient [4].…”

Breast and cervical cancer screening practices in nine countries of Eastern Europe and Central Asia: A population-based survey

“…Larger (urban) polyclinics employ both general practitioners and out-patient specialists (e.g. primary care gynaecologists) [13] , [14] , [15] , [16] . The preventive exams provided comprise annual opportunistic cervical smears starting from age 18, and commonly stained by Romanowsky-Giemsa staining, as well as clinical breast exam (CBE) for women of a broad age range [17] , [18] .…”

“…The preventive exams provided comprise annual opportunistic cervical smears starting from age 18, and commonly stained by Romanowsky-Giemsa staining, as well as clinical breast exam (CBE) for women of a broad age range [17] , [18] . Target population can either self-refer, be referred by their general practitioner or recommended to participate by their employer [13] , [14] , [16] .…”