NEW SCHEMES OF MANAGEMENT OF PUBLIC HEALTH: INTERNATIONAL AND NATIONAL DEVELOPMENTS
Jan.1, 2011 a Federal Law No.83-ФЗ(=FL) from May 8, 2010 (edited version from Feb.7, 2011) was put into effect: On inserting amendments in legal acts of the Russian Federation in connection with improving legal position of state (or municipal) establishments. It meant a transition of METPs (=medical establishment for treatment and prevention) into novel organizational and legal forms of activity. All these novelties have induced much fuss among medical servicers providers. This step was generally (both within, as well as without RUSSIA) considered as a compelled one. However, our review of literature on this spot showed wide spread of such a reform throughout the world, it also confirmed the capabilities of this reform for elevated efficiency of METPs, for activated competitiveness and improved quality of medical services. In the EU, introduction of novel organizational and legal forms of activity of METPs brought about a new classification of hospitals along 5 indicators, i.e. scope of independence in activity, involvement in market relations, extent of financial responsibilities, grade of accountability, level of social functions. For the contents of these indicators, a hospital could be referred to as either autonomous, incorporated, or privatized establishment. Estonia, Norway, Portugal, the UK, also Spanish Andaluzia and Italian Venice accomplished restructuring of state hospitals into half-independent public firms, having in store elevated efficiency of activity of a METP. These new models of hospital ownership presume semi-autonomous structure of self-administration, implying preservation of it as still a state organization. Many countries that adopted medical insurance also began to introduce novel organizational and legal forms of activity of METPs. A transfer to a contractual basis of outer relations of METPs which was undertaken on that way resulted in emerging of more favorable conditions for developing competitiveness between providers of medical services. In some European countries, e.g. Netherlands, Finland, etc. a right was granted to private commercial medical establishments to contest for obtaining state order for providing medical services. Partial fund-hedging for general practitioners of primary medical care is to be considered also as one pathway of the reform of public health which has been introduced in the UK, Spain, Italy, Sweden, Finland, and Estonia. The afore-indicated pathway has proved to possess quite a few benefits, the main one being a more flexible system for providing primary medical care. That implied the enlargement of the list of medical services, safeguarding the timely access to medical care, and so on and so forth. It was in the 90th of the 20th century that - for primary medical care - a transfer from regular outpatient facilities to occasional general practitioner practices has occurred in countries of Eastern Europe and RUSSIA. Family doctors proved under these circumstances to be more qualified for medium-grade medical care. Particularly in RUSSIA, certain attempts has been made since 2005 to bring state (municipal) ME into the frame of autonomous noncommercial establishments. Favorable tendencies of operational activity of the aforementioned model were proved in few studies, nevertheless, no real widespread of it occurred here. Several Regions of the Russian Federation (Vologda Region, Kirov Region) have started the project for a transfer of public health to a single-channel funding. It goes without saying that certain new models for operation of METP suit some countries, while other models suit another countries. But the general overall trend consists in more and more autonomous (independent) status of a METP implying elevated responsibility of a manager for the efficiency of expenditure of financial means. The changes emerging in RUSSIA are definite to activate the not yet realized potential benefits of METPs.