Goal of research: Identifying the directions of specialty medical care systems transformation, methods of its rationing and changes in health workers motivation under the influence of medico-technological, managerial and economic factors
- the review of international literature, statistical analysis, international comparisons,
- cross-tabulatory, disperse, regression, factor, discriminant and claster analysis of the data of the surveys in 2007-2016.
Empirical base of research:
- WHO database, OECD health data, Rosstat data,
- surveys of medical workers conducted by the Levada Center commissioned by the Independent Institute of Social Policy in 2007 and VCIOM in 2011, NRU-HSE with the support of the Ministry of Health in 2013, NRU-HSE and C-media in 2016,
- interviews with health managers and physicians in two regions of the country in 2017.
Results of research: Analyzed trends in the development of hospitals and outpatient-inpatient systems in the leading Western countries and Russia. Reviewed international studies of the impact of these processes on cost and quality of care. Determined measures to ensure continuity of medical care and coordination of individual services. Compared the integration processes.
Theoretical basis of health care rationing is presented. The legal norms of access to care rationing are analyzed. Rationing practices are addressed in two regions of Russia. The actors, methods and rationing criteria are determined.
The role of Russia physicians’ monetary motivation and their attitude towards extra paid work are estimated. The changes in the physicians working practices in 2007-2016, their impact on the work motivation are analyzed. The changes in the interaction of physicians and patients are addressed.
Level of implementation, recommendations on implementation or outcomes of the implementation of the results. Hospitals development and integration forms are suggested for health policy to facilitate access to care. These proposals are to be used in the work on the Strategy of health development in 2018-2014 an further period until 2035.