The concept of health care development of the Russian Federation to the city of On the priority directions of health care development in the Russian Federation

The draft Concept for the development of the healthcare system in the Russian Federation until 2020 has been submitted to the State Duma.

I am citing an article by Irina Nevinnaya "Financial injection. Expenses of state medicine for an" average "patient by 2020 will grow 8 times" in " Russian newspaper"dated January 16, 2009:

"Yesterday, the flower of domestic medicine gathered at the Ministry of Health and Social Development: a draft Concept for the development of the country's health care until 2020 was presented to the experts and the public.

So far, we are talking about the first, draft version: it is to be discussed in the State Duma, the Federation Council, and the Public Chamber. But the strategic document on the basis of which the new structure of Russian state medicine will be built will have to be completed very quickly. Because already in June should be ready new edition the main law in this area is the law on compulsory health insurance.

Will change financial model health care. Within the framework of state guarantees medical care for patients will remain free. At the same time, the current highly confusing and non-transparent system of financing from several sources will be replaced by simpler “one-channel” financing. The main source should be the MHIF. This will make it possible to avoid duplicate use of funds and ultimately treat more and better at less cost.

At the same time, the cost of medical care guaranteed by the state is expected to be seriously increased in the same way as it happened in last years... If today on average in the country a little more than 5 thousand rubles a year is spent per patient, then already in 2010 the per capita standard will almost triple - up to 13 700 rubles, and in 2020 the state, according to plans, should spend on the treatment of one person in 8 times more than now - 43,700 rubles a year.

New organization medical care, which should ideally equalize everyone - from residents of capitals to "bear corners" - in the amount, quality and speed of assistance received. To do this, of course, is incredibly difficult. It is necessary, to put it simply, to link all medical facilities into a single chain - from the primary, where the patient comes when he becomes ill, to modern high-tech centers, and to make sure that the patient with the minimum expenditure of time and effort gets exactly to that level of care, in that institution where he will be provided with assistance adequate to his condition. For remote regions of the country, in particular, the concept proposes to actively develop the work of mobile specialized teams and telemedicine - when the best specialists from leading clinics help local doctors to establish a diagnosis and determine the optimal treatment regimen.

Training will play an important role. Together with the Ministry of Education, the Ministry of Health and Social Development is going to carry out a serious modernization of training and retraining of physicians of all levels and specialties.

According to the academician of the Russian Academy of Sciences and the Russian Academy of Medical Sciences, ex-Minister of Health Evgeny Chazov, the concept revives the good that distinguished Soviet medicine. It is, in particular, about such a direction of medicine, which has completely collapsed in the post-perestroika years, as prevention. In addition, according to the academician, it is necessary to "untie" the hands of the heads of clinics, who today cannot independently resolve financial issues.

Academician, director of the N.I. Bakuleva Leo Bokeria. The fate of a person, according to him, is decided by the level of specialized care. In our country, the system of personal licensing of doctors has yet to be created. In addition, according to Bokeria, it is necessary to try to implement the principle of "money follows the patient", so that a person can decide for himself which medical institution he should turn to for help.

Public discussion of the draft concept in the State Duma is expected next week. "

Resolution of April 15, 2014 No. 294. The state program is aimed at improving the health of the population and the performance indicators of health care organizations on the basis of constant modernization of the technological base of the industry, the development of medical science and education, the improvement of the staff, the introduction of information technologies and modern management standards.

reference

The state program was developed by the Russian Ministry of Health.

The state program "Development of health care" (hereinafter referred to as the state program) is aimed at improving the health of the population and the performance of health care organizations on the basis of constant modernization of the technological base of the industry, development of medical science and education, improvement of the workforce, introduction of information technologies and modern management standards.

The responsible executor of the state program is the Ministry of Health of Russia, the co-executor is the FMBA of Russia, the participants are the Ministry of Foreign Affairs of Russia, the Ministry of Defense of the Russian Federation, the Ministry of Industry and Trade of the Russian Federation, the Ministry of Agriculture of the Russian Federation, the Ministry of Labor of the Russian Federation, the Ministry of Energy of the Russian Federation, the Ministry of Finance of Russia, the Ministry of Economic Development of Russia, the Federal Tax Service of Russia, the Federal Penitentiary Service of Russia, Roszdravnadzor, Rospotrebnadzor, FSSP of Russia, Rosaviatsia, Rosimushchestvo, Rosavtodor, Rosmorrechflot, FANO Russia, FOMS.

Part state program the following routines are included:

- "Prevention of diseases and the formation healthy way life. Development of primary health care ";

- "Improving the provision of specialized, including high-tech, medical care, ambulance, including emergency specialized medical care, medical evacuation";

- "Development and implementation innovative methods diagnostics, prevention and treatment, as well as the basics of personalized medicine ”;

- "Protection of the health of mothers and children";

- "Development of medical rehabilitation and spa treatment, including children";

- "Provision of palliative care, including for children";

- "Staffing of the health care system";

- "Development international relations in the field of health protection ";

- "Expertise and control and supervisory functions in the field of health protection";

- "Medical and sanitary provision selected categories citizens ";

- "Management of the development of the industry."

The goal of the state program is to ensure the availability of medical care and improve efficiency. medical services, the volumes, types and quality of which should correspond to the level of morbidity and the needs of the population, the advanced achievements of medical science.

As part of the implementation of the state program, the following tasks are being solved:

Ensuring the priority of prevention in the field of health protection and the development of primary health care;

Improving the efficiency of the provision of specialized medical care, including high-tech, as well as emergency medical care;

Development and implementation of innovative methods of diagnosis, prevention and treatment, as well as technologies of personalized medicine;

Improving the efficiency of obstetric and childhood services;

Development of medical rehabilitation of the population and improvement of the system of sanatorium-resort treatment;

Provision of palliative care for patients suffering from incurable diseases;

Providing the health care system with highly qualified and motivated personnel;

Improving the efficiency and transparency of control and supervisory functions in the field of health protection.

The state program determines the development of healthcare in Russia until 2020 and is implemented in two stages: the first stage (2013–2015) - structural transformations; the second stage (2016–2020) is the development of innovative potential in healthcare.

Resource support of the state program at the expense of funds federal budget determined taking into account the need to achieve the indicators provided for by the Decrees of the President of Russia dated May 7, 2012 No. 597, No. 598, No. 606, and the Concept of the demographic policy of the Russian Federation for the period up to 2025.

Volume financial security state programs for 2013-2020 from all levels budget system amounts to 26,620.8 billion rubles, including funds from the federal budget - 2,451.2 billion rubles, funds from the consolidated budgets of the constituent entities of the Federation - 11,079.4 billion rubles, funds Federal Fund compulsory health insurance- 13,090.2 billion rubles.

The amount of funding for the state program will be specified when drafting budgets for the corresponding year and planning period.

As part of the implementation of the state program, it is planned to achieve the following main results:

Creation of sustainable motivation of the population to maintain a healthy lifestyle;

Increasing the satisfaction of the population with the quality of medical care;

Creation of conditions for any citizen of the country, regardless of his place of residence, to receive a guaranteed volume of medical care that meets uniform requirements for accessibility and quality;

Formation of scientific and educational clusters based on the best medical universities;

Establishment of uniform state priorities in the field of biomedicine, creation of new scientific schools;

Increasing social attractiveness, the level of qualifications of medical personnel and the prestige of the profession, including on the basis of a significant increase wages;

Creation of conditions for population growth and increase in life expectancy.

The effectiveness of the implementation of the state program is determined by the achievement of the following indicators by 2020:

Reduction of mortality from all causes to 11.4 cases per 1000 population; reduction of infant mortality to 6.4 cases per 1000 live births;

Reduction of mortality (per 100 thousand population) from diseases of the circulatory system to 622.4 cases, from road traffic accidents - up to 10 cases, from neoplasms (including malignant ones) - up to 190 cases, from tuberculosis - up to 11.2 ;

Reducing the consumption of alcoholic products (in terms of absolute alcohol, liters per capita per year) to 10 and the prevalence of tobacco consumption among the adult population up to 25%, among children and adolescents - up to 15%;

Reducing the incidence of tuberculosis to 35 cases per 100 thousand population;

Increase in life expectancy at birth to 74.3 years;

Increase in the average salary of doctors and workers by 2018 medical organizations with a higher medical (pharmaceutical) or other higher education, providing medical services (providing medical services), from the average salary in the relevant region to 200%, as well as an increase in the average salary of nursing (pharmaceutical) personnel and junior medical personnel ( personnel providing conditions for the provision of medical services) from the average salary in the relevant region to 100%.

State program for the development of healthcare in the Russian Federation

The state program defines the goals, objectives, main directions of health care development and activities, mechanisms for their implementation and financial support. According to the forecast, the costs of implementing the measures of the State Program from the budgets of all levels will be allocated funds in the amount of more than 33 trillion rubles.

“The State Program formulates the main priorities for the development of the industry, within the framework of which the Ministry plans to work in medium term- says the Minister Veronika Skvortsova. “The program reflects the main approaches to solving such fundamental issues for the industry as improving the healthcare infrastructure, creating a unified preventive environment, improving the quality of medical care, and increasing the level of training of medical personnel and wages in the industry.”

The state program was developed by the Ministry of Health of Russia in cooperation with the scientific and medical community and was publicly discussed, including at the site of the Open Government.

The basis for the formation of measures aimed at combating such serious socially significant diseases as diseases of the circulatory system, tuberculosis, malignant neoplasms, were the results of the analysis of the implementation of the activities of the priority national project "Health" and modernization programs, generalization of the positive experience accumulated during the implementation of these large-scale projects.

The implementation of the measures of the State Program is envisaged in two stages: the first stage - from 2013 to 2015, the second stage - from 2016 to 2020.

The state program includes subprograms: “Prevention of diseases and the formation of a healthy lifestyle. Development of primary health care ”; "Improving the provision of specialized, including high-tech medical care, ambulance, including emergency specialized medical care, medical evacuation"; "Development and implementation of innovative methods of diagnosis and treatment"; "Protection of maternal and child health"; "Development of medical rehabilitation and spa treatment, including for children"; "Provision of palliative care, including for children"; "Staffing of the health care system"; "Development of international relations in the field of health protection"; "Expertise and control and supervisory functions in the field of health protection"; "Medical and sanitary provision of certain categories of citizens"; "Program Implementation Management" - 11 subprograms in total.

The immediate results of the implementation of the state program will be:

1 reduction in mortality from all causes (per 1000 population) to 11.4 in 2020,

2 reduction of maternal mortality (cases per 100 thousand live births) to 15.5 in 2020,

3 the decrease in infant mortality (cases per 1000 live births) will decrease from 7.8 in 2016 to 6.4 in 2020,

4 reduction in mortality from diseases of the circulatory system (per 100 thousand population) to 622.4 in 2020,

5 reduction of mortality from road traffic accidents (per 100 thousand population) to 10 in 2020,

6 reduction in mortality from neoplasms (including malignant ones) (per 100 thousand population) to 190 in 2020,

7 reduction in mortality from tuberculosis (per 100 thousand population) to 11.2 in 2020,

8 reduction in consumption of alcoholic beverages (in terms of absolute alcohol) (liters per capita per year) to 10 in 2020,

9 reducing the prevalence of tobacco use among the adult population (percentage) to 25 in 2020,

10 reducing the prevalence of tobacco use among children and adolescents (percentage) to 15 in 2020,

11 the decrease in the incidence of tuberculosis (per 100 thousand population) will decrease from 51.9 in 2016 to 35 in 2020,

12 increase in the provision of doctors (per 10 thousand population) to 44.8 in 2020,

13 achieving the ratio of doctors and nurses to 1: 3 in 2020,

14 the increase in the average salary of doctors and employees of medical organizations with higher medical (pharmaceutical) or other higher education, providing medical services from the average salary in the relevant region will grow to 200% by 2018,

15 an increase in the average salary of nursing staff from the average salary in the relevant region to 100% by 2018,

16 the increase in the average salary of nursing staff from the average salary in the corresponding region will grow to 100% by 2018,

17 increasing life expectancy at birth to 74.3 years in 2020.

Structure of the Concept PART I. Analysis of the situation and goals of the Concept. PART II. The main directions of health care development. PART III. The main directions of public health protection. PART IV. Legislative and regulatory support for the implementation of the Concept.

The main directions of health care development; improvement of the program of state guarantees; improving the efficiency of healthcare management; improvement of the medical personnel management system and the creation of a continuous education system medical professionals; the formation of the National Drug Policy and the creation of conditions for the development of the domestic medical and pharmaceutical industry; continuation and expansion of long-term departmental programs in priority areas of health care; development of medical science and innovations in health care; development and implementation of a single information system in healthcare.

Organization and management problems The first problem is the lack of cost-effective management mechanisms the state system health care. Today, in the Russian Federation, the estimated and budgetary distribution of funds in health care facilities in relation to volume indicators prevails, which leads to ineffective expenditure of resources, an increase in the volume of medical care and the disinterest of healthcare leaders in expanding prevention and the use of resource-saving technologies. The second problem is ineffective planning. The lack of a strategic plan for the development of the industry, detailed by region, indicating specific targets for all levels of management (federal, regional, municipal and health care facilities) and the absence of sanctions related to non-compliance with these indicators. Outdated standards for planning the volume of medical care. Outdated standards of work of doctors for the provision of medical care to patients. Insufficiency and inconsistency of standards (medical care, equipment, requirements for the qualifications of personnel, etc.) to modern international standards... The third problem is ineffective regulation: Lack of regulation of prices for medicines and expensive equipment when purchasing at the expense of public funds; Lack of a unified tariff policy and unified modern ways payment for medical care. The fourth problem is the imperfection of the health care quality control system and its inadequacy international requirements

Conclusions To achieve the goals set by the country's leadership in 2020 to reduce the overall mortality rate to 10.0 and increase life expectancy to 75 years, a gradual increase in state funding for the SGBP to a level that allows ensuring modern standards of medical care is required, i.e. at least 2.5 times (or 6% in the share of GDP). To increase the efficiency of the SGBP implementation, it will be necessary to combine all sources of funding for all types of medical care in CHI system and development of a unified tariff policy. To improve efficiency government controlled and alignment of the constituent entities of the Russian Federation to a single level of financing of the SGBP will require centralization of financial and management functions at the level of the Ministry of Health and Social Development of the Russian Federation and the development of strategic plans in each constituent entity of the Russian Federation with indicators for quarterly monitoring.

Analysis of the problems faced by the Russian citizen and the patient in the healthcare sector Quote: Firstly, not only is there not enough information in the media about how to lead a healthy lifestyle, but unhealthy behaviors are actively promoted (smoking, excessive alcohol consumption, violence) as well as anti-scientific recommendations for the treatment of diseases. Secondly, upon entering a medical and prophylactic institution, our patient is practically deprived of rights: he does not have the opportunity to choose the attending physician and the medical and prophylactic institution; does not have information about the quality of the provided treatment, its possible options and health consequences; often he is forced to waste time sitting in lines at the clinic or in the admission department of the hospital; long months to wait for the necessary planned operation. Often, he has to deal with the unfriendliness, and in some cases with the elementary impoliteness of the medical staff and, perhaps, the worst thing, to be unsure whether he has enough money to pay for the necessary treatment. The last of the problems leads to the fact that many patients simply stopped seeking medical help at those stages of the disease when it is still possible to maintain health and life. As a result, poor health indicators, high mortality from manageable causes and low levels of satisfaction with the quality of medical care (in Russia, this indicator is less than 40%, while in developed countries it is up to 60%). FUNCTIONS OF SMO PROVIDE INFORMATION OF PATIENTS AND PROTECTION OF THE RIGHTS TO FREE HELP! Goals of the Concept for the Development of Healthcare of the Russian Federation until 2020 1. Decrease in the general mortality rate of the population from 14.6 in 2007 to 10 in 2020. 2. Increase in life expectancy of the population from 67.5 in 2007 to 75 years in 2020 3. Promotion and implementation of measures aimed at increasing the birth rate. 4. Stabilization of the population of the Russian Federation: by 2011, stop the decline in the country's population and stabilize the number to 143 million people, by 2020, bring the population to 145 million. 5. Increasing the availability of medical care to the population of the Russian Federation: elimination of queues in polyclinics and queues for routine medical care. 6. Reducing inequality between various constituent entities of the Russian Federation, rural and urban population to a level of no more than 10% in terms of mortality and life expectancy. 7. Increasing the satisfaction of the population with the quality and availability of medical care up to 65%. 8. Stabilization of morbidity by 2015 9. Increasing the population's commitment to a healthy lifestyle and responsibility for their own health: reducing the proportion of smokers among the adult population to 20%, reducing alcohol consumption to 9 liters / year per capita.

Key directions of health care development 2.1. Increasing funding and improving the efficiency of the State Guarantee Program (SGBP) 2.2. Improving the efficiency of organization and management of the healthcare system in the Russian Federation 2.3. Improving the qualifications of medical workers and creating a system of motivating them for quality work 2.4. National drug policy (NLP), development of pharmaceutical production and domestic medical industry 2.5. Development of long-term targeted programs aimed at reducing mortality and morbidity of the population of the Russian Federation, leveling the quality and availability of medical care in various constituent entities of the Russian Federation and improving medical care rural population 2.6. Development of medical science and innovations in healthcare 2.7. Development and implementation of a unified information system in healthcare

The concept of health care development in the Russian Federation until 2020 presents the strategic and tactical issues of health care development in our state. This document provides a systematic analysis of the state of health care in the Russian Federation, as well as outlines the main goals and directions of the industry development, which will ensure the availability and quality of medical care and significantly improve the health resource of Russian citizens.

The concept was developed in accordance with the Constitution of the Russian Federation, federal laws and other regulatory legal acts of the Russian Federation, generally recognized principles and norms of international law in the field of health care and taking into account domestic and foreign experience.

The main goals development of healthcare in the Russian Federation:

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  stopping by 2011 the decline in the population of the Russian Federation and bringing the number to 145 million by 2020;
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  increasing the life expectancy of the population up to 75 years;
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  a decrease in the general mortality rate to 10 ‰ (that is, by 1.5 times in relation to 2007);
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  reduction of the infant mortality rate to 7.5 ‰;
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  a decrease in the maternal mortality rate per 100,000 live births to 18.6;
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  formation of a healthy lifestyle for the population, including a decrease in the prevalence of tobacco use by up to 25% and a decrease in alcohol consumption to 9 liters per capita per year;
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  improving the quality and availability of medical care guaranteed to the population of the Russian Federation.

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  creation of conditions, opportunities and motivation of the population of the Russian Federation for a healthy lifestyle;
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  go to modern system organization of medical care;
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  concretization of state guarantees for the provision of free medical care to citizens;
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  creation of an effective management model financial resources government guarantee programs;
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  improving the provision of medicines to citizens on an outpatient basis within the framework of the compulsory health insurance system;
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  advanced training of medical workers and the creation of a system of motivating them to quality work;
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  development of medical science and innovations in health care;
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1. Formation in the population of an attitude towards maintaining a healthy lifestyle, which is the main condition for maintaining and strengthening the health of society. The population should develop economic and sociocultural motivation to be healthy, and the state should provide legal, economic, organizational and infrastructural conditions for a healthy lifestyle. It is necessary to improve medical and hygienic education and upbringing of the population, to create an effective system of measures to combat bad habits, to prevent risk factors for the development of non-communicable diseases, etc.

^ 2. Guaranteed provision of the population of the Russian Federation with high-quality medical care based on the use of modern technologies organization and provision of diagnostic, treatment, rehabilitation and preventive services, the effectiveness and safety of which (for specific diseases or pathological conditions) is confirmed in accordance with the principles of evidence-based medicine.

The guaranteed provision of every citizen of the Russian Federation with high-quality medical care should be ensured by the following measures:

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  concretization of state guarantees for the provision of free medical care;
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  standardization of medical care;
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  organization of medical care;
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  provision of medicines to citizens on an outpatient basis;
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  implementation of a unified personnel policy;
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  innovative development of health care;
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  modernization of the system of financial support for the provision of medical care;
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  informatization of health care.

Also, systems for monitoring the quality of medical care will be created, the material and technical base of healthcare institutions will be modernized, a system of continuous training of personnel will be formed and will begin to be implemented, priorities for innovative development of healthcare will be determined, interdepartmental targeted scientific programs will be formed to develop and implement new highly effective technologies for prevention and diagnostics. and treatment of socially significant diseases and pathological conditions. In addition, at the first stage, the implementation of the Priority National Project "Health" will be continued in the following areas:

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  the formation of a healthy lifestyle;
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  development of primary health care and medical prevention;
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  improvement of specialized, including high-tech, medical care for socially significant diseases (including cardiovascular and oncological), cobined injuries in road traffic accidents;
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  development of the blood service;
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  improvement of medical care for mothers and children. On the second stage the implementation of the Concept (2016–2020) envisages a phased transition to a self-regulatory system for organizing medical care based on the created infrastructure and human resources for health care; inclusion of high-tech and emergency medical care in the compulsory health insurance system; integration budget investments in tariffs for medical care; creation of a system of drug provision of citizens on an outpatient basis within the framework of compulsory medical insurance.

The effective functioning of the health care system is determined by the main system-forming factors:

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  improvement of the organizational system, which makes it possible to ensure the formation of a healthy lifestyle and the provision of high-quality free medical care to all citizens of the Russian Federation (within the framework of state guarantees);
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  development of infrastructure and resource provision of health care, including financial, material, technical and technological equipment of medical institutions based on innovative approaches and the principle of standardization;
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  the presence of a sufficient number of trained medical personnel capable of solving the tasks set for the health care of the Russian Federation. These factors are interdependent and mutually determining, in connection with which the modernization of health care requires the harmonious development of each of them and the entire system as a whole.

The founders of domestic health care defined the science of public health and health care with such main tasks as: studying the influence of medical and social factors, conditions and lifestyle on health different groups population; development of scientifically grounded recommendations for the prevention and elimination of adverse social conditions and factors, as well as recreational activities that ensure optimal human interaction with the environment and contribute to the performance of basic types of life and improve the quality of life.

In the Great Medical Encyclopedia (BME, 3rd ed., T. 25. - P. 60), the purpose of our subject is indicated as the study of the healing, as well as the unfavorable influence of social factors and conditions on the health of the population, the development of scientifically grounded recommendations for the elimination and prevention of the influence of social conditions and factors harmful to human health in order to improve the level of public health.

The main purpose of public health and health care and academic discipline- assessment of the criteria of public health and the quality of medical care, their optimization. Taking into account the Order of the Ministry of Health and social development RF No. 83 of 03/01/2000 "On the improvement of teaching in medical and pharmaceutical universities of public health and health care", the following definition was adopted: "Public health is the most important economic and social potential of the country, due to the impact of various factors environment and the way of life of the population, allowing to ensure the optimal level of quality and safety of life. "

Unlike various clinical disciplines, public health studies the state of health not of individual individuals, but of collectives, social groups and society as a whole in relation to the conditions and way of life.

As a teaching subject, "Public health and health care", first of all, contributes to improving the quality of training of future medical specialists, the formation of their skills not only to correctly diagnose and treat a patient, but also the ability to organize high level health care, the ability to clearly ensure their activities.

The structure of the subject: 1) history of health care; 2) theoretical problems of health care; 3) the state of health and methods of its study; 4) the organization of medical and social security and health insurance; 5) organization of medical care for the population; 6) ensuring the sanitary and epidemiological well-being of the population; 7) economic and planning-organizational forms of improving health care, management, marketing and modeling of medical services; 8) international cooperation in the field of medicine and health care.

Methods of medical and social research: 1) historical; 2) dynamic observation and description; 3) sanitary and statistical; 4) clinical and statistical; 5) medical and sociological analysis; 6) expert assessments; 7) medical genetic analysis; 8) system analysis and modeling; 9) organizational experiment; 10) planning and regulatory, etc.

Public health and health care is the science of health strategy and tactics. The objects of medical and social research are: 1) groups of persons, the population of the administrative territory; 2) separate institutions (polyclinics, hospitals, diagnostic centers, specialized services); 3) health authorities; 4) objects of the environment; 5) general and specific risk factors for various diseases, etc.