The need of the population for hospitalization is determined. Determining the needs of the population. There are rules and regulations in the ZO
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State educational institution of higher professional education
Chita State Medical Academy
federal agency for health and social development
Department of Public Health and Health
Course work
in the discipline Public health and healthcare
Health planning. Determining the needs of the population in outpatient and inpatient care
Introduction
Health resources in any society are always limited, so the issues of their more efficient use are key. Currently, there is a situation in the Russian Federation when state obligations to provide the population with free medical care of the required volume and quality are provided with financial resources by no more than half.
The lack of financial and other resources will not be overcome in the near future. Under these conditions, the role of financial planning methods in health care is growing as a procedure for bringing the level of consumption of health care resources by the population in line with the existing limited economic opportunities.
State and municipal medical institutions exist solely at the expense of health care expenditures planned in the budgets of all levels and funds of compulsory medical insurance. The correct combination of these sources, the use of the most effective, optimal mechanisms for bringing these funds to medical institutions are among the most important tasks of healthcare organizers.
On average, in the Russian Federation, budgetary funds account for the prevailing share in total health care expenditures - 60% or more. The use of these funds is carried out according to the budgetary-estimated principle. However, the mechanisms for using funds from the two main sources (budget and CHI) are different. With all the evidence of greater efficiency and expediency of the insurance principle of spending money on paying for medical care, the budget-estimate principle continues to be preserved. At the same time, it is also obvious that with a lack of funds in any industry in any field of activity, it is necessary to consolidate funds, use them in the direction of the "main blow", to solve the most significant tasks in tactical and strategic terms. The implementation of these principles is possible through the expansion of competent financial planning in health care.
Rational planning allows not only to concentrate resources on priority areas, but also to implement an integrated approach to solving the most pressing health problems based on intersectoral interaction.
Subject of research: principles, tasks, directions and methods of planning in the field of healthcare.
Object of research: articles, normative materials and documents, as well as works of Russian and foreign authors on the issues of health planning and economics.
Purpose: to study the planning mechanism at health care enterprises.
Make a literature review
To study the theoretical aspects of planning in health care;
Analyze the economic methods of planning the activities of a medical institution;
Consider the main problems in health planning;
Study and analyze the results of your own research.
· Conclusion. Conclusion.
Research materials: articles, normative materials and documents, as well as the works of Russian and foreign authors on the planning and economics of health care.
1. Healthcare planning as a branch of the economy
Planning as an integral part of economic management is a set of methods and tools that allow you to choose the best development option that ensures the efficient use of resources.
Planning is divided into:
1) by level:
federations (state planning),
industries (industry planning),
regions (regional planning),
individual organizations, enterprises, institutions;
2) by the time factor:
perspective,
3) by methods:
balance,
normative.
Planning only “from the achieved level” (determining future changes based on existing trends, subject to their persistence and past experience), is acceptable if the society is not in the process of profound changes and is satisfied with the state of the social sector (in particular, the organization of the health care system). However, there is always the danger of repeating the mistakes made and the inevitable conflict with changing needs and new opportunities.
In order to achieve the most rational use of limited resources, it is necessary to determine their return as accurately as possible, compare it with costs, and compare various options for development programs in terms of costs and benefits.
Health planning is the substantiation and development of the population's need for medical care, drug provision, and sanitary and anti-epidemic services in accordance with the possibilities of satisfying them.
Lisitsin Yu.P. gives the following definition of healthcare planning: “health planning at the present stage should be considered as a specially created multifactorial subsystem of healthcare management, which has dynamic goals, a multi-sectoral goal-forming complex and functional links between elements both within healthcare and with other industries.”
2. Basic principles, types and methods of planning
Basic principles of planning the health care system of the Russian Federation:
ensuring social guarantees for the population in obtaining the necessary medical care, and first of all, the implementation of the State Guarantees Program;
compliance of health care resources with the needs of the population in medical care.
The development of health care should take place under the following conditions:
the unity of the goals of the system development at different levels of organization and management, both for the current period and for the future;
efficient use of material, financial, labor and other resources of medical institutions;
strengthening the material and technical base of medical institutions;
improving the quality and efficiency of medical care.
The command economy was characterized by directive planning of health care, when the complex plans included sections: labor plan (number and wage fund), plan for material and technical service; investment plan (construction and equipment of medical institutions); plan for labor resources (needs, training, advanced training).
In the conditions of decentralization of the management system and demonopolization of the state health care system, the content and methods of planning have changed from directive to recommendatory. However, the normative method of planning has been preserved using the relevant norms and standards (rates for the workload of medical personnel - the number of patients per 1 hour of outpatient admission; norms for the average annual bed occupancy in a hospital; staffing standards, etc.).
The specifics of the Russian economy is determined by the high level of differentiation of economic, social, and demographic indicators of regional development. Strengthening spatial heterogeneity makes it difficult to pursue a unified policy of socio-economic transformations, leads to the disintegration of the national economy, weakening the integrity of society and the state.
A significant factor contributing to overcoming the disintegration of the Russian economy is the use of the program-target method of planning, which is successfully used in various sectors of the national economy, including healthcare. The importance of state regulation of the development of regional healthcare is due to the significant stratification of Russian regions both in terms of demographic characteristics and the level of public investment in the industry, which is reflected in the table in the Appendix to this course work.
Program-targeted planning for the development of regional health care has been practiced on the territory of all subjects of the Russian Federation since 1998 and is regulated by government regulations issued annually. However, due to the heterogeneity of the main financial program indicators for the constituent entities of the Russian Federation, the effectiveness of program activities will also be different.
The relevance of the economic assessment of the effects of the implementation of regional targeted programs increases with a change in the procedure for providing citizens of the Russian Federation with state social assistance (monetization of benefits). With the adoption of the Federal Law of August 22, 2004 No. 122-FZ "On State Social Assistance", it becomes necessary to unify the principles of organization and mechanisms for the implementation of medical and economic control of drug care, preferential prosthetics provided to certain categories of citizens within the framework of the said law.
So, in market relations, the role of optimal planning increases, when, in order to most fully meet the needs of the population in healthcare services, taking into account the state of the material, technical and resource base, the option of further development of the system is chosen.
To this end:
1) complex indicators are analyzed:
material and technical base of healthcare facilities in the region;
standards for providing the population (children and adults) with medical care;
population health and its dynamics;
financial, material and human resources of health care in the region;
clinical examination and preventive work, etc.
2) questions are being studied:
further development of medical care in its main types, taking into account the demographic characteristics in the region;
development of health insurance (CMI and VHI);
introduction of resource-saving technologies;
improving the health management system;
Improving the quality of medical care for the population.
3. Economic methods of planning the activities of a medical institution
The transition to economic methods of industry management involves a change in approaches to planning at the level of healthcare facilities. While maintaining budget planning (a systematic process of drawing up, reviewing, approving and executing the budget), instead of the usual volumetric indicators that reflect the number of visits, bed days, etc., financial standards become decisive.
The advantage of economic planning methods is that they create material incentives and affect the wages of medical workers. At the same time, complex indicators of quality and effectiveness are needed that most fully characterize the goals facing the medical institution and its divisions.
Planning the work of health facilities is to determine:
the main goals and functions of health facilities and indicators, the implementation of which contributes to the achievement of these goals;
types and volumes of medical care, taking into account the level of morbidity and age and sex structure of the population served;
needs for financial and material resources and calculations of financial standards;
maximum volume indicators of activity, taking into account the planned volumes of financing from all sources.
The indicator of the volume of outpatient care is expressed in the number of visits per 1000 population:
P \u003d AhKp + D + P;,
where P is the number of visits to doctors in total (per 1000 population); A -- incidence rate (per 1000 population); Кп - coefficient of repeated visits (per 1000 population); D - the number of dispensary visits (per 1000 population); P; -- number of preventive visits (per 1000 population).
The indicator of the volume of inpatient care is expressed in the number of bed-days per 1000 population. The needs of the population for inpatient care - the required number of average annual beds per 1000 population (K), are determined as follows:
1. K \u003d A x R x P / D x 100
where A is the incidence rate (per 1000 population); R -- percentage of selection of patients for hospitalization; R -- the average duration of the patient's stay in bed; D -- average annual bed occupancy (number of bed-days).
2. K = Q x Pp / D x Pp
where Q is the total number of bed-days spent by patients in the hospital in the reporting year; R -- population in the reference year; D -- an indicator of the average number of days of bed use in the billing year; Pb is the population in the reporting year.
where Y is the rate of hospitalization (per 1000 population); R -- the average duration of the patient's stay in bed.
The indicator of the volume of emergency medical care is expressed in the number of calls per 1000 population.
The most important stage of planning is the analysis of the system of providing medical care to the population according to the following parameters:
the degree of accessibility for the population of medical care within the framework of the territorial Program of state guarantees;
the quality of medical care;
efficiency of use of existing capacities of health facilities.
Accounting and expenditure of funds in a budgetary institution is carried out in accordance with the budget of income and expenses approved in accordance with the established procedure. It is the main planning and financial document of the health facility, compiled for a year on the basis of operational network and production indicators in accordance with the economic classification of budget expenditures of the Russian Federation: 100,000 - current expenses; 200,000 -- capital expenditures; 300,000 -- the provision of loans (budget loans) minus repayment.
The planning of expenses according to the estimate is based on the volume of activity of the medical facility for the past period on the basis of labor, material and financial norms of expenses. Then, justification and calculation of the amounts of expenses for each economic classification code are carried out.
The main document for determining the official salaries of medical workers are tariff lists, which, together with the staffing table, are compiled simultaneously with an estimate for each position of all structural divisions and the institution as a whole.
4. Application of business planning in the health system
The commercialization of health care, which is expressed in an increase in the volume of paid medical services, the introduction of various organizational and legal forms of entrepreneurship and the development of private medical practice, predetermines a change in the economic status of a medical organization. Now both the patient and the health facility are participants in the medical services market. Under these conditions, the importance of such a direction of activity of an independently managing service-producing organization as business planning increases.
A business plan is a clearly structured document that describes all the main aspects of the activities of a medical organization from the moment it is created to its design capacity; it includes the development of the project goal, the assessment of the actual economic performance of the medical organization, market analysis and customer information, the definition of a competitive strategy to achieve the goals. A well-written business plan increases the organization's chances of obtaining funds from a prospective investor.
The business plan is developed for 1-5 years. The sequence of drawing up a business plan:
a decision is made to implement measures to improve the existing medical organization or to create a new organizational and legal form (for example, a medical autonomous non-profit organization);
the own capabilities of health facilities in the implementation of the project are assessed;
medical services are selected, the provision of which will be the goal of the project;
the possibility of a market for these medical services is being explored;
a place is chosen for the implementation of the intended activity;
are being developed:
production plan;
marketing plan;
organizational plan;
financial plan;
possible risks from this project are analyzed;
a summary of the business plan is drawn up, which in the final text becomes the first section of the document.
A well-developed business plan helps healthcare facilities develop, strengthen their position in the medical services market, and predict their economic development in the future.
To develop an effective plan, it is necessary to analyze the external environment and the actual state of the medical institution.
External environment: prospects for the development of health care and the market for medical services, the state of competition, consumers of medical services, trends in the development of the external environment that are not controlled by the medical organization, but have an impact on its activities.
Internal environment: marketing, finance, production activities, human resources, administrative activities.
An analysis of the external environment makes it possible to assess both external hazards that may impede the activities of a health facility, and opportunities that can help achieve the intended goals. Analysis of the internal environment is aimed at identifying the strengths and weaknesses of the medical institution, identifying areas for improvement.
If a medical organization decides to introduce paid medical services or expands their list, the following work to collect information should precede the preparation of a business plan:
the sources and volumes of financing are being studied;
the amounts of underfunding for all sources are determined;
the material and technical base of the institution is being studied;
Personnel are characterized and evaluated by qualification, age, length of service;
analyzes the assistance provided by type, quality, timeliness and accessibility;
the types of services offered to the population for a fee are determined;
the demand of the population is being studied;
a plan for the scope of activities is determined;
expected income is determined.
5. Major challenges in health planning
As you know, the strategic task of the national project "Health" is to improve the quality and accessibility of medical care. This is precisely what measures are aimed at strengthening the material and technical base and improving the skills of primary care personnel, increasing wages for district service specialists, creating high-tech centers, vaccine prevention, etc. The implementation of a set of such large-scale measures cannot but require changes in planning and evaluating health performance.
One of the main planning tools is the widely used system of state (municipal) orders-tasks for the performance of certain volumes of medical care. At the same time, it is also obvious that the planning methods used are far from perfect. This fully applies to the specified orders-tasks, on which special hopes are placed in connection with the proposed expansion of the organizational and legal forms of medical organizations. It is advisable to identify the main problems in this area, as well as outline possible ways to solve them.
In order to make the analysis of the situation with the formation and implementation of state (municipal) orders-tasks more complete, we will name the reasons why this form of planning is dominant in domestic healthcare today. It:
ensuring the constitutional rights of citizens to receive free medical care;
ensuring a coordinated flow of resources to the industry from the CHI system, as well as from the budgets of all levels;
equalization of financial conditions for the functioning of state and municipal health care in various regions;
development of outpatient care and reduction of inpatient care;
differentiation of medical care financed from the budget and from compulsory medical insurance;
determining the compliance of the volume of state guarantees for free medical care with the allocated resources.
The experience available in many regions allows us to formulate a list of the main problems that need to be addressed now, and not transferred to the conditions when medical organizations of new organizational and legal forms appear, and private medicine will participate on a common basis in the implementation of the Program of State Guarantees for the Provision of Russian Federation Citizens Free Medical Care Federation.
These problems include the following:
imperfection of the regulatory framework for the formation of orders-tasks for the provision of medical care;
the need to ensure the constitutional rights of citizens to free medical care, regardless of the amount of resource support for the order;
the need to select and unify the optimal method of paying for medical services (fund maintenance, global budget, system of diagnostically related groups, etc.);
the need to increase the availability of medical care;
lack of effective mechanisms to ensure the coordination of the activities of medical organizations of various subordination in the formation and implementation of orders-tasks;
discrepancy between the interests of the customer and the contractor;
orientation of health care managers only on volumetric (resource) performance indicators;
the absence in the orders-tasks of specific tasks for the development of preventive medicine;
lack of effective methods of control over the fulfillment of orders-tasks. planning healthcare medical institution
Probably, most of the questions that need to be answered are related to the imperfection of the regulatory framework for planning activities in the health sector.
The research materials were articles, normative materials and documents, as well as the works of Russian and foreign authors on the issues of health planning and economics.
Materials from the following medical journals were analyzed:
- "Issues of Economics and Management for Healthcare Managers";
- “Chief. doctor";
- "International Medical Reviews";
- "Health".
Research method: analytical.
Rresults of own research
In view of the impossibility of considering the topic of planning on the example of a specific medical institution due to the closeness and inaccessibility of this financial information, we will consider this topic on the example of the Russian Federation.
After analyzing the methodological and regulatory literature on planning in the healthcare sector of the Russian Federation, I found out the following:
For the next two years, the tasks of the industry will be:
Increasing the priority of primary health care.
The transition to new forms of remuneration for doctors, the introduction of a system of material incentives for medical workers based on the final results of their activities: cash payments to general (family) practitioners, district therapists, district pediatricians and nurses of general (family) practitioners, district therapists, district pediatricians, taking into account volume and quality of medical care in 2008 will amount to 12.8 billion rubles, in 2009 -17.7 billion rubles.
Training and retraining of general practitioners, district therapists and pediatricians, staffing the district service with medical personnel, reducing the part-time coefficient to 1.25. In 2008, it is planned to train 6318 doctors (including 1500 general practitioners), in 2009 - 7530 doctors (including 1500 general practitioners). Necessary financial support in 2008 - 0.2 billion rubles, in 2009 - 0.3 billion rubles.
Strengthening the diagnostic service of primary health care. Equipping municipal medical organizations with radiographic equipment, equipment for ultrasound examinations, electrocardiographs and laboratory equipment. It is planned to equip 5,085 outpatient clinics in 2008, and 5,085 in 2009. Financial support: in 2008 - 14.3 billion rubles, in 2009 - 15.4 billion rubles.
Strengthening the material and technical base of the ambulance service, including equipping ambulance teams with modern vehicles and intensive care vehicles. In 2008, it is planned to purchase 6060 ambulances, including 120 reanimobiles and 120 reanimobiles with incubators, in 2009 - the same number. Financial support: in 2008 - 3.6 billion rubles, in 2009 - 3.9 billion rubles.
Strengthening the preventive focus of health care, the formation of a culture of health among the population, increasing motivation for its preservation, in-depth medical examination, the formation of a Health Passport for each resident of the country.
The revival of the preventive direction in health care. Structuring the system of medical prevention in such a way that health becomes the main life value. Formation among the population of motivation for personal responsibility for their own health, education of health culture skills in children. A special place in improving the state of health of the nation will be occupied by medical education.
Restoration and expansion of the practice of dispensary observation of patients, medical examination of the able-bodied population, as well as those living in rural areas.
When evaluating the activities of medical institutions, indicators of preventive work should become a priority, for which it is necessary to develop a clear system of economic motivation in this area.
It is necessary to create economic incentives for the preservation and strengthening of a citizen's health. Within the framework of this direction, it is planned to vaccinate 25 million people against hepatitis B, 15 million against rubella, 300 thousand against poliomyelitis, and 44 million against influenza. children - to identify hereditary diseases. Conduct medical examinations for more than 22 million people of working age from 35 to 55 years.
Financial support:
for immunization under the National Immunization Schedule in 2008 - 12.8 billion rubles, in 2009 - 17.7 billion rubles;
for the detection and treatment of those infected with the hepatitis C virus and HIV in 2008 - 3.7 billion rubles, in 2009 - 7.7 billion rubles;
for examination of newborns in 2008-2009. - 1.8 billion rubles;
for medical examination of the population in 2008 - 2 billion rubles, in 2009 - 4 billion rubles.
Meeting the needs of the population in expensive types of medical care, transferring federal specialized institutions to work under the state order.
With the existing system of budgetary and estimated financing, in the context of a discrepancy between the volume of necessary medical care and the amount of financial resources allocated for its provision, there is low economic interest in the mutually beneficial development of relations between participants in the process of providing high-tech medical care - from the state to medical institutions.
An effective redistribution of resources can be achieved on the basis of a targeted system of financing medical institutions focused on achieving the desired results. Such a system is the formation of a state task (order) for high-tech types of medical care.
Formation and implementation of the state task (order), which guarantees the availability of high-tech medical care to any citizen of our country, will achieve not only a significant medical and economic, but also a tangible social effect, will solve a number of problems of state support for the population, especially people with low incomes.
To increase the provision of high-tech types of medical care, a set of organizational measures will be carried out, and funding will also increase. In 2008, the fulfillment of quotas for high-tech medical care (128,000) will require the allocation of 9.5 billion rubles from the federal budget. In 2009, the fulfillment of quotas (170 thousand) will require 17.5 billion rubles.
To meet the needs of the population in high-tech types of medical care, it is also necessary to create medical centers that, taking into account the achievements of medical science, can make a breakthrough in domestic healthcare in the field of high technologies.
Priority areas for the development of high-tech medical care are cardiovascular surgery, traumatology, orthopedics and arthroplasty, neurosurgery, reproductive technologies, and endocrinology.
In 2008, it is planned to build six centers, in 2009 - nine centers. Financial support will amount to 12.6 and 19.4 billion rubles, respectively.
Conclusion
Thus, over the next two years, the tasks of the industry will be to increase the priority of primary health care; strengthening the preventive focus of health care; meeting the needs of the population in expensive types of assistance, transferring federal specialized institutions to work under the state order, etc.
Conclusion
The formation of state policy in health care and the provision of medical care in modern conditions is primarily associated with providing the population of the Russian Federation with guaranteed, free medical care of the required volume and quality and makes new demands on the creation of new forms of industry management, significantly increases the role of planning.
During the period of transition to a market economy, the search for effective mechanisms to improve health care is one of the most urgent tasks. Of great importance in providing affordable, free medical care to the population is the correspondence of the volume of guaranteed medical care to their financial support. The analysis of scientific sources, the regulatory and methodological framework, as well as the experience of implementing the state order in the healthcare system indicate the need to develop theoretical and practical foundations for its implementation, in particular, planning algorithms and tools aimed at optimizing the work of medical institutions, the effective use of available limited resources.
An analysis of the existing literature data showed the absence of clear technologies for assessing the effectiveness of program-targeted planning for the development of Russian health care and recommendations for its further improvement. Since in the domestic literature there is practically no information on approaches to the choice of criteria for the effectiveness of medical programs, as well as on the systems of economic measurements of quality processes in health care.
Thus, the planning and evaluation of the results of the activities of medical organizations require serious changes, and the strengthening of the resource base of health care, which is expected in the coming years, is a favorable factor for this. The first step in this direction may be the introduction of indicators of the quality of medical care, reflecting the state of health of the population, as the main planned indicators. The regions (municipalities) themselves may well take the initiative in this matter, without waiting for the corresponding indicators to appear in the federal program of state guarantees. Undoubtedly, good prerequisites for solving these problems have been created by the development and implementation of the national project "Health".
Literature
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3. Visyashchev V. A. Business planning: theory and practice. - 2nd ed., corrected. and additional - Donetsk: LLC "Nord Computer", 2008.
4. Gabueva L.A. Tax planning in healthcare institutions with entrepreneurial activity in 2008 // Glav. doctor - 2001.-6-p.26-36
5. Kadyrov F.N. Incentive wage systems in health care. Ed. 2nd, revised, and additional. - M.: ID Grant, 2003.
6. Kenneth J. Cook Small business. Strategic planning: Translated from English .. - M .: Publishing house "Dovgan", 1998.
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13. Decree of the Government of the Russian Federation of September 11, 1998 No. 1096 "On approval of the Program of state guarantees for providing citizens of the Russian Federation with free medical care" (as amended of October 11, 1999 No. 1194, No. 907 of November 29, 2000, No. 550 of 07.24.01 and so on ).
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15. Modern methods of management and financial management of a healthcare institution. Edited by F.N. Kadyrov. - M.: ID Grant, 2001
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17. Trushkina L.Yu., Tleptserishev R.A., Trushkin A.G., Demyanova L.M. Economics and Health Management: Textbook. Rostov n/a: Phoenix, 2003.
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In order to implement paragraph 2 of the set of measures to provide the healthcare system of the Russian Federation with medical personnel until 2018, approved by the order of the Government of the Russian Federation of April 15, 2013 N 614-r (Sobraniye zakonodatelstva Rossiyskoy Federatsii, 2013, N 16, art. 2017), I order:
Approve the methodology for calculating the need for specialists with secondary vocational (medical) education in accordance with.
| Minister | IN AND. Skvortsova |
Application
to the Ministry of Health
Russian Federation
dated February 14, 2018 N 73
Methodology
calculation of the need for specialists with secondary vocational (medical) education
1. In order to provide methodological assistance in current planning, identifying a shortage or excess of medical workers with a secondary professional (medical) education (hereinafter referred to as nursing staff) in medical organizations subordinate to the executive bodies of state power of the constituent entities of the Russian Federation and local governments (hereinafter referred to as medical organizations) developed a methodology for calculating the need for specialists with secondary vocational (medical) education (hereinafter - the Methodology).
2. When determining the need for paramedical personnel, the following may be taken into account:
availability of medical personnel (per 10,000 population) providing medical care on an outpatient basis to the population of a constituent entity of the Russian Federation, calculated according to the methodology for calculating the need for medical personnel;
availability of hospital beds in the constituent entities of the Russian Federation (per 10,000 population), calculated according to the methodology for calculating the need for medical personnel;
features of the provision of pre-hospital medical care by paramedical personnel, provided for by the procedures for the provision of medical care, approved by the Ministry of Health of the Russian Federation;
the presence in the constituent entity of the Russian Federation of settlements remote (more than 300 km) from medical organizations in which specialized medical care is provided;
territorial features of the subjects of the Russian Federation (location of the subject in the regions of the Far North and areas equivalent to them, the proportion of the rural population);
volumes of medical care provided within the framework of territorial programs of state guarantees of free provision of medical care to citizens of the Russian Federation (hereinafter referred to as TPSG);
the age composition of the nursing staff working in medical organizations;
the presence in medical organizations of structural units: feldsher-obstetric stations (hereinafter - FAP), feldsher health centers (hereinafter - FP).
3. The Methodology uses the conditional division of nursing staff into groups, taking into account their functional duties:
"treatment group", including paramedical personnel working with doctors on an outpatient appointment, paramedical personnel performing an independent outpatient appointment (obstetrician of the examination room, paramedic of the FAP or OP, paramedic of the pre-medical appointment, etc.), paramedical personnel, providing medical care in stationary conditions, in a day hospital and emergency medical care;
"Treatment-diagnostic group", which includes the nursing staff of diagnostic and auxiliary departments (offices) (nurses for functional diagnostics, nurses for physiotherapy, laboratory assistants of clinical laboratories, instructors in physical therapy, etc.);
"management group", including paramedical personnel - heads of FAP - paramedic (nurse), heads of health centers - paramedic (nurse), medical statisticians, heads of offices, chief (senior) nurses, etc .;
"reinforcement group", including nursing staff, namely nurses, ward (guard) nurses, general hospital nursing staff, nursing staff of the admissions department, providing assistance to students in educational organizations;
Specialists of the "treatment and diagnostic group" and "control group" are included in the "paraclinical group".
4. It is advisable to calculate the required number of nursing staff according to the algorithm for calculating the need for nursing staff:
Table N 1
Recommended Algorithm for Calculating the Need for Nursing Personnel
| For emergency medical care | For primary health care | To provide specialized medical care |
|---|---|---|
| Determining the number of ambulance teams | Calculation of the number of doctors, taking into account the territorial coefficients | Calculation of the number of beds, taking into account the territorial coefficients |
| Calculation of the number of paramedical personnel working with doctors on an outpatient appointment and on an independent appointment (taking into account the coefficients of the ratio of doctors and paramedical personnel) | Calculation of the number of nursing staff, taking into account the standard number of beds per position of nursing staff | |
| Calculation of the standard for the number of paramedical personnel of the dispatching service | Calculation of the "reinforcement group" (taking into account the coefficients of the ratio of doctors and nurses) | Calculation of the "reinforcement group" (taking into account the coefficients of the ratio of nursing staff employed in auxiliary and main activities) |
| Calculation of the standard for the number of paramedical personnel of the "management group" | Calculation of the "paraclinical group" (taking into account the ratio to the average medical staff of the "treatment group") | Calculation of the "paraclinical group" (taking into account the coefficient of relation to the average medical staff of the "treatment group") |
| Calculation of the need for nurses | Calculation of the number of nursing staff in day hospitals | |
| Calculation of the need for paramedical personnel - total | ||
| Comparison with the actual number of nursing staff, determining the deficit or surplus | ||
5. Calculation of the need for paramedical personnel providing emergency medical care:
5.1. To calculate the need for paramedical personnel providing emergency medical care (hereinafter - EMS) to the population, it is recommended to use:
the average standard for the volume of ambulances (number of calls per 1 insured person), approved in the Program of State Guarantees of Free Medical Assistance to Citizens for the current and planned periods;
the estimated number of stations and / or departments of the ambulance service, approved by order of the Ministry of Health of the Russian Federation of June 20, 2013 N 388n "On approval of the Procedure for the provision of emergency, including emergency specialized, medical care" (registered by the Ministry of Justice of the Russian Federation on August 16, 2013 , registration N 29422), as amended by order of the Ministry of Health of the Russian Federation of January 22, 2016 N 33n (registered by the Ministry of Justice of the Russian Federation on March 9, 2016, registration N 41353), by order of the Ministry of Health of the Russian Federation of May 5, 2016 N 283n (registered by the Ministry of Justice of the Russian Federation on May 26, 2016, registration N 42283) (hereinafter - the order of the Ministry of Health of the Russian Federation of June 20, 2013 N 388n);
the estimated number of ambulance teams approved by order of the Ministry of Health of the Russian Federation dated June 20, 2013 N 388n.
5.2. To calculate the need for nursing staff, it is recommended to use the following indicators (form of federal statistical observation N 30):
number of calls;
the number of individuals of paramedical personnel;
the number of medical mobile teams, including specialized teams;
the number of paramedic mobile teams;
the number of individuals of the dispatching service according to the staff list of stations (departments) of the NSR (if any);
the number of individuals of the "management group" out of the total number of individuals of paramedical personnel;
number of calls per 1 inhabitant (form of federal statistical observation N 30 / population of the subject of the Russian Federation);
the number of paramedical personnel per 10,000 population (form of federal statistical observation N 30 / population of a constituent entity of the Russian Federation * 10,000);
the number of calls per 1 insured person, established by the Territorial Program of State Guarantees of Free Provision of Medical Assistance to Citizens of a Subject of the Russian Federation (TPPG).
5.3. The number of paramedical personnel of mobile ambulance teams is recommended to be calculated according to the formula:
LFvb \u003d CHBx2 * KS * HF,
NChvb - the calculated standard for the number of paramedical personnel of mobile ambulance teams;
ChB - the number of visiting teams of the SMP;
KS is the shift coefficient of the work of mobile teams of the ambulance service;
To take into account the peculiarities of the constituent entities of the Russian Federation, it is possible to use corrective coefficients:
KS - to take into account the duration of the work of the ambulance mobile team when organizing work less than 24 hours a day. With a 24-hour work of the brigade, the coefficient can be equal to 1, from 9 to 12 hours - 0.5, from 6 to 8 hours - 0.25;
KV - to account for the number of SME workers older than working age. If the proportion of nurses at this age is less than 10% of all nurses at the station and / or department of the ambulance, then it is advisable to take the coefficient as 1; from 10% to 15% - 1.01; over 15% - 1.02.
5.4. The number of paramedical personnel of the EMS dispatch service is recommended to be calculated using the formula:
NChds \u003d NDSsmp * KDS,
NChds - the calculated standard for the number of paramedical personnel of the EMS dispatch service;
NDSsmp - the actual number of individuals of the paramedical personnel of the EMS dispatch service;
KDS - coefficient of presence of the dispatching service.
To take into account the peculiarities of the constituent entities of the Russian Federation, it is possible to use a correction factor for the availability of a dispatch service. KDS allows to take into account the presence of a single dispatch service for the NSR in the constituent entity of the Russian Federation. If there is no such service, then the CDS can be equated to 1. If there is a single NSR dispatch service, the CDS is equated to 0.3.
5.5. The number of paramedical personnel of the "management group" is characterized by the number of stations and (or) departments of the SMP (form of federal statistical observation No. 30).
5.6. The estimated standard for the number of paramedical personnel of the EMS (absolute number) is recommended to be determined by the formula:
LFsmp \u003d LFvb + LFds + LFgu,
NChsmp - the standard number of paramedical personnel of the ambulance service;
NChvb - the normative number of paramedical personnel of mobile ambulance teams;
NChds is the standard number of paramedical personnel of the EMS dispatch service;
NChgu - the normative number of paramedical personnel of the "management group" of the SMP.
5.7. The estimated standard of provision with paramedical personnel per 10 thousand population is recommended to be determined by the formula:
OBNPsmp \u003d LFsmp * 10000 / population of the subject,
NChsmp - the standard number of paramedical personnel of the ambulance service (absolute number);
OBNChsmp - provision with paramedical personnel of the ambulance service per 10 thousand people.
5.8. The deficit / surplus of EMS nurses can be defined as the difference between the calculated standard for the number of EMS nurses (absolute number) and the actual number of EMS nurses (absolute number).
6. Calculation of the need for nursing staff involved in the provision of medical care on an outpatient basis:
6.1. The basis for calculating the required number of nursing staff working with doctors, as well as performing independent outpatient appointments (examination room midwife, medical assistant FAP or FP, medical assistant of the pre-medical appointment, etc.), may be the availability of medical personnel per 10 thousand population.
The number of doctors (absolute number) should be determined by the formula:
ChVap \u003d ObV * ChN / 1000,
NVap - the number of doctors providing medical care on an outpatient basis;
Pv is the number of doctors per 10,000 people;
CHN - population.
Since the indicator of provision with medical personnel per 10 thousand of the population already takes into account territorial and other coefficients that take into account the characteristics of each subject of the Russian Federation, then when calculating the number of nursing staff working with doctors who conduct outpatient appointments, such coefficients may not be considered.
6.2. When calculating the required number of paramedical personnel performing independent outpatient appointments (examination room midwife, FAP or FP paramedic, pre-medical appointment room paramedic, etc.), it is possible to use information on the number of relevant rooms. The actual number of offices (structural divisions) is indicated on the basis of federal statistical observation form No. 30.
6.3. The calculation of the number of nurses in the "reinforcement group" for each profile of medical care provided on an outpatient basis, it is advisable to make on the basis of the ratio method, taking into account the recommended aggregated calculated ratios of the ratio of nurses and doctors.
6.4. The need for nurses in the "treatment group" includes the estimated number of nurses working with doctors on outpatient appointments and performing independent outpatient appointments (examination room midwife, FAP or FP paramedic, pre-medical reception room paramedic, etc.) , which is expedient to calculate taking into account the procedures for providing medical #.
6.5. The calculation of the number of nursing staff of the "treatment and diagnostic group" and "control group", as a rule, is carried out on the basis of the ratio method, taking into account the calculated ratio coefficients:
Table No. 2
| Recommended aggregated calculated ratios of the ratio of paramedical personnel and doctors engaged in the main and auxiliary activities | ||||
|---|---|---|---|---|
| paramedical staff working with doctors conducting outpatient appointments | paramedical staff working in self-administration rooms | amplification group nursing staff | nursing staff of the paraclinical group | |
| 2 | 3 | 4 | 5 | |
| Total for the treatment and diagnostic group | 0,17 | |||
| Total by control group | 0,06 | |||
The corresponding calculation coefficients are multiplied by the number of nurses in the "treatment group".
6.6. The estimated number of paramedical personnel involved in the provision or providing independent medical care on an outpatient basis may include the estimated number of paramedical personnel of the "treatment group", "treatment and diagnostic group" and "management group".
6.7. The basis for calculating the required number of nursing staff in day hospitals of medical organizations providing medical care on an outpatient basis and at home is the number of places in day hospitals.
6.7.1. It is advisable to carry out the estimated number of nursing staff by the number of day hospital beds on the basis of the ratio method, taking into account the recommended correction factors:
Table No. 3
| Standard value | |
|---|---|
| 1,05 | |
| 1,03 | |
| 2. Coefficients taking into account the proportion of the population of a constituent entity of the Russian Federation living in rural areas | |
| for entities where at least 50% of the population lives in rural areas | 1,11 |
| for entities where 30% to 50% of the population lives in rural areas | 1,05 |
| 3. Coefficients taking into account the volume of medical care within the framework of the TPSG, which is performed by medical organizations of federal and private ownership | |
| for subjects in which from 5% to 10% of primary health care for TPSG is provided in medical organizations of federal and private ownership | 0,98 |
| for subjects in which from 10% to 20% of primary health care for TPSG is provided in medical organizations of federal and private ownership | 0,95 |
| 4. Coefficients taking into account the population density of the subject of the Russian Federation | |
| for subjects with low population density (lower than in the Russian Federation as a whole) | 1,05 |
| for subjects with a high population density (higher than in the Russian Federation as a whole) | 0,83 |
| 5. Coefficients taking into account the presence in the subject of the Russian Federation of settlements remote (more than 300 km) from the regional (municipal) center, where specialized assistance is provided | |
| for entities in which 30% to 50% of the population lives in remote settlements | 1,15 |
| for subjects in which more than 50% of the population lives in remote settlements | 1,10 |
| 6. Coefficients taking into account the level of medical care | |
| for subjects in which from 70% to 90% of medical care is provided in medical organizations of the 1st level | 1,20 |
| for subjects in which from 50% to 70% of medical care is provided in medical organizations of the 1st level | 1,10 |
| 1,74 | |
The final correction factor is recommended to be multiplied by the number of nurses "by the number of places" for each profile of medical care. To take into account the peculiarities of the constituent entities of the Russian Federation, it is advisable to apply the developed corrective coefficients to the number of nursing staff "by the number of seats." If the features of the subject of the Russian Federation satisfy the described condition, then the corresponding value of the coefficient from the "normative value" is taken into account, if they do not satisfy, then the value of the coefficient is 1. After filling in all the lines, the final correction factor for the subject of the Russian Federation can be calculated. The value of the final adjustment factor, as a rule, is calculated individually for each subject of the Russian Federation.
6.7.2. The estimated number of paramedical personnel involved in the provision of medical care in day hospitals may include the estimated number of paramedical personnel of the main groups.
6.8. The need for paramedical personnel may include the estimated number of paramedical personnel of the "treatment group", "treatment and diagnostic group" and "management group" engaged in providing medical care to the population on an outpatient basis, as well as the estimated number of paramedical personnel required to provide medical care in day hospitals.
6.9. To account for the number of nursing staff older than working age (women aged 55 and over, men aged 60 and over), it is recommended to apply the age load factor.
The calculation of the need for nursing staff, taking into account the age load, can be determined by the formula:
LFam \u003d Cham * KV,
NCham - the calculated standard for the number of paramedical personnel for the provision of medical care on an outpatient basis;
Cham - the estimated standard for the number of nurses for the provision of medical care on an outpatient basis without taking into account the age load factor;
KV - coefficient of age load.
CV is recommended to be used to account for the number of nursing staff older than working age. If the proportion of paramedical personnel older than working age is less than 10% of all paramedical workers of the station and / or department of the EMS, then the coefficient may be equal to 1; from 10% to 15% - 1.01; over 15% - 1.02.
6.10. The deficit or surplus of nursing staff providing medical care to the population on an outpatient basis, in day hospitals, can be defined as the difference between the calculated and actual number of nursing staff (absolute number).
7.1. The basis for calculating the required number of nursing staff providing medical care in hospitals is the provision of beds per 10,000 people.
The number of hospital beds (absolute number) is recommended to be calculated using the formula:
CHK \u003d ObK * CHN / 1000,
CHK - the number of beds in a round-the-clock hospital;
ObK - provision with beds per 10 thousand population;
CHN - population.
7.2. To determine the number of nurses providing medical care in hospitals, it is advisable to recalculate the number of beds per employee of nurses in accordance with the procedures for providing medical care.
7.3. To take into account the territorial and other characteristics of the constituent entities of the Russian Federation, it is recommended to apply the recommended correction factors to the number of nursing staff by the number of beds, which are selected from the "Standard value" based on the territorial characteristics of the constituent entities of the Russian Federation and the number of hospitalizations per 1000 population (hospitalization rate):
Table No. 4
| Recommended Correction Factors | Standard value |
|---|---|
| 1. Coefficients taking into account the location of the subject of the Russian Federation in the regions of the Far North and equated to them | |
| for entities located entirely in the regions of the Far North and equated to them | 1,05 |
| for subjects in which less than 50% of the population lives in the regions of the Far North and equated to them | 1,03 |
| 2. Coefficients taking into account the level of hospitalization of the population | |
| for entities with a hospitalization rate of 195.5 per 1,000 population and above | 1,00 |
| for entities with hospitalization rates between 176.0 and 185.7 per 1,000 population | 0,94 |
| for entities with hospitalization rates between 166.2 and 176.0 per 1,000 population | 0,90 |
| for entities with a hospitalization rate of less than 166.2 per 1,000 population | 0,84 |
| Final correction factor | 0,77 |
The total final correction factor is calculated automatically and is individual for each subject of the Russian Federation.
7.4. The need for "treatment group" nurses providing medical care in inpatient settings includes the estimated number of nurses by number of beds and "reinforcement teams" for each profile of hospital care.
7.5. The calculation of the number of nurses in the "treatment and diagnostic group" and "control group", as a rule, is carried out on the basis of the ratio method, taking into account the aggregated calculation coefficients:
Table No. 5
7.6. The basis for calculating the required number of nursing staff in day hospitals may be the number of places in day hospitals obtained by calculation.
7.6.1. It is advisable to determine the estimated number of nurses in terms of the number of day hospital beds, taking into account the aggregated calculated coefficients for the ratio of nurses.
7.6.2. The estimated number of nurses in terms of the number of seats is carried out taking into account the recommended correction factors:
Table No. 6
If the features of the subject of the Russian Federation satisfy the described condition, then in the column "for the subject of the Russian Federation" it is advisable to put the corresponding value of the coefficient from the "normative value", if they do not satisfy, then the value of the coefficient can be - 1. After filling in all the lines, it is preferable to calculate the final correction factor , which is calculated automatically and may be individual for each subject of the Russian Federation.
7.6.3. The estimated number of paramedical personnel involved in the provision of medical care in day hospitals includes the estimated number of paramedical personnel of the main groups.
7.7. The need for paramedical personnel includes the estimated number of paramedical personnel of the "treatment group", "treatment and diagnostic group" and "management group" employed in providing inpatient care to the population, as well as the estimated number of paramedical personnel required to provide medical care in conditions day hospitals.
7.8. To account for the number of nursing staff older than working age (women aged 55 and over, men aged 60 and over), it is recommended to apply the age load factor.
The calculation of the need for nursing staff, taking into account the age load, can be carried out according to the formula:
LFst \u003d Chst * KV,
NChst - the calculated standard for the number of paramedical personnel to provide medical care to the population in stationary conditions;
Chst - the calculated standard for the number of nursing staff to provide medical care to the population in stationary conditions without taking into account the age load factor;
KV - coefficient of age load.
The EF may take into account the number of nurses older than working age. If the proportion of paramedical personnel older than working age is less than 10% of all paramedical workers, then the coefficient can be equal to 1; from 10% to 15% - 1.01; over 15% - 1.02.
7.9. The shortage/surplus of nursing staff providing medical care to the population in inpatient and day hospital conditions is recommended to be defined as the difference between the calculated and actual number of nursing staff (absolute number).
8. The need for nurses to provide medical care to the population as a whole in the constituent entity of the Russian Federation may include the estimated number of nurses needed to provide emergency medical care, medical care in outpatient and inpatient settings, day hospital conditions, and it is recommended to calculate using the formula:
LF \u003d LFsmp + LFam + LFst,
NChsmp - the standard number of paramedical personnel for the provision of emergency medical care;
NCham - the calculated standard for the number of paramedical personnel for the provision of medical care on an outpatient basis;
NChst - the calculated standard for the number of paramedical personnel for the provision of medical care in inpatient conditions.
8.1. The estimated standard for the number of paramedical personnel per 10,000 population (provision with paramedical personnel per 10,000 population) is recommended to be carried out according to the formula:
OBNC \u003d LF * 10,000 / population of a constituent entity of the Russian Federation,
NCh - normative number of nurses (absolute number);
OBNP - provision with paramedical personnel per 10,000 population.
Document overview
A methodology has been developed for calculating the need for specialists with secondary vocational (medical) education.
It is intended to provide methodological assistance in current planning, identifying a shortage or excess of nursing staff in medical organizations subordinate to regional and local authorities.
The indicators that are taken into account when determining the need are determined. Among them are the data of the form of federal statistical observation N 30 "Information on a medical organization", the availability of medical personnel, hospital beds, the features of the provision of pre-hospital medical care by paramedical staff, the presence in the region of settlements remote from medical organizations. You can also take into account the territorial features, the age composition of the nursing staff, the presence of structural units in medical organizations.
The conditional division of nursing staff into groups is used, taking into account their functional duties.
Teaching aid
Irkutsk, 2004
MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
GOU VPO IRKUTSK STATE MEDICAL UNIVERSITY
PLANNING IN HEALTH CARE.
IN OUTPATIENT CLINIC
AND HOSPITAL MEDICAL CARE
Teaching aid
Irkutsk, 2004
The teaching aid has been prepared by:
Gaidarov G.M. – doctor of medical sciences, professor, head
Department of Public Health and Health
GOU VPO IGMU
Kulesh D.V. – candidate of medical sciences, assistant of the department
public health and health care
GOU VPO IGMU
Reviewers:
Abashin N.N. - Candidate of Medical Sciences,
First Deputy Executive Director
state institution of the territorial fund
compulsory medical insurance of citizens
Irkutsk region
Kuptsevich A.S. - deputy chief
Health Administration Administration
Irkutsk region
Planning in health care. Determining the needs of the population in outpatient and inpatient medical care (educational manual). - Irkutsk, 2004. - 28 p.
The teaching aid reflects the main approaches and principles in planning medical care for the population at the present stage, determining the needs of the population for outpatient and inpatient medical care. The manual is intended for students of medical and preventive, pediatric, medical and preventive faculties of the Medical University, interns, clinical residents of the department.
The teaching aid is printed by decision of the Central Coordinating Council of ISMU.
TOPIC: “PLANNING IN HEALTH CARE.
DETERMINING THE NEEDS OF THE POPULATION
IN OUTPATIENT AND POLYCLINIC AND INPATIENT MEDICAL CARE"
INTRODUCTION
The place of the lesson is the department.
The duration of the study of the topic is 4 hours.
The purpose of the lesson: to study the basics of planning in health care; know the basic principles and methods of planning; study the definition of the need for outpatient and inpatient care.
Specific tasks:
The student must know:
What is planning in health care at the present stage; planning principles; types of plans and methods of planning; what are the units of measurement of the capacity of outpatient and inpatient medical institutions and the main indicators of the plan in health care; what is outpatient care case.
The student must be able to:
Calculate planned indicators and determine the need for outpatient and inpatient medical care.
Implementation plan
First stage of the lesson:
Introductory word of the teacher (the topic of the lesson according to the thematic plan of practical classes, determination of the purpose and objectives of the lesson) - 5 min.
Test and oral control on questions to the topic of the lesson - 45 min.
Conclusion of the teacher on the results of the survey. Pay attention to the main sections of the topic - 15 min.
Second stage of the lesson:
Mastering the methods for calculating the main planned indicators of the work of an outpatient and inpatient institution. Independent work with educational, teaching aids, solving situational problems. Calculation of planned indicators and determination of the need for outpatient and inpatient medical care - 75 min.
Summing up the results of assignments, control of the final assignments of students - 15 min.
Discussion of the material. Discussion - 30 min.
Health planning
From a technological point of view, planning consists in the development of systems of plans that reflect various aspects of the activities of medical institutions or the development of healthcare in a certain area. From the socio-economic side, planning consists in taking into account the social laws of development, economic and other interests of healthcare entities.
Planning is the process of making and executing decisions on the use of the resources of an industry or organization by performing basic tasks to achieve the main goal.
The basis of the planning system is the definition at all levels of government - from federal to institutional - interrelated strategic goals, strategic objectives and strategic priorities for the development of health care.
The purpose of planning at the current stage is to create a regulatory and legal framework for the implementation of a healthcare development strategy that includes, among other things, ensuring the highest possible level of access to medical care for the population in modern socio-economic conditions by increasing the efficiency of healthcare.
Basic principles of health planning
at the present stage:
1. End-to-end planning principle for all levels: federal, subject of the Russian Federation, municipal, institutional.
Thus, the higher level offers the lower level the main parameters for planning and coordinates them with it, taking into account the formation and implementation of state (municipal) orders, local climatic, geographical, socio-economic, sanitary-hygienic, political and other conditions. After that, these parameters become the basis for planning at both levels).
2. Availability of a unified system for the Russian Federation of social standards, norms and regulations used for healthcare planning.
So, for example, the standards for the volume of medical care are the necessary volumes of medical and organizational measures, as a result of which it is possible to prevent the occurrence of diseases, ensure recovery in acute diseases and achieve remission in chronic diseases (for example, the average length of a patient's stay in bed, the function of a medical position, protocols for managing patients - standards, etc.). At the federal level, when planning state guarantees, federal basic standards for the volume of medical care are established, which are then detailed at the level of the constituent entities of the Russian Federation, taking into account local characteristics, in the form of territorial standards for the volume of medical care (for example, the number of bed-days per 1000 population in the provision of inpatient medical care or number of visits per 1000 population in the provision of outpatient medical care).
3. Continuity of the planning process based on a combination of strategic and current planning.
Strategic health planning is the definition of goals, objectives, priorities, procedures, volumes, conditions for the health care activities of the Russian Federation, its constituent entities, municipalities and individual medical institutions for a period of several years.
Current healthcare planning - determining the procedure and conditions for the implementation of strategic healthcare plans for the next year for all levels (federal, subject of the Federation, municipality and individual medical institution). In the process of current planning, the implementation of strategic plans is monitored and, if necessary, they are adjusted. Thus, the principle of continuity of the planning process in health care is implemented.
At the stage of current planning, the constituent entities of the Russian Federation, municipalities assess the progress of the implementation of the strategic plan, primarily from the point of view of providing state guarantees in providing citizens with free medical care. Discrepancies with the strategic plan are revealed. Their causes are analyzed, and based on the results of the analysis, proposals are made to eliminate the causes of discrepancies or to clarify and adjust the strategic plan. Then a detailed quarterly planning of the implementation of the tasks of the strategic plan for the current year is carried out.
One of the tools for the implementation of state guarantees in the provision of medical care to citizens at the stage of current planning is the state (municipal) order.
State order - a state assignment to regional medical institutions for the provision of free medical care to citizens of the Russian Federation living in the territory of a constituent entity of the Federation, containing the types and volumes of medical care provided with financial resources for their implementation from the regional health budget and compulsory medical insurance.
Municipal order - the volume of medical care planned to be provided to residents of the municipality within the framework of the Territorial Program of State Guarantees at the expense of the budget and compulsory medical insurance.
Plan- this is a document that defines the essence, sequence, direction and tactics of the activities of specific performers, at specific times and in specific areas of activity.
Plans are:
1. promising (for a long period);
2. current (operational, monthly and annual);
3. plans for the activities of institutions;
4. development plans (construction, repair, reconstruction);
5. comprehensive plans;
6. plans-tasks for the object;
For certain types of healthcare institutions, the main indicators of the plan are the following:
For a fixed network - "hospital bed";
For outpatient clinics - "number of visits per shift";
For an ambulance station, “number of calls per year”;
For a blood transfusion station, “the amount of blood collected
For the center of the state sanitary and epidemiological
supervision – “population served”
The most commonly used planning methods are:
1. analytical (used to assess the initial and achieved levels when drawing up a plan and analyzing its implementation);
2. comparative (an integral part of the analytical method) - makes it possible to determine the direction of development processes, for example, morbidity, mortality, etc.;
3. balance method (allows to identify an imbalance, for example, training and growth of the network of healthcare facilities);
4. normative (to determine the need for normative indicators based on the use of the balance method);
5. experimental (calculation of indicators based on the experiment);
6. economic and mathematical methods are used when necessary to scientifically substantiate the optimal options for the plan;
7. other special methods.
In health care, traditionally planned:
1. the need for personnel;
2. production activities (production (planned) indicators);
3. prospects for financing.
Determining the needs of the population
Proper planning of the outpatient network is of great importance due to the fact that these institutions provide medical services to a large part of the population in need of treatment (approximately 80%).
The standard of the population's need for outpatient care is 11.5 visits per 1 inhabitant per year.
The calculation of the needs of the population in outpatient care can be performed using the formula (1):
P \u003d A × Kp + D + Pr
where P - number of visits by the population to doctors in outpatient clinics (per 1000 population);
BUT - incidence rate (addressability per 1000 population);
Kp - coefficient of repetition of visits for medical purposes per 1 disease in this specialty;
D - the number of dispensary visits due to morbidity;
Etc - number of preventive maintenance visits.
The workload norms for personnel of health care institutions, along with the population's need for medical care, are the main indicators in planning the number of medical personnel. The main concept here is "medical position". It is understood as a certain amount of work (load) of a doctor for a year providing home care and leading an outpatient appointment. For each individual specialty, the “function of a medical position” is calculated - a planned and actually performed function based on the results of work over the past year.
The planned function of a medical position is determined by the number of visits (in the clinic at the reception, at home and during professional examinations), which must be performed by one medical position of a certain specialty during the calendar year (2).
F = B × C × D
where F - the function of one medical position of a given specialty;
B - the load of a doctor of this specialty for 1 hour of work in a polyclinic and at home for various types of work;
FROM - the number of hours of work at the reception, at professional examinations and at home;
G is the number of working days in a year.
The planned function of a medical position is used when planning the number of medical positions for outpatient services for the population in order to determine the need for medical positions in certain specialties (3).
where AT - number of medical positions for outpatient care;
L - standard number of outpatient visits per 1 inhabitant per year (see Table 1);
H - population of the planned territory;
F - function of the medical office.
Formula (3) establishes the absolute need for a medical position of a certain specialty in an outpatient network.
Methodology for planning inpatient care for the population
When planning inpatient care, the population's need for beds is determined, and the number of beds per 1000 of the population served is considered a measure of this need.
Table 1 - Standards for inpatient care to the population
1. The level of appeal of the population for medical care to outpatient clinics, in connection with diseases per 1000 population. The appeal of the population for medical care reflects the level of morbidity.
2. Rate of hospitalization. Having data on the appealability, it is possible to determine the need of patients for hospitalization, which is determined as a percentage of the number of outpatient visits.
3. Average annual bed occupancy. According to the established norms, a hospital bed should approximately function in a year: in the city - 340 days and in the countryside - 310 days. This indicator is influenced by factors such as bed downtime due to a change of patient, hospital repairs, and treatment of wards. It takes 25-45 days a year.
4. The average number of days the patient stays in bed. This indicator is set at an average of 11.8–12.5 days and is differentiated by bed profiles.
The need of the population for hospital beds is determined by the following formula (4):
Where To - the required number of average annual beds (desired value) per 1000 population;
BUT - the level of negotiability (morbidity) per 1000 population;
P - hospitalization rate per 100 patients seeking medical care (percentage of selection of patients per bed);
R - the average number of days the patient stays in bed;
D - the planned number of days of use (occupancy) of a bed per year.
This is how the need for beds of different profiles is determined, taking into account differentiated indicators of negotiability and selection for a bed for each specialty. Note that the "number of beds" is an indicator of the capacity of the hospital.
The calculation of the need for medical personnel is carried out as follows (5):
Number of doctors for the hospital = Number of hospital beds__
Number of beds per doctor
1. Analytical method. It is used to evaluate the initial and achieved levels when comparing the plan and analyzing its implementation. Using the analytical method, the provision of the population with medical and paramedical personnel, hospital beds is determined; the volume indicators of medical care are calculated (the percentage of hospitalizations, the average number of visits per inhabitant per year), the function of the hospital bed (bed turnover) and the medical position (the average number of visits per one medical position per year) is analyzed.
2. The comparative method - an integral part of the analytical one - makes it possible to determine the direction of development processes. Analytical and comparative methods are used to evaluate various indicators, such as morbidity, mortality, and others, in space and time, i.e. when comparing them with similar indicators of other territorial zones or in dynamics over a number of years.
3. Balance method. It is used to substantiate the correct correlations between health development plans in various economic and administrative regions of the country.
4. Economic-mathematical method.
5. Experimental method.
6. The normative method is used in the preparation of any plan and is based on the use of relevant norms and standards of medical care. There are the following groups of basic standards in health care:
Standards for ensuring the needs of the population in medical care;
Staffing standards;
Standards for the use of labor of medical workers (load);
Material support standards;
financial standards.
PLANNING METHODOLOGY
OUTPATIENT POLYCLINIC NETWORK
Proper planning of the outpatient network is of great importance due to the fact that these institutions provide medical services to a large part of the population in need of treatment (approximately 80%).
The standard of the population's need for outpatient care is 11.5 visits per 1 inhabitant per year.
The calculation of the needs of the population in outpatient care can be performed using the formula (1):
P \u003d A × Kp + D + Pr
where P - number of visits by the population to doctors in outpatient clinics (per 1000 population);
BUT - incidence rate (addressability per 1000 population);
Kp - coefficient of repetition of visits for medical purposes per 1 disease in this specialty;
D - the number of dispensary visits due to morbidity;
Etc - number of preventive maintenance visits.
The workload norms for personnel of health care institutions, along with the population's need for medical care, are the main indicators in planning the number of medical personnel. The main concept here is "medical position". It is understood as a certain amount of work (load) of a doctor for a year providing home care and leading an outpatient appointment. For each individual specialty, the “function of a medical position” is calculated - a planned and actually performed function based on the results of work over the past year.
The planned function of a medical position is determined by the number of visits (in the clinic at the reception, at home and during professional examinations), which must be performed by one medical position of a certain specialty during the calendar year (2).
F = B × C × D
where F - the function of one medical position of a given specialty;
B - the load of a doctor of this specialty for 1 hour of work in a polyclinic and at home for various types of work;
FROM - the number of hours of work at the reception, at professional examinations and at home;
G is the number of working days in a year.
The planned function of a medical position is used when planning the number of medical positions for outpatient services for the population in order to determine the need for medical positions in certain specialties (3).
where AT - number of medical positions for outpatient care;
L - standard number of outpatient visits per 1 inhabitant per year (see Table 1);
H - population of the planned territory;
F - function of the medical office.
Formula (3) establishes the absolute need for a medical position of a certain specialty in an outpatient network.
METHOD OF PLANNING STATIONARY
HELP TO THE POPULATION
When planning inpatient care, the population's need for beds is determined, and the number of beds per 1000 of the population served is considered a measure of this need.
Table 1 - Standards for inpatient care to the population
1. The level of appeal of the population for medical care to outpatient clinics, in connection with diseases per 1000 population. The appeal of the population for medical care reflects the level of morbidity.
2. Rate of hospitalization. Having data on the appealability, it is possible to determine the need of patients for hospitalization, which is determined as a percentage of the number of outpatient visits.
3. Average annual bed occupancy. According to the established norms, a hospital bed should approximately function in a year: in the city - 340 days and in the countryside - 310 days. This indicator is influenced by factors such as bed downtime due to a change of patient, hospital repairs, and treatment of wards. It takes 25-45 days a year.
4. The average number of days the patient stays in bed. This indicator is set at an average of 11.8–12.5 days and is differentiated by bed profiles.
The need of the population for hospital beds is determined by the following formula (4):
Where To - the required number of average annual beds (desired value) per 1000 population;
BUT - the level of negotiability (morbidity) per 1000 population;
P - hospitalization rate per 100 patients seeking medical care (percentage of selection of patients per bed);
R - the average number of days the patient stays in bed;
D - the planned number of days of use (occupancy) of a bed per year.
This is how the need for beds of different profiles is determined, taking into account differentiated indicators of negotiability and selection for a bed for each specialty. Note that the "number of beds" is an indicator of the capacity of the hospital.
