Problems of Social Hygiene, Public Health and History of MedicineProblems of Social Hygiene, Public Health and History of Medicine0869-866X2412-2106Joint-Stock Company Chicot12110.32687/0869-866X-2019-27-4-384-388Научная статьяThe conflict of interests and organizational structures in conditions of health care commercializationAleksandrovaO. A.a762rab@mail.ruKomolovaO. A.-The Federal State Budget Institution of Science «The Institute of Social Economic Problems of Population» of the Russian Academy of SciencesThe Federal State Budget Educational Institution of Higher Education «The Financial University under the Government of the Russian Federation»The State Autonomous Educational Institution of Higher Education «The Moscow Municipal University of Management of the Moscow government»1512201927438438806042021Copyright © 2019,2019The article based on the analysis of foreign experience of commercialization of health care and introducing management methods typical for business into the work of medical organizations, shows the difficult conflict of interests within the medical community itself, as well as the clash of organizational cultures of doctors and managers. As a result, the population suffers as it either cut of from medical care or pays for imposed medical services. And the doctors suffer because of the pursuit of their leadership for economic efficiency and productivity without taking into account the specifics of the medical profession, and this leads to overwork, stress and early professional burnout. Based on a survey of Russian experts, the authors show that while in the West they come to a conclusion about the need for a management revolution that returns doctors to their priority role and prioritizes not patient's profits, but patient interests, Russia is rapidly moving along the path of unrestrained health care commercialization and fetishization indicators in the medical industry. The article describes a system of economic and organizational-legal factors that provoke a conflict of interest that arise management and staff, and also reveals the absence of mechanisms that are designed to contain its negative consequences and to some extent operate in countries whose approaches to organization Russia is rapidly adopting in health care. In addition, the opinions and arguments of the experts are given in relation to the new question for Russia as to whether the head of the medical organization should be a clinician or a manager.medical servicesmanagement of a medical organizationconflict of interestsorganizational cultureмедицинские услугиуправление медицинской организациейконфликт интересоворганизационная культура1.Александрова О. А. Экономическая и идейная десуверенизация как угроза социальному государству. В кн.: Управление социальными изменениями в нестабильных условиях. Материалы Всероссийской научной конференции. Московский государственный университет им. М. В. Ломоносова. М.: ООО «МАКС Пресс»; 2016. C. 19-23.2.Александрова О. А. Социальная политика и ВТО. В кн.: Ткаченко А. А. (ред.). Влияние глобализации и членства в ВТО на качество жизни населения стран группы БРИКС: Сборник статей по материалам Международной научной конференции (Москва, 17 марта 2015 г.). М.: Финансовый университет; 2016.3.Гоулд Е., Ждановская А. Почему все же ГАТС ведет к коммерциализации общественных благ? Режим доступа: http://wto-inform.ru/experts/aleksandra_zhdanovskaya_vto_inform_ellen_gould_ekspert_po_gats_kanada_pochemu_vse_zhe_gats_vedet_k_k/ (дата обращения 17.04.2013).4.MacLeod I., Powell E. The Social Services - Needs and Means. Conservative Political Center; 1954.5.Abel-Smith B. Value for Money in Health Service: a comparative study. Heinemann; 1976.6.Titmuss R. Commitment to Welfare, Allen and Unwine. London: Allen & Unwin; 1968.7.The Government’s Expenditure Plans. London: HMSO;1980-1981.8.Enock K., Markwell S. Interactions between managers, doctors and others Режим доступа: https://www.healthknowledge.org.uk/public-health-textbook/organisation-management/5a-understanding-itd/interactions (дата обращения 15.09.2018 г.).9.Rider E. A., Gilligan M. A., Osterberg L., Branch W. T. Healthcare at the Crossroads: The Need to Shape an Organizational Culture of Humanistic Teaching and Practice. Режим доступа: https://www.researchgate.net/publication/325031279_Healthcare_at_the_Crossroads_The_Need_to_Shape_an_Organizational_Culture_of_Humanistic_Teaching_and_Practice (дата обращения 16.09.2018 г.).10.Чубарова Т. В. Кризис российской здравоохранительной системы и политики. Экономическая наука современной России. Экспресс-выпуск. 2007;1(12):25.11.Улумбекова Г. Э. Здравоохранение России: 2018-2024 гг. Что надо делать? ОРГЗДРАВ: новости, мнения, обучение. Вестник ВШОУЗ. 2018;(1).12.Александрова О. А. Реформа бюджетных учреждений: мнение пациентов и врачей. Гуманитарные науки. Вестник Финансового университета. 2017;1(25):54-63.13.Чубарова Т. В. Перспективы реформы здравоохранения в России: необходимость новых подходов. Проблемы прогнозирования. 2004;(5):79.14.«Нас учили врачевать, а управление медицинской организацией - это другой вид профессиональной деятельности…». Интервью с Г. Э. Улумбековой. Режим доступа: https://cyberleninka.ru/article/n/nas-uchili-vrachevat-a-upravlenie-meditsinskoy-organizatsiey-eto-drugoy-vid-professionalnoy-deyatelnosti-1 (дата обращения 12.08.2018).