Problems of Social Hygiene,
Public Health and History of Medicine

Health insurance issues are an important area of social interaction between different troupes of the population in the Russian Federation. This article discusses aspects of the current state of the market of medical voluntary and compulsory insurance in the Russian Federation. For this purpose, the article provides a comparative analysis of the concepts of “compulsory health insurance” and “voluntary health insurance”. Also data are given on studying the market of medical insurance in Russia in recent times, and presents forecasts of researchers in the development of health insurance in the perspective up to 2020 in addition, the highlighted trends in the costs of financing health care. The problems of the Russian compulsory and voluntary medical insurance market and possible ways of their development are considered.

The current stage of development of health systems is characterized by an increasing role of specialists with secondary medical and higher (nursing) education, which imposes additional requirements on their medical, pedagogical, psychological and technical knowledge and skills. The article presents the results of a study implemented in 2019 on the development of medical personnel in the capital's healthcare system. One of the research methods was an expert survey in the form of a series of in-depth structured interviews with the leadership of medical colleges, universities and institutions of additional professional education (N = 15), the scenario of which included blocks of questions regarding the main determinants of the quality of training of nursing staff and bachelors in the direction of “Nursing”, as well as ideas for introducing the capital standard of a nurse. The analysis of the information obtained made it possible to identify a number of problems and directions for their solution: at the college level, this is, first of all, poor-quality production practice, which is due to the overload of medical staff and, in general, not serious attitude to trainees, as well as insufficient communication training of future nurses; in the case of undergraduate studies, the main problems are related to students who have gone to university just after school, who have a poor idea of their future profession and are poorly motivated to study in condition when courses that dedicated to studying nursing medical skills, initially aimed at a more professionally trained contingent, have been significantly reduced. Experts, who support the idea of expanding the functions of nurses, the main obstacles to its implementation see in the stereotypes that the chief physicians and the medical community as a whole have about the purely secondary role of the nursing staff, as well as the corresponding attitudes of the nurses themselves. Regarding the standard of the capital's nurse, experts agree that the main emphasis should be on the development of universal competencies, attention to deontological and ethical issues.

The article substantiates the relevance of the study of the essence, tools and mechanisms of digital transformation of the health sector. A comparative assessment of the current health care system in the cities of the world is presented, trends in the use of end-to-end technologies for improving the health care system in Russia are revealed. The development of the health sector in modern conditions is based on the introduction of new information and communication technologies, for the proactive use of which, it is necessary to increase the digital skills and awareness of health workers and the population. The national projects of the Russian Federation «Health care» and «Digital economy» speak about the need to implement design solutions for the formation of competence models of personnel in the conditions of global digitalization. The formation of the digital contour of the health sector should be based on a clear understanding of the competence profile, its inclusion in the innovative health care system and the preservation of human capital. The use of competence approach to the digital transformation of healthcare contributes to improving the adaptability of the existing system of health organization to the new technological order provides the possibility of introducing cross-cutting technologies in the processes of decision-making to improve the accessibility and quality of care.

In many countries of the world, demographic changes have occurred, characterized by an increase in the share of socially inactive elderly people. The goal is a medical and demographic analysis of the elderly in the Far East. For Khabarovsk and Birobidzhan, seasonal patterns of mortality and self-preserving behavior of older people were investigated. In order to determine the actions and personal attitudes of self-preserving behavior for the prevention of cardiovascular diseases, elderly people who visited the Vertical fitness center in Birobidzhan were interviewed. It was found that the overall mortality rate among older people is higher among men than among women. The main causes of death are cardiovascular diseases, which have a pronounced seasonality with a maximum in winter. It is shown that 23% of men and 48% of women do not demonstrate high social and physical activity and do not have any skills to maintain their health.

This article reports an assessment of direct expenses for surgical treatment of patients with cerebral palsy and secondary orthopedic complications, who have undergone single-event multilevel orthopedic surgeries (SEMLS). It has been demonstrated that modern approach based on SEMLS is substantiated from the medical point of view and at present it is also justified from the point of view of economic assistance for that type of treating activity of a Federal Centre specialized in trauma and orthopaedics. Organization of surgical treatment using multilevel orthopaedic interventions requires selection of implants for specific characteristics and, on expenditure side, not exceeding funding of direct expenses intended for this treating process.

The article investigated the state of the competitive environment on the market of medical services of the Krasnodar territory, which included socio-economic indicators needed to understand current market conditions such as the number of medical organizations of primary care and health manpower; the volume of paid medical services, rendered to population of the region and individual costs for medical services; the investment performance of the industry, the possibility of participation of private medical organizations in the implementation of the Territorial program of obligatory medical insurance.The author's interpretation reveals the concept of «business reputation of a primary-level medical organization». It is proved that the «business reputation» on the Internet or online reputation has become a strategic tool for ensuring the competitive advantages of a primary - level medical organization. The content analysis of Internet resources conducted in the study showed that the online reputation of a primary care organization is primarily patient reviews (negative and positive), and online reputation management in the Internet is continuous work with patient reviews, the process of communicating with the audience, publishing information materials, etc.Monitoring popular sites on this topic prodoctorov.ru and Yandex. Search and analysis of patient reviews of medical organizations in Sochi allowed the authors to assess the online reputation of primary care organizations.In conclusion, the article presents an algorithm for managing online reputation on the Internet to ensure the competitiveness of primary care organizations.

The article presents the results of the author's research that determines the degree of influence of monotonous (monotonous) labor processes on the drivers (and their assistants) of traction rolling stock of railway transport. Information is collected in order to develop a set of measures to overcome the monotony of work, improve the quality of working life and psychophysiological health of employees, and as a result, ensure traffic safety, improving the safety system for drivers and improving the quality of passenger transport.

The article deals with results of comparative analysis of the dynamics and trends of the incidents of malignant neoplasms in the population of the Moscow region. The Central Federal district and the Russian federation as a whole according to Rosstat data for 2009-2018. It was established that in Moscow region in comparison with other territories, the level and growth rates of the incidence of malignant neoplasms were lower. In the structure of the incidence of malignant neoplasms, the first rank places are occupied by breast, skin, lung, colon and prostate cancer. Attention is drawn to the fact that over the entire period of observation, the indicator of the number of people under medical supervision in the Moscow region was consistently higher than in the Russian Federation and the Central Federal district. Over the period of 2012-2018, the share of malignant neoplasms of the first stage of the spread of the tumor process increased by 23.4% in the region, and the share of stages III and IV decreased (by 16.9% and 12.3%, respectively).The increase in the number of newly detected malignancies seems to be due to increased diagnostic capabilities in recent times.

Modern approaches to public health protection in the world are increasingly focused on health conservation, which involves focusing health care efforts on prevention. Timely identification of patients with arterial hypertension (AH) and provision of effective medical care is the main organizational reserve for preventing health losses. Based on the concept of “cardiovascular continuum”, analysis of literature sources and the study itself, organizational measures have been developed to preserve health and prevent health losses and reduce mortality from diseases of the circulatory system. From the perspective of the concept of “cardiovascular continuum”, the causes of death from BSC are two parallel interrelated processes: arterial hypertension and atherosclerosis, which are the consequences of endothelial dysfunction. Analysis of literature sources and survey results 123 of experts and healthcare professionals in a number of subjects of the Russian Federation show that adequate and timely medical care to the population at BSK, and a reduction in population systolic blood pressure and the reduction of lepidopteron low-density (LDL) are organizational reserves predotvratit loss health and reduce mortality from CVD. We have developed a set of measures to reduce mortality from circulatory diseases in accordance with the concept of the “cardiovascular continuum” include the following: increase population coverage with BSK medical assistance; medical surveillance and treatment of patients with prehypertension; decreased population levels of cholesterol in arterial hypertension (AH); carrying out of thrombolytic therapy; medical emergency cardiovascular conditions in accordance with the concept of “Golden hour”; improving the provision of medicines to the population, increasing the provision of cardiologists to the population. The implementation of a set of measures in the pilot rural district allowed reducing the total mortality of the population for the year of analysis by 12%.

This article analyzes the main indicators of the incidence and life expectancy of the population of the Republic of Sakha (Yakutia) over a twenty-year period. An increase in the incidence rate of the population was revealed that exceeded the average for the country and the Far Eastern Federal District, including for oncological diseases, the level of which increased several times in the republic. The value of the indicator of life expectancy in the republic approached the average Russian level, while 20 years ago a much lower indicator was determined. In the dynamics of indicators of the morbidity of the population and life expectancy over a twenty-year period, a polynomial trend has been outlined. For example, the incidence of neoplasms and diseases of the circulatory system showed a sharp increase in 2004, followed by a decrease, for diseases of the digestive system - similarly, an increase in 2001 and a subsequent decrease. This aspect requires an additional detailed study of the causes of such changes in order to be able to predict them in the future.

The article considers the first results of the Federal priority health care project that began in 2018 in Russia, aimed at organizing a new model of medical care. The mechanism of operation of a perfect polyclinic from the point of view of lean production is formed and developed thanks to management decisions based on the principles of lean production, allowing to increase the efficiency of the health care system. Definition of technology “lean clinic”, using basic tools and structuring of losses in the field of medicine, according to the methodology of lean production, along with the generalization of positive foreign experience of introduction of technologies of lean production in health and its adaptation in Russia, will create a comfortable environment for doctors, medical staff and patients. The article presents statistical and analytical data on the regional practice of implementing the concept of “lean polyclinic”, as well as expert assessments that allow us to draw conclusions about the progress of the project.

In a rapidly changing world, legal protection of children from the standpoint of public health, namely from the standpoint of protecting the health of the child population from the adverse effects of various factors, including social ones, is of particular importance, thereby complementing the concept of “safe childhood” in terms of risk management safety of a child’s life and his health. Despite the fact that the institution of the Commissioner for the Rights of the Child in Russia was established more than ten years ago and is active in promoting the protection of children's health, many medical workers, specialists in healthcare and preventive medicine, unfortunately, are not fully aware of functions of this state structure and, accordingly, do not use its resource capabilities in the implementation of key installations of national projects. The aim of this work was to analyze the types of activities of the institution of the Presidential Commissioner for the Rights of the Child to identify and present the modern features of his human rights and operational-organizational assistance in protecting health and creating an environment for “safe childhood” from the standpoint of public health.

The current state of the Russian pharmaceutical market, its potential and development trends are significant for the state. The medical industry is strategically important, requiring efforts in its maintenance and development, which is reduced to reducing dependence on imported goods and origin. But at the same time, full import substitution in this industry is out of the question. In the context of global globalization and the current state of Affairs, the exchange of experience and medicines as its results is extremely important and relevant. Compliance with customs legislation when importing goods to the territory of the EEU is a fundamental principle of foreign economic activity, including medicines. The article analyzes the procedure for moving medicines, taking into account legislative innovations.

A survey of dentists and managing clinics-branches of the scientific and practical dental complex showed a high level of professional satisfaction. The main advantages in the activities of rapidly developing network-type dental clinics that actively implement the most advanced, unique technologies and tools have been identified. The main motivational factors that positively affect the result of staff activities, as well as reduce their degree of professional satisfaction, are identified. Moreover, according to the results of respondents' answers, approaches were identified to improve the motivating component in personnel management, as well as to level existing problems within the team. Studying the opinions of medical personnel (doctors and managers) will help the administration to analyze the potential of the personnel potential of clinics and will contribute to the development of plans to improve the organization of staff work and network development.

The article represents the results of a studying the information field of the healthcare sector in Russia. Measurements were made in the Yandex search engine, as well as in the Medialogia media database. The study was conducted between December 01, 2019 and may 15, 2020. The results of the studying are one part of the studying of the image of Russian healthcare and may be necessary for further work on its correction.

The article presents an overview of the problem of strategies for hygienic expertise in education. The purpose of the article is to identify special formats of strategies for hygienic expertise in education from the perspective of modern practices of cross-cultural analysis based on a review of a sample of sources in the WoS and Scopus databases of domestic and foreign science. The research is based on the methodology of cross-cultural approach; the research used methods of analytical review of publications (WoS, Scopus, RSCI databases), interpretation, contextual analysis, statistical methods, which made it possible to study special formats of strategies for hygienic expertise in education and identify the specifics of the interpretation of hygienic expertise in modern domestic and foreign studies. Based on a scientific review of a sample of sources, the main approaches to the interpretation and definition of hygienic expertise are defined. The content and subject of research is established, taking into account cross-cultural characteristics, geographical distribution of publications. Based on the existing knowledge, the main types of strategies for hygienic expertise are identified: medical-physiological, psychological-biological, socio-pedagogical, cultural-humanitarian, which are the methodological basis for preparing and making decisions in education. In conclusion, the article summarizes the features of research on hygiene expertise strategies in education from the perspective of modern practices of cross-cultural analysis in domestic and foreign science.

The aim of this study was to analyze quality-of-life parameters in patients with coronary heart disease in Chelyabinsk region. The number of patients with coronary heart disease who took part in this research was 830 people. The data were collected with using of application form that was supplemented by the Russian-language questionnaire SF-36. We determined the medical and social characteristics, the assessment of the conditions and lifestyle of patients with coronary heart disease, and the subjective assessment of the quality of life by themselves. We have been revealed statistically significant differences in assessing the quality of life by patients of different territorial groups. The data should be differentially use in developing of regional and territorial programs in order to reduce mortality from coronary heart disease.