Peculiarities of consumption of health care goods and services 0. Peculiarities of the health care services market. Healthcare Labor Market

ITS PLACE IN THE GENERAL SYSTEM OF POPULATION NEEDS FEATURES OF CONSUMPTION OF GOODS AND HEALTH CARE SERVICES

The main purpose of the economy as an economy is to provide people livelihood and maintain the conditions of existence necessary for people. Main condition of existence a person is served by his health, therefore, maintaining the health of people is legitimately considered as one of the defining tasks of the economy.

The means of subsistence in conjunction with the conditions of existence are designed to satisfy the needs of people, including such a fundamental one as the need for health. Since the need for health cannot be satisfied directly, by producing and providing, selling to the consumer a product called "health", the economy is able to satisfy this specific need only through services and goods that promote the maintenance and promotion of health, prevent diseases and cure them. .

Considering that the needs for health care services and goods are manifested and are in direct relationship with other needs of people, the state, society and form an integral part of this general system of needs, we will consider human needs as a whole, highlighting the group of needs we are interested in. At the same time, let us establish the place occupied by the needs for health goods and services in common system personal, family, social needs.

Everything that a person needs, that he needs, without which it is difficult or even impossible to live, is called needs. All people strive to satiate or, as economists say, to satisfy their needs. Things, objects, services with the help of which a person, family, people satisfy various, numerous needs, are usually called goods.

The need for health is undoubtedly one of the primary vital needs, the satisfaction of which is the main task of health care and is ensured by all its means, including economic ones. Therefore, health itself as a source of satisfaction of vital needs and medical methods and means of health care should be considered as benefits.

Some human needs, such as oxygen, water, partly heat, are met from natural sources. Nature itself has created the conditions of existence, thanks to which a person saturates such needs without much effort and expense, like animals. it freely available to allgood, for which you do not have to pay money or pay with labor, give other things in return. Man owes the presence of such free goods to nature. Concern for natural resources, protection of the natural environment, its restoration is a kind of payment for free benefits.

Natural sources in the form of fresh air, clean water, sunlight and heat also represent free goods that contribute to the preservation and promotion of health. This and much more is received by a person from nature in the form of natural medicines and methods of treatment. As accessibility decreases, such benefits are less and less free. In addition, due to the adverse environmental consequences of the production and economic activities of people, leading to environmental pollution, many types of natural benefits that people cannot do without become anti-benefits that undermine human health.

But many other needs, especially in food, clothing, shelter, movement, spiritual goods, can only be satisfied with the help of the means of subsistence created by people themselves. This, as mentioned earlier, economic benefits that people don't get for free. They are

can only be obtained for money, through the expenditure of labor, or in exchange for other goods.

And can we consider economic, paid, say, medical services, schooling, free travel for pensioners and the disabled in public transport? And much more, for which all citizens or their individual categories do not pay money? Yes, these are economic benefits, for which not the one who receives them pays, but other people represented by the state, society. Such benefits are known as public.

Actually, one has to pay for free, natural benefits, spending efforts on picking up the fruits of nature, carrying out environmental protection measures. So there is no clear boundary between paid and free goods. The continuous increase in the needs of people, the increase in their diversity, on the one hand, and the limited possibilities for satisfying them due to the insufficiency of available sources, on the other, lead to an increase in the share of economic benefits in comparison with free, non-economic ones. Even natural water and clean air are becoming less and less accessible, more and more often you have to pay money for benefits that were free. More and more benefits a person receives not directly from natural sources, but through the economy, economic activity. The creation by people of the things they need, benefits is the main economic process, called production.

Created by people products and services health care are, of course, economic benefits. Even medicinal herbs and medicines of natural origin, treatment through the use of thermal springs, mud, mineral waters require preliminary efforts in the form of collection, preparation, arrangement, packaging, transportation and other procedures. Certain types of natural remedies used require the support of medical personnel. All this testifies to the economic nature of benefits in the form of goods and services used in health care.

The very processes of creating and using treatments are so closely related to the economy that it is appropriate to call them not the provision of services, but prodhealth leadership.

Use, application, use of goods, satisfaction of needs, satisfaction of needs in economics called consumption. The word "consumption" must therefore be understood in its own broad sense, meaning both eating, and wearing clothes, and living in a house, and traveling in a car, and serving in a bathhouse (consumption of services), and reading a book (consumption of spiritual goods). Consumption is the final process in the name of which the economy works, operates. It is legitimate to consider consumption as the goal of the economy, but with one significant caveat. It is necessary to consume exactly as much as is required for a full life, in volumes determined by the physiological needs of the body, the spiritual needs of the individual, rational, scientifically based standards. Otherwise, consumption can develop into unrestrained, harmful consumerism, those. consumption for the sake of consumption, and not for the sake of satisfying needs. Consumer trends often lead to the accumulation of goods in excess

quantity, beyond all measure, and besides, also unused. The causes of consumerism most often lie in greed, money-grubbing, immoderation

The consumption of health goods and services fits into the above general description of consumption, but at the same time has certain characteristics. If we are talking about medicines, special types of clothing and footwear for sick people, bandages, bandages, devices that facilitate the performance of vital functions, and other similar means, then consumption means in the economic sense use, useknowledge. Consumption of medical equipment means its usage in the process of diagnosis and treatment. The same applies to buildings, premises, equipment that form the fixed assets of healthcare organizations.

The situation is more complicated with the consumption of health services in the form of diverse activities of medical and auxiliary medical personnel. In health care they are called treatment, nursing. In the economy, the use of services, including medical ones, is commonly called service consumption, at the same time, this is understood as the receipt by the consumer of benefits in the form of the results of the activities of persons providing him with assistance, assistance, treatment, service.

In health care, the consumption of services is not always the final process in the full sense of the word. Services complete a certain type of production and treatment activity or stage of the treatment process. The rest, which completes the process, is the assimilation by the patient's body of the results of treatment. An indirect analogy is the consumption of food, which, strictly speaking, is completed by its assimilation by the body. The only difference is that the results of treatment are rarely absorbed as quickly and reliably as food. The consumption of certain types of health services, for example, diagnostic, consulting, health-improving services, can be legitimately considered the final procedure of the corresponding types of activity.

There is reason to talk about consumer trends in health care, watching the sick or even pseudo-sick, ready to spend the bulk of their lives in medical institutions without the need for it. In particular, overconsumption, harmful consumerism is manifested in the immoderate use or even abuse of medicines, unconditioned by the need for health.

Many people's needs are saturable in the sense that they can be sufficiently satisfied by known means. For example, it is quite enough for a person to consume a diet with a calorie content of approximately 2500 calories per day. Consumption beyond this limit of saturation becomes excessive, even harmful. Another thing is that people always want to consume more varied, tasty food. Or it is unlikely to have more than two refrigerators in the apartment. But the need for knowledge is limited by a clear boundary. Among the unsaturated, unlimited include the need for cash, although there is a known limit to the number of

money, quite sufficient for a comfortable existence of a person.

As for the needs for health care goods and services, they should, in our opinion, be classified as saturable. Even the original need

in health is satiated in the sense that the painless state of health of a person whose body normally performs its inherent functions may well be called the norm of health that sufficiently satisfies the needs for it. Accordingly, the saturation of the need for health care goods and services should be considered the possibility of obtaining them in quantity and composition, time and place, determined by the state of people's health and objectively necessary means of maintaining it. At the same time, the quality of methods and means of treatment, scientific knowledge about human health is not limited by a predetermined limit.

Are the needs the same? different people? It is obvious that certain needs, for example, for food, clothing, knowledge, are characteristic of all people, while others are far from being for everyone, but only for those who need them. The need for health is obviously inherent in all normal people, but the need for certain health services and goods is for those who need them. It appears that the need for modern diagnostics the state of the human body, dangerous diseases, in anti-epidemic measures, in sanitation and hygiene, in health-improving procedures are universal, apply to all people (to a slightly different degree, depending on age, gender, health status, regional characteristics).

To a certain extent, the needs of a person, family, group of people, society differ. Therefore, allocate personal, family, group, communityneeds.

The needs for services and goods intended for the protection of human health, treatment, are mostly personal, individual in nature. The object of care, service, satisfaction of needs for medical supplies is ultimately a person, a person. Health individual person there is that elementary cell that makes up the level of health of families, social groups, the population of the region, the country. Therefore, the personal needs of a person in the means of maintaining health form the basis of the entire system of needs for health services and goods.

In addition, there are personal needs, due to the fact that in medicine a huge role is played by self-medication, home treatment under the supervision of doctors, and even self-treatment. Any person needs a home first aid kit in the form of a set of standard or individually designed medicines. Each person must have devices for measuring temperature, and in some cases - special equipment, the appearance of which is determined by the nature of the disease. The presence in every home of health-improving, sanitation and hygiene facilities has become a sign of medical and even general culture.

The category of personal needs in healthcare facilities should include the availability of elementary, common medical knowledge, household reference medical literature, the ability to recognize signs of a sudden widespread disease and provide the simplest emergency care. People who are prone to diseases or chronically ill need a means of calling for medical help.

In special cases, individual patients can afford to meet the need for a personal doctor, more often people use the services of family doctors.

Family medical needs may exceed the sum of the personal needs of each family member, since sometimes health and health problems arise that relate to the family as a whole due to, for example, hereditary diseases, the danger of spreading the disease of one of the family members to the whole family. Individual health care products, physiotherapy exercises, drugs may be the object of the needs of the whole family or several family members. This fully applies to the subjects of sanitation and hygiene.

For all the importance of personal and family needs for health care services and goods, such needs can be met almost in full, at the normative level, only when they become part of group, public needs. There are compelling reasons for such a conclusion.

First, rendering medical services individually to each person in need of them at home, through personal treatment, would require a significant increase in medical personnel, the delivery of treatments to each individual, which would lead to a huge increase in costs and the cost of care.

Secondly, the provision of health care services in their public form makes it possible to concentrate medical staff, medical equipment, diagnostic and treatment tools, create favorable conditions for treatment and the provision of other services required by medical science within relatively narrow areas of polyclinics and hospital hospitals. This significantly improves the quality and reliability of service and treatment by making it complex, comprehensive and providing sterile conditions. In addition, with a collective, multi-personal service, cost savings and a better use of the production potential of clinics are achieved.

The reasons given are so significant that they give grounds for asserting the social nature of the bulk of the needs for health care. There is no doubt that the health of each person is of intrinsic value both for him personally and for the state and society. It is clear that the processes of treating patients are personally oriented, mass treatment is the exception rather than the rule. But the needs for health services and goods are of a public nature in the sense that they are characteristic of almost all people and can only be fully satisfied.

3 using public forms. Thus, the consumption of health care products is predominantly mass public

And Rakter, has a social nature.

This thesis is also supported by the consideration that the same concerns

Evania, for all their specificity, is characteristic of many people, has

Etion to spread on a massive scale. Therefore, the treatment of one tre-

There is no cure for many in the same way that the treatment of many requires the treatment of Ka *Dogo of them.

The public need for health care arises as a result of the integration, connection and interaction of personal and family needs. With group, collective. The ship's crew needs a ship's doctor and a medical center, the population of the village - a small clinic, the city needs a variety of clinics, hospitals, doctors, and the country as a whole - a comprehensive health care system that can meet the needs of the entire population.

In economics, needs are usually divided into material and spiritual. material call the needs of people in things, objects, material values, while spiritual needs- this is the need for spiritual food in the form of knowledge, beliefs, cultural values, information, information about the world around us, intellectual communication.

Health needs are both material and spiritual in nature. Material needs include the need for medicines, clinical nutrition, medical clothing and footwear, material and technical means of treatment in the form of materials, energy, equipment, vehicles, devices, premises, buildings, structures. The need for the science of health, for medical knowledge, for information about diseases and methods of their treatment, for consultations, for a culture of health, for healthy way life.

These are fairly obvious truths. But it is not always so easy to classify health care needs as obviously material or spiritual. The problem is not solved in such a simple way with regard to the nature of health services in the form of essential medical activities in the process of treating patients. The need for an operation to remove or even replace organs and their parts is formally material in nature and is directly related to the application of physical effort. But it is inseparable from the spiritual need in the form of the initial establishment of the type of disease and the method of treatment. Examining the patient's examination data, listening to his complaints, prescribing a medicine, the doctor most likely satisfies the spiritual needs of the patients, but in the process of taking medicines, using other material means of treatment, the needs materialize, acquire a material form.

The thing is that health itself combines inextricably linked, interacting material and spiritual principles. Therefore, both the need for health and the need for healthcare facilities that provide it are of a complex material and spiritual nature. This connection is so strong that it is often not possible to separate the material and spiritual aspects of health services. This is one of the most characteristic features health care services, needs for them and the processes of their consumption, which distinguishes the health care economy into the category of very specific sectors of the economy and the service sector.

Usually, it is customary to rank people's needs, establishing a measure of importance, significance of a particular group of needs in the general hierarchy, often depicted as a "needs pyramid". Sociologists quite often place at the top of such a "pyramid" the need of people for self-realization, self-expression, self-affirmation, and at the base of the pyramid -

physiological needs, considered as the simplest, are not so

chimy and important. At the same time, the need for health and healthcare is not

ZN is separated as independent, but is included in the need for security

The nursery should proceed from the fact that the need for health and its protection is

essential character and without its satisfaction other needs cannot

be realized, then this need deserves the highest place.

Since health is initially present in a healthy organism, psycho-

until the need for health becomes adequate to the need for life

Only by virtue of the loss of health comes the realization that the physical and

spiritual health is the main, main life value.

Questions

1. 
   What are needs and how are they related to the conditions and means of existence
   people?
2. 
   Name the main types of benefits and sources of their receipt.
3. 
   How are the production and consumption of goods in the form of goods related?
   and services?
4. 
   Describe the types of needs of a person, family, society in interconnection
   with health economics.
5. 
   What is the social nature of health care needs?
6. 
   How are material and spiritual needs related?
7. 
   What does the “pyramid of needs” mean and how is it built?

1.4. PRODUCTION AND ECONOMIC PROCESSES IN HEALTH CARE

Consumption, satisfaction of needs, representing the ultimate goal of the economy, are inextricably linked with production, that is, with the creation of an economic product that is then consumed. Production not only ensures current consumption, but also creates the opportunity to recreate and reproduce the consumed product of production activity again and again. The processes of treatment, health care are usually not called production, although in reality health care is nothing more than the production of medical services or (in a broader sense, the production and reproduction of people's health).

The production processes in the economy are as continuous as the life of the people of society, which they are called upon to provide with the necessary means of subsistence. The economy, the core of which is production, is dynamic. The development of the economy, the change in its conditions are due to a number of reasons.

Firstly, the natural source of Economics - nature - is changing, constantly exhausted. So you have to limit consumption

natural resources, create interchangeable, restore renewable resources.

Secondly, it is necessary to constantly maintain the consumption of people's means of subsistence and the conditions of their existence. So the "production boiler" must cook more and more new food. Moreover, due to the growth in the number of people - consumers and the increase in their needs, it is necessary to prepare more and more voluminous and tasty "economic food". And just as the existence of people, society, does not stop for a minute, cannot interrupt its operation and the production economy - the life support system.

Thirdly, everything created by man, the economy in the form of a "second nature" - the means of production and infrastructure - is constantly wearing out. A dynamic economy is designed to recreate and reproduce the anthropogenic nature.

Fourth, scientific, technological and social progress stimulates people to look for new ways and means of production, improve their lifestyle - this is another incentive for the economy to continuously function.

The economy, therefore, is called upon not to be at rest, but to act, to work for the people and in the name of the people. Economic actions also include the production activities of the people themselves, their interaction with the means of production and among themselves. Production leads to the transformation of economic resources into the economic product needed by a person, society.

Factors of production

The economic resources involved in the production process begin to play the most active role in it, turning from a source into a participant in production. To emphasize this important circumstance, it is advisable, along with the concept of "production resources", to use the concept of "factors of production". Under production factors understand the types of economic resources that are used in production, become participants in it, affect the quantity and quality of the product produced, including the production of health services.

AT economic theory quite often the concepts of "production resources" and "factors of production" do not differ, they are considered identical. This view implies that the factors of production are formed from economic resources. And yet there are certain differences between the factors of production and production resources. A resource is something that can be used, something that is intended for use, and factors - something that affects production, is used in production processes, including in production activities, the provision of services.

In economics, the three factors of production that have become classic are widely known: land, labor, capital.

Land as a factor of production is not only land in the proper sense

ova, that is, land and the location of production facilities - the Earth is understood in a broad sense as the totality of all natural

cvpcoB planet Earth involved in the production process. These are arable land, other agricultural land, land under the object-industrial purpose, minerals, water resources, air basin, vegetable and animal world nature. Because healthcare uses Natural resources, a natural conditions affect health, the natural factor plays a significant role in the health economy.

Labor, understood as a factor of production, is the employed labor force, that is, the part of the population participating in production activities. Labor - production factor- usually measured by the number of workers employed in production, or the amount of working time spent by these workers. At the same time, the quality of labor, its productivity, and returns are also taken into account. In the health care economy, the labor factor plays a decisive role. The volume and quality of medical services provided, the degree of satisfaction of needs for them, and the effectiveness of treatment directly depend on the quantitative and qualitative composition of medical personnel.

Capital is the third factor of production. It is understood as the means of production created by people used to obtain the manufactured product. This is, first of all, fixed assets in the form of industrial buildings, structures, equipment, instruments, apparatus. It is customary to include production as capital. infrastructure in the form of means of communication, communication, heat, energy and water supply.

In economics, the main means of production, considered as a factor of production, are called physical capital, to emphasize its material, material nature. In practical, applied economics, fixed assets are also called main funds.

In the health care economy, the main means of production are important role, because the:

1. 
   the presence of buildings and structures, equipment determines the number of places (pain
   beds) in hospitals, and in polyclinics - throughput, -
   all this affects the comfort of treatment;
2. 
   the availability of instruments, equipment determines the quality and efficiency
   treatment;

-k °^ The volume and st RU kt SD and fixed assets serve as a determining condition - "The effectiveness of recreational, restorative health care.

The word "capital" is also tied to money, understood as

lower capital. However, money capital, unlike physical capital, does not

It is customary to consider it a factor of production, since money itself is in pro-

do not participate in leadership. But money capital, called investment

and or investments, used to purchase fixed assets

ic capital, becomes a tangible, important factor of production

> especially when it comes to expanding it, increasing the

A > competitiveness.

Considering the concept of "production capital" in a broad sense, it should be added to fixed capital negotiable in the form of current, rapidly expendable resources of production. The need for working capital is often acute in medical organizations, and in terms of its importance, this capital should be included in the third factor.

In addition to these three leading factors of production, one more, fourth factor is often mentioned in modern economic literature. it entrepreneurship, entrepreneurial activity, entrepreneurship. Entrepreneurship characterizes people who are actively involved in production and in production management, who are able to effectively, optimally use economic resources in order to obtain the highest results. The entrepreneurial abilities of the organizers and participants in production make it possible, with the same economic resources, to obtain an economic product in a larger quantity and best quality. If the volume of production is given, then, thanks to the entrepreneurial factor, it is possible to reduce the amount of resources expended, to carry out production at lower costs, using resource-saving technologies and progressive methods of organizing labor and production.

In the process of establishing market relations in the Russian economy and partly in health care, an idea arose of entrepreneurship as a private sector that diverts funds, factors of production from the state, public sector. Meanwhile, the essence of entrepreneurship is different. It is designed to inspire initiative, direct efforts to find ways to more fully, better, more affordable meet the needs for medical goods and services in comparison with the level provided by public medicine.

can also be considered as a factor of production. scientific and technical potencial, characterized by the degree of education, professionalism of workers, the progressiveness of the means of production used, the use of scientific achievements in production. The scientific and technical and technical and technological potential of health care is one of the main criteria for the ability of the health care system to fulfill its main purpose.

Knowledge of the factors of production makes it possible to assess the production capabilities of the economy as a whole and its individual links, such as the health care economy.

Action production system

Since the economy is designed to produce what people need, its main function is to production final and related intermediate economic product. Economic objects involved in production and flowing in it production processes called productionNoah system. The simplest structure of the production system and the scheme of its operation are shown in fig. 3.

This is a general, enlarged scheme of production related to any type of production and economic activity. The specifics of the production

Rice. 3. Scheme of the production system.

of the health care system lies in the way in which productive resources are transformed into an economic product of productive activity, and in the nature of the product itself. Such a transformation always occurs in the process of production activity.

From everyday life, household appliances are well known that transform one type of product into another. Having turned meat, bread and onions in a meat grinder, we get minced meat. Putting meat, potatoes, cereals and salt in a pot of water, pouring water over them and boiling them, the cook will cook meat soup as a result. By putting firewood into the stove and burning it, we get heat.

The manufacturing economy operates in a similar way. Economic resources are fed into it, and as a result of the production transformation of which an economic product is created. Of course, the analogy between a production system and a meat grinder or a saucepan is largely arbitrary. In production, we are not dealing with the transformation of one type of resource, let's say material, into one type of product, but a wide variety of resources into a variety of products, and in a variety of ways.

Economic resources include both natural and labor, and means of production (tools and objects of labor), and information. All these resources enter the production system and mix and combine in it. But this is not a mechanical connection, but the production interaction of resources of different origin. Labor resources, using fixed assets and information, applying a variety of technologies for processing natural resources, raw materials, materials, energy, ensure the creation of the necessary product of the required quality. So the production process as a whole is much more pure and diverse than a specific type of transformation of one material into another. But still general scheme The action of the production system in the foot resembles the process of turning one thing into another. in Health care, the work of medical workers in its unity and interaction with equipment, preparations, sources of matter and energy Affects the human body, ensures the maintenance, strengthening, restoration of health through the production of diagnostic results, medicine Nnghh means, updated organs, conditions life activity, in a ko-Nom account - health itself. Of course, Dicine's production activities are very specific in that the transformation of resources
covers the involvement of a person - the object of treatment, in the process of transformation. In addition, the produced product is also exceptionally original, which can be informational (diagnosis), material (medicine), physiological (physiological changes in the body achieved through treatment), a new or renewed organ (the result of an organ transplant, surgery, drug exposure), improvement in health status.

At the beginning of the working day, many millions of people go to enterprises, institutions, their jobs, ready to realize their labor abilities. As soon as these people begin to perform their work duties, they become workers, production participants, part of the production transformation that turns resources into an economic product. Those involved in the production process labor resources, representing the most important, creative part of the resources of production. In health care, labor resources are represented by medical personnel, scientists, support staff, employees of the administrative apparatus.

During its labor activity workers use fixed assets of production(sometimes called fixed assets) in the form of buildings, structures, machines, equipment, tools. As soon as a worker turns on a device, unit, machine, these resources become an integral part of the production transformation. They contribute to production and themselves participate in the transformation of production resources into a manufactured product, gradually wearing out, partially devoting themselves to the goals of production. Fixed assets represent material and material resources of production, along with others material resources, such as the materials used in production and the energy that forms working capital. AT unlike fixed assets, current assets are fully used during one production cycle (for example, dressings, a syringe, a portion of a medicinal product), that is, they are not used repeatedly.

The production process captures, "sucks" Natural resources in the form of natural resources. People are involved in the production of many types of minerals, flora and fauna of nature, water, air, earth. Thus, natural resources are converted into working capital: raw materials, materials, fuel, energy, which enter the converter and become participants, components of production. They are the material basis of the economic product.

In medical production activities, natural resources such as medicinal herbs, mineral waters, healing springs, mud, natural recreational products are directly used. At the same time, natural resources form the material basis for the creation of material means used in medicine.

federal agency health

and social development RF

GOU VPO Altai State

Medical University of Roszdrav

Department of Economics and Management

Test

in the discipline "Health Economics"

on the topic: Medical service as an economic category.

Option No. 5

Completed by a 4th year student of 792 groups

Full name Bolotskikh T.E.

Checked by: Vorobieva V.V.

Barnaul - 2010

1. Introduction…………………………………………………………………..3

2.1 Features of medical services………………………………………………………………………………………………………………………………5-8

2.2 Private and public health services……………………….8-11

3. Conclusion………………………………………………………………..11

4. List of used literature………………………………………………11

5. Practical part……………………………………………………….12

Introduction.

The modern understanding of health has long gone beyond reasoning on moral and ethical topics and is considered, among other things, as an economic category. The characteristic features of medical services are considered in detail. Particular importance is attached to highlighting the differences between private and public goods in the composition of medical services. This allows you to identify the features of the functioning of health care in the conditions of modern market economy. As a result, it is possible to identify the theoretical prerequisites for the existence of market and non-market relations in the health care system, as well as their relationship. The dual nature of the medical service leaves its mark on the development of the entire health care system.

Medical service as an economic category.

In the course of the functioning of the public health market, special economic benefits are created: medical and diagnostic services, pharmaceuticals, medical equipment and tools, etc.

Good is everything through which human needs are realized. Medical services as benefits satisfy the human need for medical care, protection and promotion of health.

In terms of the scarcity of goods in relation to our needs, we speak of economic goods. They are the result of human activities. A medical service as a good is called economic if its possession is for the subject the result of refusing to possess another good. At present, given the continuous increase in people's need for high-tech methods of diagnosis and treatment, for highly effective medicines and medical equipment, a significant part of medical services is classified as economic benefits. But there are also such benefits that, in comparison with our needs, are available in unlimited quantities. Such goods are called free, or non-economic. These are natural resources in the form of, for example, mud or balneological treatment. Fresh air, clean water, sunlight, herbal remedies are also free goods.

It is advisable to carry out the division of goods into goods and services, based on the sign of materiality.

A commodity is a product that is in material form. In health care, goods are goods that are a condition for the provision of medical services. These include medicines, medical devices. They can be accumulated, stored for a long time, provided to consumers regardless of the place and time of their creation. Usually such a product is only an attachment to medical activities.

Service is action. Unlike goods, services do not have the property of accumulation, preservation over a long period of time. The process of their production and consumption, as a rule, coincides in time and space.

It should be emphasized that there is no significant disagreement in the economic literature about the definition of a service. Usually, a service is understood as a specific production activity, the results of which are expressed in a beneficial effect that satisfies any human needs.

Describing the service, K. Marx wrote: “This expression generally means nothing more than that special use value that this labor adds, like any labor; but the special use value of this labor has here received the specific name of “services” because labor provides services not as a thing, but as an activity…”; referring to consumer services. K. Marx further noted that "at any given moment, among the commodities, along with the commodities that exist in the form of goods, there is a certain number of commodities in the form of services."

F. Kotler gives the following definition: “A service is any event or benefit that one party can offer to another and which is basically intangible and does not lead to taking possession of anything. The production of services may or may not be related to the commodity in its material form. “Services are understood to mean a wide variety of activities and commercial pursuits.”

In the work of Economics, K. McConnell and S. Brew believe that a service is “that which is intangible (not visible) and in exchange for which a consumer, firm or government is ready to provide something of value” .

Russian scientists also understand a service as an expedient human activity, the result of which has a beneficial effect that satisfies any human needs.

Thus, summarizing all of the above, we can assume that the meaningful certainty of a service as a good contains something special. This good is a relationship between people, an intangible beneficial effect of the direct interactions of economic entities, i.e. the result of material activity, regardless of whether this result acquires a material form.

It is customary to distinguish between material services, when the beneficial effect of the activity is embodied in a material object, and the so-called intangible, pure services, when the beneficial effect is directed directly to the person himself. The basis of the allocation of material and non-material goods in the classical economic theory was assumed to be the form of being, from the point of view of its materiality or lack of it. Therefore, to material wealth Goods were things, and intangibles were services. In semantic terms, the use of the concept of “non-material good” is incorrect, since all goods are material, and materiality and materiality are not identical concepts. Proceeding from this criterion, Soviet economic science, as it seems right, attributed services of the first kind to the sphere of material production, and the labor for their provision to productive labor, which increases the value of the goods created in society. The so-called non-material sphere was considered non-productive, and the work of providing pure services (including the activities of health workers) was considered unproductive, not creating or increasing value, although socially useful. The process of transformation of the economy, the recognition of human capital as national wealth, forced many to rethink this assessment. An analysis of publications on this issue (Boyarintsev V.I., Korchagin V.P., Kucherenko V.Z., Lisitsyn Yu.P., Polyakov I.V., Seleznev V.D.) allows us to conclude that the approach to healthcare is gradually being overcome as a non-manufacturing area. The health of the nation, and, consequently, measures to preserve and strengthen it, are beginning to be considered as one of the most important factors determining the national security of the country, its national wealth.

Health services are the activities of health professionals that result in the beneficial effect of restoring, maintaining and promoting health. The product of medical activity is formed in the process of providing medical services. Medical activity does not end with the creation of material wealth, it does not end with the act of their appropriation. Medical activity is aimed at changing the state of the object, which is a person. The task of medical activity is not to create any benefit that can be appropriated, but to change the unfavorable state of a person to a state that can be considered a blessing.

The statement of Academician Yu.P. Lisitsyn on the productive significance of the labor of workers in the entire healthcare industry. In this regard, the scientist notes that "the main economic and medical category - a medical service, as you know, is not a spiritual concept, but a materialized one, manifested in the specific activities of a physician and paramedical personnel in the implementation of specific measures for the prevention, diagnosis, treatment, rehabilitation, administrative and economic , managerial and other actions aimed at maintaining, strengthening, improving, reproducing individual and public health.

2.1 Features of medical services.

Although services are only a kind of specific professional activity and do not have fundamental differences from the point of view of economic interpretation, nevertheless, in healthcare, as in any other industry that provides services, there are some peculiarities.

The following characteristic features of medical services can be distinguished:

The intangibility of medical services. Features of health care services are manifested, as a rule, through their embodiment in the person himself and are mostly in the form of intangible services (intangibility). The intangibility of services is manifested primarily in the impossibility of demonstrating their effect to a particular patient, up to direct provision. No patient ever manages to know in advance everything about the beneficial effect and side effects of the services provided to him. The assessment of the usefulness of this service to the patient and the possible side effect is usually carried out by analogy with the provision of similar services to other patients. I would like to note that modern information technologies make it possible in some cases to carry out computer forecasting of the usefulness of a service before it is provided (for example, in reconstructive plastic surgery), we should not forget that this is only an approximate estimate that does not fully take into account many parameters.

At the same time, part of medical services may have, in addition to intangible manifestations, a material embodiment (commodity component). For example, the installation of intravascular stents, pacemakers, orthopedic prostheses, the use of filling material, dental crowns and prostheses, organ transplants, etc. Thus, part of medical services contains both intangible and material (commodity) components. It is rather difficult, and sometimes impossible, to draw a clear line between tangible and intangible services, because you can see the interpenetration, the formation of adjacent forms. The degree of tangibility of each specific medical service is determined by their quantitative ratio. The division of medical services according to the degree of their tangibility is used in the construction of evidence-based pricing methods. I would like to note that an increase in the degree of tangibility of medical services has a significant impact on the increase in their cost (typical for Russia due to the low wages of medical staff).

individual character. Health care services almost always have a pronounced individual character, as they are intended in most cases for a specific individual. At the same time, the quality of medical services is largely determined by the initial state of the consumer (patient). Even with the mass provision of services, one should not forget that in the end the service is provided to a specific patient. This leads to a high degree of individualization of the medical service production process and, as a result, to the difficulty of predicting the expected effect. This feature makes high demands on the social responsibility of healthcare workers, and also puts forward the need to insure their professional activities.

The continuity of the processes of supply and consumption. The consumption of a significant part of health services coincides with their production in time and space, which naturally follows from their individual nature. This feature is due to the fact that these processes are carried out with the direct interaction of the subject and object of medical activity. In most cases, the provision of medical care requires the direct participation in this process not only of health workers, but also of patients-consumers of medical services. There are no exceptions to this rule and services related to the creation of material objects - pacemakers, dentures, orthopedic products. At various stages of the provision of these services, however, there is inevitably a need for direct contact between the service provider and their consumer.

Medical services are a useful activity that does not create material values, they usually do not lead to ownership of anything. Although it happens that a person, receiving a medical service, for example, in the form of dentures, also acquires the prosthesis itself (an element of the product in the service).

An element of a product in a medical service can be an extract from a medical history, medical examination data, a doctor's prescription, etc. But an element of a product in a service still cannot be considered as a product in the full sense of the word, because an element of a product in a service is inseparable from it and, as a rule, has no independent value.

Recently, due to the improvement of people's well-being and the development of new technologies, there has been an increase in the number of medical services provided. Investments related to the provision of medical services are considered profitable in developed countries with a market economy. Moreover, not only private investors who invest their money in the creation of medical organizations and those who profit from it, but also the state, because a healthy person, participating in the creation of GDP, generates income, and the country spends less money on treating diseases and paying disability benefits.

At the same time, some types of medical services require large investments, such as the services of hospitals, sanatoriums, diagnostic centers, while others, for example, the services of a massage therapist, dentist, reflexologist, can cost a relatively small initial capital investment. But all of them are distinguished by a high level of professionalism of workers.

An important component of the medical market is the definition of the service involved in it. But, despite the development of healthcare and its strengthening in the economy, a generally accepted definition of a medical service has not yet been developed, because. definitions that are important in economics in general may not always apply to health economics in particular. Thus, it is considered that a service is a change in the state of a person or a product belonging to an economic unit, which occurs as a result of the activities of another economic unit with the prior consent of the first. However, if the patient is in an unconscious state and he needs medical care, then he cannot agree to provide it, and even more so to pay for it. Of course, the patient needs help, but the question arises, who will pay for it and how much?

When answering the question of what makes a consumer, seller or enterprise interested in a particular product, we come across a very significant in the theory of exchange, but little specific concept of utility. There is consumer benefit and producer benefit.

The benefit of the consumer (patient) can be understood as the subjectively assessed ability of the product to satisfy the needs of one's own health. Each product has a known basic benefit, which consists in its technical and functional features (quality in the narrow sense). From this it is necessary to distinguish additional benefits associated with features that do not directly affect the existence or functioning of the product, for example, a heated emitter of an electric massager. This also includes additional product functions (the possibility of using it for purposes not originally intended), as well as accompanying circumstances (purchase, payment, removal of the product after use).

Finally, additional benefits include features of the product that increase the degree of satisfaction and prestige of its user, and the product often takes on the character of a symbol of a certain social status.

However, the “benefit” or “benefit” derived from a medical service is difficult to describe. If it is still possible to describe the basic benefit of a medical service, which is expressed in relieving the patient of suffering, then additional functions of medical services are quite rare, although they do exist. So, for example, a person who treated a disease in a sanatorium often acquires an increase in the general level of health caused by proper nutrition, rest regimen and physical education. If a person rests in a prestigious sanatorium (for example, in Baden-Baden), then he maintains a certain social status.

The benefit of the provider of a medical service (doctor, hospital) usually consists in profit, growth of the enterprise, guarantee of further activity, optimal capacity utilization, prestige, improvement in the quality of the patient's health, etc.

There are a number of definitions of medical service. All of them are the point of view of their authors, but only a few really reflect the essence of medical services. Let's analyze the definition: "Dental service is any activity or benefit that one party (dental clinic, dentist) can offer another (patient)" (L.N. Tupikova, S.E. Tupikov, 2002). We believe that such a definition does not sufficiently reflect the focus of the service on human health. So if a dentist provides transportation for a patient to take him to an appointment, or a dental clinic sells toothpaste to the other side (economic benefits), this is unlikely to be a dental service.

The following definition characterizes a medical service as “professional actions aimed at maintaining or maintaining an optimal level of health of an individual” (A.V. Reshetnikov, 2003). This definition really reflects the focus of medical services on human health. But, with the undoubted correctness of such a postulate, in the definition of a medical service, it is necessary to include such a concept as benefit. So S.I. Ozhegov in the Dictionary of the Russian Language defines a service as an action that benefits another.

The provision of medical services, paradoxical as it may seem, may not always be aimed only at maintaining or maintaining the optimal level of health of the individual. According to a number of data, about 2,000 teenage girls a year in the United States undergo breast augmentation surgery, and in 1998 the number of such operations doubled compared to 1992. The German magazine Der Spiegel notes that in Germany, according to approximate It is estimated that between 300,000 and 500,000 cosmetic surgeries are performed annually. At the same time, today dentists, gynecologists and dermatologists already offer cosmetic surgery and laser skin resurfacing in order to compensate for the decrease in fees from health insurance companies. The number of clients affected by cosmetic surgery has increased 10 times since the 1980s. Among them there are patients with scars on the face, blinded after surgery, even a fatal outcome has been recorded. There is a known case of coma after fat removal, as well as suicide after a failed cosmetic surgery. All this is clearly not conducive to maintaining or maintaining an optimal level of health.

A person may have a number of special needs, which he can satisfy with the help of a medical service, incl. receive cosmetic surgery services: hymenoplasty (plasty of the hymen); circumcision performed during the operation of preputiotomy during ritual circumcision of the foreskin (among Muslims, Jews); increase the volume of the breast (often for commercial reasons of the patient). Although there may not be direct medical indications for surgery in these cases, these services have consumer utility for the patient. In some cases, the provision of medical services at the request of the client may cause the latter, in the future, quite significant harm to health, but subjectively, at some point in time, a person can benefit from this and he is ready to pay for it.

In connection with the foregoing, we (S.A. Stolyarov, 2003) define a medical service as follows: “A medical service is any professional action aimed at changing or maintaining physical or mental health, in order to benefit its consumer (patient), in one form or another."

In the world there is a tendency to diversify the service sector. Many previously separate types of services are beginning to be combined within one company, incl. and in healthcare. By offering a range of services, health care facilities can increase their competitiveness, weaken possible risks through their diversification.

Often services merge into a single complex of financial services. There is a combination of various services within the business. Health care firms are beginning to offer life and health insurance services, tourist services for the treatment and rehabilitation of patients abroad, etc. The hospital can open a pharmacy kiosk for the sale of medicines and medical equipment; conclude an agreement with an insurance company for the provision of paid medical services that are not included in the mandatory list of free services; to offer (for a fee) the transportation of convalescents home with their own transport, etc.

Medical services, like a number of others, have 5 main characteristics (Figure 1.9) that distinguish them from goods such as medicines: lack of ownership; intangibility; continuity of production and consumption of services; inability of services to store; quality variability.

Rice. 1.9. Properties of medical services

1. Lack of ownership. If a person has purchased a product that has a physical embodiment, then he becomes its owner, which cannot be said about the service. People are forced to purchase medical services throughout their lives. By consuming a service, a person has access to it for a limited period of time. Having an insurance policy in hand, its owner can only see a doctor during a certain period, which is paid by the patient.

2. The intangibility, elusiveness or intangible nature of medical services, such as examinations, means that they cannot be transported, stored or packaged at all. And you cannot demonstrate, see, try, or study them before receiving these services. At the same time, it is possible to evaluate medical services only after they have been received, and even then with difficulty.

The intangibility of medical services causes problems for both their sellers and buyers. This means that potential consumers cannot see or touch many medical services before purchasing or using them. A typical question they might ask themselves is, “What could this be like?”

It is difficult for the patient to understand and evaluate what is being sold before purchasing the service, and sometimes even after receiving it. He is forced to take the word of the service seller. For example, a patient who has applied to a medical institution cannot not only see the process of diagnosis and treatment, but also assess what was done and whether it was done correctly. Therefore, on the part of consumers of medical services, there is always an element of hope and trust in the seller of the service.

At the same time, intangibility complicates the activity of their seller. Health care providers face the following challenges:

It is difficult to show your product to patients;

It is even more difficult to explain to patients what they are paying money for.

The enterprise can only describe the benefits that result from the provision of this service, and the patient can evaluate the services themselves only after they have been performed (although not always).

To build trust on the part of customers, a medical service provider can take a number of measures:

· to increase the tangibility of your service, if possible;

emphasize the importance of the service;

focus on the benefits of the service;

Invite a celebrity to promote your service.

To increase the materiality of the service, to make it more tangible, the presence of an element of the product in the service in a variety of forms can. This may be modeling the patient's future appearance on a computer before cosmetic surgery, as well as providing clients with information about employees, their experience and qualifications.

3. Inseparability of production and consumption. The production and consumption of medical services are closely interconnected and cannot be separated in time (Fig. 1.10).

Rice. 1.10. Inseparability of production and consumption

medical services

With the inextricable relationship between the production and consumption of services, the degree of contact between the seller and the client may be different, for example, during car repairs, there is usually no need for the personal presence of the customer, but the provision of medical services is inseparable from the one who provides them. So, treatment in a hospital is impossible without medical personnel.

It should be noted that when selling medical services, there may sometimes be exceptions and there may be a time gap between their sale and consumption. So a voucher to a sanatorium is usually sold before a person receives medical services, but their continuity of production and consumption is preserved.

4. Failure of services to store. The specificity of the production of medical services lies in the fact that, unlike goods, services cannot be produced for future use and stored. You can only provide a service when an order arrives or a client appears.

An important distinguishing feature of medical services is their "momentary". They cannot be saved for further sale and provision. Unoccupied hospital beds, rooms in a sanatorium, medical services not rendered cannot be restored. If the demand for services becomes greater than the supply, then this cannot be corrected, as in the sale of medicines, by taking the goods from the warehouse. Similarly, if the capacity for services exceeds the demand for them, then revenue and (or) the cost of services is lost.

5. Quality variability or heterogeneity. An inevitable consequence of the simultaneity of production and consumption of medical services is the variability of its performance. One of the most important indicators of medical services is their quality. It is customary to distinguish three components of the quality of medical care: the quality of the structure, the quality of the technology, the quality of the result.

The quality of the structure implies the ability of health facilities to provide medical services at the proper level. This includes staff qualifications, necessary equipment, condition of buildings and premises, drug supply, financing, etc.

The quality of the technology characterizes the optimality of the complex of diagnostic and treatment measures provided to the patient.

The quality of the result is the ratio of the results actually achieved to those actually achievable.

All components of quality are closely interconnected and have a great influence on each other. Thus, a low level of structure quality is unlikely to provide an acceptable level of technology quality, and a violation of diagnostic and treatment technology can lead to adverse results for the patient. So in the Altai Territory in 2003 the following incident occurred. In one of dental offices the dentist, before extracting the tooth, performed local anesthesia for three patients with an aqueous solution of ammonia instead of lidocaine. Even if there was a pharmacy mistake in the packaging of the drug, then the doctor’s fault is obvious, because. he performed anesthesia in the “conveyor mode” - he injected and sent the patient to the corridor to wait “when the tongue goes numb” (although the patient had to be in the chair under the supervision of a doctor), after which he performed the same manipulations and in the same mode with the rest of the patients . Result: low quality of the structure (illiterate doctor) → non-compliance with the technology of service provision (lack of observation of the patient) → unfavorable results for the patient (tissue necrosis).

The quality of the service depends quite heavily on who provides it, as well as where and when it is provided. In one hospital, treatment and service are of high quality, in another, located nearby, of lower quality. Inside the hospital, one doctor is polite and efficient, while the other is arrogant and damages the prestige of the hospital. Even the same specialist provides services in different ways during the day.

When buying a product, the consumer simultaneously receives information about certain standards of its use. The person providing medical services is quite another matter. Sometimes even a highly qualified doctor can make a gross mistake. Expressions like "My life is in your hands" describe this situation very well.

In most cases, the quality of medical services can only be expressed descriptively, and the consumer can evaluate it only after it has been purchased.

To reduce the variability of medical services, it is necessary to identify the causes of this phenomenon. Most often, their inconsistency or variability in quality is associated with the qualifications of the employee, in addition, variability can be caused by a lack of competition, poor preparation and education, a lack of communication and information, and a lack of regular support from managers.

In principle, the variability of medical services can also be associated with inappropriate personal traits. medical worker which are very difficult to identify at the stage of personnel selection.

Another very important source of variability in medical services is, of course, the person himself, his uniqueness, which explains a high degree individualization of services in accordance with the requirements of the consumer, this makes it impossible to mass-produce them. For example, an abnormally located appendix can cause a lot of problems for the surgeon during an appendectomy. At the same time, this raises the problem of managing consumer behavior, or at least taking into account behavioral factors when working with customers.

Another problem is the ambiguity of the evaluation of the result. For example, lethal outcome can be assessed from two points of view. Every effort may be made by medical professionals, but the patient may die due to the nature of the disease and the characteristics of his body, while the doctor may believe that he has done everything in his power. On the part of the relatives of the patient, accusations (sometimes quite justified) can be made that the doctor has not done everything to adequately treat the patient.

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Operating in a market economy, healthcare, like any other industry, to a certain extent, is subject to the laws of the market.

In everyday life, the market is most often associated with a place where you can buy food, clothes, household goods, etc. This is the oldest form of the market - the traditional place where buyers and sellers make transactions. From an economic point of view, the market reflects the relationship that develops between producers, sellers, intermediaries and consumers of goods and services. There are many definitions of the market, but they all boil down to the fact that the market is a set of economic relations that manifest themselves in the exchange of goods and services, as a result of which demand, supply and price are formed in a competitive environment.

The market for medical goods and services is a market segment that provides medical goods and services to maintain and improve the health of the population. It makes it possible to receive and provide medical services, guarantees their required volume and appropriate level of quality.

The healthcare market includes a whole system of interconnected markets: medical services, medicines, labor of medical personnel, scientific developments, medical technologies, medical equipment, etc.

There are the following basic concepts of the market:
. demand;
. sentence;
. service;
. price;
. competition;
. marketing.

Demand is one of fundamental concepts market economy. With regard to healthcare, demand (need) is the amount of medical goods and services that society (individual patients) is willing and able to purchase in a given period of time at a certain price.

There are the following types of demand in the market of medical goods and services.

Negative demand: for vaccinations, appointments with doctors of certain specialties, painful, expensive procedures, etc.

hidden demand. When individual patients may experience a need that cannot be met with the medical products and services available on the market, for example: family doctor services, disposable medical products, service services, individual meals in a hospital, etc.

Falling demand. For example, the demand for syringes, reusable blood transfusion systems, and domestically produced antihypertensive drugs has recently fallen, so the market has responded with increased supply for syringes and disposable blood transfusion systems, and imported drugs.

irregular demand. These are seasonal fluctuations. For example, the demand for spa treatment is higher in spring and summer than in autumn and winter. Appeals to individual medical specialists depend on the seasonality of certain diseases (flu, peptic ulcer, viral hepatitis, etc.).

Excessive demand. In healthcare, there is an excessive demand for urgent medical care on holidays and after holidays, when patients suffering from chronic diseases violate their diet, regimen, and abuse alcohol; the level of injury increases.

C \u003d N x P,

Where C is the demand for medical services;
N is the number of patients;
P is an indicator of the population's access to medical services.

The next fundamental concept of the market is supply. The amount of supply is determined by the quantity of goods and services that the producer (seller) is willing and able to sell at a given price in a certain period of time.

In healthcare terms, supply is the quantity of medical goods and services that manufacturers can provide to the population in a given period of time. The supply, other things being equal, also changes depending on the change in price: as prices rise, manufacturers (sellers) offer patients more goods and services. When prices fall, their interest decreases and, accordingly, the volume of goods and services produced by them decreases.

A medical service is a structural element of preventive, therapeutic and diagnostic, rehabilitation, sanatorium, sanitary and epidemiological, medicinal, prosthetic and orthopedic and other types of assistance, which has a certain cost.

The most difficult object of standardization in healthcare is medical services. The need for standardization of medical services is determined by the needs of the population in obtaining affordable and high-quality medical care, as well as the emergence of fundamentally new medical technologies, medicines, medical products, and equipment.

Medical services are divided into:
. simple;
. complex.

According to their functional purpose, medical services are divided into:
. preventive;
. diagnostic;
. medical;
. recovery and rehabilitation;
. service.

Manipulations, examinations and procedures as separate medical measures aimed at providing medical care, but not having an independent completed preventive, diagnostic, therapeutic or rehabilitation value, are auxiliary elements of medical services. So, for example, the removal of an organ from a donor, autopsy, etc.

According to the conditions and place of provision, medical services can be divided into those provided at home, in outpatient clinics, hospitals, sanatoriums and other health care institutions. A simple medical service is an indivisible service, such as diagnostic manipulation, medical examination, etc.

A complex service can be represented as a set of simple services that reflect the technological process of providing medical care for a given disease that has developed in each particular institution.

In addition, a distinction is made between standard and individual medical services.

Standard medical services are mainly provided according to a unified technology for the vast majority of patients and have relatively stable pricing.

Individual medical services have a wide range of manipulations, diagnostic, treatment procedures, a large range of medicines and medical products. They have differentiated price lists that maximally take into account the individuality of costs in their implementation.

Specific features of medical services:
. intangibility;
. perishability;
. quality variability;
. ambiguity in the evaluation of the result;
. A medical service is a product not only of the manufacturer (medical worker), but also of the consumer (patient).

Intangibility

A medical service cannot be seen, heard, touched, felt until it is consumed. No patient will ever be able to know in advance absolutely everything about consumer properties ah services rendered to him. Any information about this, even coming from the attending physician, will always be of a probabilistic nature. The assessment of consumer properties of medical services is carried out, as a rule, at the level of subjective perception of their effectiveness (beneficial effect and side effects), sensations and emotional experiences of patients.

Perishability

Unlike goods for both medical and non-medical purposes, which are first produced, then for some time can be stored in a warehouse, or stand in a store for the purpose of sale, a medical service is characterized by the fact that its production process coincides with the sales process. Medical services are not subject to storage and accumulation for the purpose of subsequent sale. It is impossible, for example, by taking advantage of the increased demand for a particular type of medical services; first accumulate, and then instantly "throw" them from the warehouse to the market.

Quality variability

Medicine is a creative process that is distinguished by high individuality and non-standard professional approach to the patient, and as a result, sometimes, unpredictable results. Despite the strict regulation of medical activity, there cannot be a single, impersonal approach to the treatment of patients even with the same pathology in healthcare, therefore, in the diagnostic and prognostic aspects, the quality of medical services can vary widely.

It depends, first of all, on the qualifications of a medical worker, the equipment of a medical institution, the availability of medical care, the time and place of the service, who is its consumer, and many other factors.

Ambiguity in the evaluation of the result

Medical service can not always be evaluated only positively. For example, if a patient's leg is amputated, we will get a positive medical effect: the patient remains alive and will be able to do some work in specially created conditions, but he becomes disabled, and this is a negative social effect.

A medical service is a product not only of the manufacturer (medical worker), but also of the consumer (patient)

The quality of a medical service is formed as a result of the coordinated actions of a medical worker and the desire of the patient to benefit. The result of treatment will largely depend on how accurately the patient follows the recommendations and prescriptions. Delay in seeking medical help can also cause an unfavorable outcome, which does not depend either on the level of qualification of medical personnel or on the nature of their actions.

Medical goods and services, like any product, have a value, the monetary expression of which is the price. In the market of medical goods and services, price occupies a central place in the competitive exchange and serves as one of the instruments for regulating this market.

The price is the amount of money for which the “buyer” can buy, and the “seller” is ready to sell this product or medical service. The price is a kind of compromise of the economic interests of market participants.

Prices are a powerful and at the same time flexible lever of economic control.
Taking into account the fact that the price is organically related to supply and demand, they distinguish the following concepts;
. demand price;
. offer price;
. balance price.

The bid price is the market price in the state of supply and demand that a buyer's market is in place. At this price, the "buyer" is able to buy a medical service or product. Above this limit, the price cannot rise, since patients will not be able to purchase it.

The offer price is the market price in such a state of supply and demand, when a so-called seller's market is formed. This is the price at which the "seller" offers his service or product. At the same time, the offer price should recoup the costs of producing a medical product and service.

When supply and demand are equal, the so-called equilibrium price is established in the market. When the price decreases, demand increases because people want to buy more goods or services, and vice versa, when the price increases, demand may decline.

Thus, the market mechanism provides a dynamic balance between supply and demand. The market in this case acts as a self-regulating system, an effective mechanism for the interaction of demand, supply and competition in the formation of prices, production and sales volumes, as well as the level of consumption of goods and services. In addition, it provides an increase in production efficiency, product quality.

However, market self-regulation is not universal and should be supplemented by mechanisms state regulation, which seems to be the fundamental idea of ​​improving market mechanisms in socially significant areas of the economy. This is especially true for the market of goods and services in healthcare.

The main link of the market mechanism is competition.

Competition is a competition between economic entities, the struggle for markets for goods and services in order to obtain higher incomes and other benefits.

Competitive struggle for economic survival and prosperity is the law of the market economy. In the market of health care products and services, competitive participants can be:
. state, municipal institutions health care - on the implementation of the state (municipal) task on a competitive basis;
. organizations producing similar goods and services for healthcare needs;
. private practitioners and pharmacists who provide similar medical goods or services for medical purposes.

Studying competitors, highlighting their strengths and weaknesses essential for gaining a certain share of the medical services market. By comparing your services with those of competitors, you can determine your competitive advantages, position in the market.

Competitive advantages are the unique, special features of medical organizations that distinguish them from others. It is they who help to make a profit higher than others who produce and provide the same medical goods and services. When defining competitive advantages, it is important to focus on patients, their needs and be sure that these advantages are perceived by them as such.

The following competitive advantages can be distinguished:
. high reputation of the healthcare organization;
. high quality of medical goods and services provided;
. focus on the patient, his needs and wishes;
. sufficient material and technical base, highly qualified personnel, modern equipment, sustainable financial support;
. the uniqueness of the offered medical goods and services;
. prices acceptable to patients, not exceeding or lower than the prices for similar medical goods and services of other market participants.

Competitive advantages should be considered as the basis for the behavior of participants in the market of medical goods and services, which is especially important in the context of the development of compulsory and voluntary medical insurance.

For the effective organization of the production and sale of medical goods and services, knowledge of the basics of medical marketing is necessary.

O.P. Shchepin, V.A. Medic

Review questions

1. What is included in the concept of "health" as a biological, economic, social category?

2. What is the public importance of health?

4. What economic resources and how are they used to maintain and promote health?

6. What is the relationship between health and the standard of living of the population, the quality of life?

8. What does the concept of "healthy lifestyle" mean?

The main purpose of the economy as an economy is to provide people livelihood and maintain the conditions of existence necessary for people. Main condition of existence a person is served by his health, therefore, maintaining the health of people is legitimately considered as one of the defining tasks of the economy.

The means of subsistence in conjunction with the conditions of existence are designed to satisfy the needs of people, including such a fundamental one as the need for health. Since the need for health cannot be satisfied directly, by producing and providing, selling to the consumer a product called "health", then

the economy is able to satisfy this specific need only through services and goods that contribute to the maintenance and promotion of health, prevent diseases and cure them.

Considering that the needs for health care services and goods are manifested and are in direct relationship with other needs of people, the state, society and form an integral part of this general system of needs, we will consider human needs as a whole, highlighting the group of needs we are interested in. At the same time, let us establish the place occupied by the needs for health care goods and services in the general system of personal, family, and social needs.

Everything that a person needs, that he needs, without which it is difficult or even impossible to live, is called needs. All people strive to satiate or, as economists say, to satisfy their needs. Things, objects, services with the help of which a person, family, people satisfy various, numerous needs, are usually called good things.

The need for health is undoubtedly one of the primary vital needs, the satisfaction of which is the main task of health care and is ensured by all its means, including economic ones. Therefore, health itself as a source of satisfaction of vital needs, and medical methods and means of health care should be considered as benefits.

Some human needs, for example, oxygen, water, partly heat, are met from natural sources. Nature itself has created the conditions of existence, thanks to which a person saturates such needs without much effort and expense, like animals. it benefits freely received by all, for which you do not have to pay money or pay with labor, give other things in return. Man owes the presence of such free goods to nature. Concern for natural resources, protection of the natural environment, its restoration is a kind of payment for free benefits.

Natural sources in the form of fresh air, clean water, sunlight and heat are also free goods that contribute to the preservation and promotion of health. This and much more man receives from nature in the form of natural medicines and treatments. As accessibility decreases, such benefits are less and less free. In addition, due to the adverse environmental consequences of the production and economic activities of people, leading to pollution environment, many types of natural benefits that people cannot do without become anti-benefits that undermine human health.

But many other needs, especially in food, clothing, housing, movement, spiritual goods, can only be satisfied with the help of the means of subsistence created by people themselves. This, as mentioned earlier, economic benefits that people don't get for free. They can only be obtained for money, through the expenditure of labor, or in exchange for other goods.

in public transport and much more, for which all citizens or their individual categories do not pay money? Yes, these are economic benefits, for which not the one who receives them pays, but other people represented by the state, society. Such benefits are known as public.

Actually, one has to pay for free, natural benefits, spending efforts on picking up the fruits of nature, carrying out environmental protection measures. So there is no clear boundary between paid and free goods. The continuous increase in the needs of people, the increase in their diversity, on the one hand, and the limited possibilities for satisfying them due to the insufficiency of available sources, on the other, lead to an increase in the share of economic benefits compared to free, non-economic ones. Even natural water and clean air are becoming less and less accessible, more and more often you have to pay money for benefits that were free. More and more benefits a person receives not directly from natural sources, but through the economy, economic activity. The creation by people of the things they need, benefits is the main economic process, called production.

Created by people products and services health care are, of course, economic benefits. Even medicinal herbs and medicines of natural origin, treatment through the use of thermal springs, mud, mineral water require preliminary efforts in the form of collection, preparation, arrangement, packaging, transportation and other procedures. Certain types of natural remedies used require the support of medical personnel. All this testifies to the economic nature of benefits in the form of goods and services used in health care.

The very processes of creating and using treatments are so closely related to the economy that it is appropriate to call them not the provision of services, but health production.

The use, application, use of goods, the saturation of needs, the satisfaction of needs in economic science are called consumption. The word “consumption” should therefore be understood in the broadest sense, meaning eating, wearing clothes, living in a house, driving a car, serving in a bathhouse (consumption of services), and reading a book (consumption of services). spiritual blessings). Consumption is the final process in the name of which the economy works, operates. It is legitimate to consider consumption as the goal of the economy, but with one significant caveat. It is necessary to consume exactly as much as is required for a full life, in volumes determined by the physiological needs of the body, the spiritual needs of the individual, rational, scientifically based standards. Otherwise, consumption can develop into unrestrained, harmful consumerism, those. consumption for the sake of consumption, and not for the sake of satisfying needs. Consumer tendencies often lead to the accumulation of goods in excessive amounts, beyond any measure, and, moreover, unused. The causes of consumerism most often lie in greed, money-grubbing, immoderation of people.

The consumption of health goods and services fits into the above general description of consumption, but at the same time has certain characteristics. When it comes to drugs,

special types of clothing and footwear for sick people, bandages, bandages, devices that facilitate the performance of vital functions, and other similar means, then consumption means in the economic sense use, application. Consumption of medical equipment means its usage in the process of diagnosis and treatment. The same applies to buildings, premises, equipment that form the fixed assets of healthcare organizations.

The situation is more complicated with the consumption of health services in the form of diverse activities of medical and auxiliary medical personnel. In health care they are called treatment, nursing. In the economy, the use of services, including medical ones, is commonly called service consumption, which is understood as the receipt by the consumer of benefits in the form of the results of the activities of persons providing him with assistance, assistance, treatment, service.

In health care, the consumption of services is not always the final process in the full sense of the word. Services complete a certain type of production and treatment activity or stage of the treatment process. The rest, which completes the process, is the assimilation by the patient's body of the results of treatment. An indirect analogy is the consumption of food, which, strictly speaking, is completed by its assimilation by the body. The only difference is that the results of treatment are rarely absorbed as quickly and reliably as food. Consumption certain types health care services, such as diagnostic, consulting, health-improving, it is legitimate to consider the final procedure for the corresponding types of activities.

There is reason to talk about consumer trends in health care, observing the sick, and even more pseudo-sick, ready to spend the bulk of their lives in medical institutions without the need for it. Such overconsumption (harmful consumerism) is manifested in the immoderate use or even abuse of medicines, not due to the need for health.

Many people's needs are saturable in the sense that they can be sufficiently satisfied by known means. For example, it is quite enough for a person to consume a diet with a calorie content of approximately 2500 calories per day. Consumption beyond this threshold of saturation becomes excessive and even harmful (another thing, people always want to consume more varied, tasty food). Or it is hardly necessary to have more than two refrigerators in the apartment. But the need for knowledge is not limited to a clear boundary. The need for money is also included among the insatiable, unlimited, although there is a known limit to the amount of money that is quite sufficient for a comfortable existence of a person.

As for the needs for health care goods and services, they should, in our opinion, be classified as saturable. Even the initial need for health is satiated in the sense that the painless state of health of a person whose body normally performs its inherent functions may well be called the norm of health that sufficiently satisfies the need for it. Accordingly, the saturation of the need for health care goods and services should be considered the possibility of obtaining them in the quantity and composition, time and place determined by

the state of human health and the objectively necessary means of maintaining it. At the same time, the quality of methods and means of treatment, scientific knowledge about human health is not limited by a predetermined limit.

Are the needs of different people the same? It is obvious that certain needs, for example, for food, clothing, knowledge, are characteristic of all people, while others are far from being for everyone, but only for those who need them. The need for health is obviously inherent in all normal people, but the need for certain services and health care products for those who need them. It seems that the need for modern diagnostics of the state of the human body, dangerous diseases, anti-epidemic measures, sanitation and hygiene, health-improving procedures are universal in nature, apply to all people (to a slightly different degree - depending on age, gender, condition health, regional peculiarities).

To a certain extent, the needs of a person, family, group of people, society differ. Therefore, allocate personal, family, group, social needs.

The needs for services and goods intended for the protection of human health, treatment, are mostly personal, individual in nature. The object of care, service, satisfaction of needs for medical supplies is ultimately a person, a person. The health of an individual is that elementary cell that makes up the level of health of families, social groups, the population of a region, a country. Therefore, the personal needs of a person in the means of maintaining health form the basis of the entire system of needs for health services and goods.

In addition, there are personal needs, due to the fact that self-medication plays a huge role in medicine, as well as home treatment - under the supervision of doctors or independently. Any person needs a home first aid kit in the form of a set of standard or individually designed medicines. Each person must have devices for measuring temperature, and in some cases - special equipment, the choice of which is determined by the nature of the disease. The presence in every home of health-improving, sanitation and hygiene facilities has become a sign of medical and even general culture.

The category of personal needs in healthcare facilities should include the availability of elementary, common medical knowledge, household reference medical literature, the ability to recognize signs of a sudden widespread disease and provide the simplest emergency care. People who are prone to diseases or chronically ill need a means of calling for medical help.

In special cases, individual patients can afford to meet the need for a personal doctor; however, more often people use the services of family doctors.

Family medical needs may exceed the sum of the personal needs of each family member, as sometimes there are health and health problems related to the family as a whole (due to, for example, hereditary diseases, the danger of spreading the disease of one of the family members to the whole family). Separate funds

health care, exercise therapy, drugs may be the object of the needs of the whole family or several family members. This fully applies to the subjects of sanitation and hygiene.

For all the importance of personal and family needs for health care services and goods, such needs can be met almost in full, at the normative level, only when they become part of group, public needs. There are compelling reasons for such a conclusion.

Firstly, the provision of medical services individually to each person in need of them at home, through personal treatment, would require a significant increase in medical personnel, the delivery of treatment products to each individual, which would lead to a huge increase in costs and the cost of care.

Secondly, the provision of health care services in their public form makes it possible to concentrate medical staff, medical equipment, diagnostic and treatment tools, create favorable conditions for treatment and the provision of other services required by medical science within relatively narrow areas of polyclinics and hospital hospitals. This significantly improves the quality and reliability of service and treatment by making it complex, comprehensive and providing sterile conditions. In addition, with collective, multi-personal service, cost savings and a better use of the production potential of clinics are achieved.

The reasons cited are so significant that they give grounds to speak about the social nature of the bulk of the needs for health care. There is no doubt that the health of each person is of intrinsic value both for him personally and for the state and society. It is clear that the processes of treating patients are personally oriented, mass treatment is the exception rather than the rule. But the needs for health care services and goods are of a public nature in the sense that they are inherent in almost all people and can be fully satisfied only with the use of social forms. Thus, the consumption of health care products is predominantly of a mass public nature, has a public nature.

This thesis is also supported by the consideration that the same diseases, for all their specificity, are characteristic of many people and tend to spread on a massive scale. Therefore, the treatment of one requires the treatment of many, just as the treatment of many requires the treatment of each of them.

The public need for health care arises as a result of the integration, connection and interaction of personal and family needs with group, collective ones. Thus, the ship's crew needs a ship's doctor and a medical center, the population of the village needs a small clinic, the city needs a variety of clinics, hospitals, doctors, and the country as a whole needs a comprehensive health care system that can satisfy the needs of the entire population.

In economics, needs are usually divided into material and spiritual. material call the needs of people in things, objects, material values, while spiritual needs- this is the need for spiritual food in the form of knowledge, beliefs, cultural values,

information, information about the world, intellectual communication.

Health needs are both material and spiritual in nature. Material and material needs include the need for medicines, clinical nutrition, medical clothing and footwear, material and technical means of treatment in the form of materials, energy, equipment, vehicles, devices, premises, buildings, structures. The need for the science of health, medical knowledge, information about diseases and methods of their treatment, consultations, culture of health, and a healthy lifestyle should be considered spiritual.

These are fairly obvious truths. But it is not always so easy to classify health care needs as obviously material or spiritual. The problem is not solved in such a simple way regarding the nature of health services in the form of the main types of medical and medical activities in the process of treating patients. The need for an operation to remove or even replace organs and their parts is formally material in nature and is directly related to the application of physical effort. But it is inseparable from the spiritual need in the form of the initial establishment of the type of disease and the method of treatment. Studying the data of the examination of the patient, listening to his complaints, prescribing a medicine, the doctor most likely satisfies the spiritual needs of patients, but in the process of taking medicines, using other material means of treatment, the needs materialize, acquire a material form.

The thing is that health itself combines inextricably linked, interacting material and spiritual principles. Therefore, both the need for health and the need for healthcare facilities that provide it are of a complex material and spiritual nature. This connection is so strong that it is often not possible to separate the material and spiritual aspects of health services. This is one of the most characteristic features of health care services, the needs for them and the processes of their consumption, which distinguishes the health care economy into the category of very specific sectors of the economy and the service sector.

Usually, it is customary to rank people's needs, establishing a measure of importance, significance of a particular group of needs in the general hierarchy, often depicted as a "needs pyramid". Sociologists quite often place at the top of such a “pyramid” the need of people for self-realization, self-expression, self-affirmation, and at its base - physiological needs, considered as the simplest, not so significant and important. At the same time, the need for health and healthcare is not singled out as an independent one, but is included in the need for security and assistance.

If we proceed from the fact that the need for health and its protection is of a vital nature and without its satisfaction other needs cannot be realized, then this need deserves the highest place. But since health is originally present in a healthy organism, psychologically people are not predisposed to consider it the highest value until the need for health becomes adequate to the need for life. Only as a result of loss of health comes awareness

the fact that physical and spiritual health is the main, main life value.

 

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