Peculiarities of consumption of health goods and services 0. Peculiarities of entrepreneurship in health care. Formation and development of the medical services market in Russia
Send your good work in the knowledge base is simple. Use the form below
Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.
Hosted at http://www.allbest.ru/
FEDERAL AGENCY FOR EDUCATION
State educational institution
higher professional education
LIPETSK STATE TECHNICAL UNIVERSITY
Faculty of Humanities and Social Sciences
Department of Sociology
COURSE WORK
on the subject: Consumption of medical services as a sociological criterion of living standards
Lipetsk 2008
Introduction
1.1 Standard of living criteria
Conclusion
List of used literature
Applications
Annex 1. Questionnaire
Annex 2. Diagrams
Appendix 3. Series of distributions and grouping tables
Introduction
The problem of healthcare is very relevant not only for modern Russia, but for the whole world as a whole. In recent years, the problems of health care, the quality of "healthy life" have become an integral part of the changes undergone by the mass consciousness of people. Factors that threaten the life and health of people are becoming more and more extensive. Environmental disasters, herbicidal and pesticide damage to the human body, oncological diseases, bronchial asthma, allergies have acquired quite visible images in the mass consciousness, one way or another regulating the behavior of the individual. There is no doubt that some factors are so objective that a person cannot prevent them. However, in many areas related to public health, the risk can be reduced to a minimum level. How much a person himself strives to reduce this danger, how much he understands it at all, can be shown by the social portrait of the average consumer of medical services.
The transition to a market economy has caused fundamental changes in the composition of consumers of medical services in Russia. This is due to the economic polarization of social groups and strata of the population, which excludes the possibility of a monotonous approach to the organization of medical care.
Since the second half of the twentieth century, the world has seen significant changes in the assessment of the role of health in the life of every person and society. In 1948, the World Health Organization defined health "as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". This, in fact, marked the beginning of the transition to understanding health and illness not only as a medical problem, but also as a general social one. Indicators of health, physical and mental well-being began to be considered by social politicians as cumulative indicators of the level of well-being (quality of life) of society as a whole and its individual strata.
The consumer of medical services is the population. Its composition, socio-demographic, psychological and economic characteristics largely determine the functions, content of activities and the mechanism of interaction of all subjects of consumption of medical services. It should also be noted such characteristics as gender, age, marital status, occupation, level of education and income of social groups that affect the degree of consumption of medical services and the assessment of the activities of medical institutions. In addition, psychographic data also play an important role: belonging to a particular social stratum, lifestyle, personal and behavioral qualities. Without this, it is difficult to unambiguously determine the degree of randomness in the use of medical services, the desire to acquire the status of a regular client in a particular medical institution, the degree of need for medical services, including paid ones, and satisfaction or dissatisfaction with the medical care provided.
Due to the importance and relevance of the problem of health care and the quality of life that largely depends on it, articles and publications devoted to the consumption of medical services, health protection and the promotion of a healthy lifestyle do not cease to appear. This topic has been widely developed both in Russia and abroad, and on present stage acquired special significance. Among Russian sociologists, Yu.P. Lisitsin, I.B. Nazarova, A.V. Reshetnikov, G.I. Tsaregorodtsev. Articles and monographs by A.E. Ivanova, M.S. Poor.
As part of a sociological study, the object of which was the consumption of medical services by the population, representative data on consumers of medical services in the city of Lipetsk were analyzed (2008, the urban population was surveyed). The sample (randomized, 150 people) was created by random selection of the population aged 18 years and older. The study was aimed at fixing the population's own assessments and reactions related to ideas about their health or ill health, to clarify the circumstances and factors influencing these assessments, and as a result, to determine the relationship between health indicators and the general level and quality of life.
This course work consists of an introduction, conclusion and three chapters, the first two of which include theory, and the third - the empirical part of the study.
Chapter 1. The standard of living of the population in modern Russian society
1.1 Standard of living criteria
The quality of life in modern concepts of quality abroad is understood as a complex characteristic of socio-economic, political, cultural, ideological, environmental factors and conditions for the existence of an individual, a person’s position in society.
The concept of quality of life is a modern continuation of the intellectual searches begun by Teilhard de Chardin and V. I. Vernadsky, who introduced the concept of “noosphere” into scientific use, which has now become one of the terms of the dictionary of socio-economic statistics: “Noosphere is the sphere of reasonably organized interaction society and nature. The biosphere turns into the noosphere with the purposeful activity of mankind through the implementation of measures for the rational use of natural resources.
The concept of quality of life adopted in post-industrial societies includes restrictions on the satisfaction of people's needs, which ensure the harmonious development of the noosphere. These restrictions include: environmental protection, concern for the safety of production and products and maintaining resource potential country.
At the same time, the central tasks in the concept of quality of life are proclaimed to be: ensuring the physical and moral health of society, expanding the consumption of environmentally friendly food products by the population, harmonizing working conditions, etc.
In the book of A.I. Subetto, the processes of managing the quality of life are associated with the survival of mankind, and the term itself is defined by the author as a system of spiritual, material, socio-cultural, environmental and demographic qualities (components of life). In this system, the level of realization of the generic forces of a person, the creative meaning of his life, is revealed. Moreover, in accordance with the doctrine of three types of quality - objective-material, functional and system-social - both individual and social qualities of life, the diversity of human needs, the potential of its comprehensive, harmonious, creative development are revealed.
The category of quality becomes a symbol of the progress and survival of civilization. At the same time, traditional ideas about the quality of goods, the quality of labor, the quality of work and the quality of products, which are widely used in quality management systems, are overcome. The quality of life as a system includes the quality of a person, the quality of education, the quality of culture, the quality of the environment (ecology), the quality of the social, economic and political organization of society.
In the 90s, the problem of protecting consumer rights and the interests of society is increasingly being considered from the standpoint of the quality of life, and this concept includes the provision of jobs, income that guarantees a certain level of well-being, a certain quality of medical care, basic social services. In addition, the quality of life implies the opportunity for all members of society to participate in making vital decisions and the use of opportunities provided by social, economic and political freedoms.
The integral indicators of the quality of life are: health as an indicator of the physical, mental, spiritual and social well-being of a person, the environment, the education system and its accessibility to the population, demographic indicators of life, the level of culture and various cultural indicators of the quality of life (indicators of the accessibility of theater, music for the population , cinema, painting, libraries, etc.), the diversity of "speech language" as a special indicator of the quality of the culture of personality and intellect. The quantitative characteristic of the quality of life includes such indicators as the degree of satisfaction of needs, material, energy, labor and financial costs for satisfying each type from the totality of objective needs.
In the literature, the concepts of "quality of life" and "standard of living" are often intertwined and replace each other, which is not entirely correct. At the same time, the standard of living is defined as an indicator that characterizes the quantity and quality of goods and services consumed in the country.
Speaking about the quality of life, it is often easy to move on to such quantitative characteristics of the standard of living as the consumer basket. This concept in the modern dictionary of market terms means a set of representative goods in given quantities with fixed prices. When determining the standard of living, mortality rates, general education level, etc. are added to the consumer basket, actually solving particular problems of the quality of life, and without giving a clear definition to the concept itself.
In the most general view the standard of living can be represented as the level of consumption of the population, characterized by both quantitative and qualitative indicators: the volume of real income per capita, the level and structure of consumption of food and non-food goods and services, the level and dynamics of prices for basic commodities, rent, payments for transport services.
1.2 Health as an indicator of the quality of life of the population
Indicators of health and morbidity are used in relation to specific groups of healthy and sick people. This obliges us to approach the assessment of a person's lifestyle not only from biological, but also from medical and social positions. Social factors are determined by the socio-economic structure of society, the level of education, culture, industrial relations between people, traditions, customs, social attitudes in the family and personal characteristics. Most of these factors, together with the hygienic characteristics of life, are included in the generalized concept of "lifestyle", the share of which influences health is more than 50% of all factors.
The biological characteristics of a person (gender, age, heredity, constitution, temperament, adaptive capabilities, etc.) make up no more than 20% of the total impact of factors on health. Both social and biological factors affect a person in certain environmental conditions, the share of influence of which is from 18 to 22%. Only a small part (8-10%) of health indicators is determined by the level of activity of medical institutions and the efforts of medical workers. Therefore, human health is a harmonious unity of biological and social qualities due to congenital and acquired biological and social properties, and the disease is a violation of this harmony.
Health acts as a synthetic indicator of the quality and standard of living. At the same time, in accordance with the presentation of the World Health Organization, the category of health includes the categories of physical, mental, spiritual and social health. An important indicator of health as an element of the quality of life is the level of self-determination of behavior, that is, a responsible attitude to the preservation and maintenance of people's health. In this sense, health acts as a real human resource that can be disposed of in different ways with different results.
At the beginning of the 21st century, the concept of "quality of life" turned into a subject scientific research and became more precise - "health-related quality of life". Quality of life today is a reliable, informative and economical method for assessing the health of a patient, both at the individual and at the group level.
The World Health Organization made a great contribution to the development of the scientific study of the quality of life - it developed the fundamental criteria for the quality of life:
physical (strength, energy, fatigue, pain, sleep, rest);
psychological (positive emotions, thinking, learning, concentration, self-esteem, appearance, experiences);
level of independence (daily activity, performance, dependence on drugs and treatment);
public life (personal relationships, social value of the subject, sexual activity);
environment (life, well-being, safety, accessibility and quality of medical and social care, security, ecology, learning opportunities, information availability);
spirituality (religion, personal beliefs).
The main tools for studying the quality of life are profiles (assessment of each component of the quality of life separately) and questionnaires (for a comprehensive assessment), which, in turn, can be general (to assess health in general) and special (to study specific nosologies). All of them do not assess the clinical severity of the disease, but reflect how the patient tolerates his illness.
There are no single generally accepted criteria and norms for the quality of life. His assessment is influenced by age, gender, nationality, socio-economic status of a person, the nature of his labor activity, religious beliefs, cultural level, regional characteristics, cultural traditions and many other factors. This is a purely subjective indicator of objectivity, and therefore the assessment of the quality of life of respondents is possible only in a comparative aspect (a patient is healthy, a patient with one disease is a patient with another disease) with the maximum leveling of all external factors.
In medical practice, the study of the quality of life is used for various purposes: to assess the effectiveness of modern clinical medicine methods and various rehabilitation technologies, to assess the severity of the patient, to determine the prognosis of the disease, the effectiveness of treatment. Quality of life is an additional criterion for the selection of individual therapy and examination of working capacity, analysis of the ratio of costs and effectiveness of medical care, in medical audit, for identifying psychological problems and monitoring them in patients in the general practice system, individualization of treatment (choosing the optimal drug for a particular patient) .
It should be noted that the assessment of the quality of life can become a prerequisite for testing drugs, new medical technologies and treatment methods at any stage.
Currently, there is an intensive development of methods for determining the quality of life for the most common chronic diseases all over the world in connection with the recognition of quality of life criteria as an integral part of a comprehensive analysis of new methods of diagnosis, treatment and prevention, health initiatives, evaluation of treatment outcomes, quality of care, etc. There is a boom in research on the quality of life around the world, and Russia has not stood aside. In Russia, the concept of studying the quality of life in medicine, proposed by the Ministry of Health of the Russian Federation (2001), has been declared a priority. However, the study of the quality of life in our country is still not widely used.
Chapter 2. Consumption of medical services
2.1 Characteristics of medical services
The service sector is one of the most promising, rapidly developing sectors of the economy. Almost all organizations in one form or another provide services, and as the market becomes saturated with goods, the demand for services grows.
Service - commission certain activities or a set of specific actions aimed at meeting the needs of others. Services often include all types of useful activities that do not create material values, that is, the main criterion is the intangible and invisible nature of the product produced in this area.
Each specific type of medical care from an economic point of view has all the characteristics of a product and acts in the form of a medical service.
A medical service is a set of necessary, sufficient, conscientious, expedient professional actions of a medical worker (executor, service provider) aimed at meeting the needs of the patient (customer, consumer of services).
In the narrowest sense, a medical service is a type of medical care provided by medical workers to the population by health care institutions. In other words, a medical service is an event or a set of measures carried out in case of diseases or with an immediate threat of their development, aimed at preventing the disease and restoring health, having an independent, complete value and a certain cost.
Health care services are not ordinary goods, the production and consumption of which are determined by the ratio of solvent demand and supply. This conscious benefit must be provided to a person at all costs, regardless of whether he is rich or poor, whether he is able to pay for it or not: after all, if this benefit is not provided, sooner or later all production ceases, because in the current conditions of the epidemic and all other misfortunes are capable of destroying all of humanity.
A medical service begins to act as a specific product that has the following distinctive properties:
intangibility (a patient who comes to see a doctor cannot know in advance the result of the visit).
Inseparability from the source of the service (a patient who has registered with a certain doctor will receive the wrong service if he ends up with another doctor due to the absence of this doctor);
Inconstancy of quality (doctors of different qualifications provide the same medical service in different ways, and even the same doctor can help the patient in different ways depending on his condition).
A medical service, like any product, has a value, a monetary value, which is the price. Prices for services consist of two main elements: cost and profit.
A medical service can be detailed and simple. A detailed medical service is understood as an elementary, indivisible service. For example, for a hospital, detailed services can be considered to be a medical history, a specific type of bacteriological examination of the operating unit, and others. If some detailed services provided by individual departments of the institution (for example, the admissions department, bacteriological laboratory, etc.) are not separately calculated, then the cost of maintaining these departments ( wage their employees, the material resources they consume and other costs) should be taken into account in the overhead costs of the institution. When calculating the cost of a detailed service, it is necessary to use its technological standard that has developed in this institution (the time spent on this service, the qualitative composition of medical workers providing this service, the types and amounts of medicines, drugs, etc. consumed).
A simple service can be represented as a set of detailed services that reflect the technological process of providing medical care using this technology that has developed in a particular institution. A simple service is understood as a completed case according to a certain nosology: for hospitals - a treated patient, for outpatient clinics - a completed case of treatment, with the exception of dental clinics, where a simple service is understood as a sanitized patient, for ambulance services - departure and treatment. The list of simple medical services can be determined either by the institution itself, or a list approved by the administration (or the health management body if these rights are delegated to it) of the given territory in accordance with the current medical and economic standards is used. When developing a list of medical services, the age factor can be taken into account, as well as the factor of difficulty in providing this type of service, due to the presence of concomitant diseases, complications, etc.
As in any other, a number of characteristics can be distinguished in a medical service, which include:
Subjects of the service (patient - medical worker);
The psychology of the service (the relationship between the subjects of the service);
The materiality of the service (the cost and material expression of the cost of satisfying the consumer).
Documentation of the service (fixed long-term comprehensive information that gives an idea of the quantitative and qualitative side of the service performed).
According to the functional purpose, medical services can be:
therapeutic and diagnostic (aimed at establishing a diagnosis or treating a disease);
prophylactic (medical examination, vaccination, sports and recreational activities);
Restorative and rehabilitation (associated with the social and medical rehabilitation of patients);
transport (transportation of patients, in particular, using the ambulance service);
Sanitary and hygienic (activities related to quarantine, sanitary education, sanitary and epidemiological control and supervision).
Thus, we can conclude that a medical service is a complex set of elements, processes and services that develops in time and space and has a certain phase, staging and staging, covering all types of work related to the preservation, implementation and practical implementation of medical care. .
2.2 Paid medical services
Since medical care in state medical institutions does not satisfy many, and it has not yet been possible to improve its quality by filing complaints, people are trying to solve their problems with the help of paid medicine. A very wealthy population turns to paid medical institutions. In percentage terms, an almost equal number of “fans” of paid medical institutions, according to our data, live in regional centers, in cities of regional subordination, in district centers and rural areas.
Paid medicine is used by people with different levels of health. More are those who have no serious health claims (first of all, young people under the age of 35). Fewer than others, apparently for financial reasons, are older people. Paid medical institutions are attracted by the following: quality of treatment, attention from the medical staff, relatively low cost of services, qualifications of doctors, availability of the necessary specialists, unlike state medical institutions, service organization, lack of queues, better equipment. The main advantages make up for the main shortcomings of public medical institutions regarding the quality of treatment and attention from the medical staff. If the respondents have real experience of receiving medical services in private medical institutions, they are five to eight times more likely than the rest of the respondents to highly appreciate the quality of service in them in comparison with the state ones.
The materials of the conducted studies have shown that private medicine has received the most significant development in dental treatment: the ratio of applications to the private and public sectors of this type of medical care is expressed in a ratio of 1:4. As for inpatient treatment, it remained almost entirely in the hands of public hospitals.
The key in the concept of “paid medicine” is “paid”, i.e. medical care for a fee. This does not bother many, there is a small category of citizens who point to the relatively low cost of the relevant services. The development of the private sector of medical services arouses concern among the majority of respondents, primarily because paid medical services are steadily crowding out guaranteed free medical care for the population. And this leads to the fact that for a significant proportion of people qualified medical care becomes inaccessible.
But still, the question of whether, over time, paid medicine will be able to replace the state one, is not quite acute today. Judging by polls, about 70% of respondents have an income below the subsistence level. Only 2% live in full prosperity; a little over 20%, in their opinion - "quite satisfactory". Only a small part of the respondents can apply to paid institutions, without limiting themselves to something else.
According to surveys conducted in 1994-1997, wealthy people of working age mostly have incomplete secondary education, work in commercial structures and live in various settlements. Thus, the resource base of paid medical care is limited and depends on the further development of the economy. But even today it functions by limiting the needs of the population in clothing, food, etc.: the developing paid medicine will help improve medical care only for the most affluent segments of the population. Of course, such a phenomenon is possible only against the background of limited financial resources of the population and the unsatisfactory quality of medical care in state medical institutions.
Research results suggest that the majority of the population has incomes that only help to biologically support life. Under these conditions, there can be no talk of paid medicine. In the current conditions, compulsory health insurance has no alternative, and it must be implemented in full.
It should be noted that about half of the population, one way or another, pays for medical services out of their own pocket. Talking about free medical care in these conditions is not entirely correct. Doctors are paid both in large cities and in district centers by representatives of all professional categories, but not equally actively. More than others - entrepreneurs, businessmen and public sector workers, less - pensioners and the unemployed.
Judging by the research data, “shadow” paid medical services have also survived. And they are mainly distributed in the public health system. For example, in state and departmental polyclinics, 23.8% of the respondents officially paid the total payment for medical care, and 7.4% unofficially (bypassing the cash registers), 3% officially paid for the services of doctors, and 12.6% unofficially. There are many cases of "shadow" payments in private clinics, as well as in private practitioners.
The expression of gratitude to the doctor for the medical service provided in the form of a gift has always existed. But today the situation seems quite different. The market of illegal paid medical services can be explained by the low salary of a doctor, the inconsistency of the system of remuneration of medical staff with the conditions of market relations. The second reason needs clarification. The remuneration of a doctor is carried out in accordance with a single tariff scale and largely preserves the traditions of the times when everything was state-owned, incl. prices for goods and services. Today, prices depend on market conditions, demand for goods and services.
2.3 The concept of health insurance
It can be argued that in the 1980s a kind of health crisis developed in our country, which manifested itself especially acutely in the following areas:
1. Health crisis. If 20 years ago the group of healthy people accounted for approximately 30% of the total population, now it is no more than 20%. More than 25% of the population is hospitalized annually, and out of every 100 births, 11 have physical and mental defects. The average life expectancy has decreased.
2. Financial crisis. Whereas in the early 1970s health spending was about 10% of GNP, now it is less than 3% of GNP.
3. The crisis of the material and technical base.
4. Personnel crisis.
Adopted in 1989, the “Regulations on a new economic mechanism in health care” was aimed at overcoming all these negative aspects. According to this document, it was assumed that, as soon as the medical facilities were ready, they would switch to new business conditions in 1990-1991. In this provision, the general principles and forms of work of health care facilities were determined on the basis of the application of economic management methods and the transition to a predominantly territorial principle of health care management. It should be noted that the concept laid down in this document largely copied the economic decisions regarding other sectors of the country's economy, and to a small extent took into account the specifics of healthcare.
It seems that, on the whole, the steps taken in this direction were correct, however, a sharp change in priorities in the conceptual development of the country, the transition to a market economy, the adoption of the law “On health insurance of citizens in the Russian Federation” radicalized the situation to a large extent and required new approaches to further development the entire public health system.
Health insurance, as noted by many authors, in broad sense- these are new economic relations in healthcare in market conditions, that is, the creation of such a system of health care and social security that would actually guarantee all residents of the Russian Federation freely accessible qualified medical care, regardless of their social status and income level.
The purpose of health insurance is to improve the quality and expand the volume of medical care through a radical increase in health care allocations, decentralization of the health fund management system, the material interest of medical workers in the final results, the economic interest of enterprises in maintaining the health of workers and the economic interest of each person in maintaining their health. This is how the purpose is broadly defined in the health insurance law.
Medical insurance is designed to guarantee citizens, in the event of an insured event, receiving medical care at the expense of accumulated funds and to finance preventive measures. Such social protection can be implemented by creating a specialized monetary fund in a unified manner, in the formation of which, in the final analysis, every citizen would take part.
In this case, health insurance takes the form of compulsory. The social nature of compulsory health insurance, which allows each citizen to receive the same medical care, is achieved by the unequal contribution of everyone to the creation of a monetary fund to pay for this care. In other words, the rich pay for the poor. It is in this that the principle of social solidarity is manifested, on which the system of compulsory health insurance is built in many European countries.
According to A.V. Telyukov, in democratic states the issue of universal access to health care is based on free individual choice, that is, it is the result of civil consent and has a solid economic, social and political basis. Under the economic basis, he understands a fairly high level of personal income: the willingness to redistribute part of the funds in favor of less fortunate fellow citizens organically follows from a high level of one's own well-being. The social foundation means that the decisions made by people in the public sphere are shaped by their own beliefs, attitudes, concepts, beliefs. The political basis of the social contract is the institutions of the legislative and executive power, which give the social contract the form of law and implement it in government policy. At the same time, both legislative and executive power are under the control of voters.
Currently, state obligations to provide free medical care are not supported by financial resources. So far, the basic CHI program has not been approved, and the territorial CHI programs are funded only by 40-60%. In the current economic situation, maintaining state obligations to provide free medical care on a universal basis is practically unrealistic. Under the most favorable conditions (implementation of state budget commitments on compulsory medical insurance contributions, attraction of additional sources of financing), financial resources will not be enough to ensure free of charge all types of medical care.
And yet today the CHI system has become quite widespread in life. But unfortunately, the awareness of the insured about the rights and privileges granted to them is very low, despite a set of measures aimed at bringing information about CHI to the population. Only an insignificant part of the respondents confidently declares their knowledge of the rights guaranteed by the compulsory medical insurance system.
The awareness of the population on the issues of compulsory health insurance is clearly insufficient. The overwhelming majority are respondents who, in the presence of an insurance policy, have never used the right to choose a medical institution or doctor. These rights, which are the cornerstone of CHI, are used very rarely by the insured. And not because the majority does not know about their right, but because health care institutions are not yet ready to implement it. The introduction of such a right assumed the emergence of competition between doctors and medical institutions, the struggle for the patient, which in turn should have led to an increase in the quality of medical care. Until this happens, isolated cases of implementation of the choice of medical institutions relate mainly to cities. But even in the regional center, with its tradition of district service, it is almost impossible to exercise this right. Equally problematic is the ability to use the right to choose a doctor. In the countryside, there is simply no such opportunity, and if there is, it is unlikely that anyone will dare to defiantly prefer one doctor to another. In small towns, people usually know each other, and this kind of demonstration will lead to an aggravation of relations. In conditions of a shortage of medical staff, such actions can put the insured or his relatives in rather difficult conditions. In the city, the possibility of exercising the right to choose a doctor is quite large, but the mechanism for using this right has not yet been developed. Any attempt is associated with great organizational difficulties.
The widely condemned precinct “enslavement” has not been overcome and has been replenished with a territorial one. Today, we sometimes encounter the reluctance of medical institutions to accept patients living in other regions, despite the insurance policy. Providing medical care to a patient permanently residing in another area, the health facility receives payment from the local territorial CHI fund, which, in turn, incurs unplanned losses, because. payment from another territory may not occur. On the other hand, the financing of health care facilities is not limited to funds from the Compulsory Health Insurance Fund, a significant share of budgetary funds. They can also represent a guarantee of timely and high-quality medical care to any citizen of the Russian Federation.
The previously established system of medical care proceeded from the fact that all health facilities, doctors and nurses are equally good. Therefore, the entire population is in the same conditions. In practice, this led to a kind of consolidation of the population for a particular clinic or district doctor, who differed from each other in qualifications, work experience, and personal qualities. The old system, in fact, has not been reorganized. The most important point of compulsory health insurance - the creation of competition in the market - has not been implemented.
Thus, the system of medical care for the population under compulsory health insurance has firmly entered the life of society, but so far only one facet: as an additional source of funding. Other aspects of the system have not received due development and are not yet known to the majority of the population. The rejection of the CHI system by a part of the population can be explained, most likely, not by its shortcomings, but by the problems of socio-economic reform of society. Not understanding the essence of compulsory medical insurance, the population associates with it failures in social policy in general, and from a savior of the situation that has developed in healthcare, the compulsory medical insurance system turns into a destroyer in the eyes of the population.
Chapter 3. The empirical part of the study
Object and subject of research
Object of study: consumption of medical services by the population.
Subject of study:
o frequency of visits to health facilities;
o reasons for refusing medical services;
o desire and unwillingness to use paid medical services;
o active participation in recreational activities;
o government measures to promote a healthy lifestyle.
Purpose and objectives of the study.
The purpose of the study: to identify the degree of dependence of the quality and standard of living on the current state of medical services.
Research objectives:
o identify the frequency of visits to medical institutions;
o identify satisfaction or dissatisfaction with the medical care provided;
o determine willingness or refusal to pay for consumed medical services;
o analyze the public's awareness of health issues;
o Assess the extent of health promotion activities undertaken by the local government;
o draw conclusions about the degree of public concern for their health.
Basic concepts: interpretation and operationalization.
Medical services
1. This is a set of necessary, sufficient, conscientious, expedient professional actions of a medical worker aimed at meeting the needs of the patient.
2. These are individual measures or a set of measures carried out in case of diseases or with an immediate threat of their development, aimed at preventing the disease and restoring health, having an independent, complete value and a certain cost.
3. This is a type of medical care provided by medical workers of health care institutions, which has such distinctive properties as intangibility, inseparability from the source of the service, and variability in quality.
The standard of living is the level of consumption of the population, characterized by quantitative and qualitative indicators: the volume of real income per capita, the level and structure of consumption of food and non-food goods and services, the level and dynamics of prices for basic commodities, rent, payments for transport services.
The quality of life
1. This is a complex characteristic of socio-economic, political, cultural, ideological, environmental factors and conditions for the existence of an individual, a person’s position in society.
2. This is a set of parameters that reflect the measurement of the course of life with an assessment of physical condition, psychological well-being, social relations and functional abilities during the development of the disease and its treatment.
3. This is a set of indicators of the general well-being of people that characterize the level of material consumption (standard of living), as well as the consumption of directly unpaid goods. The quality of life implies: a) a clean environment; b) personal and national security; c) political and economic freedoms; d) other conditions of human well-being that are difficult to quantify.
4. This is a constantly evolving economic and philosophical category that characterizes the material and spiritual comfort of people's existence.
Positive and negative factors influencing the consumption of medical services by the population
Positive:
o poor environmental and climatic conditions living dream;
o seasonal and astrometeorological indicators;
o epidemics of viral and other diseases;
o stressful situations in people's lives;
o hereditary factors.
Negative:
o preventive measures;
o self-medication;
o maintaining one's health on a regular basis by taking medication;
o healthy lifestyle;
o seasonal changes due to the fact that in summer the doctor is visited less often than in the cold season;
o excessive employment of the population, when the patient constantly postpones going to the clinic.
Research hypotheses.
Research hypotheses:
o the frequency of consumption of medical services among the population of young and middle age is reduced, which negatively affects their quality of life;
o the majority of the population trusts private medical institutions more than public ones, but the level of income does not always allow them to be used;
o the current state of the healthcare sector is assessed by the majority of the population as unsatisfactory;
o the level of active participation of the population in recreational activities is extremely low due to the fact that the local administration pays insufficient attention to the promotion of a healthy lifestyle.
health quality of life medical
Research plan.
|
September 2007 |
Definition of the research topic, object and subject of research, identification of goals and objectives |
|
|
October 2007 |
Definition of operationalization and interpretation of the key concepts of the study, hypothesis building |
|
|
November - December 2007 |
Search for theoretical material |
|
|
January 2008 |
Building a research plan |
|
|
February 2008 |
Determination of sampling, instrumentation and methods of information collection |
|
|
March - April 2008 |
Working with the practical part of the study, conducting a survey |
|
|
Analysis of the research results, writing a report |
Sampling - probabilistic, was created by the method of random selection of the population aged 18 years and older. The study involved 150 people.
Methods of collecting information, characteristics of the toolkit.
Information collection methods:
o questionnaire survey;
o analysis of documents.
Characteristics of the toolkit:
o questionnaire sheet (150 copies);
o explanations for the questionnaire;
o data processing program (Microsoft Excel, Microsoft Word).
The questionnaire consists of 34 questions, including 24 closed questions (4 yes-no questions, 1 alternative question, 3 scale questions), 2 open questions, 8 semi-closed questions. You can also select 1 trap question, 2 filter questions, 1 indirect question, 2 silencer questions.
The questionnaire is divided into 5 semantic blocks:
1) recent frequency and reasons for seeking medical care;
2) willingness to pay for medical services;
3) assessment of the state of the healthcare sector;
4) health assessment;
5) passport.
Research results.
The frequency of visits to doctors to a certain extent correlates with data on self-assessment of the state of health and the presence of chronic diseases among the respondents. However, this kind of dependence is corrected by the very fact of the presence of a medical institution, its remoteness from the place of residence of the respondents, and the degree of satisfaction with medical care.
Over the past year, 57% of those surveyed sought medical help (Diagram 1). At the same time, 24% applied for the purpose of treating a disease, while the rest - for subjective reasons, such as undergoing a mandatory medical examination (12%) or obtaining a sick leave or certificate (19%) (Diagram 2). Most of the respondents over the past three years did not rest in sanatoriums (70%) did not stay in the hospital (59%) (Diagrams 10 and 11).
Of course, there is a direct relationship between the frequency of visits to medical institutions and the state of health. However, a small number (2.5%) of citizens with an unsatisfactory assessment of their state of health never turn to doctors at all, and only 10% always turn. The overwhelming majority seek medical help only in case of a serious illness (27%), in case of unclear diagnosis (14.5%) or in case of need to obtain a sick leave (45%) (Diagram 19).
Despite the general trend, one third of people with poor health go to the doctor quite rarely. Presumably, the respondents either exaggerate their assessment of their state of health as unsatisfactory, or really have serious illnesses, but they do not trust the medical staff and self-medicate. However, with regard to the latter, judging by the survey data, only 10% consider such measures acceptable, and almost half of the respondents combine self-treatment and doctor's prescriptions (Diagram 12).
So, the frequency of visiting a doctor depends on a number of factors. Women are much more likely than men to visit medical institutions (the proportion of women who assess their health as unsatisfactory is much higher). The frequency of visits to the doctor also increases in proportion to age.
Over the past few years, the frequency of visits to medical institutions in case of deterioration in health has decreased. 30% of the respondents believe that they consume medical services in the same volume as before, 21% believe that they began to use them less often and 28.5% answered that they did not use them at all (Diagram 13). This is partly due to the fact that people are not satisfied with the level of care provided in the public health system.
Medical care does not fully satisfy one third of the population, regardless of gender, education, age and occupation. This does not mean that others are completely satisfied with this level. Judging by the polls, the most complaints are about the professionalism of medical personnel (15%), followed by the organization of the reception of patients (14%), the hygienic state of medical institutions (9%), the provision of medical equipment (8%) and, finally, the provision of medicines ( 6%) (Diagram 14).
Satisfaction or dissatisfaction with a particular medical service depends on various factors and accordingly varies within different social and age groups. Despite the large percentage of those who are dissatisfied with the medical care provided, one third of the respondents are quite satisfied with the existing form of compulsory medical insurance (Diagram 24).
Since medical care in state medical institutions does not satisfy many people, people try to solve their problems with the help of paid medicine. Only 14% of the respondents did not use paid medical services, 20% use them constantly and 41% from time to time (Diagram 5).
Paid medicine is used by people with different levels of health. Most of those who have no serious claims to health, less than others, apparently for financial reasons, are older people. Paid medical institutions are attracted by the following: lack of queues (33%), higher quality of treatment (30%), low level of trust in public medical institutions (14%) and the lack of other way out if the service is provided only for a fee or the availability of the necessary specialists, in contrast from state medical institutions (8%) (Diagram 6).
It should also be noted that most of the respondents, if necessary, are ready to pay for various types of medical services. At the same time, not everyone can afford to do this without damage to their material condition. This state of affairs shows that health still plays a fairly significant role in the life of the population. 54% of respondents chose health as a priority value, which is in third place after family (92%) and children (84%) and is almost equal to material well-being (53%) (Diagram 26).
As the study showed, the choice of health as the most important value was motivated as follows: 20.5% believe that "no matter how much you care about health, it still won't happen." In caring for their health, 28% of respondents proceed from the fact that "health is the most important thing in my life and I do everything in such a way as not to harm it." However, the majority (51%) take a more moderate position in this regard: “health is important, but I don’t want to limit myself in many ways” (Diagram 28).
The majority of respondents assess their health status as satisfactory (42%), 22% and 27% as good and poor, respectively, and only 5% say that their health is excellent, and 2% - very poor (Diagram 27). According to the survey, men are more optimistic than women in assessing the state of their health. While the percentage of men and women who rate it as satisfactory is approximately the same, the proportion of men who rate their health as good is significantly higher than the proportion of women.
An important point in the category of defining health is the level of self-determining behavior, that is, a responsible attitude to the preservation and maintenance of people's health. Despite the fact that 37% of respondents believe that a person is responsible for their health (Diagram 20), the degree of self-preserving behavior in relation to health is quite low. Speaking about what most negatively affects the state of health, respondents name subjective factors, such as poor ecology (34%), frequent stress (30.5%), hard work or study (28%), poor quality of health care services (19 %), poor nutrition (14%), lack of financial resources to buy medicines (11%) (Diagram 16).
When asked why people get sick so often, mostly subjective reasons were also named. 21% thought it was due to the infrequent seeking of medical care, while 17%, in contrast, noted the low level of medical services as the decisive reason. 6% also mentioned the lack of promotion of a healthy lifestyle among the population (Diagram 18). However, when asked about their desire to take part in any recreational activities held by the administration, 48% answered that they were not interested, 28% that they would like to do this, and only 15% said that they had already taken part in such promotions. (Diagram 22).
The survey involved 150 people, including 69 men and 81 women (Diagram 29). The predominant age groups are 26 to 40 years old, 41 to 55 years old and 56 to 65 years old (Diagram 30). Most of the respondents are working, technical professions predominate (Diagrams 32 and 33). When asked about their income, 28% say that “there is almost always enough money”, 54% of respondents define their income as “only enough for the most necessary” and for 15% “there is never enough money” (Diagram 34).
It should be noted that almost half of the respondents (47%) defined their standard of living as average (Diagram 25). Undoubtedly, the standard of living reveals a clear relationship with the definition of the state of one's own health. The respondents, who were more satisfied with their state of health, assessed the quality of life in general according to higher parameters. To the question of what improvements should be made in the field of medical services in order to raise the standard of living of the population, the following answers were received: it is necessary to improve the systems for receiving patients in polyclinics (28%), to reduce the cost of paid medical services and medicines (24% ), provide medical institutions with better equipment (18%), increase the professionalism of doctors and nurses (16%), conduct more activities promoting a healthy lifestyle (8%) (Diagram 15).
Similar Documents
The system of indicators of the standard of living of the population on an example municipality"Urvansky district". Geographical bases for studying the quality of life of the population of the region. Statistics of income and savings of the population, consumption of material goods and services.
term paper, added 05/26/2010
Analysis of the standard of living and indicators of income differentiation of the population. Nutrition of the population as an object of statistical observation. Consumption of non-food goods and services. Identification of patterns of change in the well-being of the population of the Penza region.
term paper, added 12/21/2014
Essential characteristics of the level and quality of life of the population of Russia. Analysis of the main indicators of the quality of life on the example of the Bryansk region. Acquaintance with the concept of a minimum level of consumption. Ways to improve the level and quality of life of the population of Russia.
thesis, added 12/08/2011
Assessment of the current level of public health, description of projects aimed at improving it. Programs to improve the quality of medical services provided. Research and evaluation of the role of health professionals in maintaining and promoting health.
presentation, added 10/03/2013
The concept of "standard of living of the population", its components. Social norms and needs, the main indicators of the standard of living. The tasks of studying the standard of living. Maslow's pyramid of needs. Statistical characteristics of the standard of living of the population of Volgograd.
term paper, added 06/10/2012
The concepts of "standard of living", "quality of life". Social policy as a means of effectively improving the standard of living. The main indicators adopted in international practice for comparing the level and quality of life of the population. Directions of social policy.
term paper, added 12/05/2014
The concepts of "standard of living", "quality of life", their formation in accordance with the main criteria for the life support of citizens. Study and analysis of the level and quality of life of the population on the example of the Krasnoyarsk Territory. demographic indicators. The proportion of the working-age population.
term paper, added 07/10/2011
Theoretical foundations of the level and quality of life of the population, indicators and their essence. The main indicators of the level and quality of life of the population of developed foreign countries and Russia. The problem of poverty, state regulation of socio-economic policy.
thesis, added 05/26/2009
The standard of living is characterized by the degree of satisfaction of material, social and cultural needs. The quality of the population in terms of quality of life: possible indicators and methods for their assessment. Sociological problems of their increase in the Belgorod region.
abstract, added 02/04/2009
Acquaintance with the concepts and structural components of the quality of life of the population. Methods for improving the skills of company personnel. Analysis of life quality criteria in force in the Russian Federation and abroad. The concept of the standard of living of the population.
Medical services are a useful activity that does not create material values; as a rule, they 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 commodity in a service still cannot be considered as a commodity in the full sense of the word, because an element of a commodity 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 market economies. Moreover, not only private investors who invest their money in the creation of medical organizations and receive profit from this have a benefit, 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, such as the services of a masseur, dentist, reflexologist, can cost a relatively small initial 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. So, 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 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 certain product, we come across a very significant in the theory of exchange, but little concrete 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 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 lies 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, in the United States about 2 thousand teenage girls a year 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. Medical services firms are beginning to offer life and health insurance services, travel services for the treatment and rehabilitation of patients abroad, and so on. 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 the dental offices, a dentist, before extracting a tooth, administered local anesthesia to 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 a 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 delivery (lack of patient monitoring) → adverse 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 training 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 of a medical worker, which are very difficult to identify at the stage of staff selection.
Another very important source of the variability of medical services is, of course, the person himself, his uniqueness, which explains the high degree of individualization of the service in accordance with the requirements of the consumer, which 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.
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 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 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. This 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 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, 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 medicinal products 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.
Use, application, use of goods, satisfaction of needs, satisfaction of needs in economics 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. The consumption of certain types of health care services, such as 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, observing the sick, and even more so the pseudo-sick, who are 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. Among the unsaturated, unlimited include the need for cash, although there is a notorious limit to the amount of money, which 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 satiable 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 satisfies the need for it to a sufficient extent. 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 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, 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 health care needs should include the presence 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 physician; 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 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 only be fully satisfied using social forms. Thus, the consumption of health care products is predominantly of a mass public nature, has a public nature.
This thesis is further supported by the consideration that the same diseases, for all their specificity, are characteristic of many people and tend to spread on a mass 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.
The economic features of medical services can be summarized in three large interdependent classification groups.
first group make up the features of health services , associated with the specifics of the manifestation of the very result of the professional activity of persons employed in the area of human activity we are considering.
What are these features?
1. The result of professional activity in health care, usually, embodied in the person himself. Material services are rather an exception for health care (for example, these are x-rays, electrocardiograms, prescriptions that record the clinical diagnostic thinking of a doctor and which, when written out, begin, like books, a life independent of the will and consciousness of the author, etc. .).
2.The service, as a sectoral result of healthcare, is always individual in nature. Although it itself deals with millions of people, in healthcare there is not only mass production, but also small-scale production. It is also impossible to produce (provide) health care services in advance, so to speak, for the future, and then wait for the emergence of demand and the sale of this kind of product. It is by no means the services themselves that are brought to the health care market, but only information about the services that can be provided to patients.
The consumption of a significant number of health services coincides with their production in time. The individuality of the provision of health care services and the creative nature of many forms of medical activity leads to the fact that the desired result (effect) can often be achieved only by the actions of a fairly limited circle of specialists or even by the actions of one person. Therefore, this feature of the manifestation of results in healthcare leads to the fact that the local (local) market for healthcare services is much more likely and much easier to merge with its opposite - the global market.
3. Reviewed by us result, despite all their individuality, can be varied in its physical volume. In this regard, in health care, the implementation of various options is realistic. We can imagine a doctor who deals with only one patient - the personal doctor of some celebrity. In this case, the result of his work will be individual in the literal sense. However, in order to maintain his own qualifications, this doctor, obviously, will need to have a more extensive practice.
The family nurse, based on the multifaceted nature of her functions, should achieve results adequate to the needs already in a wider physical volume, dealing with a number of individuals different ages(usually starting with children school years) and social position. Providing assistance to each member of the family, taking into account specific conditions, the family nurse can achieve the desired effect only by solving a wide range of professional tasks. She should also be competent in matters of family planning, parenting, psychology and physiology of child development, problems of overcoming stress and emotional barriers, sexual behavior, knowledge of geriatrics, etc.
4. A health outcome is complex and can be broken down into many sub-outcomes (or quasi-outcomes). This implies the importance of realizing that in order to achieve a common result - health - the efforts of both narrow specialists and general practitioners, as well as other categories of health workers, are necessary.
At the same time, it is advisable to dwell on the very concept of health as a result of medical activity.
Improving the health of the population is not only necessary, but, perhaps, the only possible a universal indicator of obtaining a certain positive result of the work of health workers in the form of a beneficial effect. Health is determined by a number of demographic and other factors. It is characterized by several main groups of indicators. The first group includes such demographic indicators as the size of the population, its composition, birth rate, mortality, natural increase, etc. The second group consists of indicators of the incidence of the population. And the third group includes indicators of the physical development of individual groups of residents. Many specific methods for assessing the result of medical activity and, accordingly, the health of the population are based on the determination of a number of indicators of a therapeutic and prophylactic nature, which are directly and more closely related to the work of medical workers.
5. Performance in health care is not directly related to the amount of costs.
6. The result is diverse in terms of manifestation and the need for repeated exposure. The range of this diversity can be quite significant: from instant results, as is the case, for example, when relieving pain, and to long-term, often painful, repetitive medical treatments that only in their totality can lead to the achievement of the goal.
7. The nature of payments for the achieved result (service rendered) can also be different. This includes direct payment, and payment through budgetary funds, and payment from funds formed in insurance organizations.
Second group definition of health service features associated with the expression of quantitative characteristics of its value . It is important to highlight a few points here:
1. The service can be provided both in the commodity (and it is in this case that it begins to have cost parameters), as well as in non-commercial form. The commodity nature of health services, and, consequently, the initial market for medical services arose already in the era of ancient civilizations (6-8 thousand years ago). With the advent of the equivalent of value, commodity relations in healthcare were transformed into commodity-money relations, which are still dominant in the industry today, although Hippocrates, the father of medicine, advised the doctor that he “behave not too inhumanely, but that drew attention not to the abundance of the patient's funds and their moderation, and sometimes he would treat for nothing, considering a grateful memory higher than momentary glory.
2. definition the value of the cost of health care services can have several options, when choosing which the doctor inevitably faces the need to solve a complex clinical and economic problem. -
3.The cost of a health care service is not a constant value given once and for all. On the contrary, it tends to change, and more often in the direction of increase (especially with long-term treatment).
4, Maybe, despite all the uncertainty and unpredictability of the treatment and prevention process, creation of economic standards, including a number of interdependent natural, cost and relative indicators and allowing, at least roughly, to determine how much the proposed process of treatment or health protection will cost.
Third group features associated with the process of providing (production) of health services.
These features include the following features:
1. Having a large number of investors(patient, family, enterprise, employer, public organizations, including confessions, insurance companies, the state and international structures) that pay for the process of providing services. Only the joint use of various investment resources makes it possible to make the process of providing health care services continuous, high-quality and efficient.
2. Variety of business relationships which are manifested in the course of providing medical services and without the presence of which the activity of modern healthcare, which has undergone significant industrialization, cannot be imagined.
3. The dependence of the course of providing healthcare services on local natural and climatic conditions, which may hinder or, conversely, be favorable for the implementation of the process of treatment or prevention of various diseases.
4. The presence of an active relationship, along the line of "doctor-patient". In the process of providing health care services, all known methods of influencing the object of labor are used: mechanical, physical, chemical, biological, socio-psychological. The patient, as an object of medical influence, has the greatest activity, whichmo, on the other hand, can be directed both to harm him and to his good. In this case, in necessary cases, the conscious activity of the patient is turned off (narcosis, hypnosis).
5.Possibility of territorial movements in the process of providing health services also distinguishes the industry from many activities in the field of material production, where the process of creating wealth, as a rule, takes place geographically in one specific place.
6. In the process of providing health services, there are ability to limit effort achievement of an intermediate result with the subsequent resumption of the provision of services with a corresponding change in the conditions for the implementation of this process.
28254 0
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 they 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 activities, 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, when 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 state regulation mechanisms, 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 pharmaceutical workers providing similar medical goods or services for medical purposes.
Studying competitors, highlighting their strengths and weaknesses are extremely important 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 required.
O.P. Shchepin, V.A. Medic
It might be useful to read:
- Offshore trap of "Crimean Titan": will the "dirty" plant be modernized?;
- How to choose electrodes for welding Welding a rail with steel;
- Production technology of fiberglass pipes Fpipes;
- Consumer properties of muesli bars and snack products;
- How to start the production of smoked fish?;
- Sheet metal stamping technology;
- From what and how are dumplings made?;
- The best Tabasaran carpets: description, patterns, features and reviews An excursion into history;