Health planning. Determination of the needs of the population in outpatient and inpatient care. General provisions of the health care system of the Russian Federation Determination of the population's need for hospital care

This is a conscious objective need for

receiving medical services and preventive

service driven by conditions

life in a specific historical framework of development

society.

In the present conditions, the need for health

is in the first place.

The population's need for health is met

public health and maintaining a healthy lifestyle.

Factors affecting the population's need for MP:

1. The incidence rate of the population.

2. The structure of morbidity.

3. Population structure, demographic characteristics.

4. Social and mental characteristics of the population.

5. The degree of development of medical science.

Demand - appealability for medical care, reinforced

the ability to satisfy these services;

this is the number of medical services that they wish to purchase

resty patients for a certain period for a certain

The demand for medical services has always been, is and will be.

Demand is a type of market relationship.

There is demand - there is supply and vice versa.

Types of demand:

1. Negative demand: this is negative demand for

vaccinations, professional examinations.

2. Lack of demand - for health services.

3. Latent demand - for services of non-traditional

medicine.

4. Falling demand - for a decrease in traffic

doctors of some specialty.

5. Irregular demand - irregular load on

polyclinic doctors by seasons of the year.

6. Full demand - complete and timely

satisfaction of the need for medical services.

7. Excessive demand - overcrowded branches

in hospitals, queues to see a doctor.

8. Irrational demand - for smoking, alcohol.

Supply - the number of medical services that

can be rendered in a certain period

time in a given territory for a given health facility.

Price is a monetary expression of the cost of a service.

The price of medical services includes: payment costs

labor of the medical staff, the profit and

costs of medical and diagnostic services.

Health Marketing:
Ethen a system of principles, methods and measures based on

based on a comprehensive study of consumer demand

body (patient) and targeted formation

medical service offers by the manufacturer

(Health care facility); it is a complex planning process,

business case and management

production of medical and pharmaceutical

services and products, pricing policy in the field

treatment-and-prophylactic process,

promoting services and products to consumers,

as well as managing their implementation.

Marketing is based on the following key

concepts: need, need, desire, demand,

product, exchange, market.

Customer focus is the core essence

marketing.

Medical marketing is characterized by

the concept of social and ethical marketing, that is

the medical organization should not only the most

fully and effectively satisfy the needs of consumers

bodies, but also maintain and improve health

and the well-being of both individual citizens and

society as a whole.

Health planning.

This is one of the most important functions of management, task

which is to find the optimal ratios

between the population's need for PPI and the

her satisfaction at a certain stage

development of society.

The health plan is an integral part of the state

plan for the socio-economic development of the country,

aimed at the most rational and effective

use of material, labor and financial

resources to achieve the result.

Plan types: Territorial, sectoral, current

(up to 1 year), promising (up to 5 years), complex.

Planning principles:

1. Regional planning: implementation

planning at the regional level, taking into account priorities

and the primary tasks of the region.

2. Scientific nature of plans: the validity of the indicators of the plan,

which should be based on data characterizing

morbidity trends and population needs for MP.

3. Reality of plans: feasibility of plans based on

on the knowledge and balance of needs for MT and economic

opportunities of the region.

4. Communication of current and long-term planning.

5. The optimal combination of sectoral and territorial

planning.

Planning methods:

1. Analytical: used for comparative assessment

baseline and achieved level when drawing up a plan

and analysis of its implementation; define security

population by medical staff, hospital beds, etc.

2. Comparative: makes it possible to determine the direction

developmental processes (morbidity, mortality).

3. Balance: allows you to identify imbalances during

fulfillment of the plan (balance of training and the growth of health care facilities).

4. Regulatory: used when drawing up a plan for

based on the balance sheet method; norms and norms are used

tivs of the population's needs for MP, the need for beds

by total number and by specialties, staff

medical staff, honey and special equipment, soft equipment,

furniture, household equipment, transport, number

APU, percentage of hospitalization, length of stay in

hospital, the number of laboratory tests.

5. Economic and mathematical.

The main sections of planning in health care:

1. Development of a network of health care institutions.

2. The need and training of medical personnel.

3. Investing in the construction and equipment of health care facilities.

4. Material and technical supply.

5. Financing (budget) of all health care and its sections.

Hospital bed planning methods:

The required number of beds is determined by performance indicators

hospital bed, percentage of selection for inpatient treatment

and the incidence rate.

K \u003d A x P x R / D x 100 or G / F; where K is the required number of beds

per 1000 inhabitants, A is the incidence rate per 1000 inhabitants,

Р - percentage of selection for hospitalization, R - average duration

stay on the bed, D- average annual bed occupancy,

D - hospitalization volume, F - bed turnover (function).

Methods for planning medical positions:

The need for medical positions is determined by the number of

population, morbidity of the population per 1

resident, functions of a medical position.

B \u003d L x N / F; where B is the required number of medical

positions of this specialty, L - standard for the number

visits per 1 inhabitant per year, F (B x C x D) - the function of physicians

position, N is the average annual population.

Study guide

Irkutsk, 2004

MINISTRY OF HEALTH OF THE RF

GOU VPO IRKUTSK STATE MEDICAL UNIVERSITY

PLANNING IN HEALTHCARE.

IN THE AMBULATORY-POLYCLINICAL

AND STATIONARY MEDICAL CARE

Study guide

Irkutsk, 2004

The teaching aid was prepared by:

Gaidarov G.M. - Doctor of Medical Sciences, Professor, Head

department of Public Health and Health

GOU VPO ISMU

D. V. Kulesh - candidate of medical sciences, assistant of the department

public health and health

GOU VPO ISMU

Reviewers:

Abashin N.N. - Candidate of Medical Sciences,

first deputy executive director

state institution of the territorial fund

compulsory health insurance of citizens

Irkutsk region

Kuptsevich A.S. - Deputy Chief of the Chief

health Administration Administration

Irkutsk region

Healthcare planning. Determination of the needs of the population in outpatient and inpatient medical care (teaching aid). - Irkutsk, 2004 .-- 28 p.

The training manual reflects the main approaches and principles in planning medical care for the population at the present stage, determining the needs of the population for outpatient and inpatient medical care. The manual is intended for students of the medical and preventive, pediatric, medical and preventive faculties of the Medical University, interns, and clinical residents of the department.

The training manual is published by the decision of the Central Coordination Council of ISMU.

TOPIC: "PLANNING IN HEALTHCARE.

DETERMINATION OF POPULATION NEEDS

IN AMBULATORY-POLYCLINICAL AND INPATENT MEDICAL CARE "

INTRODUCTION

The place of the lesson is the department.

The duration of the study of the topic is 4 hours.

Purpose of the lesson: to study the basics of planning in health care; know the basic principles and methods of planning; study the definition of the need for outpatient and inpatient medical care.

Specific tasks:

The student should know:

What is planning in healthcare at the present stage; planning principles; types of plans and planning methods; what are the units of measuring the capacity of outpatient and inpatient medical institutions and the main indicators of the plan's indicators in health care; what is an outpatient service case.

The student should be able to:

Calculate planned indicators and determine the need for outpatient and inpatient medical care.

Plan of the

The first stage of the lesson:

Introductory speech of the teacher (the topic of the lesson according to the thematic plan of practical lessons, definition of the goal and objectives of the lesson) - 5 min.

Test and oral control on questions related to the topic of the lesson - 45 min.

The conclusion of the teacher based on the survey results. Pay attention to the main sections of the topic - 15 min.

The second stage of the lesson:

Mastering the methods of calculating the main planned indicators of the work of an outpatient and inpatient institution. Independent work with educational, teaching aids, solving situational problems. Calculation of planned indicators and determination of the need for outpatient and inpatient medical care - 75 min.

Summing up the results of assignments, monitoring the final assignments of students - 15 min.

Discussion of the material. Discussion - 30 min.

Health planning

From a technological point of view, planning consists in the development of systems of plans reflecting various aspects of the activities of medical institutions or the development of health care in a particular area. From the socio-economic side, planning is to take into account the social laws of development, economic and other interests of health care subjects.

Planning is the process of making and executing decisions on how to use the resources of an industry or an organization by completing key tasks to achieve a major goal.

The basis of the planning system is the definition at all levels of government - from federal to institutional - interrelated strategic goals, strategic objectives and strategic priorities for health care development.

The goal of planning at the present stage is to create a regulatory and legal basis for the implementation of a health care development strategy, including ensuring the highest possible level of accessibility of medical care for the population in modern socio-economic conditions by increasing the efficiency of health care.

Basic principles of planning in health care

at the present stage:

1. The end-to-end planning principle for all levels: federal, constituent entity of the Russian Federation, municipal, institutional.

So, the higher level proposes to the lower level the basic parameters for planning and coordinates them with him, taking into account the formation and implementation of state (municipal) orders, local climatic and geographical, socio-economic, sanitary and hygienic, political and other conditions. The specified parameters then become the basis for planning at both levels).

2. Availability of a unified system of social standards, norms and norms used for health planning for the Russian Federation.

So, for example, the standards for the volume of medical care are the necessary volumes of medical and organizational measures, as a result of which it is possible to prevent the occurrence of diseases, ensure recovery in acute diseases and achieve remission in chronic diseases (for example, the average duration of a patient's stay in bed, the function of a medical position, patient management protocols - standards, etc.). At the federal level, when planning state guarantees, federal basic standards for the volume of medical care are established, which are then detailed at the level of the constituent entities of the Russian Federation, taking into account local characteristics, in the form of territorial standards for the volume of medical care (for example, the number of bed-days per 1000 population in the provision of inpatient medical care or the number of visits per 1000 population in the provision of outpatient medical care).

3. Continuity of the planning process based on a combination of strategic and current planning.

Strategic health planning is the definition of goals, objectives, priorities, order, volumes, conditions for the health care of the Russian Federation, its constituent entities, municipalities and individual medical institutions for the future in several years.

Current health planning - determination of the procedure and conditions for the implementation of strategic health plans for the next year for all levels (federal, constituent entity of the Federation, municipal formation and an individual medical institution). In the process of current planning, the progress of the implementation of strategic plans is monitored and, if necessary, adjusted. Thus, the principle of the continuity of the planning process in healthcare is implemented.

At the stage of current planning, the constituent entities of the Russian Federation, municipalities assess the progress of the strategic plan, primarily from the point of view of ensuring state guarantees in the provision of free medical care to citizens. Discrepancies with the strategic plan are revealed. Their reasons are analyzed, based on the results of the analysis, proposals are made to eliminate the causes of discrepancies or to clarify and adjust the strategic plan. Then, a detailed quarterly planning of the implementation of the tasks of the strategic plan for the current year is carried out.

One of the tools for the implementation of state guarantees in the provision of medical care to citizens at the stage of current planning is the state (municipal) order.

State order - a state task to regional medical institutions for the provision of free medical care to citizens of the Russian Federation residing in the territory of a constituent entity of the Federation, containing the types and volumes of medical care provided with financial resources for their implementation from the regional health budget and compulsory medical insurance.

Municipal order - the volume of medical care planned to be provided to residents of the municipality within the framework of the Territorial Program of State Guarantees at the expense of the budget and compulsory health insurance.

Plan Is a document that defines the essence, sequence, focus and tactics of the activities of specific performers, in specific terms and in specific areas of activity.

Plans are:

1. promising (for a long period);

2. current (operational, monthly and annual);

3. plans for the activities of institutions;

4. development plans (construction, renovation, reconstruction);

5. comprehensive plans;

6. task plans for the object;

For certain types of healthcare institutions, the main plan indicators are as follows:

For the stationary network - "hospital bed";

For outpatient clinics - “number of visits per shift”;

For an ambulance station - “number of calls per year”;

For a blood transfusion station - “the amount of prepared blood

For the center of the state sanitary and epidemiological

supervision - "the number of the population served"

Among the planning methods, the most commonly used are:

1.analytical (used to assess the initial and achieved levels when drawing up a plan and analyzing its implementation);

2. comparative (an integral part of the analytical method) - makes it possible to determine the direction of development processes, for example, morbidity, mortality, etc .;

3. balance method (allows to identify imbalances, for example, training and growth of the network of health care facilities);

4. normative (to determine the need for normative indicators based on the use of the balance method);

5. experimental (calculation of indicators based on experiment);

6. economic and mathematical methods are used when necessary to scientifically substantiate the optimal options for the plan;

7. other special methods.

In healthcare, it is traditionally planned:

1. the need for personnel;

2. production activity (production (planned) indicators);

3. funding prospects.

Determining the needs of the population

AND STATIONARYMEDICAL CARE

Study guide

Irkutsk, 2004

MINISTRY OF HEALTH OF THE RF

GOU VPO IRKUTSK STATE MEDICAL UNIVERSITY

PLANNING IN HEALTHCARE.

DETERMINATION OF POPULATION NEEDS

IN THE AMBULATORY-POLYCLINICAL

AND STATIONARYMEDICAL CARE

Study guide

Irkutsk, 2004

The teaching aid was prepared by:

- Doctor of Medical Sciences, Professor, Head

Department of Public Health and Health Care

GOU VPO ISMU

- candidate of medical sciences, assistant of the department

Public health and healthcare

GOU VPO ISMU

Reviewers:

– candidate of Medical Sciences,

First Deputy Executive Director

state institution of the territorial fund

compulsory health insurance of citizens

- Deputy Chief of the Chief

health Administration Administration

Irkutsk region

Healthcare planning. Determination of the needs of the population in outpatient and inpatient medical care (teaching aid). - Irkutsk, 2004 .-- 28 p.

The training manual is published by the decision of the Central Coordination Council of ISMU.

TOPIC: "PLANNING IN HEALTHCARE.

DETERMINATION OF POPULATION NEEDS

IN AMBULATORY-POLYCLINICAL AND INPATENT MEDICAL CARE "

INTRODUCTION

The place of the lesson is the department.

The duration of the study of the topic is 4 hours.

Purpose of the lesson: to study the basics of planning in health care; know the basic principles and methods of planning; study the definition of the need for outpatient and inpatient medical care.

Specific tasks:

The student should know:

The student should be able to:

Calculate planned indicators and determine the need for outpatient and inpatient medical care.

Plan of the

The first stage of the lesson:

Introductory speech of the teacher (the topic of the lesson according to the thematic plan of practical lessons, definition of the goal and objectives of the lesson) - 5 min.

Test and oral control on questions related to the topic of the lesson - 45 min.

The conclusion of the teacher based on the survey results. Pay attention to the main sections of the topic - 15 min.

The second stage of the lesson:

Summing up the results of assignments, monitoring the final assignments of students - 15 min.

Discussion of the material. Discussion - 30 min.

Health planning

Planning Is the process of making and executing decisions on the use of the resources of an industry or organization by performing basic tasks to achieve the main goal.

purpose planning at the present stage is to create a regulatory and legal framework for the implementation of a health care development strategy, including ensuring the highest possible level of accessibility of medical care for the population in modern socio-economic conditions by increasing the efficiency of health care.

Basic principles of planning in health care

at the present stage:

1. The end-to-end planning principle for all levels: federal, constituent entity of the Russian Federation, municipal, institutional.

2. Availability of a unified system of social standards, norms and norms used for health planning for the Russian Federation.

So, for example, the standards for the volume of medical care - these are the necessary volumes of medical and organizational measures, as a result of which it is possible to prevent the occurrence of diseases, ensure recovery in acute diseases and achieve remission in chronic diseases (for example, the average duration of a patient's stay in bed, the function of a medical position, protocols for managing patients - standards, etc. ). At the federal level, when planning state guarantees, federal basic standards for the volume of medical care are established, which are then detailed at the level of the constituent entities of the Russian Federation, taking into account local characteristics, in the form of territorial standards for the volume of medical care (for example, the number of bed-days per 1000 population in the provision of inpatient medical care or the number of visits per 1000 population in the provision of outpatient medical care).

3. Continuity of the planning process based on a combination of strategic and ongoing planning.

Strategic health planning - determination of goals, objectives, priorities, order, volumes, conditions of health care activities in the Russian Federation, its constituent entities, municipalities and individual medical institutions for the future in several years.

Current health planning - determination of the procedure and conditions for the implementation of strategic health plans for the next year for all levels (federal, constituent entity of the Federation, municipal formation and a separate medical institution). In the process of current planning, the progress of the implementation of strategic plans is monitored and, if necessary, adjusted. Thus, the principle of the continuity of the planning process in healthcare is implemented.

One of the tools for the implementation of state guarantees in the provision of medical care to citizens at the stage of current planning isstate (municipal) order.

Government order - a state task to regional medical institutions for the provision of free medical care to citizens of the Russian Federation residing in the territory of a constituent entity of the Federation, containing the types and volumes of medical care provided with financial resources for their implementation from the regional health budget and compulsory medical insurance funds.

Municipal order - the volume of medical care planned to be provided to residents of the municipality within the framework of the Territorial program of state guarantees at the expense of the budget and compulsory medical insurance.

Plan - This is a document that defines the essence, sequence, focus and tactics of the activities of specific performers, in specific terms and in specific areas of activity.

Plans are:

1. promising (for a long period);

2. current (operational, monthly and annual);

3. plans for the activities of institutions;

Average length of stay of the patient in bed in this case, it can be planned at the level of the standard of this indicator in the Program of state guarantees for providing citizens of the region with free medical care or the indicator actually developed in this specialized department, provided that it does not exceed the standard for the Program of State Guarantees.

The average number of days a bed is open. The target is calculated using the formula:

D \u003d F x T,

F - bed turnover (planned);

T is the planned average length of stay of the patient in bed (in days).

Planned indicators of the number of bed-days and the number of hospitalized patients can be calculated using the following formulas:

CD \u003d M x T,

M \u003d L x F,

L - the number of estimated beds;

F - bed turnover (planned).

Definition of differentiated needs

in hospital beds per 1000 inhabitants

They calculate both the total need for bed capacity and for individual bed profiles, including for administrative territories.

A x R x P

k= ,

D x 100

Where k

Planning by prioritizing

required number of beds

For this, several calculation options are used.

Option 1:

Determination of the required number of beds based on the level of hospitalization. The calculation is carried out as follows.

H x P x T

TO = ,

L x 100

P is the percentage of hospitalization;

Option 2:

Based on the number of patients treated and the planned bed turnover. The calculation is made according to the formulas:

F \u003d D pl / T,

where F - bed turnover;

D is the planned average number of days of bed work per year;

T - Average length of stay of the patient in bed (planned).

The required number of beds will be determined by the formula:

K \u003dM f / F pl,

M is the number of patients treated (actual);

F - planned bed turnover.

Option 3:

Based on the number of bed days spent and the average number of bed days per year. The calculation is carried out according to the following formulas.

(1) K \u003d (M fx T pl) / D pl \u003d KD / D pl ; (2) K \u003d KD f / D pl ,

M f - the actual number of hospitalized (treated);

T is the average number of days the patient is in bed (plan);

КД - the number of bed-days spent;

CD f - actual number of bed-days;

D; D pl - number of days of bed use per year (plan);

Calculation according to formula 1 is advisable when the main estimated indicator (or the indicator for which funding is made) is the number of patients treated. If it is necessary to determine the number of beds based on the indicators of the number of bed-days spent, then data on the actual number of bed-days and the planned number of days of bed work per year are used (formula 2)

Reference task

For an outpatient clinic:

The number of full-time positions of outpatient doctors (in two ways: based on the size of the attached population and based on the amount of work);

Scope of work (based on the number of staff positions and the function of the medical position);

By hospital:

Calculate the required number of hospital beds in three options: based on the level of hospitalization, based on the number of patients treated and the planned bed turnover, based on the number of bed-days spent and the average number of days of bed work per year.

A) Calculation of the number of full-time positions of outpatient doctors if it is known that according to the program of state guarantees, the norm of outpatient visits per 1 inhabitant per year is 9.1, the population in the service area of \u200b\u200bthe polyclinic is a person, the planned function of a medical position was 5,500 visits, and the number of visits in equivalent units was:

1. Based on the size of the attached population:

L x H

(1) B \u003d, Where

B - the planned number of posts of outpatient doctors;

L is the norm of outpatient visits per 1 inhabitant per year;

H - the size of the attached population or its contingent (women, children, workers, etc.);

F - the function of a medical position

B \u003d 9.1 * / 5 500 \u003d 20.1 medical positions

2. Based on the scope of work:

(2) B \u003d P / Fpl, Where

B - the number of established posts;

P is the total number of visits in equivalent units;

Fpl is a planned function of a medical position.

B \u003d / 5,500 \u003d 19.7 medical positions

B) Determination of the scope of work in an outpatient clinic if it is known that 20 district general practitioners work in the polyclinic, the time norm for 1 visit is 15 minutes, the annual budget of the doctor's working time is 1,810 hours, and the planned function of the medical position is 5,500 visits:

1. Based on the number of staff positions and the function of the medical position.

(3) N n \u003d 60 / N in, Where

N n is the doctor's load per hour;

N c - the norm of time (time spent) for 1 visit;

60 - the number of minutes in 1 hour.

N n \u003d 60/15 \u003d 4 patients per hour of admission

(4) Ф \u003d N n x B x K, Where

F is the planned function of a medical position;

N n - The doctor's workload per hour;

B - the annual budget of the working time of the position (in hours);

K - the coefficient of using the working time of the position (0.923).

F \u003d 4 * 1,810 * 0.923 \u003d 6,682.5 visits

(5) Scope of work \u003d Fplx B, Where

Scope of work - number of visits

Fpl is the planned function of a medical position;

B - the number of medical positions.

Scope of work \u003d 6 682.5 * 20 \u003d visits

C) Calculation of the cost of the doctor's working time for one case of polyclinic service, if it is known that a patient who sought medical help from a local general practitioner initially called him at home, and then visited him at the clinic 2 more times. At the same time, the actual data on the time spent on visiting a doctor by patients for the previous reporting period in this health facility was: repeatedly in the polyclinic for 12 minutes, initially and again at home for 30 minutes.

(6) Т \u003d t 1 + t 2 + t 3 +… + tn

Where, T is the time spent on one case of polyclinic service;

t 1 - the time spent on the initial visit (appeal), depending on the place of medical care (in the clinic or at home);

t 2, t 3, ... tn – time spent on repeat visits, depending on the place of medical care (in the clinic or at home).

T \u003d 30 + 12 + 12 \u003d 54 minutes. costs of a doctor's working time per case of outpatient care

D) Calculation of the planned indicators of the work of the therapeutic department of an inpatient medical facility if it is known that in the current reporting period this department is not planned to be closed for repairs, the average downtime required to prepare the bed for the next patient is 1 day, the average length of stay of the patient in the bed in accordance with the territorial standard was 13.7 days, and number of beds according to the estimate 60:

N - tp

(7) F = ,

T + tn

Where F is the bed turnover;

N is the number of calendar days in the planning period;

tp - the average number of days of downtime associated with the planned closure of the bed for repairs;

T is the average length of stay of the patient on the bed (in days);

tn - the average downtime required to prepare the bed for the next patient (in days).

F \u003d (365 - 0) / (13.7 + 1) \u003d 24.8 patients

(8) D \u003d F x T,

where D is the average number of days of bed work (planned);

F - bed turnover (planned);

T is the average length of stay of the patient on the bed (in days) - the standard for the State Guarantee Program.

D \u003d 24.8 * 13.7 \u003d 339.8 days

(9) M \u003d L x F,

where M is the planned number of hospitalized patients;

L - the number of estimated beds;

F - bed turnover (planned).

M \u003d 60 * 24.8 \u003d 1 488 patients

(10) CD \u003d M x T,

where KD is the number of bed-days in the planning period;

M is the planned number of hospitalized patients;

T is the average duration of stay in the bed planned (in days).

CD \u003d 1 488 * 13.7 \u003d, 6 bed-days

E) Determination of the differentiated need for hospital beds per 1000 inhabitants N-sky district,if it is known that the referral rate per 1000 population was 1324, the percentage of selection for hospitalization was 25%, the average number of days of work in the bed was 320 days, and the average planned number of days of stay of the patient in the bed was 14.0 days for all hospitals operating in the district :

A x R x P

(11) k = ,

D x 100

Where k - the required number of average annual beds per 1000 inhabitants;

A - the level of referral (morbidity) per 1000 population;

R - the percentage of hospitalization or the percentage of selection for hospitalization from among those who applied;

P - the average planned number of days of stay of the patient in bed;

D - the average planned number of days of bed work per year.

k \u003d * 25 * 14.0) / (320 * 100) \u003d 14.5 beds per 1000 populationN district

E) Calculation of the required number of beds in the hospital, if it is known that the number of the population served by the hospital was a person, the percentage of hospitalization was 21.6%, the actual average number of days the patient stayed in the bed was 13.5 days, the planned - 14.0 days, the actual average number of days of work in the bed was 332.8 days, planned - 335.0 days, the actual indicator of the number of hospitalized patients was 4,985, and the planned bed turnover was 23.5, the actual indicator of the number of bed-days in the hospital was bed-days:

H x P x T

(12) K \u003d ,

L x 100

where H is the population size;

P is the percentage of hospitalization;

T - the average number of days of stay of the patient on the bed;

D is the average number of days the bed is open per year.

K \u003d * 21.6 * 13.5) / (332.8 * 100) \u003d 204.7 coins

(13) K \u003dM f / F pl,

where K is the required number of beds;

M is the number of treated (hospitalized) patients (actual);

F - planned bed turnover.

K \u003d 4 985 / 23.5 \u003d 212.1 beds

(21) K \u003d (M f x T pl) / D pl \u003d KD / D pl,

where K is the required number of beds;

M f - the actual number of hospitalized (treated)

Sick;

T pl - the average number of days of stay of the patient in bed (plan);

KD - the number of bed-days spent

D is the number of days of using the bed per year (plan);

K \u003d * 14.0) / 335 \u003d / 335 \u003d 208.3 beds

(22) K \u003dCD f / D pl,

Where K is the required number of beds;

CD f - actual number of bed-days;

D pl - the number of days of use of the bed per year is planned.

K \u003d / 335 \u003d 208.6 beds

Self-study assignments

1. Calculate the required number of beds in the RCH hospitalN district, if it is known that the number of people served by the hospital is 52,125 residents, the percentage of hospitalization of the population according to the data of referrals is 24%, the average number of days spent in a bed is 14.3 days and the average number of days of work in a bed per year is 326.

2. Calculate the number of full-time posts of outpatient doctors, if the standard for the number of visits per inhabitant per year under the state guarantees program is 9.1, the population attached to the polyclinic is 16,470 and the planned function of a medical post is 5,500 visits.

3. Calculate the required number of full-time positions, if the planned function of the medical position of the district general practitioner in the polyclinic was 5,500, the number of visits to the polyclinic for diseases was 5,000, for preventive examinations 5,000, home visits 1,000 and consultative visits 250. Working time costs On average, one visit to the clinic is 15 minutes for diseases, 30 minutes for preventive examinations, 37 minutes for home visits. and for a consultative visit at the clinic 23 min.

4. Calculate the planned function of a medical position of a neurologist in a polyclinic at a consultative appointment for adults, if the annual budget of a neurologist's working time is 1,778.7 hours, and the cost of working time for a consultative appointment with a patient on average per visit is 25 minutes.

5. Determine the differentiated need for maternity beds in the territory of the municipalityN if the birth rate was 9.1 per 1000 population, the coverage of all parturient women in hospitalization was 98%, the average length of stay of parturient women in the hospital was 8.6 days (taking into account the pathology of pregnancy and childbirth) and the average number of days of bed working - 300 days a year ...

6. Calculate the planned rates of bed turnover, the number of hospitalized patients and the number of bed-days of the municipal hospital of the cityN (by bed profiles), where 4 departments function: therapy for 40 beds, surgery for 60 beds, pediatrics for 45 beds and gynecology for 40 beds. The recommended standard of the average number of days of work of the bed for therapy as a planned indicator was 340 days; in surgery, pediatrics and gynecology - 330 days. Territorial standards for the average duration of a patient's stay in a therapeutic bed were 13.7 days; in a surgical bed - 9.9 days; in a pediatric bed - 10.9 days; on a gynecological bed - 7.7 days.

7. Calculate the required number of beds in a hospital-type medical facility in all possible ways, in general and by bed profiles, if it is known that this medical facility actually operates three departments (general therapy for 45 beds, pediatrics for 40 beds and gynecology for 35 beds). The actual number of hospitalized patients in the previous reporting period (year) in therapy was 1 283, in pediatrics 1 011 and in gynecology 1 810. The territorial standard for the average length of stay in bed in these departments, respectively, was 13.7; 10.9 and 7.7 days, and the actual indicator of the number of bed-days spent by patients over the past year was recorded in therapy 16 108 (it should be noted that for 14 days in the 3rd quarter the hospital's therapeutic department did not function due to repairs), pediatrics 12 917 and in gynecology 10 812 bed-days. Evaluate your result.

8. In polyclinic N Based on actual data from the previous reporting period, an average of one outpatient care case consisted of one initial home care visit and three follow-up visits, one of which also took place at home. Calculate the cost of working time of a local general practitioner for one case of polyclinic service, if the recommended time standards are: for an initial medical and diagnostic visit in a polyclinic - 18 minutes, at home - 30 minutes; for a second visit to the clinic - 12 minutes, at home - 30 minutes.

9. Calculate the planned volume of work in an outpatient clinic if it serves 14 city sites at the recommended rate of workload for a local general practitioner of 4 people per hour and an annual working time budget of 1,663.2 hours.

10. Calculate the planned indicators of bed turnover, the average number of days of bed work, the number of hospitalized patients and the number of bed-days of a children's hospital of an infectious profile for 50 beds in the future reporting period (year), if repair works with closure are planned within 49 days of the second half of the year bed capacity, and the territorial standard for the average length of stay of a sick child in an infectious bed was 9.4 days.

11. Determine the differentiated need for hospital beds per 1000 inhabitantsN region, if for the planned year the incidence of 1,100 per 1,000 inhabitants (urban and rural population) is predicted, the percentage of selection for hospitalization is 24.6%, the average number of days of bed work per year in all hospitals is 325 days and the average number of days of stay patient in bed - 14.6 days.

test questions

1. What is planning and what is it from a technological and socio-economic point of view?

2. What is the main goal of planning in health care at the present stage?

3. What are the basic principles of planning in health care?

4. What are the standards for the volume of medical care?

5. What is strategic health planning?

7. What is current health planning?

8. Give a definition of the state and municipal order in health care.

9. What is a plan? List the main types of plans.

10. What are the main planning methods that are most commonly used in health care?

11. What measures of the plan in health care do you know?

12. What does traditional planning of a polyclinic work include?

13. What is the function of a medical position and what is the method of calculating it?

14. What methods are used to plan the number of staff positions of doctors in an outpatient clinic and what is the method of calculating them?

15. How is the planning of the scope of work carried out in an outpatient clinic?

16. What is meant by a case of polyclinic service?

17. What are the units for measuring the capacity of outpatient and inpatient facilities?

18. What are the main planned indicators of the hospital with the methodology for their calculation.

19. How to determine the differentiated need for hospital beds per 1000 inhabitants?

20. List the ways in which the required number of beds in the hospital can be determined, and provide a calculation methodology.

Test tasks

001. What is the basis of a health planning system?

a) determination at all levels of strategic goals, objectives and priorities for health development;

b) creation of a unified regulatory framework for the implementation of the health development strategy;

c) improving the efficiency of management;

d) improving the efficiency of the use of industry resources.

002. Strategic planning is:

a) linking the staff of doctors to the amount of funding;

b) the process of making and executing decisions on the use of the organization's resources to accomplish a major task and achieve goals;

c) determination of goals, objectives, priorities, order, volumes, conditions for the health care of the Russian Federation, its constituent entities, municipalities and individual medical institutions for the future in several years.

003. What is meant by a government order in healthcare?

and) a state task to regional medical institutions for the provision of free medical care to citizens of the Russian Federation residing in the territory of a constituent entity of the Federation, containing the types and volumes of medical care provided with financial resources for their implementation from the regional health budget and compulsory medical insurance funds;

b) the volume of medical care for regional and municipal health care institutions at the expense of the state budget;

c) the volume of medical care planned to be provided to residents of the municipality within the framework of the Territorial Program of State Guarantees at the expense of the budget and compulsory medical insurance.

004. What is the purpose of planning at the present stage?

A) creation of a regulatory framework for the implementation of a health care development strategy, including ensuring the highest possible level of accessibility of medical care for the population in certain socio-economic conditions by increasing the efficiency of health care;

b) the continuity of the planning process based on a combination of strategic and current planning.

005. Current planning is:

a) determination of the procedure and conditions for the implementation of strategic health plans for the next year for all levels (federal, subject of the Federation, municipal formation and a separate medical institution);

b) determination of goals, objectives, priorities, order, volumes, conditions for the health care of the Russian Federation, its constituent entities, municipalities and individual medical institutions for the future in several years.

006. What is meant by a municipal order in health care?

a) an order for the provision of medical care to residents of the municipality in accordance with the State Guarantees Program at the expense of the regional budget;

b) the volume of medical care planned to be provided to residents of the municipality within the framework of the Territorial program of state guarantees at the expense of the budget and compulsory medical insurance.

007. Which of the following is not a principle of planning in healthcare at the present stage?

a) the cross-cutting principle;

b) the existence of a uniform system of social standards, norms and norms used for health planning for the Russian Federation;

c) democratic centralism;

d) the continuity of the planning process.

008. What is called a plan when planning the need for personnel, production activities, financing prospects in health care?

a) determination of goals, tasks, priorities, order, volumes, conditions of activity of medical health care institutions for the future in several years.

b) a document defining the essence, sequence, focus and tactics of the activities of specific performers, in specific terms and in specific areas of activity.

009. Which of the following is not a planning option by prioritizing the number of beds needed?

a) calculation based on the level of hospitalization of patients;

b) calculation based on the number of patients treated and the planned bed turnover;

c) calculation based on the number of bed-days spent and the average number of days of bed work per year;

d) determination of the differentiated need for hospital beds per 1000 inhabitants.

010. What is the measure of the plan's indicators in an outpatient and inpatient medical institution?

a) number of calls per year and hospital bed;

b) the size of the population served and the hospital bed;

c) the number of visits per shift and the hospital bed;

d) the number of people served and the number of calls per year.

011. "Medical position" is a unit of measurement of power:

a) hospital;

b) the united hospital;

c) polyclinics;

d) an ununified hospital.

012. The average downtime for a general somatic bed should not exceed:

a) 0.5 days

b) 1 day

c) 2 days

d) 3 days

013. What is the unit for measuring the power of the hospital?

a) visit;

b) bed-day;

c) hospital bed;

d) calling an ambulance.

014. Which of the following is not one of the ways to calculate the number of full-time positions in an outpatient clinic?

a) calculation based on the size of the attached population;

b) calculation based on the scope of work;

c) calculation by the formula

015. Which of the following is not used when determining the need for inpatient medical care for the population?

a) calculation of the scope of work based on the number of staff positions and the function of a medical position;

b) determination of the differentiated need for hospital beds per 1000 inhabitants;

c) planning by first determining the required number of beds;

d) calculation of planned indicators of the volume of activities of hospitals in hospitals;

e) calculation by the formula.

016 What is a polyclinic service case?

a) the set of visits made at each visit of the patient to a specialist doctor;

b) the totality of visits made by all patients of the polyclinic to all specialist doctors per shift;

c) one visit to a doctor when a patient applies for medical help;

d) every appeal of a patient receiving outpatient treatment in a polyclinic to an outpatient doctor.

017. Which of the following is not the main planned indicator of the hospital's work?

a) the function of a medical position;

b) the average number of days of bed work per year;

c) bed turnover;

d) all of the above.

018. Which of the following is not the main method of planning in health care?

a) analytical;

b) comparative;

c) sociological;

d) regulatory;

e) experimental;

019. Which of the following parameters is not used to determine the differentiated need for hospital beds per 1000 inhabitants using the formula?

a) the level of referral (morbidity) per 1000 population;

b) the average planned number of days of stay of the patient in bed;

c) the average level of planned bed downtime;

d) the percentage of hospitalization or the percentage of selection for hospitalization from among those who applied;

e) the average planned number of days of bed operation per year.

Main

1. Public health and health care: Textbook. for stud. / Ed. ,. - M .: MEDpress-inform, 2002 .-- 528 p.

2. , Luchkevich medicine and healthcare organization. In 2v. - SPb., 1998.

3. Social hygiene (medicine) and healthcare organization. Ed. Acad. , 1998.

Additional

1. economic analysis and planning of the activities of medical institutions: Labor indicators. Manufacturing activities. Financial condition. Budgeting. - M .: International Center for Financial and Economic Development, 1999. - p. 198.

2. et al. Methodological approaches to the development of strategic and current health plans in the Russian Federation. - M .: TSNIIOIZ, 2000 .-- p. 136.

3. Lectures on the organization and economics of health care. Scientific publication. / Under total. ed. , R. Schiff - Yekaterinburg: "SV-96". 2003 .-- 352 p.

INTRODUCTION …………………………………………………………………… .3

Health planning …………………………………………… 4

Determining the needs of the population

in outpatient care …………………………………… ..7

Determination of the population's need for stationary

medical care ………………………………………………………… ..11

Reference task …………………………………………………………………… 15

Tasks for independent work ………………………………………… 20

Test questions ……………………………………………………… .22

Test tasks ………………………………………………………. ……… 23

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State educational institution of higher professional education

Chita State Medical Academy

federal Agency for Health and Social Development

Department of Public Health and Health Care

Course work

by discipline Public health and health care

Health planning. Determination of the population's need for outpatient and inpatient care

Introduction

Health resources are always limited in any society, so the issues of their more efficient use are key. At present, in the Russian Federation, there is a situation where state obligations to provide the population with free medical care of the required volume and quality are provided with financial resources by no more than half.

The shortage of financial and other resources will not be overcome in the near future. In these conditions, the role of financial planning methods in health care increases as a procedure for bringing the level of consumption of health care resources by the population in line with the existing limited economic opportunities.

State and municipal medical institutions exist exclusively at the expense of health care expenditures planned in the budgets of all levels and compulsory health insurance funds. The correct combination of these sources, the use of the most effective, optimal mechanisms for bringing these funds to medical institutions are among the most important tasks of healthcare organizers.

On average, in the Russian Federation, budgetary funds account for the prevailing share in total health care expenditures - 60% and more. The use of these funds is carried out on a budgetary basis. However, the mechanisms for using funds from the two main sources (budget and compulsory medical insurance) are different. With all the obviousness of the greater efficiency and expediency of the insurance principle of spending funds to pay for medical care, the budget-estimate principle continues to be preserved. At the same time, it is also obvious that with a lack of funds in any industry in any field of activity, it is necessary to consolidate funds, use them in the direction of the "main strike", to solve the most significant tactical and strategic tasks. The implementation of these principles is possible through the expansion of competent financial planning in health care.

Rational planning allows not only focusing resources on priority areas, but also implementing an integrated approach to solving the most pressing health problems based on intersectoral interaction.

Subject of research: principles, objectives, directions and methods of planning in the health sector.

Object of research: articles, normative materials and documents, as well as works of Russian and foreign authors on health planning and economics.

Purpose: to study the planning mechanism in healthcare enterprises.

· Review the literature

Study the theoretical aspects of health planning;

Analyze the economic methods of planning the activities of a medical institution;

Consider major issues in health planning;

Study and analyze the results of your own research.

· Conclusion. Output.

Research materials: articles, normative materials and documents, as well as works of Russian and foreign authors on health planning and economics.

1. Planning health care as a branch of the economy

Planning as an integral part of economic management is a set of methods and tools that allow you to choose the optimal development option that ensures the efficient use of resources.

Planning is subdivided into:

1) by level:

Federation (state planning),

Sectors (sectoral planning),

Regions (regional planning),

Individual organizations, enterprises, institutions;

2) by the time factor:

Current,

Promising,

Target;

3) by methods:

Balance sheet,

Normative.

Planning only "from the achieved level" (determination of future changes based on existing trends, subject to their persistence and past experience) is acceptable if the society is not in the process of profound changes and is satisfied with the state of the social sector (in particular, the organization of the health care system). However, at the same time, there is always a danger of repeating mistakes made and inevitably a conflict with changing needs and new opportunities.

In order to achieve the most rational use of limited resources, it is necessary to determine their return as accurately as possible, compare it with costs, and compare different options for development programs in terms of costs and benefits.

Health planning is the substantiation and development of the needs of the population in medical care, drug provision and sanitary and anti-epidemic services in accordance with the possibilities of their satisfaction.

Lisitsin Yu.P. gives the following definition of health planning: "health planning at the present stage should be considered as a specially created multifactorial health management subsystem with dynamic goals, a multi-sectoral target-forming complex and functional connections between elements both within health care and with other sectors."

2. Basic principles, types and methods of planning

Basic principles of planning the health care system of the Russian Federation:

Ensuring social guarantees of the population in obtaining the necessary medical care, and first of all, the implementation of the State Guarantee Program;

Compliance of health care resources with the needs of the population in health care.

The development of health care must take place under the following conditions:

Unity of development goals of the system at different levels of organization and management both for the current period and for the future;

Effective use of material, financial, labor and other resources of medical institutions;

Strengthening the material and technical base of medical institutions;

Improving the quality and efficiency of medical care.

The command economy was characterized by directive planning of health care, when the complex plans included the following sections: labor plan (number and payroll), material and technical service plan; investment plan (construction and equipment of medical institutions); workforce plan (needs, training, professional development).

In the context of the decentralization of the management system and the demonopolization of the state health care system, the content and methods of planning have changed from a directive to a recommendatory nature. However, the normative method of planning with the use of appropriate norms and standards has been preserved (norms for the workload of medical personnel - the number of patients per 1 hour of outpatient admission; standards for the average annual bed occupancy in a hospital; staff standards, etc.).

The specificity of the Russian economy is determined by the high level of differentiation of economic, social, demographic indicators of regional development. The strengthening of spatial heterogeneity makes it difficult to pursue a unified policy of socio-economic transformations, leads to the disintegration of the national economy, weakening the integrity of society and the state.

A significant factor contributing to overcoming the disintegration of the Russian economy is the use of the program-targeted planning method, which is successfully used in various sectors of the national economy, including healthcare. The importance of state regulation of the development of regional health care is due to the significant stratification of Russian regions both in terms of demographic characteristics and the level of public investment in the industry, which is reflected in the table in the Appendix to this course work.

Program-target planning for the development of regional health care has been practiced on the territory of all constituent entities of the Russian Federation since 1998 and is regulated by government regulations issued annually. However, due to the heterogeneity of the main financial program indicators for the constituent entities of the Russian Federation, the effectiveness of program activities will also be different.

The relevance of the economic assessment of the effects of the implementation of regional target programs increases with a change in the procedure for providing citizens of the Russian Federation with state social assistance (monetization of benefits). With the adoption of the Federal Law of August 22, 2004 No. 122-FZ "On State Social Assistance", it becomes necessary to unify the principles of organization and mechanisms for the implementation of medical and economic control of medicinal care, preferential prosthetics provided to certain categories of citizens within the framework of the above law.

So, in market relations, the role of optimal planning increases, when for the fullest satisfaction of the population's needs for health services, taking into account the state of the material, technical and resource base, the option of further development of the system is selected.

To this end:

1) complex indicators are analyzed:

Material and technical base of medical facilities in the region;

Standards for providing the population (children and adults) with medical care;

Population health and its dynamics;

Financial, material and labor resources of the health care of the region;

Clinical examination and preventive work, etc.

2) questions are being studied:

Further development of medical care in its main types, taking into account the demographic characteristics in the region;

Development of health insurance (compulsory medical insurance and voluntary medical insurance);

Introduction of resource-saving technologies;

Improving the health care management system;

Improving the quality of medical care for the population.

3. Economic methods of planning the activities of a medical institution

The transition to economic methods of managing the industry presupposes a change in approaches to planning at the level of health care facilities. While maintaining budget planning (a systematic process of drawing up, reviewing, approving and executing a budget), instead of the usual volumetric indicators reflecting the number of visits, bed-days, etc., financial standards are of decisive importance.

The advantage of economic planning methods is that they create material incentives and affect the wages of medical workers. At the same time, complex indicators of quality and effectiveness are needed, which most fully characterize the goals facing the medical institution and its departments.

Planning the work of a health facility is to determine:

1) the main goals and functions of health care facilities and indicators, the implementation of which contributes to the achievement of these goals;

2) types and volumes of medical care, taking into account the level of morbidity and gender and age structure of the population served;

3) the need for financial and material resources and the calculation of financial standards;

4) maximum volume indicators of activity, taking into account the planned volumes of financing from all sources.

The indicator of the volume of outpatient care is expressed in the number of visits per 1000 population:

P \u003d AxKp + D + P ;,

where P is the number of visits to doctors in total (per 1000 population); A - incidence rate (per 1000 population); Кп is the coefficient of repeat visits (per 1000 population); D - the number of dispensary visits (per 1000 population); P; - the number of preventive visits (per 1000 population).

The indicator of the volume of inpatient care is expressed in the number of bed-days per 1000 population. The needs of the population for inpatient care - the required number of average annual beds per 1000 population (K), are determined as follows:

1.K \u003d A x R x P / D x 100

where A is the incidence rate (per 1000 population); R is the percentage of patients selected for hospitalization; P is the average length of stay of the patient on the bed; D - average annual bed occupancy (number of bed-days).

2.K \u003d Q x Pp / D x Pp

where Q is the total number of bed-days spent by patients in the hospital in the reporting year; Р - population size in the reference year; D is an indicator of the average number of days of bed use in a given year; Pb - population size in the reporting year.

where Y is the hospitalization rate (per 1000 population); P is the average length of stay of the patient in bed.

Ambulance volume is expressed in terms of calls per 1000 population.

The most important planning stage is the analysis of the system of providing medical care to the population according to the following parameters:

The degree of accessibility of medical care for the population within the framework of the territorial program of state guarantees;

The quality of medical care;

Efficiency of using the existing capacities of health care facilities.

Accounting and spending of funds in a budgetary institution is carried out in accordance with the estimated income and expenses approved in the prescribed manner. It is the main planning and financial document of a health facility, compiled for a year on the basis of operational network and production indicators in accordance with the economic classification of budget expenditures of the Russian Federation: 100,000 - current expenditures; 200,000 - capital expenditures; 300,000 - granting loans (budget loans) minus repayment.

Cost planning according to the estimate is based on the volume of activity of the healthcare facility for the past period on the basis of labor, material and financial norms of expenses. Then, justification and calculation of the amount of expenses for each code of economic classification are carried out.

The main document for determining the official salaries of medical workers is the tariff lists, which, together with the staffing table, are drawn up simultaneously with the estimate for each position of all structural divisions and the institution as a whole.

4. Application of business planning in the healthcare system

The commercialization of health care, expressed in an increase in the volume of paid medical services, the introduction of various organizational and legal forms of entrepreneurship and the development of private medical practice, predetermines a change in the economic status of a medical organization. Now both the patient and the healthcare facility are participants in the medical services market. In these conditions, the importance of such a direction of activity of an independently operating service-producing organization as business planning increases.

A business plan is a clearly structured document describing all the main aspects of the activities of a medical organization from the moment of its creation to reaching its design capacity; it includes the development of a project goal, an assessment of the actual economic performance of a medical organization, market analysis and customer information, determination of a competitive strategy to achieve the set goals. A well-written business plan increases the organization's chances of receiving funds from the prospective investor.

The business plan is developed for 1-5 years. The sequence of drawing up a business plan:

A decision is made to introduce measures to improve the existing medical organization or to create a new organizational and legal form (for example, a medical autonomous non-profit organization);

Own capabilities of the healthcare facility in project implementation are assessed;

Medical services are selected, the provision of which will be the goal of the project;

Market opportunity for these medical services is being investigated;

A place is selected for the implementation of the planned activity;

Developed:

Production plan;

Marketing plan;

Organizational plan;

Financial plan;

Possible risks from this project are analyzed;

A summary of the business plan is drawn up, which becomes the first section of the document in the final text.

A well-developed business plan helps hospitals develop, strengthen their positions in the medical services market, and predict their economic movement for the future.

To develop an effective plan, it is necessary to analyze the external environment and the actual state of the medical institution.

External environment: prospects for the development of health care and the market for medical services, the state of competition, consumers of medical services, trends in the development of the external environment, not controlled by a medical organization, but influencing its activities.

Internal environment: marketing, finance, production activities, human resources, administrative activities.

Analysis of the external environment makes it possible to assess both the dangers from the outside, which can impede the activities of the health care facility, and the opportunities that can help achieve the intended goals. The analysis of the internal environment is aimed at identifying the strengths and weaknesses of a medical institution, identifying areas for improvement.

If a medical organization decides to introduce paid medical services or expands their list, the following work on collecting information should precede the drawing up of a business plan:

Sources and amounts of funding are being studied;

The amount of underfunding for all sources is determined;

The material and technical base of the institution is being studied;

Characterization and assessment of personnel in terms of qualifications, age, experience is carried out;

The assistance provided is analyzed by type, quality, timeliness and availability;

The types of services offered to the population for a fee are determined;

Population demand is being studied;

A plan is determined by the scope of activities;

The expected income is determined.

5. Major challenges in health planning

As you know, the strategic task of the national project "Health" is to improve the quality and availability of medical care. This is exactly what the measures are aimed at to strengthen the material and technical base and improve the qualifications of primary care personnel, increase the salaries of district service specialists, create high-tech centers, vaccine prevention, etc. The implementation of a complex of such large-scale measures cannot but require changes in planning and assessing health performance.

One of the main planning tools is the widely used system of state (municipal) orders-assignments for the implementation of certain volumes of medical care. At the same time, it is also obvious that the planning methods used are far from perfect. This fully applies to the specified orders, tasks, which are pinned on special hopes in connection with the proposed expansion of the organizational and legal forms of medical organizations. It is advisable to identify the main problems in this area, as well as outline possible ways to solve them.

In order for the analysis of the situation with the formation and implementation of state (municipal) orders-assignments to be more complete, let us name the reasons why this form of planning today is dominant in the domestic health care. It:

Ensuring the constitutional rights of citizens to receive free medical care;

Ensuring a coordinated flow of resources into the industry from the CHI system, as well as from the budgets of all levels;

Equalization of financial conditions for the functioning of state and municipal health care in different regions;

Development of outpatient care and reduction of inpatient care;

Differentiation of medical care financed from the budget and from the CHI;

Determination of the correspondence of the volume of state guarantees for free medical care to the allocated resources.

The experience available in many regions allows us to formulate a list of the main problems that need to be solved now, and not be transferred to the conditions when medical organizations of new organizational and legal forms will appear, and private medicine will, on a general basis, participate in the implementation of the Program of state guarantees for the provision of citizens of the Russian Federation. Federation of Free Medical Care.

These problems include the following:

Imperfection of the regulatory framework for the formation of orders-tasks for the provision of medical care;

The need to ensure the constitutional rights of citizens to free medical care, regardless of the volume of resource provision of the order;

The need to select and unify the optimal method of payment for medical services (fund holding, global budget, system of diagnostically related groups, etc.);

The need to increase the availability of medical care;

Lack of effective mechanisms to ensure the coordination of the activities of medical organizations of various subordination in the formation and implementation of orders-assignments;

Mismatch of interests of the customer and the contractor;

Orientation of healthcare leaders only to volumetric (resource) performance indicators;

Lack of specific tasks for the development of preventive medicine in orders-assignments;

Lack of effective methods of control over the execution of task orders.

Probably most of the questions that need to be answered are related to the imperfection of the regulatory framework for planning activities in the health sector.

The research materials were articles, normative materials and documents, as well as works of Russian and foreign authors on the issues of health planning and economics.

Materials from the following medical journals were analyzed:

- "Issues of Economics and Management for Healthcare Managers";

- "Heads. doctor";

- "International medical reviews";

- "Healthcare".

Research method: analytical.

Results of our own research

In view of the impossibility of considering the topic of planning on the example of a specific medical institution due to the closed nature and inaccessibility of this financial information, we will consider this topic on the example of the Russian Federation.

After analyzing the methodological and regulatory literature on health planning in the Russian Federation, I found out the following:

For the next two years, the objectives of the industry will be:

Conclusion

The formation of state policy in health protection and the provision of medical care in modern conditions is primarily associated with the provision of the population of the Russian Federation with guaranteed, free medical care of the required volume and quality and makes new requirements for the creation of new forms of industry management, significantly increases the role of planning.

In the period of transition to a market economy, the search for effective mechanisms to improve health care performance is one of the most urgent tasks. Of great importance in providing affordable, free medical care to the population is the correspondence of the volumes of guaranteed medical care to their financial support. Analysis of scientific sources, regulatory and methodological base, as well as the experience of implementing state orders in the health care system indicate the need to develop theoretical and practical foundations for its implementation, in particular, algorithms and planning tools aimed at optimizing the work of medical institutions, efficient use of available limited resources.

An analysis of the existing literature data showed the absence of clear technologies for assessing the effectiveness of program-targeted planning for the development of Russian health care and recommendations for its further improvement. Since in the domestic literature there is practically no information about approaches to the choice of criteria for the effectiveness of medical programs, as well as about systems of economic measurements of quality processes in health care.

Thus, planning and assessing the performance of medical organizations require serious changes, and the expected strengthening of the resource base of health care in the coming years is a favorable factor for this. The first step in this direction can be the introduction of indicators of the quality of medical care, reflecting the state of health of the population, as the main planned indicators. The initiative in this matter may well be shown by the regions (municipalities) themselves, without waiting for the corresponding indicators to appear in the federal program of state guarantees. Undoubtedly, good prerequisites for solving these problems have been created by the development and implementation of the national project "Health".

Literature

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5. Kadyrov F.N. Incentive pay systems in health care. Ed. 2nd, revised, and add. - M .: ID Grant, 2003.

6. Kenneth J. Cook Small business. Strategic planning: Translated from English .. - M.: "Dovgan" Publishing House, 1998.

7. Kozyrev VA, Korsakova VV Business plan of the enterprise: Textbook. allowance / Moscow state. un-t of railways (MIIT). Department of Management. - M.: MIIT, 2009.

8. L. A. Gabueva Economics of health care facilities: economic efficiency and business planning - M .: ID Grant, 2009

10. On changing the norms of reimbursement of travel expenses in the territory of the Russian Federation // Vopr. Economics and Management for Healthcare Managers -2007. -5 -s.22-23

11. Planning of medical care within the framework of territorial programs of state guarantees, providing citizens of the Russian Federation with free medical care // Vopr. Economics and Management for Healthcare Executives -2008. -2 -s. 25-26

12. Popov VM, Lyapunov SI Business planning: Textbook for students. universities, training., on econ. specialist. / Russian Academy of Economics. G.V. Plekhanov. - M.: Finance and Statistics, 2009.

13. Decree of the Government of the Russian Federation of 11.09.98 No. 1096 "On approval of the Program of state guarantees for the provision of citizens of the Russian Federation with free medical care" (as amended on 11.10.99 No. 1194, dated 29.11.2000 No. 907, dated 24.07.01 No. 550 and so on ).

14. Expenditures on health care next year will increase // Vopr. Economics and Management for Healthcare Executives -2009. -5 -s.13

15. Modern methods of management and financial management of healthcare institutions. Edited by F.N. Kadyrov. - M .: ID Grant, 2001

16. Social hygiene and healthcare organization / Ed. A.F. Serenko and V.M. Ermakova. - 2nd ed. - M .: Medicine, 1984 .-- 640 p.

17. Trushkina L.Yu., Tleptserishev R.A., Trushkin A.G., Demyanova L.M. Health Economics and Management: Textbook. Rostov n / a: Phoenix, 2003.

18. Chavpevtsov V.F., Kudrin K.L. The quality of medical care, problems and prospects for ensuring its guarantees in the CHI system / V.F. Chavpevtsov, K.L. Kudrin // International medical reviews. 2003. T. 3, No. 3. S. 209-215.

19. Shipova VM, Levin AV, Methodological bases for planning the total volume of medical care and its specialized types // Glav. doctor - 2010.-5-p.15-27

20. Shamshurina N.G. Pricing and Profit - Healthcare 1, 2008.

In order to implement paragraph 2 of the set of measures to provide the healthcare system of the Russian Federation with medical personnel until 2018, approved by the order of the Government of the Russian Federation dated April 15, 2013 N 614-r (Collected Legislation of the Russian Federation, 2013, N 16, Art. 2017), I order:

Approve the methodology for calculating the need for specialists with secondary vocational (medical) education in accordance with.

Minister

IN AND. Skvortsova

application
to the Ministry of Health
Russian Federation
dated February 14, 2018 N 73

Methodology
calculating the need for specialists with secondary vocational (medical) education

1. In order to provide methodological assistance in current planning, identify a shortage or excess of medical workers with secondary vocational (medical) education (hereinafter referred to as nursing staff) in medical organizations subordinate to the executive bodies of state power of the constituent entities of the Russian Federation and local governments (hereinafter referred to as medical organizations) developed a methodology for calculating the need for specialists with secondary vocational (medical) education (hereinafter - the Methodology).

2. When determining the need for nursing staff, the following may be taken into account:

the provision of medical personnel (per 10 thousand of the population) providing medical care on an outpatient basis to the population of the constituent entity of the Russian Federation, calculated according to the methodology for calculating the need for medical personnel;

the provision of hospital beds in the constituent entities of the Russian Federation (per 10 thousand population), calculated according to the methodology for calculating the need for medical personnel;

features of the provision of pre-medical care by nurses, as provided for by the procedures for the provision of medical care approved by the Ministry of Health of the Russian Federation;

presence in the constituent entity of the Russian Federation of settlements remote (more than 300 km) from medical organizations in which specialized medical care is provided;

territorial features of the constituent entities of the Russian Federation (location of the constituent entity in the regions of the Far North and equivalent localities, the proportion of the rural population);

the volume of medical care provided within the framework of territorial programs of state guarantees of free provision of medical care to citizens of the Russian Federation (hereinafter - TPGG);

the age composition of nursing staff working in medical organizations;

the presence in medical organizations of structural units: feldsher-obstetric points (hereinafter - FAP), medical assistant health posts (hereinafter - FP).

3. The Methodology uses a conditional division of nursing personnel into groups, taking into account their functional responsibilities:

"treatment group", which includes nursing staff working with doctors at outpatient appointments, nursing staff performing independent outpatient appointments (an examination room midwife, a FAP or FP paramedic, a first-aid doctor's office, etc.), nursing staff, providing medical care in inpatient conditions, in a day hospital and ambulance;

"treatment and diagnostic group", which includes nursing staff of diagnostic and auxiliary departments (offices) (nurses for functional diagnostics, nurses for physiotherapy, laboratory assistants in clinical laboratories, instructors in physiotherapy exercises, etc.);

"management group", including nursing staff - heads of FAP - paramedic (nurse), heads of health centers - paramedic (nurse), medical statisticians, heads of offices, chief (senior) nurses, etc .;

"reinforcement group", which includes nurses, namely nurses, ward (sentry) nurses, general hospital nurses, nursing staff of the admission department, providing assistance to students in educational institutions;

Specialists of the "treatment and diagnostic group" and "management # group" are included in the "paraclinical group".

4. It is advisable to calculate the required number of paramedical personnel according to the algorithm for calculating the need for paramedical personnel:

Table N 1

Recommended algorithm for calculating the need for nursing staff

To provide emergency medical care	To provide primary health care	To provide specialized medical care
Determination of the number of emergency medical teams	Calculation of the number of doctors, taking into account territorial coefficients	Calculation of the number of beds, taking into account the territorial coefficients
Determination of the number of emergency medical teams	Calculation of the number of nursing staff working with doctors at outpatient appointments and at independent appointments (taking into account the ratio of doctors and nurses)	Calculation of the number of nursing staff, taking into account the standard number of beds per position of nursing staff
Calculation of the standard for the number of nurses in the dispatch service	Calculation of the "amplification group" (taking into account the ratio of doctors and nurses)	Calculation of the "reinforcement group" (taking into account the coefficients of the ratio of nurses employed in auxiliary and main activities)
Calculation of the standard for the number of nurses in the "management group"	Calculation of the "paraclinical group" (taking into account the ratio to the nursing staff of the "treatment group")	Calculation of the "paraclinical group" (taking into account the ratio of the ratio to the nursing staff of the "treatment group")
Calculation of the need for nursing staff		Calculation of the number of nursing staff in day hospitals
Calculation of the need for paramedical personnel - total
Comparison with the actual number of nursing staff, determination of deficit or surplus

5. Calculation of the need for paramedical personnel providing emergency medical care:

5.1. To calculate the need for paramedical personnel providing emergency medical care (hereinafter referred to as EMS) to the population, it is recommended to use:

the average standard for the volume of emergency medical services (the number of calls per 1 insured person), approved in the Program of state guarantees for free provision of medical care to citizens for the current and planned periods;

the estimated number of stations and / or emergency departments, approved by order of the Ministry of Health of the Russian Federation of June 20, 2013 N 388n "On approval of the Procedure for the provision of emergency, including specialized emergency medical care" (registered by the Ministry of Justice of the Russian Federation on August 16, 2013 No. , registration N 29422), as amended by order of the Ministry of Health of the Russian Federation dated January 22, 2016 N 33n (registered by the Ministry of Justice of the Russian Federation on March 9, 2016, registration N 41353), by order of the Ministry of Health of the Russian Federation dated May 5, 2016 . N 283n (registered by the Ministry of Justice of the Russian Federation on May 26, 2016, registration N 42283) (hereinafter - the order of the Ministry of Health of the Russian Federation of June 20, 2013 N 388n);

the estimated number of field ambulance teams approved by order of the Ministry of Health of the Russian Federation dated June 20, 2013 N 388n.

5.2. To calculate the need for nursing staff, it is recommended to use the following indicators (form of federal statistical observation N 30):

number of calls;

the number of individuals of nursing staff;

the number of medical mobile teams, including specialized teams;

the number of paramedic mobile teams;

the number of individuals of the dispatch service according to the staffing table of stations (departments) of the NSR (if any);

the number of individuals of the "management group" from the total number of individuals of the nursing staff;

number of calls per 1 inhabitant (form of federal statistical observation N 30 / population size of the subject of the Russian Federation);

the number of nursing staff per 10 thousand of the population (form of federal statistical observation N 30 / population of the constituent entity of the Russian Federation * 10 000);

the number of calls per one insured person, established by the Territorial Program of State Guarantees of Free Provision of Medical Care to Citizens of the Subject of the Russian Federation (TPGG).

5.3. It is recommended to calculate the number of paramedical personnel of the ambulance field teams using the formula:

НЧвб \u003d ЧБх2 * КС * КВ,

NCHvb - the estimated standard for the number of paramedical personnel of the field ambulance teams;

ЧБ - the number of visiting teams of the ambulance;

КС - coefficient of shift of work of field crews of the ambulance;

To take into account the peculiarities of the constituent entities of the Russian Federation, it is possible to use correction coefficients:

KS - to take into account the duration of the work of the field emergency brigade when organizing work less than 24 hours a day. With a 24-hour team work, the coefficient can be 1, from 9 to 12 hours - 0.5, from 6 to 8 hours - 0.25;

КВ - to take into account the number of SME workers over working age. If the proportion of nurses at this age is less than 10% of all nurses at the station and / or emergency department, then the coefficient should be taken as 1; from 10% to 15% - 1.01; over 15% - 1.02.

5.4. It is recommended to calculate the number of paramedical personnel of the emergency dispatch service using the formula:

NCHds \u003d CHDSsmp * CDS,

NCHds - the estimated standard for the number of nurses in the emergency dispatch service;

ChDSsmp - the actual number of individuals of the nursing staff of the emergency dispatch service;

CDS - dispatching service availability factor.

To take into account the peculiarities of the constituent entities of the Russian Federation, it is possible to use a correction factor for the presence of a dispatch service. The CDS makes it possible to take into account the presence of a unified dispatch service of the NSR in the constituent entity of the Russian Federation. If there is no such service, then the CDS can be equal to 1. In the presence of a single dispatching service of the NSR, the CDS is equal to 0.3.

5.5. The number of nursing staff of the "control group" is characterized by the number of stations and (or) emergency departments (Federal Statistical Observation Form N 30).

5.6. The estimated standard for the number of nursing staff in the emergency room (absolute number) is recommended to be determined by the formula:

NCHsmp \u003d NCHvb + NCHds + NCHgu,

NCHsmp - the normative number of nursing staff of the emergency medical service;

NCHvb - the normative number of nursing staff of the ambulance field teams;

NCHds - the normative number of nurses in the emergency dispatch service;

NCHGU - the normative number of nurses in the "management group" of the emergency medical service.

5.7. The estimated standard for provision of paramedical personnel per 10 thousand of the population is recommended to be determined by the formula:

OBNCHsmp \u003d NCHsmp * 10000 / population size of the subject,

NCHsmp - normative number of nursing staff of the emergency medical service (absolute number);

OBNCHSMP - provision of emergency medical personnel per 10 thousand population.

5.8. The deficit / surplus of EMC nurses can be defined as the difference between the estimated standard for the number of EMC nurses (absolute number) and the actual number of EMC nurses (absolute number).

6. Calculation of the need for paramedical personnel involved in the provision of medical care on an outpatient basis:

6.1. The basis for calculating the required number of nursing staff working with doctors, as well as carrying out an independent outpatient appointment (a midwife in an examination room, a paramedic of a FAP or FP, a paramedic of a first-aid office, etc.) may be the provision of medical personnel per 10 thousand of the population.

The number of doctors (absolute number) should be determined by the formula:

CHVap \u003d OBV * CHN / 1000,

CHVap - the number of doctors providing medical care on an outpatient basis;

OBV - provision of doctors per 10 thousand of the population;

CHN - population size.

Since the indicator of the provision of medical personnel per 10 thousand of the population already takes into account territorial and other coefficients that take into account the characteristics of each constituent entity of the Russian Federation, then when calculating the number of nurses working with doctors conducting outpatient appointments, such coefficients may not be considered.

6.2. When calculating the required number of paramedical personnel performing an independent outpatient appointment (a midwife in an examination room, a paramedic of a FAP or FP, a paramedic of a first-aid appointment, etc.), it is possible to use information on the number of relevant rooms. The actual number of offices (structural units) is indicated on the basis of federal statistical observation form N 30.

6.3. It is advisable to calculate the number of nurses in the "reinforcement group" for each profile of medical care provided on an outpatient basis on the basis of the ratio method, taking into account the recommended aggregated calculation coefficients of the ratio of nurses and doctors.

6.4. The need for nursing staff in the "treatment group" includes the estimated number of nursing staff working with doctors at outpatient appointments and performing independent outpatient appointments (examination room midwife, FAP or FF paramedic, first-aid doctor, etc.) , which is advisable to calculate taking into account the order of medical #.

6.5. The calculation of the number of nurses in the "treatment and diagnostic group" and "management group" is usually carried out on the basis of the ratio method, taking into account the calculated ratio coefficients:

Table N 2

	Recommended aggregated calculated ratios of the ratio of nurses and doctors engaged in main and auxiliary activities
	nursing staff working with outpatient doctors	nursing staff working in self-admission offices	nursing staff of the reinforcement group	paraclinical nursing staff
	2	3	4	5
Total for the treatment and diagnostic group				0,17
Total by control group			0,06

The corresponding calculated coefficients are multiplied by the number of nurses in the "treatment group".

6.6. The estimated number of paramedical personnel involved in the provision or providing independent medical care on an outpatient basis may include the estimated number of paramedical personnel in the "treatment group", "treatment-diagnostic group" and "management group".

6.7. The basis for calculating the required number of nursing staff of day hospitals of medical organizations providing medical care on an outpatient basis and at home is the number of places in day hospitals.

6.7.1. It is advisable to carry out the estimated number of nursing staff by the number of day hospital beds based on the ratio method, taking into account the recommended correction factors:

Table N 3

	Normative value

	1,05
	1,03
2. Coefficients taking into account the share of the population of the constituent entity of the Russian Federation living in rural areas
for entities in which at least 50% of the population lives in rural areas	1,11
for entities in which from 30% to 50% of the population lives in rural areas	1,05
3. Coefficients taking into account the volume of medical care within the TPGG, which is performed by medical organizations of federal and private ownership
for entities in which from 5% to 10% of primary health care for TPGG is provided in medical organizations of federal and private ownership	0,98
for subjects in which from 10% to 20% of primary health care for TPGG is provided in medical organizations of federal and private ownership	0,95
4. Coefficients taking into account the population density of the constituent entity of the Russian Federation
for subjects with a low population density (lower than in the whole of the Russian Federation)	1,05
for subjects with a high population density (higher than the whole of the Russian Federation)	0,83
5. Coefficients taking into account the presence in the constituent entity of the Russian Federation of settlements remote (more than 300 km) from the regional (municipal) center, where specialized assistance is provided
for entities in which from 30% to 50% of the population lives in remote settlements	1,15
for entities in which more than 50% of the population lives in remote settlements	1,10
6. Coefficients taking into account the level of medical care
for subjects in which from 70% to 90% of medical care is provided in medical organizations of the 1st level	1,20
for subjects in which from 50% to 70% of medical care is provided in medical organizations of the 1st level	1,10
	1,74

The final correction factor is recommended to be multiplied by the number of nursing staff "by the number of places" for each profile of medical care. To take into account the peculiarities of the constituent entities of the Russian Federation, it is advisable to apply the developed correcting coefficients to the number of nurses "by the number of places" If the features of the constituent entity of the Russian Federation satisfy the described condition, then the corresponding value of the coefficient from the "standard value" is taken into account, if they do not, then the coefficient value is 1. After filling in all the lines, the final correction coefficient for the constituent entity of the Russian Federation can be calculated. The value of the final correction coefficient, as a rule, is calculated individually for each constituent entity of the Russian Federation.

6.7.2. The estimated number of nursing staff involved in the provision of health care in day hospitals may include the estimated number of nursing staff for the main groups.

6.8. The need for paramedical personnel may include the estimated number of paramedical personnel of the "treatment group", "treatment-diagnostic group" and "management group" involved in providing medical care to the population on an outpatient basis, as well as the estimated number of paramedical personnel required to provide medical care in day hospitals.

6.9. To take into account the number of nurses over working age (women 55 and older, men 60 and older), it is recommended to use the age load factor.

The calculation of the need for nursing staff, taking into account the age load, can be determined by the formula:

LFm \u003d Cham * KV,

NCHam - the estimated standard for the number of nurses for the provision of medical care on an outpatient basis;

Cham - the estimated standard for the number of nurses for the provision of medical care on an outpatient basis, without taking into account the age load factor;

КВ - coefficient of age load.

CV is recommended to be used to account for the number of nurses over working age. If the proportion of nurses over working age is less than 10% of all nurses at the station and / or the emergency department, then the coefficient may be equal to 1; from 10% to 15% - 1.01; over 15% - 1.02.

6.10. The deficit or surplus of nursing staff providing medical care to the population on an outpatient basis, in day hospitals, can be defined as the difference between the estimated and actual number of nursing staff (absolute number).

7.1. The basis for calculating the required number of nurses providing medical care in inpatient conditions is the provision of beds per 10 thousand of the population.

The number of hospital beds (absolute number) is recommended to be calculated using the formula:

CHK \u003d OBK * CHN / 1000,

CHK - the number of beds in a 24-hour hospital;

OBK - provision of beds per 10 thousand population;

CHN - population size.

7.2. To determine the number of paramedical personnel providing medical care in inpatient conditions, it is advisable to recalculate the number of beds per one paramedical personnel in accordance with the procedures for providing medical care.

7.3. To take into account the territorial and other peculiarities of the constituent entities of the Russian Federation, it is recommended to apply the recommended correction factors to the number of nursing staff by the number of beds, which are selected from the "Standard value" based on the territorial characteristics of the constituent entities of the Russian Federation and the number of hospitalizations per 1000 population (hospitalization rate):

Table N 4

Recommended correction factors	Normative value
1. Coefficients taking into account the location of the constituent entity of the Russian Federation in the regions of the Far North and equated to them
for entities located entirely in the Far North and equated to them	1,05
for entities in which less than 50% of the population lives in the regions of the Far North and equated to them	1,03
2. Coefficients taking into account the level of hospitalization of the population
for subjects in which the hospitalization rate is 195.5 per 1000 population and above	1,00
for subjects in which the hospitalization rate is from 176.0 to 185.7 per 1000 population	0,94
for subjects in which the hospitalization rate is from 166.2 to 176.0 per 1000 population	0,90
for subjects in which the hospitalization rate is less than 166.2 per 1000 population	0,84
Final adjustment factor	0,77

The total final adjustment factor is calculated automatically and is individual for each constituent entity of the Russian Federation.

7.4. The need for nursing staff of the "treatment group" providing medical care in inpatient conditions includes the estimated number of nurses by the number of beds and the "reinforcement group" for each profile of inpatient care.

7.5. The calculation of the number of nurses in the "treatment and diagnostic group" and the "management group" is usually carried out on the basis of the ratio method, taking into account the aggregated calculation coefficients:

Table N 5

7.6. The basis for calculating the required number of nursing staff, in day hospitals, may be the number of places in day hospitals obtained by calculation.

7.6.1. It is advisable to determine the estimated number of paramedical personnel by the number of day hospital beds taking into account the enlarged design coefficients of the ratio of paramedical personnel.

7.6.2. The estimated number of nursing staff by the number of places is carried out taking into account the recommended correction factors:

Table N 6

If the characteristics of the constituent entity of the Russian Federation satisfy the described condition, then it is advisable to put the corresponding value of the coefficient from the "standard value" in the column "for the constituent entity of the Russian Federation"; if they do not, then the value of the coefficient may be -1. , which is calculated automatically and can be individual for each subject of the Russian Federation.

7.6.3. The estimated number of nursing staff involved in the provision of medical care in day hospitals includes the estimated number of nursing staff for the main groups.

7.7. The need for paramedical personnel includes the estimated number of paramedical personnel of the "treatment group", "treatment and diagnostic group" and "management group" involved in providing inpatient care to the population, as well as the estimated number of paramedical personnel required to provide medical care in conditions day hospitals.

7.8. To take into account the number of nurses over working age (women 55 and older, men 60 and older), it is recommended to use the age load factor.

The calculation of the need for nursing staff, taking into account the age load, can be carried out according to the formula:

NCHst \u003d Chst * KV,

NCHst - the estimated standard for the number of nurses for the provision of medical care to the population in stationary conditions;

Chst - the estimated standard for the number of nursing staff for the provision of medical care to the population in stationary conditions, without taking into account the coefficient of age load;

КВ - coefficient of age load.

CV can take into account the number of nursing staff over working age. If the proportion of paramedical personnel over working age is less than 10% of all paramedical personnel, then the coefficient may be equal to 1; from 10% to 15% - 1.01; over 15% - 1.02.

7.9. It is recommended to define the deficit / surplus of nurses providing medical care to the population in inpatient and day hospitals as the difference between the estimated and actual number of nurses (absolute number).

8. The need for paramedical personnel to provide medical care to the population as a whole in the constituent entity of the Russian Federation may include the estimated number of paramedical personnel required to provide emergency medical care, medical care in outpatient and inpatient settings, day hospital conditions, and it is recommended to calculate by the formula:

LF \u003d LFsmp + LFm + LFst,

NCHsmp - the normative number of nurses for the provision of emergency medical care;

NCHam - the estimated standard for the number of nurses for the provision of medical care on an outpatient basis;

NCHst - the estimated standard for the number of nurses for the provision of medical care in stationary conditions.

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Health planning. Determination of the needs of the population in outpatient and inpatient care. General provisions of the health care system of the Russian Federation Determination of the population's need for hospital care

Reviewers:

Definition of differentiated needs

Planning by prioritizing

B \u003d 9.1 * / 5 500 \u003d 20.1 medical positions

F \u003d (365 - 0) / (13.7 + 1) \u003d 24.8 patients

D \u003d 24.8 * 13.7 \u003d 339.8 days

M \u003d 60 * 24.8 \u003d 1 488 patients

CD \u003d 1 488 * 13.7 \u003d, 6 bed-days

K \u003d * 21.6 * 13.5) / (332.8 * 100) \u003d 204.7 coins

K \u003d 4 985 / 23.5 \u003d 212.1 beds

K \u003d * 14.0) / 335 \u003d / 335 \u003d 208.3 beds

Methodology calculating the need for specialists with secondary vocational (medical) education

Recommended algorithm for calculating the need for nursing staff

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Methodology
calculating the need for specialists with secondary vocational (medical) education