Experimental study of the possibility of using the process approach to optimize drug supply to a medical facility. Medicines for inpatients

22.05.2019

Medicines for health care facilities: problems and solutions. Organization fundamentals drug supply LPU. Legal regulation of drug supply for medical institutions. Problems of drug supply to health care facilities and their solution.

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Introduction ................................................. .................................................. ........ 3

Chapter 1. Pharmaceutical provision of healthcare facilities: problems and ways to solve them ... ... 5

1.1. Fundamentals of the organization of drug provision for health care facilities ........................ 5

1.2. Legal regulation of drug provision for health care facilities ... ... ... ... ...... 9

1.3. Problems of drug provision for health care facilities and their solution ... ... ............. 17

Chapter 2. Experimental research the possibility of using a process approach to optimize drug provision in health care facilities ... 28

Conclusion ……………………………………………………………………… .32

References …………………………………………………………… 34

INTRODUCTION

The relevance of the work.Health - necessary condition labor potential, the main criterion for the effectiveness of public administration. The position of recognizing health as the highest national priority of the state finds understanding and firm support from the Russian leadership. The management of health care facilities in the context of reforms and a transitional economy requires fundamentally new approaches to increasing the socio-economic efficiency of using the limited economic resources of health care. The main strategies for the survival of the socio-economic system of health care facilities are traditionally considered to be efficiency and productivity.

As the above data demonstrate, modern system Russian healthcare requires significant changes. Serious reforms in the direction of increasing the efficiency of the system began to be implemented only recently. Achieving the set goals requires a consistent and thoughtful policy. So far it is impossible to say about positive results, firstly, due to the mistakes made, miscalculations, and secondly, insufficient quantity time to assess the results of the work, thirdly, due to the complexity of the tasks. After all, in fact, the whole system has to be built anew, based on modern global standards.[ 9 ]

Among the problems, the solution of which will provide an increase in the efficiency of economic resource management, should include the creation of an effective system for control and monitoring of drug supply. One of the priority directions for solving this problem is to optimize the use of drugs in the treatment and diagnostic process without compromising the quality of delivery. medical care... In this regard, the most relevant issues are the provision of medicines in health care facilities.[ 7 ]

Object of study:drug provision of health care facilities.

Subject of study:the peculiarities of the provision of medicinal products for health care facilities.

Purpose of the study: to study the peculiarities of drug provision of health care facilities.

Research objectives:

1. Explore fundamentals of the organization of drug supply to health care facilities.

2. Consider legal regulation of drug provision of medical institutions.

3. Analyze the problems of drug supply to health care facilities and their solution.

4. Conduct an experimental study of the possibility of using the process approach to optimize drug provision in health care facilities.

Met about d research:analysis of literary sources on this topic, generalization, abstraction, synthesis, experiment.

Work structure.The work is written on 35 sheets printed text... The work contains an introduction, 2 chapters, including paragraphs, a conclusion and a list of used literature.

CHAPTER 1. DRUG SUPPLY OF HEALTHCARE PROVISION: PROBLEMS AND WAYS OF THEIR SOLUTION

Fundamentals of the organization of drug supply to health care facilities

The provision of drugs for patients undergoing treatment in medical institutions is carried out free of charge at the expense of the compulsory medical insurance and the state budget within the framework of the Program of state guarantees for the provision of free medical care to citizens of the Russian Federation. Small health care facilities, especially those located in rural areas, are provided with medicines and products medical purpose through territorial self-supporting pharmacies of the general type. Supply of large health care facilities located in cities and regional centers is carried out through a network of specialized pharmacies, which can be self-supporting (interhospital and hospital) or budgetary (health care pharmacies).

An interhospital pharmacy is organized for the provision of drugs to health care facilities with a total number of beds of at least 500, as well as in settlements where in all health care facilities the total number of hospital beds is from 100 to 500. In addition to inpatient health care facilities, it can be assigned to supply medical offices of polyclinics, health centers , educational institutions and social security... A self-supporting hospital pharmacy is organized for the provision of drugs to one medical institution with a number of hospital beds of 500 or more, as well as in settlements if there are at least 100 hospital beds in a medical institution. These pharmacies perform identical functions, however, they differ in economic terms and in their subordination. Self-supporting - to the pharmacy committee, and budget-financed - to the head physician of the healthcare facility. [ 6 ]

Interhospital and self-supporting hospital pharmacies do not sell drugs to the population. They perform production, information, supply and financial and economic functions.

The peculiarities of the provision of drugs to health care facilities are the manufacture and dispensing of drugs from the pharmacy not for one patient, but for the department as a whole, based on the actual number of patients in it. At the same time, liquid dosage forms prevail in the formulation, especially for parenteral administration.[ 15 ]

Medicines can be dispensed to a patient only on the basis of prescriptions written by a doctor. Forms of prescription forms and the procedure for filling them out have been approved. For discharging free recipes for outpatient treatment of patients from the category of persons specified in Articles 6.1 and 6.7 of the Law "On State social assistance", are used prescription forms the established form. For the prescription of Schedule II narcotic drugs and psychotropic substances, special prescription forms are used. These recipes are subject to quantitative accounting. The prescription must contain: the name of the medicinal product (both the international non-proprietary name and the trade name); the method of administration of the medicinal product, indicating the dose, frequency, time of administration and its duration; expiration date of the prescription; payment order.[ 21 ]

Maximum term the validity of preferential prescriptions for medicines is 1 month (30 calendar days) from the date of discharge. This does not mean that the period of delayed prescription servicing in the absence of the drug in the pharmacy organization is also 1 month. In the absence of a drug in a pharmacy organization, a patient who comes with a prescription is put on delayed service for up to 10 working days. If, while on deferred service, the prescription expires, then according to such a prescription, the drug can be dispensed without re-issuing it. This requirement does not apply to narcotic drugs and psychotropic substances, the validity of prescriptions for which is 5 days. V general case for chronic patients, it is possible to establish a prescription validity period of 1 year, but for citizens who have the right to receive a set of social services, this option is not provided.

It is forbidden to write prescriptions: for medicinal products that are not authorized in the prescribed manner for medical use; with absence medical indications; for medicines used only in medical institutions (anesthetic ether, chloroethyl, etc.); for narcotic drugs and psychotropic substances included in List II of the List of narcotic drugs, psychotropic substances and their precursors subject to control in Russian Federation approved by Decree of the Government of the Russian Federation of June 30, 1998 N 681 (hereinafter referred to as Schedule II narcotic drugs and psychotropic substances), for the treatment of drug addiction; for narcotic drugs and psychotropic substances of Schedules II and III to private practitioners.

The Social Insurance Fund does not pay the pharmaceutical organization the costs of providing medicines: to persons who are not included in the federal register of persons entitled to receive state social assistance; not included in the List of Medicines; according to prescriptions issued in violation of the established procedure.[ 7 ]

By order of 09.01.2007 N 1 of the Ministry of Health and social development Of the Russian Federation approved the List of medical devices and specialized products health food for children with disabilities who are released on prescriptions from a doctor (paramedic) in the provision of additional free medical care to certain categories of citizens who are entitled to receive state social assistance. This List consists of two sections - medical products and specialized health food products for children with disabilities.[ 1 ]

The appointment of medical devices and specialized food products is made by the doctors of the relevant medical and preventive institutions after a personal examination of the patient and in the presence of medical indications. The same prescription forms are used for prescribing medical products and specialty food products as for prescribing medicines. You can get specialized food products for disabled children in pharmacies that supply citizens with medical products and specialized health food products. The dispensing of medical products and specialized medical food products for disabled children by pharmacies is carried out in the manner prescribed for the dispensing of medicines.[ 13 ]

LEGAL REGULATION OF MEDICINAL PROVISION OF HEALTH INSTITUTIONS

The creation of equal opportunities and conditions for receiving medical and pharmaceutical care for various groups of the population is one of the most important components of the state's social policy. The state is responsible for the availability of medicines (drugs). In January 1998, at the 101st session of the WHO Executive Board, a decision was made regarding WHO's activities in the field of drug supply. It expresses concern about the current situation in the world in which one third of the population the globe does not have guaranteed access to the most necessary medicines... On 18 May 2002, the 55th World Health Assembly called on Member States to reaffirm their commitment to expanding access to essential medicines to ensure that they are physically and financially accessible to all people who need them.

One of the directions of state support for the least protected social categories of the population is the provision of various benefits, including the right to free or preferential provision of drugs and medical products (MP).Currently, legislative acts in the field of drug supply (PM) make up about 30% of the legislative framework in the healthcare sector of the Russian Federation. The fundamental document in the health care system is the Fundamentals of the Legislation of the Russian Federation on the Protection of Citizens' Health. Article 44 determines that the categories of citizens provided with drugs and medical devices on preferential terms are established by the Government of the Russian Federation, the governments of the republics within the Russian Federation. The right to write prescriptions for preferential categories citizens have physicians attending state, municipal and private systems health care.

In accordance with the Federal Laws "On veterans", "On social protection of citizens exposed to radiation as a result of the Chernobyl disaster", "On social protection of citizens exposed to radiation as a result of tests at the Semipalatinsk test site", "On the rehabilitation of victims of political repression", By the decrees of the Government of the Russian Federation of July 30, 1994, No. 890 and of July 10, 1995, No. 685, and other laws and decrees of the Government of the Russian Federation, more than 50 groups of citizens and categories of diseases have the right to free and with a 50% discount on prescription drugs.[ 11 ]

The list of population groups and categories of diseases, for treatment in health facilities of which drugs and medical devices are dispensed on prescriptions of doctors free of charge or with a 50% discount, approved by the Government of the Russian Federation of July 30, 1994, No. 890 "On state support development of the medical industry and improving the provision of the population and health care institutions with medicines and medical products ”. In accordance with this decree, war invalids, participants of the Great Patriotic War, veterans of military operations, persons awarded with the sign "Resident of blockade Leningrad", and others are provided with free provision of medicines on prescriptions from doctors in the manner determined by the constituent entities of the Russian Federation, not lower than the standards established by the Government of the Russian Federation.[ 8 ]

Pensioners receiving an old-age, disability or survivor's pension in minimum dimensions, persons who worked during the Great Patriotic War at air defense facilities, in the rear, persons who were political repression, and others are entitled to a 50% reduction in the cost of prescription drugs.Such specific groups of drugs as anticancer, antituberculosis, antidiabetic, drugs used to treat asthma, mental, some cardiovascular, endocrine and a number of other diseases in full should be dispensed to the population free of charge.[ 16 ]

In pursuance of the Decree of the Government of the Russian Federation No. 890, by order of the Ministry of Healthcare of Russia dated 09.06.95, No. 161, a mandatory range of drugs for pharmacies serving outpatients in the Russian Federation. This list includes drugs of 38 pharmacotherapeutic groups (about 270 names) and about 70 names of medical products. Authorized health authorities and the pharmacy service to adjust the mandatory assortment minimum in relation to local conditions for different categories of pharmacies, taking into account their profile.[ 2 ]

The Federal Law of 12.01.1995 No. 5HFZ "On Veterans" establishes the following categories of veterans: veterans of the Great Patriotic War, veterans of military operations on the territory of the USSR and the territories of other states, veterans military service, veterans public service, labor veterans. Persons who belong to these categories of veterans and disabled war veterans are identified. In accordance with Article 14 of this Federal Law, as amended on July 25, 2002, war invalids are provided with free provision of medicines on prescriptions from doctors in the manner determined by the constituent entities of the Russian Federation, not lower than the norms established by the Government of the Russian Federation.In accordance with clause 2 of the Decree of the Government of the Russian Federation of July 17, 1995 No. 710, the norms for dispensing drugs and medical devices to disabled people and other groups of the population in accordance with the Federal Law "On Veterans" are determined by the attending physician based on the severity and nature of the disease. The same decree approved the procedure for preferential leave of drugs and medical devices to war invalids and other groups of the population during their outpatient treatment in accordance with the Federal Law “On Veterans”. In accordance with the Procedure, preferential dispensing of drugs and medical devices is carried out by pharmacy organizations, regardless of the form of ownership, according to prescriptions of doctors, written out in accordance with the established procedure. War invalids and other categories of the population should be registered in pharmacies at their place of residence for preferential and free provision of drugs and medical devices in the manner determined by the executive authority of the constituent entity of the Russian Federation. In pharmacies, a reserve of drugs and medical devices should be formed, the nomenclature and quantity of which is determined annually taking into account the type of diseases attached to the pharmacy organization these groups population and consumption of drugs and medical devices for the previous year. The procedure for creating a reserve is determined by the executive authority of the constituent entity of the Russian Federation. [ 10 ]

In the case of a temporary absence of a prescribed drug and the impossibility of replacing it similar drugs the administration of the pharmacy is obliged, leaving the prescription, to register the patient, to take measures for the earliest possible receipt of drugs and to notify the patient of his receipt. In the event of a long delay in providing the patient with the necessary drugs, the administration of the pharmacy is obliged, in agreement with the doctor who wrote the prescription, to resolve the issue of replacing this drug with another. Preferential leave for people with drugs and medical devices can be carried out by a doctor at an appointment at a polyclinic (patients with diabetes, chronic diseases) or when visiting a lonely patient at home.[ 14 ]

One of serious problems In the implementation of the Federal Law "On Veterans", the fulfillment of state guarantees of preferential drug provision for veterans remains. Federal Law "On Amendments to Article 10 of the Federal Law" On Veterans "" dated November 18, 1998 No. 172H FZ, financing of these benefits is provided at the expense of the budgets of the constituent entities of the Russian Federation. The procedure for reimbursement of expenses is approved, respectively, by the Government of the Russian Federation and the executive authorities of the constituent entities of the Russian Federation. The expenses of the state authorities of the constituent entities of the Russian Federation, local self-government bodies associated with the provision of benefits to veterans are taken into account in the mutual settlements of the federal budget and the budgets of the constituent entities of the Russian Federation and have a target value. Besides, additional funds for financing preferential drug provision can be obtained from any sources not prohibited by law. Order of the Ministry of Health of Russia dated June 25, 1999 No. 251 defines measures aimed at providing war veterans with drugs on a preferential basis.

In order to increase the volume and quality of the provision of medical and medical and social care to elderly and elderly people, prevention premature aging By order of the Ministry of Health of Russia dated July 28, 1999, No. 297, a system of measures was introduced to improve the organization of medical care for the elderly.Fundamental to legal regulation activities of health care institutions in the field of PL have such legislative acts as the Law of the RSFSR "On medical insurance of citizens in the RSFSR", Federal laws "On narcotic drugs and psychotropic substances", "On medicines", "On psychiatric care and guarantees of citizens in its provision " and etc.[ 3 ]

Issues related to drug circulation received detailed legal support in the Federal Law "On Medicines" (1998), which created legal basis activities of subjects of drug circulation, established a system government agencies carrying out law enforcement practice in accordance with the law, distributed the powers of the executive authorities in the field of drug circulation. The law is a normative act of complex content, regulates all essential aspects of relations arising in the sphere of circulation of drugs on the territory of the country, except for drugs and psychotropic substances.[ 1 5]

In accordance with article 6 of this law, the Government of the Russian Federation ensures the implementation in the Russian Federation of a unified state policy in the field of providing the population of the Russian Federation with medicines, develops and implements federal programs providing the population of the Russian Federation with drugs, and also establishes the procedure for social protection citizens, preferential and free drug provision for certain categories of citizens. The executive authorities of the constituent entities of the Russian Federation in the sphere of drug circulation develop and implement regional programs for providing the population of the constituent entities of the Russian Federation with drugs (Article 7).[ 9 ]

The law also establishes the basic principles of the system of state guarantees for the availability of drugs to the general population of the Russian Federation. Article 42 for the first time introduces the concept of "state system for ensuring the availability of drugs" and identifies two sources of financing for the PA population, which should solve this problem: federal and territorial budget programs and compulsory health insurance (MHI). The availability of drugs under the compulsory medical insurance is ensured by the conclusion of tariff agreements. [ 11 ]

The state system of guarantees of the availability of providing the population with drugs is also established by other regulatory acts:

The program of state guarantees for the provision of free medical care to citizens of the Russian Federation, approved by the Decree of the Government of the Russian Federation of 11.09.1998, No. 1096 (as amended on 24.07.2001);

Decree of the Government of the Russian Federation of 09.11.2001, No. 782 "On state regulation of prices for medicines";

By the joint order of the Ministry of Health of Russia and the Federal Fund for the Compulsory Medical Insurance of the Russian Federation of 03.19.2001, No. 79/17 "On agreements between the Ministry of Health of Russia, the Federal Compulsory Medical Insurance Fund and the executive authorities of the constituent entities of the Russian Federation on the provision of medical care to the population."[ 8 ]

In pursuance of Article 32 of the Federal Law "On Medicines", as well as in order to streamline preferential provision On April 8, 1999, the Government of the Russian Federation adopted Resolution No. 393 “On guaranteed provision of citizens with vital and essential medicines, as well as on certain conditions of preferential provision of medicines for citizens”. This decree provides:

To develop and approve the minimum range of medicines necessary for the provision of medical care, the availability of which is mandatory for pharmacies, providing in it as an integral part of the List of vital and essential medicines;

To develop and approve the procedure for issuing prescriptions for medicines to citizens who seek medical care in an outpatient clinic, regardless of its organizational and legal form, bearing in mind that the prescription of medicines, the rate of their dispensing and the issue of prescriptions are carried out by the attending physician based on the severity , the nature of the disease and the standards of its diagnosis and treatment;the procedure for dispensing medicinal products in pharmacies, providing for the rules for replacing a medicinal product for which a prescription has been issued in case of its absence.[ 20 ]

In accordance with this decree, preferential categories of citizens who have the right, during outpatient treatment, for free provision of medicines or for a 50% discount in their payment, prescriptions are issued:

For medicines included in the minimum range of medicines required for the provision of medical care - by the sole attending physician of a state or municipal outpatient clinic at the place of permanent residence of these citizens or at the place of their attachment for medical care;

For medicines that are not included in the minimum assortment, as well as for narcotic, psychotropic, potent drugs, special drugs (antineoplastic, anti-tuberculosis, antidiabetic, immunosuppressants) - by the attending physician on the basis of the decision of the clinical expert commission of the polyclinic institution, or by the relevant specialists of the polyclinic institution, or by the doctors of the relevant specialized medical and prophylactic institutions (dispensaries).[ 19 ]

The decree defines the limits of the sole competence of a doctor in prescribing drugs on preferential terms. V individual cases associated with the need to provide urgent medical care, prescribing medicines and prescribing prescriptions are possible solely by the attending physician without prior agreement with the clinical expert commission of the polyclinic institution.The decree also provides for the implementation of measures to control the appointment and issue of preferential prescriptions and the availability in pharmacies of the minimum range of drugs necessary for the provision of medical care.In pursuance of this resolution, the Ministry of Health of Russia issued an order dated 23.08.1999, No. 328 "On the rational prescription of medicines, the rules for prescribing them and the procedure for their dispensing by pharmacies (organizations)", which is aimed at streamlining the work of healthcare facilities, eliminating duplication drug assistance and more rational use of public funds earmarked for drug benefits.[ 3 ]

In order to implement the decrees of the Government of the Russian Federation of 11.09.1998 No. 1096 "On the approval of the Program of state guarantees for the provision of citizens of the Russian Federation with free medical care", dated 8.04.1999 No. 393 and in pursuance of the Decree of the Government of the Russian Federation of 30.07.1994 No. 890 On January 26, 2000, by order of the Ministry of Health of Russia No. 30, the List of Vital and Essential Medicines (Vital and Essential Medicines) was developed and agreed with the Ministry of Economics and the Ministry of Finance of Russia, which is used as a baseline in the formation of the minimum range of drugs required for pharmacies. The list includes 395 positions of international non-proprietary names (or about 10 thousand trade names). The heads of the healthcare authorities of the constituent entities of the Russian Federation were instructed to develop and approve regulatory documents regulating drug provision of medical institutions and benefit categories of the population, including a range of drugs not less than the VED list. Establish control over the availability of medicines in medical and pharmacy organizations, regardless of the organizational and legal form, which are included in the territorial regulatory documents regulating drug provision to privileged categories of the population as part of the implementation of the State Guarantee Program for the provision of free medical care to citizens of the Russian Federation. At present, by the order of the Government of the Russian Federation of 04.04.2002, No. 425Hr, a new list of vital drugs has been approved. By order of the Ministry of Health of Russia dated April 23, 2002, No. 130, the order of the Ministry of Health of Russia dated January 26, 2000, No. 30 became invalid.[ 2 ]

Per last years in the constituent entities of the Russian Federation, the regional legal framework of the Russian Federation in the field of health care and drug provision is being actively formed. Currently, 31 constituent entities of the Russian Federation have adopted laws that create a legal basis for state regulation of activities in the field of providing the population with drugs. The results of a comparative study of the regulatory and legal framework of the regions of the Russian Federation in the field of drug provision showed different approaches to organizing the drug supply for the population at the territorial level, which differ in the composition of the participants in the drug supply process, their administrative and functional subordination, and information interaction. In many existing regulatory legal acts in the field of providing the population with affordable and high-quality drugs, there is no mechanism for monitoring their implementation by the executive authorities, and responsibility for violation of these norms is not established. The lack of uniform principles for the organization and financing of drug care in most constituent entities of the Russian Federation leads to a lack of equal opportunities in obtaining it and does not provide the inherent guarantees of drug availability for privileged categories of citizens within the framework of state guarantees for the provision of free medical care to citizens of the Russian Federation.

PROBLEMS OF MEDICINAL PROVISION OF HEALTH INSTITUTIONS AND THEIR SOLUTION

Health care facilities are the most important sector of the health care system, which is designed to take on the bulk of the population's requests for medical care - up to 80% of all patients annually. The level of drug supply largely affects the quality of the doctor's treatment measures, which is associated with the correct, scientifically grounded and rational organization of the activities of pharmacies serving the population. Characterizing the network of health care facilities, it should be noted that in the Russian Federation there are about 17 thousand outpatient clinics and polyclinics of all levels of subordination (municipal, subject of the Russian Federation and federal subordination). The number of visits to health care facilities per 1 inhabitant per year, having decreased by 1995 to 9.1 by 2002, increased to 9.6 (in 2001 - 9.5; in 2000 - 9.4; in 1999 -9.3). In 2003, the value this indicator decreased slightly and amounted to 9.4 visits per 1 inhabitant. At the same time, the largest number of visits per 1 inhabitant is noted in the Republic of Tatarstan (12.8), and the smallest - in the Republic of Ingushetia. In the total amount of financing of the country's health care, expenditures on health care facilities in 2002-2004. did not exceed 26-28% of total expenditures for the implementation of the Program of State Guarantees for the Provision of Free Medical Care to the Citizens of the Russian Federation. [ 1 5]

The problem of organizing drug supply that has developed in health care facilities determines the increased attention to the development of scientifically grounded measures to ensure the availability of drug care to the population, the tasks of which are the effective and economical use of available health care resources, accessibility and quality. Prescription of medicines (drugs) is carried out by the attending physician or specialist with an average special education(paramedic, midwife, dentist) in accordance with Art. 54 of the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens and in the manner determined by the Instruction of the Ministry of Health of the Russian Federation (No. 328 of 23.08.99). The majority of citizens of the Russian Federation, when treated in a healthcare facility, must purchase drugs at the expense of own funds both over-the-counter and prescription dispensing. In this regard, the problem is a decrease in the availability of drugs for a significant part of the population due to a multiple increase in prices, which is associated not only with the commercialization of pharmaceutical enterprises and pharmacy organizations, but also the presence of a network of intermediary organizations.[ 11 ]

The solution to this problem is in a number of areas, among which we note the creation of a system of tender purchases of drugs and state registration of manufacturer's selling prices for drugs included in the List of Vital and Essential Medicines (in accordance with the decrees of the Government of the Russian Federation and Orders of the Ministry of Health and Social Development of the Russian Federation). Great importance has also improved the legislative framework governing the production of drugs and drug supply to the population. The main conceptual directions for improving drug supply for the population of the Russian Federation are: creation of optimal models for pricing and procurement of effective and safe drugs; development of a strategy aimed at ensuring the rational use of drugs by doctors and patients; promoting the development of domestic production of pharmaceuticals; ensuring quality control, safety and efficiency of domestic and imported drugs; stimulating foreign investment in the Russian pharmaceutical sector. The fundamental document in the field of drug circulation is The federal law"On Medicines" (1998), the main purpose of which is to regulate relations arising in connection with the development, production, manufacture, preclinical and clinical trials of drugs, control of their quality, efficacy, safety, and trade in drugs. State regulation of relations arising in the environment of drug circulation is carried out through state registration of drugs; licensing of activities in the field of drug circulation; adaptation and certification of specialists employed in the field of drug circulation; state control of production, manufacture, quality, efficiency, safety of drugs. State registration new drugs, new combinations of previously registered drugs are subject to; Medicines previously registered but produced elsewhere dosage forms, with a new dosage or other composition of excipients; reproduced drugs (drugs that came into circulation after the expiration of the patent rights to original drugs that came into circulation with their own registered names).[ 6 ]

In accordance with the Program of state guarantees for the provision of free medical care to citizens of the Russian Federation for 2006, approved by the Decree of the Government of the Russian Federation No. 461 of July 28, 2005, when providing emergency medical care, inpatient medical care and medical care in day hospitals of all types, free drug care is provided ... In outpatient treatment, free or preferential drug provision covers only groups of the population and patients with diseases defined by the RF Government Decisions. By order of the Ministry of Health of the Russian Federation No. 30 dated January 26, 00, regulatory documents (forms) regulating drug provision of medical institutions and privileged categories of citizens operating in the constituent entities of the Russian Federation must include an assortment of drugs not less than the List of Vital and Essential Drugs. Currently, the List of Vital and Essential Medicines, approved by the Order of the Government of the Russian Federation No. 2343-r dated December 29, 2005, is in force. About 45 million people in Russia need to purchase drugs free of charge or with a 50% discount when undergoing treatment in a healthcare facility (Table 1) ...[ 8 ]

Pharmaceutical provision follows from the general strategy for the development of health care and social policy of the state. The provision of drugs to the population at the level of primary health care is carried out in the retail sector of the pharmaceutical market, which determines the quality of drug supply to the population.

Table 1

	Estimated number
Disabled people I, II, III groups (adults)	9 000 000
Disabled children under the age of 16	517 700
WWII veterans and invalids and persons equated to them	2 178 500
Children of the first three years of life	3 919 000
Radiation-Exposed Citizens	569 800
Military personnel, citizens called up for military training, and military service veterans	3 500 000

The retail segment includes the business of selling goods (or services) directly to end consumers. In the promotion system pharmacy products the retail segment is represented by pharmacy institutions, which include pharmacies serving the population, pharmacy points, pharmacy booths, pharmacy stores. The activities of pharmacies are carried out in accordance with the legislation of the Russian Federation, regulatory documents Ministry of Health and Social Development of the Russian Federation and executive authorities. According to the data of the Ministry of Health and the SR of the Russian Federation, at the beginning of 2000, more than 19,217 pharmacies, 35,284 pharmacies, 12,360 pharmacy kiosks, 1,318 pharmacy stores and 5,962 wholesalers were providing drug supply to the population in the Russian Federation at the level of health care facilities. The load per one pharmacy in terms of the number of inhabitants was 8.8 thousand people. The annual growth in the number of pharmacies is 12-17%. Specific gravity sales of drugs in retail trade turnover for the period from 1998 to 2002 ranged from 2.6 to 3.1%. In the structure of trade turnover, drugs account for about 85%.Of the total number of pharmacies, 65.2% have a state organizational and legal form, 34.8% have other forms. In the wholesale sector, enterprises of non-state organizational and legal form and departmental subordination prevail (96.5%). The pharmacy service management system is presented in three forms: a structural unit as part of a healthcare management body (62.0%); an independent governing body under the executive authorities of the constituent entities of the Russian Federation (22.0%); non-governmental organization (OJSC, LLC, etc.), which is entrusted with a number of functions of state administration (16.0%).

Important factors that determine the effectiveness of the health care system at all stages of providing medical care to the population is the rational use and availability of drugs and pharmaceutical care in general. At the same time, one of the activities in the field of drug provision is to increase the availability of drug care, which is carried out on the basis of optimizing the activities of participants in the pharmaceutical market, using a rational pricing system, forming an assortment policy, rational use of financial resources and drugs by introducing formulary system and treatment regimens in accordance with standards and a number of other factors.[ 17 ]

Special attention should be paid to the situation with drug supply to the population in modern Russia. After the collapse of the USSR, the Russian pharmaceutical industry has undergone significant changes. During the existence of the USSR, the population's need for medicines was mainly provided Russian manufacturers, the missing drugs were purchased in the countries of Central Europe. With the collapse of the USSR, a single pharmaceutical industry ceased to exist - the former Soviet republics took their factories, while the Russian ones gradually fell into decay. In the first years after the transition to a market economy, the production of medicines was unprofitable, as prices for raw materials, energy, and transport rose sharply; foreign-made drugs literally poured into the Russian market (the import of which was given significant benefits), thus creating a tough competitive environment. As a result, by 1997, the volume of domestic production in the pharmaceutical industry decreased by 60%, manufacturers were forced to raise prices, which resulted in the fact that domestic drugs could not withstand the competition. By 1998, the volume of production of medicines decreased 5 times 15 ... By the same time, 120 pharmaceutical factories, 21 factories producing components of medicines, and 42 research institutes synthesizing immunobiological drugs were operating at 25-50% of their capacities, and 70-90% of their equipment expired.At the same time, 93% of pharmaceutical companies produced medicines based on imported components. By the end of the 90s. the share of imported drugs was already 65% and continued to grow over the following years. In 2006 this share was 78%. Despite the decline of the domestic pharmaceutical industry, producer prices were constantly growing. So, from 1997 to 2001, they grew by 150% (i.e., an increase of 37-38% per year).After the default, Russian manufacturers gradually began to gain strength, many pharmaceutical plants began to be re-equipped, equipped with modern equipment. Today in Russia there are three sectors of the pharmaceutical market: retail / commercial (sale drugs through pharmacies; financed by consumers' funds), hospital (hospital purchases; financed by regional and federal budgets), DLO (additional drug supply programs; financed by the federal budget). In 2007, the shares of these market sectors were 73%, 13% and 14%, respectively. Since 2008, the third sector has been called the Essential Medicines Provision (NMP) program, but out of habit all market participants still call it DLO.

As can be seen from the share distribution, the state today does not play such a significant role in the supply of medicines as it used to be, but it continues to influence the development of the pharmaceutical market in Russia, since it is it that provides funds for federal targeted programs and priority projects.With the collapse of the centralized drug supply, which was in the USSR, the constituent entities of the Russian Federation developed their own programs for the procurement of drugs. Medicines for hospitals began to be purchased at the expense of territorial funds of the obligatory health insurance(OMS).With the introduction of the health insurance system in modern Russia, the quality of medical care was also monitored by insurance companies. medical organizations and the Compulsory Health Insurance Fund (MHIF). The compulsory medical insurance system was created as a state guarantee of the right of citizens to receive free medical services in the legally established volume. However, in order to save funds, compulsory medical insurance funds purchase medicines mainly for competitive basis, which sometimes leads to low efficiency of treatment due to the use of cheap drugs.[ 6 ]

The system of voluntary medical insurance (VHI), which was additionally created in the commercial sector, was supposed to improve the quality of services provided in the course of competition between insurance organizations. However, so far the VHI system has not yielded the expected results, since it is largely used not by the patient individually, but by the employing company as one of the elements of the social package. So, according to S. Gotovats (member of the board of the company "Renaissance Insurance", deputy. general director on individual types insurance), only 5-7% of the population are individually involved in the voluntary health insurance system.[ 17 ]

In theory, when hospitalized, patients should receive medicines free of charge - they are purchased by hospitals at their own expense, from the compulsory medical insurance funds or from the DLO budget, but often these drugs are not enough or they are not delivered on time, so patients are forced to buy medicines for their own money. According to WHO estimates, in 2003, hospitalized patients paid for 80% of drugs from their own funds. This is largely due to insufficient funding of hospitals, since they have to buy many drugs at market prices. In addition, delays in government payments for drugs supplied serve to disruptions in the organization of drug supply in hospitals.Outpatients buy medicines from pharmacies or receive them free of charge on preferential prescriptions. After the collapse of the USSR, many pharmacies began operating on a private basis due to a lack of government funding. Today, many pharmacies operate as commercial enterprises while providing preferential prescriptions, which are also subject to significant government delays. Therefore, a number of pharmacies refuse to participate in the DLO program.

In 2006, 22,400 polyclinics, 10,200 hospitals, 24,000 pharmacies and pharmacies, 40,000 pharmacy booths, 470 foreign manufacturers, 600 domestic, 1,000 distributors were registered in Russia.The abundant number of factors on the pharmaceutical market has led to a sharp increase in the number of drugs approved for sale in Russia, with a rather low purchasing power compared to European countries and the United States. Today, about 150,000 names are included in the State Register of Medicines, while many European countries medicine uses only a few thousand successfully. The main problem is that among this set of drugs sold in the Russian Federation, there are a large number of ineffective drugs. Only 12% of all drugs in 2007 had proven efficacy (i.e., innovative, original drugs), the rest were copies of original drugs (so-called branded generics and generic generics), for which clinical trials are practically not conducted and which cost significantly cheaper. Many of these drugs are restricted or banned in Europe and come from Far Eastern and Eastern European countries. And because of the low purchasing power of the population, doctors prescribe drugs, often focusing not on efficiency, but on price. In addition, there are about 12% of counterfeit products on the Russian pharmaceutical market.

If we separately talk about the formation of prices for certain drugs, then, first of all, the state fixes the manufacturer's price when registering a drug. Then a maximum mark-up is set on this price, which should contain the retail price of the drug. The limiter is set for both wholesale and retail prices. If for the wholesale price it is 25% plus to the manufacturer's cost, then for the retail price it is plus 30% to the wholesale price. In reality, each region sets its own maximum markup, in addition, there can be several distributors - and the drug is resold several times. As a result, the final price is 120-200% higher than the manufacturer's price.To combat this phenomenon, the state has created a list of vital and essential medicines to ensure their availability. The main criteria for entering this list were efficiency, safety and price. But since demand is guaranteed for drugs from this list, manufacturing companies pay bribes to officials responsible for forming the list. As a result, the list includes drugs that do not meet the criterion of "vital necessity".In 1998, the standard was approved in Russia GMP (Good Manufacturing Practice , "Rules for the organization of production and quality control of drugs"). The transition to these rules will take 5 years. That is, after this period, companies whose production does not meet the requirements GMP , theoretically should have ceased to exist. However, in reality this did not happen. Today, indeed, a number of large domestic companies are switching to standards GMP but this process has just begun.

CHAPTER 2. EXPERIMENTAL STUDY OF THE POSSIBILITY OF USING THE PROCESS APPROACH TO OPTIMIZE THE DRUG SUPPLY OF THE HEALTHCARE

Until now, the process approach to the management of organizations practically does not find application in health care institutions, both at the level of management of the organization as a whole, and in the management of individual areas of activity.As applied to the process of supplying health care facilities with medicines (drugs), the analysis of the risks borne by the consumer is of greatest importance. medical services as a result of untimely provision of drugs or receiving drugs of inadequate quality.Within the framework of the process approach, a preventive-type medical institution can be viewed as a business system, which is an interconnected set of business processes, the ultimate goal of which is to provide quality medical services.

The purpose of the present study was the study of the possibility of using the process approach to optimize the drug provision of health care facilities.

We have developed a business process "drug provision of medical facilities", which consists of 9 stages, for the practical implementation of each stage, we have proposed the content and main directions of the work of the performers:

I ... Drawing up and filing of applications by departments of health care institutions.

II. Examination of applications in health care facilities.

III ... Formation of an order in a pharmacy.

IV ... Checking the application at the main financial department.

V ... Carrying out a procurement procedure in an agency under a government order.

VI ... Conclusion of government contracts between suppliers and healthcare facilities.

Vii ... Supply of drugs to the pharmacy of the healthcare facility.

VIII ... Storage of drugs in the pharmacy of the medical facility.

IX ... Dispensing drugs to the departments of health care facilities.

To improve the quality of primary applications, we have proposed an algorithm for drawing up applications at the level of department heads.

The key link in the business process "drug provision of healthcare facilities" is the preliminary examination of applications for drugs in healthcare institutions, for which it was proposed to introduce an official structure "expert group" into healthcare facilities, the composition of which is formed as a process team. The expert group includes: chairman - deputy chief physician for medical work, leading specialists of health care facilities in areas, clinical pharmacologists, head of a pharmacy, economists, lawyers.

Most difficult question resource provision of the business process "drug provision of medical facilities" is the training of personnel involved in its implementation. Participates in the business process a large number of executors (clinical pharmacologists, pharmacists, heads of departments, economists, lawyers, System Administrator), which should work as a process team with common goals, a common understanding of the assigned tasks and appropriate training to perform the assigned work. The formation of process teams is one of the most important problems of all enterprises without exception. The preparation of such a team requires a lot of time, money and skill in managing personnel.

The problem is that the knowledge that team members should have is not included not only in basic, but also in postgraduate training. Basically, this is knowledge from related disciplines or from other areas of knowledge, therefore, the forms of training for specialists should be non-standard.

The business process "examination of the application" is regulated by technological map“Examination of the application”. Rational drug provision of healthcare facilities is based on VEN -analysis, allowing to formulate priorities for subsequent purchases of drugs, both from the point of view of the effectiveness of pharmacotherapy, and from the point of view of the feasibility of spending on their purchase.

The applications submitted by the branches are calculated in the pharmacy, summarized by the assortment items of the same name, and in the form of a draft application are submitted to the expert council. Further, the draft application is subjected to VEN - and then ABC analysis to form groups AV, BV, CV; AE, BE, CE and AN, BN, CN.

In allocating funding, priority should be given to vital groups ( V ) and the necessary (E) drugs, therefore, when planning purchases, first of all, funds should be allocated for the group AV , in which the most expensive or purchased in large quantities assortment positions are concentrated, then expenses for groups are planned BV and CV.

After the funds have been allocated for the group of vital drugs, they are considering the possibilities of financing the group AE, WE CE. Due to the fact that in the group of necessary drugs, a choice is allowed alternative options pharmacotherapy, the range of drugs in this group should be carefully analyzed by the method of cost-effective selection, in order to select the most effective, safe and economically available drugs. And only if, after allocating funds for groups V and E, the healthcare facility still has free funds, they can be used to purchase a small amount of the most frequently used secondary ( N ) medicines mainly for symptomatic therapy.

The data allows you to competently draw up an application for the competition XYZ / VEN -analysis. Special attention should appeal to groups XV, YV and ZV , so they include vital drugs with different uniformity of consumption, the supply of which in health care facilities must be constant. Due to the special importance of drugs from groups XV and YV it is advisable to draw up an application taking into account the maximum desired margin.

Medicines included in the XE groups and YE not as critical to the treatment process as a group V , most often, a healthcare institution has a certain margin of time to purchase them, so their number can be calculated at the level of the current stock.

Thus, the introduction of a process approach to the management of drug supply in health care facilities contributes to an increase in the economic efficiency of drug procurement, optimization of the range of drugs used in health care facilities, and, ultimately, leads to an improvement in the quality of medical care in health care institutions due to the timely and uninterrupted provision of the treatment process. important and necessary drugs.

CONCLUSION

The practice of functioning of state (municipal) institutions, including in the field of health care, shows that there are a number of economic, legal, organizational issues, the solution of which is necessary to improve the organization of medical care and the efficiency of using the resources available in health care, incl. medicines. An inextricable relationship is needed between the pharmacy service and many departments of the healthcare facility at different levels: the administration of the institution, the senior nurse, guard and procedural nurses performing the appointment of the attending physician. Under the existing conditions of work, strict reporting is required, professional control over the rational use, storage, shelf life of drugs in the departments of medical institutions, over activities related to the circulation of narcotic and psychotropic drugs. The creation of a material flow management system in a medical facility is the basis for a stable and harmonious provision of the medical process with pharmaceutical goods.

Health care guarantees are very important element social policy of Russia, however, the management of medical care at the present time is still carried out according to its actually formed volumes without aligning the resources and obligations of the health care system and without preliminary planning and approval of the volume, structure and conditions for the provision of medical care.The introduction of a process approach to the management of drug supply in health care facilities contributes to an increase in the economic efficiency of drug procurement, optimization of the range of drugs used in health care facilities, and, ultimately, leads to an improvement in the quality of medical care in health care institutions due to the timely and uninterrupted provision of the treatment process with vital and necessary LS.The need to reform the pharmaceutical healthcare sector is determined by a number of reasons: there is a high growth rate of drug costs, especially in health care facilities, which, however, do not provide an increase in the volume and quality of drug care; there is a decrease social role drug assistance; there is no positive dynamics in the indicators of life expectancy and quality of life, a decrease in mortality and cases of serious complications of the disease among Russians.

In the context of the development of a market economy, a new social structure of social life has emerged. The industry is developing mechanisms and forms of economic and social ties that are different from the previous ones. But the drug supply system is still seen as essential

part of the medical supply system, as one of the main structural

links of health care. The further development of transformations in the industry is impossible without the most complete understanding of the attitude of healthcare practitioners and pharmaceutical service to real situation in the field of providing drug care, without assessing their views on the prospects for the development of the drug supply system for health care facilities.

BIBLIOGRAPHY

Alekseev N.A.Optimization of drug supply in a multidisciplinary hospital based on pharmacoeconomic analysis // Health Economics. - 2007. -No. 1. -C. 42-45.
Velichkovsky BT Reforms and health of the population of the country. - M., 2001 .-- 36 p.
Vilken A.E.Drug policy: the position of the Ministry of Health of Russia // Medical courier. - 1997. - No. 2 (3) - S. 25-26.
Gerasimenko N.F. Essays on the formation of modern Russian legislation in the field of public health protection. - M .: GEOTAR-MEDIA, 2001 .-- 351 p.
Glembotskaya G.T., Morozova T.V. IV Russian National Congress "Man and Medicine": Abstracts. report - M., 1997 .-- S. 313.
Activities and resources of health care institutions. Digest of articles. - M .: GEOTAR-MED, 2004.- 64 p.
Domanskaya O. Experience in the rational use of drugs in a multidisciplinary hospital // Remedium. -2003. -№ 1-2. -S.46-48.
Dremova N.B., Ovod A.I., Solyanina V.A. Methodological approaches to determining the amount of funds for drug provision of patients in a hospital // Economic Bulletin of Pharmacy, 2004, No. 7.
Ishmukhametov A.A. Theoretical and methodological foundations the functioning of the system of drug assistance to the population as an integral part of the organization of health care.- SPb., 2001.-200 p.
F.N. Kadyrov Economic service of medical institutions. - M .: GRANT, 2000 .-- 800 p.
The Constitution of the Russian Federation of 12.12.1993 (as amended by the Federal Constitutional Law of 21.07.2007 No. 5-FKZ) // Rossiyskaya Gazeta, No. 237, 25.12.1993.
Kovalevsky M. A. Constitutional principles of compulsory medical insurance. - M., 2000 .-- 117 p.
Medic V.A., Yuriev V.K. Course of lectures on public health and healthcare. - M .: Medicine, 2003 .-- 368 p.
Ovod A.I. Drug budget management // Chief physician.-2005. -No. 10. -C. 27.
On the results of the work of the Ministry of Health and Social Development of the Russian Federation in 2010 and tasks for 2011. Moscow, 2011.- P.145.
Padalkin V.P. The cost of drug treatment is growing, federal allocations are not increasing // Medical Courier. - 1997. - No. 2 (3) - S. 26-27.
Shamshurina N.G. The economy of a medical institution. - M .: MTsFER, 2001 .-- 278 p.
V.I. Starodubov Problems and Prospects for Financing Russian Health Care // Health Economics. -2007. -№1. -WITH. 6-9.
Telnova E.A. Critical analysis of the state of the drug supply system for the privileged category of the population // Pharmacy. -2006. -№3.-С. 16-20.
Tolkacheva I.V., Dremova N.B. Methodological approaches to improving drug provision for patients in specialized hospitals // Biologically active compounds of natural origin: mater. int. scientific and practical conf. - Belgorod: "Polyterra", 2008. - S. 231-235.
Yurgel N.V., Khubieva M.Yu. Features of regional drug policy in the context of healthcare modernization // Pharmacy. -2007. -№5. - S. 39-42.

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Transcript

1 Medicines for inpatients

2 Clinical and economic analysis is a methodology for comparative assessment of the quality of two or more methods of prevention, diagnosis, drug (pharmacoeconomics) and non-drug treatment based on a complex interrelated accounting of the results of medical intervention and the costs of its implementation.

3 ORDER OF THE MINISTRY OF HEALTH OF THE RF dated May 27, 2002 N 163 ON APPROVAL OF THE INDUSTRY STANDARD "CLINIC - ECONOMIC RESEARCH. GENERAL PROVISIONS"

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4 Clinical and economic substantiation of the feasibility of using drugs or non-drug treatment methods should be taken into account when developing: - patient management protocols; - a list of vital and essential medicines; - formular lists and lists; - other normative documents regulating the volume and structure of medical care to the population.

5 Basic methods of pharmacoeconomic analysis "cost - effectiveness" "cost minimization" "cost - utility (utility)" "cost - benefit"

6 An auxiliary type of clinical and economic analysis, the analysis of the "cost of treating the disease"

7 Analysis of the "cost of treating a disease" is a method of studying all the costs associated with the management of patients with a particular disease, both at a certain stage (period of time) and at all stages of medical care, as well as disability and premature mortality.

8 Cost of therapy Direct costs Indirect costs Intangible (intangible) costs

9 Direct medical costs (include all costs incurred by the health care system) - costs of diagnostic, treatment, rehabilitation and preventive medical services, manipulations and procedures, including those provided at home (including payment for working hours medical professionals); - costs of medicines; - costs of maintaining a patient in a medical institution; - the cost of transporting the patient by ambulance; - payment for the use of medical equipment, space and funds (distribution of fixed costs from budget items), etc.

10 Direct non-medical costs: - cash ("pocket") costs of patients (for example - payment for services in a medical institution); - costs of non-medical services provided to patients at home (for example, social services); - the cost of moving patients (by personal transport, public transport - not sanitary), etc.

11 Indirect (alternative) costs (costs of lost opportunities): - costs for the period when the patient is absent from his workplace due to illness or disability, including the cost of paying for sick leave, disability benefits and other social payments stipulated by the current legislation; - the "cost" of the time away from work of his family members or friends associated with his illness; - economic losses from reduced productivity at the place of work; - economic losses from premature death.

12 Intangible (intangible) costs - the costs associated with pain, suffering, discomfort that a patient experiences as a result of the course of treatment he undergoes - due to the difficulties with an accurate quantitative measurement in monetary terms, today usually remain outside the scope of the analysis performed.

13 Cost-effectiveness analysis is a type of clinical and economic analysis in which the results and costs of two or more interventions are compared, the effectiveness of which is different, and the results are measured in the same units (millimeters of mercury, hemoglobin concentration, number prevented complications, years of saved life, etc.).

14 Cost-minimization analysis is a special case of cost-effectiveness analysis, in which two or more interventions are compared that are characterized by identical effectiveness and safety, but different costs. It is recommended to apply cost minimization analysis in comparative research different forms or different conditions the use of one drug or one medical technology.

15 Cost-utility (utility) analysis - a variant of the cost-effectiveness analysis, in which the results of an intervention are evaluated in terms of “utility” from the point of view of the consumer of health care (for example, the quality of life); the integral indicator "quality-adjusted life years" (QALY) is most often used.

16 Cost-benefit analysis is a type of clinical-economic analysis in which both costs and results are presented in monetary terms. This makes it possible to compare the cost-effectiveness of different interventions with results expressed in different units (for example, an influenza vaccination program with an intensive neonatal care system for nursing low birth weight babies).

17 Cost-effective drug selection and formulary creation system (rational pharmaceutical management)

18 Formulary - a list of medicinal products that are restrictive for use and procurement, agreed and accepted at the international and (or) state level practical advice(standards) of treatment, evidence-based approach to the management of rational pharmacotherapy, a thorough analysis of the morbidity structure, evidence-based data on the most clinically and cost-effective and safe drugs, research data on the level of consumption and cost of treatment for each disease.

19 Formular system Three levels: federal, territorial healthcare facility

20 Federal level (formulary committee of the Ministry of Health of the Russian Federation) analysis and assessment of data on the use of treatment protocols in healthcare facilities, interaction, side effects Drugs, results of pharmacoeconomic and pharmacoepidemiological studies, analysis of international experience, national standards, study scientific evidence clinical and economic efficiency of drugs

21 The territorial level (the level of the constituent entities of the Russian Federation) makes it possible to compile a formulary list of drugs for the treatment of the most common diseases in the region; ensure the availability of drugs included in the formulary list; use the most effective ways appointment and use of drugs; to provide a reliable system of drug supply to health care facilities in the region; organize information and educational support for the implementation of the territorial formal system.

22 Level of health care facilities development of a limited list of drugs based on the analysis of the morbidity structure, treatment quality standards and previous purchases; determination of the use of drugs that are not included in the form; inclusion and exclusion of drugs from the form; assessment of drug use; selection of the reporting system adverse reactions; informational support of personnel about medicinal products, formulary, etc.

23 Drug supply system for inpatients

24 Supply of health care facilities with medicines Hospital pharmacies (pharmacies of health care facilities) Interhospital pharmacies Pharmacies serving the population

25 The main tasks of a hospital pharmacy is to provide departments of health care facilities according to their requirements with drugs and pharmaceutical goods; identifying the need for drugs in accordance with the profile and specifics of the work of the healthcare facility; organization of systematic information of doctors of hospitals about the pharmacy assortment

26 Functions of a pharmacy Health care facility receives claims for drugs and medical devices from the departments of health care facilities; manufactures medicinal products and controls their quality; systematically monitors correct storage and the expenditure of drugs and medical devices in the subdivisions of health care facilities; ensures compliance with all requirements of the pharmaceutical order and sanitary regime; tells doctors all necessary information about LP, their pharmacological action, side effects, dosages, etc .; ensures the storage of drugs and other goods in accordance with the established rules

27 The number of staff of a pharmacy in a medical facility, Order of the Ministry of Health of the USSR 758 of the city (for self-supporting hospital and interhospital pharmacies)

28 Dispensing, storage and accounting of drugs in pharmacies Stock of drugs Narcotic drugs 3 months (PP 1148) poisonous drugs for no more than 2 weeks of need for a pharmacy of a healthcare facility and 1 month for an MBA other drugs - no more than 2 months for a pharmacy of a healthcare facility and not more than the standard of stocks for IBA

29 Order of the Ministry of Health of the Russian Federation dated (as amended by the Order of the Ministry of Health and Social Development of Russia dated No. 13n) The procedure for issuing invoices to a pharmacy organization for obtaining drugs for medical organizations

30 Procedure for registration of requirements To ensure the treatment and diagnostic process, medical organizations receive medicinal products from the pharmacy organization according to the requirements of invoices approved in the prescribed manner.

31 Procedure for registration of requirements The requirement indicates the number, date, sender and recipient of the medicinal product, the name of the medicinal product (indicating the dosage, form of release (tablets, ampoules, ointments, suppositories, etc.), type of packaging (boxes, vials, tubes, etc.) .p.), method of administration (for injections, for external use, oral administration, eye drops, etc.), the amount of drugs requested, the amount and cost of the drugs dispensed.

32 The order of registration of requirements The names of the medicinal product are written on Latin Requirements-invoices for drugs, subject to quantitative accounting, are written out on separate forms of invoices-invoices for each group of medicinal products.

33 The order of registration of requirements Requirements-invoices of the structural unit of the MO (office, department, etc.) for medicinal products sent to the pharmacy organization are drawn up in the same manner, signed by the head of the relevant unit and issued with the MO stamp. his surname and initials, medical history number.

34 The order of registration of requirements Dentists, dentists can write out, with their signature, invoices-invoices only for medicinal products used in the dental office, without the right to hand them out to patients. Requirements for toxic drugs, in addition to the signature of the dentist or dentist, must be signed by the head of the institution (department) or his deputy and the round seal of the medical organization.

35 Retention of claims In pharmacy organizations, claims overhead from medical institutions for dispensing narcotic drugs and psychotropic substances of lists II and III are stored for 10 years, for dispensing other drugs subject to quantitative accounting - for 3 years, other drug groups - in within one calendar year.

36 Storage of claims Claims-invoices of medical organizations must be stored in a pharmacy organization under conditions that ensure safety, in a stitched and sealed form and drawn up in volumes indicating the month and year. After the expiration of the storage period, the invoices are subject to destruction in the presence of members of the commission created in the pharmacy organization, about which acts are drawn up

37 Estimated standards for the need for narcotic drugs order of the Ministry of Health of the Russian Federation from No. 330 Order of the Ministry of Health of Russia from No. 2

38 Delivery of goods from the pharmacies of health care facilities and MBA invoices (requirements): In the hospital pharmacy they are discharged for all drugs in 2 copies. x copies

39 Medicines are dispensed to the departments of health care facilities Narcotic drugs for 15 days Psychotropic drugs for 1 month

40 Accounting of inventory items in pharmacies of health care facilities and MBA in total (monetary) terms, all inventory items are taken into account; in a physical meter (subject-quantitative accounting), certain groups of drugs are taken into account.

41 Subject-quantitative accounting Order of the Ministry of Health of the Russian Federation from n (as amended by pr. MZ 634n)

In addition, new medicinal products for clinical trials, scarce and expensive medicinal products, dressings, and containers are subject to quantitative accounting in pharmacies of health care facilities.

43 Order of the Ministry of Health of the USSR dated 747 Instructions for the registration of medicines, dressings and medical products in medical and preventive health care institutions that are funded by the USSR State budget

44 Rules for the storage of medicines Pr. MZS RF from the city of 706n "Rules for the storage of drugs" of the PP of the Russian Federation from the city "On the procedure for storing narcotic drugs and psychotropic substances" Order of the Ministry of Health and Social Development of Russia 484n from the city "On the approval of special requirements for the storage conditions of narcotic drugs and psychotropic substances registered in the established order in the Russian Federation as drugs intended for medical use, in pharmacies, medical institutions, research, educational institutions and drug wholesalers "

45 Rules for the storage of medicines Pr. The Ministry of Health of the Russian Federation dated 377 "On approval of instructions for organizing storage of various groups of drugs and medical devices in pharmacies" (except drugs) Sanitary rules of the joint venture Sanitary and epidemiological requirements for the conditions of transportation, storage and distribution of medical immunobiological preparations to citizens

46 PP from g "On the procedure for storing narcotic drugs and psychotropic substances" (as revised by the PP dated August 6, 2015 807) The 3rd category includes premises of medical organizations intended for storing a 15-day supply of narcotic drugs and psychotropic substances, included in list II of the list, and a monthly supply of psychotropic substances included in list III list,

47 PP 1148 Category 4 includes premises of medical organizations intended for storing a daily supply of narcotic drugs and psychotropic substances included in List II of List, and a three-day supply of psychotropic substances included in List III of List, as well as premises of medical organizations intended for storage of unused drugs taken from relatives of deceased patients.

48 PP 1148 The places of temporary storage of NS and PV include packs, kits, kits for the provision of primary health care, emergency and specialized medical care, which include NS and PV. Decision on the need to organize temporary storage sites intended for storing NS and PS in an amount not exceeding the daily supply, to which the average posts can be attributed medical staff medical organizations, workplaces pharmaceutical workers prescription department of pharmacy organizations, etc., is accepted by the head legal entity.

49 Registration of used drugs Oral administration of narcotic drugs should be carried out only in the presence of a nurse. The attending physician must draw up the appointment and use of narcotic drugs in the medical history.The attending physicians or doctors on duty must on the same day (with the exception of weekends and holidays) to hand over used ampoules from narcotic drugs to the deputy. the head of the medical department, and in institutions where he is absent - to the head of the healthcare facility. The destruction of used ampoules is carried out by a commission chaired by the head with the execution of an act in the prescribed form.

Department of General Medical Practice and Polyclinic Therapy FPK and ATS Procedure for circulation of medicines in a hospital Scheme of circulation of medicines in a hospital Draws up a request to a pharmacy

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The system of drug supply for healthcare institutions at the present stage

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Introduction

Conclusion

Bibliography

Introduction

Planning is one of critical species economic work.

Health planning is the justification and development of a certain ratio of the needs of the population in medical care, drug provision and sanitary and anti-epidemic services with the possibilities of meeting them.

Basic principles of health planning:

· Scientific and technical feasibility of plans;

· Highlighting priority problems;

· Combination of current and forward planning;

· Combination of sectoral and territorial planning;

· Cost-effectiveness of plans.

Medicines are an integral part of the healthcare sector. All participants in the medical services market inevitably face the need for accurate planning of the assortment, categories, dosages of medicines, clarifications of international and proprietary names: from medical and preventive institutions (MPIs): district polyclinics, hospitals, diagnostic centers to pharmacies, insurance funds and various governing bodies. level.

The main tasks of drug supply for medical institutions are:

efficient use of financial resources allocated to pay for medicines;

elimination of the shortage of medicines and medical products in medical institutions;

ensuring the rights of insured persons in the CHI system to receive medicines that guarantee high-quality medical care.

The purpose of this work is to consider the system of drug provision of healthcare institutions at the present stage and the prospects for the development of this area, since at the present time, at the level of state power, the health care system is being reformed in order to achieve a rational distribution of funds and increase the quality of medical care.

1. Financing of medical institutions

State and municipal medical institutions are budgetary institutions, i.e. organizations created by state authorities of the Russian Federation, state authorities of constituent entities of the Russian Federation, local authorities for the implementation of managerial, socio-cultural, scientific and technical or other functions of a non-commercial nature, the activities of which are financed from the corresponding budget or the budget of the state extra-budgetary fund on the basis of estimates income and expenses.

State or municipal health care institutions actually fulfill a public order: the state or the municipality provides the institution with the necessary funds, which are directed towards the achievement of strictly defined non-commercial social goals. The institution, for its part, performs the functions assigned to it to provide medical care to the population, which, in accordance with paragraph 1 of Article 41 of the Constitution of the Russian Federation, is free for citizens.

Dependence of state (municipal) health care institutions on adequate funding from the budget of the corresponding level. The issue is not so much in the amount and timeliness of budget allocations allocated to health care institutions, but in the specifics of the estimated funding mechanism itself. In general, the budgetary sphere is characterized by a deficit in the allocation of funds, which is due to a number of factors of a political, economic, legal nature.

The estimated financing procedure does not contribute to the introduction of new economic mechanisms and more effective use available resources.

In accordance with the Concept for the development of healthcare until 2020 and the List of Presidential Orders on the development of Russian healthcare and education in the constituent entities of the Russian Federation, the strategic goal of healthcare reform is the transition to single-channel financing and the introduction of the per capita principle of payment for medical care.

Currently, there is a budgetary and insurance model for financing the state health care system in Russia. This model is based on the attraction of funds from the budgetary system of the Russian Federation (all levels) and compulsory health insurance funds. The multichannel nature of health care financing reduces the manageability of the industry and creates difficulties in exercising control over the rational and targeted spending of funds and the quality of medical care.

In the "Main directions of activity of the Government of the Russian Federation for the period up to 2012" it is envisaged to increase the share of compulsory health insurance funds in health care financing by 2012 to 70%. By the Decree of the President of the Russian Federation of June 28, 2007 No. 825 "On the assessment of the effectiveness of the executive authorities of the constituent entities of the Russian Federation", the share of compulsory medical insurance funds in the expenditures of the consolidated budget of the constituent entity was included in the list of indicators for assessing the effectiveness of the governors' activities.

The transition to a predominantly single-channel form of healthcare financing assumes that the bulk of funds will be channeled from the CHI system, while payment for medical care will be based on the end result based on complex indicators of the volume and quality of services provided.

Single-channel financing has a number of advantages. First, it will ensure that all health care is fully funded at real costs. Currently, tariffs in the CHI system are formed on the basis of the planned volumes of medical care and allocated funding. Single-channel funding will allow this approach to be replaced by calculating the cost of treatment for a completed case according to standards of care. The transition to payment for the work done will lead to a change in the structure and quality of medical care itself.

The general planning scheme can be presented as follows:

Determination of the main goals and functions of the medical institution

Determination of the types and volumes of medical care, the provision of which leads to the achievement of the set goals

Formation of the structure of health care facilities (structure of departments, management system)

Determination of the need for financial, material and labor resources required to carry out the volume of treatment.

Calculation of the estimated receipts of funds.

Adjustment of planned indicators.

Determination of indicators that most accurately characterize the degree of achievement of goals and which need to be stimulated.

On the allocated funds, the medical and preventive institution purchases medicines through public procurement.

State procurements- a part of goods and services produced in the country or abroad, purchased by the government, state bodies at the expense of the state budget. Such purchases are carried out by the state for the needs of its own consumption (purchase of equipment, medicines, medical products, etc., etc.) and in order to ensure consumption by the population.

The purchase of medicines for state and municipal needs is carried out in accordance with the Federal Law of July 21, 2005 No. 94 FZ "On placing orders for the supply of goods, performance of work, provision of services for state and municipal needs" in compliance with the requirements of the Federal Law of July 26, 2006 No. 135-FZ "On Protection of Competition".

The public procurement process, including the purchase of medicines, takes place in several stages.

Stage I - Preparation of tender documentation.

At this stage, the institution (customer) draws up and forms the terms of reference in accordance with the need for medicines and allocated in cash... In a competitive environment, the customer must find a supplier who can offer him a minimum price for the offered goods, works and services, as well as fulfill other essential conditions for him (additional requirements for product quality, delivery times, forms and terms of payments, etc. .).

Stage II - Publication of information about the competition.

For the publication of this kind of ads, it is traditional to use conventional means mass media - newspapers, magazines, specialized applications. All information is published on the website of the state order on the Internet.

Stage III - Provision of tender documentation.

Together with the announcement of information about the upcoming auction or tender, the customer posts Required documents on the holding of the tender, which sets out the conditions for the tender, the requirements for the participants in the placement of the order.

Stage IV - Clarification of the conditions of the competition.

At this stage, there is a direct interaction between the participant in the order placement and the customer. On the basis of FZ-94, all questions on the conduct of the tender and clarifications on the tender documentation are made by the participant in the order placement only in writing.

Stage V - Collection and registration of bids.

The participant in the placement of the order shall submit its applications that meet the conditions of the tender documentation.

Stage VI - Opening of envelopes and determination of the winner.

On this stage the winner of the competition is determined, which meets all the conditions of the competition.

Stage VII - Conclusion of a state or municipal contract with the winner of the competition.

Financing of health care institutions is carried out according to cost items. The cost of drug provision is 25-30% of the budget of the institution, so today there is an acute issue of strengthening control over the registration of drugs.

drug supply health care institution

2. Rules for storage and accounting of medicines and medical devices

the daily work of the hospital nurses, along with the pharmacy division, is associated with medicines and medical products in terms of systematizing their storage, accounting and monitoring consumption, expiration dates, and compliance with storage rules. In this regard, medical personnel must also know the legislative and legal documents in the field of drug circulation and have an idea of the activities of the pharmacy of the healthcare facility.

To ensure the treatment and diagnostic process, health care facilities receive medicines from the pharmacy (organization) according to the invoice requirements, approved in the prescribed manner.

The head of the department (cabinet) is responsible for the storage and consumption of medicines and medical products, as well as for the order at storage sites, compliance with the rules for issuing and prescribing medicines. The head nurse is the direct executor of the organization of storage and consumption of medicines and medical products.

In the premises where medicines are stored, a certain temperature and humidity must be maintained. Checking the compliance of their condition with the established requirements is carried out at least once a day based on the indicators of hygrometers and thermometers, its results are reflected in special accounting logs.

Storage of medicines in departments (offices) should be organized in lockers, while the storage conditions for medicines are indicated on the packaging of each dosage form. It is envisaged to be placed in storage places, taking into account the division into groups: toxicological - narcotic drugs, psychotropic substances, potent and poisonous drugs; by method of application: Outdoor , Internal ; by release form: Injection , Eye drops ", etc .;

Health care facilities, as well as their subdivisions carrying out activities related to the circulation of narcotic drugs, psychotropic substances and their precursors (substances often used in the production, manufacture, processing of narcotic drugs and psychotropic substances included in the list of narcotic drugs, psychotropic substances) are obliged to keep registration logs in accordance with the established forms.

3. Planning of drug supply using integrated systems

The planning of medical care and drug provision should be carried out "from the bottom up": from planning medical care in a health care institution to planning at the level of a health management body of a municipality (territory) on the basis of medical standards containing the required volume of diagnostic studies, treatment procedures, medicines and requirements for treatment results and population demand for specific medical services.

Based on the analysis of demand, proposals should be formed for restructuring the network of municipal (territorial) health care and, ultimately, proposals for a reasonable municipal (territorial) order for medical care and medicines.

The system should automate the process of obtaining reliable and justified comprehensive assessments of the quality of the work of a medical institution and an individual doctor, analyzing the results of examinations, determining the cost of providing medical care for making management decisions to improve its quality in specific medical institutions.

The management of drug supply should be based on the formulary system and "drug standards" that are part of the economic models of health services. Of particular relevance and importance are the issues of rational provision of the therapeutic and diagnostic process with drugs, consumables and medical products in the context of limited financial resources for health care, including budget funds and the compulsory medical insurance system allocated for drug provision.

In this regard, an organizational and economic mechanism is proposed based on models of medical services, which makes it possible to really determine the volume of medical care and drug supply, oriented to market relations and smooth transition to building an integrated system of managed care.

The implementation of a bank of medical services together with an information retrieval system for medicines allows solving the following tasks:

.to create an integral, interconnected, dynamically developing and constantly updated system for the provision of drug care;

2.create a single automated formulary reference book of medicines with data on the form of release, synonyms, analogues, therapeutic effect, indications for use;

.reduce unreasonable polypharmacy (Polypharmacy in medicine is the simultaneous (often unreasonable) prescription of many drugs or medical procedures);

.use the obtained reference in the models (standards) of medical care to calculate the cost of drug provision of medical technology and integrated assessment the quality of medical care;

.provide an automated extract and a system for recording issued prescriptions;

.to create a system of accounting, receipt and use of drugs in health care institutions through the use of rational pharmacotherapy.

Formation of an order plan for medicines based on the use of formalized medical technologies is provided by:

the possibility of standardizing the consumption of reagents and Supplies used for diagnostic research in accordance with simple health service models;

the possibility of establishing natural norms the provision of drugs for the "drug standard" of models by nosology, and, as a fact, the predictability of costs for drugs and the determination of the general need for them in inpatient treatment; for inpatient replacement technologies; for outpatient care; in terms of medicines provided to outpatients on a free and preferential basis. The process of developing formulary lists in combination with models makes it possible to solve the problem of rational use of drugs on the basis of a cost-effective method of their selection, taking into account morbidity, resource provision, and the use of rational pharmacotherapy; calculate the prices of medical services taking into account the basic, territorial or prevailing prices for medicines for the health care institution, the municipality and the territory as a whole; predict the need for them and form a sound procurement project. The introduction of an automated integrated system for assessing the cost of drug standards in practical health care will increase the level of knowledge of medical personnel in matters of drug provision, speed up the process of choosing drugs by a doctor and create conditions for their rational use.

4. New approach drug management

The modeling of the list of medicines in the healthcare sector was carried out discretely - within the framework of the drug supply system, when the general planning of drug supply to the population was carried out by the Ministry of Health, and the procurement of drugs, assortment management - by the pharmacies themselves, the participation of healthcare entities was minimal. The organization of the drug supply system according to the market principle often leads to a shortage of certain categories, names and dosages of drugs. The situation is complicated in many respects by the policy of financing drug provision for privileged categories of the population, which led to the emergence of structural distortions in the drug supply system.

If quite recently the availability of certain medicines in a pharmacy entirely depended on the assortment policy of the administration, then the launch of a number of projects within the framework of the healthcare sector reform will radically change the state of affairs, and not only at the level of individual pharmacies, but also at the level of the system as a whole. ... The new approach to drug supply management, which is supposed to be introduced as part of the healthcare reform, implies comprehensive planning not only in the drug supply system, but also in the healthcare sector as a whole. As part of this approach, all subjects of the health sector are included in the planning system - the Ministry of Health, Roszdravnadzor, territorial bodies healthcare management, insurance organizations, medical institutions, doctors, as well as participants in the pharmaceutical market - federal and regional distributors, pharmacy organizations of various organizational and legal forms. Necessary conditions integrated planning at the level of the system as a whole are: the creation of a unified information field of the healthcare sector and the system of drug supply, and the informatization of institutions - participants in the system.

Modeling the list of drugs in the drug supply system, focused on meeting the needs of the population, and thus, at achieving optimality in the range of drugs on the scale of the system, are two multidirectional processes that can be conditionally characterized as "top-down" and "bottom-up".

As part of the first, "top-down" process at the level of the Ministry of Health, catalogs of medicines approved for sale on the territory of the Russian Federation are created, this information is supplied to territorial health authorities, whose task is to create and correct doctor's reference books, and pharmaceutical organizations. Further, the updated information is transferred to insurance companies, medical institutions. Federal pharmaceutical organizations transfer information to territorial pharmacy chains and other institutions. In the "top-down" process, the modeling of the list of drugs is largely determined by the policy and structure of financing the drug supply system; the state here not only acts as a purchaser of drugs at the federal level through specialized organizations, but also as a market regulator.

4.1 Updating and synchronizing the transfer of reference information and the federal register to DLO participants

The "bottom-up" process of modeling the list of medicines at the system level is focused mainly on quantitative indicators and is a form feedback required for the full management of drug supply. Within the framework of this process the collection of statistical information is carried out, which is carried out in the system of medical organizations - from district and city health care facilities to territorial ones - and further, to federal health authorities. In parallel, the process of collecting statistical information takes place in the system of pharmaceutical enterprises, information in the form of financial statements, sales statistics, the results of patient surveys are sent to distributor companies at the regional and federal levels. Based on this information, as well as materials from the Ministry of Health, distribution companies plan the volume of purchases, assortment and pricing policy. Thus, the distribution companies of the pharmaceutical market become the key elements of the system, and the efficiency of the system as a whole depends on the effectiveness of their actions. In turn, the effectiveness of the actions of distributors of the pharmaceutical market depends on the quality of collection, processing, analysis of information by pharmacies and the quality of materials provided by the Ministry of Health.

The new principle of functioning determines the shift in emphasis in the distribution of functions of the subjects of the system. Thus, the Ministry of Health and Social Development gets the opportunity, instead of directive planning of the system, to concentrate on the tasks of improving the management system. pharmaceutical activities and drug supply organizations. The likelihood of a shortage of drugs in such a system is minimized, it becomes possible to balance the growth of prices for various categories of drugs. This approach makes it possible to ensure the availability and reliability of information about medicines and thereby solve the long-standing problem of the Russian market of medical services.

The effectiveness of planning drug provision in such a system is achieved through the use of not only planned, but also statistical indicators, and making forecasts regarding further development the need for medicines. Distributing companies based on the accumulated information form the supply of drugs, at the same time, the demand in the drug supply system is coordinated both indirectly - by medical institutions, medical specialists, and directly - by departments of different levels.

4.2 Implementation of the supplementary drug provision program

So far, the implementation of the new approach is carried out only within the framework of the Supplementary Drug Supply (DRP) program. The program, the purpose of which is to provide preferential categories of the population with medicines, implies the participation of many subjects of the health sector: city and district health care facilities, compulsory medical insurance funds of various levels, regional and federal health authorities. An important fact is that DLO is based on a different order of interactions between the subjects of the drug supply system, and medical institutions also play an active role in the program. The program provides for a different principle of financing drug provision, which is based on detailed accounting and control of prescriptions of medicines by medical specialists, verification of the eligibility and necessity of prescribing, as well as control over the dispensing of medicines by pharmacies participating in the DLO program. Specialists of the medical industry assess the new principle of financing drug provision positively, since it allows financing real-life needs for drug provision, and more efficiently distributing funds between health care entities - for example, channeling funds saved through DLO for the purchase of diagnostic equipment and information technology for medical institutions, renew the fleet of ambulance stations, etc. But at present, this principle of financing has no right to exist, since funding of institutions occurs strictly according to the items of expenditure, as mentioned above.

The main element of the DLO program is the database of statistical data on the need for drug provision, which is constantly updated and updated - not only at the beginning of the reporting periods, but in fact at any time - taking into account the changes in the patient's need for drug provision. Each of the participants gets dedicated access to essential elements programs. Naturally, the creation of such a database becomes possible only if there is an opportunity interactive interaction subjects of the system, which implies the existence of all forms of feedback between the participants and the existence of a single information space of the DLO program.

Fig. 1 Centralized data processing and interaction of DLO participants

The collection of medical data arrays, analysis and updating is carried out at the level of data processing centers (DPC), which provide information to health authorities. The quality of information at the exit from the data center is determined by two parameters: the quality of information entering the data center from health care facilities and pharmacies, and the quality of information processing in the data center itself. The basic principle of the system functioning assumes controllability of information quality control processes both at the level of local health care facilities and pharmacies, and at the data center level. However, in practice, at the moment there is only the possibility of controlling the quality of information processing at the data center level - due to the relative transparency of the structure. At the level of local hospitals and pharmacies, quality control of information processes is difficult due to insufficient provision of computer equipment, often due to a lack of competent personnel who can work in the information system of the program.

Fig. 2 Issuing prescriptions in health care facilities and transferring information to TFOMS (DPC)

But positive shifts in information quality management in local health care facilities and pharmacies have already been outlined. While we are talking about the primary informatization of health care facilities and pharmacies, the second stage in the development of the program should be the massive development of quality management systems for the collection and processing of information. The process of primary informatization takes place in health care facilities and pharmacies in parallel - in medical institutions due to healthcare reform projects, in pharmacies - either at their own expense or at the expense of large distributors of pharmaceutical products.

Fig. 3 Dispensing of medicines in pharmacies and transfer of information to TFOMS (DPC)

Modeling the list of medicines in the DLO program should be divided into several levels: the level of healthcare facilities and pharmacies, the level of territorial CHI funds and data centers created on their basis, the level of health authorities and the federal CHI fund.

The role of healthcare institutions in modeling the list of medicines is passive - it consists mainly of registering prescribed prescriptions, maintaining statistics and recording changes in patient needs. The collected data is then transferred to the data centers created on the basis of the territorial funds of the CHI. In pharmacies, especially in pharmacy chains, the modeling of the list of medicines takes place within the framework of assortment management - using our own accounting information, information materials DLO programs, data from distributors of the pharmaceutical market, legal and other information of the pharmacy form an idea of the market development, and, accordingly, the necessary purchases and the range of drugs in the new reporting period. Some of this information, coming in the form of feedback to distribution companies, allows us to supplement the overall picture and adjust the volume of drug purchases.

Territorial CHI funds, on the basis of aggregated data center data, model the list of medicines that are necessary for providing medicines to privileged categories of the population in the region. Based on the models obtained, the costs for the implementation of DLO are predicted in the current and future periods, drug procurement is planned, and stocks are managed within the region. The TFOMS data are transferred to the federal level and are used in modeling the list of drugs, as well as clarifying, making changes to the structure of drug provision in the regions. The federal health authorities, based on the information received, adjust plans for future periods for financing the DLO program, exercise control over the activities of program participants, and have the opportunity to comprehensively manage drug provision.

Conclusion

There is a need for an inextricable relationship between the pharmacy service and many departments of the healthcare facility at different levels: the administration of the institution, the head nurse, the guard and procedural nurses who perform the appointments of the attending physician. Under the existing conditions of work, strict reporting is required, professional control over the rational use, storage, shelf life of drugs in the departments of medical institutions, over activities related to the circulation of narcotic and psychotropic drugs. The creation of a material flow management system in a medical facility is the basis for a stable and harmonious provision of the medical process with pharmaceutical goods.

The result of the process of multilevel interactive modeling of the list of medicines in the DLO program is more flexible and efficient management - both at the regional and federal levels.

The integrated system serves as the basis for organizing relationships between the territorial health management body, the territorial compulsory medical insurance fund, insurance medical organizations, medical and preventive institutions, allows to comprehensively solve the problem of formalizing medical technologies and calculating the cost (price) of medical services with the transition to payment for a completed case treatment in accordance with a medical standard (model) and automated assessment of the quality of medical care, provides a transition to managed care.

Guarantees in the field of healthcare are a very important element of Russia's social policy, however, the management of medical care is currently still carried out according to its actual volume, without aligning the resources and obligations of the healthcare system and without preliminary planning and approval of the volume, structure and conditions for the provision of medical care. ...

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Policy in the field of drug provision of healthcare institutions. Chapter 1. General provisions of drug supply in the Russian Federation. 1.1 Rules for provision of drugs in the compulsory health insurance system.

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INTRODUCTION

CHAPTER 1. DRUG SUPPLY OF HEALTHCARE PROVISION: PROBLEMS AND WAYS OF THEIR SOLUTION

1.1 Fundamentals of the organization of drug supply to health care facilities

1.2 Legal regulation of drug supply to health care facilities

1.3 Problems of drug supply to health care facilities and their solution

CHAPTER 2. EXPERIMENTAL STUDY OF THE POSSIBILITY OF USING THE PROCESS APPROACH TO OPTIMIZE THE DRUG SUPPLY OF THE HEALTHCARE

CONCLUSION

BIBLIOGRAPHY

INTRODUCTION

The relevance of the work. Health is a necessary condition for labor potential, the main criterion for the effectiveness of public administration. The position of recognizing health as the highest national priority of the state finds understanding and firm support from the Russian leadership. The management of health care facilities in the context of reforms and a transitional economy requires fundamentally new approaches to increasing the socio-economic efficiency of using the limited economic resources of health care. The main strategies for the survival of the socio-economic system of health care facilities are traditionally considered to be efficiency and productivity.

As the above data demonstrate, the modern Russian healthcare system requires significant changes. Serious reforms in the direction of increasing the efficiency of the system began to be implemented only recently. Achieving the set goals requires a consistent and thoughtful policy. So far, it is impossible to say about positive results, firstly, due to the mistakes and miscalculations made, secondly, the insufficient amount of time to assess the results of the work, and thirdly, due to the complexity of the tasks set. After all, in fact, the whole system has to be built anew, based on modern global standards.

Among the problems, the solution of which will provide an increase in the efficiency of economic resource management, should include the creation of an effective system for control and monitoring of drug supply. One of the priority directions for solving this problem is to optimize the use of drugs in the treatment and diagnostic process without compromising the quality of medical care. In this regard, the most relevant issues are the provision of medicines in health care facilities.

Object of study: drug provision of health care facilities.

Subject of study: the peculiarities of the provision of medicinal products for health care facilities.

Purpose of the study: to study the peculiarities of drug provision of health care facilities.

Research objectives:

1. To study the basics of the organization of drug supply to medical institutions.

2. Consider the legal regulation of the provision of medicines for health care facilities.

3. Analyze the problems of drug supply to health care facilities and their solution.

4. Conduct an experimental study of the possibility of using the process approach to optimize drug supply to health care facilities.

MetOd research: analysis of literary sources on this topic, generalization, abstraction, synthesis, experiment.

Work structure. The work is written on 35 sheets of printed text. The work contains an introduction, 2 chapters, including paragraphs, a conclusion and a list of used literature.

CHAPTER 1. DRUG SUPPLY OF HEALTHCARE PROVISION: PROBLEMS AND WAYS OF THEIR SOLUTION

1.1 Fundamentals of the organization of drug supply to health care facilities

The provision of drugs for patients undergoing treatment in medical institutions is carried out free of charge at the expense of the compulsory medical insurance and the state budget within the framework of the Program of state guarantees for the provision of free medical care to citizens of the Russian Federation. Small health facilities, especially those located in rural areas, are provided with medicines and medical products through territorial self-supporting general pharmacies. Supply of large health care facilities located in cities and regional centers is carried out through a network of specialized pharmacies, which can be self-supporting (interhospital and hospital) or budgetary (health care pharmacies).

An interhospital pharmacy is organized for the provision of drugs to health care facilities with a total number of beds of at least 500, as well as in settlements where in all health care facilities the total number of hospital beds is from 100 to 500. In addition to inpatient health care facilities, it can be assigned to supply medical offices of polyclinics, health centers , educational and social welfare institutions. A self-supporting hospital pharmacy is organized for the provision of drugs to one medical institution with a number of hospital beds of 500 or more, as well as in settlements if there are at least 100 hospital beds in a medical institution. These pharmacies perform the same functions, but differ in economic terms and in their subordination. Self-supporting - to the pharmacy committee, and budget-financed - to the head physician of the healthcare facility.

Interhospital and self-supporting hospital pharmacies do not sell drugs to the population. They perform production, information, supply and financial and economic functions.

Medicines can be dispensed to a patient only on the basis of prescriptions written by a doctor. Forms of prescription forms and the procedure for filling them out have been approved. To issue free prescriptions for outpatient treatment of patients from the category of persons specified in Articles 6.1 and 6.7 of the Law "On State Social Assistance", prescription forms of the established form are used. For the prescription of Schedule II narcotic drugs and psychotropic substances, special prescription forms are used. These recipes are subject to quantitative accounting. The prescription must contain: the name of the medicinal product (both the international non-proprietary name and the trade name); the method of administration of the medicinal product, indicating the dose, frequency, time of administration and its duration; expiration date of the prescription; payment order.

The maximum validity period for prescriptions for prescription drugs is 1 month (30 calendar days) from the date of discharge. This does not mean that the period of delayed prescription servicing in the absence of the drug in the pharmacy organization is also 1 month. In the absence of a drug in a pharmacy organization, a patient who comes with a prescription is put on delayed service for up to 10 working days. If, while on deferred service, the prescription expires, then according to such a prescription, the drug can be dispensed without re-issuing it. This requirement does not apply to narcotic drugs and psychotropic substances, the validity of prescriptions for which is 5 days. In general, for chronic patients, it is possible to establish a prescription validity period of 1 year, but for citizens eligible for a set of social services, this option is not provided.

It is forbidden to write prescriptions: for medicinal products that are not approved for medical use in accordance with the established procedure; in the absence of medical indications; for medicines used only in medical institutions (anesthetic ether, chloroethyl, etc.); for narcotic drugs and psychotropic substances included in List II of the List of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation, approved by the Decree of the Government of the Russian Federation of June 30, 1998 N 681 (hereinafter - drugs and psychotropic substances of Schedule II ), for the treatment of drug addiction; for narcotic drugs and psychotropic substances of Schedules II and III to private practitioners.

By order of 01/09/2007 N 1, the Ministry of Health and Social Development of the Russian Federation approved the List of medical products and specialized medical food products for disabled children, dispensed by prescriptions of a doctor (paramedic) when providing additional free medical care to certain categories of citizens eligible for state social assistance. This List consists of two sections - medical products and specialized health food products for children with disabilities.

1 .2 NSpeer regulation of drug supply to health care facilities

The creation of equal opportunities and conditions for receiving medical and pharmaceutical care for various groups of the population is one of the most important components of the state's social policy. The state is responsible for the availability of medicines (drugs). In January 1998, at the 101st session of the WHO Executive Board, a decision was made regarding WHO's activities in the field of drug supply. It expresses concern over the global situation in which one third of the world's population does not have guaranteed access to the most essential medicines. On 18 May 2002, the 55th World Health Assembly called on Member States to reaffirm their commitment to expanding access to essential medicines to ensure that they are physically and financially accessible to all people who need them.

One of the directions of state support for the least protected social categories of the population is the provision of various benefits, including the right to free or preferential provision of drugs and medical products (MP). Currently, legislative acts in the field of drug supply (PM) make up about 30% of the legislative framework in the healthcare sector of the Russian Federation. The fundamental document in the health care system is the Fundamentals of the Legislation of the Russian Federation on the Protection of Citizens' Health. Article 44 determines that the categories of citizens provided with drugs and medical devices on preferential terms are established by the Government of the Russian Federation, the governments of the republics within the Russian Federation. Physicians of the state, municipal and private health care systems have the right to write prescriptions for privileged categories of citizens.

The list of population groups and categories of diseases, in the treatment of which drugs and medical devices are dispensed on prescriptions of doctors free of charge or with a 50% discount, was approved by the Government of the Russian Federation of July 30, 1994, No. 890 "On state support for the development of the medical industry and improving the provision of the population and healthcare institutions with medicines and medical products ”. In accordance with this decree, war invalids, veterans of the Great Patriotic War, war veterans, persons awarded the sign "Resident of the besieged Leningrad" and others are provided with free provision of medicines on prescriptions from doctors in the manner determined by the constituent entities of the Russian Federation, not lower than the norms established by the Government RF.

Pensioners receiving a pension for old age, disability or in the event of the loss of a breadwinner in the minimum amount, persons who worked during the Great Patriotic War at air defense facilities, in the rear, persons subjected to political repression, and others have the right to reduce the cost of medicines on a prescription by 50%. Such specific groups of drugs as anticancer, antituberculosis, antidiabetic, drugs used to treat asthma, mental, some cardiovascular, endocrine and a number of other diseases in full should be dispensed to the population free of charge.

In pursuance of Resolution of the Government of the Russian Federation No. 890, by order of the Ministry of Healthcare of the Russian Federation dated 09.06.95, No. 161, a mandatory range of drugs was approved for pharmacies serving outpatients in the Russian Federation. This list includes drugs of 38 pharmacotherapeutic groups (about 270 names) and about 70 names of medical products. Authorized the health authorities and the pharmacy service to adjust the mandatory assortment minimum in relation to local conditions for various categories of pharmacies, taking into account their profile.

The Federal Law of 12.01.1995 No. 5HFZ "On Veterans" establishes the following categories of veterans: veterans of the Great Patriotic War, veterans of military operations on the territory of the USSR and the territories of other states, military service veterans, civil service veterans, labor veterans. Persons who belong to these categories of veterans and disabled war veterans are identified. In accordance with Article 14 of this Federal Law, as amended on July 25, 2002, war invalids are provided with free provision of medicines on prescriptions from doctors in the manner determined by the constituent entities of the Russian Federation, not lower than the norms established by the Government of the Russian Federation. In accordance with clause 2 of the Decree of the Government of the Russian Federation of July 17, 1995 No. 710, the norms for dispensing drugs and medical devices to disabled people and other groups of the population in accordance with the Federal Law "On Veterans" are determined by the attending physician based on the severity and nature of the disease. The same decree approved the procedure for preferential leave of drugs and medical devices to war invalids and other groups of the population during their outpatient treatment in accordance with the Federal Law “On Veterans”. In accordance with the Procedure, preferential dispensing of drugs and medical devices is carried out by pharmacy organizations, regardless of the form of ownership, according to prescriptions of doctors, written out in accordance with the established procedure. War invalids and other categories of the population should be registered in pharmacies at their place of residence for preferential and free provision of drugs and medical devices in the manner determined by the executive authority of the constituent entity of the Russian Federation. In pharmacies, a reserve of drugs and medical devices should be formed, the nomenclature and quantity of which is determined annually, taking into account the type of diseases attached to the pharmacy organization of the indicated groups of the population and the consumption of drugs and medical devices for the previous year. The procedure for creating a reserve is determined by the executive authority of the constituent entity of the Russian Federation.

In the case of a temporary absence of a prescribed drug and the impossibility of replacing it with similar drugs, the administration of the pharmacy is obliged, leaving the prescription, to register the patient, take measures to obtain the drug as soon as possible and notify the patient of his receipt. In the event of a long delay in providing the patient with the necessary drugs, the administration of the pharmacy is obliged, in agreement with the doctor who wrote the prescription, to resolve the issue of replacing this drug with another. Preferential leave for people with drugs and medical devices can be carried out by a doctor at an appointment at a polyclinic (patients with diabetes, chronic diseases) or when visiting a lonely patient at home.

One of the serious problems in the implementation of the Federal Law "On Veterans" remains the implementation of state guarantees of preferential drug provision for veterans. Federal Law "On Amendments to Article 10 of the Federal Law" On Veterans "" dated November 18, 1998 No. 172H FZ, financing of these benefits is provided at the expense of the budgets of the constituent entities of the Russian Federation. The procedure for reimbursement of expenses is approved, respectively, by the Government of the Russian Federation and the executive authorities of the constituent entities of the Russian Federation. The expenses of the state authorities of the constituent entities of the Russian Federation, local self-government bodies associated with the provision of benefits to veterans are taken into account in the mutual settlements of the federal budget and the budgets of the constituent entities of the Russian Federation and have a target value. In addition, additional funds for financing preferential drug provision can be obtained from any sources not prohibited by law. Order of the Ministry of Health of Russia dated June 25, 1999 No. 251 defines measures aimed at providing war veterans with drugs on a preferential basis.

In order to increase the volume and quality of medical and medical and social care for elderly and elderly people, and to prevent premature aging, by order of the Ministry of Health of Russia No. 297 dated July 28, 1999, a system of measures was introduced to improve the organization of medical care for the elderly. Of fundamental importance for the legal regulation of the activities of healthcare institutions in the field of PL are such legislative acts as the Law of the RSFSR "On medical insurance of citizens in the RSFSR", Federal laws "On narcotic drugs and psychotropic substances", "On medicines", "On psychiatric care and guarantees of citizens in its provision ", etc.

Issues related to the circulation of drugs received detailed legal support in the Federal Law "On Medicines" (1998), which created the legal basis for the activities of subjects of drug circulation, established a system of state bodies carrying out law enforcement practice in accordance with the law, distributed the powers of executive authorities in the sphere of drug circulation. The law is a normative act of complex content, regulates all essential aspects of relations arising in the sphere of circulation of drugs on the territory of the country, except for drugs and psychotropic substances.

In accordance with article 6 of this law, the Government of the Russian Federation ensures the implementation in the Russian Federation of a unified state policy in the field of providing the population of the Russian Federation with drugs, develops and implements federal programs for providing the population of the Russian Federation with drugs, and also establishes the procedure for social protection of citizens, preferential and free drug provision for certain categories. citizens. The executive authorities of the constituent entities of the Russian Federation in the sphere of drug circulation develop and implement regional programs for providing the population of the constituent entities of the Russian Federation with drugs (Article 7).

The state system of guarantees of the availability of providing the population with drugs is also established by other regulatory acts:

Decree of the Government of the Russian Federation of 09.11.2001, No. 782 "On state regulation of prices for medicines";

In pursuance of Article 32 of the Federal Law "On Medicines", as well as in order to streamline preferential provision of medicines to citizens and rational use of state allocations allocated for these purposes, the Government of the Russian Federation on April 8, 1999 adopted Resolution No. 393 "On guaranteed provision of citizens with vital and the most important medicines, as well as some conditions of preferential provision of medicines to citizens ”. This decree provides:

To develop and approve the procedure for issuing prescriptions for medicines to citizens who seek medical care in an outpatient clinic, regardless of its organizational and legal form, bearing in mind that the prescription of medicines, the rate of their dispensing and the issue of prescriptions are carried out by the attending physician based on the severity , the nature of the disease and the standards of its diagnosis and treatment; the procedure for dispensing medicinal products in pharmacies, providing for the rules for replacing a medicinal product for which a prescription has been issued in case of its absence. drug supply preventive hospital

For drugs that are not included in the minimum range, as well as for narcotic, psychotropic, potent drugs, special drugs (antineoplastic, anti-tuberculosis, antidiabetic, immunosuppressants) - by the attending physician based on the decision of the clinical expert commission of the polyclinic institution, or the relevant specialists of the polyclinic institution, or by doctors of the relevant specialized medical and preventive institutions (dispensaries).

The decree defines the limits of the sole competence of a doctor in prescribing drugs on preferential terms. In some cases, related to the need to provide urgent medical care, prescribing medicines and prescribing prescriptions are possible solely by the attending physician without prior agreement with the clinical expert commission of the polyclinic institution. The decree also provides for the implementation of measures to control the appointment and issue of preferential prescriptions and the availability in pharmacies of the minimum range of drugs necessary for the provision of medical care. In pursuance of this resolution, the Ministry of Health of Russia issued an order dated 23.08.1999, No. 328 "On the rational prescription of medicines, the rules for prescribing them and the procedure for their dispensing by pharmacies (organizations)", which is aimed at streamlining the work of healthcare facilities, eliminating duplication drug assistance and more rational use of public funds earmarked for drug benefits.

In recent years, in the constituent entities of the Russian Federation, the regional legal framework of the Russian Federation in the field of health care and drug provision has been actively formed. Currently, 31 constituent entities of the Russian Federation have adopted laws that create a legal basis for state regulation of activities in the field of providing the population with drugs. The results of a comparative study of the regulatory and legal framework of the regions of the Russian Federation in the field of drug provision showed different approaches to organizing the drug supply for the population at the territorial level, which differ in the composition of the participants in the drug supply process, their administrative and functional subordination, and information interaction. In many existing regulatory legal acts in the field of providing the population with affordable and high-quality drugs, there is no mechanism for monitoring their implementation by the executive authorities, and responsibility for violation of these norms is not established. The lack of uniform principles for the organization and financing of drug care in most constituent entities of the Russian Federation leads to a lack of equal opportunities in obtaining it and does not provide the inherent guarantees of drug availability for privileged categories of citizens within the framework of state guarantees for the provision of free medical care to citizens of the Russian Federation.

1.3 NSProblems of drug provision for healthcare facilities and their solution

Health care facilities are the most important sector of the health care system, which is designed to take on the bulk of the population's requests for medical care - up to 80% of all patients annually. The level of drug supply in many respects affects the quality of the medical measures carried out by the doctor, which is associated with the correct, scientifically grounded and rational organization of the activities of pharmacies serving the population. Characterizing the network of health care facilities, it should be noted that in the Russian Federation there are about 17 thousand outpatient clinics and polyclinics of all levels of subordination (municipal, subject of the Russian Federation and federal subordination). The number of visits to health care facilities per 1 inhabitant per year, having decreased by 1995 to 9.1 by 2002, increased to 9.6 (in 2001 - 9.5; in 2000 - 9.4; in 1999 -9.3). In 2003, the value of this indicator slightly decreased and amounted to 9.4 visits per 1 inhabitant. At the same time, the largest number of visits per 1 inhabitant is noted in the Republic of Tatarstan (12.8), and the smallest - in the Republic of Ingushetia. In the total amount of financing of the country's health care, expenditures on health care facilities in 2002-2004. did not exceed 26-28% of total expenditures for the implementation of the Program of State Guarantees for the Provision of Free Medical Care to the Citizens of the Russian Federation.

The problem of organizing drug supply that has developed in health care facilities determines the increased attention to the development of scientifically grounded measures to ensure the availability of drug care to the population, the tasks of which are the effective and economical use of available health care resources, accessibility and quality. Prescription of medicines (drugs) is carried out by the attending physician or specialist with secondary specialized education (paramedic, midwife, dentist) in accordance with Art. 54 of the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens and in the manner determined by the Instruction of the Ministry of Health of the Russian Federation (No. 328 of 23.08.99). Most citizens of the Russian Federation, while being treated in a healthcare facility, must purchase drugs at their own expense, both for OTC and prescription dispensing. In this regard, the problem is a decrease in the availability of drugs for a significant part of the population due to a multiple increase in prices, which is associated not only with the commercialization of pharmaceutical enterprises and pharmacy organizations, but also with the presence of a network of intermediary organizations.

The solution to this problem is in a number of areas, among which we note the creation of a system of tender purchases of drugs and state registration of manufacturer's selling prices for drugs included in the List of Vital and Essential Medicines (in accordance with the decrees of the Government of the Russian Federation and Orders of the Ministry of Health and Social Development of the Russian Federation). Improvement of the legal framework governing the production of drugs and drug supply to the population is also of great importance. The main conceptual directions for improving drug supply for the population of the Russian Federation are: creation of optimal models for pricing and procurement of effective and safe drugs; development of a strategy aimed at ensuring the rational use of drugs by doctors and patients; promoting the development of domestic production of pharmaceuticals; ensuring quality control, safety and efficiency of domestic and imported drugs; stimulating foreign investment in the Russian pharmaceutical sector. The fundamental document in the field of drug circulation is the Federal Law "On Medicines" (1998), the main purpose of which is to regulate relations arising in connection with the development, production, manufacture, preclinical and clinical trials of drugs, control of their quality, efficacy, safety, trade. LS. State regulation of relations arising in the environment of drug circulation is carried out through state registration of drugs; licensing of activities in the field of drug circulation; adaptation and certification of specialists employed in the field of drug circulation; state control of production, manufacture, quality, efficiency, safety of drugs. New drugs, new combinations of previously registered drugs are subject to state registration; Medicines previously registered, but produced in other dosage forms, with a new dosage or a different composition of excipients; reproduced drugs (drugs that came into circulation after the expiration of the patent rights to original drugs that came into circulation with their own registered names).

The retail segment includes the business of selling goods (or services) directly to end consumers. In the system of promoting pharmacy products, the retail link is represented by pharmacy institutions, which include pharmacies serving the population, pharmacy points, pharmacy kiosks, and pharmacy stores. The activities of pharmacies are carried out in accordance with the legislation of the Russian Federation, regulatory documents of the Ministry of Health and the SR of the Russian Federation and executive authorities. According to the data of the Ministry of Health and the SR of the Russian Federation, at the beginning of 2000, more than 19,217 pharmacies, 35,284 pharmacies, 12,360 pharmacy kiosks, 1,318 pharmacy stores and 5,962 wholesalers were providing drug supply to the population in the Russian Federation at the level of health care facilities. The load per one pharmacy in terms of the number of inhabitants was 8.8 thousand people. The annual growth in the number of pharmacies is 12-17%. The share of drug sales in the retail trade turnover for the period from 1998 to 2002 ranges from 2.6 to 3.1%. In the structure of trade turnover, drugs account for about 85%. Of the total number of pharmacies, 65.2% have a state organizational and legal form, 34.8% have other forms. In the wholesale sector, enterprises of non-state organizational and legal form and departmental subordination prevail (96.5%). The pharmacy service management system is presented in three forms: a structural unit as part of a healthcare management body (62.0%); an independent governing body under the executive authorities of the constituent entities of the Russian Federation (22.0%); non-governmental organization (OJSC, LLC, etc.), which is entrusted with a number of functions of state administration (16.0%).

Rational use and availability of drugs and pharmaceutical care in general are important factors that determine the effectiveness of the health care system at all stages of providing medical care to the population. At the same time, one of the activities in the field of drug provision is to increase the availability of drug care, which is carried out on the basis of optimizing the activities of participants in the pharmaceutical market, using a rational pricing system, forming an assortment policy, rational use of financial resources and drugs by introducing a formulary system and treatment regimens in accordance with with standards and a number of other factors.

The situation with drug supply to the population in modern Russia deserves special attention. After the collapse of the USSR, the Russian pharmaceutical industry has undergone significant changes. During the existence of the USSR, the population's need for medicines was mainly provided by Russian manufacturers, the missing medicines were purchased in the countries of Central Europe. With the collapse of the USSR, a single pharmaceutical industry ceased to exist - the former Soviet republics took their factories, while the Russian ones gradually fell into decay. In the first years after the transition to a market economy, the production of medicines was unprofitable, as prices for raw materials, energy, and transport rose sharply; foreign-made drugs literally poured into the Russian market (the import of which was given significant benefits), thus creating a tough competitive environment. As a result, by 1997, the volume of domestic production in the pharmaceutical industry decreased by 60%, manufacturers were forced to raise prices, which resulted in the fact that domestic drugs could not withstand the competition. By 1998, the volume of production of medicines had decreased 5 times15. By the same time, 120 pharmaceutical factories, 21 factories producing components of medicines, and 42 research institutes synthesizing immunobiological drugs were operating at 25-50% of their capacities, and 70-90% of their equipment expired. At the same time, 93% of pharmaceutical companies produced medicines based on imported components. By the end of the 90s. the share of imported drugs was already 65% and continued to grow over the following years. In 2006 this share was 78%. Despite the decline of the domestic pharmaceutical industry, producer prices were constantly growing. So, from 1997 to 2001, they grew by 150% (i.e., an increase of 37-38% per year). After the default, Russian manufacturers gradually began to gain strength, many pharmaceutical plants began to be re-equipped, equipped with modern equipment. Today in Russia there are three sectors of the pharmaceutical market: retail / commercial (sale of drugs through pharmacies; financed by consumers), hospital (hospital purchases; financed from regional and federal budgets), DLO (additional drug provision programs; financed by federal budget). In 2007 the shares of these market sectors were 73%, 13% and 14%, respectively. Since 2008, the third sector has been called the Essential Medicines Provision (NMP) program, but out of habit all market participants still call it DLO.

As can be seen from the share distribution, the state today does not play such a significant role in the supply of medicines as it used to be, but it continues to influence the development of the pharmaceutical market in Russia, since it is it that provides funds for federal targeted programs and priority projects. With the collapse of the centralized drug supply, which was in the USSR, the constituent entities of the Russian Federation developed their own programs for the procurement of drugs. Medicines for hospitals began to be purchased at the expense of territorial compulsory health insurance funds (MHI). With the introduction of the medical insurance system in modern Russia, the quality of medical care was also controlled by insurance medical organizations and the Mandatory Medical Insurance Fund (MHIF). The compulsory medical insurance system was created as a state guarantee of the right of citizens to receive free medical services in the legally established volume. However, in order to save money, MHI funds purchase medicines mainly on a competitive basis, which sometimes leads to low efficiency of treatment due to the use of cheap drugs.

The system of voluntary medical insurance (VHI), which was additionally created in the commercial sector, was supposed to improve the quality of services provided in the course of competition between insurance organizations. However, so far the VHI system has not yielded the expected results, since it is largely used not by the patient individually, but by the employing company as one of the elements of the social package. So, according to S. Gotovats (member of the board of Renaissance Insurance company, deputy general director for individual types of insurance), only 5-7% of the population are individually involved in the voluntary health insurance system.

In theory, when hospitalized, patients should receive medicines free of charge - they are purchased by hospitals at their own expense, from the compulsory medical insurance funds or from the DLO budget, but often these drugs are not enough or they are not delivered on time, so patients are forced to buy medicines for their own money. According to WHO estimates, in 2003, hospitalized patients paid for 80% of drugs from their own funds. This is largely due to insufficient funding of hospitals, since they have to buy many drugs at market prices. In addition, delays in government payments for drugs supplied serve to disruptions in the organization of drug supply in hospitals. Outpatients buy medicines from pharmacies or receive them free of charge on preferential prescriptions. After the collapse of the USSR, many pharmacies began operating on a private basis due to a lack of government funding. Today, many pharmacies operate as commercial enterprises while providing preferential prescriptions, which are also subject to significant government delays. Therefore, a number of pharmacies refuse to participate in the DLO program.

In 2006, 22,400 polyclinics, 10,200 hospitals, 24,000 pharmacies and pharmacies, 40,000 pharmacy booths, 470 foreign manufacturers, 600 domestic, 1,000 distributors were registered in Russia. The abundant number of factors on the pharmaceutical market has led to a sharp increase in the number of drugs approved for sale in Russia, with a rather low purchasing power compared to European countries and the United States. Today, about 150,000 names are included in the State Register of Medicines, while in many European countries, medicine is successfully used only by a few thousand. The main problem is that among this set of drugs sold in the Russian Federation, there are a large number of ineffective drugs. Only 12% of all drugs in 2007 had proven efficacy (i.e., innovative, original drugs), the rest were copies of original drugs (so-called branded generics and generic generics), for which clinical trials are practically not conducted and which cost significantly cheaper. Many of these drugs are restricted or banned in Europe and come from Far Eastern and Eastern European countries. And because of the low purchasing power of the population, doctors prescribe drugs, often focusing not on efficiency, but on price. In addition, there are about 12% of counterfeit products on the Russian pharmaceutical market.

If we separately talk about the formation of prices for certain drugs, then, first of all, the state fixes the manufacturer's price when registering a drug. Then a maximum mark-up is set on this price, which should contain the retail price of the drug. The limiter is set for both wholesale and retail prices. If for the wholesale price it is 25% plus to the manufacturer's cost, then for the retail price it is plus 30% to the wholesale price. In reality, each region sets its own maximum markup, in addition, there can be several distributors - and the drug is resold several times. As a result, the final price is 120-200% higher than the manufacturer's price. To combat this phenomenon, the state has created a list of vital and essential medicines to ensure their availability. The main criteria for entering this list were efficiency, safety and price. But since demand is guaranteed for drugs from this list, manufacturing companies pay bribes to officials responsible for forming the list. As a result, the list includes drugs that do not meet the criterion of "vital necessity". In 1998, the GMP standard (Good Manufacturing Practice, “Rules for the organization of production and quality control of drugs”) was approved in Russia. The transition to these rules will take 5 years. That is, after this period, companies whose production does not comply with GMP requirements, in theory, should have ceased to exist. However, in reality this did not happen. Today, indeed, a number of large domestic companies are switching to GMP standards, but this process has just begun.

CHAPTER 2.EXPERIMENTAL STUDYPOSSIBILITIES OF USING THE PROCESS APPROACH TO OPTIMIZE THE DRUG SUPPLY OF A HEALTH INSTITUTIONAL

Until now, the process approach to the management of organizations practically does not find application in health care institutions, both at the level of management of the organization as a whole, and in the management of individual areas of activity. As applied to the process of supplying health care facilities with drugs (MPs), the analysis of the risks that the consumer of medical services incurs as a result of untimely provision of drugs or the receipt of drugs of inadequate quality acquires the greatest significance. Within the framework of the process approach, a preventive-type medical institution can be viewed as a business system, which is an interconnected set of business processes, the ultimate goal of which is to provide quality medical services.

The purpose of this study was to study the possibility of using the process approach to optimize drug provision in health care facilities.

I. Drawing up and filing of applications by departments of health care institutions.

II. Examination of applications in health care facilities.

III. Formation of an order in a pharmacy.

IV. Checking the application at the main financial department.

V. Carrying out the procurement procedure in the agency for the state order.

Vi. Conclusion of government contracts between suppliers and healthcare facilities.

Vii. Supply of drugs to the pharmacy of the healthcare facility.

VIII. Storage of drugs in the pharmacy of the medical facility.

IX. Dispensing drugs to the departments of health care facilities.

To improve the quality of primary applications, we have proposed an algorithm for drawing up applications at the level of department heads.

The most difficult issue of resource provision of the business process "drug provision of medical facilities" is the training of personnel involved in its implementation. A large number of performers (clinical pharmacologists, pharmacists, department heads, economists, lawyers, system administrator) are involved in the business process, who must work as a process team with common goals, a common understanding of the assigned tasks and appropriate training to perform the assigned work. The formation of process teams is one of the most important problems of all enterprises without exception. The preparation of such a team requires a lot of time, money and skill in managing personnel.

The business process "examination of the application" is regulated by the technological map "examination of the application". Rational drug provision of healthcare facilities is based on VEN-analysis, which makes it possible to formulate priorities for subsequent drug purchases, both in terms of the effectiveness of pharmacotherapy and in terms of the reasonableness of the cost of purchasing them.

The applications submitted by the branches are calculated in the pharmacy, summarized by the assortment items of the same name, and in the form of a draft application are submitted to the expert council. Further, the draft application is subjected to VEN- and then ABC-analysis to form groups AV, BV, CV; AE, BE, CE and AN, BN, CN.

When allocating funding, priorities should be given to groups of vital (V) and necessary (E) drugs, therefore, when planning purchases, first of all, funds should be allocated for the AV group, in which the most expensive or purchased in large quantities assortment items are concentrated, then expenses are planned into groups BV and CV.

After the funds have been allocated for the group of vital drugs, they are considering the possibilities of financing the group AE, WE CE. Due to the fact that in the group of necessary drugs the choice of alternative pharmacotherapy options is allowed, the range of drugs in this group should be carefully analyzed using the cost-effective selection method in order to select the most effective, safe and economically available drugs. And only if, after the allocation of funds for groups V and E, the medical facilities have free funds, they can be used to purchase a small amount of the most commonly used secondary (N) drugs, mainly for symptomatic therapy.

The data of XYZ / VEN-analysis allow to correctly draw up an application for the competition. Particular attention should be paid to groups XV, YV and ZV, as they include vital drugs with different uniformity of consumption, the supply of which in health care facilities must be constant. Due to the particular importance of drugs from groups XV and YV, it is advisable to draw up an application taking into account the maximum desired stock.

The drugs included in the XE and YE groups are not as critical for the treatment process as group V, most often there is a certain margin of time for their purchase from a health care institution, so their quantity can be calculated at the level of the current stock.

As a result of the analytical work carried out by the expert group, a consolidated annual application of the institution is drawn up. It should be noted that health care facilities cannot direct all allocated funding for the purchase of drugs through the system of competitive bidding or auctions due to the fact that drug consumption is generally uneven and can change dramatically in a short time, therefore, a certain reserve of funds should remain for more efficient types of purchases - through price quotations or one-time contracts. Each health facility determines the size of the funding reserve independently, taking into account the actual conditions of supply. Thus, the introduction of a process approach to the management of drug supply in health care facilities contributes to an increase in the economic efficiency of drug procurement, optimization of the range of drugs used in health care facilities, and, ultimately, leads to an improvement in the quality of medical care in health care institutions due to the timely and uninterrupted provision of the treatment process. important and necessary drugs.

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