The role of the pharmacy in the provision of drugs to the population. Providing the population of russia with strategically important medicines
Discipline: Economy
Kind of work: Thesis
Topic: Formation of a drug supply management system for the population of the subject Russian Federation
1. DRUG SUPPLY SYSTEM AS
SUBSYSTEM OF HEALTHCARE SERVICES 9
1.1. The essence of the pharmaceutical subsystem of health care and
state regulation of drug supply to the population
in Russia for the present stage 9
1.2. Characteristics of the current state of the field of medicinal
treatment 26
1.3. Foreign experience of drug provision of the population 38
2. ANALYSIS OF THE SYSTEMS OPERATING IN THE SUBJECTS OF THE RUSSIAN FEDERATION
DRUG MANAGEMENT AND
DEVELOPMENT OF THE CONCEPT OF THEIR FORMATION UNDER CONDITIONS
MODERN RUSSIA 48
2.1. The structure of drug supply to the population of the constituent entity of the Russian Federation,
object and subject of management 48
2.2. Analysis of control systems operating in the constituent entities of the Russian Federation
drug provision and their shortcomings 55
2.3. Formulary system as a method of improving management
drug provision 75
2.4. The concept of forming an effective management system
provision of drugs for the population of a constituent entity of the Russian Federation 79
3. PROPOSALS FOR DRUG MANAGEMENT SYSTEM
PROVIDING THE POPULATION OF THE SUBJECT OF THE RUSSIAN FEDERATION 87
3.1. Optimization and planning of drug supply for
basis formulary system 87
3.2. Improving procurement and distribution organization
medicines 97
3.3. Improvement of accounting and control of medicinal
providing NO
4. BACKGROUND OF THE FUNCTIONING OF THE PROPOSED DRUG MANAGEMENT SYSTEM. 125
4.1. Proposals for the improvement of legislative and other
regulatory legal acts in the field of drug provision .... 125
4.2. Creation of a single information space in the field
drug circulation and monitoring of medicinal
providing 133
4.3. Quality assurance of medicines 144
Conclusions and conclusion 153
List of used literary sources 159
Drug supply for the population is an integral part of the complex medical services provided to the population by the healthcare system. In this regard, we note that the availability of medicines directly affects the efficiency of the health care system and the health status of the population.
The modern state structure of the Russian Federation before
believes the significant independence of its subjects, including in the field
financing and management of health care and drug supply
eat. In the context of existing problems in the health system throughout
country general characteristic for the vast majority of regions is
there is insufficient satisfaction of the need for medicines.
Problems with drug provision are experienced as benefit categories
population and medical institutions, which significantly reduces the quality and
-, availability medical care in the regions.
Of course, as many researchers rightly note, this situation associated with a common low level financing of health care, both from regional and municipal budgets, and from territorial compulsory medical insurance funds, however, imperfect management of the process of drug provision at the regional level often leads to irrational spending of both allocated Money and the actual medicines, which further complicates the unfavorable situation.
Considering the great importance and social significance of the problems of drug supply in the complex of health services, many aspects of the organization and management of drug supply for the population were studied in the works of domestic scientists. Among them, first of all, the works of A.D. Apazova, A.M. Afanasyeva, V.L. Bagirova, A.I. Vyalkova, V.L. Goncharenko, V.I. Dorofeeva, N.N. Karevoy, A.A. Lina, P.V. Lopatin,
L.A. Loshakova, L.V. Moshkova, V.P. Padalkina, K.F. Puzyni, V.E. Rokhchina,
; A.M. Taranova, R.U. Khabrieva, A.G. Chuchalina et al. Highly appreciating the contribution of
of the authors listed above, it should be noted that the formation of a comprehensive system of drug supply management for the population at the level of a constituent entity of the Russian Federation in modern conditions not paid enough attention. This and all of the above justifies the relevance of the selected research topic.
The aim of the thesis is to form a system of drug supply management for the population of the constituent entity of the Russian Federation.
In accordance with the purpose of the dissertation, the following tasks were set:
® investigate the essence of the pharmaceutical subsystem of health care and
state regulation of drug supply to the population in
Russia at the present stage;
© to consider the current state of the field of drug circulation in
Russia and give a description of its participants;
o study the foreign experience of drug provision of the population;
^ © to investigate the structure of drug supply for the population at the level of
subject of the Russian Federation, to determine the object and subject of management;
© to analyze the existing regional drug supply management systems and identify existing shortcomings; © to develop a concept for the formation of a drug management system
provision of the population of the constituent entity of the Russian Federation in conditions modern Russia; © to develop the content of the management functions that form the system
management of drug supply for the population of the constituent entity of the Russian Federation; ® formulate proposals for improving the regulatory and information support for the functioning of the drug supply management system for the population of the constituent entity of the Russian Federation and develop measures to ensure the quality of drugs in the regional drug supply system.
The object of the research is the process of drug supply.
^ population in the health care system of the constituent entity of the Russian Federation.
The subject of the research is the drug supply management system for the population of the constituent entity of the Russian Federation.
The theoretical and methodological basis of the study was the works of domestic and foreign scientists on health economics, regional health care management, economics and organization of pharmacy. In addition, the work used the materials of scientific and practical conferences, legislative and regulatory legal acts of government bodies at the federal and regional levels.
As specific methods studies used: analysis of the content of literature on the selected topic, logical, comparative and statistical analysis, the provisions of the systematic approach
The information base of the study was the statistical data of the Ministry of Health of the Russian Federation, Federal Fund OMS, Goskomstat of the Russian Federation, Ministry of Finance of the Russian Federation, data published in periodicals, as well as data presented on medical and pharmaceutical sites on the Internet. For the analysis of drug supply in individual constituent entities of the Russian Federation, data from territorial health authorities and territorial compulsory medical insurance funds were used.
The scientific novelty of the research results is as follows: ® the essence of the pharmaceutical subsystem of health care and the applied methods of state regulation of drug supply have been determined; the structure of drug supply to the population at the level of the constituent entity of the Russian Federation has been established; the current regional drug supply management systems were analyzed, their shortcomings were identified and formulated;
® a concept was developed for the formation of a drug supply management system for the population of a constituent entity of the Russian Federation in the conditions of modern Russia, within the framework of which a model of drug supply for the population within the framework of the regional health care system was proposed and the composition and content of management functions were formulated;
o formulated an algorithm for the introduction of a formulary drug supply system at the level of a constituent entity of the Russian Federation, on the basis of which a procedure for planning the need for drugs necessary for drug supply to the population within the framework of the regional health care system was developed;
o proposed and substantiated methods for improving the procurement and distribution of medicines at the level of a constituent entity of the Russian Federation; the functions and procedure for interaction of subjects of drug supply in the process of procurement and distribution of drugs are formulated;
® an algorithm has been developed for the construction and operation of automated systems for accounting for drug supply in health care facilities and preferential drug supply for the population of the constituent entity of the Russian Federation, on the basis of which drug supply will be monitored;
o formulated and substantiated proposals for improving the regulatory documents governing the sphere of drug supply to the population of the constituent entity of the Russian Federation;
© formed the structure and procedure for creating a regional unified information space in the field of drug circulation; developed and disclosed the main directions of monitoring drug supply to the population of the constituent entity of the Russian Federation;
o a set of measures has been developed to ensure the quality of drugs in the drug supply system of the population of the constituent entity of the Russian Federation.
The practical significance of the dissertation work is that the conclusions formulated by the author and the results of the study can serve as the basis for the formation of drug management systems for the population in the constituent entities of the Russian Federation. The developed recommendations can be used in the work of territorial health authorities and territorial compulsory medical insurance funds.
The materials of the dissertation were used:
about the St. Petersburg State Chemical and Pharmaceutical Academy in educational process with students, graduate students and students of the faculty of additional professional education, as well as in research work (act of implementation);
about CJSC "CM PHARM" in marketing research pharmaceutical market(act of implementation).
1. DRUG SUPPLY SYSTEM AS A SUBSYSTEM OF A COMPLEX OF HEALTHCARE SERVICES
1.1. The essence of the pharmaceutical subsystem of health care and state regulation of drug supply
population in Russia at the present stage
Pharmaceutical activity means professional activity in the health care system for the provision of pharmaceutical services, which consists in providing health care institutions and the population with the necessary medicines.
It is obvious that the role of medicine in the process of curing a sick person is extremely important. No matter how professional the doctor is, without the necessary medicines he will be powerless to help a person cope with the disease. Accordingly, drug provision is inextricably linked with the complex of services provided by the health care system to the population. The provision of medicines can be considered a special kind of medical service, without which the normal functioning of the entire health care system is impossible. Medicines are needed in inpatient and outpatient treatment, in the diagnosis and prevention of diseases, in the provision of emergency medical care and in the fight against epidemics.
Summing up, it should be said that the main function of the pharmaceutical subsystem of health care is to ensure medicines to conduct an effective diagnostic, therapeutic and prophylactic process.
Consider historical aspect development of pharmacy. The first ones to reach
before us, mentions of pharmacies and the profession of a pharmacist refer to the XIII table
tii. The word "Apotheca" is of Greek origin. Its initial
A> new meaning - specialized, or general, store or warehouse. However, since
over time, the semantic load has changed, and now this word in most languages means a health care institution, a pharmacy in the modern sense.
In the 15th century, the term "pharmacist" appears for the first time - from the Latin "provisor" - foreseeing, anticipating, foreseeing what he says about important role pharmacist in the course of treatment. The doctor makes a diagnosis, and the pharmacist foresees the direction of the disease and, with the help of drugs, predetermines, corrects its course and further development for the purpose of healing. The first educational establishments, preparing pharmacists, were opened in Montpellier (south of France), Padua, Barcelona (Spain) in the middle of the 16th century.
The most complete and regulated " guidelines"On the creation of pharmacies and what is today called" pharmaceutical management "were created at the end of the XVII - early XIX centuries In the same period, public associations of pharmacists were founded - "Obercollegium Medicum et Sanitatis" in Berlin in 1796, "Societe libre des Pharmacients" in Paris and the "Royal School of Pharmacy" in London in 1842. Special departments are created for pharmacists at universities , v different countries and cities, special codes of laws and regulations are formed, regulating both their professional training and practical activities.
In Russia, the first legislative document on pharmacy was the Pharmaceutical Charter (1789), which ordered the pharmacist to engage in pharmaceutical business and made serious demands on him.
By the beginning of the XXI century, the appearance of the Russian pharmaceuticals defined by the past decade of economic and political reforms. During this period, the existing long time hard centralized system state security the population with medicines changed to a decentralized one with a predominance of market mechanisms and principles of insurance medicine.
Today, according to the Federal Law "On Medicines", the circulation of medicines means activities that include
including “development, research, production, manufacturing, storage, packaging, transportation, state registration, standardization and quality control, sale, labeling, advertising, use of medicinal products, destruction of expired medicinal products or expired medicinal products and other actions in the field of medicinal products circulation ”.
The main subjects of the pharmaceutical subsystem of health care are: drug development organizations, drug manufacturers, wholesale and retail enterprises, healthcare facilities, as well as government bodies that regulate and manage this area.
V general view the main components of the process of drug provision of the population are presented below in Fig. 1.1.
Retail link
Drug development
LS production
Wholesale link
Population
Rice. 1.1. The main components of the drug provision process
Since medicines are a special commodity of great social significance, the availability and availability of which directly affects the health of the population, the role of the state in this area is very great. In most countries of the world, the state actively participates in the drug supply system by regulating and financing this area in order to increase the availability of drug care to the population. Generally speaking about health care, of which the medicinal
provision, then its feature, as an object of management, is the significant role of state regulation, since in the course of numerous studies it has been shown that it is impossible to achieve effective health care by purely market methods.
In Russia, the population, according to the Constitution of the Russian Federation, medical care in state and municipal institutions health care is provided free of charge. Since medicines are a necessary part of the process of providing medical care, the state pays for the medicines used in health care institutions to provide medical services. For this, funds are used, accumulated in the CHI system, as well as funds from the state budget.
Another item of government spending on medicines is the payment of preferential and free medicines for outpatient treatment, which are provided to certain groups of the population within the framework of the state social protection policy. Currently, about 30% of the population of the country enjoy benefits for drug provision, i.e. more than 45 million people. Of these, about 17 million are entitled to free purchase of medicines, and the rest - a 50% discount.
All in all, more than half of the medicines circulating on the market are paid at the expense of the state. According to some estimates, up to 70% of drugs are paid for from the state budget and compulsory medical insurance funds.
With such a volume of payment for drug assistance to the population, the state is an active participant in the sphere of drug circulation and is forced to rather strictly regulate this area, since the market mechanism does not contribute to the fullest satisfaction of the population's need for drugs, especially socially unprotected groups.
Before moving on to a direct consideration of the mechanisms of state regulation, let us consider the fundamental legal framework governing drug provision of the population. It should be noted that legislative acts in the field of medicinal ...
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Providing the population of Russia with strategically important medicines
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DRUG SUPPLY OF THE POPULATION OF RUSSIA:
OLD PROBLEMS AND NEW CONTEXTS
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Improving human health and reducing mortality is the goal and end result of the creative work of the Government, healthcare institutions and every specialist working in this area.
Since the middle of the 20th century, several hundred definitions and concepts of population health have been proposed, in the context of which various models and indicators have been proposed for measuring it. The most commonly used indicators are the indicator average duration life (or life expectancy at birth) and crude death rate.
A study of the available literature shows that the socio-economic development of Russia in 2010 is characterized by generally positive dynamics for most indicators. The main demographic indicators have improved, the employment of the population has increased, there have been positive changes in a number of health indicators and social service population. In 2010, the Government of the country implemented measures to strengthen the protection of the population, ensured the necessary volumes and quality of social and medical services, and the availability of high-quality and safe medicines. The scale of the state's activities in the field of employment has expanded, including curbing the growth of unemployment, providing targeted support to citizens in employment. In 2010, real disposable cash income amounted to 104.1% (in 2009 - 102.1%).
As a result of the consistent implementation of demographic policy measures at the federal and regional levels the positive dynamics of demographic processes in the Russian Federation in 2010 was further developed. The population of the Russian Federation, as of January 1, 2010, amounted to 141,914.5 thousand people, which is 10.5 thousand people more than on January 1, 2009. The natural population decline has decreased in comparison with 2006 by 2.8 times - from 687.1 thousand people in 2006. up to 241.4 thousand people in 2010. In 2010, 1789.6 thousand children were born, which is 27.9 thousand children (1.6%) more than in 2009. The birth rate was 12.6 per 1000 population against 12.4 in 2009. Mortality in comparison with 2009 increased by 20.5 thousand people, or 1.0%. The mortality rate was 14.3 per 1000 population, while in 2009 it was 14.2.
In the first half of 2010, there was a positive trend in the decrease in mortality. The excess of the number of deaths over the number of births decreased to 1.13 times (in 2009 - 1.14). Natural population decline in 2010 amounted to 241.4 thousand people, or 3% less than in 2009. Coefficient natural loss amounted to 1.7 per 1000 population (in
2009 -1.8), which is the minimum value for 1993-2010.
According to preliminary estimates of Rosstat, life expectancy at birth in 2010 compared to 2009. increased by 0.31 years, including men - by
0.26 years, women - by 0.2 years and in 2010 - men and women - 68.98 years, men - 63.03 years, women - 74.87 years.
An acute problem the mortality rate of the population of working age remains. Of the total number of deaths, people of working age make up about 30%. In the first place are circulatory diseases and external reasons(accidents, poisoning, injuries). The mortality rate for men of working age is almost 4 times higher than the mortality rate for women of working age. The mortality rate from causes determined by behavioral factors in men of working age is significantly higher than in women of working age. In 2010, mortality rates improved for almost all types of major diseases, except for diseases of the circulatory system, digestive organs, and accidental drowning. In 2010, for the first time in the past three years, a decrease in mortality from neoplasms was recorded. The number of deaths from neoplasms in 2010 compared to 2009 decreased by 1.3 thousand people or by 0.4% and amounted to 292.3 thousand people. Index infant mortality has a stable positive trend - this indicator has decreased in 61 constituent entities of the Russian Federation. In 46 constituent entities of the Russian Federation, the infant mortality rate is below the national average.
Analysis of the study of materials published by the Ministry of Health and Social Development of the Russian Federation allows us to conclude that a lot of work has been done on legal regulation in the field of drug circulation, providing citizens with affordable and high-quality drugs, including expensive drugs, stimulating import substitution and introducing innovations in the production of drugs. means and medical equipment. With the aim of improving legislative regulation legal relations in the field of drug circulation, taking into account the interests and priorities of the domestic pharmaceutical industry, the Federal Law of April 12, 2010 No. No. 61-FZ "On the Circulation of Medicines". The law makes it possible to ensure transparency of the drug registration procedure, to increase the availability of drugs to citizens of the Russian Federation, establishes general principles state regulation of prices for medicinal products influencing the provision of priority health care needs in order to prevent and treat diseases prevailing in the structure of morbidity in the Russian Federation. With the entry into force of this law on January 1, 2011, the manufacturer is obliged to register the maximum selling prices for vital and essential medicines, and the constituent entities of the Russian Federation - to establish maximum wholesale and maximum retail markups. The results of monitoring the affordability of medicines, carried out monthly in the constituent entities of the Russian Federation, reveal a steady trend towards a decrease in the price level for vital and essential medicines. On average, in the Russian Federation in the outpatient segment of the pharmaceutical market there was a decrease in the price level by 2.64%, in the hospital segment - 2.58%. In the outpatient segment, the cost of imported drugs decreased by 3.58%, in the hospital segment - by 3.72%. Prices for domestic medicines decreased by 1.52% in the outpatient segment and 1.22% in the hospital segment. In pursuance of the Federal Law, the Ministry prepared the List of vital and essential medicines for 2011, approved by the order of the Government of the Russian Federation of November 11, 2010 No. 1938-r. In order to ensure guarantees and availability of high-quality medical care to citizens, the Ministry approved orders on the minimum range of drugs for medical use, consisting of 60 names of drugs (50 names refer to vital drugs, including 45 drugs are included in preferential list), and also developed a list of strategically important medicines,
required for production in the Russian Federation, including 57 international non-proprietary names of medicines. The price segmentation of the pharmaceutical market has changed. “In 10 years, the volume of sales of medicines in our country will amount to about one and a half trillion rubles. A very significant figure. In fact, we have to reach the average European level of drug consumption, which, of course, must ultimately be converted into life expectancy and its quality, "- President Dmitry Medvedev said this optimistic quote in his speech at a meeting of the modernization commission and technological development of the Russian economy, which took place in the city of Pokrovsk, Vladimir region on August 31, 2009. ...
However, in his speech at a meeting on drug provision preferential categories citizens of the elderly, President Dmitry A. Medvedev reports: “according to statistics, since the beginning of 2010 there has been a tendency towards a decrease in the price level, but this is just statistical data, because somewhere this is a decrease, and somewhere, unfortunately , No. Moreover, it depends on the group of drugs. The people I spoke with here say the following: if the situation looks more or less normal with regard to our medicines (either there is no growth, or even for some drugs, in fact, there has been a decrease in prices), then the situation with foreign drugs is somewhat different. Of course, we need to engage in import substitution, we need to revive our industry, but, nevertheless, we cannot ignore the situation on the market of foreign drugs so far. In general, the situation this year is stable, because until recently, the growth in drug prices significantly exceeded the inflation rate. We have put in quite a lot of effort to stop this growth. But it is obvious that the efficiency of public procurement both at the federal and regional levels, at the municipal level is a matter of our common concern, including for pensioners who have drug benefits. In total, now, as I understand it, there are about 4 million such people, which is 70% of the total number of beneficiaries. Obviously, this is the most vulnerable group of people. These are invalids, war and labor veterans. It is difficult for such people to get the so-called concessional prescription. They sometimes stand in queues for months, in order to get an appointment at the clinic, and subsequently they seek, accordingly, to buy this prescription. Therefore, there are at least two questions. The first question is what do we do with the expiration dates of these recipes. You may need to extend the validity period for preferential prescriptions. And the second question or a way to solve this problem is the introduction of other forms of drug delivery, including targeted or home delivery of drugs to elderly people.
One of the main priorities of the Ministry of Health and Social Development of the Russian Federation was the fulfillment of social obligations in terms of providing certain categories of citizens with the necessary drugs as part of a set of social services, and financing the costs of the centralized purchase of drugs intended for the treatment of patients with malignant neoplasms of the lymphoid, hematopoietic and related them of tissues, hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, multiple sclerosis, as well as after organ and tissue transplantation. The list of drugs centrally purchased at the expense of the federal budget for the treatment of these diseases includes 18 drugs. As of January 1, 2011, the Federal Register numbered 102.6 thousand recipients of drugs purchased centrally at the expense of the federal budget (an increase in comparison with 2009 was 20.8%). The costs for these purposes in
2010 amounted to 42501.0 million rubles. According to the federal register of patients requiring treatment with expensive drugs, formed on the basis of data from the constituent entities of the Russian Federation as of January 2008. 25,592 people included, January 2009 - 52,814 people, January 2010 - 77145 people, January 2011 - 102602 people. About 65% of elderly patients suffer from malignant neoplasms of the lymphoid,
hematopoietic and related tissues, about 15% - with multiple sclerosis and about 13% of patients after organ and tissue transplantation. T.A. Golikova noted in her report that “this is an expensive, really expensive treatment. Our cost of one recipe today is in 2010, according to data for 6 months, 63.2 thousand rubles. At the same time, however, last year it was 73.5 thousand rubles. That is, gradually, due to the fact that domestic drugs, domestic generics, which are quite high quality and completely replace foreign ones, appear on the market, we have managed to reduce the cost of this recipe. If we refer to the category of elderly people, the highest consumption is 64.8 percent for diseases related to oncology, and in money terms, it is 58 percent of the consumption of expensive drugs. ”
The number of citizens who received medicines in the form of a set of social services as of January 1, 2010 amounted to 4182.4 thousand people, which is 17% (893.1 thousand people) less than in 2009, including participants of the Great Patriotic War-304.2 thousand people, which is 33.2% less than in 2009. The number of recipient citizens as of January 1, 2011 amounted to 4156.0 thousand people, which is 0.6% less than in 2010. The norm of financial costs per month per citizen receiving state social assistance in the form of a social service for the provision of medicines, medical products, specialized products health food for children with disabilities in 2011 is 570 rubles, which is 7.3% higher than the 2010 standard (531 rubles). The total amount of budgetary appropriations transferred to the budgets of the constituent entities of the Russian Federation for the implementation of these powers in 2010 amounted to 43321.7 million rubles. In 2011, the federal budget provides for payment of medicines provided in the form of a set of social services, 32,720.0 million rubles and 13,600.0 million rubles of other interbudgetary transfers. The size of the consolidated financial standard per recipient per month in 2011 is 850 rubles per month, which is 12.4% more than in 2010. In her speech, the Minister of Health and Social Development of the Russian Federation, T.A. Golikova, noted: “And in the first year of the implementation of the law, all our citizens received natural support. Only with next year, that is, since 2006, we have decided to legislatively implement the choice. As a result, today, as you rightly said, 70% of us have actually abandoned the natural package. The number of citizens who have chosen a social package for 2011 is 4052 thousand. But in the course of the year, the number of these citizens grows by an average of 500-600 thousand people. The growth of the financial standard (up to 952 rubles) may be somewhat adjusted depending on how many citizens will increase during the 11th year. But traditionally, and always it sounds in the reports of the governors, including it sounded in Kursk, when the governor reported that the standard is very small. Financial standard, which, within the framework of the law on state and social assistance really over 500 rubles a month. But today, taking into account the fact that we provide these other interbudgetary transfers to the regions of the Russian Federation, the so-called consolidated standard at the expense of the federal budget in the 10th will amount to 757 rubles per month and will increase by 13% compared to the 9th level. year, and in 2011 it is 26%, it is 952 rubles, but it can be adjusted, as I said, depending on the number of citizens that we have. We have the most frequent and significant pathologies among the elderly are diseases of the cardiovascular system - 36%. Since 2005, there has been a tendency towards an increase in the proportion of diseases of the organs of vision from 7, 1 in the 5th year to 7.4 in the 9th year, and malignant neoplasms- from 3.5 to 4.2 percent. The cost of dispensed drugs to these citizens amounted to almost 24 billion rubles out of 44 billion, or 54%. That is, 70 percent are citizens, if we take the number, and 54 percent is money. In terms of money, we have in the first place drugs, which are prescribed with the permission of the medical commission. These are practically all expensive drugs. In second place are hormones and
drugs affecting endocrine system, are extremely in demand, and extremely insufficient provision of patients diabetes mellitus... And the third place is taken by drugs that affect cardiovascular system, although in the structure of morbidity and mortality they occupy the first place ”.
The main, first priority of the Main Directions of Anti-Crisis Actions and the Policy of Modernization of the Russian Economy of the Government of the Russian Federation for 2010 was determined to support social stability and ensure full-fledged social protection of the population. Large-scale measures were taken to provide material support to low-income groups of the population, primarily pensioners. Share social payments in monetary income of the population increased from 14.9% in 2009. up to 18% in 2010 The ratio between per capita income and size living wage per capita increased from 3.26 times in 2009. up to 3.29 times in 2010 Certain categories of citizens (disabled people, war and labor veterans, some other categories of citizens) in accordance with Federal law of August 22, 2004 No. 122-FZ, measures were provided social support as a monthly cash payment(EDV) and a set of social services, including drug provision, Spa treatment, travel to and from the place of treatment, and travel to railway transport... Since April 2010, the size of the EDV has been increased by 10%.
According to T.A. Golikova, “2010 is a year for health care, labor relations, pension security and social development has been very intense. Many changes have been initiated this year, which should lead to an improvement in the quality of life of people. " Despite the great work done by the Government of Russia in various areas, the Ministry of Health and Social Development of the Russian Federation for the period from January 1 to November 30, 2010 received 77824 written applications from citizens on various issues, which is 21580 more than in the same period of 2009. The largest number requests (34%) concerned social issues - pension provision, social protection, questions of medical and social expertise. At the same time, the total number of applications on these issues decreased by 9.5% compared to the same period last year (in 2009, these applications amounted to 43.5%). The number of calls on the organization of medical care in comparison with 2009. increased by 4.3% and amounted to 32.5% (in 2009 - 28.2%), the number of questions on drug provision increased by 2% and amounted to 6.2% (in 2009 - 4.2%), the number appeals on labor and employment issues in 2010 increased by 1.6% and amounted to 7.8% (in
2009 - 6.2.
As part of the control over the implementation by the state authorities of the constituent entities of the Russian Federation of the delegated powers to organize the provision of certain categories of citizens with the necessary medicines, Roszdravnadzor monitors the indicators of preferential drug provision and conducts inspections directly at the points of delivery of medical and drug assistance (treatment and pharmacies), public health authorities of the constituent entities of the Russian Federation. As part of the implementation by the constituent entities of the Russian Federation of the delegated powers to organize preferential drug provision for certain categories of citizens, drugs were supplied to the regions for a total amount of 42,173,047 thousand rubles, which is 8.4% less volumes deliveries in 2009. The size of the inventory of medicines purchased and supplied in 2009, but remained unclaimed at the end of the year, amounted to 3.5 billion rubles. within the framework of regional purchases and 4.2 billion rubles. on "high-cost" nosologies. It should be noted that the number of citizens eligible for preferential drug provision in 2010 decreased compared to 2009. and amounted to 01.01.2010. 4182 thousand people. average cost prescription under the ONLS program has a tendency to increase and by the end of 2010 amounted to 724 rubles, which is 3.6% more than in 2009 (699 rubles). Financial cost ratio,
per one beneficiary, per month increased in 2010 by 13% compared to 2009. and amounted to 757 rubles. During 2010, 507,915 prescriptions were issued for high-cost nosologies (14% more than in 2009), of which 507,804 prescriptions were served for the amount of 31,875,813 thousand rubles. (2.2% less than in 2009). By the general list 58326984 prescriptions were written out (8% less than in 2009), of which 58180507 prescriptions were served for the amount of 42148861 thousand rubles. (4% less than in 2009).
The Federal Service for Surveillance in Healthcare and Social Development considers written and oral applications of citizens as one of the indicators of the quality of the provision of medical, social and drug assistance to the population. In 2010, out of 19457 written applications, 3382 or 17% (in 2009 - 2124 or 15%) related to issues related to the provision of essential medicines to benefit categories of the population. The Federal Service for Surveillance in Healthcare and Social Development notes the stabilization of the number of citizens' appeals on these issues in central office Roszdravnadzor and conservation is sufficient a large number appeals to territorial bodies(in 2010 - 4687 - 31%, in 2009 - 3197 - 37.8%). The majority of citizens' appeals on the issues of preferential drug provision are associated with patient dissatisfaction with the lack of medicines in pharmacies - 1998 (59%), the refusal of a doctor to prescribe medicines - 640 (18.9%), the duration of deferred service in pharmacies - 347 (10.2 %). In 2010, Roszdravnadzor received 488 appeals from citizens of the Russian Federation (in 2009 - 243 appeals) regarding the provision of information on the List of Essential and Essential Medicines, regulation of prices for medicines, provision of information on maximum selling prices.
In 2010, the territorial compulsory health insurance funds and insurance medical organizations from citizens, including insured persons, 19.35 million applications were received. The number of complaints has decreased compared to previous periods and amounts to about 50 thousand complaints per year. About 60% of the complaints registered in the Russian Federation were found to be justified. In the structure of reasons for justified complaints on drug provision, 3.36 thousand complaints (11.2%) were received, the quality of medical care was 2.61 thousand complaints (8.7%), ethics and deontology medical professionals- 0.93 thousand complaints (3.1%).
Thus, the protection of public health occupies a central place in the structure of the vital interests of the individual, society and the state, and is one of the system-forming factors. A reflection of social disadvantage in society over the years are negative trends in the state of health of the population, weak social protection, reduced availability of highly effective treatments, insufficient funding for health care. The transformations carried out in Russia, significant differentiation cash income population, availability of medical care. Currently Russian healthcare a well-thought-out strategy and policy is required at the level of a constituent entity of the federation with a clearly built system of goals, objectives, forms and methods of managing regional development processes in the field of drug supply. It is necessary to develop a common policy in drug supply population, allowing to comply with the insurance principle in the implementation of state guarantees of preferential drug provision: everyone in need had the opportunity to timely receive a drug, regardless of the person's place of residence, social status and from belonging to the federal or regional beneficiary. Special attention to pay to vulnerable groups of the population, as well as to form a control system for rational spending of allocated budget funds and rational prescription of medicines.
Literature
1. 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
2. Verbatim report of the meeting on the provision of drugs for privileged categories of elderly citizens. October 20, 2010 Kozelsk. (http: www.kremlin.ru/transcripts / 9294)
3. About activity Federal Service on supervision in the field of health care and social development in
2010.-M.-2011.-P.86-87
4. Mandatory health insurance in the Russian Federation in 2010-2011 - M.-S. 21
5.Zubkova, G.I. Nanotechnology in medicine / G.I. Zubkova // Bulletin Kazan. technol. un-that. - 2011. - T. 14, No. 2. - P. 191.
© A. M. Kuznetsova - asp. department state municipal government and sociology; R. G. Tukhbatullina - Dr. of Pharm. Sci., Dir. Kazan Medical and Pharmaceutical School (college) hi.