ORGANIZATIONAL APPROACHES TO PUBLIC-PRIVATE PARTNERSHIP IN HEALTHCARE

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RELEVANCE
Different studies can find different approaches to PPP. In general terms, they can be characterized as a narrow and broad approach. The difference in these approaches was most fully explained by Professor V.N. Mochalnikov. In a broad sense, PPP should be considered as various forms of interaction between the state and business to achieve common goals within the framework of the country's socio-economic development. Narrowly, it is an institutional and organizational cooperation between the state and business for the implementation of specific projects in various areas of the economy. [1]
In the future, financial spending on health care will increase. The development of new medical technologies and the emergence of medicines, an increase in the number of the elderly population, an increase in the volume of paid medical services, a decrease in the ability to pay of citizens leads to an increase in the need for medical care and to an increase in prices for medical services.
The main goal of PPP in the health sector is to develop the solvation of the public and private sectors in order to implement socially important projects and to develop the participation of private medical institutions in the CHI system. At the outpatient level, it is necessary to stimulate the development of public-private partnerships, to actively involve small and medium-sized businesses in the system of providing citizens with free medical care. This is possible only with an increase in the tariff for paying for medical care within the framework of compulsory health insurance. [2]
It is also worth taking into account that there is an opinion, formulated by a number of major experts, that for the successful development of the national health system, it is necessary to look for new solutions in organizing the work of medical institutions. Equipping medical institutions with modern medical equipment is an insufficient condition for the development of healthcare in Russia, but undoubtedly important. However, in order to achieve the set tasks within the framework of the current reform, there is an urgent need to attract additional funding, which can be provided by the private sector. In addition, it is the private sector that can bring more flexibility to the national health care system, mainly in terms of hospital organization.
Considering the above, it can be argued that this study of existing ways to solve problems of public health protection as a result of interaction with private organizations that provide medical services is relevant.
TARGET
Support the organization's approaches to public-private partnerships in healthcare in the Russian Federation with arguments, and show the positive dynamics of this interaction. Research objectives:
1. Consider the state of the problem of organizing public-private partnerships in health care.
2. To carry out an expert assessment of the problems of public-private partnership in health care on the example of the provision of services by a private medical organization.
METHODS
1. Study design. Questions for the survey were drawn up. The participants (objects) of the research were: 1) students of VSMU named after N.N. Burdenko 1-6 course 2) workers and students of other professions. In addition, heads of private medical institutions took part in the survey. The questionnaire consisted of several parts: the first part concerned quantitative indicators of patients' referral to private and public health care institutions; second, what is needed to improve the quality of health care; the third is about the criteria for choosing a doctor; fourth - whether the pricing policy corresponds to the high level of medical services provision.
The results of the study tested our hypothesis: the possibility of using the obtained results to improve the work of medical institutions, both private and public, and this will certainly affect the quality of medical services provided.
2. Criteria for compliance. A survey among people of different professions and age categories showed that the urgency and necessity for the population of public-private partnerships in health care is high. As such, there were no criteria for inclusion, exclusion and exclusion from the study. the respondents took the questionnaire on a voluntary basis: only at their own request.
3.Conditions of conducting. The private clinics and centers mentioned by the research participants are located in Voronezh. The respondents are representatives of various strata of society, but this will not affect the objectivity of the generalized conclusions of the study and their generalization. The survey was conducted in the form of online testing.
4. Duration of research. The planned study duration is 2 months, during which the planned time intervals have not been changed.
5. The main outcome of the study. Thus, 86% of those who voted consider it necessary to have a public-private partnership. 76.1% consider it effective, which gives grounds for its further improvement. Most of the respondents believe that private clinics complement the work of government agencies. Nevertheless, 54.3% of the population seek medical help at private medical institutions, of which 64.5% for diagnostics, 29% for treatment. Despite the advantage in choosing private clinics, 63.3% voted to reduce prices for medical services. Also, 73.9% of citizens believe that services under the compulsory medical insurance system should be available not only in state organizations, but also in private ones.
6. Additional study outcomes. The indicators characterizing the additional expected results of the study made it possible to assess the increase in the level of demand for services of public medical organizations. According to the respondents, it is necessary to improve the quality of medical care, provide offices with modern equipment, and distribute patient flows so as to reduce the waiting lists. 52.7% of the population believe that at the moment the distribution of patients between medical organizations is not effective in terms of an even load on medical personnel and universal coverage of citizens with quality medical care.
7. Analysis in subgroups. The survey involved 1050 respondents, of whom 71% were women and 29% were men aged 18 to 55 years.
8. Methods of registration of outcomes. In this study, we used the questionnaire method on the proposed questions.
9. Statistical analysis. At the end of the online testing, the summarized results were presented in the form of diagrams and statistical processing.
RESULTS.
The results of the survey are the following: on average, about 6,000 people apply to a private organization per year. Of the total number of requests for medical care: 70% of the initial treatment, 30% of repeated, of which 50% of requests for treatment of the disease, 50% of requests for the necessary diagnostics.
The diseases treated by patients depend on the profile of the medical organization. So, for example, in cardiological medical centers, most of the calls are for cardiac diseases, followed by pediatric ones, etc.
The choice of a doctor to whom they seek medical help depends not only on the disease, but also on the professionalism of the specialist. For example, in one of the private medical organizations one highly qualified gastroenterologist serves 150 people per month.
The choice of a private medical organization largely depends on the pricing policy. Pricing policy should be based on a high level of medical care. As a rule, qualified medical care at a high level determines the high cost of providing these services. And this is one of the provoking factors for the interaction of private and public organizations. For example, a patient receives a consultation from a specialist in a private organization, after which he receives the necessary list of examinations. If the price policy is above average, the patient applies to a state organization, where they receive partially or completely the necessary diagnostics, then the patient returns to a private organization for further diagnosis and treatment. Some respondents expressed a desire for private medical organizations to provide emergency medical care, inpatient care around the clock.
DISCUSSION
PPP allows you to regulate the rise in prices in the health sector and ensure the availability of qualified medical care for citizens.
The system of both state and municipal health care does not have organizational capabilities without cooperation with private organizations, medical service providers, to protect the health of the population, including effective treatment and prophylactic care.
The increase in the number of PPP projects in health care directly depends on the smoothing of the legislative requirements for the structure of the tariff for compulsory medical care, as well as the coordination of the terms of concession and tariff agreements in this area in order to reduce the financial risks of investors in PPP projects for which the choice of the model of activity of the future co-owner is important. partner. It is valuable to understand what volume of services will be provided according to the rates of compulsory health insurance, voluntary health insurance, or it will be completely paid. [3]
In order to improve the quality of medical care to insured citizens, it is necessary to ensure the creation of a competitive environment between medical organizations. Fulfillment of these conditions implies activity in the CHI system of medical organizations of all forms.Summary of the main research result. Most residents of Voronezh apply to private medical organizations, because they receive highly qualified medical care there, this is also due to the fact that this appeal requires a minimum amount of time, there are no queues (since the appointment is in progress). However, not all social strata of our society can afford to seek medical help from private medical institutions. And these results showed that this is one of the clearest indicators of the benefits of partnership between private and public organizations. One of the options for solving this problem is the possibility of expanding CHI tariffs in private organizations, confirmed by the legislative framework.
CONCLUSION
The practical application of the proposed recommendations should contribute to an increase in the level of provided medical services, and, consequently, to an increase in the level of patient satisfaction both with services and with public medical institutions.
Within the framework of public-private partnerships, public and private medical organizations, in particular in Voronezh, work together to solve problems or provide medical services at the proper level, having a common understanding of the goals, methods and forms of cooperation. But this partnership also requires the creation of a clear legal basis.
Without a doubt, this study speaks of the benefits of public-private partnership in health care, which is based on: openness and clarity of information about public-private partnership, except for those that constitute state secrets and other protected by law; ensuring competition; non-discrimination, equality of the parties to the agreement and their equality before the law; the conscientious fulfillment of obligations by the parties under the agreement; fair distribution of risks and obligations between the parties; freedom to conclude an agreement.

About the authors

Daria G. Smyslova

Voronezh Medical University named after N.N. Burdenko

Author for correspondence.
Email: dariags@mail.ru
ORCID iD: 0000-0001-9217-7660
SPIN-code: 4541-7754
Russian Federation

Viktoriya S. Shvetsova

Voronezh Medical University named after N.N. Burdenko

Email: shvetsovavi2207@mail.ru
ORCID iD: 0000-0003-2669-3848
SPIN-code: 4661-2275
Russian Federation

Irina S. Kuleshova

Voronezh Medical University named after N.N. Burdenko

Email: irina200398@mail.ru
ORCID iD: 0000-0001-9039-7643
SPIN-code: 8140-7714
Russian Federation

References