[Monitoring the implementation of the compulsory health insurance program for the prevention of dental diseases]

The purpose of the study is to monitor the implementation of the CHI program for the prevention of dental diseases. Based on the analysis of the monitoring results, the need for adjustment and direction of improvement of the observed process was identified. During the period from 2013 to 2018, there was a slight increase in the volume of preventive care per 1 insured citizen, from 0.186 visits to 0.211, which does not meet the recommended indicator and is insufficient. In the dynamics of expenses per 1 insured citizen, there is a trend of significant growth of 1.93 times. The cost of 1 visit with a preventive purpose in the dynamics also increased by 1.71 times, amounting to 603.16 rubles in 2018. it is Necessary to specify in detail the methodology for conducting a preventive examination, its interpretation and the list of services provided during this period.

[On the issue of normative legal regulation of the work of a doctor in a dental office of a multidisciplinary hospital]

OBJECTIVE

The purpose of the study is to investigate the existing normative legal documents governing the activities of doctors specializing in «dentistry», providing medical care in a multidisciplinary hospital.

MATERIAL AND METHODS

The normative legal coverage of medical workers' activities on delivering dental care for adult population with infectious diseases in stationary conditions for a thirty-year period was analyzed. The research and information method and content analysis were used.

RESULTS

The existing regulatory legal framework governing the activities of medical workers does not contain time standards for one patient who is on inpatient treatment to visit doctors specializing in «dentistry» in a multidisciplinary hospital, which does not correspond with modern requirements and does not allow determining the workload norms and standard numbers of these specialists.

CONCLUSION

Despite the presented modern possibilities of introducing the latest technologies and intensifying the activities of doctors specializing in «dentistry» on an outpatient basis, the organization of medical care and the delivering of dental services in a hospital including to infectious patients require further improvement.

[Development of an expert assessment of the quality of dental care]

The article proposes a methodology for creating an assessment of the quality of dental care based on the use of the method of analysis of hierarchies and the theory of fuzzy logic. Approbation of the methodology was carried out on the assessment of the quality of dental services for the manufacture of metal-ceramic crowns. When conducting a new assessment, you can achieve a reduction in the time of its conduct by 6 times, increasing the number of evaluation criteria by 2 times and get results with a confidence factor (p=0.95). Evaluation allows you to combine existing descriptive, quantitative, radiological, functional assessments into a system and rank their significance for the final result. This allows assessing the quality of treatment more objectively.

[Implementation of obligatory medical insurance programs in dentistry based on the cost of relative unit of labor intensity]

THE AIM OF THE STUDY

Was to analyze financial feasibility of obligatory medical insurance programs in dentistry based on the cost of relative unit of labor intensity.

MATERIAL AND METHODS

The study is based on statistical analysis of service types and costs dynamics in dental obligatory medical insurance programs in Russia in 2013-2018.

RESULTS

The study identified trends in financing health care, government guarantee programs and financial costs per 1 unit of labor intensity, which should be taken into account when making a medical and economic feasibility study of basic and territorial government guarantee programs to provide citizens of the Russian Federation with free medical care and planning the dental section of the compulsory medical insurance program.

CONCLUSION

The financial possibilities of implementing the compulsory medical insurance program in the field of dentistry in the Russian Federation are limited by reducing the cost of dental services from the total amount of healthcare financing, not proportional to the increase in inflation and the level of expenses for the compulsory medical insurance program, aggravation of the pathology of patients and untimely treatment for dental services. The provision of planned dental services and preventive measures will reduce the financial costs of these services.

[Analysis of dental care provided to the adult population with infectious diseases in in-patient departments]

The purpose of the study was to analyze the types and volumes of treatment and prophylactic services provided to the adult population with infectious diseases in the dental office of a multidisciplinary hospital.

MATERIALS AND METHODS

The types and volumes of dental care provided to the adult population with infectious diseases in a multidisciplinary hospital have been analyzed.

RESULTS

The study showed that dentists use 49 types of services when treating adults with infectious diseases, which corresponds to 29.88% of the compulsory medical insurance classifier in Moscow. Provided services can be conditionally divided into 4 groups: consultation, diagnostic, preventive and medicinal manipulations. The share of consulting services corresponds to 18.16±0.41% of the total volume of services provided; on average patients made 320.8 visits to the dentist's doctors per year, which corresponds to 2.38 visits for each patient. The proportion of medicinal manipulations, diagnostic and preventive services corresponds to 68.64±0.49%, 7.02±0.27% and 6.17±0.26%, respectively. Services related to the diagnosis and treatment of diseases of the oral mucosa and salivary glands dominate with 69.3%, on average 5.51 services are provided per visit.

CONCLUSION

The compulsory medical insurance program for the city of Moscow should provide services for the diagnosis, treatment and prevention of dental diseases, provided by doctors specializing in «dentistry», for patients with infectious diseases who are undergoing treatment in inpatient conditions.

[Objective opportunity to achieve the goal of CHI based on the analysis of the potential of doctors in the field of dentistry]

Purpose of work is to determine the objective possibility of achieving the goal of the CHI program-the protection of the constitutional rights of citizens to receive free quality and affordable dental care based on the analysis of the potential of doctors in the field of dentistry. The study used the materials of the state statistical annual reports of the Ministry of health of the Russian Federation, forms No. 30 and No. 14-MED (CHI). The system of balanced indicators adapted by us served as a tool for effective process analysis of the personnel potential of doctors in the field of dentistry. Incorporating factor for achieving a strategic goal for the system CHI the results of analysis of practice-oriented factors of the potential of specialist doctors dentistry meets up 3.88 points, and the objective possibility of implementation of the CHI in the field of dentistry is 77.6 per cent. This indicator allows to measure the degree of success of the CHI system in the present and future and is intended for management as a decision-making tool in the process of personnel management.

[Economic model of scientific rationale for the real expenses on modernization of material resources]

The study convincingly showed the presence of negative trends in the provision of medical dental organizations with material supplies. Thus, in 2014-2018 the basic growth rate of financial resources allocate for these purposes was only 15.96%. The corresponding value for the renewal of drugs and dressing materials equaled 12.28%, for reagents and chemicals, glass, chemical glassware - 6.62%, a decrease was revealed in the costs of medical instruments and food. The real amount of expenses for updating inventory in 1 working day for 1 doctor in the profile of dentistry and dental hygienist should correspond to 2067.16 rubles, which is 3.49 times higher than the allocated financial resources. Dentistry is still not included in the priority areas of healthcare in terms of financing. Under such circumstances, medical dental organizations cannot satisfy the growing need of the population for high-quality dental care. New technologies integration in the daily dental practice dictates the need for of new standards formation and a list of expenditure of inventories in the provision of medical and diagnostic assistance in the field of «dentistry».

[The readiness of restorative dentistry departments for the implementation of modern technologies]

The study showed the presence of negative dynamics in the provision of population with orthopedic dentists and dental technicians, as well as a decrease in the staffing of medical organizations with these specialists. The fact of exceeding the basic rate of loss of dental technicians over the same indicator for dentists-orthopedists by 2 times was established. The possibility of increasing the availability of personnel by combining positions is revealed, since the coefficient of concurrency among dentists-orthopedists and dental technicians is less than the average for the specialty. The trends of decreasing interest of specialists in obtaining qualification categories are noted. According to the survey of 305 specialists, a model of the most probable structural «profile» of a dentist-orthopedist was created and the characteristic features of the learning processes and practical use of knowledge on the main new technologies in orthopedic dentistry were determined. The data obtained in the course of the study indicate that there are limited opportunities to improve the availability and quality of dental orthopedic care and the introduction of new prosthetics technologies.

[Regulatory framework of the new system of wage payment in research institutions]

Changes in the legislation, the development of the regulatory and legal framework governing relations in the sphere of wage payment for health care workers has caused the transition of medical organizations to the new system of salaries payments (NSWP). This system has given executives and economists significant freedom when determining the size of payments to the employee per hour worked, including stimulating and compensation payments, bonuses and other regular pension benefits. However, given situation has also resulted in the need for studies intended on the formulation of the criteria's for medical workers of different specialties actions evaluation and the quality of medical services that they have provided, as well as on the efficiency of the health care organizations in general.

[Medical and socio-economic significance of mouth sanitation]

The cost of providing dental services under the program of compulsory health insurance (CHI) in the 1 insured citizen in 2017 correspond 412.06 RUB. The proportion of patients sanitized of the number needing treatment is 57.05%, means of rehabilitation of mouth - 50.39%. Untimely treatment of the population for dental care, limiting its availability, insufficient funding of medical organizations contribute to the deterioration of the dental status of patients. Thus, the implementation of the CHI program in terms of sanitation of the mouth is very problematic. Consequently, the management of the situation requires social solutions and involves the collective responsibility of health authorities and society as a whole for the dental status of the population.

[Analysis of the amount of preventive dental care provided in terms of Compulsory Medical Insurance program]

AIM

Based on the comprehensive socio-economic study the analysis of the amount of dental and preventive care provided in terms of Compulsory Medical Insurance program has been made.

MATERIAL AND METHODS

The study was based in six dental clinics of the Central Federal District of Russia, treating children and adults with the total amount of attached and insured patients equaled 170.000 in each.

RESULTS

Visits for the purpose of prophylaxis make up 24.87±0.27% in the structure of all methods. Dental care specialists have conducted 25 413.0 prophylaxis admissions of their patients. 35 563.29 conventional units of labor input are elaborated on the total cost of 4 614 812.16 rubles. In the purpose of diseases prevention it is planned to spend the average of 0.21 conventional units of labor input on each insured citizen or 2.1 minute on the cost of 27.31 rubles. It was spent 0.51 conventional units of labor input or 5.1 minutes that costs 66,06 rubles for each patient. These data indicate the lack of funding and time to conduct quality preventive care.

CONCLUSION

Dental diseases prophylaxis is at the low rate which is proved by the study results - only 0.19 visits with preventive purposes per one insured person. The total share of preventive services in the structure of all services, not including specialists, is 17.51±0.06%.

[The labor regulation of restorative dentists]

The study of regulatory legal documentation indicates that the labor standards of dentists-orthopedists are not approved at the state level. The current technical-organizational and medical conditions activities of these specialists have led to the need to establish the existing norms of the workload and the development of modern normative documents on work of dentists-orthopedists.

[General strategy for the development of dental laboratories with CAD/CAM systems]

The need for the practice of dentistry in the digital (CAD/CAM) technologies have initiated the emergence of dental laboratories as a separate and independent legal entities. The choice of a strategy for the development of these laboratories is aimed at ensuring the achievement of the main goals in the long term. It is established that the type of innovation in terms of 'Shake test' J. Daya, in these organizations can be designated as an option 'C' - a strategy of gradual conquest of the market. The main components of the development are: work with staff, information support, financial optimization; material and technical support, marketing activities, organizational and legal support, the formation of the quality system.

[Compensation of moral harm caused by poor quality of dental care]

The study presents a review of the legislative regulation of compensation for moral damage in case of poor medical dental care and judicial practice according to the types of civil cases for 25 years as well as the main tendencies of existing court dental practice and the long-term trends.

[Criteria for quality assessment and labor payment for dental care professionals]

Internal regulatory documents of the medical organization reflecting the calculation of incentive payments and a personalized assessment of the quality of dental care were analyzed. It is found that until now the new system of wage payment has not solved the problem of stimulating dental care professionals depending on the results of their work and needs to be changed. The applied criteria of quality assessment and the intensity of labor must have measurable parameters that exclude subjective appraisal; the integrative coefficient of labor quality must be created. A transparent mechanism of wage payment is also needed in order to motivate staff highly to achieve the qualitative and quantitative indicators of labor that are incorporated in it by the medical organization authority and are related with their work goals. Every criterion outlined in the 'Regulation on Inner Control of the Quality and Safety of Dental Care' should reflect the intensity and quality of dental services and correspond with the criteria of the incentive premiums calculation, that have been prescribed in the 'Wage payment regulations'.

[Legislative regulatory framework for medical care quality and safety control]

The paper presents the analysis of legislative and regulatory framework for the control of the quality and safety of medical activities. Legislative and regulatory framework requires mandatory internal control of the quality and safety of medical activities and dictates its structure. In the development of the internal control of the quality and safety of medical activities there is, however, a need to consider medical and social, legal, organizational, ethical and economic issues.

[Human resources provision for maxillofacial surgery facilities]

The aim of the study was to analyze the key trends of medical staff provision for maxillofacial surgery facilities. It is established that the provision of the population with maxillofacial surgeons staff has slightly decreased from 0.08 (year 2011) to 0.06 (year 2015). The amount of staff positions at this period has increased by 17.22%, the intensity of growth of employed positions has grown by 15.74%, which makes the understaffing rate equal to approximately 8-10%. The coefficient of part-time workers has also varied slightly from 1.4 in 2011 to 1.26 in 2015. Over 93% of maxillofacial surgeons work in hospitals. The qualification category was awarded to over 46.0% of specialists in this field, 97.6% of maxillofacial surgeons have a specialist certificate. The results indicate the need for a new project of personnel policy strategy for further training and professional growth of maxillofacial surgeons.

[Regulatory framework of the new wage payment system in dentistry]

The paper presents the analysis of regulatory frameworks for wage payment system in federal, state and municipal dental clinics. The new wage payment system provided significant freedom for employers in payments size determination by regulation of basic, stimulating and compensative salary payoffs. The study highlights the need for scientific studies on dental care quality assessment criteria for wage payment system.

[The dinamics of preventive dental visits in mandatory health insurance system]

The analysis on the current standards of the amount of Medical care provided for dental diseases treatment in Russia within mandatory health insurance program has been made. The study revealed more than 80-fold difference in the number of visits for one insured patient in different regions of Russian Federation. The annual increase in financial expenses covering dental visits for prophylactic purposes is identified. It is recommended that the Federal Fund of Mandatory Health Insurance to state a clear definition to the term 'Dental visit for prophylactic purposes', while the territorial funds should strengthen the requirements for approved reporting forms submition.

[Out-patient dental service visit costs in obligatory insurance system]

Significant vary of cost price is being observed in the medical organizations not only in the different subjects of the Russian Federation, but in the same federal region of the Russian Federation. So in the medical organizations of the Central Federal Region the fourfold difference of cost price of attendance with the prophylactic aim is observed. These facts make the planning of financial recourses difficult by elaborating the plans of state tasks and programs of state guarantees in general.

[Payment of out-patient dental service according to tariffs in obligatory insurance system]

Cost price of dental services in system of obligatory medical insurance is higher two fold than officially determined tariffs. Costs of the same services in medical organizations of the same federal region in Russia tend to varyMeasures directed at the stimulation of reduction of expenses connected with the keep of those medical organizations that have increased expenses (compared to other medical organizations) should be considered.

[The current training system of managerial human resources for dental service]

The study provides some data confirming the need to divide labor functions of specialists in organization of health care, to differentiate the approaches for their education, to uniform the professional abilities and to implement the accumulative system of advanced training.

[Elaboration of health care quality criteria in maxillofacial surgery]

Criteria of quality of care in oral and maxillofacial surgery should reflect not only the quality of the repair functions of chewing, swallowing, breathing, speech, and should take into account the psycho-emotional condition of the patient; satisfaction of its appearance, quality cosmetic fill configuration of the face, tooth defects, smiles; adaptation to implants and dentures; their quality, the conditions and possibilities of their use. The application of the provisions of the international classification of functioning, disability and health in oral and maxillofacial surgery, is a condition that will allow to unify the approaches to the development of quality criteria of this type of medical care.

[Corporative culture of stomatological institution appraisal by the questionnaire method]

Multiple processes in economics reflect in management and corporative culture of any institution. Long-term motivational influence plays main role in the motivation mechanism; in turn motives form stable and long-term acting system integrated into corporative culture of any stomatological institution. Integration of the interests of the institution and separate members of the staff becomes the basic condition of the interested attitude to work.