CHAPTER FOUR
Introduction
This study will mainly focus on the ways that can be proposed so as to make the medical care provision of Russia be improved. The results that will be achieved from this research work will immensely contribute to the improved and much efficient health care provision in Russia.
Findings
Notably, the research methodology employed a mixture of both qualitative and quantitative analysis. We shall therefore look at the various prospects of Russian healthcare business in the global international healthcare market. Some of the most visible prospects and fragments that are the backbone of the healthcare sector include demographic issues, financial, operational, regulatory, and innovational. These are basically the core issues that dictate the success or failure of the industry.
Demographics
Aging Population
Essentially, for any health care sector to be able to project for the future, they must take into consideration their population. The study revealed that the aging population is on the upward increase. Similarly, the life expectancy has seen an upward surge. There is an approximated 72.3 years in 2014 to an expected 73.3 years in 2019. This will ultimately increase the number of people aged 65 years and above and as such, the aging population will see a drastic increase. The number of persons aged over 65 years will increase to an estimated 604 million worldwide. This translates to slightly over ten percent of the global population. Some of the factors that can be accredited to this increase in life expectancy include declining infant mortality rates, improved living conditions, improved access to medicine and medical facilities, better and a much improved control of communicable and viral diseases, declining mortality rates among the elderly, and increased income in the country which sees the majority of the population practice proper sanitation (Gurtoo and Williams, 2015). These factors mainly ensure that the aging population stays with good and proper health and therefore, the mortality age is increased.
However, interestingly, an aging population does not directly impact the healthcare provision. Some other factors such as cost and technology directly affect the provision of health care.
Chronic and Communicable Diseases
There is an increase in the number of chronic diseases in Russia. Some of the most common chronic diseases include cancer and HIV/AIDS which have an adverse effect on the life expectancy (Khristenko, 2014). Cancer, cardiovascular diseases, diabetes tend to claim lives if the patients at a much younger age and faster rate. Other diseases which have a negative effect on the life expectancy include obesity, hypertension, sexually transmitted diseases, dementia, cardiovascular diseases, and tuberculosis. These diseases particularly affect the children the most and thus infant mortality rate is increased. However, this majorly occurs in the remote areas with no access to medical care. However, the government has disbursed sufficient funds to tackle this issue. Diabetes is also increasing at an alarming rate in the country. In fact, the rate is not only increasing in Russia, but also across the globe. This has prompted Russia to shift from a more curative approach to a preventive one. People across all ages are encouraged to practice a healthy lifestyle and frequent the checkups in hospitals. The onset of these chronic diseases has really bothered the healthcare provision worldwide.
Similarly, communicable disease are being combatted by carrying out vaccinations starting from a very young age. Alternatively, people are further urged to practice healthy lifestyles and sanitation so as to keep the risk of getting these communicable diseases at an all-time low.
Access
With the increasing population, the government has found the need of increasing their reach to all people in the country. However, solely offering healthcare services might not be quite as effective as combatting them. The government has laid out infrastructure, provided the remote areas with adequate lighting, and proper sanitation. Furthermore, the government has laid out a project of mobile clinics and enhanced reach to these areas.
Increased wealth per household also helps to increase the access to healthcare. Inasmuch as the government is laying out public health services, the poor families will be unable to access these services. This is because these public services are usually marred by inadequate funding, poor service delivery, and system failure. This then gives rise and an opportunity for the private healthcare sector to thrive and thus alienating the low income families. Insurance plans are seen as a lucrative business idea and also convenient means of taking care of the medical bills. However, this creates some form of system hierarchy. Nonetheless, the private healthcare sector plays a significant role in the provision of medical care. Importantly, the private sector provides a competition for the public healthcare. This has ensured that there is quality healthcare all over the country, and also at affordable prices. The number of beds have increased courtesy of the private hospitals and this reduces the stress on the public hospitals (Krishna Mohan and Krishna Naik, 2006). This ensures that there is adequate healthcare and reduced strain on the available public healthcare resources.
The government should be able to adequately fund these public healthcare systems so as to increase and enhance access.
Consumer Engagement
Nowadays, consumers are well informed and aware of their participation in the healthcare and as a result, they become more actively engaged and involved. This has ensured that they are aware of their financial involvement and responsibilities. As a result, they have taken medical insurance covers. In addition, the consumers have raised their expectations on the type and quality of service that they are to expect from these hospitals. The healthcare providers then have to match to these expectations so as to remain relevant in the market. Particularly in the middle income and high income households, the need to have a highly efficient healthcare service has forced the providers to increase their sufficiency and service delivery (Ramanujam, 2009). This is a group of households that place high value on their wellbeing and will only accept the best quality healthcare there is. Some of the trends that dictate consumer engagement include
Employer-sponsored health plans
Favorable relationships between consumers and healthcare companies driven by technology. This reduces transactions and alternatively increase interdependency.
Consumers place high value on online and mobile information exchange.
The high involvement in healthcare sector by consumers has reinvented the customer engagement policies (Berkowitz, 2017).this is because of the changing trends in the consumer awareness and practices and thus, the healthcare sector has to come up with more innovative consumer engagement policies. The hospitals and healthcare institutions have adopted the use of electronic health records, formed online portals to effectively interact with their potential clients, and at the same time retain their old ones. Furthermore, the mode of treatment has shifted from treating the disease and rather focusing on the wellbeing of the patient. The hospitals train their employees to be customer-focused and also implement the use of technology in disseminating care.
Financial
Government Spending
This is by far the most crucial aspect of any sector in the country. Crucially speaking, the healthcare sector is one of the largest in the country and also demands a lot of resources. Healthcare accounts for approximately 10 percent of the nation’s GDP. However, realistically speaking, with the challenging economic times, the government finds it hard and difficult to disburse the necessary resources to this sector. Specifically, the Russian economy has been faced with the sanctions and falling of prices and this poses as a threat to an efficient care provision. The healthcare in Russia is in a wanting state. Inadequate resources and capital in the healthcare sector. This in turn results in low pay for the medical workers, and thus demotivating them. Another downsize to this is that the provision of free medicine practically becomes impossible. The hospitals do not have modern equipment to treat chronic diseases. The healthcare sector commanded an approximate 4 percent on the nations GDP and this is two times lower than other countries in the United States and some European Union Countries and also Britain (Schieber, 1997). Therefore, Russia has a long way to go in order to effectively compete with these countries.
The government needs to take into consideration the aging population and also the constantly growing population.
Health Care Reform
Legislation is the key ideology in cost-cutting and simultaneously expanding the healthcare provision. Many countries have adopted healthcare reform through various platforms. For example, in the United States, the Affordable Care Act is now active and running. In Russia, the Law on Health Protection of the Citizens of St. Petersburg is one of the many healthcare reforms legislations. The Health Protection of the Citizens of St. Petersburg passed some of the following reforms in the healthcare act;
Pass laws among other legislative acts based on the health protection of the citizens,
Ensure that there is control functions within the St. Petersburg laws
Compliance with environmental protection
Tax exemptions, fees, or any other forms of legal payments that are in line with protecting the healthcare of the citizens in St. Petersburg.
This is just one of the numerous regional legislations in Russia. Various regions have proposed and implemented their own health care reform acts. Overall, the government should aim towards eliminating and reducing unnecessary drug provision and usage and instead focus on upgrading and improving the public hospitals. Alternatively, the government should also reform the classes of hospitals into one healthcare system so enhance efficiency and service provision.
Drug Price Reforms
Inasmuch as the reforms in healthcare are to be carried out, the drug manufacturers will always have to justify the costs of their drugs. However, sometimes, the prices of the drugs shoot beyond the roof and thus make it impossible for majority of the people to afford it. The government needs to intervene and create reforms in drug pricing so that they can be affordable to a large portion of the people and also discourage commercialization of the drug products.
Public/ Private Partnerships
This is a two-way venture that will ensure that the health sector is not monopolized and their there is cohesion between the private and public sectors. An example of this is when the government creates a drug research institute and invite the private sector stakeholders to participate and share ideas (Organization for Economic Co-operation and Development, 2006). This creates cohesion between these two players in the healthcare sector and also ensure that there is effective understanding. Essentially, these partnerships will ensure that healthcare is availed to nearly every person in the country (Organization for Economic Co-operation and Development, 2011). It will ensure that there is extensive reach even in the most remote areas.
Operational
As the trend in healthcare provision shifts from a traditional one to a more modern one, the healthcare providers also need to shift too in their operations. Glaring loopholes in the quality of healthcare provision that lead to health inequalities in the national, regional, and local levels need to be reduced. Introducing patient-centered systems will encourage the patients to adopt their own health practices. Furthermore, patient-centered healthcare provision will extend from the hospital and inpatient relationship (Shalowitz et al, 2013). Therefore, there will be more platforms for the patients to interact with the doctors and other medical practitioners. Nowadays, the hospitals and healthcare institutions provide other forms of services such as caregiving in patient’s homes and the elderly places. Developing platforms that will facilitate the interaction between the patients and healthcare providers will further facilitate interaction. Implementing services such as Integrated Practice Unit (IPU), using preventive care and disease management, and outpatient surgical services are some ways to enhance the operational need to shift.
Infrastructure
Russia has extensive and one of the best infrastructure in the world. This means that the road network is extensive and the railway network is quite as reliable. However, the rural areas are not covered extensively as the urban areas. This therefore deters the quick reach to the healthcare centers. Having electrical power is also a necessity for provision of quality healthcare. Power failures will also prevent the effective dissemination of healthcare. With the much adopted use of technology, hospitals have become mechanized and a lot of the crucial equipment in hospitals depend on electrical power to run. Russia has reliable nuclear power and this makes it possible for them to have an efficient healthcare sector.
Operational shift will redefine the logistics of the healthcare sector in the country. Employing the use of technology in the healthcare provision and shifting towards a patient/ consumer-centered caregiving will not only improve the quality of the healthcare in Russia, but also ensure that it is one of the best in the globe. Having medical insurance covers is one of the unique things that Russia has (Fortenberry and Fortenberry, 2010). This ensures that the patient is covered at all times and there will minimal hurdles in settling the bill.
Service Provision
Although sometimes the healthcare practitioners may strive to behave in a good and correct manner, a gap may exist between the optimal outcome and what can be realistically accomplished. To do so, one has to apply some core principles that are guides to any health practitioner. They include;
Do no harm: Practitioners should strive and ever do what is right at all times no matter what principles they have. That is, they should always take care extra care when they are making decisions.
Respect autonomy: This is a situation where by one should decide how to stay his/her life without being affected by anyone else. Thus, the health practitioners should take into consideration the respect of autonomy before they make their decisions.
Be just: Medical practitioners should forever be equitable and fair to every patient.
Be faithful: Practitioners should uphold loyalty and fidelity and in so doing, they will make good decisions to every patient they are dealing with (Brown, 1992). These guides will not only ensure effective care giving, but also create a sense of satisfaction to the patients/clients.
Evaluation
For evaluation of data in a clinic or hospital, it is important that one uses proper evaluating tools. This will enable the healthcare providers get a good look at the performance of their dissemination of health services and highlight the areas that need improvement and other areas that are commendable. To achieve this, one needs to come up with a proper evaluating tool that will be efficient and easy to use.
Recording of current performance is commendable since this will act as a past performance record later. These records need to be handled and assessed properly and with care. These records will highlight the current performance that will be judged with the future performance records. They will be used to assess the best way to go about a certain issue like a botched surgery based on its past performance. A good example is when a hospital gets a patient suffering from smallpox. The hospital will be judged based on their previous performance records and then decide on the way to go regarding this particular patient.
Getting data ready. This is the process by which all previous performance records which include financial statements and achieved feats during the previous times are brought for evaluation. To break it down, one chooses some records that are required for use in a specific field or line of work. Example, when a health officer asks you to review his performance level over the past one year, one does not go about asking for his or her salary slips. Designing a proper data collection plan will go a long way into eliminating unnecessary and unwanted records.
Choosing what information is supposed to be used to address each quality measure is a factor to be considered. This is whereby one chooses specific needed information that is supposed to be used during the performance evaluation. For example, when performing outpatient services such as eye checkups, or free body screening, the quality measure will be judged based on the number of people who turned up for the event and also the quality of healthcare service given. The longevity and quality of the care given is one of the important factors needed to address the performance evaluation.
The information sources are also another factor. One needs to have credible sources of information for the performance evaluation to be effective. Some of the trusted sources of information include records, people (clinical staff). All these information sources need to be trustworthy for an efficient performance evaluation. The evaluating team needs to be aware of the existence of these sources and the level of integrity of the sources to eliminate biasness.
The way that the information should be collected is a significant factor. This is the methodology stage of performance evaluation and the evaluating team should decide how to use these information and how much that they need for efficient evaluation. Chart audits, surveys, financial statements, recommendations for a job well done, questionnaires and interviews are just but a few examples of information gathered. The team may decide to come up with a way of incorporating all these into one simple task and thus eliminate bulky statements and past performance records. For example, when deciding to use the charts and audited reports, one may choose to follow it up with an interview or questionnaires to the health bodies’ staff. This might help to ascertain the truth of the past records and at the same time reduce the amount of data that might otherwise prove to be a hindrance.
The amount of information to be collected is also another factor. Too much information may lead to bulky evaluation processes whereas too little and inadequate sources may lead to skimpy inefficient evaluation results. It is advisable to always collect the information presented to you. However, much of these presentations may be a repetition of themselves. For example, chart records and auditing records may prove to contain the same results.
How to use all these data to evaluate the performance is the last step. There is a number of ways that one may achieve that and the evaluation team needs to come up with the best plan. Random sampling is one of the ways. This involves selecting a random sample from a population at random using any of the random means be it lottery method. This gives an estimate of the general performance levels since evaluating the whole healthcare sector in the country may prove to be tiresome and cumbersome and might require more capital. Standardizing this data is another way of getting the performance results. The results give an overview of the weaknesses and strengths that the firm or company has. This gives the evaluating team with a range or rubric of how to choose the listed companies by the given rubric or performance gauge measure (Hillestad and Berkowitz, 1991). Thus, there will be a fair and uniform form of service evaluation.
Upholding Ethical Practices
Any field of profession needs to have a regulatory environment for the cases where there might need an urgent intervention when all other guidelines have been discussed (Hillestad and Berkowitz, 2013). A healthcare environment is a sensitive one and should be handled with utmost care. This is because it deals with numerous material and all these should be handled with precision. The healthcare environment is subject to scrutiny from other regulatory bodies because of the nature of the output. There are emissions into the air and most of these emissions originate from chemical outputs. These regulatory bodies keep on evolving due to the dynamic nature of these environment changes. There are new diseases that need to be taken care of, new hospitals, new drugs which need to be experimented to test their effectiveness and new patients.
The doctor should know the condition that his patient has, answer his questions correctly and accurately and prescribe proper treatment (Guimón and Sartorius, 2000). This will highlight competence on his part and at the same time ensure that the wellbeing of the patient is upheld. This is one of the fundamental ethics that the doctors should adhere to. For each medical condition, there is a ‘best’ treatment and it is up to the doctor to know about that treatment and how use it effectively (Guimón and Sartorius, 2000). This is majorly adopted in medical dilemma cases. Much of medical care is a matter of life, death, serious pain or disability. Some of the reasons as to why insurance companies reject compensation include non-covered charges, referral from a primary care physician, out-of-network providers, minor errors and wrong insurance companies. Doctors and other medical caregivers should uphold ethical practices o as to ensure that their patients get the best medical care and avert the possible causes of pain and disability. Practitioners should refrain from rushing to make decisions which might not only affect the patients but might turn up to be failure to themselves and ending up reducing the client’s self-esteem which is the best virtue in health practitioners.
Government Regulation
The government should also step in and actively regulate the intake of certain commodities. There are diseases that come as a result of irresponsible human behavior. For example, liver cirrhosis is as a result of irresponsible alcohol intake, obesity is as a result of irresponsible consumption of junk food. When the government comes into play and impose stringent laws such as increasing tax on alcohol and cigarettes among other drugs, the intake of these drugs will decrease drastically. Healthy dietary practices should be adopted immediately or else the government faces the risk of having an unhealthy youth generation. Most teenagers are facing obesity due to unhealthy diet practices. Proposing restrictions on food items for these children can help a great deal in regulating the consumption of food. Furthermore, the government should also propose an age restriction for the purchase of junk food for kids. Specifically, the junk food includes sodas, burgers, among other fast foods. However, this does not mean that this will deter people from engaging in these unhealthy practices, but it will at least create some form of awareness. Furthermore, it will help the people not buy these high sugar and fat foods in large quantities. Imposing high tax on alcohol and cigarettes will also make it unaffordable to a proportion of the population.
This is an important aspect of any profession. They are even more crucial in the healthcare sector. A code of conduct can be described as the instrument through which proper regulations on public health are enforced (Organization for Economic Co-operation and Development, 2012). There is medical code conduct for doctors and other medical practitioners from all over the world. However, there are some critical issues that are raised by code of conduct. These include the following;
Adoption without follow-up
Voluntary Adoption
Transparency
Regulatory Components.
Adoption without follow-up: Basically, there lacks consistency in the adoption and implementation of the code of conduct by the senior health care providers in the management. Therefore, violation of the code happens to be rampant and the junior staff follow suit. For the adoption to be fully successful, the senior members should uphold the code.
Voluntary Adoption: The adoption of the World Health Organization code of conduct happens to be voluntary. Therefore, some countries may fail to adopt the code. They resort to using their own code and therefore, the code is weakened. This prevent a uniform code of conduct across all countries and therefore, competition is not fully exercised.
Transparency: The main benefit of the code of conduct is that it ensures that all the decisions made are in accordance with it. When all the healthcare providers conform to it, transparency, integrity, and consistency will be evident in the healthcare sector.
Regulatory Components: Some of the world’s healthcare organizations such as International Red Cross Society, and Red Crescent Society do not a common ground for administering laws. Therefore, there are no specific punishments for the violations of the public health laws (Giuliano, 2011). This is a loophole that needs to be sealed so as to prevent further violations.
Waste
Delivery quality and efficient healthcare also means that innovative ways should be devised to eliminate the waste out of the system. This is particularly a tricky situation since quality healthcare is delivered to more patients at a cost-cutting budget. This means that majority of the organizations will have to shift towards complex and fundamental changes to cut down the operational expenses. For example, the adoption of a digital technology platform in place of manual file records will generally translate to more free space due to the elimination of manual records. Furthermore, technology will greatly reduce the reliance of a traditional face to face patient-doctor treatment and adopt a more effective patient self-management (Cooper, 1994). This will save the patients’ time and money for carrying out regular visits. However, face-to-face is still crucial in numerous cases.
Alternative Care Delivery and Operational Models
As a result of this tremendous change in healthcare service delivery such as cost pressures, adoption of technological means of healthcare delivery, and a change in consumer preferences, numerous health care systems have developed alternative care delivery (Clow and Baack, 2012). These will be used when there is less need of visiting the hospital. In addition, the operational models have also experienced a shift in logistics. For example, the decentralization of the healthcare delivery from national to a more local level have enhanced efficiency and increased the quality of healthcare delivery (Fortenberry, 2011). Healthcare delivery now takes place at a much personalized level. Some of the alternative care delivery systems developed include;
Retail clinics: These are usually staffed by nurses and physicians. Their main advantage includes their convenient location and this enhances reachability and access. Importantly, they have also evolved from being primary care givers to chronic disease management.
Home care: This has been made possible by the use of technology. Home health care provides sufficient health care to the people and also ensures that satisfaction levels of the patients is high (Cooper et al., 2015). This ensures that there is contentment from both the patients and the caregivers.
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