The hospital-substituting technologies: condition and strategic tasks of their development

The program of state guarantees of free medical care of citizens for 2019 and up to 2020-2021 plans to reduce volume of inpatient medical care through development of hospital-replacing technologies. The economic feasibility of hospital-replacing technologies is in significantly lower cost of medical services in a day hospital as compared with twenty-four hours hospital (UPC). However, the existing legislative framework and the lack of proactive financial mechanisms do not stimulate development of hospital-replacing technologies. The purpose of study is to analyze reporting data and results of SWOT analysis of rating of factors affecting introduction of day hospitals, On the basis of analysis the strategic objectives of development of hospital-replacing technologies are formed. The study applied statistical analysis, direct observation, sociological survey, SWOT analysis. The analysis was applied to data from forms of Federal statistical observation No. 14 and industrial statistical monitoring No. 14 for 2009-2018. Based on results of SWOT analysis, experts were interviewed by the heads of health care authorities and medical organizations regarding development of strategy of medical care of children with disabilities. The expert survey was carried out with health care managers in Moscow, the Moscow oblast, Orenburg, Chelyabinsk, Samara, Ivanovo, Ryazan oblasts and the Republic of North Ossetia-Alania. The analysis established that in 2018 the number of medical care organizations increased up to 6495, including medical institutions providing outpatient medical care (41.4%) and in-patient medical care (58.6 %). The analysis demonstrated that percentage of treated patients in day hospitals out of the total number of hospitalized patients (in hospitals was 29,1% in 2018, while in 2009 this percentage was significantly lower - 15,6%, which indicates the intensification of the use of the bed fund of the UPC, which to some extent is associated with increased development of hospital-replacing technologies. The results of SWOT analysis demonstrated that the strategic objectives of development of hospital-replacing technologies should be targeted to develop financial stability of health care, active position of the heads managers of health care institutions and medical organizations and introduction of innovations if needed. It is necessary to develop modern management methods, rational application of health care resources, implementation of economic incentives in all components of health care system, ensure functioning of the system, including effective contract.