In recent history, the functions and forms of health care remain insufficiently analyzed, despite the fact that the incentives invested in medicine determine not only the volume and structure of medical care, but also the reasons for its provision, which are becoming wider, and costs are increasing. The COVID-19 pandemic, as well as the global geopolitical, ideological and economic crisis that emerged in 2022, will require changes in both the structure and economics of the health care system in accordance with its main mission – providing conditions in which people can be healthy.The aim of this article is to analyze the concept of a modern health care system.Materials and methods. Statistical materials of the Russian Research Institute of Health, methods of content analysis, analytical materials of Russian and foreign researchers, including those posted on the Internet, were used.Results. The materials presented in the article allow us to talk about the emergence of a new form of healthcare organization during the life of just one generation of people, where economic incentives are dominant, characteristic of the market and commodity production, the vector of development of which is largely determined by the interests of international financial institutions, clinical corporations, as well as enterprises, manufacturing medical and pharmaceutical products. The expansion of the resource base in this model can occur by attributing epidemic character to certain diseases, as well as by turning social phenomena into medical problems. Therefore, there is always a shortage of resources, and it is not possible to eliminate it without changing the paradigm of the development of the industry and qualified management.Findings. Radical changes in the structure and economics of health care need to be made in line with the industry’s core mission of providing conditions in which people can stay healthy. The basis of these changes is the displacement of market self-regulation and the genesis of a mixed public-private (hybrid) healthcare economy.

Background: Russian state policy for health protection, rehabilitation, and health improvement requires studying regional mortality rates, including those related to COVID-19.Objective: To assess differences in COVID-19-related mortality between the regions of the same federal district.Materials and methods: Mortality data are sourced from death records in the Unified State Register of Civil Status Acts. The data were analyzed using unweighted arithmetic means, specific indicators, and standard deviation (the mean ± standard deviation). To eliminate the distortion by an age factor in mortality rates comparison, we replaced the age structure of the individual region’s population with that of Russia through indirect standardization of mortality rates. We used K-means clustering to group the regions by COVID-19-related mortality rates.Results: In 2021 Russia had 2,446,922 deaths, i.e. 648,615 (36.1%) and 163,645 (7.2%) cases more compared to 2019 and 2020, respectively. Of the total number, 17.3% of cases (424,252) had COVID-19 as a primary cause of death: nearly three times more than in 2020 (144,691 COVID-19-related deaths). Based on the average sizes of all individual age groups related to the respective region, nonstandardized and standardized COVID-19-related mortality rates were 265.30 ± 103.16 and 279.28 ± 91.07 per 100,000 persons in 2021, respectively. The cluster analysis showed that the largest number of regions (28 regions in 8 federal districts) comprised the third cluster with an average mortality rate of 276.26 ± 15.16 per 100,000 persons. The first cluster with an average mortality rate of 406.43 ± 29.26 per 100,000 persons included 12 regions in 7 federal districts. The second сluster included 21 regions (341.49 ± 18.16 per 100,000 persons) in 6 federal districts, the fourth cluster – 17 regions (196.73 ± 25.05 per 100,000 persons) in 6 districts, and the fifth cluster – 7 regions (87.22 ± 12.42 per 100,000 persons) in 5 districts.Conclusions: There is no common explanation for the COVID-19-related mortality differences not only between the regions of the same country but also between countries. This lack of understanding gets worse because one should also separate the pandemic’s health factors from social, psychological, and economic ones. The government should play a more important role in healthcare management, reform payment systems, and eliminate private financial intermediaries used to pay for medical services.Restrictions: The Unified State Register of Civil Status Acts data, which consisted of preliminary death certificates, may differ from the data of the Federal State Statistics Service, which became available to researchers later in 2022.

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Introduction: The policy of mortality decline of the population of Russia, pursued by the state, requires consideration of the regional peculiarities of mortality in territorial subjects of the Russian Federation by gender and age. The regional situation on male and female mortality also should be considered when developing the measures directed to prevent various diseases including infectious ones. In this regard, the studies of gender and age indicators of mortality during the periods of infectious pandemics become relevant.Objective: The analysis of gender and age rates of COVID-19 mortality in 2021 in order to substantiate the best management decisions in the sphere of the organization of medical care and statistical registration of lethal outcomes during the pandemic spread of dangerous viral infections.Material and methods: The main source of information on mortality in 2020 is data of the State Statistics of Mortality of Rosstat. The data on mortality in 2021 are presented in the records on death cases in Federal State Information System “Unified State Register of Registration of Acts of Current State”. To evaluate the obtained data, simple (unweighted) arithmetic mean values, specific indicators, a root mean square (standard) deviation of the mean values, coefficient of variation were used (a measure of the spread of attribute values – the ratio of a standard deviation to the arithmetic-mean).Results: In 2021 17.3% of total number of all deaths had COVID-19 as an initial cause of death. 248,134 cases of those were women (58.5%), 176,116 cases were men (41.5%). The mortality rate from COVID-19 increased by an average 1.7 times upon transition from one five-year-old age group to another, 85% of those who died from COVID-19 were aged 60 years and older. In 2021 the coronavirus infection of COVID-19 contributed significantly to female mortality more, than male mortality, which is inconsistent with the data on gender structure of COVID-19 mortality in other countries, as well as with the widespread belief that men are more vulnerable to this infection.Conclusions: Growth rates of COVID-19 mortality depending on age resembles the aging rate, reflecting the biological nature of mortality. Total excess mortality is the better basis for assessment of changes in the population health during pandemics, than mortality from COVID-19 alone. The organization of systematic checks of correctness of coding the causes of death at the state registration of death is necessary.Restrictions: Data of the Federal State Information System “Unified State Register of Registration of Acts of Current State” can differ from data of Rosstat which in 2022 became available to professional researchers later, than data of the Federal State Information System “Unified State Register of Registration of Acts of Current State”.