Too many and too few: The paradoxical case of physicians in the Russian Federation

Gerry, Christopher J.; Sheiman, Igor

doi:10.1002/hpm.2471

Cited by 9 publications

(7 citation statements)

References 16 publications

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“…Postgraduate training is skewed toward specialists, particularly those who provide private services (eg, dentists, urologists), while the number of generalists in training is falling. The structural imbalances in supply have become a characteristic of the current health system, 42 which reflects the lack of strategic vision in the governance of the system.…”

Section: Discussionmentioning

confidence: 99%

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The evolving Semashko model of primary health care: the case of the Russian Federation

Sheiman¹,

Shishkin²,

Shevsky³

2018

RMHP

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This paper addresses the major developments in primary care in the Russian Federation under the evolving Semashko model. The overview of the original model and its current version indicates some positive characteristics, including the financial accessibility of care, focus on prevention, patient lists, and gatekeeping by primary-care providers. However, in practice these characteristics do not work according to expectations. The current primary-care system is inefficient and has low quality of care by international standards. The major reasons for the gap between the positive characteristics of the model and the actual developments are discussed, including the excessive specialization of primary care, weak health-workforce policy, the delay in the shift to a general practitioner model, and the dominance of the multispecialty polyclinic, which does not prove advantageous over alternative models. Government attempts to strengthen primary care cover a wide range of activities, but they are not enough to improve the system and cannot do this without more a systematic and consistent approach. The major lesson learnt is that the lack of generalists and coordination cannot be compensated for by the growing number of specialists in the staff of primary-care facilities. Big multispecialty settings (polyclinics in the Russian context) have the potential for more integrated service delivery, but to make it happen, action is needed. Simple decisions, like merging polyclinics, do not help much.

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Section: Discussionmentioning

confidence: 99%

“…A deeply rooted perception of physicians as a “cheap” health care resource has traditionally limited the motivation to work in primary care. 42 …”

Section: Current Activities To Strengthen Primary Carementioning

confidence: 99%

The evolving Semashko model of primary health care: the case of the Russian Federation

Sheiman¹,

Shishkin²,

Shevsky³

2018

RMHP

Self Cite

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“…However, in the period since the break-up of the Soviet Union, this management structure acted as a brake on measures to improve hospital efficiency, now urgently needed to address longstanding problems, including growing imbalances in the medical workforce. 34 More nuanced mechanisms to ensure accountability have been introduced recently as a result of new public management reforms, 35 including pay-for-performance schemes, based on objective measures, and mechanisms to improve quality and safety, such as mandatory continuing medical education. Superficially, these innovations look familiar to those in other industrialised countries.…”

Section: Discussionmentioning

confidence: 99%

Understanding the role of physicians within the managerial structure of Russian hospitals

et al. 2019

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“…DPs available are overburdened having the average catchment of around 2,700 residents and in some regions -3,000-3,500 residents. [17] Most of them have a narrow clinical area that is not enough to detect new urological cases. The Program is based on the active role of urologists in district physicians training, but this can hardly be sustainable, since urologists are busy with their own tasks.…”

Section: Discussionmentioning

confidence: 99%

“…The proclaimed method of dynamic dispensary surveillance does not work well in practice because of the shortage of primary care physicians and their limited clinical area. [17] Only less than half or the detected new cases are subject to the actual dispensary surveillance. [18] There is a strong evidence of the low level of teamwork, coordination and continuity of care, including poor interaction of policlinics and hospitals' physicians in managing patients.…”

Section: Introductionmentioning

confidence: 99%

Building the integrated system of urological services: The impact on utilization and cost of care

Apolihin

Sheiman

Shishkin

et al. 2018

IJH

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Integrated pathways are commonly seen as the way to strengthen service delivery in many countries. Russia has traditionally had a multilevel system of care that consists of facilities varying in terms of the complexity of cases treated. The attempts are currently made to strengthen this system with an emphasis on closer interaction between individual providers. The recent innovation is to establish a new intermediate level of inter-district specialty centers that serve the population of a few local areas and provide additional services. The early detection of new cases and their follow-up management have been activated as a part of a new model. It is piloted in a Russian region with the focus on the cases of benign prostate hyperplasia. The objective of the paper is to present the new model and to evaluate its first impact on urological service performance. The major findings include: 1) the growth of the new urological cases detected at the level of primary care and a gradual decline in the frequency of the most complicated and neglected cases; 2) the optimization of patients flows across the levels of service delivery – the rise in the utilization at the first levels of service delivery and the decline in the share of tertiary care; 3) the need for additional funding to treat the increased number of cases, with the first signs of slowing down this process; 4) a decrease in unit costs as the result of the changes in the structure of new cases, shifts in the utilization of care by the levels of service delivery. These trends are discussed with the focus on the identification of strengths and weaknesses of the new model, as well as the ways to ensure its sustainability.The major lesson learnt is that building a multilevel system of service delivery can be seen as the instrument of integration of care and efficiency savings for a country with limited financial resources for health. This process should go parallel with more profound changes in the health system, of which the most important is strengthening primary care, particularly coordination function of general practitioners.

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Too many and too few: The paradoxical case of physicians in the Russian Federation

Cited by 9 publications

References 16 publications

The evolving Semashko model of primary health care: the case of the Russian Federation

The evolving Semashko model of primary health care: the case of the Russian Federation

Understanding the role of physicians within the managerial structure of Russian hospitals

Building the integrated system of urological services: The impact on utilization and cost of care

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