[EVALUATION OF THE MEDICAL AND ECONOMIC EFFICIENCY OF NON-INVASIVE PRENATAL TESTING IN MOSCOW].

AIM: to evaluate the medical and economic efficiency of prenatal diagnostics of fetal chromosomal abnormalities (CA) in pregnant women in Moscow using a non-invasive prenatal test (NIPT) as a second-line model. A comparative analysis of the medical and economic efficiency of standard prenatal screening and prenatal screening with NIPT in groups of pregnant women, registered in Moscow, with high and medium fetal CA risk was carried out. Analysis was based on the number of children born with CA and the costs of medical care (direct costs) and social payments (indirect costs), calculated for both scenarios. Following standard prenatal screening 111 children with CA would be born, following prenatal screening with NIPT - only 26. Including NIPT in prenatal diagnostics increases direct costs by 299.97 million rubles and reduces annual indirect costs from 61.19 to 28.95 million rubles. Starting from the 13th year of using NIPT the estimated effect of reducing indirect costs would exceed direct costs. NIPT in prenatal diagnostics can increase the detection of fetal CA and reduce indirect costs. Assessing the indirect costs in economic efficiency enhances the accuracy of the estimate.

[The improvement of medical care of patients with oncologic diseases within the framework of the Priority National Project "Health"].

The article presents analysis of development of oncologic medical care with purpose to improve survival of oncologic patients and to decrease population mortality of malignant neoplasms within the framework of implementation of measures of the Priority National Project "Health" and the State Program "Health Care Development". The analysis is presented concerning crude and age-standardized incidence and mortality rates and provision of oncologic medical services with hi-tech medical equipment. The comparative analysis of project and process management methods demonstrated that project management is an efficient instrument for increasing accessibility and quality od medical care at a given period of time and to form points of increase for future development.

[The actual problems of organization of medical care for rural population].

Population health status and medical care in rural areas is discussed. Trends in dynamics of such health indicators as mortality, morbidity and prevalence of socially perilous diseases are worse among rural population as compared with urban population. Economical, environmental, industrial and other factors impacting on health of rural population are revealed. Sociological research data demonstrating attitude of rural population to health and to medical care are quoted. Problems of financing, manpower strength and material and technical equipping in rural health institutions are discussed. Importance of priority national project "Health" for enhancement of rural medical care is shown including necessary measures for its realization.

[Modeling of normative and legal acts within the health care system]. / K voprosu o model'noi razrabotke normativno-pravovykh aktov v sisteme zdravookhraneniia.

The article deals with the issues of conceptual and methodological motivation of stages related with working out and approving the draft projects of regional healthcare legislation through superpositioning the legislative activity of the subjects of the Russian Federation on the provisions of the basic law "On Healthcare". The common features of the basic law are described; the specificity of the recommended structure and item-by-item sequence of principles and norms of regional laws "On Healthcare" is defined.

[Patient's safety as the key issue in quality of health care]. / Bezopasnost' patsienta kak vazhneishii aspekt problemy kachestva meditsinskoi pomoshchi.

The safety of the patient is discussed, in the offered article, tightly related with the promotion of the quality of medical care rendered to population. Data from various countries (Australia, Great Britain, Denmark etc) about damage, made to the patient's health at medical interventions, are presented. Some mechanism, related with the collection of information, as well as measures used to warn the population against the preventable damage to patients' health are described. The WHO recommendations on paying more attention to patients' safety are illustrated. The related activities implemented in Russia are depicted; and measures, needed to promote such activities, are indicated.

[Classification and organization technologies in public health]. / O klassifikatsii organizatsionnykh tekhnologii v zdravookhranenii.

The authors discuss the impact and main characteristics of organization technologies in public health and the processes of their development and evaluation. They offer an original definition of the notion "organization technologies" with approaches to their classification. A system of logical bases is offered, which can be used for classification. These bases include the level of organization maturity and stage of development of organization technology, its destination to a certain level of management, type of influence and concentration of trend, mechanism of effect, functional group, and methods of development.

[Paradigm as a methodological approach to analyzing Russia's public health system]. / Paradigma kak metodologicheskii podkhod k analizu zdravookhraneniia Rossii.

A concept of paradigm is applied to the analysis of the national public health system. Whether it can be used as a methodological regulator in public health management is considered. Evidence is provided for the theoretical premises of constructing a paradigm of the public health system, its philosophical bases, the notional system, methodology, and the technological framework. The theoretical and practical aspects of public health paradigm, such as identification, interpretation, and rationalization are used to analyze at the conceptual and practical level, as well as search for new ways of reforming the public health system by the paradigm approach as a deeper development of the existing paradigm or its modification. This can become a foundation for the realignments of the theoretical and practical bases of the national public health system. The formation of the new paradigm of the public health system is to take place not in a revolutionary, but in a developmental mode. Priority should be given not to radical transformations and drastic changing of the key concepts, but to the fluent increasing of new knowledge and their inclusion of the theory and practice of public health. The promises of using the paradigm methodology, allowing the internal and external principles of the operation and function of the public health system to be integrated. In this context, the paradigm approach may be used as a methodological tool for analyzing person-society-state-economy-management relations within the framework of the public health system.