Ministry of Health of Russian Federation.

Approved.

Head,

Department of training and human resources

MOH of Russian Federation.

N.N.Volodin

Unified curriculim for postgraduste physicians training

Social Hygene and Organization of Health Care

Moscow, 2002

Course I

Social hygene and health care organization in contemporary times (further social hygene is replaced by term public health)

1.1 Public health and organization of health care

1.1.1 Science ofpubic health

1.1.1.1 Field of public health

1.1.1.2 Methodology and methods of public health

1.1.1.3 Change in public health and health care

1.1.1.4 Organism and environment., biological and social aspekts of health and disease

1.1.1.5 Human health and society

1.1.2 Theoretical basis of health care

1.1.2.1 Health care as a system of health protection

1.1.2.2 Govermental policies in health care

1.1.2.3 Strategic planning in health care

1.1.2.4 Economics and health care

1.1.2.5 Interplay of governmental policies, public and privat interests in health care

1.1.3 Health and health care in Russian Federation

1.1.3.1 Status of health and health care priorities

1.1.3.2 International perspective and possible ways of development of Russian health care

1.1.3.3 Medical insurance in Russia. Historical development of medical insurance. Organization of insurance. Insurance as social protection in market economy

1.1.3.4 Scientific basis of health care development planning

1.1.3.5 Main problems of diferentiation and integration in health care

1.1.4 Regional public health programs

1.1.4.1 Environment protection

1.1.4.2 Occupational health and workplace hazard protection

1.1.4.3 Prevention in specific groups of population

1.1.4.4 Health promotion and healthy life style

1.1.5 New economic mechanisms (market mechanisms) in the work of health care organizations

1.1.5.1 Quality control system in health care

1.1.5.2 Market relations in health care

1.1.5.3 Healh care institutes and insurance system

1.2 History of medicine and health care in Russia

1.2.1 Medicine and health care in Russia

1.2.1.1 Materialism, and patriotism among Russian health care people

1.2.1.2 Influence of philosophy on development of medicine and health care

1.2.1.3 Progressiveity of Russian medicine and health care

1.2.1.4 Public health and medicine in Russia 1861-1917. Town medicine and factory medicine. Zemskaja medicine

1.2.1.5 Development of Public Health in Russia

1.2.2 Medicineand health care in soviet time

1.2.2.1 Sovet of physicians colleges

1.2.2.2 Creation of Narkomzdrav of Russian Federation, first Ministry of Health

1.2.2.3 Development of Public Healh

1.2.2.4 Creation of GINZ - State Institute of People's Health Care

1.2.2.5 Health care development during first five-year plans

1.2.2.6 Development of Narkomzdrav of Soviet Union

1.2.2.7 Health care during the Second World War

1.2.2.8 Academy of medical sciences

1.2.2.9 Health care in 50s and 60s

1.2.2.9 Healthcare in 70s and 80s

1.3 Behavioral scences

1.3.1 Medical psychology

1.3.1.1 Personalty

1.3.1.2 Psychological problems of a person

1.3.1.3 Psychological defences

1.3.1.4 Psychology in health care administration

1.3.1.5 Psychosomatic and psychogenic diseases

1.3.2 Medical ethics

1.3.2.1 Medical ethics and deonology. Definitions

1.3.2.2 Medical ethics and deontology in physicians work

1.3.2.2.1 Doctor-patient relationships

1.3.2.2.2 Doctor-relatives relationships

1.3.2.2.3 Professional relations

1.3.2.2.4 Disclosure

1.3.3 Problems of bioethics

1.3.3.1 Euthanasia

1.3.3.2 Death and transplantation

1.3.3.3 Abortion

1.3.3.4 Informed consent

1.3.4 Ethics and deontology in health care administration

1.3.4.1 Ethical conflicts and their resolution

1.3.4.2 Training in ethics and deontology

1.4 Public health and most important diseases

1.4.1 Cardiovascular diseases

1.4.1.1 CVD as public health problem

1.4.1.2 Epidemiology. Mortality and morbidity

1.4.1.3 Risk factors

1.4.1.4 Primary prevention

1.4.1.5 Advances in diagnosis and treatment

1.4.1.6 Oranization of specialized care for CVD

1.4.2 Rheumatic diseases

1.4.3 Cancer

1.4.4 Accidents

1.4.5 Pulmonary diseases

1.4.6 Nervous system disorders

1.4.7 Mental Health

1.4.8 Diseases of dependence

1.4.8.1 Public health importance

1.4.8.2 Epidemiology. Mortality and morbidity

1.4.8.3 Public health approaches and medical aspects of alcohol consumpion, heavy drinking and alcoholism

1.4.8.4 Prevention - organization, public information, medical aspects

1.4.8.5 Narcological services n Russia

1.4.8.6 Legal aspects

1.4.8.7 Diagnosis and treatment of diseases of dependence.

1.4.8.8 Role of health care nstitution in combating diseases of dependence

1.4.8.9 Responcibilities of health care in preventing diseases of dependence

1.4.8.10 Antialcohol propaganda

Course II

Legal aspekts of health care

Course III

Health care management, economics and planning in health care

3.1 Health care management

3.1.1 Theoretical basis of management

3.1.1.1 Science of management

3.1.1.2 Methods of management

3.1.1.3 Subject and object of management

3.1.1.4 Technology of management

3.1.1.5 Systems approach in management

3.1.2 Health care management

3.1.2.1 Decentralization in health care

3.1.2.2 Administrative structure

3.1.2.3 Goals and functions of management

3.1.2.4 Management process

3.1.2.5 Management cyce,

3.1.3 Information in management process

3.1.3.1 Decentralized data collection

3.1.3.2 Centralized data collection

3.1.3.3 Role of different data source in management

3.1.4 Decision-making in health care management

3.1.4.1 Types of decision-making questions in health care

3.1.4.2 Information analysis as main step in decision-making

3.1.4.3 Implementation

3.1.4.4 Control of implementation

3.1.5 Modern Health Care management

3.1.5.1 Management in medicine

3.1.5.2 Marketing in health care, study of supply and demand

3.1.5.3 Basket of services (state guarantees)

3.1.5.4 Paid services n health care

3.1.5.5 Voluntary insurance provision

3.1.5.6 Market in health care

3.1.6 Health administration

3.1.6.1 Structure and functioning of health administrations on different levels

3.1.6.2 Team decision-making

3.1.6.3 Control in health administration

3.1.6.4 Managment of medical institutions

3.1.6.5 Reporting and documents flow in health administration

3.1.6.6 Planning in health care administration

3.1.6.7 Control of health care intitutions activity

3.1.7 Psychology in management

3.1.7.1 Social psychology of interaction between management and workers

3.1.7.2 Authority and power

3.1.7.3 Personaity of the leader

3.1.7.4 Team as subject of management

3.1.7.5 Interpersonal relations in the group

3.1.7.6 Leadership

3.1.7.7 Motivation

3.1.7.8 Psychological atmosphere in a group

3.1.8 Human resources

3.1.8.1 "head hunting"

3.1.8.2 Rational use of human resources

3.1.8.3 Work with administrative personal

3.1.8.4 Training person for administrative work

3.1.8.5 Continuos medical eduction

3.1.8.6 Role of management in organizing CME

3.1.8.7 Licenure and re-licensure

3.1.8.8 Computers in human resources management

3.2 Economics and healh care planning

3.2.1 Modern economic problems in national health care

3.2.1.1 Health of a nation - indicator of economical and social developent of a state. Definition of public health

3.2.1.2 Economical aspects of health of a person, population and state

3.2.2 Health care as a social protection instrument

3.2.2.1 National system of social protection. Definitions and components

3.2.2.2 Role of insurance companies

3.2.3 Market and market mechanisms in health care

3.2.3.1 Free maket. Market in health care

3.2.3.2 Social problems of transition economy

3.2.3.3 Types of market relations in health care

3.2.3.4 Property rights in health care

3.2.3.5 Law and privatisation in medicine

3.2.3.6 Health as a privat and public property (good)

3.2.3.7 Marketing in health care. Goals and objectives

3.2.4 Economic effectiveness in health care

3.2.4.1 Effetiveness of health care: societal, medical and economical perspective

3.2.4.2 Methods of economical evauation in health care

3.2.4.3 Opportunity cost and its importance in health care evaluation

3.2.4.4 Economic evaluation of consequences of morbidity and mortality

3.2.4.5 Economic evaluation of resource use in health care

3.3 Planning and financig in health care

3.3.1 Sources of health care financing

3.3.1.1 State, local, agency and non-budgetary financing

3.3.1.2 Relative size of state, public and out-of-pocket expences in different systems (taxes, insurance and fees)

3.3.1.3 Role of insurance system

3.3.1.4 Funds and their use in national health system

3.3.1.5 Medical insurance funds. Legal status, interaction with budgetary financing

3.3.1.6 Accounting and audit in insurance-based health care

3.3.1.7 Problems of real and planned financing in health care

3.3.1.8 Capitation payment calculations

3.3.1.9 Results-based salary calculation

3.3.1.10 Economical stimulation and financing optimization in combined budget-insurance system

3.3.2 Health care costs. Prices and taxes

3.3.2.1 Background. Cost, price, taxation

3.3.2.2 Calculation of cost of provision (production cost). Cost in hospital, clinic and ambulance

3.3.2.3 Insurance companies, tariffs

3.3.2.4 Taxation of health care institutes.Extempts

3.3.3 Planning in health care

3.3.3.1 Contemporary state of directive, norm-based and financial regulations in health care

3.3.3.2 State purchase, control numbers, economical norms and limits

3.3.3.3 Plans of economical and social development of health care institute

3.3.3.3.1 Methods of state, local and goal-directed planning

3.3.3.3.2 Planning and coordination in health care in market economy

3.3.3.4 Demand for health care

3.3.3.4.1 Needs and demand for health services, role for planning

3.3.3.4.2 How to study demand

3.3.3.4.3 Planning of human resources training

3.3.3.4.4 Planning of CME

3.3.3.5 Strategic and business planning in helth care

3.4 Social protection and medical insurance

3.4.1 National system of social protection

3.4.1.1 Health care as a system of social protection

3.4.1.2 State-owned and non-governmental organizations in health care and social protection

3.4.1.3 Health administration as coordinator of social protection

3.4.1.4 Insurance companies as social protection system

3.4.2 Laws and regulations of medical insurance

3.4.2.1 Constitution of RF

3.4.2.2 Other laws

3.4.2.3 Definitions of terms insurance, medical insurance and insurance

medicine

3.4.2.4 Implementation (medical insurance)

3.4.3 Organization of medical insurance

3.4.3.1 Interaction between insurance companies

3.4.3.2 Goals and objectives of medical insurance funds

3.4.3.3 Types of insurance organizations, structure and function

3.4.3.4 Licensing of insurance activity

3.4.3.5 Interaction between insurance company and health care institutes

3.5 Mechanisms of realization of medical insurance

3.5.1 Sources of financing in the obligatory medical insurance

3.5.1.1 Payment for working and unemployed population

3.5.1.2 Capitation payment calculations

3.5.1.3 Basket and regional programs

3.5.1.4 System of payments frominsurance comany to health care institution

3.5.1.5 Financing in obligatory medical insurance

3.5.2 Medical insurance - principles,goals and possibilities

3.5.2.1 Rights and needs

3.5.2.2 Interaction between insurance funds and insurance companies

3.5.2.3 Insurance payment schemes

3.5.2.4 Pricing policy

3.5.2.5 Licensing and accreditation of medical institutions

3.5.4 Technology in insurance

3.5.4.1 Information processing systems in obligatory medical insurance

3.5.4.2 Pecuilarities of the use of computers in insurance

3.5.4.3 Data processing and analysis in obligatory medical insurance

3.5.5 Healh care institutions in insurance system

3.5.5.1 Status of medical institution in insutance system

3.5.5.2 Preparing health care institutions for activity in insurance system

3.5.5.3 Salary and other pecuilarities of work under insurance schemes

3.5.5.4 Analysis of effectiveness of personnell work

3.6 Management under insurance financing

3.6.1 Marketing in health care

3.6.1.1 Definitions and principles of marketing

3.6.1.2 Types of marketing

3.6.1.3 Functons of marketing

3.6.2 Technology in health care management

3.6.2.1 Computers in management: data aquisitons and analysis

3.6.2.2 Software suites, data bases

3.7 Informational systems in health care and medical insurance

3.7.1 Documents flow

3.7.2 Methods of data procesing and analysis

3.7.3 Prognostic methods

3.7.4 Methods of effectiveness analysis

3.8 Health care institution as subject of medical insurance

3.8.0 Legal basis

3.8.1 Legal status of health care institutions

3.8.2 Preparing institution for work under health insurance

3.8.3 Work under obligatory and voluntary insurance

3.8.4 Work outside insurance schemes

3.8.5 Organization and employment under insurance

3.8.5.1 Collective forms of work organization

3.8.5.2 Leasing

3.8.5.3 Corporations and other forms of ompany organizations

3.8.5.4 Private practice

3.8.6 Comprehensive evaluation of employees in health care

Course IV Material resources in health care

Course V Medical statistics and computers

5.1 Theory and methods of statistics

5.1.1 Theory of statistics

5.1.1.1 General statistical theory

5.1.1.2 Basic ideas

5.1.1.3 Individual and public health

5.1.1.4 Health statistics and health care

5.1.2 Methods of collection and analysis of medical data

5.1.2.1 Organization and stages of research

5.1.2.2 Observational studies

5.1.2.3 Types of observational studies

5.1.2.4 Methods of studies in public health and clinical trials

5.1.2.5 Ratios and other relative indicators

5.1.2.7 Statistical significance

5.1.2.8 Standardiation n health care

5.2 Health statistics

5.2.1 Methodology

5.2.1.1 health as a multivariable-dependent characteristic

5.2.1.2 Interdependence

5.2.1.3 Factor weights

5.2.2 Study of population health

5.2.2.1 Health as social and economical entity

5.2.2.2 Dynamics of health

5.2.2.3 Survelliance systems

5.2.2.4 Health as a management category

5.2.2.5 Factors controllable and uncontrollable

5.2.2.6 Methods of study of health

5.2.2.7 Statistical indicators of health

5.2.2.8 Comperhensie health evaluation

5.2.3 Non-infectious diseases epidemiology

5.2.3.1 Methods of epidemiological studies

5.2.3.2 Evidence-based medicine

5.2.3.3 Goals and types of epidemiological studies

5.2.3.4 Cross-sectional studies. Risk factors and risk goups

5.2.3.5 Cohort studies. Registers

5.2.3.6 Epidemiology of main non-infectious diseases

5.2.3.7 Preventive programs. Its effectiveness and implementation

5.2.4 Environment and health

5.2.4.1 Environmental factors and health

5.2.4.2 Informational systems of environmental monitoring

5.2.4.3 Registers. Risk groups. Methodology of environmental monitoring (survelliance)

5.2.4.4 Analysis of environmental risks

5.2.4.5 Restoration of environment

5.2.4.6 Social factors and health

5.2.4.7 Collecting information about social factors

5.2.4.8 Occupational health

5.2.5 Health status analysis for survivors of Tchernobyl nuclear disaster

5.2.6 Demography and health

5.2.6.1 Methods of study

5.2.6.2 Birth rate

5.2.6.3 Mortality

5.2.6.4 Life expectancy

5.2.6.5 Migration

5.3 Health care statistics

5.3.1 Collection of data

5.3.1.1 Primary reporting forms

5.3.1.2 Summary reporting forms

5.3.1.3 Analysis of health care institution activity

5.3.2 Expert evaluation in health care

5.3.2.1 Expert evaluation

5.3.2.2 Statistical analysis of expert evaluations

5.3.3 Methods of quality and effectiveness assessment

5.3.3.1 Process evaluaton

5.3.3.2 Quality indicators

5.3.4 Decision support systems

5.3.4.1 Informational technologies in health care

5.3.4.2 Informational infrastructure

5.3.4.3 Telemedicine and communication technologies

5.3.4.4 Informational space of health care

5.3.5 Mathematical models and computers in health care. International experience

5.4 Questions of international comparison of health

5.4.1 International comarison of health and disease

5.4.2 International classification of diseases

5.4.2.1 Basic qustions of classification of diseases, accidents and death causes

5.4.2.2 ICD-10

Course VI

Health care organization

6.1 Primary care

6.2 Prevenion and health promotion

6.3 Hosptials and its role in health care

6.4 Rural health care

6.5 Chlild health

6.6 Adolescent health

6.7 Maternal health

6.8 Tertiary care

6.9 Emergency medicine

6.10 Handicapped expertise

6.11 Rehabilitation

6.12 Pharmaceutical services

Course VII

Sanitation-hygene control organization

7.1 Theory of Sanepid control

7.2 Organization of work of centers of SH institutes

7.3 Planning of anti-epidemics control

7.4 Administration of SH system

Course VIII

International health