The quality of medical care should be based on the provision of high-tech care by doctors, the implementation of preventive measures, accurate diagnosis, good treatment using modern technologies and productive comfortable rehabilitation.
General components and characteristics of the ILC
In the literature you can find more than one definition of this concept. Many countries adhere to the WHO definition, which states that the quality of medical care is the optimal medical care for the patient’s health in accordance with the current level of medical science, the patient’s diagnosis, his age, and response to treatment. It is important that minimal means are used, the risk of injuries and complications is minimized, the patient must be satisfied with the result of the care.
The definition of the Central Health Research Institute of the Ministry of Health of the Russian Federation is simpler and more understandable. It states that the quality of medical care is a common set of all characteristics that confirm the conformity of medical care actions to the necessary needs of the population, modern technologies, medical science, and patient expectations.
The standard of medical care is a document that contains a certain list of necessary manipulations when treating a specific disease or condition.
Characteristics of medical care
The characteristics of the ILC include:
- Professional competence.
- Performance.
- Availability.
- Interpersonal relationships of the patient and the doctor.
- Continuity.
- Efficiency.
- Convenience.
- Security.
- Satisfaction.
Under professional competence is understood the presence of skills and knowledge of health workers, as well as auxiliary staff, the ability to use them in work, in accordance with standards, clinical guidelines, protocols. Poor professional competence is expressed not only in small deviations from the standards, but also in gross errors that can reduce the effectiveness of treatment, which can jeopardize the health and even human life.
The accessibility of medical care is understood to mean that it should not in any way depend on criteria such as social status, culture, organization.
The quality of medical care will depend on the effectiveness and efficiency of the applied technologies in the field of medicine. To evaluate the effectiveness, you need to answer 2 questions:
- Will the treatment prescribed by the doctor lead to the desired result?
- Will the result be the best in specific conditions if the treatment prescribed by the doctor is used?
Under interpersonal relationships understand the relationship between the health worker and the patient, medical staff and management, in General, the health care system and the people.
Efficiency is defined as the ratio of resources spent to the result. It is always a relative concept, so it is used to compare alternative solutions.
By continuity, it is understood that the patient can receive all the necessary medical care without delays, interruptions, unreasonable repetitions.
Quality control of medical care provides such a characteristic as safety. By it is meant the reduction of all possible risks from a side effect to a minimum during treatment, during diagnosis.
Convenience means cleanliness, comfort, confidentiality in medical facilities. The concept of patient satisfaction includes the fact that the healthcare system must comply with the requirements of health workers, the needs and expectations of the patient.
Legislation Overview
The regulations that govern the standard of quality of care include:
- The federal law, which is called "On the Basics of Protecting Citizens in the Russian Federation" No. 323.
- Federal law entitled "On Compulsory Health Insurance in the Russian Federation" No. 326.
- Order of the Ministry of Health (“On the Approval of Evaluation Criteria”) No. 520.
Federal law No. 323 contains the characteristics of the timeliness of medical care, the correct choice of the necessary treatment method, the result of the treatment result. This law also contains information on the examination of the quality of medical care.
Federal Law No. 326 is designed to regulate the process of monitoring ILC in medical facilities. There are clear rules, forms, conditions and terms for the provision of medical care. The law applies only to state clinics, where the patient receives treatment as part of the compulsory medical insurance program. In private-type clinics, the basis of the relationship between the institution and the patient is the individual contract concluded between them.
The order of the Ministry of Health is a normative act that defines the standards and criteria that are used in assessing the quality of medical care.
Medical care: quality and evaluation
This issue is regulated by the Federal Law entitled "On Compulsory Health Insurance in the Russian Federation" No. 326. According to him, for assessing the ILC, an examination is used, which is divided into planned and target.
A targeted examination is carried out in the following cases:
- Complaints from the patient.
- Complications of the disease.
- Unpredictable death.
- In individual individual cases, with repeated treatment of the patient with the same diagnosis.
As for the planned examination, it passes according to the previously planned schedule, which is made up of interested organizations - MHI funds. At least 5% of cases of providing medical care for the entire reporting period should be subject to this type of assessment.
An examination of the quality of medical care is required to be carried out only by the compulsory medical insurance funds. Speaking on their behalf, the examination is carried out by experts who meet professional requirements, which are regulated by law:
- Experience of at least 10 years.
- Higher education.
- Accreditation of an expert doctor.
- The position of a doctor in a specific required area.
An expert doctor evaluates the literacy of medical documentation, its compliance with legal requirements and the possible impact on the patient's condition. He considers the correct diagnosis, the timing of treatment and the final result.
ILC Management
In order to properly organize the work of the health care system, there are special organizations that provide medical care based on ensuring the necessary needs of patients. These organizations exist on the basis of a state program to guarantee free medical care to all citizens of the Russian Federation.
The quality control system of medical care is based on the principles of:
- Continuity of management.
- Using the achievements of the evidence base of medicine.
- Examinations based on developed medical standards.
- Unity in approaches when conducting examinations.
- Use of legal and economic methods.
- Monitoring of the ILC control system.
- Analysis of economic efficiency, cost ratio with the optimal level of ILC.
- The study of the opinion of the population on the quality of medical care.
Levels of responsibility
The quality of medical care is the safety of medical activity and control. Now there are 3 levels of control over the activities of medical institutions:
- State.
- Internal (in the medical institution).
- Departmental.
Such a system was created not to duplicate inspections, but to establish a clear framework of responsibility for the proper provision of medical services.
State control is mainly aimed at licensing the activities of medical organizations and conducting various checks on the observance of human rights in the field of healthcare.
ILC in surgery
This issue is regulated by order of the Ministry of Health of Russia No. 922n. The specific procedure for the provision of medical care in the profile of surgery applies to all medical institutions. It appears in the following forms:
- Primary health care phase.
- Specialized ambulance.
Medical care is provided on an outpatient basis (conditions that do not include treatment and observation by doctors around the clock), in a day hospital (treatment and observation only in the daytime), in hospital conditions (observation and treatment by medical staff around the clock).
At the primary health care provision, measures are taken to prevent, diagnose, treat surgical diseases, as well as medical rehabilitation, the formation of healthy lifestyle. It includes:
- First-aid primary health care.
- Primary health care.
- Specialized primary health care.
Primary health care implies a form of providing medical services in which specialists treat in an inpatient setting or in an outpatient setting. The responsibilities of pre-primary primary care of a medical nature are performed by a health worker, whose education should be no lower than secondary.
As for medical care, it is performed by general practitioners (district) or a family doctor. If, upon examination by these specialists, indications for contacting a surgeon are revealed, then they give a referral to him.
With specialized primary care primary care, the surgeon examines the patient and prescribes treatment. If this is not enough, he directs the patient to a medical organization that specializes in surgical profile.
An ambulance is needed when surgery is urgently needed. It is equipped with paramedic and medical teams on the basis of the order of the Ministry of Health and Social Development No. 179 of 01/01/2004.
If there is a need to evacuate a patient during examination by ambulance specialists, then they perform it in an emergency emergency form. An ambulance team delivers a person with a life-threatening condition to the 24-hour department of anesthesiology, intensive care, or surgery. After the elimination of life-threatening factors, the patient is transferred to the surgical department for further medical care. If necessary, the surgeon attracts other specialists to conduct adequate treatment.
The procedure for providing medical care according to the profile of surgery should be based on accurate diagnostics, conscientious treatment using advanced technologies and productive comfortable rehabilitation.
Routine Surgery Assistance
Such medical care should be provided in cases of preventive measures. They are carried out only with simple diseases that do not require emergency assistance at the moment and do not pose a threat to the health and life of the patient.
To improve the quality of medical care, patients who have an atypical course of the disease, there is no positive result in treatment, there is no final diagnosis, they are sent to more high-tech medical organizations.
Also, patients who have specific medical indications are sent for rehabilitation in sanatorium complexes.
Patient Protection
In the healthcare sector, unfortunately, there are still cases of the imposition of paid services, dishonest doctors, financial losses or harm to health. Here, the Law on the Protection of the Rights of Consumers of Medical Services No. 2300-1 becomes on the side of the patient. In Art. 31 of this law states that a period of 10 days is given for taking action on a claim, and the countdown starts from the date of receipt of the complaint. In Art. 16 it is written that the provisions of the contract that violate the rights of the patient are declared null and void.
The quality of medical care is the adequate provision of conscientious, satisfying public health services. The patient has the right to:
- Getting quality medical care in full and on time.
- Acquaintance with full information about the contractor and upcoming services.
- Providing him with exhaustive information affecting the quality of medical services provided.
It is important to note that there is no difference on what basis (paid or free) the services are provided. Consumer protection means quality and full service. The state monitors the quality of medical care.
Patient Rights in the Case of Unfair Provision of Medical Services
In the case of illiterate provision of services that do not comply with the concluded contract or state regulations, the consumer has the right to demand a reduction in the cost of treatment, eliminate the deficiencies through follow-up care, reimburse costs, terminate the contract to cover losses, and also receive re-rendered services.
A person who received medical treatment with violations of the law can write an appeal to Roszdravnadzor and Rospotrebnadzor. These bodies are responsible for meeting the criteria for the quality of medical care. They are required to conduct a check in the medical institution for which the complaint was received.