Ekologiya cheloveka (Human Ecology)Ekologiya cheloveka (Human Ecology)1728-08692949-1444Eco-Vector12185910.17816/humeco121859Research ArticlePerformance of management of the health system (on the example of the Arkhangelsk region)ShelyginKirill V.<p>MD, Dr. Sci. (Med.), associate professor</p>shellugin@yandex.ruhttps://orcid.org/0000-0002-4827-2369UshakovaTatyana N.<p>Cand. Sci. (Econ.), associate professor</p>ushakovatn@gmail.comhttps://orcid.org/0000-0002-1933-8277ZykovaNatalia V.<p>Cand. Sci. (Econ.), associate professor</p>zykovanv@gmail.comhttps://orcid.org/0000-0001-7537-6860LozhkinaLada I.<p>Cand. Sci. (Psychol.)</p>lada1@yandex.ruhttps://orcid.org/0000-0002-3687-6122MikityukValentina A.<p>Cand. Sci. (Econ.)</p>mva-vam2010@yandex.ruhttps://orcid.org/0000-0003-1522-5133Northern State Medical University250720233031691801601202309032023Copyright © 2023, Eco-Vector2023<p><strong><em>BACKGROUND: </em></strong>Currently, health care occupies an exceptional place in a socially oriented economy. To assess the effective functioning of the health care system, it is necessary to constantly monitor performance indicators that allow you to determine the level of saving the health of the population.</p>
<p><strong><em>AIM: </em></strong>Determine the degree of effectiveness of health system management based on a comparative analysis of certain target indicators with their actual values.</p>
<p><strong><em>MATERIALS AND METHODS: </em></strong>An analysis of the indicators contained in the State program of the Arkhangelsk region "Health care development in the Arkhangelsk region" was carried out. The following parameters were chosen as targets: life expectancy at birth; maternal mortality per 100 000 live births; infant mortality per 1000 live births; total fertility rate; number of doctors per 10 000 population; number of average medical personnel per one doctor. Analysis period 20102020. The study is retrospective, descriptive, not randomized. The level of performance was calculated from the ratio of target and actual indicators and their subsequent integration. The analysis of dynamic series for the presence of anomalous values (outliers) was carried out by the Irwin method.</p>
<p><strong><em>RESULTS: </em></strong>The main indicators that ensure the level of performance are maternal mortality and availability of doctors. The availability of doctors per 10,000 population was significantly higher than the target indicators over the entire time period by an average of 32.8%. The target indicators of maternal mortality were lower than the actual ones on average by 50.1%, which seems to be due to overestimation of the target indicator.</p>
<p><strong><em>CONCLUSION: </em></strong>Target indicators of health care system performance tend to overestimate against the background of the lack of a clearly defined methodological apparatus for their calculation, which, in most cases, leads to a mismatch between their dynamics and the dynamics of actual indicators, increasing the calculated level of health care system management performance.</p>public healthhealth care systemArkhangelsk Regionmanagement performancetargetsindicatorsобщественное здоровьесистема здравоохраненияАрхангельская областьрезультативность управленияцелевые показателииндикаторы[Krivenko NV. Opportunities for improving the healthcare performance to retain human capital and ensure socio-demographic security of the region. Economic Analysis: Theory and Practice. 2018;17(9):1642–1660. (In Russ). doi: 10.24891/ea.17.9.1642][GOST R ISO 9000—2015 Sistemy menedzhmenta kachestva. Osnovnye polozheniya i slovar'. Moscow: Standartinform; 2015. P. 17. (In Russ). Available from: https ://docs.cntd.ru/document/1200124393][Mikhaylova Yu, Golubev N, Danaev A, et al. Comprehensive analysis of effectiveness and efficiency of medical organizations of the Stavropol territory providing primary care in the context of principles of lean manufacturing in healthcare. Social Aspects of Population Health. 2022;68(3):1. (In Russ). doi: 10.21045/2071-5021-2022-68-3-1][Smirnova EV, Volkova O. Citizens' complaints about the availability and quality of medical care as a tool to evaluate the effectiveness of “A new model of a primary healthcare organization”. Health Care Standardization Problems. 2021;(3-4):3–12. (In Russ). doi: 10.26347/1607-2502202103-04003-012][Ivanova SN. Public health and health care development in the regions of Russia. Siberian Journal of Life Sciences and Agriculture. 2021;13(2):47–63. (In Russ). doi: 10.12731/2658-6649-2021-13-2-47-63][http://demogr.nes.ru/ [Internet]. Rossiiskaya baza dannykh po rozhdaemosti i smertnosti. Tsentr demograficheskikh issledovanii Rossiiskoi ekonomicheskoi shkoly. (In Russ). Available from: http://demogr.nes.ru/index.php/ru/demogr_indicat/data https ://rosstat.gov.ru/ [Internet]. Baza dannykh Federal'noi sluzhby gosudarstvennoi statistiki (Rosstat). (In Russ). Available from:][https://rosstat.gov.ru/folder/10705][Postanovlenie Pravitel'stva Arkhangel'skoi oblasti ot 12 oktyabrya 2012 goda N 462-pp “Ob utverzhdenii gosudarstvennoi programmy Arkhangel'skoi oblasti “Razvitie zdravookhraneniya Arkhangel'skoi oblasti” (s izmeneniyami na 9 janvarja 2023 goda)”. (In Russ). Available from: https ://docs.cntd.ru/document/462600002][Popukaylo VS. Detection of outliers in processing of small size data. Tekhnologiya i konstruirovanie v elektronnoi apparature. 2016;(4-5):42–46. (In Russ). doi: 10.15222/tkea2016.4-5.42][Askarov RA, Frants MV, Utyasheva IB, et al. Identification of life expected factors: analysis of panel data. Health Care of the Russian Federation. 2019;63(6):313–321. (In Russ). doi: 10.18821/0044-197X-2019-63-6-313-321][Skipin DL, Yukhtanova YuA, Kryzhanovskii OA, Tokmakova EG. Life expectancy in Russia's regions. Economic and Social Changes: Facts, Trends, Forecast. 2022;15(2):156–171. (In Russ). doi: 10.15838/esc.2022.2.80.10][Padrul MM, Isaeva NV, Cherkasova EV, Berseneva SN. Epidemiological assessment of long-term maternal and failed maternal mortality. Perm Medical Journal. 2022;39(3):114–121. (In Russ). doi: 10.17816/pmj393114-121][Shapovalova MA, Boiko YuP, Ugurchieva KhYu, et al. On the issue of trends and causes of infant mortality. Caspian Journal of Medicine and Pharmacy. 2022;3(3):30–38. (In Russ). doi: 10.48612/agmu/2022.3.3.30.38][Reprintseva EV. Comparative assessment of doctor`s supply in Russia and Europe. Azimuth of Scientific Research: Economics and Administration. 2018;7(3):240–243. (In Russ).][Mediko-demograficheskie pokazateli Rossiiskoi federatsii, 2009 god. Moscow: Russian Research Institute of Health; 2010. 175 p. (In Russ).][https ://rosstat.gov.ru/][[Internet]. Rosstat. Zdravookhranenie v Rossii 2009, 2011, statisticheskii sbornik. (In Russ). Available from: https ://rosstat.gov.ru/folder/210/document/13218][Boyko YuP, Shapovalova MA, Shcherbin AV, et al. Analysis of maternal mortality in the Russian Federation the main trends. Caspian Journal of Medicine and Pharmacy. 2020;1(3-4):8–16. (In Russ). doi: 10.17021/2020.1.3-4.8.16]