Improving effectiveness of the specialized medical care: the case of restructuring

The paper addresses the issues of organization of medical care in the Russian Federation and explores the case of specialized medical care restructuring. The new approach towards specialized medical care povision is suggested as an alternative to the prevalent understanding of the restructuring such as reduction of hospital beds, hospitals and their staff for financial reasons. The new approach includes (1) a four-level system of medical aid, (2) the expansion of disease prevention, (3) the introduction of standardized approaches in routine work, (4) a thorough quality control at all levels of medical care.The pilot project of the restructuring of urologic medical care started in 2010 in Voronezh region. The empirical data were provided by the Institute of Urology (Moscow) and Voronezh Regional Health Department.The implimentation of a new approach revealed poor performance of the primary medical care provision. The outcomes of the pilot project were an increase in detecting diseases and in the availability of specialized outpatient and inpatient care. The overcoming of the previous systems flaws caused the need to increase health care costs. However, the introduction of new organizational technologies, providing urological care, resulted in lower unit costs by 21.7% over four years.Experience of the structural reform presented in the article shows that in cases where inefficiency of the health care system is associated not only with unreasonably high costs for treatment of diseases, but also with insufficient or delayed detectability of diseases, introduction of new approaches to the organization of health care does not lead to saving costs, but to increasing effectiveness and efficiency of health care provision.