Methods of estimation of effect and efficiency in the health care system (Metody oceny efektywnosci w systemie ochrony zdrowia Republiki Bialorusi)

It is obvious, that not only social and economic conditions influence population health, but also health influences economy to a not small degree. Therefore, determination of the definition of effect and efficiency in health care services, and separation of techniques and criteria of their estimation are fundamental issues. The effectiveness of health care services system can be considered at three levels - macroeconomic, within the limits of national economy as a whole; microeconomic, covering activity of each separate therapeutic and prophylactic entity; midieconomic - level of communications within the health care services system. At each of the examined levels, the effect of health care services activity can be defined. Its correlation with expenses is characterized by efficiency. The difficulty in defining the efficiency of health care services is caused by the fact that effect is complex and consists of medical, social and economic components. Methods for determining the economic efficiency of the separate entities of health care services (microeconomic level) are based, largely, on the methods of economic analysis of activities of hospitals and polyclinics. At midi - and macroeconomic levels the approach based on determining the value of separate medical interventions, as well as losses caused by diseases plays a significant role. A number of methodologies are used to determine the economic efficiency of health care, among them - the methodologies for calculating economic effect on the basis of shortening of the periodic inability to work of employees of enterprises of national economy are considered basic. The term effectiveness of health care means the degree of achievement of specified clinical outcome. With respect to an individual patient it means either recovery or an improvement of health status. At the level of a health care facility or health care as a whole, the medical effectiveness is measured by a complex of specific indicators, such as the proportion of cured patients, reduction in the number of transitions to chronic diseases, decrease in morbidity levels in the community, "health index". Social efficiency is the degree of achievement of the social result. With respect to an individual patient it is the return to an active social life, satisfaction with health care. At the level of health care as a whole, it is an increase in the life expectancy, decrease of the mortality and disability indicators, general satisfaction of the community with the health care system. The satisfaction of patients is the most difficult criterion in the assessment of health care quality. This criterion is subjective, it is influenced by a number of factors. The effect of medical and organizational actions is not always easily compared to expenses. One of the possible methodologies for measuring the social effect of health care at a state level can be our methodology for calculating the direct income of a state from the birth of a child and its upbringing.