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NDPHS Database

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Improving resource allocation for primary health care service in Kaliningrad region, Russia

Project title Improving resource allocation for primary health care service in Kaliningrad region, Russia
Database Data inserted through the NDPHS Project Pipeline
ID in the source database 131
Thematic area Primary Health Care
Topic Improving resource allocation for primary health care services by increasing their share in provision of medical help to Kaliningrad residents.
Project geographical area Russia
Substate level / administrative units /regions Kaliningrad Oblast
Lead partner (organisation) University of Tromsø - Institute of Community Medicine
Lead partner (owner or/and project manager) no data
Partner organisations
Start date 2009-12-01
End date 2010-12-01
Duration (months) 12
Target audience 1. Direct : Providers of primary and health care services, health officials, representatives of medical insurance companies 2. Indirect: Patients seeking primary health care services 3. Other: Officials of the Federal Ministry of Health and Social Services, medical community
Summary This project is aimed at improving resource allocation for primary health care services by increasing their share in provision of medical help to Kaliningrad residents. This objective will be achieved through holding seminars and conferences with Kaliningrad officials and medical professionals during which the respective Norwegian and Russian experience will be highlighted. The partners will also undertake assessment of appropriateness of referrals to secondary care services and assess economic losses associated with unjustified referrals. Based on the results of this assessment the recommedations to improve the referral process will be developed and presented to health care officials in Kaliningrad. It is expected that as a result of the project's activities expenses associated with unjustified provision of secondary health care services will be reduced by 10%.
Background Currently health care services in Kaliningrad oblast are going through the period of reforms whose goal is to ensure provision of accessible, free-of-charge and quality medical services and to reduce direct and indirect medical costs through early detection and quality treatment of diseases. The need for organizational changes in provision of medical services also stems from the economic trends affecting health care system. Specifically, while the amount of funds available for health care through the Programme of Government Guarantees in Medical Help for residents of Kaliningrad province has increased to 3018,8 mln rubles, so did the deficit, going up from 10% in 2000 to 27,1% in 2006. As a result, the gap between the declared goals and the real economic conditions of providing medical care is growing with employers and residents spending more and more on medical services. One of the forces driving up health care expenses is inadequate coordination of work burden between primary and secondary (specialized) medical services that is reflected in unjustified referral rates to secondary care. By “unjustified referrals” we mean the situations when patients whose conditions can and should be treated effectively at primary care level are either being referred to secondary care institutions or being accepted by the latter without proper referrals. As medical institutions are paid by insurance companies by the number of patients served, they do have a built-in incentive to provide services even to those who can be easily treated elsewhere, eg., in primary care facilities. As treatment costs at specialized institutions are considerably higher than those at primary facilities, the practice of unjustified referrals results in financial and other resources being redistributed in favour of secondary care. On the other hand, the system of primary care institutions including the network of polyclinics and general practitioners does not receive the resources needed for its development. Specifically, up to 80% of financial resources allocated for health care end up in supporting secondary care while the Targeted Programme “Development of Health Care Services of the Kaliningrad Province, 2007-2011” calls for strengthening primary care services. Reducing the number of unjustified referrals and thereby increasing the share of financial and other resources allocated for primary health care is also in line with the NDPHS’s objectives such as “improving peoples’ health and social well-being.” After all, the bulk of medical services is provided by primary institutions so that providing them with resources to hire additional staff or upgrade its skill or update their equipment will contribute to improving health of residents of Kaliningrad oblast.
Objectives 1. Reduce the number of unjustified referrals to secondary health services; 2. Increase the share of resources devoted to service delivery in primary health care institutions in pilot region of Kaliningrad
Specific objectives/indicators 1. Promotion of best experience of Norway in effective integration / collaboration between primary and secondary health care institutions Workshops and trainings about effective integration / collaboration between primary and secondary health care levels will be held by Norwegian partners in Kaliningrad 2. Reduce the number of patients of secondary health care institutions with the respective increase in the volume of patients getting assistance through primary care institutions in pilot region of Kaliningrad. The respective normative documents will be updated to ensure the proper resource allocation for primary health care. 3. Increase resource allocation for primary health care institutions in pilot region of Kaliningrad These trends will be tracked through analyzing quarterly reports submitted by health care institutions in pilot region of Kaliningrad. The report includes references to the number of patients served as well as the respective payments provided by Health Insurance Fund 4. Improved collaboration between primary and secondary health care institutions in pilot region of Kaliningrad, including criteria referral to hospitals Improved collaboration is reflected in the decrease in the number of unjustified referrals to secondary health care institutions as established by the respective assessment 5. Development of pathway for patients between primary and secondary health care levels Seminars for decision makers and physicians of primary and secondary health care facilities reflecting the Norwegian approaches to referral practices will be held
Results 1. Reducing expenses associated with unjustified provision of secondary health care services by 10% 2. The respective increase in funds allocated for provision of primary health care services in pilot institutions by 5% 3. Recommendations on reducing economic losses from unjustified referrals to secondary health care services developed 4. Recommendations on optimizing resource allocation between primary and secondary services in Kaliningrad developed 5. Decision makers and physicians of primary and secondary health care facilities on issues related to reallocation of resources trained
Total foreseen budget EUR 163,000
Total implementation costs
(for completed projects, if available)
no data
Conversion to € was done on
(according to the relevant
exchange rate at
Infoeuro Monthly Files)
no data
Financing agencies / organisations Norwegian Ministry of Health and Care Services
Project's URL / project's website no data
Papers associated with this project no data
Further information no data
Last posted: on 2010-12-02 at 15:54:15

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