Kemerovo Institute of Socioeconomic Problems of Healthcare,

Kemerovo, Russia

 

Labor force deficit is caused by high level and unfavorable prediction of mortality indices for working age population at the background of low birth rate, increasing general morbidity (including occupational one) and population incapacitation [15]. These tendencies are common for Siberian Federal District [7, 8, 13, 14].

The strategy of Siberia economic development supposes creation of dynamically developing social economic system of innovative type, with world standards compliance [3-5].

The possibility of effective health management with evidence-based policy is presented in multiple studies [1, 2]. The essential importance of preventive and rehabilitation measures is shown for decrease in population morbidity with many types of pathology [9-11].

Development of new, more effective organizational models for complex rehabilitation is considered as one of the actual tasks in healthcare system [6, 9, 12].

According to the article 40 of Federal Law from 21.11.2011, #323-F3, “About Foundations of Health Protection for Citizens of Russian Federation”, and the Order of Ministry of Healthcare of Russian Federation #1705n from 29.12.2012, the organization of medical assistance with medical rehabilitation includes three stages depending on patient’s state severity.

The first (I) stage of medical rehabilitation is performed in acute period of disease or trauma. It is realized in intensive care units with main disease specialization after confirmation of possibility of functions restoration (rehabilitation potential) and absence of contraindications to rehabilitation methods.

The regional hospitals include 273 physiotherapy departments (rooms), 118 departments (rooms) of remedial gymnastics. About 600,000 patients receive in-hospital treatment annually.

Transfer to the second (II) stage is necessary for adult patients who receive treatment in departments including 8,384 beds and 11 profiles.

The stage II of medical rehabilitation is realized in inhospital conditions of medical facilities (rehabilitation centers, rehabilitation departments) in early restoration period of disease or trauma, in late rehabilitation period and in period of residual disease.

At the stage II specialized medical rehabilitation is performed in 7 multiprofile medical specialized facilities, which evaluate population losses from mortality, disability and diseases (injury, central nervous system disease, blood circulation disease, malignant tumors, diseases of perinatal period). The facilities are concentrated in the north of Kuzbass in Kemerovo, for the south – in Prokopyevsk and Novokuznetsk.

In 2013 in the region the specialized assistance of the stage II was realized with 378 hospital beds. Availability of rehabilitation beds for 10,000 of population was 1.38. More than 6,000 patients received treatment. There were 105,925 bed-days or 0.04 bed-days for 1 person.

The third stage (III) of medical rehabilitation assistance is performed in early and late rehabilitation periods, in period of residual disease, in chronical course of disease without exacerbation, for patients with rehabilitation potential in departments (rooms) of rehabilitation, physiotherapy, remedial gymnastics, reflexotherapy, manual therapy, psychotherapy, medical psychology, speech therapy (surdopedagogy, visual impairment specialist and other specialists) in medical facilities, which render assistance in outpatient conditions and at home.

The stage III of medical rehabilitation is performed in outpatient conditions of medical organizations and sanatorium-resort facilities. In the regional medical facilities the rehabilitation is realized by means of 50 departments and 383 rooms (physiotherapy, therapeutic exercises, reflexotherapy, manual therapy et al.). The coverage of outpatient rehabilitation assistance for adult population was 13 % in 2013.  Restorative treatment was performed for 95.0 % of disabled children.

For rendering home assistance for non-mobile patients the mobile specialized team was developed. It includes instruction coordinator of remedial gymnastics, massage and physiotherapy nurses, logopedist (if necessary).

According to the data from Federal Agency of State Statistics, Kemerovo region includes 53 sanatorium-resort facilities of different departmental affiliation, including 9 adult sanatoriums (2,328 beds), 16 pediatric sanatoriums (1,645 beds), 1 twenty-four-hour recreation camp (300 beds), 26 health and recreation resorts (2,961 beds). Each year about 11 thousand children revitalize themselves in the sanatoriums.

In 2013 the volume of palliative assistance for 1 person was 0.08 bed-days with consideration of beds for nursing care.