Medical activity in the health care system of workers in the Russian Federation

Abstract

Introduction. One of the most important directions in the development of health care in the Russian Federation is the improvement of approaches to maintaining the health of workers. In order to achieve this aim measures are being taken to prevent the development of occupational diseases, ensure the proper quality and availability of medical care in the occupational medicine and the staffing of medical organizations. Particular attention is paid to preventive measures, a healthy lifestyle and its promotion, and the identification of early signs of occupational diseases. The aim of the article is to determine perspective directions for the development of the health care system for workers with harmful (or) hazardous factors and working conditions, including an analysis of volumetric and structural indicators of medical activity as well as existing and developing legal acts regulating medical care for occupational medicine. Materials and methods. The legal acts regulating the health care of the workers, data from scientific research and scientific publications, statistical reports (form No. 30 "Information about the medical organization"; reporting materials of occupational medicine centers of the Russia's federal constituent entities) for the period 2016-2020 were studied and analyzed. Results. Today measures to improve the legal regulation of the health care of workers are one of the priority tasks of the state. Medical activity in the health of workers consists in carrying out preventive measures (determining a list of harmful and(or) dangerous production factors and work during the performance of which mandatory preliminary medical examinations are carried out upon admission to work and periodic medical examinations; a special assessment of working conditions; mandatory preliminary and periodic medical examinations), examinations of professional suitability, examinations of the connection between the disease and the occupation; medical care in occupational medicine; medical rehabilitation for medical reasons, medical and social expertise, social rehabilitation, spa and sanatorium treatment. In accordance with statistical data 654 occupational pathologists worked in the Russian Federation in 2020. In medical organizations 1961 full-time positions of occupational pathologists were organized, while the number of occupied positions was 1311, i. e. the staffing of occupational pathologists was 66.8%. A downward trend in the staffing of medical organizations with occupational pathologists has been noted over the past few years. Only 18.2% of all occupational pathologists had the highest category; 74% of occupational pathologists do not have a qualification category. The insufficient level of staffing and qualification of occupational pathologists has led to an increase in the burden on doctors and a decrease in the quality of preventive, therapeutic and diagnostic measures. The number of persons subjected to mandatory preliminary and periodic medical examinations amounted to 8.9 and 9.5 million people in 2018 and 2019 respectively. 7.43 million people were subject to inspections in 2020. The proportion of those examined within 3 years (from 2018 to 2020) remains at the same level and ranges from 98.2 to 98.6%. The share of examined persons with temporary/permanent medical contraindications to work in 2019 and 2020 did not change and amounted to 1.4%. In 2018 this index was 1.8%. At the same time the volumetric and structural indicators of medical activity in occupational medicine are poorly understood because occupational diseases are not socially significant and they are not recorded in the Unified State Health Information System. In this regard it is advisable to optimize approaches to statistical analysis: take into account the volumetric and structural indicators of medical activity in the system of protecting the health of workers including examinations of professional suitability and examinations of the connection between the disease and the occupation, mandatory preliminary and periodic medical examinations. Limitations. The study examined the results of a limited number of statistical forms. Conclusion. The regulatory legal acts in the Russian Federation makes it possible to provide workers with high-quality and affordable medical care. Currently, serious work is underway to modernize the legal acts regulating the protection of the health of workers in order to save the health of workers and their efficiency by obtaining and analyzing objective information sufficient to develop evidence-based tactical and strategic management decisions for the prevention of professional, professionally conditioned and general morbidity, reducing disability due to occupational diseases, reducing labor losses due to illness, maintaining working longevity. Volumetric and structural indicators of medical activity in occupational medicine are currently little studied, in this regard it is advisable to optimize approaches to statistical analysis. Special attention should be paid to the quality of staffing of medical organizations: the quality of continuous professional education of occupational pathologists. It is advisable to continue work to increase the availability of medical care in occupational medicine and the effectiveness of organizing mandatory medical examinations including telemedicine technologies and mobile medical teams. Mandatory medical examinations of workers must be carried out including using technical means and medical devices that provide automated remote transmission of information about the health status of workers and remote monitoring of their health status. Ethics. The authors were guided by the ethical principles of medical research as outlined in the latest revision of the Declaration of Helsinki by the World Medical Association.