Healthcare
Natalya K. Guseva1,
Vitaly A. Berdutin2, Pavel S. Zubeev3
1 State Educational
Establishment of Higher Professional Training Nizhny Novgorod State Medical
Academy of the Ministry of Public Health of the Russian Federation, 603005,
Nizhny Novgorod, Russia;
2 The Volga District
Medical Centre under the Federal Medical and Biological Agency of Russia,
603001, Nizhny Novgorod, Russia
3 State budget health
agency of Nizhny Novgorod region "City Hospital ¹33"
Disability
Indicators of in the social protection system of Russia
People with
disabilities are categories of the population, which is particularly acute
manifestation of inequality in economic, social, moral and political aspects
due to their existing violations and Disability. Therefore, it should be
remembered that disability indicators indirectly reveal the level of social
protection of certain citizens of patients, and are the subject of a special
study and in-depth analysis, especially in the context of solving the problems
of social protection of the population. Many factors such as the level of
economic and social development, environment, demographics, incidence,
condition and activity of medical organizations, institutions of social
protection of the population can affect on indicators of primary disability.
The subject of
special interest is a link of the level and dynamics of primary disability with
legislative activity in the social sphere. There was studied the effect of the
implementation of laws and regulations on social protection of the population
on the level and dynamics of primary disability in the Nizhny Novgorod region
and in the whole of the Russian Federation. The study showed the presence of an
abrupt increase in the number of citizens recognized as disabled for the first
time in 1985, 1991, 1995, 1998, 2004 and 2005, which is associated with the release
of the well-known regulations on social protection of the sick, the disabled,
veterans., it has increased the number of appeals to the medical and social
expertise institution in order to obtain pensions and benefits that the state
guaranteed during these years (Table 1). The decrease of new cases of
disability and primary disability index was observed after the boom. It
recovered a little before the next ascent.
And only in the
last ten years, from 2005 to the present time there is an annual decline of
primary disability, particularly pronounced in 2008. An intensive rate (the number of new cases of disability in
10,000 adult population) declined from 154.5 in 2006 to 77.2 in 2008. It
amounted to 71.2 per 10,000 adult population in 2014. Reducing of intensive indicator is observed against the background of
growth of morbidity, including disabling pathology, and relatively high
mortality.
The overall
incidence of the region increased by 4.3% and diseases of the circulatory
system - by 7.9% from 2010 to 2014. There is a question about the availability
of expert assistance, including for certain socially vulnerable population
groups. In this regard, particular concern are the following contributors:
Table 1.
Dynamics of indicators of primary disability in 1985 and 2014 depending
on the regulatory framework of social protection of invalids in the Russian
Federation.
|
years |
The rate of growth
(decrease) of primary disability in% in Russia |
The primary disability
and the growth rate of it in Nizhny Novgorod region, % |
Legal acts which
adversely affect the material and social position of the disabled individual
contingents |
|
1985 |
+ 81,88 |
28467 + 190,42 |
Resolution of the Central Committee of the CPSU and the USSR Council
of Ministers on 26.07.1984 N812, and the order of the USSR Ministry of Health
03.09.1984 N1015 |
|
1991 1992 |
+ 19,18 + 22,09 |
29821 + 40,67 40754 + 36,66 |
Resolution
of
the Council of Ministers of the USSR
N375 of 14.04.1990 and N917 of
12.09.1990 |
|
1995 |
+ 19,84 |
58859 + 35,76 |
Federal
Law ¹ 181 of 11.24.1995 and Federal
Law ¹ 5 of 12.01.1995 |
|
2004 2005 |
+ 38,65 + 18,8 |
38414ò+ 14,80 49361 + 28,50 |
Federal
Law ¹ 122 of 22.08.2004 |
|
2008 2011 2014 |
- 12,8 - 5,0 - 9,1 |
21600 - 24,11 19969 – 9,2 19364 – 3,0 |
Changing
of the approaches to the definition of disability, the implementation of the
federal target for social protection and rehabilitation of disabled people |
Ø Persons of no fixed abode, who, as a rule, do not have identity
documents, never seen by doctors, living in extremely harsh conditions and get
into medical organizations in a serious condition. The territorial offices of
the Federal Migration Service carry out registration of persons who have no
fixed residence, the place of residence at the addresses of institutions of
social services on the basis of their statements and identity documents, with
the issuance of the certificate of registration in accordance with the
normative acts. In the absence of identity documents, prior to the record, the
registration is done on the basis of an application for a term determined by
mutual agreement of the person with the administration of social service
institutions (2). The lack of fixed residence is one of the criteria of need
citizens to social services (1). Timely detection of these citizens and helping
them in obtaining social and health services are quite difficult, as these
persons are often marginalized and behave deviant, and there is no exact
statistics about this.
Ø People with reduced mobility and not mobile, who now have the
possibility of obtaining certain administrative procedures in the electronic
form, can be examined at home or by correspondence, if there is a corresponding
decision of the institution medical and social assessment (3). However, many
patients, particularly those from rural areas, haven’t access to computer
information systems. The possibility of outpatient clinics in terms of
examination of patients also is limited. Sometimes there are unreasonable
demands from medical organizations to patients on execution of inspection
standards that require transportation of immobile patient to the clinic.
Patients from remote rural communities are forced to
repeatedly visit medical facilities and institutions of medical and social
expertise to undergo the necessary medical examinations and to conduct the
survey. This is evidenced by a decrease
of primary disability in the Nizhny Novgorod region in the period from 2010 to
2014. For the whole adult population of the region in primary disability index
decline was 2.4 per 10,000 , in people older than working age - 8.6 per 10,000
, older than working age living in rural areas - 9.6 per 10,000.
Conclusion:
1. Reduced disability in the social welfare system is indirect evidence of
decline in social protection of patients with medical and social consequences
of the disease.
2. During the study of disability indicators it’s necessary to sift the
primary disability (age, place of residence, social status), as well as
indicators of overall morbidity, including disabling pathology.
3. If any evidence of a decrease in the availability of expert assistance
to individual citizens contingent, it is important to take measures for their
social protection.
Literature:
1. Federal
Law ¹ 442 of 28.12.2013 "About the basis of social services to citizens in
the Russian Federation", Art. 15.
2. Decree
of RF Government ¹ 713 of 17.07.1995 "On approval of the rules of
registration and withdrawal of Russian citizens to register at the place of
stay or residence within the Russian Federation and the list of officials
responsible for the registration".
3. Order
of the Ministry of Labor and Social Protection of the Russian Federation ¹
59í of 29.01.2014 "Administrative
Regulations on the provision of public services for the medical and social
expertise"
Information about authors:
1. First author
Natalya K. Guseva, Sc.D., Professor
of the Department of extreme surgery and medical expertise at the Nizhny Novgorod
State Medical Academy, E-mail: medexpert52@mail.ru,
orcid.org/0000-0001-7756-3555
2. Additional authors
· Vitaly A. Berdutin, PhD, Deputy Head of the Marketing Department of the
Federal fiscal health institutions “Volga District Medical Center” of the
Federal Medical and Biological Agency, E-mail: vberdt@gmail.com, orcid.org/0000-0003—3211-0899
· Pavel S. Zubeev, Sc.D., Professor, chief doctor of the City Hospital ¹33
(Nizhny Novgorod, Russia), head of the Department of of extreme surgery and
medical expertise at the Nizhny Novgorod State Medical Academy, E-mail: mlpu33@mail.ru