Analysis of the external and internal environment of a medical organization. Factors of forming the income of a medical organization

EFFECTS OF THE EXTERNAL ENVIRONMENT ON THE MANAGEMENT OF MEDICAL ORGANIZATIONS

A.A. Gromov, Candidate of Economic Sciences, Associate Professor of the Department of Social Sciences, Kharkiv National Medical University

The relevance of studying the influence of the external environment on the functioning of any organization is due to its constantly increasing role in effective management. In the modern globalizing world, the external environment is dynamically changing, prompting organizations to form adaptive responses to uncontrolled factors of their development. In modern conditions, improving management is associated not so much with the internal environment as it is conditioned by the goals that are achieved just in the external environment. The management policy of medical institutions and firms is no exception. Its content is of particular interest, because social organizations in essence and the services provided are forced to operate in an open market environment and in conditions of global competition.

It is known that the external environment of a medical organization is a set of factors and conditions that exist outside of it, but affect the process of making managerial decisions. It seems that the greatest impact on the activities of medical manufacturers is exerted by uncontrollable factors (the outstripping growth in the average cost of medicine in comparison with this growth in other spheres of the economy, monopoly of clinics and pharmaceutical TNCs, the system of higher and secondary medical education).

The reason for the natural outstripping growth in average costs of medical services is in the institutional features of the medical services market, such as the asymmetry of information about their quality and the stimulation of demand for them by the supply itself. The growth of costs is influenced by the natural monopoly of hospitals, which practically do not compete with each other, as well as such a phenomenon of the medical services market as payment for treatment not by the patient himself, but by a third party (government, insurance company, firm, etc.).

The rise in health care costs is also influenced by the emergence of new medical discoveries. Foreign practice shows that awareness of fundamentally new diagnostic and treatment methods and the desire to use them is a factor in the rapid growth of expectations of many people. It should be noted that only part of these expectations are due to real needs for improving health, the rest is a tribute to fashion.

One of the most important influencing factors is the overestimated requirements for additional medical services, which stimulate diversified and often aggressive marketing of pharmaceutical companies.

Changes in the structure of diseases and the emergence of, for example, AIDS, SARS, and bird flu also affect the outstripping growth of average costs of medical care. At the same time, the cost of creating an AIDS vaccine alone reaches more than $ 1 billion a year.

The main reason for the increased demand for medical services is the significant growth of GDP, which serves as the basis for the growth of citizens' incomes. Constantly growing incomes shift the population's demand to more expensive medicines and medical services, triggers the "Giffen paradox": income growth leads not only to an increase in the level of demand, but also to a change in its structure - an increase in the share of consumption of those services that can be equated with luxury goods.

A significant factor in the influence of the external environment is the monopoly of producers. A monopoly position is usually occupied by large specialized clinics or large multidisciplinary hospital complexes. The economic advantage of large producers is that economies of scale are triggered to improve production efficiency. Another version of monopoly is natural monopoly within a specific territory. From the point of view of the external market, the monopoly of foreign pharmaceutical companies exerts a great influence on medical organizations, which contribute to inflating the costs of medical care by supporting corruption schemes during tenders, high prices for medicines and equipment, and subordinating doctors to themselves using network marketing tools.

It is known that monopoly is dangerous due to stagnation and rising prices. However, it faces competition in the managerial market. More effective competition arises in the case of the formation of a quasi-market for medical services. Therefore, managers should be interested in its formation and pursue an active policy aimed at concluding contracts with local authorities and obtaining government orders. This means replacing the mechanism of budgetary distribution of medical services with an act of purchase and sale.

The system of training medical personnel, which is in a state of reform, has a significant impact on the efficiency of management of medical institutions, which has a significant impact on the quality of training. The content of education is changing - student practice is being canceled, a number of theoretical disciplines are being reduced, work with phantoms, and not with patients, is increasing, etc. These circumstances must be taken into account by modern management when concluding contracts with employees and graduates of medical universities.

Thus, effective management in a modern medical organization is possible only if it adapts to constant changes in the external environment. It is impossible to stop the growth of medical care costs, but it is possible to find other reserves of rational use of resources, new forms of organizational structures, a higher degree of autonomy of units within a medical organization, which encourages savings and efficiency, competent marketing of paid services, etc.

An important and modern factor in management is currently becoming the initiation of changes, which should turn into a decisive management strategy of a medical organization.

Topic: Internal and external environment of healthcare organization Completed by: M.K. Kaidaulov Checked by: candidate of medical sciences, Altynbekova U.A.

Introduction Plan 1 Internal environment of the medical organization 2 External environment of the medical organization Conclusion

Introductions A medical organization is an organization that carries out activities in the field of healthcare or the provision of medical services,

Introductions
Medical organization - an organization
carrying out activities in the field
health care or the provision of medical services,
supporting the development of medicine as a science,
dealing with activities to maintain
health and medical care to people
through study, diagnosis, treatment and
possible prevention of illness and injury.
Factors that affect the activity of medical
organizations can be divided into 2 groups
* Internal factors
* External factors

1 Internal environment of medical organizations

Goal - a specific end state or desired result,
which the organization seeks to achieve
Organizational structure is a logical relationship
levels of management and functional areas, built in
such a form that allows you to most effectively achieve
goals of the organization.
Technology is a combination of qualifications,
equipment, infrastructure, tools and related
technical knowledge necessary to implement the desired
transformations in materials, information or people.
Human resources are the driving force of the medical organization

1 Purpose and vision of the medical organization Example No. 6 polyclinic Seeks continuous improvement of its activities, applying management,

1 Purpose and vision of the medical organization
Example No. 6 polyclinic
Seeks continuous improvement in its performance by applying
management, medical and informational Innovation, for
maintaining mutual trust between the clinic and patients,
in order to preserve the most valuable thing that a person has - his
health.
Our vision
City polyclinic №6 - mobile, dynamically developing
a medical organization that guarantees patients the accuracy and
reliability of results.

2 The structure of the medical organization

3 Technologies Technology - means, processes and tools used in the treatment of a patient. * Reception and examination of a doctor in different directions * K

3 Technology
Technology - means, process and tools used in
patient treatments.
* Reception and examination of a doctor in different directions
* Advisory assistance
* Diagnostic service: ultrasound, ECG, fluorography, endoscopy
* Clinical and diagnostic research: types of analyzes
* Outpatient surgery: dressing, suture removal,
sigmoidoscopy, plaster bandages, removal of foreign bodies
* Physiotherapy services
* Dental services

4 Human resources

Administrative staff
Medical staff:
GPs, nurses, workers
functional diagnostics, narrow
specialists,
Support staff: engineers,
electricians, security guards

External factors External variables are all those factors that are outside the organization and can affect it. External

External factors
External variables are all those factors that are behind
outside the organization and can affect it. External
the environment in which the organization has to operate is in
continuous movement, subject to change. Ability
organizations to respond and cope with these changes
the external environment is one of the most important components
her success.
By the nature of the impact on the organization, external
environment of direct impact and external environment of indirect
impact

10. External factors of direct influence

1 Resource providers: technological resources,
financial, medical resources,
service providers
2 Consumers: Patients, their shopping
ability, demand
3 Competitors: strengths and weaknesses,
Services
4 State authorities: Local authorities, KM,
MH

11. External factors of indirect impact

1 Social STEP factors include change
demographic situation, educational level, system
health and social services
2 Technological STEP factors - they mean such
changes in the scientific and technical sphere as scientific and technical
progress, obsolescence of knowledge, introduction of new technologies.
3 Economic step-by-step factors include the dynamics of the level
inflation, interest rate (discount rate), tax rates,
exchange rates, income level of the population
4 Political STEP factors are related to the general external and
internal government policy, political stability
situations

12. Conclusion The above internal and external factors of medical organizations are an integral part of the activities of these organizations.

Conclusion
The above internal and external factors
medical organizations are an integral part
activities of these organizations. Analysis of internal and
external factors improves strategic planning
medical organizations and increases sensitivity
medical organizations to changes in environmental factors

13. Resources Used 1 Order of Acting Of the Minister of Health of the Republic of Kazakhstan dated November 26, 2009 No. 791 On the approval of the Qualification

Resources used
1 Order of the acting Minister of Health of the Republic of Kazakhstan dated November 26
2009 No. 791 On approval of the Qualification characteristics
health care workers
2 www.gp6.kz
3 www.google.kz

The activity of any system is carried out through the identification of the main characteristics and properties inherent in it. From this point of view, the system is considered as a set of elements (services, links, departments) that have certain properties, and a set of links between these elements and their properties, united by a single purpose of activity. The parameters are input, process, output, feedback control and limiting.

An important means of characterizing a system are its properties, which are manifested through integrity, interaction and interdependence through its functionality, structure, connections, and external environment. Properties are the quality of parameters of objects and factors, i.e. external manifestations of the way by which knowledge about these objects and factors of the external environment is obtained. Properties make it possible to describe objects and factors of the system quantitatively, expressing them in units of a certain dimension.

Properties are external manifestations of the process by which knowledge about an object is obtained, and they are observed. Properties provide the ability to describe system objects quantitatively, expressing them in units, as having a certain dimension.

The properties of health care facilities change under the influence of medical and recreational activities. In this context, it is customary to highlight the following main properties of the system:

The totality of its components in the form of structural transformations of the subjects of the healthcare system;

The most significant connections between them;

Features of its organization that determine the possibility of its creation. Among these factors are socio-economic and ecological-climatogeographic, working conditions, etc., as well as healthcare organizations and their quantitative relationships;

Integrative properties inherent in the system as a whole, but not inherent in any of its components separately. Therefore, dividing the system into separate parts, it is impossible to cognize all its properties as a whole.

Regarding the conditions inherent in the health care system, we note the following:

It functions in time and space, being in motion and in the process of reform;

The structural units of the system are relatively autonomous in organizationally and are functionally dependent on each other;

The system is characterized by the presence of a single basis for the classification of its subdivisions;

The system has unity.

Functioning in the environment and experiencing its impact, health care, in turn, increasingly affects the economic results and social transformations achieved in the country, regions, and economic sectors. The relationship between the environment and the healthcare sector can be considered one of the main features of the functioning of this system, its external characteristic, which largely determines its properties (i.e., internal characteristics).

The most important property of the sphere under consideration is its integrity, which consists in the irreducibility of its properties to the properties of its structural units, and vice versa.

The health care system has the inherent properties of reforming and developing, adapting to new socio-economic conditions. This is achieved through the reform of existing structures and their elements, by creating new connections and innovations, forms of medical activity with their local goals and means of achieving them.

The most important of these properties of the health care system are integrity and isolation. If every part of the system is so related to every other part that changes in some part cause changes in all other parts and in the system as a whole, then the system is said to behave like a whole.

The sub-sectors of the health care system have the basic properties of complex systems that require a systematic approach to their analysis and synthesis, namely, complexity, mobility, and adaptability. In expanded form, the totality of these subsectors is characterized by such features as:

The presence of a large number of components;

The complex nature of the interaction between them;

The complexity of the functions performed by these subsectors;

Complicated management;

The impact on the system of a large number of systemic factors of the external environment.

The adaptability, reformability and restructuring of the health care system is understood as the ability of the system to change its structure and the need for health care organizers to choose the best options for behavior in accordance with the new goals of health care under the influence of environmental factors. The ability of the industry to adapt to changing conditions and environmental factors depends on them. The systemic inertia of an industry determines the time required to transfer it from one state to another, given the parameters of its management.

Let us single out several main features of the system under study: its integrity, integrability, the predominance of a holistic property over the sum of the properties of constituent elements, the presence of sets of constituent components, their interconnections and relationships, the presence of exchange of resources, information, fixed assets with other systems and with the environment.

A fundamental feature of the health care system is that the patient, his health problems, and improving the quality of health-improving and medical care are an integral part of it. This presupposes that the health care system has special properties that fundamentally distinguish its functioning from that of other systems operating in accordance with rigidly defined laws. Unlike the latter, the health care system has the following features:

Informational content of the ongoing health and healing processes;

Variability of individual parameters of the system;

The uniqueness and predictability of the ongoing processes in specific conditions;

The availability of the system's maximum capabilities, determined by the available resources;

The ability to change, reform its structure while maintaining integrity, and shape behaviors;

Ability to resist tendencies that destroy the system and adapt to changing conditions;

The ability and desire for goal-setting, in contrast to closed systems, to which goals are set from the outside;

Limited formalized description.

It is advisable to take these features as a basis for the development of models and methodologies for systems analysis of health services, links and sectors. At the same time, it is necessary to take into account the integrity of the system, various types of connections (including system and factor-forming ones), structure and organization, multilevel and the presence of a hierarchy of levels, management,

purpose and expedient nature of functioning, self-organization, functioning, reforming and development of health care. It is important to know what kind of uncertainty in the formulation of the problem occurs at the initial stage of its reforming and consideration.

A systematic analysis of healthcare organizations and the state of people's health reveals a high degree of interdependence of various elements and aspects of socio-economic and political development. These aspects are becoming more and more closely interconnected, as can be judged from the analysis of the level of health and demographic processes in economically developed countries of the world. The effective development of the health care system has positive consequences in other sectors of the national economy.

The system-wide property of this sphere of life support is that a change (weakening) of any of its elements, for example, a preventive link, has a negative impact on all its other services and units, and leads to a deterioration in the operation of the system as a whole. Conversely, any positive change in the preventive link dramatically improves the performance of all components of the system.

Most characteristic signsfound in many definitions of the health system are as follows:

Movement towards integrity and functional unity;

Increasing the variety of structural units of the system and their functions;

Complication of the processes of reforming and functioning;

Existence and expansion of connections: quantitative and qualitative, positive and negative, one-sided and multifaceted, intrasystem and intersystem;

Complexity (polyfunctionality) of behavior, nonlinearity of characteristics;

Increasing the level of informatization;

Irregular influx of influences (environmental factors) not statistically distributed in time;

Multidimensionality: medical and social, economic, psychological, ecological, technical and technological;

Counterintuitiveness (cause and effect are not rigidly and unambiguously connected neither in time nor in space);

Non-linearity.

For the completeness of the parameters and properties of the health care system, it is necessary to highlight the organizational and management characteristics. The creation of a manageable health care system requires the identification of such elements and relationships between them (structural structure of the system), which implement its purposeful functioning. Elements of any content required to implement a function are called parts or components of the system. The set of parts (components) of the system forms its elemental (component) composition. An ordered set of relations between parts, necessary for the implementation of a function, forms the structure (structure, location, order) of the system, i.e. the set of its elements and the relationships between them. In this case, the concept of "connection" can characterize both the structure (statics) and the functioning (dynamics) of the system.

The material structure is the bearer of specific types and parameters of system elements and their interrelationships. A formal structure is understood as a set of functional elements and their relations, necessary and sufficient for the system to achieve its goals.

The organizational structure of the system is one of the basic concepts of the theory of healthcare management. This structure is defined as a set of services, sectors, subsystems, united by hierarchical relationships. They carry out the distribution of management functions between the heads of services, subsectors (chief specialists), on the one hand, and their subordinate structures to achieve the goals of the system, on the other.

The organizational structure unites human, material and financial resources involved in the management of the industry divisions; organizes connections between them. The organizational structure of the health care system is determined by the following characteristics:

A link (department) is one of the organizationally isolated, relatively independent management bodies that perform certain management functions. Links between the links of one level of the hierarchy are called horizontal and express the relationship of interaction (coordination);

The level (step) of the hierarchy is a group of links in which healthcare organizers have approximately the same powers. Links between levels of the hierarchy are called vertical and express the relationship of subordination of the lower levels to the upper ones. For each link of management, communications with all subordinate levels are called internal, and the rest are called external. Sometimes the level of the hierarchy is defined as the ratio of the number of outgoing links to the number of incoming ones;

The degree of centralization (decentralization) of management. A control system is called centralized if decisions are made only in the central (senior) body of the system. The central governing body has the right to dispose of all material, financial and human resources of the system, to make decisions, to redistribute resources from one part of the system to another, to coordinate the activities of all its parts.

A management system is called decentralized if decisions are made by individual elements (levels) of the system independently of other elements and are not corrected by the central management body. A decentralized system has the advantage that the controls are as close as possible to the control objects.

In reality, some decisions are made centrally, and some are decentralized.

With an incorrect division of the system into links, sectors, as well as a violation of managerial ties between subsystems located at different hierarchical levels, so-called pathological structures arise. Their simplest example - double subordination, when for some medical-production (pharmaceutical) organizations there are two management systems that significantly reduce the efficiency of their work.

Review questions

1. What is included in the concept of "system properties"?

2. What are the main properties of the system?

3. List the conditions inherent in the health care system.

4. What are the main features of sub-sectors of the health care system?

5. What are the features of the functioning of the health care system?

6. Name the characteristic features of the functioning of the health care system.

7. What is the organizational structure of the health care system?

8. What are the main characteristics of the organizational structure of the health care system.

Healthcare as a system

In nature, biological (individual), socio-economic (organization) and sanitary-ecological (nature), as well as mechanical systems are traditionally distinguished. System, systematic approach, system analysis and others are important categories in the study of health care, whatever its subsystem, service, link or element we consider. Currently, along with such qualities of a health care director (manager), such as knowledge, skills, skills, such a category as systems thinking is especially relevant. It can be argued that our successes are related to the extent to which we think systemically and approach the solution of certain health problems, and our failures are caused by deviations from the systematic approach. This statement is especially relevant for the medical community, all employees of the health care system, its leaders. It is they who deal with all known systems: biological, social, economic and management, technical and cybernetic, information.

Integritythe system does not mean its homogeneity and indivisibility: on the contrary, in the system it is possible to distinguish between certain constituent parts - services, links, sub-sectors, their elements.

Divisibilityhealth care system in parts does not mean the isolation of its structures from each other. The integrity of this system is based on the fact that the internal connections of the parts (services, links) that form the structure of the system are in a certain respect stronger, more essential, more important than their external connections.

Integritythe system is due to the fact that as a whole, it possesses such properties that do not and cannot be in its constituent parts and elements. Withdrawal or weakening of the work of any link (for example, preventive) leads to the loss of its essential systemic properties.

Opennessa health care system means that it is part of a larger system - economic, social, political.

The internal and external integrity of systems are generalized, combined, synthesized into the concept of a goal, which, as it were, dictates both the structure and

functions of the system ... The structure of the system acts as a variant of the goal.

Systems, especially health care systems, are not frozen. They are in dynamics ( life cycle: development - growth - balance - decline - degradation; birth - life - death), etc.

The need to combine various services, sectors and sub-sectors, areas of activity aimed at promoting and protecting health into a single system is due to the common goals of their activities and the close relationships that exist between them. The functioning of health care in the new economic conditions further contributes to the establishment of relationships and interactions between its constituent subsystems and elements. First of all, such links arise between such mutually complementary subsystems as treatment and prophylactic, medicinal and sanatorium care, sanitary and epidemiological supervision, the medical industry, prosthetic and orthopedic, etc.

The effective provision of protection and promotion of the health of the nation largely depends on how consistently all of the above subsystems and services develop. unified system health care of the country. Any mismatch in their functioning threatens society with additional social and economic losses. Therefore, when determining the ways of development of each element of this national economic system, one cannot but take into account its relationship with other services and sectors of health care.

Solving the problem of the optimal strategy for the functioning of the healthcare industry is impossible without creating a systematic concept for its development. In turn, a scientifically based concept of health development cannot be developed without a systematic approach to comprehensive measures to protect, maintain and improve the health of the nation, and improve population policy. The existing, so far, unsystematic, fragmented, disintegration approach to the development of health care at the state level leads to a decrease in the effectiveness of the proposed measures in this socially significant field of activity both at the federal, and at the regional and local levels.

A systematic approach to reforming and developing healthcare is necessary from the point of view of taking into account the needs of the population in specific forms and types of medical care, allocating resources both between all subsystems and elements of the industry, and between individual medical and preventive organizations; increasing the efficiency and accuracy of assessing the volume of medical and diagnostic procedures depending on the functional purpose of objects and structural formations of the unified health care system. United by inter-element connections and mechanisms, its services and sectors, individual subsystems closely interact with each other. Any significant changes in some of them invariably give rise to corresponding changes in other subsystems. According to the laws of dialectics, this approach presupposes complementarity, mutual support of interacting subsectors and subsystems, and the inevitably arising effect becomes an additional source of health care development as a whole, better quality medical and preventive care for the population. Integrated subsystems create

preconditions for the fullest disclosure of the health care capacity for change, reform and development.

It is known that expanding the range of drugs and increasing their effectiveness, the emergence of new unique drugs and samples of medical equipment (and sometimes simply improving their clinical parameters) are an effective incentive to develop more advanced medical, diagnostic, health-improving and rehabilitation technologies. At the same time, the resistance of the health care system to the impact of negative factors significantly increases: a reduction in the volume of budget financing, limitation of risk factors for the occurrence of diseases and their "contribution" to the formation of the level of health of citizens, etc.

A unified health care system is characterized by the presence of certain integral properties that belong to it as a system, but are not inherent in any of its subsystems - the so-called synergistic effect. Systemis a set of interrelated elements that form an integrity or a whole, consisting of parts ordered according to a certain law or principle.Moreover, the whole is not the arithmetic sum of the parts. The interaction of elements in the system to achieve certain goals allows you to get a completely new quality.

It is clear that the quality of health of the population, medical and demographic processes in the country, although largely depends on the effective work of individual structural elements and subsystems of the health care system, on their functional characteristics, but they are not fully determined by them.

Thus, the formation and development of the health care system requires a systemic and integrated approaches within the framework of the national economy to resources, organizational and legal forms of functioning, the implementation of search opportunities and implementation of effective options for medical, social and therapeutic and preventive care. With this approach, it is possible to overcome the narrow departmental orientation of public health management and achieve a more effective development of interrelated sectors and spheres of activity in health care.

The Almaty WHO Conference (1978) on Primary Health Care has radically changed the paradigm of health care worldwide and led to the development of a new concept of health care - the concept defining the boundaries of the state's responsibility for the health of the population.This allowed WHO in the 70s of the last century to form such concepts as "Health for All", "Health Protection", "Healthy City" and others, which defined new directions for the health system and showed that health is not only medical care, and a wide range of various preventive measures.

One of the main problems of modern healthcare is ensuring its availability and high qualitytaking into account limited resources, demographic structure (aging population) and the state of the natural and social environment.

According to the WHO (1960s), health is a state of complete physical, spiritual and social well-being, which makes it possible to maximize the existing functional capabilities of a person.

In 1977, WHO expanded the definition of health by adding the concept social and economic productivity of the individual,and set the goal of achieving, by the year 2000, the health status of the world's population in which peoples can lead socially and economically productive lives.

In 1995, WHO, given that demographic, political and economic conditions are changing in developing countries, and the needs of health systems in developed countries are increasing, called on the whole world to commit to "make significant progress towards better health and ensure the development of health services accordingly" whereby the following objectives were identified:

Make health and living issues a political outlook;

Provide patients with public health care;

To intensify activities in the field of health protection;

Engage in the prevention and control of social diseases.

These provisions have become the foundation of all national health systems.

Health individuals and entire populations is determined not only by their genetic properties, but also by the impact of pathogenic factors and the availability of medical care.

No one doubts the relationship between poverty, poor sanitary working and living conditions, and morbidity rates. However, it was believed that the availability of public health care should smooth out regional and class differences in health status. Nevertheless, using the example of the UK, where public health care exists, in the early 80s of the last century, it was proved that, despite the availability of guaranteed accessibility to medical care, people from the poor strata of society get sick much more often than the wealthier population.

This made it necessary to seriously reconsider the role of social factors and determine the 3 most important components of the socio-economic status of people, which have a large indirect impact on health: education, occupation, income level.

The factors that enhance the impact on health of the above components of socio-economic status include: risky behavior, socio-psychological stresses, unhealthy working and living conditions, lack of self-control over one's own health, inadequate support of families and socially unprotected groups of the population from the authorities structures and public organizations.

Hence, it follows that in modern healthcare, the tasks of ensuring the accessibility of medical care are added to the tasks of limiting the impact on people of harmful social, physical and psychological factors, teaching people the forms and methods of promoting health and self-control in relation to their own health, active involvement of the population in solving issues health care.

In this regard, the main tasks of modern health care are the effective management of health systems with the active participation of government and nongovernmental (public) organizations and the protection of the rights of all social groups population to receive high quality medical care.

Taking these circumstances into account, the European Meeting held by WHO in 1994 in Amsterdam adopted the "Declaration on the Development of Patients' Rights in Europe". The Declaration states that the concept of health adopted in this document is based on the principles of the resolution on health for all of the World Health Assembly (May 1977) and the corresponding model of health presented at the Almaty Conference of the WHO (September 1978), i.e. ie, thus, health care includes a full range of services, covering such areas of activity as strengthening and protecting public health, disease prevention, diagnosis, treatment, care and rehabilitation. The section of the Declaration “Purpose of the document” states that, in its essence and focus, this document reflects the desire of people not only to improve the quality of medical and preventive care they receive, but also to more fully recognize their rights as patients.

The articulation of patients' rights promotes a more complete awareness of people of their share of responsibility both when seeking medical care and in the course of receiving such care. This, in turn, serves as a guarantee of mutual support and respect in the relationship between patients and healthcare professionals.

Patients should be aware that they, too, can make important practical contributions to improving health system performance.

The role of patients in improving the quality of preventive care is of particular importance in today's environment, when existing complex health systems are largely funded from collective sources and when health workers and patients can have an equal interest in the economical and equitable use of available resources.

Goals and objectives of the Declaration:

Reaffirm basic human rights in the field of health care and ensure that the dignity and integrity of the patient as a person is protected;

To propose to WHO Member States general principles underlying patient rights that can be used in revising national health system policies;

Encourage patients to get the most out of their contacts with the healthcare system;

Promote an atmosphere of mutual supportiveness in the relationship between patients and health workers;

Strengthen the relationship (dialogue) between organizations representing the interests of patients, healthcare professionals, healthcare authorities, government agencies;

Develop the international cooperation in this region;

Guarantee the protection of fundamental human rights and promote the humanization of care for all categories of patients, especially the most vulnerable, such as children, psychiatric patients, and seriously ill patients.

Thus, the activity of any modern health care system should be primarily based on the strict observance of the rights of patients, taking into account their responsibility for their health.

An important aspect of understanding the essence of health care is to consider issues related to the possibilities of health intervention in the process health-disease(fig. 1).

Figure: one.The health-disease process and the possibilities of intervention in it

In accordance with the possibilities of public health intervention in the health-disease process at the state level, its regional structures a comprehensive program of public health protection is being developed, within the framework of which the health care system operates.

The structure of the complex program includes sections:

Health management and protection- a set of legislative, social and economic measures aimed at eliminating or limiting risk factors for diseases, injuries and death at the level of the individual, social group and society as a whole.

Primary preventionincludes measures aimed at preventing disease:

Sanitary and hygienic measures to eliminate unfavorable factors labor, everyday life, environmental violations;

Sanitary and anti-epidemic measures (vaccination, quarantine measures, bacteriological infection control, disinfection, disinsection);

Health education; propaganda healthy way life;

Health improvement of healthy people.

Secondary prevention- active detection and effective treatment illness on early stages... The central place in the conduct of secondary prevention measures is taken by the dispensary method (clinical examination of population groups with a high risk of disease: children, adolescents, pregnant women, workers in industries that are harmful to health, people living in adverse environmental conditions).

Tertiary prevention- prevention of complications in persons who have had serious illnesses, as well as medical examination of persons suffering from chronic somatic diseases in order to prevent an exacerbation of their course. Based on the above directions of the health care system, one can schematically represent its main structures (Fig. 2).

Figure: 2.Linkages between essential health components

However, if this structure of the health care system is considered from the point of view of the functions of subjects (organizations of the system), the division will be rather arbitrary, since almost all of them actively interact with each other. For example, organizations that provide medical care to patients, simultaneously with clinical activities, carry out a lot of preventive work (vaccination, medical examination, health education).

Suentaeva D. R.

master student "Almaty Management University"

FACTORS OF FORMATION OF INCOME OF A MEDICAL ORGANIZATION

annotation

The existing practice of planning the formation and distribution of income in healthcare organizations should be reformed in favor of focusing on the development trends of certain types of medical services. Healthcare organizations must improve their potential in the process of forming and distributing costs, planning the organization's income and expenses, drawing up investment plans, introducing innovative medical products, etc.

Keywords: healthcare organization, income, factors of income generation

Suentaeva G.R.

undergraduate of “Almaty Management University”

FACTORS OF FORMATION OF INCOME HEALTH ORGANIZATIONS

Abstract

The current practice of planning the formation and distribution of income in health care organizations should be reformed to focus on trends in the development of certain types of medical services. Health organizations have the potential of improving the process of formation and distribution costs, planning revenues and expenses, preparation of investment plans, the introduction of innovative medical products.

Keywords: health organization, revenues, income generation factors

It seems that the classification of factors according to the following criteria satisfies the tasks of a comprehensive analysis of the income of a medical organization:

By the influence of the external and internal environment of the medical organization.

The entire set of environmental factors of a medical organization can be differentiated into 2 groups: microenvironmental factors and macroenvironmental factors.

The microenvironment is represented by factors that are directly related to the medical organization and its capabilities. These include factors that directly and directly affect the income of a medical organization:

the state acts as a regulating, protecting and leading link;
suppliers;
consumers: individuals and enterprises;
competitors.

The macroenvironment is represented by factors of a broader plan that have an indirect impact on the microenvironment, such as factors of a political, economic, scientific and technical, social, demographic nature:

economic factors include the financial condition of the country, the purchasing power of the population, the rate of inflation, the real income of the population;
scientific and technological factors are critical for the emergence of technological innovation in the field of medicine. The growth of income, the development and efficiency of the functioning of any medical organization are possible only when it fully uses all the achievements of scientific and technological progress;
to social factors the external environment includes the health care system and consumer culture of the population, moral norms of its behavior, professional and personal qualities medical professionals, the level of health care;
demographic factors, on the one hand, determine the real possibilities of providing a medical organization with labor resources, and on the other, they form the level and scale of market needs;
political factors determine the degree of stability in society, which is important for attracting investments, including foreign ones, and the development of foreign economic activity of a medical organization;
environmental factors are represented by statutory restrictions on the volume of environmental pollution and are expressed by the regulation of discharges into water bodies, emissions into the atmosphere, as well as the collection of payments for both regulatory and excess environmental pollution.

The influence of the internal environment on the size of the income of a medical organization is characterized by the following main factors and their characteristics:

production of medical services: volume, structure of services of a medical organization; provision of raw materials and materials; medical equipment; location of the organization and availability of infrastructure; quality control of services, costs; technologies; innovations; information;
medical personnel: labor potential, number of employees, personnel structure, labor productivity, staff turnover, labor costs, interests and needs of employees;
management organization: organizational structure, management system; management level, etc.
marketing: market share; marketing budget and its execution; marketing plans and programs; image, reputation and quality of medical services; advertising, pricing;
finance and accounting: own and borrowed funds and their ratio; effective accounting system, including cost accounting, budgeting, profit planning.

By the components of human activity.

In the classification of economic resources, in all types of human activity, 3 components can be distinguished:

1. Regulated work performed according to a given technology, instructions, scheme, when the performer of the work does not introduce any elements of novelty, his own creativity into it. Such labor is called α-labor.

2. Creative work - the creation of new ideas, methods, products, technologies. This component is called β-labor.

Motivational and coordination work aimed at ensuring effective interaction between people and social groups. This activity is referred to as ɣ-labor.

All factors based on the results of creative work can be subdivided into areas of a technical, organizational, economic and social nature, which together form the toolkit with which the income growth of a medical organization is achieved. These areas are very diverse, among the most important of them are:

improving the organization of medical services and labor;
scientific and technological progress and its implementation;
improvement of forms and methods of management;
improving the quality of medical services;
development of concentration, specialization, cooperation, combination;
improving the motivation system for medical personnel;
raising the cultural, professional and qualification level of medical workers and others.

One way or another, all of the listed areas of creative work contribute to the development and improvement of economic systems, that is, they contribute to the growth of income. Therefore, we can assume that creative work is a complex factor in income growth.

Regulated α-labor prevails in the activities of nursing staff, as well as in the activities of secretaries, ordinary accountants, economists, lawyers of a medical organization. Creative work is typical for doctors, doctors, researchers. β-labor can also constitute a significant part of the activities of physicians-innovators, designers of systems of work organization, law and management.

Motivational and coordinating work is the main one in the activities of managers; the share of ɣ -work is especially important in the activities of those who belong to the highest hierarchy of the enterprise. Along with ɣ-work, the activities of effective managers can contain a significant part of β-work, the results of which are usually not formalized in the form of inventions and rationalizations.

As follows from the theorem on the profitability of labor components, the results (β-labor in the form of inventions, new medical technologies, rationalization proposals, computer programs, etc.) make the greatest contribution to the increase in the income of the enterprise.

Taking into account these components of labor is especially important when analyzing ways to increase the volume of medical services. Due to α-labor, this is possible only as a result of an increase in the number of medical staff or the intensity of their work, that is, in this case, there is a linear relationship. Fundamentally different possibilities of β-labor. Here, the decisive role is played by the creative abilities of a person and the conditions for their implementation. With the use of these resources (that is, thanks to new technical and organizational ideas), the volume of medical services can be increased with the same or reduced number of personnel. In other words, the influence of β-labor on the volume of output is characterized by non-linear effects. Similar effects are characteristic of α-labor, although to a lesser extent.

The third component (ɣ-labor) creates conditions for the effective implementation of human creative abilities due to the system of ethical and legal norms, traditions, social atmosphere in the country and in medical organizations, which significantly depends on the personal qualities of leaders at all levels.

III. Institutional factors.

By analogy with the factors of productivity, the factors of income of a medical organization can be classified according to the types of institutional norms (rules).

Based on the definition of the category “institution”, two main types of institutional factors can be distinguished:

informal factors, which include traditions, customs, culture, moral norms, social conventions, corporate culture and others;
formal factors existing in the form of official texts, fixed in legal documents These include: the Constitution of the state, laws, regulations, contracts between participants in market relations, etc.

All institutional factors influencing the performance of a particular medical organization can be divided into five levels: international, state, regional, sectoral, and intraindustrial.

The main institutional factors of the international level include: international division and cooperation of labor, monetary relations, exchange rules in the field of science and technology, migration relations, international business etiquette, capital movement and foreign investment, etc.

At the regional level, institutional factors are implemented by the relevant governing bodies. Within the limits of their competence, the regions provide medical organizations with orders on a commercial basis, privileges in tariffs for the use of electric, thermal energy, and rent. Center of gravity of implementation social policy transferred to the regional level, especially in terms of housing and communal services, consumer services, education, health care, social protection, increasing employment, etc. Their opportunities are expanding in regulating wages on the basis of agreements between associations of trade unions, employers and local authorities.

Sectoral institutional factors are implemented by state and regional authorities and include industry-wide and cross-sectoral activities. These include measures for the development, concentration and specialization of the output of products of cross-sectoral and sectoral application, regulation research works of a sectoral nature, the development and implementation of industry-wide standards for the use of resources, etc.

At the intra-organizational level, institutional factors encompass a wide range of organizational, technical, economic and social measures designed to solve the problems of increasing efficiency on the scale of a medical organization. These factors include various regulatory options based on formal and informal rules.

According to the degree of controllability of a medical organization, the factors can be divided into:

adjustable;
poorly regulated;
unregulated.

The regulated factors include the factors characterizing the quality of management, the level of organization of the provision of medical services and medical labor, the degree of use of resources, etc.

Poorly regulated factors are most often understood as factors with great inertia, the change of which over a certain period of time depends little on management decisions. These factors include: the volume and structure of fixed assets, characteristics of the level of equipment with medical equipment, etc.

Unregulated factors include factors characterizing tax legislation, natural and climatic conditions, etc.

Thus, in this article, we have developed a classification of income factors of a medical organization according to four criteria: by the influence of the external and internal environment of the medical organization; by the components of human activity; by types of institutional norms (rules); by the degree of controllability.

Literature

Vyvarets A.D. Enterprise Economics: A Textbook for University Students. - M .: UNITI-DANA, 2012 .-- 312 p.
Efremov B.C. Business systems of post-industrial society; On labor, capital and profit of a commercial enterprise // Management abroad. 2009. No. 5. - P. 164

References

Vyvarets A.D. Business Economics: A textbook for university students. - M.: UNITY-DANA, 2012 .-- 312 p.
Efremov B.C. Business of post-industrial society; On labor, capital and profits of business management // abroad. 2009. No. 5. - S. 164
Lopez - Navidad A, Domingo P, Viedma MA. Professional characteristic of the transplant coordinators. Transplant Proc 2014 .-- 333 p.

The main factors in preserving the health of Russians are the socio-economic responsibility of the state and employers for the health of the population and workers, investments of the state and business, as well as investments in their own health by citizens themselves.

The modern principles of health development policy are:

Aiming at overcoming the demographic crisis in the country,

Priority in solving urgent health problems,

Preventive focus,

Universal availability and high quality of medical care,

Required resource provision,

Economic efficiency of resource use,

Increasing the economic responsibility and interest of all subjects for the health and life of citizens,

Target-oriented approach.

The health care system development policy should be active and aimed at medical and social prevention of morbidity, disability and mortality of the population and the rehabilitation of patients, and not a passive health care development policy - this is "medicine of diseases" aimed at expanding outpatient and inpatient

treating a growing number of patients.

The effective functioning of the health care system is determined by the main system-forming factors:

Improving the organizational system to ensure the formation of a healthy lifestyle and the provision of high-quality free medical care to all citizens Russian Federation (within the framework of state guarantees);

Development of infrastructure and resource provision of health care, including financial, material and technical and technological equipment of medical institutions based on innovative approaches and the principle of standardization;

Availability of a sufficient number of trained medical personnel capable of solving the tasks set for the health care of the Russian Federation.

At the present stage, there are several mechanisms for the financial and economic reform of healthcare:
- introduction of resource-saving technologies for economic activities of medical institutions, which will significantly reduce costs that do not affect the quantity and quality of medical care;
- introduction of financing of medical institutions on a per-patient basis, which will contribute to the most equitable financing;
- standardization of medical services will make it possible to conduct a cost assessment of the medical services provided;
- reforming property relations, which consists in increasing the efficiency of using the existing material and technical values;
- the development of paid medicine within the framework of public health care institutions, aimed primarily at the formation of new high-quality relationships between the medical staff and the patient, and secondly, at reducing government spending associated with improving culture, quality of service, while maintaining state guarantees of free medical care, or more precisely medical care paid for by either the federal or the federal subject of the budget;
- development of private medicine, not as an alternative to the public sector, but as an equal partner in the medical services market.
Factors affecting the projected indicators of health care development.

1. Provision of financial resources of state guarantees to the population in the field of health care.
2. Improving the organization of medical care for the population.
3. Reforming medical education and personnel policy
4. Improving the organization of drug supply.
2. Concept and types of investments. The essence of the investment project. Features of investment planning in healthcare.

Investments- long-term capital investment in the economy in order to generate income.

Investment is an integral part of the modern economy. Investments differ from loans in the degree of risk for the investor (lender) - the loan and interest must be repaid within the agreed period, regardless of the profitability of the project, investments are returned and generate income only in profitable projects. If the project is unprofitable, investments may be lost.

Investments provide dynamic development of the company and contribute to the solution of such problems as:

Expansion of own business activities by accumulating financial and material resources;

· Purchase of new businesses;

· Diversification of activities due to the development of new areas of business.

Investment classification criteria the following:

1) the object of capital investment: real (direct) investment - investments aimed at increasing the fixed assets of the company, both for production and non-production purposes; carried out through new construction of fixed assets, expansion, technical re-equipment or reconstruction of existing enterprises; financial (portfolio) investments - the acquisition of assets in the form of securities to make a profit; formation of a portfolio of securities;

2) the frequency of investment: short-term investments - investments of funds for a period of up to one year (financial investments of the company); long-term investments - investments of funds in the implementation of projects that ensure that the enterprise receives benefits for a period exceeding one year (the predominant form of long-term investments of the enterprise is capital investments in the reproduction of fixed assets);

3) the nature of the firm's participation in the investment process: direct investments, which imply the direct participation of the investing firm in the choice of investment objects; indirect investments, which involve the participation of an intermediary, investment fund or financial intermediary in the process of choosing an investment object (most often these are investments in securities);

4) the form of ownership of the invested funds: private investments, which characterize the investments of funds of individuals and entrepreneurial organizations of non-state forms of ownership; state investments - investments of funds of state enterprises, state enterprises, the state budget of its various levels and state extra-budgetary funds.

In investment theory, venture investments and annuities are distinguished separately. Venture investments due to the need to finance small innovative firms in new technologies. Annuity - a type of investment that brings the depositor a certain income at regular intervals.

Investment project - an object of real investment, planned for implementation in the form of acquisition, new construction, expansion, reconstruction, etc. based on the review and evaluation of the business plan. The set of ongoing investment projects represents an investment program (for example, an investment program for housing construction, processing of agricultural products, creation of social infrastructure, etc.).

The first pre-investment phase is a set of actions to justify an investment project, search for and involve interested organizations and firms in the project. It includes the following activities:

Search for investment concepts (business ideas).

Preliminary preparation investment project,

Formulation of the project and assessment of its technical, economic and financial acceptability.

Final consideration of the project and making decisions on it.

If the decision is positive, the logical continuation of the first phase is the second - the investment phase. The investment phase of the project implementation, in aggregate, consists of the following activities:

Establishing the legal, financial, organizational framework for the project.

Detailed engineering and technical design.

Construction of facilities included in the project.

Installation of equipment.

Pre-production marketing.

Recruitment and training of personnel.

Commissioning and start-up.

The investment phase is a set of actions for the creation of new production assets and infrastructure for their normal operation. This is the phase of project implementation, during which the assets of enterprises are formed, contracts for the supply of raw materials and components are concluded, a set of workers and employees is made, and a portfolio of orders is formed. At this stage, it is especially important to monitor the project - to observe the degree of provision or reasonable change in its parameters.

The third - the operational phase is a set of actions for the operation of the created fixed assets with the replacement of depreciated equipment. It significantly affects the effectiveness of the funds invested in the project. During the operational phase, the following activities are carried out:

Reaching full production capacity.

Creation of repair centers and a dealer network.

Expansion and modernization.

Current monitoring of the economic indicators of the project.

Some practicing economists identify the fourth phase of the development and implementation of an investment project. The liquidation phase is a set of actions aimed at liquidating the fixed assets created as a result of the project. It consists in the liquidation or conservation of the design object. The corresponding costs and residual values \u200b\u200bare already taken into account during the research and development of the feasibility study.

In a market economy, the decisive condition for the development and sustainable viability of firms of any profile is the efficiency of capital investment in one or another investment project. A firm's decision to invest in a project is determined by the goals it sets for itself.

There are several types of classification of investment projects:

· 1. Forced capital investments carried out in order to improve the reliability of production and safety measures, aimed at meeting environmental requirements in accordance with new legislative acts in this area and taking into account other elements of state regulation.

· 2. Investments in order to maintain positions in the market (maintain a stable level of production)

· 3. Investments in the renewal of fixed assets (maintenance of continuous operations)

· 4. Investments in order to save operating costs (cost reduction)

· 5. Investments in order to increase income (expansion of activities - increase in production capacity)

6. Risky capital investments (new construction, introduction of new technologies)

This classification is an integral element of the management of the investment process of the corporation.

Investment design is the development of a set of technical documentation containing a feasibility study (drawings, explanatory notes, business plan of an investment project). Its integral part is the development of an estimate that determines the cost of an investment project.

The quality of the technological justification and the level of design solutions largely determine the efficiency of investments, the estimated cost of building an investment object, and the timing of its implementation.

The project of an enterprise or structure includes: technological, construction, economic parts.

The technological part contains design solutions that determine the technology and organization of the production of goods (products, works, services), the nature and types of equipment, the level of mechanization and automation of labor.

The construction part includes space-planning (the main dimensions of buildings and structures, roads, the location and size of their individual parts, number of storeys, etc.) and structural.

The economic part of the project contains calculations that make it possible to choose a construction site, determine the capacity and composition of the enterprise, the level of labor productivity of its employees.

Design stages:

A) pre-design development

B) design assignment

C) work on the project

Thus, an investment project is, first of all, a comprehensive plan of measures, including design, construction, acquisition of technologies and equipment, training, etc., aimed at creating a new or modernizing existing production of goods (products, works, services) with the purpose of obtaining economic benefits.

Investment design is the development of a comprehensive strategy for financing a business unit or an enterprise as a whole. The basis of investment planning is a detailed analysis of the market, forecast of production and sales, as well as the capital structure.

Therefore, the investment project must address the following issues:

formation (or analysis of existing) demand and determination of the potential capacity of the sales market

revealing key factorsthat underlie the success of the future project and define the main idea of \u200b\u200bthe project

detailed description of the product in terms of meeting the needs

After a preliminary calculation of the design indicators, the funding needs are determined. At the same time, the amount of funds necessary and sufficient to cover the capital deficit at each calculated moment of time is determined. Based on the data obtained, a strategy for financing the enterprise is developed - attracting equity or debt capital. Based on a detailed financial analysis, financial indicators, financial ratios are calculated and the financial stability of the project is assessed.

The detailed financial plan and budget are a quantitative expression of marketing and production plans and reflect the degree of their balance.

Thus, as a result of financial analysis, the following are determined:

· objective of the project;

Loan amount (investment)

The estimated maturity of the loan (return on capital)

The size and structure of own funds

Potential investors

To assess projects for the acquisition of new technology requires knowledge of the so-called innovative management, which is especially necessary in the face of a shortage of budgetary resources and competition in the medical equipment market.

Medical equipment worth over 20 thousand rubles is included in fixed assets and can be considered as an investment requiring a business plan. However, for budgetary institutions that do not receive real payments for services rendered, drawing up a business plan in its classical sense is difficult for the following reasons:

Due to the lack of proceeds from sales, it is impossible to assess the basic indicators of self-supporting efficiency: profit from sales, cash flow (cash-flo), profitability of sales, payback period of equipment (Payback period, PP)

Difficulties arise with the calculation of indicators of the net present value (NPV), internal rate of return (IRR), which are “exotic” for the budgetary sphere.

Heads of budgetary institutions, being recipients of budgetary funds, do not have the right to attract funds from credit institutions

Different sources of financing of compulsory medical services of healthcare institutions (budget and funds of compulsory medical insurance) do not always give a holistic idea of \u200b\u200bthe cost of a particular service, especially since there are no requirements for calculating the cost of free services

When calculating services, temporary (!) Instructions for calculating the cost of medical services are used, approved by the Ministry of Health N 01-23 / 4-10 and The Russian Academy Medical Sciences N 01-02 / 41 of 10.11.1999, which does not reflect the latest changes in the budget classification, the Budget Code of the Russian Federation, a new procedure for preparing financial statements.

The existing contradictions should not be an obstacle for financial analysts of the healthcare system when choosing methods for estimating capital costs.

In budgetary organizations, the role of the investor financing the costs of equipping and re-equipping fixed assets is mainly the state. It is it that, by legislative acts, determines the procedure for the supply of goods for state and municipal needs, as well as monitoring for the supply of diagnostic medical equipment and sanitary vehicles.

The basic document regulating expensive supplies for budgetary institutions worth more than 100 thousand rubles per quarter is Federal Law of 21.07.2005 N 94-FZ "On placing orders for the supply of goods, performance of work, provision of services for state and municipal needs" (hereinafter - Federal Law N 94-FZ). This document prescribes in detail all the procedures related to the supply of goods and the provision of services for budgetary institutions at the expense of budgetary funds, which allows strict control over the implementation of Federal Law No. 94-FZ at all stages of its implementation. From this point of view, the Law is flawless. However, even before the stage of purchasing medical technological equipment, it is necessary to conduct a thorough pre-investment preparation, preferably with the use of the so-called sensitivity analysis of the project, which answers the question: "What will happen if ...?"

Choosing a financial model for project evaluation. The key point for assessing the attractiveness of a project and its monitoring is the choice of a financial model for analyzing and assessing risks at all stages of its implementation. The purpose of building a financial model in relation to the healthcare industry can be to assess the economic efficiency of transferring resources to medical services and to determine the time perspectives of efficiency.

In our opinion, these conditions are fully met by the cost-effectiveness analysis method, based on calculating costs according to the principle of dividing into fixed and variable costs (direct costing). Literally this method is translated as "cost-effective analysis", in the Russian practice of investment design it is more often referred to as "operational" with the definition of the break-even point of the project.

As an example, consider the option of purchasing an additional device for hemodialysis for the Department of Nephrology and Hemodialysis of the Federal State Institution "Northern Medical Center named after N. A. Semashko ".

Over the past decade, the Ministry of Health of the Russian Federation and the health authorities of the constituent entities of the Russian Federation have been working to improve dialysis care. In most territories, outpatient dialysis centers or inpatient hemodialysis departments are organized, and the number of the latter is increasing every year. At the same time, the number of dialysis units is 3.5 times behind the demand. In the Arkhangelsk region, the provision of dialysis care is also insufficient. In the region, 15-16 people out of 120-140 people who need hemodialysis therapy are taken annually for dialysis. In general, in the Arkhangelsk region, one “artificial kidney” apparatus provides an average of 472 hemodialysis procedures per year, while the norm is 600. The profitability of using dialysis equipment is especially low in departments where the number of dialysis places does not exceed 3, and the maximum in departments where hemodialysis places are 6 and more. In the theory of investment, the concept of "investment" is defined ambiguously.

An important task is the problem of attracting investments, including foreign ones, in operating and developing enterprises. For this, it is necessary to substantiate and substantiate the design of projects (proposals) requiring investment. For these and some other purposes, a business plan is applied.

When preparing a business plan for a medical institution, an analysis of the volume and structure of the market for paid medical services is carried out, during which materials from specialized publications, statistical compilations with data on the medical services market are used, or their own research is carried out. It also analyzes the development trends of the market for paid medical services and markets for compulsory and voluntary medical insurance, the situation in which affects the volume of demand for paid medical services. The business plan should contain information about the main segments of the market for paid medical services and types of medical organizations. The market analysis should also provide information on competitors, existing health care programs and the cost of the health care services being considered.

The business plan describes the concept of a healthcare facility, which can be a multidisciplinary clinic or a specialized healthcare facility. When developing the concept of a medical institution, data on the most popular paid medical services and the structure of demand for paid medical services are taken into account, taking into account the proposed location of the medical center.

To assess income, when preparing a business plan, an analysis of the demand for paid medical services from various groups of clients is carried out: private clients purchasing policies for services under one of the proposed programs, corporate clients paying for medical services for their employees, as well as clients who go to commercial medical centers.

Assessment of income is carried out on the basis of information on the shares of services provided to holders of VHI policies and one-time clients of the medical center. Also, to assess income, data on the average cost of the VHI policy and the average cost per visit to a commercial medical center are used. This takes into account the seasonal fluctuations in the demand for the services of paid medical centers.

To analyze the ability of a medical institution to attract clients, the results of surveys are used that identify factors that influence the choice of a medical institution for various groups of consumers of medical services. When developing a marketing strategy, the demographic characteristics of the main consumers by type of medical services are taken into account, as well as information about the sources of information taken into account when choosing a medical institution.

The business plan should include a description of the location of the project and the benefits of the selected location in terms of setting up a medical facility. The business plan contains information about the initial costs, including the cost of building or renting a facility for a medical facility, and the cost of purchasing and installing the necessary equipment. The salaries of the specialists of the institution, the cost of purchasing drugs and various materials, repairs and replacement of equipment, as well as utility bills are considered as current expenses.

The business plan of a medical institution contains information on the documents required to obtain a license to carry out medical activities, and on the requirements of the regional Health Committee for the qualifications of specialists of the medical center. The project costs take into account the amount of the license fee and other costs that are required to collect and prepare the necessary documents.

The business plan should describe the timeline for the project, taking into account the time required to build and equip the center, as well as to find qualified employees. The income generation schedule takes into account the gradual increase in the number of clients of the medical institution.

As part of the financial and economic analysis of the project, the key performance indicators of the project are calculated, and a cash flow statement and income statement for the project in question must be submitted. In addition, the business plan includes a risk analysis, which analyzes the change in project efficiency in the event of adverse changes in the paid medical services market or in case of deviation of the project parameters from the expected values.