New structure and functions rayon health care department (RHCD) And its new
role as public purchaser of health care services:
Strategic goals of RHCD:
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To assess health care needs and to guarantee its accessibility for rayon
population
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To improve outputs of health service (number of patients treated)
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To improve outcomes of health service (quality of health care)
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To inform patients about health services and patients’ rights
Operational goals of RHCD:
Task 1: Pooling and collecting funds and setting up the business
plan for the RHCD
To analyze volume of financial resources based on laws and
algorithms that are available for the rayon health care budget and RHCD’s
financial plan.
Task 2: Health care needs assessment
To analyze utilization of rayon health care facilities and patient
flows and output and outcome of health care services. State statistics provide
basic information on utilization of health care facilities.
Task 3: Restructuring process of health care providers at Rayon
level
To set up an action plan in order to transform health care
facilities into autonomous providers (development of statute for autonomous
health care providers)
Task 4: Allocating and shifting resources to health care providers
To develop budget reallocation plan on a planned volume of health
care care according to the medical needs of rayon level and to prepare
proposals for draft programs of territory social-economic development and local
budget drafts, submit them to rayon authorities’ consideration and guarantee
their fulfilment.
Task 5: Negotiations and contracting
To prepare contracts according to legal requirements. Data has to
be collected and analyzed in terms of quality, quantity and dynamic development
of utilisation and patient flow. RHCD has to develop a strategy for contracting
according to the health services agreed upon. Negotiations have to be conducted
between RHCD and health care providers that will be contracted. RHCD has to
report to rayon authorities.
Task 6: Implementing adequate payment mechanisms
Capitation fee for primary care and block contract for inpatient
care.
To define capitation techniques and to collect patient lists from
family physicians. Methodology how to transfer cash flow to autonomous health
care providers has to be developed.
Task 7: Public advice and information
To inform population through local media and local announcements
and provide basic information on family medicine and about health care services
and patient rights. Advice has to be given to population and patients have to
be informed about provided health care services.
Task 8: Monitoring, evaluation and health performance management
To analyze epidemiological trends, patient flows and access to
different health care providers.
Analysis of efficiency and quality indicators will play key role
for measurement fulfilment of strategic and operational goals. Improve referral
system and to support the coordination between facilities and inpatient
departments. Improve outpatient care by setting clear criteria for
hospitalization.
RHCD’s organizational structure and job descriptions:
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Head of RHCD
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to conclude contracts on health care services purchase at the expense of the
Rayon budget
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to provide implementation of health state policy
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to ensure planning and control process according to requirements of RHCD,
Oblast State Administration and Rayon State Administration and to focus on its
organizational targets
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to prepare proposals for draft programs of territory social-economic
development and local budget drafts, submit them to Rayon State
Administration’s consideration and guarantee their fulfilment
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to set up a financial (business) plan for RHCD and to command finance within
adopted income and expenditure budget to maintain the department
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to forecast the development of a network of healthcare facilities to provide
population with health care
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to organize, delegate and control the work of the department and take care of
for efficient usage of human resources within RHCD
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to insure that RHCD acts as an independent purchaser without influence by
hospital or health care providers
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to be responsible for accreditation of rayon health care providers
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to organize work on labour protection, safe traffic and fire protection of
health care facilities
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to develop together with his deputy a strategy for the negotiations with the
health care providers
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to be responsible for the fulfilment of the tasks assigned to the department by
the Head of Rayon State Administration and to provide advice for Rayon Council
and Rayon State Administration for medical needs assessment
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to ensure data protection and patients’ rights
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to define the responsibility level of his/her deputies, heads of the department
units
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to issue orders within his/her competence, organize and control their
fulfilment
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to approve provisions on department units and functional responsibilities of
its workers
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to appoint and dismiss the department workers
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to have a right to take part in meetings of local self-government bodies and
speak on the issues related to his/her competence
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to inform population on the state of liabilities assigned to the department
through mass-media
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to make reports and documentation and to provide all necessary information to
Oblast and Rayon State administration
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Economist
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to set up a budgetary reallocation plan for rayon health care facilities
according to the medical needs of rayon population
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to issue adequate types of payment for health care providers
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to increase the efficiency of resources on rayon level
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to be responsible for the outputs (number of patents treated) of health
services
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to analyze data (for example state statistics) by usage of IT-technology
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to create indicators in order to evaluate efficiency (number of beds, average
bed occupancy, average length of stay, use of diagnostic centre, use of
operational rooms, structure of cured patients)
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to conduct volume and cost comparison on oblast and national level
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to analyze cost of services
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to conduct financial analysis
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to support competitive environment of health care providers
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to make reports and documentation
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to fulfils special tasks given by Head of RHCD
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Physician (medical controller)
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to be responsible for outcomes (quality of health care)
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to issue medical monitoring by analyzing of official state and other
statistics, epidemiological trends
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to make assessment of medical needs for the rayon population by analyzing
patient flows and clinical pathways
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to monitor the implementation of (national) medical standards
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to implement performance and case management (insure that the right patient is
treated at the right time on the right place)
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to avoid that patients, which belong to outpatient care, are treated inpatient
(incorrect assignment of hospital bed days)
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to reduce the length of an individual inpatient stay, if it’s from the medical
point of view not necessary
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to ensure that primary care treatment is actually being done at the primary
care level
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to ensure that secondary care treatment is performed at the secondary level and
so on
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to provide medical advice for the economist and legal specialist, to the rayon
council and by request to citizens
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to inform patients about health services and provide medical assistance to
population
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to focus on prevention of infectious diseases, epidemics and their liquidation
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to provide environmental preservation and maintenance of public
sanitary-epidemiological welfare as well as adherence to standards of health
care activity, requirements of State pharmacopoeia, standards of healthcare
service, medical materials and technologies
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to coordinate his work with the economist and legal specialist
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to make reports and documentation
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to fulfil special tasks given by Head of RHCD
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Accountant
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to support the command of finance within adopted income and expenditure budget
to maintain the department
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to transfer funds from oblast and rayon to health care providers (pooling)
according to legal requirements and regulations
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to pay invoices on time to health care providers according to legal
requirements and regulations of the contract
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to ensure correct accounting and book keeping according to legal requirements
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to coordinate his work with the economist
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to support the economist by his daily work
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to make reports and documentation
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to fulfil special tasks given by Head of RHCD
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Legal specialist (usually located in Rayon State administration)
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to give advice for improvement of current used contracts
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to cover all legal aspects of contracting in terms of fulfilment of health care
legislative acts, state standards, criteria and requirements
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to apply changes on the legal level to the contract
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to work out new forms of contracts and statutes and provides options for
decision making if necessary
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to provide legal advice to economist and physician, rayon council and by
request to citizens of rayon
When fulfilling the tasks assigned, the RHCD shall cooperate with
other subdivisions of Rayon Administration, local self-government bodies as
well as enterprises, facilities, organizations and public unions.
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