Performance of management of the health system (on the example of the Arkhangelsk region)

BACKGROUND: Currently, health care occupies an exceptional place in a socially oriented economy. To assess the effective functioning of the health care system, it is necessary to constantly monitor performance indicators that allow you to determine the level of saving the health of the population. AIM: Determine the degree of effectiveness of health system management based on a comparative analysis of certain target indicators with their actual values. MATERIALS AND METHODS: An analysis of the indicators contained in the State program of the Arkhangelsk region "Health care development in the Arkhangelsk region" was carried out. The following parameters were chosen as targets: life expectancy at birth; maternal mortality per 100 000 live births; infant mortality per 1000 live births; total fertility rate; number of doctors per 10 000 population; number of average medical personnel per one doctor. Analysis period 20102020. The study is retrospective, descriptive, not randomized. The level of performance was calculated from the ratio of target and actual indicators and their subsequent integration. The analysis of dynamic series for the presence of anomalous values (outliers) was carried out by the Irwin method. RESULTS: The main indicators that ensure the level of performance are maternal mortality and availability of doctors. The availability of doctors per 10,000 population was significantly higher than the target indicators over the entire time period by an average of 32.8%. The target indicators of maternal mortality were lower than the actual ones on average by 50.1%, which seems to be due to overestimation of the target indicator. CONCLUSION: Target indicators of health care system performance tend to overestimate against the background of the lack of a clearly defined methodological apparatus for their calculation, which, in most cases, leads to a mismatch between their dynamics and the dynamics of actual indicators, increasing the calculated level of health care system management performance.