Providing High-tech Health Care in the Murmansk region

1. Providing High-tech Health Care  in the Murmansk region A.D. Rubin 2008

2. Territory • The Murmansk region isone of the largest andeconomically developedregions in European north of Russia;it is the only subject of the Russian Federation, almost entirely located beyond the Arctic Circle, it occupies the whole of Kola Peninsula, which is washed by the Barents Sea and the White Sea. • The population density of 1 sq. km is an average of 6.6 people.

3. The Murmansk Region It borders on Norway and Finland Participant of EuroArctic  Baretsregion

4. The Murmansk Region The nonfreezing Kola Gulf Direct access to the Ocean

5. The Murmansk Region It occupies the Kola Peninsula, to the north of the Arctic Circle The territory of 144.9 thousand sq.km.

6. Territory • The population density of 1 sq. km is an average of 6.6 people. Length From West to East – 550 km, from North to South – 440 km.

7. Population health is influenced by extremely adverse climatic conditions of the Kola North  (a complex relief, unfavorable wind and temperature conditions, long polar day and polar night, high magnetic activity and humidity, frequent changes in atmospheric pressure, which cause a syndrome of “polar stress”).

8. Principaldemographic indicators

9. The dynamics of the resident population size in the Murmansk region (in thousands)

10. The number of births  in the Murmansk region(according to the registry office data)

11. Fertility. Mortality. Natural increase. Fertility Mortality Natural increase\loss

12. The structure of the overall incidence of adult population  Diseases of the musculoskeletal system  Diseases of the digestive apparatus Diseases of the endocrine system  Tumors Diseases of the nervous system Others Diseases of the circulatory system  Diseases of urogenital system Eye diseases Infectious diseases  Skin and subcutaneous adipose tissue  diseases Injuries and intoxication

13. The structure of mortality for the main classes of reasons  Diseases of the circulatory system  Accidents, injuries and intoxication Tumors Diseases of the respiratory apparatus Diseases of the digestive apparatus Infectious and parasitic diseases Other reasons

14. Providing High-tech Health Care

15. Providing high-tech health care (HHC) to Russian population is one of the areas of priority national project (PNP) “Health”. It is regulated by the orders of Ministry of Health and Social Development  of the Russian Federation  (MHSDRF) with the allocation of quotas for the regions. Annually about 1000 residents of the Murmansk region  receive treatment in federal health centers.

16. To improve the quality and access to medical care for those people, who need high-tech care, the following documents were developed andadopted in the Murmansk region: • Administrative Regulations on the provision of public service “Submissionand providing high-tech health care to citizens of the Murmansk Region”; • An Order of the Murmansk Health Care Committee, which regulates procedure of selection and  Committee’s activity on patients referral to treatment at clinics. • Software product ”Referral to treatmentin Research Institute (RI)”, which is the basis for annual reports.

17. Referral to high-tech care in federal institutions referred patients children Application allocated quota

18. Referral to high-tech care in federal institutions and Municipal Regional Clinical Hospitals (MRCH) 2005 2007 Moscow St. Petersburg MRCH MCH FSA “N.I. Pirogov NMSC”, Murmansk Others

19. Referral to high-tech care in federal institutions in 2007 on the following profiles Cardiosurgery Traumatology and Orthopedics Hematology Maxillofacial surgery Rheumatology Ophthalmology Oncology Endocrinology Urology Others

20. Certain types of medical care keep higher-priority: implantation of large joints, certain types of heart surgery, neurosurgical treatment, in vitro fertilization etc. As at 01.10.2008, 244 persons are included into the “waiting list “(within the allocated quota)

21. Murmansk population is provided by medical care of the highest level, which is financed from the federal budget. In 2007 GHA “P.A. Bayandin Murmansk Regional Clinical Hospital” (MRCH) was included in the List of Medical Practical Institutions (MPI), which take part in the public task on providing high-tech care.

22. Clinical, logistical, intellectual and industrial facilities of the Region allow to use high-tech treatment in cardio vascular surgery, neurosurgery, traumatologyand orthopedics.

23. As at 01.01.2008, using funds for residents of the Murmansk Region and Republic of Karelia from the federal budget, the following operations were performed: 180 cardio vascular operations (100%); 70 trauma and orthopedic operations (100 %).

24. As at 01.10.2008, using funds for residents of the Murmansk Region and Republic of Karelia from the federal budget, the following operations were performed: 200 cardio vascular operations (91% of the total quota); 91 trauma and orthopedic operations (91% of the total quota). 30 additional quotasin neurosurgical profile for residents of the Murmansk region were allocated, in October 2008 7 operations were performed.

25. The cost of the regional budget for providing high-tech medical service in the Region was in 2007 - 330.7 million  rubles, scheduled for 2008 – 375,1 million rubles.

26. Number of high-tech care recipients in Murmansk Regional Clinical Hospital for the period from 2003 to 2008 (from the federal and regional budgets).

27. The structure of patients after high-tech care surgical treatment in Murmansk Regional Clinical Hospital in 2007 Urology Neurosurgery Traumatology and Orthopedics Cardiosurgery Ophthalmology

28. The structure of patients after high-tech care surgical treatment in Murmansk Regional Clinical Hospital for 9 months in 2008 Neurosurgery Traumatology and Orthopedics Urology Cardiosurgery Ophthalmology

29. Operationswith artificial blood circulation  and lethality in Murmansk Regional Clinical Hospital for the period from 1992 to 2007 The number of operations Lethality In January 2007, the 2000-th operation with the use of coronary artery bypass graftingwas performed in Murmansk Regional Clinical Hospital

30. The number of operations on heart with an coronary artery bypass grafting(including operations on the working heart)

31. The number of operations on major arteries The number of implanted pacemakers with radiofrequency ablation

32. The number of patients with diagnostic and therapeutic endovascular interventions

33. The number of rentgen-surgical interventions and operations

34. The data of A.N. BakulevSCCVS, RAMN The average frequency of rentgen-endovascular operations to 1 million people in 2006 The Northwest region Northwest region RF The Murmansk region

35. P.A. Bayandin Murmansk Regional Clinical Hospital takes the 15th place among all Russian clinics by the number of endovascular coronary interventions, but in terms of 1 mln. population and operating room workload – one of the ten most active clinics in Russia. (The data of A.N. BakulevSCCVS, RAMN)

36. Coronary arteriography is the only method for choosing the best tactics of treatment in patients with coronary heart disease. The need for coronary arteriography per 1 million of population  is more than 3,000 procedures a year. Today coronary arteriography is the «gold standard» of coronary heart disease (CHD) diagnosis

37. Replacement arthroplasty

38. Replacement arthroplasty Hip joint Knee joint

39. New high-tech methods of treatment were introduced in Murmansk Regional Clinical Hospital in 2003 - 2007: - Knee replacement; - Endovascular treatment of abdominal aneurysm; - Endovascular treatment of hysteromyoma; - Endovascularbifurcationalstenting ofcoronary arteries in coronary heart disease; - Newendovascularmethods of treatment of ischemic stroke and hemorrhagic stroke; - Stabilizing operations on the spine  using submersible systems; - Laser discission of secondary cataract; - Laserdescemetogoniopunctura;

40. - Combined phacoemulsification withprofundussclerotomy; - Intravitrial introduction of Gemaza; - Cataract phacoemulsification with implantation of intracapsular ring in lens subluxation; - Application of allodrainsin profundussclerotomy; - Endoscopic operations on bile-excreting tractus using endoscopes with side-optics; - Operations for improving hearing; - Endoscopic operations on the nose and paranasal sinus; - Associatedoperations invalvular defects and coronary heart disease.

41. Completion of the reconstruction of centralized operational unit in Murmansk Regional Clinical Hospital in 2008 will increase implement of high-tech methods of surgical treatment in 1,7 times 

42. Thank you for your attention!