Vol 20, No 1 (2021)

The modernization of the healthcare sector today is intricately associated with the necessity of additional financial investments, including private capital, which is also reflected in the general global trends in the development of public-private partnership (PPP) practices. Today, PPPs are becoming an effective mechanism for implementing innovative treatment practices, re-equipping medical institutions, improving the quality of medical care, and modernizing and digitalizing the healthcare sector altogether. In this regard, it becomes urgent to study the best practices of applying the PPP mechanism in the field of healthcare in different countries for the possibility of adapting the successful experiences in the Russian reality.

To date, no state has been able to build an ideal system of PPP. Thus, in the field of healthcare, it is critically important to conduct regular analysis of PPP projects, study mistakes and apply positive practices aimed to improve the procedures and mechanisms for effective cooperation between business and the state.

This study is a retrospective analysis of the health of Russian students. It covers the period from the end of the nineteenth century to the present day. In this study, scientific documents were analyzed. Historically, from the late nineteenth to early twentieth centuries, researchers mainly investigated the physical development of students and their reproductive behavior. In the 40s to 50s and beginning of the 60s, the interest of scientists in social and hygienic research in the student environment was declining. The greatest number of scientific research on the problem of health protection of students fell from the 60s to 80s. In the 90s, the most important problem was the deterioration of the health of students due to the socio-economic crisis in the country and the fall in the standard of living of the population. A distinctive feature of research on the health of students of the twentieth century is their regional nature. The topic focused on the most urgent problems of the well-being of students.

The problem of pediatric oncology involves a wide range of medical, economic, social, emotional, and other related problems. The family is one of the key accomplices in the process of diagnosis, treatment, rehabilitation, and, most importantly, the resocialization of the child after overcoming cancer and building a strategy for his future.

Based on the results of the medical and sociological survey of parents with children having cancer, the author noted that respondents’ ideas about the future of their child are determined by the peculiarities of their social situation and mainly have optimistic formulations. Their hope for the child’s recovery is understood to be the key guarantee of the well-being of the future family. Nevertheless, expectations of overcoming the disease, expressed with a positive connotation, are also mirrored in the parents’ fears regarding the risks of cancer recurrence. In addition, the construction by parents of a positive picture of their child’s future is associated with a stable financial situation, presence of siblings in the family, and the age of respondents is over 50 years.

BACKGROUND: One of the most relevant areas of research in the sociology of medicine is the study of the problems of the quality of medical care, the development of approaches and criteria for assessing it at the current stage of development, institutional changes in medicine, the perception of transformational changes in the social institute of medicine by the population. The cornerstone of the health system is the subject relationship in the context of the doctor-patient bond. The determinicity of these interactions by the deontological principles of medicine determines the high level of expectations of patients regarding the personality of the doctor, which, in turn, affects the characteristics of the social status and the spectrum of social roles of medical workers. Despite objective changes in social interactions due to the departure from the paternalistic approach of modern medicine and the strengthening of patient autonomy trends regarding his life and health, the basis for the sustainability of the health system as a social institution remains the patient’s trust in the doctor, on the one hand, and the high level of professional motivation of medical workers on the other. This becomes the key to the effectiveness of the system, its flexibility and effective opposition to modern challenges, including the COVID-19 pandemic.

AIM: To study the attitudes and expectations of patients and health professionals regarding aspects of the image, openness and responsiveness of the health system, the risks of its commercialization and compliance with the needs of patients, as well as the peculiarity of motivation of medical workers, conflicts and professional errors, and based on the survey data, to characterize and compare the attitude of patients and health system managers to interaction in the combination of «medical worker – patient».

MATERIALS AND METHODS: A sociological study was implemented in 2019 on the basis of a republican sample of patients (n=800) and a representative sample of health managers of the Grodno region of the Republic of Belarus (n=143). For statistical data analysis, the methods of non-parametric statistics of Statistica 10.0 were applied: estimating intergroup differences by calculating the Kruskal-Wallis test, establishing relationships through correlation analysis with calculating the Pearson correlation coefficient.

RESULTS: The majority (54,3% of patients surveyed) claim that the main factor affecting their attitude and image of institutions and health workers is «the reputation of the institution›s employees and their clinical experience», in second place in terms of response rates 35,3% «the appearance of buildings, equipment of departments and offices, corridors»; the third place (28,9%) was taken by the answer «preventive work with the population». Managers call the defining motives in the activities of medical workers: «professional interest» (70,3%), «the opportunity to earn money for a living» (52,1%), «compassion and assistance to the patient» (41,3%).

The results of the study indicate that there are no direct causes and manifestations of conflict situations in the «doctor—patient» communications.

In the situation of medical errors, 51,3% of respondents consider the most common subjective errors of the doctor, 22,3% — medical. Managers more regard the medical errors encountered as organizational (31,2%) or purely deontological (31,2%). Thus, the majority of managers (62,2%) associate professional deontological errors of medical workers with errors in the behavior of a doctor with patients and relatives of patients. There is a relationship between the level of the leader and the frequency of qualification of professional error as an objective error (r=-0.28; p<0.05): the higher the position the leader occupies, the more often he notes precisely objective errors and tends to respond adequately to them.

Despite the fact that in order to be able to pay for paid medical services, 34,4% of patients are forced to reduce other costs, one in three patients (about 32%) considers additional remuneration to the medical worker directly from patients and their relatives, which is manifested by the so-called corruption «environmental pressure» — however, the vast majority of health managers categorically do not allow such situations.

CONCLUSIONS: It was revealed that patient attitudes reflect the commercialization of social interactions in the doctor-patient system and create conditions for corrupt «environmental pressure», but despite this, relations generally unconditionally maintain a humanistic orientation and priority motive in the form of compassion and patient assistance. Most patients note trust in doctors, two-thirds have never clashed with healthcare professionals, the main image factor is «the reputation of the institution›s employees and their clinical experience». It was also revealed that the degree of professionalism has a direct impact on the perception of medical errors: for example, patients are much more likely to interpret any incomprehensible situation as a mistake, and health managers, on the contrary, regard the errors encountered more as organizational or deontological, and there is a positive correlation between the level of the leader and the frequency of qualification of professional error as an objective error.

The patients’ legal status is often at the core of legal discourse, such as in terms of registration of expensive medicines and their inclusion in lists (e.g., life-saving medicines and expensive medicines), diagnosis of new diseases that require additional state support, and creation of special organizations of assistance to seriously ill children. However, it is not often possible to hear the “voice” of the patient in professional discussions of representatives of state bodies, lawyers, and human rights defenders. In this study, the author hypothesized that it is not enough for scientific discussions to developed proposals for implementation in regulatory regulation to conduct only legal interpretation and analysis. No less important is the definition of the “actual balance of forces in society,” which is a part of the immediate task of practical sociology. This study aimed to confirm this belief by considering the legal status of patients with congenital immunopathologies from the perspective of the patients themselves through a sociological survey, questionnaire survey, and in-depth interview.

Hearing loss is one of the most pressing problems of a modern person, which is reflected not only in high prevalence rates, but also in a wide range of social problems associated with hearing disorders. The author notes that the most important conditions for improving the quality of life of patients with hearing loss, in addition to the need to search for effective methods of treatment, is the provision of their rehabilitation (compensatory adaptation) with the help of hearing aids and/or the use of hearing aids based on scientific literature analysis. In addition to the clinical tasks of hearing correction to ensure a high quality of life, providing a wide range of social support measures for this group of patients seems necessary. First of all, the author notes the need for measures aimed at improving the quality of life of a person with hearing impairments (providing employment opportunities, financial support, hearing aids, and social and psychological support) and expanding the practice of outreach work with the population, potentially contributing to an increased level of awareness of citizens about hearing impairment problems. The author also notes the need for timely access to medical care and contributing to reducing persistent stigma against people with hearing impairment in the Russian society.

The article is devoted to the opening of the Professional skills’ school "Bioethics and Medical Law" based on the Institute of Social Sciences at Sechenov University in September 2020. The project “Professional skills’ schools” has been existing at Sechenov University since 2014. The School's program consists of three training modules: "Fundamentals of Bioethics", "Bioethics: a medical and sociological view" and "Medical Law". The purpose of the School "Bioethics and Medical Law" is the in-depth training of graduate students in the field of bioethics, medical law and the sociology of medicine to acquire additional knowledge, skills and abilities to analyze ethical and legal problems of clinical practice and research activities in the field of biomedicine. Students at the School get a unique opportunity to study not only the theoretical aspects of bioethics, but also to gain practical skills in solving ethical problems in medical practice based on approaches using the methodology of social and humanitarian sciences.