Vol 16, No 2 (2017)

The health care is considered as a social institution since XX century. The main purpose of health care is in amelioration, rehabilitation and promotion of health. This social institution, according to its implementing functions, comprises four sub-institutions. The analysis of trends of institutionalization of the sub-institution «Palliative medical care» is presented in methodological plane of system of social structural functions (AGIL). From the perspective of dysfunctional practices of sub-institution of palliative medical care developing in Russia, a medicalization of palliative care is discussed.

The normative base and publications were analyzed to review present notions «defect of medical care», «medical error». The absence of unified comprehension of the given definitions in the Russian legal practice was established. The established situation has advantages of pretrial and extrajudicial mode of settlement of disputes (mediation) in case of consideration of conflicts related to medical care support as an instrument directed to quick searching of decision mutually acceptable for both sides, including necessity of compensation of damage done.

The article considers problem of non-developing pregnancy as an important social occurrence progressively deteriorating level of birth rate despite achievements of modern medicine. The evaluation was implemented concerning medical social portrait of women with non-developing pregnancy. The reliable relationship is established between developed pathology of pregnancy and presence of somatic diseases, number of abortions and miscarriages and also housing conditions, public professional activity, unfavorable conditions of labor, presence of occupational hazards.

The article presents the analysis of results of complex medical sociological survey of effectiveness and efficiency of medical care as main criteria of its quality and accessibility. The survey comprised 1,737 patients of various social groups of population of Moscow and 203 physicians of polyclinics. At self-rating of health, 13.2% of respondents determined it as unsatisfactory, 45.1% as satisfactory and 31.3% as good. In all population groups, the most called-for proved to be polyclinic institutions. The high level of satisfaction of patients with quality of emergency medical care was established in all groups. The quality of medical care in polyclinics and hospitals was assessed significantly lower. The most negatively assessed criteria turned out transition to fee-for-service forms of medical support and time limits of waiting for all modes of medical care, except emergency medical care and district therapist. The evaluation by physicians of their own activity and present problems is characterized by their unanimity in need of increasing of salary (100%) and increasing of typical sectoral standards of time of reception of a patient (96.5%), decreasing of intensity of work of medical personal (92.3%) and reduction of some forms of record cards with the purpose of releasing of time and attention of physician for a patient (88.4%). The disrespectful attitude of patients to medical personnel was mentioned by 77.3% of physicians which is a new phenomenon testifying loss of confidence in patient-physician relationship. The quality of implemented work was assessed equally and rather high by both young and experienced physicians. The positive and negative aspects of reorganization of health care were analyzed. Two alternatives of problems were established to focus plans of development of system of Moscow health care to support accessible and qualitative medical care of population.

The article presents the analysis of impact of research competence on the process of professional self-realization of practical physicians. The personal self-perception of physician from positioning of oneself as active subject of cognition, opened to new experience and ready for getting out of available scope of knowledge is considered as an indicator of availability and developness of research competence at the stage of post-graduate stage of profession genesis. The article presents a complex of qualities of subject needed to successful self-realization in profession in conditions of modern medicine. The questionnaire survey was applied to assess through physicians the process of receiving and application of experience of research activities in university and also of the course of professional self-realization. The questionnaire emphasized such research skills as scientific informational, methodological, theoretical, empirical, written speech and communicative speech ones. The testing was applied to compare self-rating of physicians in the area of research skills and real research knowledge and skills. The results testify an inadequate attention to development of research competence at pre- and post-graduation work stages of professional genesis. The cohort of young specialists is considered as a most perspective one for working in this direction in state structures.

The cataract is one of leading causes of low vision and blindness in the world. It is well known that a significant decreasing of vision or its total loss result in deterioration of quality of life, including total or partial loss of working capacity. On the basis of official statistics data, a study was carried out шт the course of which costs of inputs to cataract treatment and dependence of disability on quality of visual functions were established.