Organisation of oral health care in Russia. The basic normative documents.

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Vagner V.D.

Organization of stomatological help in Russia. The basic normative documents.

The Ministry of Public health of the Russian Federation, and in the subjects of the Federation - their administrations, which have in their structure Committees (Managements, Departments, Ministries) of Public health services plans, organizes, directs and supervises the stomatological service in Russia.

At all the administrative levels of management of Public health services the main expert of stomatology, and as a rule, on the public beginnings is nominated. In a number of territories the experts in narrow sections stomatology (therapy, maxillofacial surgery etc.) are nominated by same principles. The main experts are nominated from the number of the most qualified doctors - stomatologists, professors, senior lecturers, scientific employees working in the area of stomatology and well knowing organization stomatological help to the population. More often these posts are occupied with the main doctors regional (republican) or large urban stomatological polyclinics. In the structure of republican (regional) stomatological polyclinics the organizational-methodical departments are created which carry out organizational-methodical job on stomatology, it’s planning, analysis of the activity of the establishments, develops the measures directed on increasing of the quality and volume of stomatological help to the population. At the level of MH RF these functions are assigned to CSSI of stomatology.
Traditionally stomatological help to the population is provided:

-in republican (regional) stomatological polyclinics;

-in educational and sience - research institutes (academies, universities) on their clinical bases;

-in the urban, regional and interregional stomatological polyclinics;

-in stomatological branches and studies of versatile polyclinics, CDC, local hospitals, (Medical attendant obstetrical centre), industrial enterprises and educational institutions;

-in departmental CPE;

-in the adult and children branches of maxillofacial surgery of stationeries.

Recently the network of private stomatological clinics (branches, laboratories) has considerably extended and their share in the volume of rendered stomatological help to the population increases from year to year.

Now at the organization of the stomatological help to the population it is necessary to use the basic orders of MH of the USSR and MH RSFSR, if they are not cancelled by the appropriate orders of MH of the Russian Federation.
The order of MH of the USSR from June 12, 1984 №670 " About the measures on the further improvement of stomatological help to the population ". This order stipulates:

- ensuring the further development of a network of stomatological polyclinics, the branches and laboratories, paying the special attention to the organization of stomatological polyclinics and first of all the children's one’s (items 1.2);

- completing stomatological polyclinics, the branches and the laboratories with the doctors and average medical personnel according to the established regular specifications and to ensure their regular increasing of their professional qualification (item 13);

- accepting the urgent measures to equipping of stomatological polyclinics (branches and laboratories), and also dental laboratories by the means of medical engineering, tools and materials (item 1.5);

- organizing activities of stomatological polyclinics, branches and laboratories in two changes, paying special attention at rendering the stomatological help to the population on Saturday, Sunday and holidays (item 1.6.1);
- ensuring organization of stomatological studies at all the industrial enterprises having personnel about 1500 and more and at all higher and average educational institutions with the number of the pupils about 800 and more (item 1.6.4);

- ensuring the introduction of the complex program of preventive maintenance of caries of teeth and diseases parodont (p .7);

- accepting the urgent measures for permanent working of available ftorator installations at water stations (item 1.7.1);

- ensuring the scheduled treatment of a cavity of mouth for children, teenagers and adult population (item 1.8);

- arranging to introduction into practice the modern methods of local and general anesthetization; forbidding the fulfilling painful stomatological operations and first of all at pulpits, sharp periodontit, the developed diseases parodont, processing vital teeth etc., without realization the appropriate anesthetization and under the indications pre-medical assistance; establishing, that the indication for realization of general anesthetization is the impossibility of rendering stomatological help using local anesthetization; centralizing of rendering anesthetization help in large stomatological polyclinics (items 1.8.5. and 1.8.6.);
- at the treatment of the patients with breaked bones of the face and widespread inflammatory processes should be fulfilled in stationeries with the subsequent transferring them for treatment to polyclinics (item 1.9.2.);

- organizing stomatological branches of the urgent help in the hospitals of the first medical help (item 1.9.3.);

- allocating the doctors for rendering orthopedic help for stationary stomatological patients for fulfilling the complex of maxillofacial prosthesis (item 1.9.5);

- ensuring complete transition to manufacturing of tooth artificial limbs with the method of individual moulding (item 1.10.2).

This order also authorizes:

- the temporary norms of the charge according the basic kinds of stomatological materials, medicines and tools for one doctor of stomatological structure and tooth engineer in a year (application 1);

- the basic rules of the program of preventive maintenance of caries of teeth and diseases of parodont among the population (application 2);

- a rule about the main doctor of stomatological polyclinic of republican, regional submission (application 3);

- a rule about stomatological polyclinics of republican, regional submission (application 4);

- the addition to the nomenclature of medical specialities and medical posts in the establishments of public health services (the post of the doctor - stomatologists for children) was entered (application 7).

The number of the items of this order are urgent nowadays, the organizers of stomatological service use them widely.

The order MH of the USSR from January 25, 1988 №50 " About transition to a new system of the account of the work of the doctors of stomatological structure and perfection the form of the organization of stomatological reception ". According purposes of development stomatological help for the population, making order in the system of the work of the doctors, stomatologists and orientating their job to the final results, this order brings in a new system of the account of the work of the doctors, which is based on measuring the volume of their job in standard units of labour input (SUL). Intensification of work of the doctor directed on rendering the maximal help at one visiting, reduces the unproductive expenses of the time connected to repeated visitings. The account of work according to SUL is focused on lifting the interest of the doctors in the final results of their own work, to stimulate the growth of productivity of their own labour and to develop the preventive orientation in the job. This order authorizes:

- the standard units of the account of labour input of job (SUL) of the doctors - stomatologists and dentists (application 1);

- the registration and accounting documentation and instruction on it’s filling (application 2,3,4);

Naturally, after more than ten years many SUL do not correspond to the expenses for their performance.

By the order of MH of the Russian Federation from October 2, 1997 № 289 " About perfection of the system of account of labour of the doctors of stomatological structure, " in connection with widely developing process of settling by the stomatological establishments the new technologies of preventive maintenance, diagnostics and treatment of stomatological diseases, introduction of modern materials, tools, equipment and according to the purposes of increasing the interest of stomatological establishments in increasing the efficiency of the work and in improvement of the quality of stomatological help to the population it is authorized to the chiefs of bodies of management of Public Health services of the subjects of the Russian Federation to develop and to approve:

1.Standard units of the account of labour input of job (SUL) of the doctors - stomatologists and dentists on the kinds of works with application of new technologies of their manufactures which are not stipulated by the order of MH of the USSR from 25.01.88 №50.

2.The norms of the charge on new kinds of stomatological materials, medicines and tools on one doctor of stomatological structure and dental mechanic in a year.

The same order entrusts to the Main dentist of MH of Russia to develop and to present for the statement the instructive letter on a technique of the account of the standard units of account of labour input of the work of the doctors - stomatologists and dentists and the norms of charging for stomatological materials, medicines and tools.

The order of MH of the USSR and State Committee Of the USSR on national education from August 11, 1988 №639/271 "About the measures on improvement of preventive maintenance of stomatological diseases in the organized children groups".

This order stipulates some measures for improvement of the activities of the bodies of the public health services and national education on warning of incidence of children, further perfection of mass preventive maintenance of stomatological diseases in the organized children groups:

-developing and ratifying the republican, regional programs of prevention of stomatological diseases in the organized children groups (item. 1.1);

-organizing the training of the average medical personnel of preschool establishments and schools to realization of the measures of complex preventive maintenance of stomatological diseases in the organized children groups (item. 1.3).

-obliging the chiefs of preschool, boarding school establishments and schools to ensure the conditions for realization of readjustment of cavity of a mouth and preventive maintenance of stomatological diseases of children during academic year (item. 1.4);

-organizing laboratories of hygiene for realization the measures on preventive maintenance of stomatological diseases in antenatal period in the structure of female advices (item. 3.1);

-introducing into the staffs of medical establishments for each children doctor - stomatologist a post of medical assistant (item. 3.2);

-obliging pediatrics service to participate in the organization of preventing of children stomatological diseases " to ensure continuity of cooperation with the stomatological service (item 3.3 and 3.4);

-ensuring normative reception of endogenous preparations of fluorine in the organized children groups in the regions with the lowered contents of fluorine in drinking water (item. 3.5);

This order recommends to reconsider the normative-technological documentation on the products of children feed for additional reduction of sugar, to expand releasing of the products of children feed with the reduced contents of sugar, to strengthen sanitary - educational activities, to satisfy the need in stomatological equipment, toolkit and materials in the schools, boarding schools sanatoriums, to develop and to ratify the new educational programs of the schools on hygiene and preventive maintenance (at the rate of 3 hours per one year in 1 -3 forms and 1 hour per one year at 4-10 forms), to add the educational programs by the questions of hygiene of a cavity of a mouth and preventive maintenance of stomatological diseases, to order in a duty of the tutors the realization of daily hygienic measures on caring of a cavity of a mouth beginning from 2-3 years age and a number of other measures.

The order of MH USSR from November 18, 1988 №830 «About the complex program of development of stomatological help to the population ". With the purposes of acceleration of development of stomatological help to the population this order authorizes the complex program of development of the stomatological help in the USSR till 2000. Except for the preamble the program contains 13 sections, which define the basic directions of perfection of stomatology and it is provided:

-increasing the number of the doctors – stomatologists at the rate of 5,9 posts by 2000 on 10 thousand population;

-increasing the number of stomatological polyclinics, including self-supporting;

-development of stationary stomatological help and increasing the specification up to 0,5 bed on 10 thousand adult population and up to 0,4 bed on 10 thousand children population;

-development of material – technical equipping of stomatological service;

-increasing the number of stomatological assistances (at the rate of a ratio between the doctors - stomatologists and assistance 1:1);

-opening the new stomatological faculties, faculties of re-education of the doctors, preparation of the scientific staff;

-development of children stomatology, in particular the orthodontic help and preventive maintenance;

-development and release new filling materials; increasing of the volume of the help at diseases of parodont and mucous environment of a cavity of a mouth;

-wide introduction of anaesthesiological manuals into stomatological practice;

-creation of the centres on rendering assistance to the patients with the inherent and acquired defects "deformations of the face and jaws;

-development and introduction of the measures on preventive maintenance and early diagnostics of malignant tumours of maxillofacial localization;

-strengthening of orthopedic branches and dental laboratories;

-perfection of the methods of diagnostics (x-ray functional diagnostics etc.).
After 1988 no additional orders on organization of the stomatological help were issued and only in 1996 in view of new economical conditions the “crisis of the state public health services” after a number of the governmental decisions the orders of МH of the Russian Federation on stomatology began to occur. It is possible to attribute to this kind of decisions the sanction to individual labour activity " the law on creation of cooperative societies and enterprise activity and a number of other ones.

The order of MHMH of the Russian Federation from March 29, 1996 №109 "About the rules of granting of the paid medical services to the population" was announced the decision of the Government of the Russian Federation from January 13 1996г. №27 “About the statement of the Rules of granting of paid medical assistance to the population by medical establishments" and it was recommended to the chiefs of the bodies of management of public health services of the subjects of the Russian Federation to arrange it’s performance.

The order of MHMH of the Russian Federation from August 6, 1996 № 312 "About the organization of working of stomatological establishments in the new economic conditions of managing". The edition of the order was preceded with the extremely insufficient budget financing of stomatological establishments, impossibility of the funds of the obligatory medical insurance to compensate deficiency of the means of the budget " that has resulted in reduction of a level of satisfaction of requirement of the population in stomatological help and it’s quality" constrained the introduction into practice the new technologies of treatment of stomatological diseases. For the decision of the given problem, even partially, the chiefs of the bodies of management of public health services, are recommended to provide:

-the budget financing of the stomatological establishments according to the executed volume of the work expressed in SUL;

-the charges which are not restored by the budget or FOME should be compensated at the expense of the self-supporting activity in working hours;

-to conduct the separate account and accumulation of property acquired according to the results of self-supporting activity;

-to conduct the separate statistical and financial account depending on the sources of financing.

The order gives a number of the assignments to the main dentist of MH of the Russian Federation, in particular, to develop the mechanism of price forming in stomatology, the standards of the volume of stomatological help etc.

The order of MH of the Russian Federation from July 2, 1999 №259 "About the statement of the plan of the measures on preparation of the realization of the reform of stomatological service. For maintenance of the citizens with guaranteed free-of-charge stomatological help adequate to the modern requirements, it is necessary to carry out reforming of the stomatological service. This order affirms the plan of preparation for reforming, providing a number of serious measures, for example: the order of rent, the mechanism of privatization of stomatological establishments " pass porting of them, development of the terms of guarantees, etc.

Stomatology - is only one of many branches of public health services and certainly all the decisions, orders, concerning organization of protection of health of the citizens of Russia are distributed also to it.

The recommended literature:

1. Bezrukov V.M. The directory on stomatology. - М., Medicine, 1998. - 656 pages.

2. Lisitsin U.P., Starodubov V.I., Grishin V.V. and others. Medical insurance. - М., 1994. - 95 pages.

3. Materials of the second congress of Stomatological Association (All-Russian) Volgograd, May 23-25, 1994 - Ekaterinburg, 1995. o 254p.

4. Pahomov G.L. Bases of organization of the stomatological help to the population. - М., Medicine, 1983. - 206 pages.

5. The unit of the normative documents on organization of stomatological help. M., Grant, 1999. - 527 pages.

6. Udincov E.I., Rogachev G.I. Reference materials on social hygiene and organization of public health services for the students and doctors of stomatological structure. - М,, 1973. - 334 pages.

7. Management, organization, socio - economic problems of the stomatological service of the country. (Works of CSRIS) М., 1991. – 226p.

8. The order of MH of the USSR from 12.06.84 №670 "About the measures on the further improvement of stomatological help to the population".

9. The order of MH of the USSR from 25.01.88 №50 "About transition to a new system of the account of work of the doctors of stomatological structure and perfection the forms of organization of stomatological reception".

10. The order of MH of the Russian Federation from 02.10.97 №289 "About perfection of the system of the account of work of the doctors of stomatological structure".

11. The order of MH of the USSR and the State Committee of the USSR on national education from 11.08.88 №639/271 "About the measures on improvement of preventive maintenance of stomatological diseases in the organized children groups".

12. The order of MH of the USSR from 18.11.1988 № 830 " About the complex program of development of stomatological help to the population"

13. The order of MHMH of the Russian Federation from 29.03.96 №109 "About the rules of granting of paid medical services to the population".

14. The order of MHMH of the Russian Federation from 06.08.96 № 312 "About the organization of the work of stomatological establishments in the new economic conditions of managing".

15. The order of MH of the Russian Federation from 02.07.99 №259 "About the statement of the plan of measures on preparation of realization the reform of stomatological service".

16. The decision of the Government of the Russian Federation from 13.01.96 №27 "About the statement of the Rules of granting the paid medical services to the population by medical establishments".