Synthesis of institutional and evolutionary and functional approaches to assess the efficiency of the regional health care system functioning

The methodology for assessing the dysfunctionality of the regional health care system has been developed on the basis of the synthesis of the principles of the institutional and evolutionary paradigm of scientific cognition and the functional approach. It allows us to assess not only the final result of its functioning in a form of public health condition at a particular territory, but also to assess the behavior of the main actors of regional health preservation or health consumption processes. From the view point of the institutional and evolutionary economic theory the regional health care system is considered in the following regulations: 1) the health care system is considered as an integral system, the influence of certain elements of the institutional health care environment on the functioning of the entire regional health protection system is assessed; 2) the changes of regional health care system dysfunctionality are taken into account at various stages of the industry reformation; 3) the regional differentiation of health care systems is taken into account both by the resulting parameters (medical and demographic situation) and by the factors of the institutional environment (environmental situation, resource support of the industry and behavioral factors), other regional heal care systems with the similar development conditions have been compared. From the view point of the functional approach the health care system is considered in the following regulations: 1) the health care system is considered as a complex of the functions it conducts in order to provide regional demographic and economic security, to increase quality and level of life in a region; 2) indicators that assess the implementation of the health care system functions are chosen and systematized on the basis of operation functions of the public health of the World Health Organisation. Method of interregional comparison is the basis for the synthesis of institutional, evolutionary and functional approaches implementation. This method suggests the performance of comparative assessment of quality indicators of regional health care system functions, the normalization of these indicators in accordance to the beat values, the calculation of integral and general indicators that allow us to characterize the level of the health care system dysfunctionality of the case study regions and to range these systems. The results of this methodology approbation in the case study of the health care systems of Perm Krai, Tatarstan, Bashkiria, Nizhny Novgorod, Samara, Sverdlovsk and Chelyabinsk regions have been presented. The health care system of Perm Krai was characterized by high rate of dysfunctionality during 2007-2015. According to the regression analysis such factors as the quality of the health care system management, the resource provision of the branch and social conditions in the region have greatly contributed to the state of health of residents of Perm Krai. The regression models that assess the impact of the health of the population of Perm Krai on both a regional Human Development Index and a Gross regional product also demonstrate the relations between these variables. Further on the basis of the revealed zones of maximum dysfunctinality the authors will develop a set of measures aimed at an efficiency increase of the regional policy in the field of the health care system of Perm Krai.