It is in light of this strategic direction in the present communication presents a number of theses, revealing the theme, as stated in the title of the publication. First you need to conditionally characterize the current state of the national health system in terms of objective reality, which does not allow at this stage of development of society and government to realize the desired principles of relationship marketing in the emerging market for medical services. As we know, market economy is not conceived without such concepts as "competition" and "competitiveness." The main factors of low, sometimes, completely absent in today's competitive health care system in Russia, are: a revolutionary transition from a centrally planned socialist system of health care to an unmanaged process of becoming a marketing relationship in the evolutionary formation of the medical services market, conservative ownership of health facilities, the uncertainty in the formation and development small businesses in the existing health care system, inappropriate action of the classical economic laws and conditions of competition and competitiveness, lack of modern managers in the public health, can competently solve organizational, technical and economical and managerial problems and challenges of medical institutions functioning in the new economic conditions of society and States, lack of health education programs (usually) courses "Managing competition in health care; unduly cautious implementation of methods of scientific planning (systems analysis, forecasting, optimization of medical practice, etc.) in the formation of the medical services market, lack of political will to implement sound management decisions on bringing to a logical introduction to the health care of modern mechanisms, methods and forms of the continuous improvement of quality of care. In the problem of building and managing the competitive environment of production and consumption of medical services should understand the negative role of incentives in the health system to facilitate the creation of conditions or lack of unproductive competition. Some of the factors inducing the identified problems and do not allow in principle to form a competitive environment in medicine are listed below. Multilevel system users (agents) of health services: the state (a program of state guarantees free medical care), the federal and territorial funds of obligatory medical insurance (CMI) (limiting the volume of medical services in accordance with the financial capacity of insurers), insurance medical organizations (the Russian model of compulsory Health Insurance - Direct financial dependence on regional funds OMC) patients (for inclusion in the consumer health care system of active influence on the quality of care); administration of health care institutions (bureaucratic directive-command control relationships of patients and healthcare workers); doctors (adoption decisions about treatment of their patients and ensure that treatment takes place in the competitive and economic vacuum).
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