+7 925 966 4690, 9am6pm (GMT+3), Monday – Friday
Russian version 






National Interests: Priorities and Security

Developing a three-tier system of primary health care and a three-stage organization of its first tier

Vol. 10, Iss. 45, DECEMBER 2014

Available online: 1 December 2014

Subject Heading: Social sphere

JEL Classification: 

Pages: 37-46

Stepchuk M.A. Medical Information and Analytical Center, Belgorod, Russian Federation

Importance The article deals with the problems of primary health care.
     Objectives I consider the need to establish an effective system of primary health care, which recently has acquired even greater relevance. Based on the results of the study, I propose to develop and test in pilot areas a three-tier system of primary health care and a three-stage organization of its first tier.
     Methods I use an integrated method of research: historical, statistical, economic, comparative analyses and a number of others. With their help, I have analyzed various aspects of primary health care in Russia and abroad and determined the most effective system of primary health care for the Belgorod region.
     Results I proposed an optimal three-tier system of primary health care and a three-stage organization of its first tire with the emphasis on prevention, which, combined with the new forms of financing and payment of labor of primary health care physicians enabled to achieve positive results in pilot areas. It is possible to apply the system not only in the said region but also in other regions.
     Conclusions and Relevance I conclude that under the conditions of health care funding shortage in the region, the use of effective forms of organization and funding of primary health care services in pilot areas would enable to motivate health care professionals to improve the quality and accessibility of primary health care services to the population, to preserve the health of assigned population at the primary stage, and to reduce the volume of medical assistance at the second and third stages. This will lead to enhancing the efficiency of medical assistance and the public health in general and contribute to people's active life prolongation.

Keywords: Keywords: primary care, prevention, patronage, rehabilitation, availability, quality


  1. Egorysheva I.V. Meditsinskie obshchestva v Rossii v kontse XVIII pervoi polovine XIX veka [Medical societies in Russia at the end of 18th and first half of 19th century]. Zdravookhranenie Rossiiskoi Federatsii Health care of Russian Federation, 2008, no. 5, pp. 4951.
  2. Kalininskaya A.A., Son I.M., Guseva S.L., Stukalov A.F. Model' reformirovaniya pervichnoi meditsinskoi pomoshchi [A model of reforming primary health care]. Zdravookhranenie Rossiiskoi Federatsii Health care of Russian Federation, 2008, no. 5, pp. 610.
  3. Kalininskaya A.A. [Funding for primary health care]. Innovatsionnye tekhnologii profilakticheskoi meditsiny v vuzovskoi nauke nachala XXI veka: materialy Mezhvuzovskoi nauchnoi konferentsii s mezhdunarodnym uchastiem, 04.05.2009 [Proc. Int. Sci. Conf. Innovation technologies of preventive medicine in high education science in the beginning of 21st century of May 4, 2009]. Moscow, Moscow State University of Medicine and Dentistry Publ., 2009, pp. 9193.
  4. Kalininskaya A.A. [Two models of general practice]. Mediko-organizatsionnye aspekty meditsinskoi pomoshchi v novykh ekonomicheskikh usloviyakh: materialy nauchnoi konferentsii s mezhdunarodnym uchastiem, posvyashchennoi 105-letiyu so dnya rozhdeniya akademika AMN SSSR, professora A.A. Minkha, 28.08.2009 [Proc. Int. Sci. Conf. Medical and organizational aspects of health care in the new economy. On occasion of the 105th anniversary of the birth of Academician of AMS of the USSR Professor Minch A.A. of August 28, 2009]. Moscow, 2009, Part 1, pp. 1820.
  5. Komarov Yu.M. Pervichnaya mediko-sanitarnaya pomoshch': kakoi ona dolzhna byt'? [Primary health care: what it should be?]. Zdravookhranenie Health care, 2008, no. 5, pp. 1928.
  6. Pervichnaya mediko-sanitarnaya pomoshch' segodnya, aktual'nee, chem kogda-libo: doklad o sostoyanii zdravookhraneniya v mire v 2008 g [The World Health Organizations Report 2008: Primary Health Care: now more important than ever]. Geneva, Documentation CentreWorld Health Organization Publ., 2008, 125 . (In Russ.)
  7. Pavlov K.V., Stepchuk M.A., Pinkus T.M., Gospodyn'ko E.M. Vliyanie novykh form finansirovaniya na effektivnost' pervichnoi mediko-sanitarnoi pomoshchi [The impact of the new forms of financing on primary health care efficiency]. Natsional'nye interesy: prioritety i bezopasnost' National interests: priorities and security, 2012, no. 7, pp. 6164.
  8. Pinkus T.M. Povyshenie strukturnoi effektivnosti sistemy zdravookhraneniya oblasti [Improving the structural efficiency of the health system]. Problemy ekonomiki i upravleniya Problems of economics and management, 2009, no. 4, pp. 181183.
  9. Ulumbekova G.E. Zdravookhranenie Rossii. Chto nado delat': nauchnoe obosnovanie Strategii razvitiya zdravookhraneniya Rossiiskoi Federatsii do 2020 goda [Healthcare in Russia. What needs to be done: the scientific rationale for the Strategy for health care development of the Russian Federation until 2020]. Moscow, GEOTAR-Media Publ., 2010, 592 p.
  10. Flek V.O., Kravchenko N.A., Sokovikova N.F. Sovremennye podkhody k otsenke effektivnosti ispol'zovaniya resursov v sisteme zdravookhraneniya [Modern approaches to evaluating the effectiveness of the use of resources in the health care system]. Menedzher zdravookhraneniya Health care manager, 2005, no. 9, pp. 1221.

View all articles of issue


ISSN 2311-875X (Online)
ISSN 2073-2872 (Print)

Journal current issue

Vol. 19, Iss. 3
March 2023