Healthcare reform: Heads of medical organizations at the forefront of problems

The article is devoted to the impact of healthcare reform on the situation in the industry and the requirements for managers of medical organizations. On the data from the expert survey, participants of which were physicians with practical experience in the field of health management; economists studying the work of the public sector; lawyers involved in the protection of patients’ rights, etc., it provides characteristics of today’s financial, logistical support and staffing of medical institutions, their relationships with founders, insurance companies and patients; there are given experts’ opinions on who should be the leaders of medical organizations — managers or clinicians, how to create their personnel reserve, what should be changed in the system of professional development and retraining of medical personnel. It is shown that the working conditions of medical organizations have radically changed, and the amount of attracted extra-budgetary funds has become an important indicator of their effectiveness. At the same time, the institutional context, in which they function, is highly controversial, devoid of a number of fundamentally important elements, and is not balanced in terms of the rights and obligations of various actors involved in the provision of medical care. This significantly complicates the activity of the management of medical institutions, generates a «conflict of interests» among them, which ultimately negatively affects patients. According to experts, today an experienced manager should be at the head of the medical institution, but — with the obligatory good knowledge and understanding of the specifics of the medical industry. Since medical institutions are now managed by medics, their training in economics and management within the system of continuing professional education becomes very important. The article is divided into two parts. The second part will be published in Population 2019 No.1.