Organizational forms of health care delivery for patients with combined somatic and mental pathology have been analyzed. The characteristics of the system of referrals, hospital admissions and treatment in psychiatric departments for patients with combined severe somatic and mental pathology is described. The basic tasks and functions of such departments are listed. Somatic diseases are presented according to the groups of diseases, most frequently occurring in mentally ill patients.
Nine clinico-statistic groups of patients were distinguished on the basis of the time of inpatient treatment of the non-randomized group of mental patients (n-57328) discharged during one year from the Moscow psychiatric hospitals, bearing in mind the diagnosis, age and the presence of a grave somatic illness. Each of these groups is characterized by the mean period of inpatient treatment, which makes it possible to use them for economic calculations in introduction of the cost accounting into activities of the psychiatric services.
Arguments for restructuring of psychiatric service on the principles of medical insurance are given. Because mental disorders are characterized by chronic development and high disability rate, the necessity of mixed budget-insurance financing of psychiatry is grounded. Obligatory state insurance must be conducted for all mentally ill persons. However, only a certain part of outpatient care and the treatment period in hospital are to be insured, while the remaining part of outpatient visits or hospital stay will be financed from the budget. The method of calculation of the incurred number of the doctor's visits and the length of hospital stay during the year is discussed.
Under an analysis of results of treatment of 186 patients with pleural exudate syndrome there were 139 patients treated by traditional methods, 47 patients treated using the proposed medico-diagnostic program based on using thoracosopy under local anesthesia. Using the proposed medico-diagnostic measures can be used at any multifield hospital where patients with pleural exudate syndrome are admitted although the hospital has neither phthisiatrical nor phthisiothoracic departments.