Diseases of various joints among adults in Russia are noted in 33 %. Among them, 10 to 15 % of patients require surgical treatment. Endoprosthesis replacement of large limb joints is a highly demanded high-tech operation that significantly improves the functional motor capabilities and quality of life of the patient. The aim of the study: to highlight the problematic issues of fnancing high-tech medical care in the profle «Traumatology and Orthopedics».

Materials and methods. On the example of hip and knee arthroplasty, an analysis was made of the realities of fnancing high-tech medical care in a changing fnancial and economic environment.

Results. Proposals are presented to bring the costs closer to the cost standards in the provision of high medical care, adjust tariffs, redistribute the burden on federal institutions in the provision of traumatological and orthopedic care.

Conclusion. The forthcoming changes in funding sources for knee and hip arthroplasty will increase the fnancial defcit in the provision of these types of care, especially in revision arthroplasty; will lead to a deterioration in the quality and results of treatment – an increase in the number of complications and repeated revision operations. The proposed measures are focused on the optimal use of budgetary resources.

Chronic diseases, which form the somatic and social deprivation of patients, imply the provision of integrated medical and social care. National health care systems are actively pursuing processes aimed at overcoming the fragmentation of health care delivery and forming a model of integrated health care. The purpose of the study. Analysis of interaction of medical organizations and continuity in the treatment of patients in rural health care in the Saratov region.

Material and methods. The authors conducted a comparative sociological study, which involved 319 physicians working in the district medical organizations of the Saratov region. The study was preceded by the construction of the medical and social portrait of the respondents.

Results. The majority (73.7 %) of the respondents assessed the degree of continuity of patient care between inpatient and outpatient facilities in the district of the region as average.

Conclusion. The study reveals the peculiarities of the organization of medical care for the rural population, which consist in the limited implementation of the principles of continuity in the management of patients, the presence of barriers to digitalization. The analysis of the degree of interaction between doctors when providing medical care to the rural population in inpatient and outpatient conditions reveals the fragmentation of rural and regional health systems.

The development of “soft skills” applicable to healthcare professionals is a necessary factor for the formation of a highly qualifed specialist engaged in medical activity.

 Aim. The aim of the survey is to study the formation of “soft skills” while undergraduates at Nursing Institute obtain higher medical education.

 Materials and methods. It has led to the analysis of four key competencies “4K”. The comparative analysis was used to describe the names of universal competencies included into the Federal State Educational Standard for Bachelor’s degree in “Nursing” and the meaning of “4K” competencies. Fulltime students of Saratov State Medical University named after V.I. Razumovsky majoring in “Nursing” were engaged into the questionnaire. It has been revealed that the development of “4K” competencies is important for medical professional staff.

Results. The present study confrmed that the training for “Nursing” at the Bachelor level following the Federal State Educational Standard contributes to the development of “soft skills”.

Conclusion. Based on the data obtained from the survey, we may conclude that the four key competencies “4K” are well formed in Bachelor of Nursing. However, the lack of information on the concept and structure of “soft skills” among students has been determined. More detailed information can be found by the use of special educational technologies and methods for mastering the “soft skills”.

Against the background of a steady increase in the number of oncological diseases, as well as the complexity of the primary morphological diagnosis of malignant neoplasms (MNT) and precancerous conditions, especially in the regions of the Russian Federation, in 2019, the creation of a number of Reference Centers (RCs) for immunohistochemical, pathomorphological, molecular genetic methods was initiated research within the framework of the federal project “Fight against oncological diseases”. In 2020, on the basis of the centralized pathoanatomical department of the Clinical Center of Sechenov University, the RC began its work.

 Aim. To analyze the work of the RC of Sechenov University and compare the results obtained with the tasks of the federal project.

Materials and methods. The data of histological, immunohistochemical studies from the registers of receipt of biopsy (surgical) materials and the issuance of the results of intravital pathoanatomical studies (account forms 014-2 / y and 057-y / 04), as well as data from the Telemedicine system of remote consultations, were analyzed.

 Results. For 21 months of work, the RC consulted 1476 requests received from 70 constituent entities of the Russian Federation. More than 10 % of reference diagnoses were made in a remote format through the Telemedicine system of remote consultations at the federal and regional levels using digital pathology techniques.

Conclusion. Despite the obvious need for the work of RCs, there are still a number of issues that have a signifcant impact on the quality of diagnostic processes: specialization of specifc RCs, expansion of the range of incoming clinical and morphological diagnoses. It also requires attention to regularly improve the skills of RC employees in Russian and international educational systems and to equip the RC, frst of all, with virtual resources. The experience of the RC has demonstrated the importance of a second medical expert opinion in the primary diagnosis and verifcation of the diagnosis of malignant neoplasms of various localizations for the regions of the Russian Federation, where the acute problem is the general shortage of general pathologists and expert doctors.

The morbidity rate of the rural population is lower than that of the urban population for all classes of diseases, which is due to the low availability of medical care (MC) for rural residents, including those with diseases of the skin and subcutaneous tissue (DSST). The purpose of our study was to study the accessibility of MP to the rural population of the Republic of Bashkortostan with DSST and determine ways to improve it.

Materials and methods. An analysis was made of the incidence of the rural population of DSST, resource provision of dermatovenereological care and the volume of primary health care and specialized, including high-tech MC, based on reporting data for the Republic of Bashkortostan (RB) in comparison with the indicators of the Russian Federation (RF) and the Volga Federal District (VFD).

Results. For the period 2013–2020 in the RB, there are high average annual incidence rates of the rural population with DSST, exceeding similar data for the RF and VFD. The provision of dermatovenerologists has decreased (the rate of decrease is 16.2 %), the number of dermatovenereological rooms has decreased (the rate of decrease is 9.3 %). In terms of the number of dermatological beds, the republic ranks frst among other regions of the VFD, and second in terms of the level of provision. The share of rural residents who received high-tech MC in 2020 amounted to 38.5 % of the total quota.

Conclusion. As a result of the study, the need to increase the role of nursing staff of central district hospitals in conducting dispensary observation of patients with chronic dermatoses, creating algorithms for constant interaction between dermatovenereologists of the consultative and diagnostic department of the Republican dermatovenerologic dispensary and doctors and / or nurses of districts, creating a republican register of patients with chronic dermatosis, increase in the volume of high-tech medical care with the use of genetic engineering biological therapy. The priority in increasing the availability of medical care for the rural population with DSST is systematic work consisting in the development and implementation of a set of organizational solutions.