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Healthcare is an important industry for the safe and successful development of any country and territorial entity. Currently, the healthcare system in the United States goes through the process of modernization, and the development and functioning of the territorial (regional and municipal) health systems is often characterized by the presence of crisis moments and the influence of various trends. A municipal level of the healthcare system is of particular interest during its analysis. The municipal healthcare is a system of state, regional, municipal, public and other measures aimed at protecting the health of the population of the municipal formation or city (public health). It is a basic structural element and the foundation of a national healthcare system as its organizational, financial, and economic readiness to provide quality and affordable healthcare to the population has a significant impact on the sustainable economic development and social stability in the society (Wolper, 2004). Therefore, it is imperative to define the negative influence of particular social and economic trends on it in order to prevent its malfunction. The following research is dedicated to the identification of the trends that have the strongest influence on the municipal healthcare facilities and definition of the ways of mitigation of their adverse effects.
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The municipal healthcare facility provides services of pre-hospital (examination and nursing), outpatient (neurology, pediatrics, surgery, dermatology) medical care and special services including expertise for the right to gun ownership or proficiency examination. Healthcare facility personnel includes administration and medical workers of high (physicians and other specialists with higher and postgraduate medical education), medium (paramedics, nurses, obstetricians, medical statisticians, physical therapists) and junior levels (nursing assistants and disinfectors) (Wolper, 2004).
On the municipal level, healthcare facility, together with pharmaceutical companies and organizations, pharmacies, forensics and educational institutions, as well as persons engaged in private medical practice, is supported by municipal healthcare authorities that not only provide it with funding, but also responsible for providing the access to the guaranteed volume of health and social care for the population, and exercising control over the quality of the provided medical services (Wolper, 2004).
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The municipal healthcare facilities are influenced by a variety of trends, but the most significant of them include social (the overall level of health in the area) and economic ones (the financing of the healthcare facilities and the demand for medical goods and services).
Social trends mostly have an indirect influence on healthcare facility. Medical and demographic structure of the municipality population is expressed in the trend of aging of the nation (particularly after the baby boom of 40-50s), and the growth of the main groups of diseases (SARS, heart diseases, and cancer). As a result, the amount of working-age people gradually decreases, thus reducing the purchasing power of the population and lowering the overall economic activity of the city, including that of healthcare business (Edington, 2009). This trend may be neutralized by petitioning for the approval of the programs of social support in the local budget. Moreover, special attention must be given to groups of working-age people that form the economically active population of the city. The other important social trends include those of the increasing mortality and decreasing fertility rates in the municipality that are manifested in the growth of the death rate of the population, including the growth of infant mortality, as well as reduced birth rate (Edington, 2009). These trends have an adverse effect on the healthcare facility by decreasing the number of potential customers in the long-term perspective. Their influence can be reduced through the development of local healthcare programs to stimulate the birth rate, provision of vaccination and other preventive measures aimed at the reduction of the mortality rate, as well as the participation of the healthcare facility in the development of social programs aimed at providing assistance to certain categories of the population.
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On the contrary, economic trends have a direct influence on the healthcare organization. The level of budget of such facilities tends to lower during the last years, which, together with the lack of municipal programs of medical support for the population results in the insufficient funding (Shen & Eggleston, 2009). The primary direction to minimize the effect of this factor is providing an increase in own budget revenues by raising the efficiency of municipal property management (including the establishment of leasing contracts with pharmacies). Another important factor, the level of demand of the population, manifests itself in the trend for the low value of the effective demand for paid medical services provided by the healthcare institution within its contractual obligations (Edington, 2009). As a result, the facility loses a part of its profit, which may lead to financial losses and wage arrears. One of the ways to minimize its influence is the creation of a flexible system of payment for medical services for patients, establishing a clear pricing for paid medical services and a clear legal separation in the list of free medical services and those provided on a fee basis.
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In order to optimize the activities of municipal healthcare facility in the present conditions, carry out the local reforms, and build an adequate system of healthcare management, it is important to take into account all the factors and trends affecting the operation of the industry. The comprehensive assessment of all influencing factors and trends will allow establishing preferences in modernizing healthcare, balancing and mitigating their negative influence, maintaining and, perhaps, increasing the existing level of medical care in the municipality, which will ultimately affect the quality of life of the population. As a result, such measures will have a positive effect for the municipal healthcare facility both in short and long-term perspectives.
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