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Activities of healthcare management entities in Russia

The disclosure of the main features of the history of the formation of the legal framework for the protection of public health in Russia would be incomplete without highlighting the issues of organizational and legal support for healthcare management. Management, as a social phenomenon, is a very promising area of ​​scientific research in the field of law, and this is directly related to the field of healthcare management.

This chapter analyzes the same chronological period of time that was taken as the basis for studying the evolution of regulatory support in the healthcare sector: from the beginning of the 10th century to the end of the 20th century. The phenomena in the field of organizational and legal support of medical management (for example, monastic medicine in Ancient Russia), as well as specific organizational and legal forms of healthcare management (for example, the Pharmaceutical Order of the late XVI - early XVIII century, the People’s Health Commissariat of the first years of the Soviet government) are investigated.

In this regard, the following aspects of the topic under consideration have been comprehensively analyzed:

- types of medical care that have become widespread in Ancient Russia (monastic, secular, traditional medicine);

- Pharmaceutical order as the first centralized medicine management body in Russia;

- the evolution of public health authorities in various historical periods of the development of Russia:

a) Medical office;

b) Medical College;

c) Medical Department of the Ministry of the Interior;

d) People's Commissariat of Health;

e) the Ministry of Health of the USSR.

The choice of these objects for a more detailed study is associated with a certain kind of selection, since for such a fairly long period of time, a rather large number of phenomena in the field of health protection of the country, organizational and legal forms of medicine management, which are of interest for studying from the perspective of history and theories of legal regulation by the healthcare sector in Russia. In this regard, the following criteria were developed for the selection of research objects on this issue:

- the adoption of the legal act under study led to the emergence of a qualitatively new form of organization of healthcare management and (or) changed the system of providing medical care to the population;

- the emergence of new functions (powers) that were absent from the previously existing health management bodies;

- a fundamental change in the overall strategy for the evolution of public health management in the country.

Folk, monastic, secular medicine - these are various types of medical care that existed in Ancient Russia. They can be considered as organizational and legal options for medical activity, since each of them had peculiar, organizational and legal characteristics that are different from the others.

The monastery medicine was an option of providing medical care, in which the help was provided by specially trained monks in the conditions of monastery hospitals. The famous historian of Russian medicine M. Mirsky cites data according to which “in the first half of the XIII century up to 70 monasteries were known, and in large cities there were, sometimes, more than ten: 17-18 in Kiev and Novgorod, 4 or more - in Vladimir Suzdal, Smolensk, Chernigov, Galich. Monasteries were in almost every ancient Russian city or its suburbs and were an integral part of the city structure and the princely administration structure "* (29).

The latter circumstance (the inclusion of monasteries in the structure of princely administration) indicates that the entire structure of monasteries (including monastery hospitals) to a certain extent were subject to administrative regulation of both church and secular authorities. In this regard, it is necessary to consider the bilateral system of management of monastic medicine: management from the principalities (secular) and from the church managerial link (monastic). The monastery hospitals were located at the monasteries, which to a greater extent determines the subordination of their church charter and uniform monastic rules. In addition, the main document defining the organization and direct management of the church economy was, as already noted, the Church Charter. Y. Duplenko rightly notes that "the Church Statute of Prince Vladimir the Holy already prescribes the organization of hospitals, as well as shelters for the blind, crippled and elderly, at churches and monasteries" * (30).

Secular medicine was a variant of the organization of medical care, in which the help was provided by professional doctors with secular (university) education, on a reimbursable basis and the possibility of treating patients at home.
As a rule, secular medicine was the most common in cities, which served as the basis for its second name - "urban medicine". "The concentration of a significant number of people in shopping and craft centers contributed to the emergence of a new profession -" healers. "There is a gradual development of traditional medicine into a professional one" * (31). Obtaining a fee for the provision of medical care, of course, contributed to an increase in the material well-being of doctors, which served as an incentive to improve their knowledge and, as a result, improve the quality of medical care for the population.

It should be noted that already in Ancient Russia there was a certain opposition between secular and monastic medicine: "spiritual and secular medicine, apparently, were in a certain antagonism to each other. The best evidence of such antagonism in the era of Vladimir Monomakh is the well-known dispute between" without a doctor "Agapit, a monk of the Kiev Pechersk Lavra and a well-known Armenian doctor in Kiev, whose name Pechersky Paterik did not leave for us" * (32).

The management of secular (city) medicine was difficult due to the lack of special bodies whose functions would include the organization and management of medical care for the population in cities. This was due, first of all, to the insufficient number of “curers”, so the organization of even a primitive system of medical support for the population, even in cities, was almost impossible.

Secular (city) medicine was regulated by the norms of the first set of written Russian law - Russian Truth. However, in this regulatory document, only issues of the provision of medical assistance for injuries resulting from unlawful actions of third parties were clearly spelled out. Issues of the legal, economic aspects of providing medical care to afflicted diseases were not adequately addressed. This allows us to conclude that the management of secular medicine was in a less developed form than the management of monastery medicine.

Studying the aspects of regulatory regulation of traditional medicine, it is necessary, first of all, to note that this is a variant of medical care, in which assistance was provided by various kinds of sorcerers, healers, healers based on people's faith in supernatural powers and the use of natural resources. A well-known researcher of the phenomenon of traditional medicine N. Vysotsky, in the introduction to his monograph of 1911, noted that "its first beginnings (traditional medicine - A.P.) are hidden in deep prehistoric antiquity and are caused by instinctive attempts to self-preservation. As observations and experience accumulate, it gradually expands and this empirical field of folk healing is developing "* (33).

Regarding the reasons for the further development of traditional medicine, the point of view of M. Kuzmin is not without interest, noting that "the monasteries attracted large masses of people (pilgrims), however, hospital and outpatient care was very limited and could not in any way satisfy the needs of the people. Therefore, along with the monastery continues to develop and traditional medicine "* (34).

Through the prism of legal regulation of health care, it is necessary to consider the issues of managing traditional medicine, which was regulated, to a greater extent, by moral and ethical standards, which were based on people's ideas about good and evil, justice and mutual assistance, which formed the basis of the system of social and legal regulation of activities people's healers. With this approach, presumably, the governing bodies and regulatory elements existed in their infancy (the council of elders, the popular council, etc.).

Aspects of management have played a significant role in improving the quality of medical care in the era of Ancient Russia. The point of view of S. G. Stetsenko on this issue, in accordance with which, it was carried out most qualitatively in secular (city) medicine. This is due to the following circumstances:

- doctors of urban medicine carried out their activities on a professional basis;

- healing was a source of their income;

- the princely estate and the city nobility preferred to be treated by representatives of secular (city) medicine, which was an additional incentive to maintain the quality of medical care at a fairly high level.

The next in terms of the quality of assistance provided was monastery medicine and then folk medicine * (35).
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