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AbstractBackground Securing primary care is an important issue for health policy. Given a threatened shortage of GPs in Germany, there are discussions about what actions to take to guarantee primary care.Objectives The aim was to obtain opinions of German GPs towards (a) the status quo and development of primary care, (b) favoured actions to secure it and (c) assessment of the actions taken.Methods In 2021 and 2022, 96 semi-structured interviews (criterion sampling) amongst GPs were conducted in all German federal states (41 face-to-face, 32 by telephone, 23 via telecommunication application). The data was analysed according to qualitative content analysis. Additionally, a short questionnaire recorded the problem of GP shortage.Results Many interviewees fear a veritable shortage of GPs in the future. They identify structural problems linked to the health care system. The interviewees suggested creating a primary care physician system or upgrading the GP position. They proposed greater support of interests about general practice in education and training, a restructuring of curricula and admissions criteria in higher medical education and reforming GP training. Building up multi-professional outpatient care centres and strengthening task shifting are valuable. The interviewees have observed progress in ensuring primary care but see a need for further action.Conclusion The study has shown that GPs, from their perspective and experience, make specific suggestions to ensure primary care in the long term. Consequently, it is advisable to consider their points of view when planning, implementing and adjusting steps to strengthen primary care.

The purpose of the paper is to identify the main prerequisites and ways of the medical reform in Ukraine under decentralization, and the emergency of fee-for-service medicine in particular. Methodology. The survey is based on the study of legally enforceable enactments which regulate medical sphere and the process of decentralization of power. Results. The article outlines the main prerequisites and ways to solve the issue of the implementation of medical reform in Ukraine under decentralization, including the emergence of fee-for-service-medicine. The problem related to health care reform in general in order to improve the availability and quality of health care have been identified. Statistical data on the main healthcare indicators in Ukraine have been presented. National healthcare accounts of Ukraine have been presented and healthcare expenditures per capita in other countries of the world has been demonstrated. Practical implications. The main steps that are necessary to undertake for implementing changes in the medical field have been determined in the article. They are the following: involvement of communities, development of social infrastructure, transportation of patients and women in labor to hospitals, involvement of social workers, support of medical institutions, and assistance by the communities in public control. It is determined that the biggest challenge for the medical sector is the reorientation to a new level of medical services. The main directions in medicine under decentralization on the implementation of material, organizational and financial conditions to provide local authorities with own and delegated powers have been emphasized. Value/originality. An approach to implementing medical reform that meets the needs of the community is developed and its essence has been explained. The complex of actions on introduction of medical reform under decentralization of the power, which has been explained as an increase in powers and financial possibilities of territorial communities has been generalized.

Introduction: Students from rural areas are under-represented in medical schools. Concerns have been raised about rural applicants' qualifications relative to those of their urban counterparts, and the impact such potential differences in competitiveness may have on their under-representation. Although studies have reported no differences in Grade Point Average (GPA) and Medical College Admission Test (MCAT) scores between applicants with and without rural attributes, to date no study has assessed if performance on the multiple mini-interview (MMI) varies between the two groups. Methods: The MMI scores of 1257 interviewees for admission to the MD program at the Faculty of Medicine, University of Manitoba, in years 2008 to 2011, were studied for an association with graduation from a rural high school and attributes in the following three domains: rural connections, employment in rural areas, and rural community service. Results: There were 205 (16.3%) rural high school graduates among interviewed applicants. Rural high school graduates scored significantly lower (mean of 4.4 on a scale of 1 to 7; p<0.05) than urban high school graduates (4.6). Among rural-attribute domains, those with rural community service alone had the highest MMI scores (4.9) while those with rural connections alone had the lowest scores (4.3; p=0.016). After adjusting for demographics, GPA, and MCAT scores in a multiple linear regression model, rural-attribute domains were not significant predictors of an applicant's MMI score. However, graduation from a rural high school was significantly associated with decreased MMI scores (a 0.122 decrease in predicted MMI scores on a scale of 1 to 7). Conclusion: Despite graduates from rural and urban high schools having comparable GPA, there exists a rural-urban divide in MMI scores that could exacerbate the under-representation of rural students in medical schools. Aboriginal applicants can also potentially be disproportionately affected, as they were more often from rural high schools than from urban high schools. Future studies need to determine systematic and institutional reasons, if any, for the differential in MMI scoring that can affect admission decisions for some rural applicants. It is also to be noted that the magnitude of difference is small enough that it may ultimately be irrelevant for future physician performance and practitioner outcomes. [ABSTRACT FROM AUTHOR]

The current issues of health care in the Russian Federation are consonant with the main causes that cardinally impeded faster implementation and more cohesive coverage with qualified medical care the rural and native population of the Trans-Baikal Region during the pre-revolutionary period. It was only due to the change social political formation that the key principles of Zemstvo medicine were implemented during development of the Soviet model of health care. The reforming of medicine in XXI century has a dramatic impact on accessibility and quality of medical care in the regions of the USSR. The article makes an attempt to reflect the continuity of historical experience of becoming of the pre-revolutionary state rural health care in the Trans-Baikal region with particular conclusions regarding the actual reforming of medical business in Russia.