1. Characteristics of Health Care in Limited Access Territories

2. The local authorities declare a territory to be a limited-access administrative territory when it holds within its boundaries industrial enterprises that design, manufacture store, or recover weapons of mass destruction, recycle radioactive and other materials or military and other facilities that operate under special security regimes to ensure safety or protection of state secrets, and stipulate special living conditions for those who live and work there. (RF Law Regarding Limited- Access Administrative Territories, No 3297-1 of July 14, 1992.) Definition of Limited Access Administrative Territory

3. RF Ministry of Health Regional Public Health Departments District and Municipal Public Health Departments Healthcare and Maintenance Institutions MedbioekstremFederal Administration Ministry of the Atomic Industry (Minatom) Healthcare and Maintenance Institutions (Infirmaries) Minatom Enterprises Hierarchical connections Interactive connections RF Public Health System

4. The Federal Administration for biomedical and emergency issues of the RF Ministry of Health (Medbioextrem Administration) is a government agency within this ministry and is the Federal executive agency with authority over healthcare of workers employed in certain sectors of industry with particularly dangerous working conditions. Major Objectives of MEDBIOEXTREM Federal Administration: medical care of citizens living in the limited-access territory, employees of organizations, institutions, and enterprises, where working conditions are associated with exposure to particularly dangerous and harmful physical, chemical and biological production factors ; provision of emergency medical aid in radiation, chemical and other accidents in the organizations and institutions, enterprises and territories served ; design and implementation of research programs to study the physiological effects of particularly dangerous and harmful physical and chemical production factors on humans and also to develop the medical specifications for medical agents to protect workers and the public from these effects; comprehensive medical and ecological evaluation of the health of workers and the public and the state of the environment in limited access administrative territories in which facilities of the RF Ministry of Atomic Energy are located.

5. The History of Central Infirmary-50 Over the more than half century of its existence Central Infirmary- 50 has grown into a large health care and maintenance institution, which employs more than 2.5 thousand people. The infirmary was established in 1946 near historical sites of the Sarov Desert at the facilities of the local hospital to provide medical care of workers at the nuclear center.

6. Demographic data Increase in the size of the population through increasing migration to the city Increase in the number of elderly

7. Since 1993 natural rate of population change has been negative Decrease in number of children

8. Changes in overall mortality rate over time Overall mortality rate is consistently below that of the RF as a whole, by an average of 20%

9. Structure Of Mortality Rate

10. Number of violent deaths

11. Structure of Morbidity Rate

12. Rate of Alcoholism, Drug Addiction, and Substance Abuse (per 100,000 population)

13. Rate of Viral Hepatitis in the Adult Population in Absolute Numbers

14. Health Care System in the City of Sarov Central Infirmary-50 Municipal Administration Mandatory Health Insurance Territorial Fund Federal Administration Hospital Municipal Polyclinic First and Emergency Dispensary Aid Plant Polyclinic Psychoneurologic Dispensary - Childrens Sanatorium Dermatological and Venereal Womens Health Center Dental Polyclinic - Childrens Polyclinic Central City Sanitary and Epidemiological Oversight Agency City Pharmacies Private Medicine Prophylactic Sanatorium Medical School Tuberculosis Dispensary Paraclinical Divisions Auxiliary Divisions Indicators of Central Infirmary-50s performance in 2000 patients treated in the hospital 21177 visits to polyclinics 907861 first aid runs 36121 Central Infirmary-50s Personnel: - Physicians 408 Mid-level medical personnel 1014 Junior medical personnel 493 Others 224

15. Federal Budget 5,1 % Physical examinations of employees in industrial enterprises Observation and treatment of occupational diseases Expert evaluation of fitness to work of those with occupational diseases Provision of aid in emergencies Implementation of ad hoc Federal programs Municipal Budget 51,5% Provision of socially significant medical aid Psychiatry and addiction treatment Venereal diseases Tuberculosis Administrative expenses Paid Medical Care 5,3% Some forms of addiction treatment Some forms of dental treatment Periodic medical examinations Auxiliary services enhancing the comfort of treatments if requested by patients Territorial Mandatory Medical Insurance Fund 38.1% Provision of medical care in accordance with territorial program for mandatory medical insurance (29 types) FUNDING SOURCES

16. Structure of Health Care Expenses

17. Age Structure of Physician Staff

18. Main Issues Negative natural population replacement rate Aging of population High level of morbidity in children and adolescents Increase in diseases association with use of alcohol and narcotics Lack of a funding system to support the development of medical care

19. Major Goals of the Infirmary Maintain the accessibility, scope, and quality of medical care Develop medical care by reallocation and efficient use of available resources, and also obtaining outside resources Implementing a medical rehabilitation system for chronic diseases of children and adolescents Prevention and treatment of drug addiction and diseases associated with use of drugs and alcohol