Introduction: A survey and analysis of the dynamics of global global trends, macrofactors and related changes in the healthcare industry shows that over the past 30 years, the medical community has gained unlimited access to information and modern expensive technologies, and medical organizations have become service-type economic entities providing high-risk services. Patients have become open opponents of the dominant relatively recently paternalistic model of the relationship between the doctor and the patient. Society in all countries has taken a clear antagonistic stance towards health workers, viewing them as a service resource that must meet the rapidly growing needs for reproductive health. Materials and methods: Information search was conducted for 2000-2020. in medical databases academy Google, OSF, CORE, MEDLINE, Cochrane Collaboration; EMBASE, SCOPUS, ISI, Web of Science. Analytical reviews, retrospective and prospective observational studies of high methodological quality followed by scenario-based prediction were to be analyzed. Results and discussion: Analysis of the main trends in the development of modern healthcare. The influence of global global trends on the main directions of the industry in the Russian Federation is shown. The work describes possible scenarios for the development of health care on a distant horizon and possible dominant models of medical organizations, the benefits and risks of each of the models. Conclusion. Identified prognostic indicators specific to certain trends of change, robastic and conditional competencies, technologies and resources for relevant scenarios.