Paid services in medical organizations. requirements for their provision. Legal basis for the provision of paid medical services in health care institutions Paid medical services in health care institutions

The government of Moscow
MOSCOW CITY HEALTH DEPARTMENT

ORDER

On approval of the Rules for the provision of paid services to citizens and legal entities by state organizations of the health care system of the city of Moscow

Document as amended by:
by order of the Department of Health of the city of Moscow dated September 9, 2015 N 764;
by order of the Department of Health of the city of Moscow dated March 2, 2017 N 148;
;
by order of the Department of Health of the city of Moscow dated June 14, 2017 N 427.
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In pursuance of the Decrees of the Government of the Russian Federation of October 4, 2012 N 1006 "On Approval of the Rules for the Provision of Paid Medical Services by Medical Organizations" and of August 15, 2013 N 706 "On Approval of the Rules for the Provision of Paid Educational Services", as well as the Decree of the Government of Moscow of December 21, 2010 N 1076-PP "On the procedure for the exercise by the executive authorities of the city of Moscow of the functions and powers of the founder of state institutions of the city of Moscow"
(Preamble as amended by Order No. 283 of April 14, 2017 of the Department of Health of the City of Moscow.

I order:

1. Approve the Rules for the provision of paid services to citizens and legal entities by state organizations of the health care system of the city of Moscow (hereinafter referred to as the Rules) (annex to this order).

2. When providing paid services, the heads of organizations of the state healthcare system of the city of Moscow should be guided by the rules approved by the Decrees of the Government of the Russian Federation of 04.10.2012 N 1006, of 15.08.2013 N 706.
by order of the Department of Health of the city of Moscow dated April 14, 2017 N 283.

3. The Head of the Department of Affairs and Coordination of Activities E.L. Nikonov ensure that this order is posted on the official website of the Moscow City Health Department.
(Clause as amended by order of the Department of Health of the city of Moscow dated April 14, 2017 N 283.

4. To consider invalid the orders of the Department of Health of the city of Moscow:

- dated December 9, 2011 N 1608 "On approval of the rules for the provision of paid services to citizens and legal entities by state institutions of all types of the Department of Health of the City of Moscow";

- dated 04.07.2013 N 677 "On amendments to the order of the Department of Health of the city of Moscow dated 09.12.2011 N 1608"

5. The control of the execution of this order shall be entrusted to the First Deputy Head of the Department of Health of the City of Moscow V.V. Pavlov.
(Clause as amended by order of the Department of Health of the city of Moscow dated April 14, 2017 N 283.

Minister of the Government of Moscow,
head of department
health care of the city of Moscow
G.N. Golukhov

Appendix. Rules for the provision of paid services to citizens and legal entities by state organizations of the health care system of the city of Moscow

Appendix
to the order of the Department
health care of the city of Moscow
dated October 2, 2013 N 944

These Rules establish the procedure for the provision of paid services to citizens and legal entities by medical, educational and other state organizations of the healthcare system of the city of Moscow.

The rules are developed in accordance with the current legislative and regulatory acts of the federal and regional levels.

1. Paid services are provided by medical, educational and other state organizations of the healthcare system of the city of Moscow (hereinafter referred to as state organizations) to citizens and legal entities in accordance with the legislation of the Russian Federation and types of income-generating activities permitted by the charters of state organizations. The provision of paid medical, educational and other services subject to licensing is carried out on the basis of a list of works, services that make up medical, educational and other activities and specified in the license for activities issued in the prescribed manner.

The Moscow City Health Department maintains a register of subordinate state organizations providing paid services (official website www.mosgorzdrav.ru)."

2. The date of commencement of the provision of paid services, the list of paid services provided by the state organization, prices (tariffs) for paid services, as well as changes in the list of paid services and changes in prices (tariffs) for paid services are approved by order of the state organization. Lists of paid services and price lists (tariffs) for paid services are compiled indicating the codes of the paid services provided in accordance with the approved nomenclature of medical and educational services.

Prior to the issuance of an order by a state organization to approve the list of paid services or to amend this order, the list of paid services that the state organization is going to provide is subject to approval by the Moscow City Health Department.

In case of termination of the provision of paid services, state organizations send relevant information to the Moscow City Health Department within 3 days in order to make changes to the register of state organizations providing paid services on the official website of the Moscow City Health Department.

3. The provision of paid services to citizens is carried out with the voluntary informed consent of the patient. The fact of voluntary informed consent to the provision of paid medical services is recorded in the patient's medical record.

4. State medical organizations of the Moscow Department of Health (hereinafter referred to as medical organizations) that provide the relevant types and volumes of medical care without charging a fee under the Program of State Guarantees of Free Provision of Medical Care to Citizens and the Territorial Program of State Guarantees of Free Provision of Medical Care to Citizens (hereinafter - respectively Program, Territorial Program), have the right to provide paid medical services:

a) on other terms than provided by the Program, territorial programs and (or) target programs, at the request of the consumer (customer), including, but not limited to:

- establishment of an individual post of medical supervision during treatment in a hospital;

- the use of drugs that are not included in the list of vital and essential drugs, if their purpose and use is not due to vital indications or replacement due to individual intolerance to drugs included in the specified list, as well as the use of medical devices, medical nutrition, in including specialized health food products that are not provided for by the standards of medical care;

b) when providing medical services anonymously, with the exception of cases provided for by the legislation of the Russian Federation;

c) citizens of foreign states, stateless persons, with the exception of persons insured under compulsory health insurance, and citizens of the Russian Federation who do not permanently reside on its territory and are not insured under compulsory health insurance, unless otherwise provided by international treaties of the Russian Federation;

d) when applying for medical services on your own, with the exception of cases and the procedure provided for in Article 21 of the Federal Law of November 21, 2011 N 323-FZ "On the Basics of Protecting the Health of Citizens in the Russian Federation", and cases of providing an ambulance, including an ambulance specialized, medical care and medical care provided in an emergency or emergency form.

5. Medical organizations can provide medical services for a fee: an individual medical post, the provision of medical services at home (except for cases when medical care at home is provided for medical reasons), medical and social assistance and other services, as well as additional services , provided in the process of providing medical care, including household and service: delivery of medicines, rental of medical products, individual preparation or ordering of dishes at the request of the patient, accommodation in a superior ward and other services provided additionally in the provision of medical care.

6. Paid services, their types, volumes and terms of provision must comply with licensing requirements, the terms of the Agreement, standards and procedures for the provision of medical care, educational and other services, regulatory documents (requirements) established by the Ministry of Health of the Russian Federation, the Ministry of Education and Science of the Russian Federation and other requirements established by law.

7. Paid medical and educational services may be provided to the full extent of the standard of medical care, state educational standards, or as one-time consultations, procedures, diagnostic studies and other services, including those in excess of the standards being met.

8. Requirements for the provision of paid services, including the content of the standards, procedures and conditions for the provision of medical care, service, educational and other services are determined by agreement of the parties and may be higher than provided for by the standards, procedures and other regulatory documents (requirements) approved by the Ministry of Health of the Russian Federation, the Ministry of Education and Science of the Russian Federation, as well as standards, procedures, conditions and requirements established on their basis by other federal and regional executive authorities.

9. When providing paid services, the mode of operation of a state organization may be established according to a separate schedule, subject to its agreement with the Founder.

At the same time, the availability, quality and volume of medical services provided under the Program, the Territorial Program of State Guarantees for the Provision of Free Medical Care to the Population of the City of Moscow, targeted comprehensive programs and, in terms of educational services provided free of charge in accordance with federal state educational standards, should not deteriorate.

10. The procedure for the provision of paid services in state organizations is regulated by the Regulations on the procedure and conditions for the provision of paid services in a state organization, developed on the basis of these Rules and approved by the head of the state organization, internal regulatory documents (orders, internal labor regulations, collective agreements, work schedules and etc.), as well as other requirements of the current legislation.

11. To provide paid services, taking into account the demand of the population for the relevant types of services and the availability of necessary funds, it is possible to organize special structural units (departments, chambers, offices for the provision of paid services), which are created by order of the head of the state organization. To carry out work on the provision of paid services, additional positions of medical and other personnel may be introduced, maintained at the expense of the sale of paid services, as well as specialist consultants from other medical institutions, research institutes, higher educational institutions with which labor contracts are concluded or civil contracts.

12. When providing paid medical services, methods of prevention, diagnosis, treatment, medical technologies, medicines, immunobiological preparations and disinfectants permitted for use in the manner prescribed by law must be used.

13. Paid services (works) are provided under contracts at the expense of personal funds of citizens, insurance premiums for voluntary medical insurance, funds of enterprises, institutions and organizations and other funds permitted by law.

14. The conclusion of contracts by state organizations for intermediary services to attract patients by third parties is not allowed.

15. Medical services cannot be provided for a fee in the provision of emergency medical care, which is provided immediately in conditions requiring medical intervention for emergency indications (in case of accidents, injuries, poisoning and other conditions and diseases); as well as when conducting a forensic medical examination and a forensic psychiatric examination (with the exception of examinations carried out in civil and arbitration cases, cases of administrative offenses); pathological and anatomical autopsy and military medical examination.

16. When receiving medical care under the Territorial Program for the provision of free medical care, the following services are not subject to payment:

- prescription and use for medical reasons of drugs (in cases of their replacement due to intolerance, rejection) that are not included in the list of vital and essential drugs;

- accommodation in small wards (boxes) of patients for medical and (or) epidemiological indications;

- joint stay of one of the parents (another legal representative) or another family member in a medical institution when providing medical care in a hospital with a child under the age of four inclusive throughout the entire period of treatment, and with a child over four years of age - if indicated;

- medical and transport services in the provision of medical care within the framework of the standards of medical care (examination and treatment of a patient in a round-the-clock hospital) in the absence of the possibility of their provision by a medical or other organization providing medical care to the patient;

- transportation, storage in the morgue of biological material received for examination, corpses of patients who died in medical and other organizations, disposal of biological material.

17. The provider of paid services is obliged to provide information about the provider of paid services and the services provided by him in accordance with the list approved by federal legislation on order of rendering paid medical and educational services.

Information posted on information stands (racks) should be available to an unlimited circle of people during the entire working time of a state organization providing paid services. Information stands (racks) are located in a place accessible to visitors and are designed in such a way that you can freely get acquainted with the information posted on them.

In addition, at the request of the consumer and (or) the customer, the service provider provides for review:

a) a copy of the constituent document of the state organization, the regulation on its branch involved in the provision of paid services;

b) a copy of the license to carry out medical, educational and other activities subject to licensing with a list of works (services) in accordance with the license.

At the conclusion of the contract, at the request of the consumer and (or) the customer, they must be provided in an accessible form with information on paid services containing the following information:

a) the procedures for the provision of medical care and the standards of medical care used in the provision of paid medical services;

b) information about a specific medical worker providing the relevant paid medical service (his professional education and qualifications);

c) information about the methods of providing medical care, the risks associated with them, possible types of medical intervention, their consequences and the expected results of the provision of medical care;

d) a list of categories of consumers entitled to receive benefits, as well as a list of benefits provided in the provision of paid medical, educational, including paid additional educational services in accordance with federal laws and other regulatory legal acts.

e) basic and additional educational programs, the cost of educational services for which is included in the basic fee under the contract;

f) additional educational programs, special courses, cycles of disciplines and other additional educational services provided for a fee only with the consent of the consumer.

The contractor is obliged to inform the consumer at his request of other information related to the contract.

18. Paid services cannot be provided by the contractor in exchange for services performed within the framework of the state (municipal) task.

19. State organizations are not entitled, without the consent of citizens, to provide additional services for a fee, as well as condition the provision of some services on the obligatory performance of others.

20. The procedure for concluding contracts for the provision of paid services and the requirements for their content are established by federal legislation on the procedure for the provision of paid services by state organizations.

21. When concluding an agreement, the consumer (customer) is provided in an accessible form with information on the possibility of obtaining the appropriate types and volumes of medical care, educational services without charging a fee within the framework of state guarantees established by the legislation of the Russian Federation.

The consumer's refusal to conclude a contract for the provision of paid services cannot be the reason for reducing the types and volumes of medical care provided to such a consumer without charging a fee.

22. The prices at which state organizations (except for autonomous ones) provide paid services, with the exception of those specified in paragraph 23 of these Rules, are set in accordance with the procedure approved by a separate order of the Moscow City Health Department.

23. Prices for orthopedic dental services provided in dental clinics and denture departments of medical organizations of the privileged category of citizens at the expense of the budget of the city of Moscow are subject to state regulation in the manner established by the Government of Moscow.

24. Payment for services is carried out by non-cash payments through credit organizations or by depositing cash directly to the cash desk of a state organization with the issuance to the patient, client of a document confirming payment (cash receipt, receipt or other form of strict reporting (document of the established sample).

25. At the request of the person who paid for the services, the medical organization is obliged to issue a Certificate of payment for medical services for submission to the tax authorities of the Russian Federation in the form established by order of the Ministry of Health of the Russian Federation and the Ministry of the Russian Federation for Taxes and Duties dated July 25, 2001 N 289 / BG-3-04 / 256 "On the implementation of the Decree of the Government of the Russian Federation of March 19, 2001 N 201" On the approval of lists of medical services and expensive types of treatment in medical organizations of the Russian Federation, medicines, the amounts of payment for which at the expense of the taxpayer's own funds are taken into account when determining the amount of social tax deduction".

26. Accounting for funds received by state organizations from the provision of paid services is carried out in accordance with the procedure established by the budgetary legislation of the Russian Federation, the Government of Moscow, and the provisions of the Budget Code of the Russian Federation.

27. State organizations providing paid services are required to keep accounting records separately for the main activity and for the provision of paid services.

28. State organizations have the right to carry out income-generating activities that correspond to these goals, only in so far as this serves to achieve the goals for which they were created, provided that such activities are indicated in their constituent documents.

Income received by a state-owned organization from this activity shall go to the budget of the city of Moscow.

Income received by state budgetary and autonomous organizations from these activities and property acquired at the expense of these incomes shall be at the independent disposal of the organization.

29. Item excluded - order of the Department of Health of the city of Moscow dated June 14, 2017 N 427 ..

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Clauses 29, 30 and 31 of the previous edition are considered, respectively, clauses 30, 31 and 32 of this edition - order of the Moscow City Health Department dated September 9, 2015 N 764.

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30. In accordance with the legislation of the Russian Federation, state healthcare organizations are liable for non-fulfillment or improper fulfillment of the conditions for the provision of paid services, non-compliance with the requirements for methods of diagnosis, prevention and treatment, training, as well as for causing harm to the health and life of the patient.

31. The Federal Service for Supervision of Consumer Rights Protection and Human Welfare, the Moscow City Health Department, and other state bodies that, in accordance with laws and other legal acts of the federal and regional levels, are entrusted with checking the activities of state organizations.

32. The harm caused to the life and health of the patient as a result of the provision of low-quality paid medical services is subject to compensation by the contractor in accordance with the legislation of the Russian Federation.

Revision of the document, taking into account
changes and additions prepared
JSC "Kodeks"

Alisa Luzgina

Six months have passed since the new rules for the provision of paid medical services by medical organizations, approved by Decree of the Government of the Russian Federation of 04.10.2012 No. 1006, came into force in pursuance of Art. 84 of the Federal Law of November 21, 2011 No. 323-FZ "On the basics of protecting the health of citizens in the Russian Federation". The provision of paid medical services has received a legislative basis. The Moscow City Polyclinic No. 220, a state budgetary health care institution, headed by the chief physician, candidate of medical sciences, doctor of the highest category, Vera Shastina, began providing paid medical services long before the legislative framework was updated. According to the results of the "Formula of Life" competition, GP No. 220 is the best polyclinic in the capital in 2012. Elena Kravchenko, deputy chief physician for paid services, shared her rich experience of the polyclinic in this area.

— Elena Mikhailovna, why did you decide to talk about the experience of organizing paid medical services by your polyclinic?

- Since when did your medical institution begin to provide paid services and what was the impetus?

Our clinic has a rich history. The first mention of it in documents dates back to 1919, and already in 1944 150 people worked in it. The modern building of the polyclinic was erected in 1976, and the need for its construction arose due to an increase in the number of attached patients and the volume of work. And the polyclinic has always maintained a high quality of services and an individual approach to the patient, which are a tradition.

GP No. 220 began to provide paid services more than eighteen years ago. Why was there a need to organize paid services? Until August 1990, the polyclinic belonged to the Fourth Directorate under the USSR Ministry of Health, where employees of organizations and institutions under the USSR government were served, funding was sufficient to maintain the polyclinic and pay employees.

In August 1990, the polyclinic was transferred to the Main Department of Health of the Moscow City Executive Committee without changing the staff and structure. In 1993-1994, in connection with the introduction of compulsory medical insurance, the financing structure of the polyclinic changed.

Since the polyclinic had a large number of employees (due to the specifics of the serviced contingent), the presence of a building of increased comfort for patients: huge lobbies, halls, corridors, armchairs, flowers, own territory, patio (the total area of ​​the building is more than 27 thousand sq. meters), modern equipment - and all this must be maintained, maintained - the administration of the institution turned to the management with a request to allow the provision of paid medical services. The permission was obtained, and since 1994, the polyclinic, in addition to budget funds and compulsory medical insurance, began to earn money from the provision of paid medical services.

During these eighteen years, the polyclinic provided paid medical services to a large number of patients, mostly insured under voluntary medical insurance contracts. In addition, the polyclinic provided paid medical services under contracts with other legal entities, as well as individuals. Considerable experience has been accumulated in the provision of paid medical services, thanks to which we can now share it with colleagues.

Since the fourth quarter of 2012, GBUZ "GP No. 220 DZM" has been an outpatient center, consisting of a parent institution and four branches.

- Elena Mikhailovna, please tell us about the peculiarities of organizing paid medical services in your medical institution, about working with insurance companies and other categories of patients - about everything related to this type of activity in the City Polyclinic No. 220.

- Once we were negotiating with an insurance company, and one of its representatives expressed surprise that patients want to be attached to our clinic, while there are a large number of modern commercial medical centers. One of the reasons for this is that many of our patients have already been treated here under the voluntary medical insurance program, and now they come to us, their children and grandchildren. This shows how important reputation is to a healthcare facility. The more attentive the attitude towards clients, the higher the quality of medical services that you provide them, the more they seek to receive services from you.

And the merit is not the building of increased comfort for the patients of the polyclinic, although its arrangement also plays a role. The main thing is the staff of the polyclinic, the level of medical staff (27 candidates of medical sciences, 144 doctors of the highest qualification category), long work experience, attention to each patient.

The medical and diagnostic department, which provides paid medical services, has been successfully managed since 1997 by a doctor of the highest category Tatyana Valentinovna Frolova. In her department, almost all doctors have the highest category or the degree of candidate of medical sciences. A full range of medical services is provided in a two-shift mode of operation of the department, in addition to the medical services of those departments that ensure the fulfillment of both the state task for the free provision of medical care to citizens under compulsory medical insurance, and paid medical services (these are the X-ray department, computed tomography, clinical diagnostic laboratory). The department is located on separately allocated areas of the polyclinic, it is equipped with modern medical equipment, which is also purchased and maintained at the expense of paid medical services.

For many years, the polyclinic has been focused on providing medical services to a certain contingent - veterans of the Great Patriotic War, participants in other wars, Chernobyl victims, who need to pay increased attention from the medical staff, and their reception sometimes requires a significant amount of time. In this regard, it was decided to separate the location of the department providing paid medical services and its registry, although there is no mention of the need to allocate separate areas in any regulatory documents.

In 2013, with the release of orders of the Ministry of Health of the Russian Federation on the attachment procedure, the number of patients wishing to attach to the Polyclinic to receive services under the compulsory medical insurance program increased, and separately allocated areas for paid medical services became even more relevant.

For 2012-2013, many regulatory documents were adopted that influenced the organization and streamlined the provision of paid medical services:

• Decree of the Government of the Russian Federation of November 10, 2011 No. 917 “On approval of the list of types of educational and medical activities carried out by organizations for the application of a tax rate of 0 percent on corporate income tax”, which made it possible to accumulate funds for the purchase of the necessary medical equipment at the end of 2012;
• Art. 84 of the Federal Law of November 21, 2011 No. 323-F3 “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”, which introduced the legislative framework for paid medical services;
• Decree of the Government of the Russian Federation of 04.10.2012 No. 1006 “On Approval of the Rules for the Provision of Paid Medical Services by Medical Organizations”;
• Decree of the Government of the Russian Federation of October 22, 2012 No. 1074 “On the program of state guarantees of free provision of medical care to citizens for 2013 and for the planned period of 2014 and 2015”;
• approved by the Ministry of Health of the Russian Federation in a large number of procedures for the provision of medical care and standards of medical care;
• issued orders of the Department of Health of the city of Moscow.

Despite the extensive experience of the polyclinic, in connection with the updating of the regulatory framework in anticipation of the entry into the market of paid medical services from January 1, 2013, a large number of new participants, in the fourth quarter of 2012, the service providing organization and support of paid medical services was strengthened in the polyclinic.

The priority activity of the Polyclinic in the provision of paid medical services is contracts with insurance companies for the provision of services to insured persons under VHI agreements. We held talks with insurance companies to analyze the work done in previous years of fruitful cooperation, outlined ways for further cooperation on the principles of partnership in order to reduce losses on both sides. As a result of the negotiations, we received answers to questions of interest to us: satisfaction with the quality of the provision of paid medical services and their cost, the structure of VHI programs and the possibility of increasing their range, and certain questions on medical and economic expertise. Insurance companies, in turn, were interested in the issues of cost reduction per insured and the speedy implementation of new software on our part to improve the organization of joint work. As a result of meetings with insurance companies, we achieved very important goals: we developed a pricing strategy, defined our niche in the VHI services market in Moscow. As of January 1, 2013, our polyclinic has entered into contracts with more than 70 insurance companies and other legal entities.

Contracts with other legal entities are contracts for professional examinations and the provision of other medical services to employees of organizations, contracts for the provision of services to patients of medical centers that do not have services, for example, X-ray examinations, computed tomography, laboratory tests, etc.

We conclude contracts with individuals for the provision of paid medical services if the citizens themselves have expressed a desire to receive services for a fee and have signed an informed consent to refuse to receive these types of medical care free of charge. In our polyclinic, these are mainly patients attached under VHI agreements, for whom these types of medical services are either not included or are limited in the VHI attachment program, as well as those patients for whom these types of medical services are not included in the territorial program of state guarantees, or they themselves decide what types of surveys they would like to carry out.

In the first quarter of 2013, an automated information system was introduced in the department of paid medical services, acquired at the expense of funds earned with the help of paid services, which includes a set of software modules and subsystems that allow automating various areas of activity of the polyclinic: making an appointment at the registry office and at website, the formation and uploading of lists of insured persons, the preparation and accounting of invoices and transcripts for invoices for working with legal entities and individuals, the maintenance of electronic outpatient patient records by medical workers. This automated information system allows you to regularly conduct a preliminary internal examination of the rendered medical services in order to minimize losses, draw up and analyze the progress of the implementation of contracts with legal entities and individuals. And also, we have finally implemented the integration of AIS with laboratory systems for monitoring and promptly obtaining data on laboratory studies. Like any complex program, our AIS requires improvements, taking into account the specifics of our clinic.

Not to the detriment of the state task

A budgetary institution can provide paid medical services subject to the fulfillment of the State task for the implementation of state guarantees of free provision of medical care to citizens, as prescribed in Federal Law No. 83-FZ of May 8, 2010.

The Polyclinic carries out monthly monitoring of the implementation of the visit plan for all structural divisions. The state task approved for 2013 1060 thousand visits. For six months of 2013, the share of visits for paid medical services amounted to 12% of the total number of visits, taking into account the state order.

Since 2013, the financing of costs for the provision of services (communications, transport, utilities, property maintenance and other services) has been carried out only at the expense of compulsory health insurance and income-generating activities.

The polyclinic is planned at the expense of income-generating activities in 2013 from 50 percent or more to finance costs under article 220 - “Payment for work, services”. At least 15% of the planned income will be directed to the acquisition of non-financial assets and the development of the Polyclinic: the purchase of modern equipment, spare parts for equipment and consumables.

— Please tell us about the plans for the development of paid medical services in the polyclinic.

- The team that works on the direction of paid medical services to GBUZ "GP No. 220 DZM" has done a lot of work, but we are not going to stop there. Our plans include the improvement and expansion of work on the provision of paid medical services, in particular, in branches. As already mentioned, our polyclinic as an outpatient center has four branches, and since 2014 we plan to include two of them in programs under voluntary medical insurance contracts with insurance companies. Currently, the branches are focused on conducting preventive examinations, issuing various certificates based on the conclusion of the medical commission and providing paid medical services in a day hospital. We also plan to expand the range of paid medical services provided through new medical equipment, which is purchased with funds received from the provision of paid medical services.

So, in 2013, new equipment was purchased: LOGIQ E9 ultrasound diagnostic system, SmartXide laser surgical device, SWISS DOLORCLAST extracorporeal shock wave therapy device, ultraviolet blood irradiation device, laser device for intravenous blood irradiation, new equipment for a dental laboratory for manufacturing nylon prostheses, laser devices: surgical and dermatological.

In the second half of 2013, in connection with the commissioning of the PCR laboratory, our clinical diagnostic laboratory will expand the range of laboratory tests.

Currently, one of the priorities is the further development of paid medical services for individuals who will be able to receive services that are not included in the program of state guarantees: shock wave therapy, medical services in aesthetic medicine, and others.

In reality, we have a lot of plans, and we shared only what has already been achieved and what we intend to implement in the very near future. The legislative base is being formed, and further development of paid medical services is inevitable.

We invite our colleagues from budgetary and commercial institutions to dialogue. A forum will be opened on the website of our polyclinic to discuss the experience of providing paid medical services and the application of regulations. Forum address on the Internet: http://forum.gp220.ru, and you can also write to the email address: [email protected]

We are committed to the exchange of experience. Despite the importance of this topic, it is not discussed enough in the press and on the Internet, and if discussion does occur, it is of an accidental nature. The exchange of experience will allow all of us to raise the level of paid medical services as soon as possible so that it is comfortable for our patients and allows them to receive all the medical services they need.

An important document for the medical community is being publicly discussed - the draft Rules for the provision of paid medical services by medical organizations. According to officials of the Ministry of Health, at the moment, some medical organizations impose paid services on patients, replacing them with free assistance. At the same time, the current regulatory legal framework does not allow a clear distinction between which services should be provided free of charge and which on a reimbursable basis. The amount of the cost of medical services provided by state institutions on a paid basis is also questionable.

The main provisions of the bill

Changes to the rules proposed by officials of the Ministry of Health will allow:

• clearly distinguish between the conditions for the provision of medical care within the framework of territorial programs of state guarantees of free provision of medical care to citizens (hereinafter referred to as territorial programs) and paid medical services
• prevent the replacement of free medical services with paid ones
• to limit the unreasonable growth of citizens' expenses for paid medical services.

• When determining tariffs for paid medical services, provide for cost-effectiveness of no more than 20 percent.
• The list of paid medical services includes medical support of the patient by a doctor or nurse during transportation to the place of treatment, examination, rehabilitation and back. But this does not apply to those cases when the service is provided within the framework of the territorial CHI program.
• Allow patients to be placed in small rooms in the absence of indications established by the Russian Ministry of Health.
• Prohibit the provision of any paid medical services in the provision of emergency medical care in emergency and urgent forms.

How to distinguish between paid and free services

At present, in medical organizations of the state and municipal health care systems, paid medical services are provided, as a rule, using the infrastructure and material and technical base acquired for budgetary funds. At the same time, it is intended to provide medical care within the framework of territorial programs, including territorial programs of compulsory medical insurance.

The provision of paid medical services on equipment, on premises, using consumables intended for the provision of free medical services, may lead to the replacement of free medical services by paid ones and an increase in the waiting time for patients to receive free medical care.

Often, medical workers are simultaneously involved in the provision of paid and free appointments, as a result of which patients wait longer for free medical care.

Purpose of the amendments to the new Rules- delimit the conditions for the provision of medical care within the framework of territorial programs and paid medical services and prevent the replacement of free medical services with paid ones.

Separate accounting for the use of drugs and consumables

The problem of paid and free services is relevant especially for level III institutions in the constituent entities of the Russian Federation, as well as for Federal specialized medical institutions subordinate to various ministries and departments of the Russian Federation. Almost all surveys and some interventions are carried out in them on a paid basis, referring to the lack of volumes under the territorial program or due to quotas. At the same time, most of the equipment was purchased and is being purchased at the expense of budget allocations from the federal budget or the budgets of the subjects of the Russian Federation. Also, the basic salary is paid at the expense of compulsory medical insurance.

reference. Medical organizations of the third level are organizations in the structure of which there are units that provide high-tech medical care.

To solve these problems, it is necessary for medical organizations to conduct separate accounting and control of the use of medicines and consumables in the provision of medical care within the framework of territorial programs and paid medical services.

Free medical care in excess of the established volumes and paid services

In the process of discussing the amendments, the medical community points to the need to develop clear criteria for the provision of paid medical care, especially in excess of the established volumes within the framework of territorial programs for the provision of free medical care.

The annual reduction in the volume of medical care in the Program of State Guarantees of Free Provision of Medical Care to Citizens, approved by the Decree of the Government of the Russian Federation, leads to various kinds of abuse on the part of medical institutions.

However, the draft regulatory legal act does not provide for the establishment of criteria for the provision of paid medical care in terms of providing medical care in excess of the established volumes within the framework of territorial programs. This is due to the fact that during the year the volume of medical care for medical organizations can be adjusted taking into account the needs of the population and the volume of medical care actually performed.

Opinion of the medical community

The Bulletin of the Accounts Chamber No. 2 of 2019 published a report on the results of the expert-analytical event "Analysis of the formation in 2017 and 2018 and the implementation in 2017 of territorial programs of state guarantees of free provision of medical care to citizens, including their financial support."

The document says that there is an increase in accounts payable of medical organizations in the following regions:

• Moscow,
• Ulyanovsk region,
• Leningrad region,
• Kirov region,
• Udmurt republic,
• Kostroma region,
• Mari El Republic.

The main reasons for accounts payable:

• underfunding of Territorial programs at the expense of budget allocations from the budgets of the subjects of the Russian Federation;
• low compulsory medical insurance tariffs that do not cover the real costs of providing medical care;
• non-fulfillment of the volume of medical care;
• the application of penalties by medical insurance organizations based on the results of an examination of the quality of medical care;
• increase in the share of expenses on wages in order to implement the Decree of the President of the Russian Federation dated May 7, 2012 No. 597 “On measures to implement state social policy”;
• non-compliance with the structure of spending funds of medical organizations working in the CHI system, including in terms of exceeding wage costs;
• rising prices for medicines and consumables, food, fuels and lubricants, an increase in tariffs for energy resources.

If the above reasons are eliminated, then it will not be necessary to make changes to the Decree of the Government of the Russian Federation of October 4, 2012 No. 1006 “On Approval of the Rules for the Provision of Paid Medical Services by Medical Organizations”.

During the discussion of the amendments, experts expressed different opinions about whether there is a general need to adopt amendments and changes to the provisions of the above Resolution.

Were suggested other ways to solve the problem:

• remove paid services from state and municipal medical institutions, since they do not solve the financial problems of medical institutions, but simply support the financial situation of medical workers in some respect;
• to increase public health financing;
• revise the new wage system;
• deal with finances in health care, namely how much money came in, how much went out and where it went.

At the stage of development of amendments, 19 proposals were submitted, of which only 4 were taken into account, and 7 were partially accepted for consideration.

We invite heads of medical institutions and doctors to take a seminar on the CME system "".

Rules for the provision of paid medical services by medical organizations

I. General provisions

1. These Rules determine the procedure and conditions for the provision of paid medical services by medical organizations to citizens.

2. For the purposes of these Rules, the following basic concepts are used:

"paid medical services" - medical services provided on a reimbursable basis at the expense of personal funds of citizens, funds of legal entities and other funds on the basis of contracts, including voluntary medical insurance contracts (hereinafter referred to as the contract);

"consumer" - an individual who intends to receive or receives paid medical services personally in accordance with the contract. A consumer receiving paid medical services is a patient covered by the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”;

"customer" - an individual (legal) person who intends to order (purchase) or order (purchase) paid medical services in accordance with the contract in favor of the consumer;

"executor" - a medical organization that provides paid medical services to consumers.

The term “medical organization” is used in these Rules in the meaning defined in the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”.

3. Paid medical services are provided by medical organizations on the basis of the list of works (services) constituting medical activities and specified in the license for medical activities issued in the prescribed manner.

4. Requirements for paid medical services, including their scope and timing of provision, are determined by agreement of the parties to the contract, unless federal laws, other regulatory legal acts of the Russian Federation provide for other requirements.

5. These Rules are brought to the attention of the consumer (customer) by the contractor in a clear and accessible form.

II. Conditions for the provision of paid medical services

6. When concluding a contract, the consumer (customer) is provided in an accessible form with information on the possibility of obtaining the appropriate types and volumes of medical care without charging a fee under the program of state guarantees of free provision of medical care to citizens and the territorial program of state guarantees of free provision of medical care to citizens (hereinafter - respectively program, territorial program).

The consumer's refusal to conclude a contract cannot be the reason for reducing the types and volumes of medical care provided to such a consumer without charging a fee within the framework of the program and the territorial program.

7. Medical organizations participating in the implementation of the program and the territorial program have the right to provide paid medical services:

a) on other terms than those stipulated by the program, territorial programs and (or) target programs, at the request of the consumer (customer), including but not limited to:

establishment of an individual post of medical observation during treatment in a hospital;

the use of drugs that are not included in the list of vital and essential drugs, if their appointment and use is not due to vital indications or replacement due to individual intolerance to drugs included in the specified list, as well as the use of medical devices, medical nutrition, including the number of specialized health food products that are not provided for by the standards of medical care;

b) when providing medical services anonymously, with the exception of cases provided for by the legislation of the Russian Federation;

c) citizens of foreign states, stateless persons, with the exception of persons insured under compulsory health insurance, and citizens of the Russian Federation who do not permanently reside on its territory and are not insured under compulsory health insurance, unless otherwise provided by international treaties of the Russian Federation;

d) when applying for medical services independently, with the exception of cases and the procedure provided for in Article 21 of the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”, and cases of emergency, including emergency specialized, medical care and medical care provided by in an urgent or emergency manner.

8. The procedure for determining prices (tariffs) for medical services provided by medical organizations that are budgetary and state-owned state (municipal) institutions is established by the bodies exercising the functions and powers of the founders.

Medical organizations of other organizational and legal forms determine prices (tariffs) for paid medical services provided on their own.

9. When providing paid medical services, the procedures for the provision of medical care approved by the Ministry of Health of the Russian Federation must be observed.

10. Paid medical services may be provided in full of the standard of medical care approved by the Ministry of Health of the Russian Federation, or at the request of the consumer in the form of separate consultations or medical interventions, including in an amount exceeding the scope of the performed standard of medical care.

III. Information about the contractor and the medical services provided by him

11. The Contractor is obliged to provide, by posting on the website of the medical organization in the information and telecommunication network "Internet", as well as on the information stands (racks) of the medical organization, information containing the following information:

a) for a legal entity - the name and company name (if any);

for an individual entrepreneur - last name, first name and patronymic (if any);

b) the address of the location of the legal entity, the data of the document confirming the fact of entering information about the legal entity in the Unified State Register of Legal Entities, indicating the body that carried out the state registration;

the address of the place of residence and the address of the place of medical activity of the individual entrepreneur, the data of the document confirming the fact of entering information about the individual entrepreneur in the Unified State Register of Individual Entrepreneurs, indicating the body that carried out the state registration;

c) information about the license to carry out medical activities (number and date of registration, list of works (services) constituting the medical activities of a medical organization in accordance with the license, name, location address and telephone number of the licensing authority that issued it);

d) a list of paid medical services indicating prices in rubles, information on the conditions, procedure, form of providing medical services and the procedure for their payment;

e) the procedure and conditions for the provision of medical care in accordance with the program and the territorial program;

f) information on medical workers involved in the provision of paid medical services, on the level of their professional education and qualifications;

g) the mode of operation of a medical organization, the work schedule of medical workers involved in the provision of paid medical services;

h) addresses and phone numbers of the executive authority of the constituent entity of the Russian Federation in the field of protecting the health of citizens, the territorial authority of the Federal Service for Supervision in the Sphere of Health Care and the territorial authority of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare.

12. Information posted on information stands (racks) should be available to an unlimited number of people during the entire working time of a medical organization providing paid medical services. Information stands (racks) are located in a place accessible to visitors and are designed in such a way that you can freely get acquainted with the information posted on them.

13. The contractor provides for review at the request of the consumer and (or) the customer:

a) a copy of the constituent document of a medical organization - a legal entity, the regulation on its branch (department, other territorially separate structural unit) involved in the provision of paid medical services, or a copy of the certificate of state registration of an individual as an individual entrepreneur;

b) a copy of the license to carry out medical activities with a list of works (services) that make up the medical activities of a medical organization in accordance with the license.

14. When concluding a contract, at the request of the consumer and (or) the customer, they must be provided in an accessible form with information on paid medical services containing the following information:

a) the procedures for the provision of medical care and the standards of medical care used in the provision of paid medical services;

b) information about a specific medical worker providing the relevant paid medical service (his professional education and qualifications);

c) information about the methods of providing medical care, the risks associated with them, possible types of medical intervention, their consequences and the expected results of the provision of medical care;

d) other information related to the subject of the contract.

15. Prior to the conclusion of the contract, the contractor shall notify the consumer (customer) in writing that failure to comply with the instructions (recommendations) of the contractor (medical worker providing paid medical services), including the prescribed treatment regimen, may reduce the quality of the provided paid medical service, entail the impossibility of its completion on time or adversely affect the health of the consumer.

IV. The procedure for concluding a contract and paying for medical services

16. The contract is concluded by the consumer (customer) and the contractor in writing.

17. The contract must contain:

a) information about the performer:

name and company name (if any) of a medical organization - a legal entity, location address, data of a document confirming the fact of entering information about a legal entity in the Unified State Register of Legal Entities, indicating the body that carried out the state registration;

surname, name and patronymic (if any) of an individual entrepreneur, address of residence and address of the place of medical activity, data of a document confirming the fact of entering information about an individual entrepreneur in the Unified State Register of Individual Entrepreneurs, indicating the body that carried out the state registration;

the number of the license to carry out medical activities, the date of its registration, indicating the list of works (services) that make up the medical activities of the medical organization in accordance with the license, the name, address of the location and telephone number of the licensing authority that issued it;

b) last name, first name and patronymic (if any), residential address and telephone number of the consumer (legal representative of the consumer);

surname, name and patronymic (if any), address of residence and telephone number of the customer - an individual;

name and address of the location of the customer - legal entity;

c) a list of paid medical services provided in accordance with the contract;

d) the cost of paid medical services, the terms and procedure for their payment;

e) conditions and terms for the provision of paid medical services;

f) position, surname, name, patronymic (if any) of the person concluding the contract on behalf of the contractor, and his signature, surname, name, patronymic (if any) of the consumer (customer) and his signature. If the customer is a legal entity, the position of the person concluding the contract on behalf of the customer is indicated;

g) the responsibility of the parties for failure to comply with the terms of the contract;

h) the procedure for changing and terminating the contract;

i) other conditions determined by agreement of the parties.

18. The contract is drawn up in 3 copies, one of which is with the contractor, the second - with the customer, the third - with the consumer. If the contract is concluded by the consumer and the contractor, it is drawn up in 2 copies.

19. An estimate may be drawn up for the provision of paid medical services. Its preparation at the request of the consumer (customer) or contractor is mandatory, while it is an integral part of the contract.

20. If the provision of paid medical services requires the provision of additional medical services on a reimbursable basis that are not provided for by the contract, the contractor is obliged to notify the consumer (customer) about this.

Without the consent of the consumer (customer), the contractor is not entitled to provide additional medical services on a reimbursable basis.

21. If the provision of paid medical services requires the provision of additional medical services for emergency reasons to eliminate the threat to the life of the consumer in case of sudden acute diseases, conditions, exacerbations of chronic diseases, such medical services are provided free of charge in accordance with the Federal Law “On the Fundamentals of Protection health of citizens in the Russian Federation”.

22. If the consumer refuses to receive medical services after the conclusion of the contract, the contract is terminated. The contractor informs the consumer (customer) about the termination of the contract at the initiative of the consumer, while the consumer (customer) pays the contractor the costs actually incurred by the contractor related to the performance of obligations under the contract.

23. The consumer (customer) is obliged to pay for the medical service provided by the contractor on time and in the manner specified by the contract.

24. In accordance with the legislation of the Russian Federation, the consumer (customer) is issued a document confirming the payment for the provided medical services (cash receipt, receipt or other form of strict accountability (document of the established form)).

25. After the execution of the contract, the Contractor shall issue to the consumer (legal representative of the consumer) medical documents (copies of medical documents, extracts from medical documents) reflecting the state of his health after receiving paid medical services.

26. The conclusion of a voluntary medical insurance contract and payment for medical services provided in accordance with the said contract shall be carried out in accordance with the Civil Code of the Russian Federation and the Law of the Russian Federation “On the organization of insurance business in the Russian Federation”.

V. Procedure for the provision of paid medical services

27. The contractor provides paid medical services, the quality of which must comply with the terms of the contract, and in the absence of conditions on their quality in the contract, the requirements for services of the corresponding type.

If the federal law, other regulatory legal acts of the Russian Federation provide for mandatory requirements for the quality of medical services, the quality of paid medical services provided must comply with these requirements.

28. Paid medical services are provided subject to the informed voluntary consent of the consumer (legal representative of the consumer), given in the manner prescribed by the legislation of the Russian Federation on the protection of the health of citizens.

29. The contractor provides the consumer (legal representative of the consumer) at his request and in a form accessible to him information:

about the state of his health, including information about the results of the examination, diagnosis, treatment methods, the risks associated with them, possible options and consequences of medical intervention, expected results of treatment;

about medicines and medical devices used in the provision of paid medical services, including their expiration dates (warranty periods), indications (contraindications) for use.

30. When providing paid medical services, the Contractor is obliged to comply with the requirements established by the legislation of the Russian Federation for the preparation and maintenance of medical records and accounting and reporting statistical forms, the procedure and deadlines for their submission.

VI. Responsibility of the contractor and control over the provision of paid medical services

31. For non-fulfillment or improper fulfillment of obligations under the contract, the performer shall be liable under the legislation of the Russian Federation.

32. Harm caused to the life or health of the patient as a result of the provision of low-quality paid medical services is subject to compensation by the contractor in accordance with the legislation of the Russian Federation.

33. Compliance with these Rules is monitored by the Federal Service for Supervision of Consumer Rights Protection and Human Welfare within the established powers.

Paid medical services include service medical services provided by medical institutions at the expense of patients of medical institutions, employers, and other individuals under formalized contracts, including patients who are served under the VHI program. Paid services can be provided to patients by state, municipal healthcare institutions within the framework of the Law of the Russian Federation on consumer protection, in accordance with the Rules for the provision of paid medical services by medical institutions. services (Resolution No. 1006 of 04.10. 2012). The Civil Code of the Russian Federation also regulates the process of paid medical care. At the same time, it is not legally allowed to replace free medical care for citizens of the Russian Federation with paid one.

Features of the provision of paid services by medical institutions

Medical institutions have the right to provide services on a paid basis in accordance with the medical services listed in their licenses to conduct medical activities. When providing such services, certain restrictions are legally established. In particular, the legislation refers to them as a paid ambulance, as well as a specialized one, which should be provided by state and municipal medical organizations. The emergency form of assistance provided by other medical institutions is also free of charge. These restrictions are established by Federal Law No. 323-FZ of November 21, 2011 (Art. 11, Art. 35).

Emergency medical care is considered to be provided in the event of a sudden deterioration in the patient's health in the acute course of the disease, sudden exacerbations of chronic diseases, in conditions that threaten the life of the patient. Russian citizens, if they have a license, can provide the following types of services:

• Preventive;
• Therapeutic and diagnostic;
• rehabilitation;
• Dental;
• Prosthetic and orthopedic.

The possibility of providing paid assistance by state and municipal medical institutions is regulated by the permits of the relevant health authorities. Medical institutions must notify patients of the list of services provided for a fee, indicating their cost, conditions for providing and receiving with the obligatory listing of privileged categories of the population. Together with this information, citizens must also be notified of the availability of certificates from specialists, and provide information about their qualifications.

Patients of clinics need to remember that services provided without registration by medical staff of municipal and state healthcare organizations of an agreement with a consumer are a gross violation of the laws of the Russian Federation. is the guarantor of providing quality and timely care to the patient. You can pay for assistance through a bank or pay directly at a medical institution using cash registers, forms that relate to strict reporting documentation. These forms of documents are approved in the manner prescribed by law. Medical institutions must, in exchange for money for assistance, provide a check or a copy of the form that confirms payment.

What services do you need to pay for?

With the participation of a medical institution in the program of state guarantees for the free provision of medical care, as well as in the regional program of state guarantees for free care of patients, such an institution, in accordance with Part 5Z of Article 84 of Law No. 323-FZ and clause 7 of the Rules, is allowed to provide paid medical care. Paid services (works) are provided:

• On conditions other than those determined by the programs, if the patient wishes, including:
  • organization for patients of individual posts with medical supervision during treatment in a hospital;
  • the use of drugs that are not vital and extremely important (except when these drugs are prescribed for health reasons or they replace drugs to which the patient has an individual intolerance, if they are included in the free list);
  • the use of medical products, therapeutic and preventive nutrition, not specified by the standards for the provision of medical care.
• Anonymously, except in cases stipulated by the legislative acts of the Russian Federation;
• Citizens of other states, stateless persons (except for citizens with compulsory medical insurance policies), Russian citizens who do not live in Russia and do not have compulsory medical insurance policies (except as specified in international agreements with the Russian Federation);
• If the patient independently applies for the provision of medical services, except for the cases provided for by Article 21 of Law No. 323-FZ, as well as when providing emergency medical care.

If the patient is unwilling to comply with the established procedure for providing medical care, for example, if he turns to the inpatient department of the hospital without having a referral from the doctor who treats him, he may be offered paid inpatient medical care.