Ambulance call on June 20. The Ministry of Health commented on the issue of paid ambulance

“Source” checked information about the appearance of paid ambulances in Russia.

Since the beginning of May there has been panic on the Internet. The message about the appearance of paid ambulances spread across social networks instantly. “The President did sign the decree. From June 20, an ambulance can be called free of charge only four times a year. And on the fifth, either pay or die.” Such information has now been published on many forums and even in some media.

The message refers to a certain decree of President Vladimir Putin. Meanwhile, on the Kremlin’s official website there is information that the president instructed the Russian Ministry of Health, together with the authorities of the Kirov region and some other regions, to analyze the results of the project, which involves the transfer of medical transport services to private organizations. This is the so-called outsourcing.

What is outsourcing?
In the Kirov region, the transport services of the ambulance station were outsourced in 2013. What does it mean? The station enters into contracts with private transport companies. They, in turn, provide the ambulance with new cars for use and also take care of all the maintenance and repair of the cars.

“Since then, we have been able to significantly reduce car rental costs,” Deputy Chairman of the regional government Dmitry Matveev told reporters. – When cars were on the budget balance, their mileage was recorded many times higher for obvious reasons. Today we pay specifically per hour of machine operation. Not for an oil change, not for repairs, but for work.

To clarify, the deputy chairman gave an example: in one of the hospitals there were two UAZ cars on the balance sheet. On each of them, two drivers worked in shifts per day. Each driver, according to documents, drove 180 km per day.

“After switching to outsourcing, it turned out that the real need of the medical institution is only 30 km per day,” said Matveev. – I see, where did the rest of the money go? “Budget means no one’s” - this attitude is unacceptable, we need to fight it.

"Mercedes" have replenished the fleet
At the end of 2015, the regional Ministry of Health entered into a new contract for a period of 5 years with Effective Healthcare System LLC. The company has already completely renewed its ambulance fleet. 43 Mercedes vehicles were delivered, 5 of which were emergency vehicles. Four vehicles (one of them is an ambulance) are in reserve, and 39 are constantly responding to calls from substations in the regional center.

All machines are equipped with new modern equipment, including an electrocardiograph, defibrillator and ventilator.

“There is no talk of any paid ambulance calls or limiting the number of calls per year,” the regional Ministry of Health notes. – This service has always been and will be free. The hysteria raised by some federal media is just the result of poor orientation on the issue.

Since March 2016, news about the introduction of fees for emergency medical care and the limitation of the number of free calls has been actively discussed on the Internet. Meanwhile, there is no reason to panic. We are talking about the legalization of private medical services, as well as the possible transfer of the right to provide ambulances to transport companies as part of outsourcing. Let's figure out where such rumors come from and what changes actually await us in 2016.

Why June 20

Sources that are actively discussing the introduction of fees for ambulance arrivals indicate the date of June 20 as the starting date for the decree. The official Kremlin website does not contain any information about the document to which Internet sources refer, but instructions from the president have been published:

1. By the first of June, report the results of testing a pilot project to transfer the authority to provide ambulances to outsourcing. Reports will be presented by representatives of the executive authorities of the regions: the Republic of Mari El and Chuvashia; Kirov, Arkhangelsk and Volgograd regions; Perm region. Please note that we are talking only about hiring transport. Calling a team in these regions remained free throughout the testing period. If the results satisfy the head of state, the project will be implemented throughout the country.
2. So that the project can be extended to all regions of Russia, the Ministry of Health has been instructed to develop a business model for cooperation with private companies. The head of state expects it to be reviewed on June 10.
3. As for the fateful date - June 20, by this time the Ministry of Health should give a review of a number of legislative initiatives relating to the work of ambulances. We'll talk about them further.

As you can see, there is not a word on the official Kremlin website that a fee will be charged for calling an ambulance in the near future. So far we are only talking about modernizing the vehicle fleet, thanks to the involvement of private companies.

What changes are coming in emergency care?

For mobile teams providing medical care to people, new rules will apply from July 1. The main changes will affect:

• arriving at a call;
• formation of brigades;
• equipment for cars and bags for medical staff.

If nothing is yet clear about the possibility of attracting private companies to provide substations with cars, other innovations in the field of assistance will very soon affect almost every Russian.

Additionally, the financing system for ambulance substations will be changed. Several years ago, only insurance companies participating in the compulsory medical insurance program allocated money for them. As it turns out, it was a mistake to put the security in the hands of such organizations. Now the government plans to return part of the subsidies from budget funds. In 2016, about 2 billion rubles were budgeted for these purposes.

How long does it take for doctors to arrive?

First of all, the changes will affect the arrival times of the brigade. From July this year, they must arrive to the call no later than 20 minutes from the moment of the call. In large cities this is often impossible, since during rush hours the traffic situation leaves much to be desired. Therefore, it is additionally planned to tighten the liability of ordinary drivers for refusing to give way to emergency services.

In some cases, you cannot wait even a third of an hour for doctors. When it comes to life and death, this is a very long interval. Therefore, all calls after the amendments come into force will be divided into difficulty classes. If help is needed urgently, the request is given a “red color” and the team must arrive on site no later than 5 minutes.

How will the structure and operating principles of ambulance services change?

Another number of amendments concerns the provision of medicines and special instruments for emergency situations in vehicles. From now on, the actions of doctors will be aimed primarily at the timely delivery of the patient to the hospital, and not at treatment. According to representatives of the Ministry of Health, this should improve the quality of services provided, and everyone who made the call will receive qualified assistance in full.

All teams will be divided by profile into:

• pediatric;
• resuscitation;
• emergency advisory;
• psychiatric.

In a number of regions, this list may be supplemented by specific teams, for example, those arriving on calls by helicopter. If possible, emergency neurological or cardiac care teams will be created separately.

Much of the new law focuses on the composition of the medical team. Now substations have the right to hire drivers without medical education, while previously only paramedics were hired for these positions. Additionally, it was allowed to hire third-year medical students from higher educational institutions. There is only one requirement for them - they need to obtain the qualifications of a nurse.

From July, a doctor must be on call, accompanied by two mid-level health workers (nurses or paramedics). It is possible that in some cases, in general-purpose vehicles, it will be allowed to send a paramedic to a call instead of a doctor. According to government officials, such personnel can perform emergency procedures well and transport the patient to the hospital.

Where did the rumors come from?

Now that you know what will change in the near future in the field of ambulance services, let's return to the news that shocked everyone about the fee for calling doctors. It cannot be said that rumors about this were started out of nowhere. At the end of 2015, a similar initiative was proposed by the Ministry of Finance, but it did not withstand the criticism of deputies:

1. Many people called it blasphemy to set a price for a person’s poor health.
2. It is not known how the price would be calculated - for the time spent by doctors, or for the mileage.
3. This proposal is unconstitutional.
4. Government institutions do not have the right to provide paid services during working hours; substations that send cars are required to work around the clock. In this case there is no non-working time.

Every person, regardless of age and gender, can seek paid ambulance services. Services are provided without established service standards. That is, doctors are with patients as long as their condition requires.

On June 20, 2016, a new Decree of the Ministry of Health “On introducing changes to the procedure for providing emergency care to Russian citizens” came into force. The order was signed by the President of the Russian Federation Vladimir Putin. The contents of the document caused different reactions among the Russian population. People, first of all, were outraged by the condition according to which the team could visit a person free of charge no more than four times a year. If a citizen needs an overtime call (the fifth one in a year), he will have to pay for the services provided.

The content of the recently adopted legislation states that only elderly people, minors and the disabled can count on free ambulance care. The rest of the country will not be able to use the free services. With this decision, the Government will save money, which will be used to purchase new ambulances. In addition, the Ministry of Health proposed fining citizens for making false calls to doctors.

Changes in the law on the provision of emergency medical care

The new law introduces changes to the composition of the medical team

According to a decree issued in 2016, a significant change affected the composition of the brigade. Previously, the ambulance team consisted of a driver-medic and a driver's paramedic. There were no nurses. The new rules allow nurses to be included in the team. Additionally, paramedic-drivers and paramedic-drivers have been abolished. Now there are responsibilities only for the driver, who, in case of a health emergency, must obey the doctor.

All teams are now divided according to their professional activities:

• Resuscitation;
• Pediatric;
• Psychiatric;
• Advisory emergency.

Therefore, before dialing 03, find out what condition the patient is in. Depending on the populated areas of the Russian Federation, ambulance teams can also arrive by helicopter. This is possible if it is far from the district center to the populated area or if public roads were blocked due to a natural disaster. If necessary, doctors will be required to quickly create cardiac or neurological care teams.

Ambulance arrival time

If more than 100 thousand citizens live in a settlement, then in accordance with the order of the Ministry of Health of the Russian Federation, medical ambulance substations are created with a twenty-minute calculation of transport accessibility.

If there are from 50 to 100 thousand people in a city, according to the order, a special medical institution with round-the-clock rapid support is created. A similar condition is also spelled out in the new resolution.

Ambulance units should be built in small villages and villages, close to local hospitals. District authorities are obliged to provide medical services to anyone who calls 03.

In megacities with a population of more than 100 thousand people, an ambulance must arrive at the address within 20 minutes. Time standards for non-deferred support are not established for other localities. The general rule is that medical services are provided immediately. If doctors do not arrive at their destination within half an hour or refuse medical assistance, a citizen can call 02. Unlawful actions of doctors entail criminal liability (Articles 124 and 125 of the Criminal Code).

How many times can you call an ambulance?

As mentioned above, a resident of the Russian Federation can call an ambulance no more than four times within one year. If you exceed the number of allowed calls, you will have to pay for the services.

Composition of non-deferred service vehicles

Now cars are equipped with new models of medical equipment that promote the use of modern technologies. Devices appear that allow indirect cardiac massage with voice accompaniment. Ventilators for newborns and children are also installed.

The ambulance is equipped with a navigator and a video recorder. In 2017, more than 20 thousand ambulances were equipped. In the northern regions, device navigators (video recorders and navigators) are available in all medical service vehicles.

President Vladimir Putin signed instructions on issues related to the organization of emergency medical care. The list contains three tasks related to the issue of transfer of state ambulance functions to private hands. This was reported on the President's website.

From June 20, 2016, changes in legislation will come into force, according to which Russian citizens will be able to call an ambulance free of charge no more than 4 times a year.

It should be noted that the draft resolutions for now intend to maintain free ambulance calls only for children, disabled people and pensioners. By the way, back in November 2015, the Ministry of Finance proposed reducing the number of free emergency medical calls and introducing fines for citizens calling “03” without sufficient grounds.

As the government in Russia explains, 70% of ambulances have already exhausted their service life. That is, 10 thousand cars need to be replaced, and the cost of one ambulance is 3 million rubles, that is, to replace all of them, 30 billion rubles are needed, which, as the government is assured, it does not have.

Personally, I believe that the government and President Putin are blatantly misleading us: there is money, but it is stolen, or spent on non-essential expenses, for example, 57 billion dollars were spent on the Olympics in Sochi, translated into rubles this is 3 trillion 705 billion rubles! It's that we don't have money! Now we have the World Cup, for which they plan to spend no less money than the Olympics!
Back in 2015, the Russian government invested more than 20 billion dollars in the US economy! And this is at a time when in Russia there is no money even for an ambulance! One gets the impression that we have an occupation regime.

Of course, officials are not worried about this, they take huge bribes, teach their children abroad, and receive treatment there themselves. At the same time, they refuse to sign an international law under which they will be forced to explain their income, which does not correspond to their official salary.
Do you still believe Putin and United Russia after this?
How long can you tolerate? — paid education, medicine, roads for heavy trucks, what else awaits us?

In a word, we have lived and are silent, we endure, for what are we enduring? - in the 1930s they endured, built factories, in 1941-1945 they endured for the sake of victory, after they endured for the sake of restoration and restored the country, in the 70s and 80s they lived a little. And why are we now putting up with officials plundering the country, robbing us of our last bits and using this to buy themselves villas in England and the USA and, in a word, get fat?! For their sake, we bear deprivation?! Think about it, people of Ugra...

V.A. Abdurrahmanov

Khanty-Mansiysk Autonomous Okrug - Ugra

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