Name of the medical institution. Treatment and preventive institutions include
Registration N 29950
In accordance with Article 14 of the Federal Law of November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724; 2012, N 26, Art. 3442 ,3446; 2013, N 27, art. 3459, 3477; N 30, art. 4038) I order:
1. Approve the nomenclature medical organizations according to the application.
2. To recognize as invalid:
Order of the Ministry of Health and Social Development of the Russian Federation dated October 7, 2005 N 627 “On approval of the Unified Nomenclature of State and Municipal Healthcare Institutions” (registered by the Ministry of Justice of the Russian Federation on October 12, 2005, registration N 7070);
Order of the Ministry of Health and Social Development of the Russian Federation dated February 19, 2007 N 120 "On amendments to the order of the Ministry of Health and Social Development of the Russian Federation dated October 7, 2005 N 627 "On approval of the Unified Nomenclature government agencies Healthcare" (registered by the Ministry of Justice of the Russian Federation on March 22, 2007, registration No. 9157);
order of the Ministry of Health and Social Development of the Russian Federation dated November 19, 2008 N 653n “On introducing changes to the annex to the order of the Ministry of Health and Social Development of the Russian Federation dated October 7, 2005 N 627 “On approval of the Unified nomenclature of state and municipal healthcare institutions ( registered by the Ministry of Justice of the Russian Federation on December 22, 2008, registration No. 12921).
Minister V. Skvortsova
Application
Nomenclature of medical organizations
I. Nomenclature of medical organizations* by type of medical activity
1. Treatment and preventive medical organizations:
1.1. Hospital (including children's).
1.2. Emergency hospital.
1.3. Local hospital.
1.4. Specialized hospitals (including those specialized in medical care), as well as specialized hospitals of state and municipal systems health care:
gynecological;
geriatric;
infectious, including children's;
medical rehabilitation, including children's;
drug treatment;
oncological;
ophthalmological;
psychiatric, including children's;
psychiatric (hospital) specialized type;
psychiatric (inpatient) specialized type with intensive observation;
psychoneurological, including children's;
tuberculosis, including children.
1.5. Maternity hospital.
1.6. Hospital.
1.7. Medical and sanitary part, including the central one.
1.8. Nursing home (hospital).
1.9. Hospice.
1.10. Leper colony.
1.11. Dispensaries, including dispensaries of state and municipal health care systems:
medical and physical education;
cardiological;
dermatovenerological;
drug treatment;
oncological;
ophthalmological;
anti-tuberculosis;
neuropsychiatric;
endocrinological.
1.12. Outpatient clinic, including medical clinic.
1.13. Clinics (including children's), as well as clinics of state and municipal health care systems:
consultative and diagnostic, including for children;
medical rehabilitation;
psychotherapeutic;
dental, including children's;
physiotherapeutic.
1.14. Women's consultation.
1.15. Children's home, including a specialized one.
1.16. Dairy kitchen.
1.17. Centers (including children's), as well as specialized centers of the state and municipal healthcare systems:
assisted reproductive technologies;
high medical technologies, including the profile of medical care;
geriatric;
diabetes;
diagnostic;
health;
consultative and diagnostic, including for children;
clinical diagnostic;
therapeutic and preventive nutrition;
treatment and rehabilitation;
physical therapy and sports medicine;
manual therapy;
medical;
medical genetics (consultation);
medical rehabilitation for internationalist soldiers;
medical rehabilitation, including children's;
medical rehabilitation for disabled people and disabled children with consequences of childhood cerebral palsy;
medical and social examination and rehabilitation of disabled people;
medical and social rehabilitation, including a department for permanent residence of disabled people and disabled children with severe forms of cerebral palsy who cannot move independently and do not care for themselves;
medical and social rehabilitation of drug addicts;
medical-surgical;
multidisciplinary;
general medical practice (family medicine);
protection of motherhood and childhood;
family health and reproduction;
security reproductive health teenagers;
palliative care;
speech pathology and neurorehabilitation;
perinatal;
occupational pathology;
prevention and control of AIDS;
psychophysiological diagnostics;
hearing rehabilitation;
rehabilitation;
specialized (according to medical care profiles);
specialized types of medical care;
audiologist.
1.18. Medical organizations for emergency medical care and blood transfusion:
ambulance station;
blood transfusion station;
blood center
1.19. Sanatorium and resort organizations:
balneological hospital;
mud bath;
resort clinic;
sanatorium;
sanatoriums for children, including for children with parents;
sanatorium-preventorium;
year-round sanatorium health camp.
2. Special type medical organizations:
2.1. Centers:
medical prevention;
disaster medicine;
medical mobilization reserves "Reserve";
medical information and analytical;
medical biophysical;
medical and social examination;
medical statistics;
pathological-anatomical;
forensic medical examination.
2.3. Laboratories:
clinical diagnostic;
bacteriological, including the diagnosis of tuberculosis.
2.4. Medical detachment, including special purpose (military district, navy).
3. Medical organizations for supervision in the field of consumer rights protection and human well-being:
3.1. Centers for Hygiene and Epidemiology.
3.2. Anti-plague center (station).
3.3. Disinfection center (station).
3.4. Center for Hygienic Education of the Population.
3.5. Center for State Sanitary and Epidemiological Surveillance.
II. Nomenclature of medical organizations of state and municipal health care systems by territorial basis
4.1. Federal.
4.2. Regional, republican, regional, district.
4.3. Municipal.
4.4. Interdistrict.
4.5. Regional.
4.6. Urban.
*Medical organizations that house structural units of educational and scientific organizations, on the basis of which practical training of medical workers is carried out (clinical bases) include the word “clinical” in their name.
The new regulatory document No. 529n “On approval of the nomenclature of medical organizations” dated 08/06/2013 introduced significant changes to the medical care system of the Russian Federation. The consolidation of some primary links led to the need to change the previously generally accepted nomenclature.
With its publication, Order No. 627 “On approval of the Unified Nomenclature of State and Municipal Health Institutions” with all amendments is no longer valid.
Later, in the letter of the Ministry of Health of the Russian Federation No. 17-2/10/2-184 “On the order of the Ministry of Health of Russia dated 08/06/2013 No. 529n” dated 01/16/2014, explanations were given on the use of the adopted law.
The above regulatory document regulates only municipal and. Private and pharmaceutical representative offices, as before, are not regulated by the above law, since they were not medical institutions.
New provisions of terminology and names of medical organizations
Medical terminology is regulated by new provisions in the legislation of the Russian Federation, which must be taken into account in the current name of medical organizations. Basic package regulatory documents, which now regulates issues of state medical care, has led to a tendency for the term “medical and preventive institution” to disappear. Federal Law of the Russian Federation dated November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” does not use the concept of health care facilities in the text. However, the definition of MO is given.
You can study the issue in more detail in Article 2 of the law, paragraph 11, which states that a medical organization is a legal entity that carries out its medical activities in accordance with the charter and a license issued by the Russian Federation. Moreover, this definition does not depend on the legal form. Also, the provisions of this Federal Law apply to other legal entities that, along with their main activities, also carry out medical practice. Moreover, these provisions relate to the provision of medical services. According to legislative laws, individual entrepreneurs engaged in medical activities are also treated as medical organizations.
Term replacement
Thus, the term “health care facility” was completely removed and replaced with the name “medical organization” from all texts of previously adopted and valid documents.
Social services for the population have changed some of the regulatory documents. The term “social service institution” has been replaced by the new wording “social service organization”. You can get acquainted with them in more detail by studying the legislative documentation in more detail.
The use of the term “medical organizations” is becoming more common every day. Moreover, the trend is observed not only in documents, but also in the media. In addition to clinics, this formulation also includes pharmacies, private medical centers, sanatorium-resort institutions and various preventive organizations.
As for printed periodicals and the professional medical environment, the use of health care facilities is still in use. This is due to its prevalence and the fact that the term has been generally accepted for a very long time. The term LPO is a “therapeutic and preventive organization”. It was adopted later and was not used as often.
For example, the Social Insurance Fund of the Russian Federation was forced to introduce on February 19, 2016 a new version 2.0.4.17 of a program for medical institutions called “Medical and Preventive Institutions.”
Name of medical organization
All MOs are classified by location into several levels:
- Federal;
- Regional, regional, district and republican;
- Interdistrict;
- Municipal;
- District;
- Urban.
In addition to this issue, Order No. 529n made significant changes to the list of names of some medical organizations. Thus, new names were introduced into the MO nomenclature:
- Bureau of Medical and Social Expertise;
- Center for Forensic Medicine;
- Center for Military Medical Expertise;
- Medical squad (including special forces).
Formation of new centers
New medical health centers were formed. This applies to assisted reproductive and high medical technology centers. A geriatric, treatment and preventive, and genetic center also emerged. Medical rehabilitation center, as well as a medical center for the rehabilitation of disabled people and disabled children with consequences of cerebral palsy. A separate area includes rehabilitation centers for drug addicts. Today there are also medical-surgical, palliative care and serological centers. There are multidisciplinary and specialized institutions. Organizations for the protection of motherhood and childhood have also been formed.
Terms excluded from the nomenclature of medical organizations
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At the same time, previously there was a state order of the Ministry of Health and Social Development of the Russian Federation dated October 7, 2005 No. 627, which stated that paramedic and obstetric centers or FAPs are structural divisions of healthcare institutions. However, according to a number of orders, they are still approved and exist as a structural part of medical organizations. From point of view legal regulation questions arise regarding the real situation in the legislation of this division. |
The exception was the term TsRB, which, despite the absence of mentions in Law No. 529n, is still found in some regions. |
Due to such inconsistencies in the nomenclature, errors may occur when changes are made to the new names of some MOs. Also, due to the absence of a number of additional words, it remains unclear whether they can be used. For example, rural, urban. There is no city, children's, central or district clinic. In some cases, the name of the medical organization may be too shortened. Moreover, the name may be much shorter than indicated in the nomenclature itself.
Any violations can cause complications in the provision of pensions for health workers, planning of rest and work schedules. Errors in regulatory documents are also unacceptable.
Thus, the practical application of Order No. 529n of the Ministry of Health of the Russian Federation requires certain improvements and changes.
In our country, a wide network of treatment and preventive institutions has been created to provide medical care. These institutions include: outpatient clinics, clinics, hospitals, clinics, medical units, health centers, dispensaries, antenatal clinics, maternity hospitals, emergency rooms, ambulance stations, blood transfusion stations, etc.
Outpatient clinic is a medical institution where medical care is provided to visiting patients and patients at home. The clinic provides the patient with qualified assistance from various specialists. The outpatient clinic accepts only doctors of basic specialties: therapist, surgeon, dentist.
The clinic is equipped necessary equipment for examination and treatment of patients. All outpatient clinics have three groups of premises: for registration and waiting for a doctor’s appointment, medical and diagnostic premises, premises for service and utility purposes.
The register is located near the entrance. There is also a directory of rooms and a schedule for seeing patients by specialists. In the corridor of the clinic and waiting rooms there are tables with literature (brochures) introducing patients to the issues of disease prevention. From the waiting room, the patient goes to the doctor’s office or to the dressing room, treatment room and other treatment rooms. The doctor’s office should have everything necessary for his work: a desk for the doctor and nurse, chairs, a couch, hot and cold water, a towel, a robe, a tonometer, a phonendoscope, prescription forms and etc.
Hospital outpatient department is an outpatient treatment and preventive institution that has: doctor’s offices for the following basic clinical profiles, such as therapy, surgery, neurology, eye diseases, diseases of the ear, nose and throat, endocrinology, orthopedics, traumatology, cardiorheumatology. The clinic also has basic diagnostic rooms: X-ray, ultrasound, functional diagnostics, clinical and biochemical laboratories, as well as offices and departments for conducting medical procedures and doctor’s appointments (procedural or manipulation rooms, a physiotherapy department with equipment for electrical and light therapy, for water procedures, a physical therapy room, etc.). The clinic has a registry office, office rooms and a number of utility rooms.
The outpatient department serves the population of a certain territory on a local basis, and therefore medical areas are organized according to certain standards.
The positions of district nurses are established in accordance with the positions of district therapists and therapists of workshop medical districts.
Dispensary is an outpatient treatment and prevention facility whose responsibilities include the treatment and prevention of diseases of a certain profile. There are the following, the most common types of dispensaries: anti-tuberculosis, psychoneurological, dermatovenerological, oncological and physical therapy.
Medical and sanitary unit is an outpatient treatment and prevention facility where workers of a given enterprise or military unit are served on a workshop basis.
The main task of the medical unit is to provide first aid, prevent diseases associated with the work process and treat them. Large medical and sanitary units have their own hospitals: in factories and factories, on collective farms and state farms there are health centers, paramedics and paramedic-obstetric stations, which are subordinate to the medical units or clinics and work under their leadership.
To institutions inpatient (or hospital) type include hospitals, clinics, hospitals, maternity hospitals, sanatoriums. Depending on the performance of tasks and the nature of subordination, hospitals are distinguished between republican, regional, city, district and rural. In addition, hospitals are multidisciplinary, with specialized departments for treating patients with various diseases, and single-profile, intended for the treatment of patients with certain diseases (tuberculosis, psychoneurological, infectious, dermatoveneral, etc.).
Hospital- a medical institution in which patients are placed who require long-term bed rest, careful examination and treatment.
District and city hospital consist of the following structural units: a hospital with an emergency department, a clinic, treatment and diagnostic departments, offices and laboratories, emergency rooms, an organizational and methodological office, a morgue, a pharmacy, and a kitchen.
The district hospital also includes a sanitary and epidemiological service. The regional hospital has a different structure, since it is an advisory, organizational and methodological center. In addition to specialized departments, it includes an X-ray and radiological department, a department of emergency and planned advisory medical care with means of air ambulance and ground transport, an organizational and methodological department with separate departments of medical statistics, a polyclinic that provides advisory assistance to patients referred from the regions .
Clinic is a hospital where students are trained and research work is carried out.
Hospital It is customary to call in our country a hospital for military and disabled people of the Great Patriotic War.
Maternity hospital is a medical and preventive institution that provides medical care to pregnant women, women in labor and postpartum women. Large maternity hospitals also provide assistance to gynecological patients. Maternity hospitals are closely connected with medical and preventive institutions of the region (with a clinic, anti-tuberculosis and dermatovenerological dispensaries), which creates conditions for comprehensive and complete medical care. The maternity hospital includes an antenatal clinic and provides social and legal assistance to pregnant women.
Sanatoriums- these are hospitals in which further follow-up treatment of patients is carried out using natural factors: air, sea water, mineral waters, therapeutic mud, etc.Medical institutions are specialized treatment and preventive institutions in which people with certain diseases are provided with a full range of medical services: diagnosis, treatment, rehabilitation after illnesses.
As a rule, medical care for the population in Russia consists of several systems:
Therapeutic medical institutions,
Surgical and traumatological institutions.
Pediatric medical institutions,
Preventive medical institutions - sanatoriums and dispensaries,
Special medical institutions - examination departments, ambulance stations and departments, medical rescue services, blood transfusion departments and stations,
Maternity.
Therapeutic
Therapeutic medical institutions unite institutions involved in treatment, prevention and medical examination the population over 15 years of age, in some cases, and the population from birth, includes hospitals and clinics. The clinics have departments of local doctors, as well as specialized doctors - surgeons, neurologists, oculists, psychiatrists, phthisiatricians, endocrinologists. As a rule, clinics are departments of hospitals. The main forms of treatment in hospitals are inpatient - the patient is sometimes in non-medical places of stay, as well as outpatient - the patient is not in places of medical stay. The hospitals have resuscitation, intensive care, surgery, otolaryngolic, neurological, gynecological, andrological, and oncology departments. There are also departments of universities and scientific institutions. There is a sanitary inspection room and a patient register. The system of therapeutic medical institutions also includes medical units and medical posts of enterprises, medical service institutions in transport, and railways.
Pediatric
Pediatric medical institutions are similar in structure to therapeutic medical institutions. Patients are monitored up to 15 years of age. There are doctors and nurses in schools and kindergartens, children's camps, Special attention is given to children of small ages 0,1,2,3 years.
Prevention
Preventive medical institutions provide sanatorium-therapeutic services to children and adults, both at their place of residence and in different regions of the country.
Special
Special medical institutions provide services of a special nature.
Alternative medicine medical centers
Exists a large number of medical centers, specializing in the use of knowledge and techniques of alternative medicine in the treatment of various types of pathologies.
Hospital is a type of civilian inpatient medical institution aimed at treating patients and/or specialized in-depth differential diagnosis of diseases in inpatient conditions. Military hospital - hospital.
In general, hospitals are classified by type of organization and by specialization.
Types of hospital organization:
Decentralized - a type of arrangement in which each department occupies a separate building of the hospital. The disadvantage of such a system is the large occupied area. It is practically never found in its pure form; a relative example is 1 city hospital.
Centralized - the vast majority of departments are combined in one building, located, as a rule, on different floors or parts of the building. As a rule, with this type of organization, technical premises, a catering unit, outpatient and thanatological (pathological) departments are located outside the boundaries of one building. Example - 15 Moscow City Clinical Hospital, Cardiocenter.
Mixed - a combination of features of both types: there are one or two large buildings with many compartments and several smaller buildings for some departments. Most large hospitals are organized according to this principle - for example, the Sklifosovsky Institute, Botkin Hospital, Filatov Hospital, Burdenko Institute
By specialization (profile):
Specialized - aimed at treating a certain class of diseases: cardiological (Cardiocenter), neurosurgical (Institute of Neurosurgery), oncology (Oncology Center), urological, infectious and many others.
General - multidisciplinary institutions aimed at diagnosing and treating a wide range of diseases.
In accordance with the treatment profile, it is planned to place wards in therapeutic, surgical and infectious diseases buildings
Sanitary checkpoint, also sanitary checkpoint
Therapeutic building
Surgical building
Gynecological Department
Clinical department
Emergency room
Infirmary is a military medical institution, directly part of military units and units, designed to provide medical care and inpatient treatment for sick and wounded military personnel who do not require long-term treatment and complex diagnostic and specialized therapeutic measures. Infirmaries are created at individual military garrisons, in military units and on ships.. Military personnel receive specialized medical care and treatment in military hospitals.
An outpatient clinic (Latin ambulatorius - performed on the go) is a medical institution that provides care to incoming patients and at home, but does not provide hospital beds.
Unlike a clinic, an outpatient clinic provides services only in basic areas, such as therapy, surgery, dentistry (sometimes pediatrics, obstetrics and gynecology).
Outpatient treatment is the organization of medical care for patients coming to a medical institution.
Outpatient treatment - treatment carried out at home or when visited by the patients themselves medical institution(as opposed to inpatient treatment, which involves placing the patient in a hospital).
A pharmacy is a special specialized organization of the healthcare system engaged in the manufacture, packaging, analysis and sale of medicines. A pharmacy is traditionally viewed as a healthcare institution, and its activities are formulated as “providing pharmaceutical care to the population.” Pharmaceutical care includes the procedure of consulting a doctor and a patient in order to determine the most effective, safe and economically feasible course of treatment.
Detoxification center is a medical institution that aims to maintain persons in a state of medium degree alcohol intoxication, until they sober up. Persons suspected of being intoxicated are taken to a sobering center by internal affairs officers. Where, upon arrival, they are examined by paramedics, and their identity is also established. If a person is found to be moderately intoxicated and requires sobering up, he is detained until he sobers up. Persons who are heavily intoxicated alcoholic coma, are delivered to medical institutions.
Women's Consultation Center (WCC) is an outpatient treatment and preventive institution, the main task of which is outpatient and dispensary care for women during pregnancy and the postpartum period, gynecological care. They work on a local basis as part of maternity hospitals, perinatal centers, district and district hospitals, and can be independent medical institutions.
Dermatovenerological dispensary (DVT) is a specialized treatment and preventive institution (dispensary) designed to provide consultative, diagnostic and therapeutic assistance to the population, as well as carry out preventive and anti-epidemic measures to prevent the occurrence of infectious skin diseases and sexually transmitted diseases.
Leper colony (from Late Latin leprosus - leper, from Ancient Greek λεπρη - leprosy) is a specialized medical and preventive institution engaged in the active identification, isolation and treatment of patients with leprosy (leprosy). The leper colony is also an organizational and methodological center for the fight against leprosy.
Leper colonies are organized in endemic areas and usually in rural areas. The leper colony includes a hospital, an outpatient clinic and an epidemiological department. Patients are provided with residential buildings, they have subsidiary plots for agricultural work and various crafts. Depending on the type and severity of the disease, patients stay in the leper colony from several months to several years. The service personnel usually also live on the territory of the leper colony in an area conditionally separated (for example, by green spaces) from the area where patients live.
A medical-labor dispensary, LTP in the USSR and some post-Soviet countries, is a type of medical and correctional institution intended for those who, by court decision, were sent for compulsory treatment for drug addiction and alcoholism. In fact, LTPs were places of deprivation of liberty, where the main method of treatment was forced labor for the patient.
Polyclinic (from ancient Greek πόλις - city and ancient Greek κλινική - healing) is a multidisciplinary or specialized treatment and preventive medical institution for providing medical care to visiting patients and patients at home.
In Russia they are distributed on a territorial basis, and are basic level medical services for the population.
A psychiatric hospital is an inpatient healthcare institution that provides treatment for mental disorders, as well as performing expert functions, engaging in forensic psychiatric, military and labor examinations.
A psychoneurological boarding school (abbreviated as PNI) is a specialized boarding house, a social security institution intended for the elderly and disabled people who do not have relatives obligated by law to support them (or it turns out to be impossible to provide care at home), and do not need inpatient treatment, but due to a chronic mental disorder they need constant outside care and supervision, household and medical care. Psychoneurological boarding schools are part of the general system psychiatric care in the country and at the same time are institutions social protection population.
Maternity hospitals provide qualified medical care to women during pregnancy, as well as medical care to newborns. Refers to medical institutions. Monitoring of pregnant women begins during pregnancy. Maternity hospitals have been established for medical monitoring of the birth of children. In maternity hospitals, sick women and newborns are completely isolated from healthy ones. As part of the maternity hospital Women's consultation and hospital, physiological obstetric department, department for women with pregnancy pathologies, observational obstetric department, wards for newborns in the 1st and 2nd obstetric departments, gynecological department.
Sanatorium (from Latin sano “I treat, heal”) is a medical and preventive institution for treatment primarily with natural (climate, mineral water, mud) and physiotherapy, diet and regimen.
A paramedic-midwife station (FAP) is a medical and preventive institution that provides the initial (pre-hospital) stage of medical care in rural areas. FAPs work as part of a rural medical district under the guidance of an outpatient clinic, local or district hospital.
Hospice is a medical institution in which patients with a predictable unfavorable outcome of the disease receive decent care.
The fundamental rules defining the legal status of an institution are contained in the Civil Code of the Russian Federation, which recognizes as an institution an organization created by the owner (founder) to carry out managerial, socio-cultural or administrative-political functions of a non-profit nature and financed by him in whole or in part (Article 120) . Consequently, medical institutions as non-profit organizations, firstly, are called upon to perform socio-cultural functions, and secondly, they do not have profit making as the main goal of their activities. Despite this, medical institutions can also carry out business activities aimed at making a profit, but only insofar as this serves to achieve the goals for which they were created.
Yes, Art. 2, 72 of the draft Federal Law “On Health Care in the Russian Federation” gives the concept healthcare organizations– these are enterprises, institutions and organizations of the healthcare system, regardless of their form of ownership.
Thus, the concept of a healthcare organization (medical organization) is broader in relation to the concept of a healthcare institution (medical institution).
Despite this, today the predominant organizational and legal form of healthcare organizations remains an institution (state and municipal). The main factors influencing the choice of this particular form are: traditional use and, as a consequence, the established established regulatory legal framework regulating the functioning of institutions (to a large extent, this is facilitated by the norms of the Civil Code of the Russian Federation, which provide as one of the forms of organizations created to achieve specific non-commercial purposes, institution); the optimality of this design for introducing into civil circulation entities that require “a limited amount of rights, necessary only for the logistical support of their activities”; ensuring a balance of interests of the owner (state) and the organization, determined by the clarity and, to a certain extent, transparency of the financing mechanism.
Since the ongoing research involves studying the administrative and legal status of institutions that directly provide medical care to the population, the concept of “medical institution” or “health care institution” will be used in the future.
Thus, under medical institution should be understood as institutions and organizations, regardless of the form of ownership, departmental affiliation and organizational and legal status, providing medical care, covering a certain territory with health care activities and consisting of a share of the health care budget per this territory. This concept should also include persons carrying out medical activities without forming a legal entity, both individually and collectively.
For departmental purposes, healthcare institutions, in the process of almost thirty years of changing their nomenclature, acquired a division into treatment and preventive, healthcare institutions of a special type, healthcare institutions for supervision in the field of consumer rights protection and human well-being, and pharmacies.
From this list of institutions, only medical and preventive institutions carry out direct medical (therapeutic) activities (hospital institutions; dispensaries; outpatient clinics; centers, including scientific and practical ones; emergency medical care institutions and blood transfusion institutions; maternal and child health institutions ; sanatorium-resort institutions), which are mandatory component all three health systems. A medical and preventive institution is a complex, dynamic socio-economic system, representing a systematically organized and relatively isolated independently functioning link in the non-productive sector of the economy, in which medical and preventive activities are carried out in order to ensure a system of national, collective and personal economic interests, characterized by technological and organizational unity and socio-economic connections.
Criteria for classifying health care facilities should be established. Thus, all healthcare institutions can be divided: depending on industry, forms of ownership, categories of the population served, the structure of the medical institution, the profile of the bed capacity, the availability of the right to provide paid services and some other classification grounds.
By industry affiliation Departmental and territorial medical institutions can be distinguished.
As noted earlier, a number of ministries and departments (Ministry of Transport and Communications of the Russian Federation, Ministry of Defense of the Russian Federation, Ministry of Internal Affairs of the Russian Federation, etc.) have a network of departmental medical institutions - hospitals. The division of medical institutions by territorial basis allows us to distinguish republican (federal and within the Russian Federation), regional (territorial), city, district, and precinct.
By forms of ownership medical institutions are divided into state (federal and constituent entities) and municipal institutions, unitary enterprises, and private organizations. State and municipal treatment and preventive institutions are created by the owner to carry out socio-cultural or other functions of a non-commercial nature and are financed by him in whole or in part. Institutions, in relation to the property assigned to them, exercise the right operational management. Republican (regional, regional, district) hospitals are state-owned. They are the property of the subject of the federation and are not subject to privatization.
Private include medical and preventive institutions whose property is privately owned, as well as persons engaged in private medical practice.
For the purposes of social medicine and healthcare organization, state and municipal owned institutions are distributed according to types (branches) of health care activities: therapeutic and preventive, health care (medical care) for women and children, sanitary and anti-epidemic, medical and pharmaceutical, medical, educational and research, sanatorium and resort, pathological anatomical (including forensic and forensic psychiatric examination), as well as or health insurance (compulsory medical insurance). / Ed. Yu.P. Lisitsyna. – M.: Prior-izdat, 1999.– P.321.]
By categories of population served medical institutions can be classified into institutions providing medical care to adults and children; residents of cities (city hospitals) and rural areas (rural hospitals); employees of all professional groups and the non-working population and only employees of one or a group of enterprises (medical units), geriatric medical institutions, institutions for war veterans, internationalist soldiers.
By structure medical institutions are divided into combined (hospital with a clinic) and non-united (having only a hospital).
The classifying feature is also profiling of bed capacity medical institutions: single-profile (specialized), dual- and multi-profile institutions.
IN modern conditions medical institutions can also be divided into free and paid. Formally, all state and municipal medical institutions are considered free; in fact, free medical institutions practically do not exist today, since paid departments and wards are organized everywhere as part of multidisciplinary and specialized institutions on a self-sufficiency basis.
The most complex, taking into account many characteristics of the classification (including features of the structure of the institution, specialization, profiling of bed capacity) is nomenclature of medical institutions.
Health care institutions providing medical care to the population have the same rights and bear the same responsibility for the quality of care, regardless of their legal and organizational structure.
Traditional for administrative law is the provision that “each institution represents the unity of three parties: organizational, economic, legal.” In our opinion, this provision is fully applicable to medical institutions.
It appears that organizational side each medical institution is composed of a team of specialists and service personnel, headed by the chief physician and his administration, the medical institution is subordinate to a higher health care management body and the medical institution has operational independence within the framework of a certain autonomy.
Economic sign a medical institution is determined by the presence of a separate property complex (material and technical base).
Legal characteristics a medical institution is formed by the totality of its legal characteristics: 1) the regulatory framework of its formation and activities; 2) the ability of a medical institution to participate on its own behalf in administrative and other legal relations; 3) subordination to management bodies of general and sectoral competence; 4) existence of a regulation on a medical institution (charter of a medical institution).
It should be noted that a modern medical institution, which is a complex medical and economic complex, along with the main, medical and diagnostic function, carries out economic, supply, operational and other functions that are the subject of legal regulation of diverse norms of various branches of law. In their totality and in interaction, they provide the medical institution with a legal basis, in other words, legal status, for its functioning.
The concept of “status” ( lat. – state, position) means “a set of general rights that determine legal capacity, and fundamental rights and obligations inseparable from persons, bodies, organizations, legal entities.” Legal status is the legally established position of a subject in society. This is a set of rights and obligations of subjects, recognized by the constitution and legislation, as well as the powers of government bodies and officials, with the help of which they fulfill their social roles.
Thus, the legal status of a medical institution is its legal status, which determines the legal guarantees of activity, the place, role and position of the medical institution in the healthcare system and sectoral management, its basic rights and obligations.
The legal status of a medical institution is a complex category, consisting of many sectoral legal statuses. Its core is the administrative-legal status. The concept of “administrative and legal status”, although not practically developed, nevertheless manifests itself as a complex of interrelated elements. This concept “reflects both the advantages and disadvantages of the actually functioning political and legal system, the principles of democracy, and the state foundations of a given society.” The definition under study contains at its core the norms of administrative legislation, since only these norms are capable of giving an institution legal certainty and providing legal conditions for managing its activities. The legal basis for the administrative and legal status of a medical institution is the regulations on the healthcare institution of the corresponding type and the regulatory legal acts of the authorities executive power regulating the legal regime of management activities of the administration of a medical institution. As the leading function of administrative legal norms, one can single out the function of organizing and regulating legal relations in the management process. She is supported by three general functions more low level: organization and regulation of the activities of management subjects; organizing the regulation of management relations between the subject and the object of management; organizing and regulating the activities of management objects.
Consequently, the administrative-legal status of all types of medical institutions includes the totality of all rights and responsibilities exercised by them in managerial administrative-legal relations, which develop primarily in the relationship of medical institutions with state and municipal executive authorities.
The basis for the substantive characteristics of the administrative and legal status of medical institutions is the following relationships that develop between executive authorities and the medical institutions subordinate to them in the sectoral, functional and territorial terms: relationships that arise in the process of making management decisions on the creation, reorganization, liquidation of medical institutions, determining the subject and the goals of their activities consistent with the goals of the state; relations in connection with and regarding the approval of the charters of institutions by executive authorities and local self-government, as well as on maintaining records of the state cadastre of registered and operating medical institutions - legal entities; relations concluded by executive bodies of state and municipal authorities various kinds administrative agreements and contracts with subordinate institutions, issuing state and municipal orders to them for the provision of medical services; relations related to state registration and licensing of activities; relations to coordinate proposals for the disposal of state and municipal property and the implementation of other decisions in accordance with the powers of the owner; numerous relationships generated by the implementation of state control and supervision of compliance by all institutions with established business rules, their implementation of various types of activities and many other rules for the protection of state, public order and public safety in all its varieties.
Peculiarities The administrative and legal status of a healthcare institution is determined by the fact that: firstly, it has never been considered in its own right, in isolation from the healthcare system of which it is recognized as an element; secondly, the administrative-legal status of medical institutions consists of state-defined properties (rights and obligations) of the institution as a subject of administrative law, characterizing the potential capabilities of the institution itself to enter into administrative-legal relations within the framework of its legal personality and the competence of state bodies that they have in areas of establishing and ensuring the organization’s implementation of its administrative and legal status; thirdly, the administrative and legal status of medical institutions is characterized by the presence of a number of elements.
It should be noted that medical institutions of different types have significant differences in the content of status elements. For example, the administrative and legal status of state (municipal) and the administrative and legal status of non-state medical institutions has a number of features.
Institutions of the state health care system, regardless of their departmental subordination, are legal entities. They act in accordance with regulations on health issues, taking into account the acts of which bodies apply to them (for example, federal institutions– on the basis of federal acts, etc.)
Institutions of the state health care system are, as a rule, under the jurisdiction of higher health authorities that direct and control the activities of these institutions. They are the property of the state, state governing bodies act as founders of this type of medical institutions, approve their charters (regulations about them) and terminate their activities. The management of state (municipal) medical institutions is carried out by officials appointed by the competent state bodies and possessing government powers.
A peculiarity of the administrative and legal status of non-state medical institutions is that they are managed by the owners (founders) or bodies authorized by them that do not have government powers. The procedure for the formation and liquidation of a non-state medical institution is regulated by legislation regulating relations in the field of licensing and accreditation of medical institutions. They can be created by decision of the owner or an authorized body. The charter (regulations) of a non-state medical institution is approved by its founders (participants). Thus, the influence of the state on them is limited. It does not manage them, but only regulates certain aspects of their activities (registers, licenses, carries out regulatory regulation, sanitary and epidemiological supervision, etc.).
Based on the above, administrative and legal status of any medical institution can be formulated as a set of rights and obligations of a medical institution, providing, within the limits of administrative legal personality, for the independent solution of the goals and objectives inherent in a particular medical institution, the implementation of the functions necessary for this, participation in management administrative legal relations that develop primarily in the relationship of medical institutions with state executive authorities and municipal authorities.
This definition of the administrative and legal status of a medical institution allows, in our opinion, to identify five main elements:
– goals and objectives of the medical institution;
– functions of a medical institution;
– powers (rights and obligations) that constitute the main content of the administrative and legal status of a medical institution;
– organizational structure of the medical institution;
– creation, reorganization and liquidation of a medical institution;
– guarantees of the rights of operation of a medical institution.
The named elements of the administrative and legal status of a medical institution can be grouped into blocks. Based on the statement of Yu.A. Tikhomirov, who classifies normatively established goals, subjects of jurisdiction, objects of influence and power as elements of competence, we propose to combine the first three elements of administrative and legal status (goals, objectives, functions and powers) into the so-called “competence block”; include the organizational structure in the “intra-organizational block”; present the creation, reorganization and liquidation of a medical institution as an “external organizational block” and form a block of administrative and legal guarantees of the rights of medical institutions.
It seems that such a structure of the administrative-legal status of medical institutions will help optimize the legal regime for solving management problems, since it involves the formation of the content of the work of a medical institution, the creation of a legal basis for its activities, the presence of an organizational structure that ensures the implementation of the functions inherent in a medical institution, the order of functioning of the medical institution , endowing him with a set of rights and obligations, as well as the presence of guarantees of these rights.
So, let’s consider each of the named blocks of elements of the administrative and legal status of medical institutions
Competence block includes the goals and objectives of the activity, functions and powers of the medical institution.
Improving the activities of medical institutions is directly dependent on the compliance of the goals and objectives of the medical institution with the level of meeting the modern needs of the population for medical care. Moreover, one of the important conditions for the successful organization of the work of a medical institution is the presence of unity of goals and objectives.
Target as a higher-order category determines the content and focus of tasks. Having recognized the goal of the medical institution as an ideal, the governing body, the team, and society will find in it the means of regulating their own activities to improve the level of work of the medical institution as a whole. Considering that the goal means the result towards which the actions are aimed, the goal of a medical institution (its creation, operation) is obviously to reduce society's losses from morbidity, disability and mortality of the population with the available resources. The purpose(s) of the activities of each medical institution is enshrined in the relevant legal act - the Charter (Regulations) of the medical institution of the corresponding type.
In modern conditions main task which medical institutions are called upon to solve in their activities is to ensure the constitutional right of citizens to health care and medical care, which is expressed in the provision of timely, accessible, high-quality medical care. The main task determines the general direction of the activities of the subjects and objects of management to meet the needs of the population for medical care and therefore presupposes the presence of a set of auxiliary tasks that contribute to the implementation of the main task. Such tasks can be divided into basic and current. The main tasks are designed to determine the most important directions in the development of medical activities and are long-term in nature (tasks for the active use by all medical institutions of progressive forms of organizing medical care, modern and effective methods and means of prevention, diagnosis and treatment, the accelerated creation of a strong modern material and technical base of medical institutions and its constant further improvement). Enshrined in legal regulations, they are a legal obligation for medical institutions of all types. The current tasks of a medical institution are, as a rule, of a private nature; they are solved by the medical institution at a particular moment, depending on the regional situation, the level and structure of morbidity among the population, the capabilities of the medical institution and other factors. Their implementation is usually designed for short periods. They are part of the program-targeted administrative and legal status of each medical institution, since for certain subjects and objects of management they have normative significance and actively contribute to the practical implementation of the main, and through the latter, the general task facing the medical institution.
An important element of the administrative and legal status of a medical institution is its functions and the legal norms that support them. The point of defining functions is to establish in a normative manner what the administration and staff of a medical institution must do to achieve their goals and objectives. While implementing the same tasks, the team and administration perform different functions. The staff of the medical institution directly carries out the functions of treating patients, diagnosing diseases, carrying out preventive work among the population, using medications, dressings and other medical supplies, therapeutic, diagnostic and other medical equipment and technology, careful handling of hospital property, etc. The administration of the medical institution provides the necessary conditions for the team to perform these functions. This is achieved by the administration exercising its managerial functions (organizing the provision of medical care to the population; introducing progressive forms and methods of work, achievements of science, technology and medical practice; selection, placement and improvement of professional and business qualifications of personnel; carrying out preventive measures; analysis of morbidity and development of measures to reduce it; logistics support for medical and other activities of a medical organization; accounting and control over the correct expenditure of funds, rational operation of medical equipment and equipment; standardization of deadlines and establishment of rules for the use of medical equipment; control over compliance with standards for the consumption of medicines, medical supplies and materials; financing the activities of structural units and performing various works; planning of social development of the team).
Along with this, in healthcare, the functions, tasks, scope and nature of the work of hospital institutions in connection with the process of differentiation and integration, as well as thanks to the improvement of forms and methods of healthcare management, have expanded significantly. Each type of hospital is characterized by certain functions, the normative consolidation of which is carried out in the regulations on hospitals. These provisions are approved by orders of the Ministry of Health and Social Development of the Russian Federation and, along with the charter, determine the legal status of institutions.
In the course of its activities, a medical institution acts not only as a treatment and prophylactic unit, but also as an economic entity that has the material and technical base to carry out its main activities, and therefore, it must have an appropriate volume to solve its inherent problems and perform functions rights and responsibilities. Rights and responsibilities are one of the most important elements of the administrative and legal status of a medical institution.
Unlike commercial organizations that have general (unlimited) legal capacity, a healthcare institution is endowed with special (limited) legal capacity, i.e., a set of only those rights and obligations that are provided for by the constituent documents. For example, in paragraph 4 “Organization of activities” of the decision of the Saratov City Duma dated April 29, 1999 No. 30-289 “On the Model Charter of a Municipal Medical Institution” it is stipulated that the institution has the right to in the prescribed manner: enter into agreements with institutions, organizations, enterprises and individuals for the provision of work and services in accordance with the types of activities of the Institution; attract other institutions, organizations, enterprises and individuals; acquire or rent fixed and working assets when carrying out activities at the expense of available financial resources, temporary financial assistance and loans and credits received for these purposes; plan its activities and determine development prospects in agreement with the Health Committee, as well as based on patient demand for services.
It should be noted that the rights belonging to a medical institution are implemented mainly by its administration. The administration of a medical institution is vested with legal powers to express these interests. However, its staff also takes part in the exercise of rights to manage a medical institution. The participation of the team in the management of a medical institution is carried out mainly through a trade union organization. The trade union of a medical institution represents and protects the interests of the team in the field of medical activities, working conditions and socio-cultural issues. In this regard, the trade union of a medical institution, together with its administration, participates in the implementation of the rights of this institution.
The responsibilities of a medical institution may be: submission to the healthcare management body of the necessary cost estimates and financial documentation in full, approved forms and for all types of activities; agreement with this body on the structure of the Institution; ensuring the safety, efficiency and intended use of property; creating safe working conditions for its employees and bearing responsibility in the prescribed manner for harm caused to an employee by injury, occupational disease or other damage to health associated with the performance of his job duties; liability in accordance with the law for violation of contractual, credit, settlement obligations, business rules; compensation for damage caused by irrational use of land and other natural resources, environmental pollution, violation of production safety rules, sanitary and hygienic standards and requirements for protecting the health of workers, the population and consumers of products (works, services); and so on.
The rights and responsibilities of medical institutions are enshrined in numerous regulations. In general terms, the administrative legal personality of medical institutions is determined by the regulations (statutes) about them. However, these acts do not contain rules that would comprehensively define the entire scope of rights and obligations of medical institutions. Therefore, today many issues of managing the activities of medical institutions, including problems of administrative legal personality, have turned out to be normatively unsettled.
To Contents intra-organizational block includes the formation of a body for managing the affairs of a medical institution. The formation of the body for managing the affairs of a medical institution - the administration - is carried out by the owner or founder in the manner prescribed by the institution's Charter. The governing body of a healthcare organization in the state-municipal sector is the head, who is appointed by the founder and is accountable to him. The highest official of the hospital is its director - chief physician, appointed and dismissed by the health authority. In accordance with the Regulations on the chief physician of a regional (regional, republican) hospital, the chief physician organizes and controls the correctness and timeliness of examination and treatment of patients, their care, dispensary services, carrying out preventive and anti-epidemic measures in the area of operation, advanced training of medical personnel, correctness maintaining medical records, providing the hospital with medical and household equipment. He systematically analyzes the hospital's performance indicators, approves the hospital's work plan and budget, controls the correct use of materials and medicines, and is responsible for the sanitary condition of the hospital, selection and placement of personnel.
He carries out the current management of the hospital’s activities on the principles of unity of command; is responsible for the organization, level, quality of the diagnostic and treatment process in the hospital in accordance with accepted standards, modern requirements science and practice; is responsible for safety precautions and compliance with sanitary and anti-epidemic requirements, etc.
The chief physician of the united hospital has deputies for medical, outpatient and administrative work.
The deputy chief physician for medical affairs (medical work) is responsible for the quality of all medical activities of the hospital; directly manages the treatment, preventive and sanitary and anti-epidemic work of the hospital; checks the effectiveness of treatment and preventive measures; analyzes each case of death in hospital and at home; ensures proper organization of therapeutic nutrition and exercise therapy; organizes consultations for patients.
The deputy chief physician for the clinic directly manages the work of the clinic and organizes outpatient care for the population; develops plans for treatment, diagnostic and anti-epidemic measures of the clinic and ensures their implementation; appoints a control and expert commission and manages its work; organizes dispensary observation of established populations and monitors its quality and effectiveness; systematically studies the morbidity rate of the population in the service area.
The deputy (assistant) chief physician for administrative and economic affairs manages all administrative and economic activities of the hospital, ensures the supply of household equipment and supplies, food, fuel, hot water, lighting, organizes meals for patients, heating, repairs, fire safety measures, linen economy, transport, etc.
External organizational block represents the totality of powers of state authorities in relation to a medical institution and includes such elements as the creation of a medical institution, state registration, licensing of activities, liquidation and reorganization of medical institutions.
Creation (establishment) medical institution is carried out by decision of the owner of the property or the body authorized by him. The procedure for creating a hospital is provided for by the norms of civil law, since the hospital is a legal entity that takes an active part in civil circulation. The founding document of the hospital is the charter, which defines the general legal status, name, address, management and control bodies, sources of financing, conditions of reorganization and liquidation. For the purpose of a unified approach and to avoid discrepancies in the constituent documents of healthcare institutions at the federal and local levels, a joint letter of the State Property Committee of the Russian Federation dated December 29, 1995 No. OK-6/10860 and the Ministry of Health and Medical Industry of the Russian Federation dated December 28, 1995 No. 2510/3499-95-19 The Model Charter of a state (municipal) health care institution was recommended for use.
As practice shows in most regions of the Russian Federation, the decision to create regional medical institutions is made by regional governors or regional governments in agreement with regional legislative bodies.
The decision to create municipal medical institutions is made by the head of the municipal entity in agreement with the representative body of local government of this municipal entity. For example, Saratov City Duma adopted a decision dated April 29, 1999 No. 30-289 “On the Model Charter of a Municipal Medical Institution,” which includes: general provisions, goals and subject matter of the Institution, property and finances of the Institution, organization of activities, management of the Institution, reorganization and liquidation of the institution. State registration of a healthcare institution is carried out at its location by a local authority state power.
When considering the issue of creating a medical institution, it is necessary to identify the need for control by the relevant authorities over the activities of health care institutions. Control affects the direct content of the activities of medical institutions that carry out not only a socially significant function, but also activities that require special knowledge and skills. One of the tools for this type of control is licensing the activities of healthcare institutions.
According to current legislation, enterprises, institutions and organizations of state, municipal and private healthcare systems can carry out their activities only with availability of a license for the chosen type of activity.
The very first legislative definition of medical licensing was proposed in Art. 21 of the Law of the RSFSR “On medical insurance of citizens in the RSFSR”, according to which “licensing is the issuance of state permission to a medical institution to carry out certain types of activities and services under compulsory and voluntary health insurance programs.”
Another definition was given in the order of the Ministry of Health of the RSFSR dated March 20, 1992 No. 93 “On measures to implement the law of the Russian Federation “On medical insurance of citizens in the RSFSR”, according to which “Licensing is the issuance of a state document (license) for the right to engage in certain types of medical activities “.
Licensing can be characterized as “a form of control over the legality of the proposed actions of a citizen or organization, permission to perform only unconditionally legal actions and refusal to commit illegal actions, which determines the type and extent of permissible activity, as well as the implementation of supervision over the actions actually carried out.”
A permit to engage in medical activities (license) is issued by the relevant executive body of the constituent entity of the Russian Federation, authorized to license this type of activity, in order to assess the capabilities of the subject (medical organization) in terms of providing medical care in the volume and functions adequate to the level of training of personnel, the state of financial technical base of the organization and its equipment.
Based on the above, we can formulate the concept licensing of medical activities, which is proposed to be understood as the activities of licensing government authorities, which is expressed in the implementation of measures to grant permission (license), which is the basis for carrying out a certain type of medical activity, as well as in exercising control over this type of activity.
Today, general provisions on licensing of medical activities in the Russian Federation are regulated by the Federal Law “On Licensing of Certain Types of Activities”, adopted on July 13, 2001.
The procedure and conditions for issuing a license to carry out medical activities are defined in the relevant Regulations approved by Decree of the Government of the Russian Federation of July 4, 2002 No. 499.
Reorganization institution (merger, accession, division, separation, transformation) can be carried out by decision of the founder in the manner and in cases provided for by current legislation. With voluntary liquidation of an institution, a liquidation commission is created by the founder; in case of a forced one, the commission is appointed by the court and carries out work on the liquidation of the Institution in accordance with the current legislation.
During liquidation and reorganization, dismissed employees are guaranteed compliance with their rights in accordance with the legislation of the Russian Federation.
The property of the liquidated Institution, after settlements made in the prescribed manner with the budget, creditors, and employees of the institution, remains in municipal ownership.
When reorganizing an institution, all documents (managerial, financial and economic, personnel, etc.) are transferred in accordance with the established rules to the successor institution.
When an institution is liquidated, documents of permanent storage are transferred for state storage to the city archival funds, documents on personnel (orders, personal files, etc.) are transferred for storage to the archival fund. The transfer and organization of documents is carried out by and at the expense of the Institution in accordance with the requirements of archival authorities.
An institution is considered to have ceased to exist after its exclusion from the unified state register of legal entities.
Administrative and legal guarantees of rights Health care facilities are:
– the possibility of invalidating in court (in whole or in part) regulations of state bodies that do not comply with laws and other regulations and violate the rights and legitimate interests of a medical institution;
– compensation for damage caused to the institution as a result of illegal actions(inaction) of state bodies or their officials, including as a result of the issuance of an act of a state body that does not comply with the law or other legal act;
– guarantee by the state of compliance with the conditions established by law for the activities of medical institutions.
It should also be noted that an indispensable component of the administrative and legal status of a medical institution is its administrative, supervised subordination to administrative oversight bodies for compliance with legislation on taxes and fees, land use rules, sanitary and epidemiological rules, fire safety rules, occupational safety regulations, etc. .
Thus, the administrative and legal status of a medical institution guarantees its stability and provides a flexible organizational and legal basis for performing its inherent functions, solving inherent problems and achieving its goals.
In the process of studying the administrative and legal status (its individual elements) of healthcare institutions, it was established that there is no single regulatory act regulating the activities of medical institutions. We consider its adoption necessary, since today there are many regulations that establish the goals and objectives, rights and obligations, structure and organization of activities of medical institutions. In general terms, these elements of the administrative and legal status of medical institutions are determined by the regulations (statutes) about them. However, these acts do not contain norms that would comprehensively define all elements of the administrative and legal status of medical institutions. Therefore, today many issues of managing the activities of medical institutions, including problems of administrative legal personality, have turned out to be normatively unsettled.
Based on the above, in our opinion, it is necessary to develop and adopt a federal law “On the basics of organization and activities of a medical institution” to combine elements of the administrative and legal status of a medical institution into one legislative act.
The structure of this law should include the following main sections:
Section 1. General provisions ( Scope of application of this Federal Law, basic concepts, principles of legal regulation of the activities of medical institutions, fundamentals of the activities of medical institutions of various organizational and legal forms of the healthcare system of the Russian Federation).
Section 2. Organization of activities ( Basic rights and obligations, the right of non-profit medical institutions to implement entrepreneurial activity, provision of paid medical services, responsibility of medical institutions for obligations, relations with government agencies).
Section 3. Creation, reorganization and liquidation of a medical institution ( founders of medical institutions, statutory documents, conditions and procedure for acquiring the right to carry out medical activities).
Section 4. U management of a health care institution ( the highest official of the institution, his functions, powers and responsibilities).
Section 5. Legal status of a medical worker(rights, duties and responsibilities of persons engaged in medical activities).
Section 6. Property and property medical institution finances(sources of financing, property and funds of a medical institution, accounting, reporting, control of the responsibilities of a medical institution in relation to the property assigned to them).
Section 7. Types of activities of medical institutions(peculiarities of activity in the public-municipal sector; features of activity in the private sector; conditions for opening and running a private medical practice; procedure for concluding and content of an agreement with a consumer of medical services (agreement for the provision of medical services); quality control of medical care in the system of private medical practice.
Section 8. Liability for violation of this Law.
Final provisions.
The adoption of this law will make it possible to fill the gaps in the legislation regulating the relations that develop in the course of the activities of medical institutions, and will also complement the provisions of the fundamental legislation of the Russian Federation on the protection of the health of citizens concerning the organization of the protection of the health of citizens in the Russian Federation.
§ 3.2. The main directions for reforming the status of healthcare institutions in modern conditions
Delivered by the President of the Russian Federation V.V. Putin, the task of modernizing healthcare, which has the main goal of ensuring the implementation of the constitutional right of citizens to affordable and high-quality medical care, has found its concretization in a number of ongoing national projects. However, the effective translation of the set objectives into practice cannot be achieved without reforming the organizational and legal mechanism for the functioning of the health care system. Therefore, improving the system for organizing the provision of medical care - the system of state and municipal healthcare institutions - is declared as one of the program points for modernizing the industry.
As already noted, the specifics of modern medical institutions are predetermined by their administrative and legal status and a significant variety of forms.
Today, according to last option nomenclature of healthcare institutions, approved in October 2005, there are 98 types of healthcare institutions in the country, including 23 hospitals, 10 dispensaries, 7 outpatient clinics, 20 types of specialized centers, including scientific and practical ones, 6 sanatorium and resort institutions . Some of them duplicate each other in their functions; in addition, each requires departmental instructions and special documents, special forms reporting and accounting, etc.
The system of the Ministry of Health and Social Development of the Russian Federation includes 18 thousand medical institutions with 1.6 million beds. Including 8862 hospitals, 1532 specialized dispensaries, 6306 independent clinics. The industry operates 210 independent blood transfusion stations, 3,172 emergency medical care stations, and 43,362 paramedic and obstetric stations.
Today's realities dictate the need for serious adjustments to the organizational and legal form of healthcare institutions. It is quite obvious that the movement should be in the direction of vesting medical organizations with fairly broad powers to use the property at their disposal and pay staff. Therefore, it seems a promising direction for the development of the organizational and legal activities of healthcare organizations, transforming them into other forms of legal entities, which was declared as one of the measures to modernize healthcare.
The need for such transformations is explained by the inability of the state (or rather, its apparatus) to fulfill social obligations to the population to provide free medical care, the inability and unwillingness to maintain already thoroughly commercialized medical institutions in their previous status.
Certain steps in this direction have been taken by the Government of the Russian Federation. In particular, draft federal laws “On Autonomous Institutions” and “On State (Municipal) Autonomous Non-Profit Organizations” were developed, regulating the status of new types of organizational and legal forms of healthcare organizations: autonomous institutions (hereinafter referred to as AU) and state (municipal) autonomous non-profit organizations organizations (hereinafter referred to as GIANO), as well as the bill “On establishing procedures, conditions and criteria introducing new organizational and legal forms of medical organizations.”
It should be noted that the effect of these laws will presumably extend not only to medical organizations, but also to other state and municipal institutions operating in social sphere– in the field of science, education, culture, social protection, employment, physical culture and sports.
The basis for the development of new organizational and legal forms was already taken existing species non-profit organizations – an institution and an autonomous non-profit organization. Accordingly, future organizations must also become non-profit. This means that the purpose of their activities is not to make a profit. The profit received is not distributed in favor of the founders and is used exclusively for statutory purposes.
An analysis of the bills showed that essentially revolutionary changes should be undertaken in the industry, affecting such fundamental positions as ownership and the possibility of changing it; powers to use and spend available material and financial resources, including those created from budgets of all levels; financial basis of the health care system; management of the activities of healthcare organizations, etc.
It was planned that medical institutions would exist in at least three organizational and legal statuses: state institutions in the usual sense (state-owned); autonomous institutions (AI), where state funding will be partially retained; state (municipal) autonomous non-profit medical organizations (ownership is transferred to them completely, organizations acquire full autonomy, etc.).
This should have allowed three main questions to be resolved: how to earn money; who is the owner of fixed assets; How this owner is responsible for his obligations.
The emergence of organizations in new organizational and legal forms was possible in two ways: by creating new organizations and by reorganizing existing institutions in the form of transformation.
While creating the founder of both organizations (and G(M)ANO and AU) in accordance with the draft laws on them, can only be the state - the Russian Federation, a constituent entity of the Russian Federation or a municipal entity represented, respectively, by the federal government, the executive body of a constituent entity of the federation or a local government body. In this case, the founder remains the only one, both when creating an autonomous institution and when creating a state (municipal) autonomous non-profit organization.
More relevant for existing state and municipal institutions is the question of their transformation into new forms, namely the question of which institutions can be transformed and into what forms.
It was assumed that some particularly important medical institutions (whose main activities cannot be adequately measured by volumetric (resulting) indicators and there is a situation where ensuring the ability to provide the necessary medical care is more important than optimizing capacity utilization) will remain in state ownership, that is, they will remain government agencies in the usual sense. These will include sanitary and epidemiological surveillance centers, infectious diseases and psychiatric hospitals, tuberculosis and drug treatment clinics, AIDS centers and children's homes (institutions of state responsibility). According to Akopyan A.S., this form should account for approximately 55–65% of all medical organizations and combine the industrial base of healthcare of the territories, emergency and urgent care, work within the framework of budget-estimated financing (tariffs), which has only the budget as its source ( real) and compulsory medical insurance payments. Their property remains state property; wages, utility bills, current and major repairs, equipment and re-equipment are the function of the state as the owner and founder. The main statutory function is to provide free medical care to the population within the framework of accepted state guarantees, according to Art. 41 of the Constitution of the Russian Federation.
A number of others will be able to take the form autonomous institutions(in which state funding will be partially retained, the transfer of property is carried out by making a decision by the owner of the property to withdraw this property from the operational management of the transformed institution and assign it to the legal successor with the right of operational management). An autonomous institution independently manages the property (including real estate) that it acquires with income from its activities. The owner of the property does not receive income from the activities and use of the property by the autonomous institution.
The land is assigned to an autonomous institution on the right of permanent, unlimited use - just as it is currently assigned to state and municipal institutions.
With the consent of the owner of the property, an autonomous institution has the right to act as a founder and contribute funds and other property to the authorized (share) capital (fund) or otherwise transfer it as a founder (participant) of other legal entities whose activities correspond to its goals and contribute to the quality provision of services (performance of work) by an autonomous institution.
Besides main activity, for the sake of which the AU was created, it carries out activities related to the free or partially paid provision of services (performance of work) in accordance with the tasks of the founder and obligations to the insurer under mandatory social insurance. This activity is financed from the budget, state extra-budgetary funds or other funds. In our opinion, the term “partially paid services” provided in accordance with the tasks and orders of the founder is unclear. Therefore, it is necessary to specify what types of services they include, whether they are included in the State Guarantees Program, and what proportion of the cost of the service may be paid.
Upon proper completion of the task and fulfillment of obligations, an autonomous medical institution has the right, at its discretion, to provide services and perform work related to its main activities for any citizens and legal entities, for a fee, by concluding a public contract. On the same basis, the AU has the right to provide services (perform work) that are additional character in relation to its main activity. At the same time, all types of additional activities of an autonomous institution must be comprehensively specified in its charter. In this regard, it is also advisable to clarify what types of activities may be provided for by the Charter, if they are additional to the main one.
It should be borne in mind that the expansion of types of additional activities (commercial) beyond the provision of paid medical services (without limiting its volumes) may lead to a situation where autonomous organizations and institutions will be interested in carrying out other types of activities that bring in significantly greater income, than medical activities. This could lead to the closure and repurposing of a number of medical institutions and aggravate the problem of ensuring universal access to medical care.
In relation to autonomous institutions, a strict management system is established in the person of the relevant supreme bodies. The structure of the governing bodies of an autonomous institution is simple, and is presented:
– the highest collegial governing body – the board of trustees;
– the sole executive body – the director;
– other bodies provided for by law and charter.
Meanwhile, there are features of the functioning of government institutions in various fields activities. For example, it is difficult to provide unified higher management bodies for a medical institution and higher educational institution, library or museum.
Basic functions of managing an autonomous institution remain with the founder. These include:
– determination of priority areas of activity of the AU;
– making changes and additions to the charter, approval of the charter in a new edition;
– reorganization and liquidation;
– approval of the transfer act and separation balance sheet;
– appointment of a liquidation commission and approval of interim and final liquidation balance sheets;
– appointment and termination of powers of a manager, unless otherwise provided by law;
– making decisions on creating branches and opening representative offices;
– consideration and approval of proposals from the head of an autonomous institution to carry out transactions for the disposal of real estate and especially valuable movable property.
Compound Board of Trustees is also formed by the founder, who appoints and early terminates the activities of council members. Its composition includes representatives of the executive body, which is in charge of the autonomous institution - the founder; the body entrusted with property management, and representatives of the public who are not in labor relations with the autonomous institution. Serving on the board of trustees is not paid; only documented expenses associated with the work of the board are reimbursed.
The board of trustees, despite the status of the highest management body, is, in fact, an advisory body whose competence includes consideration and issuance of recommendations on issues within the competence of the founder, since the founder himself does not have the right to make decisions on these issues without considering the recommendations of the board of trustees . The only issue in which the board of trustees acts independently, as a supervisory body, is the approval of the manager’s proposals for a major transaction or a transaction in relation to which there is a conflict of interest (interested party transactions).
The competence of the head (chief physician) of an autonomous institution includes all issues of the current management of the organization, with the exception of issues within the competence of the founder and the council.
Also, the manager is assigned property liability in the amount of losses caused to the autonomous institution as a result of violation of the terms of a major transaction and an interested party transaction, regardless of whether the transaction was declared invalid. For the purposes of the bill, a major transaction is recognized as a transaction if its price or the value of the alienated or encumbered property exceeds 5% of the book value of the assets of the autonomous institution for the last reporting period.
The most extreme form freedom - autonomous non-profit medical organizations – new form a non-profit organization, which today is not provided for by either the Civil Code of the Russian Federation or the Federal Law “On Non-Profit Organizations” (property is transferred to them completely, organizations acquire full autonomy, etc.). Transforming an institution into a state (municipal) autonomous non-profit organization will be appropriate in a situation where the institution is not in a monopoly position, optimization of the capacities of institutions of this profile is necessary, and there is managerial potential for independent management. Among such institutions may be: city hospitals in cities where there are two or more hospitals of the same type, specialized hospitals in regions where there are other hospitals providing a similar type of care, research institute clinics, if in their area of activity there are other hospitals providing a similar type of care , diagnostic centers if there are other organizations in their area of activity that provide similar types of diagnostic services, city clinics if there are two or more clinics in the city.
Options for “special conversion cases” were also considered. For example, when a dental clinic for adults is transformed into a G(M)ANO or is privatized, local doctors and general practitioners, upon leaving the outpatient clinic, create group practices (at least 5 doctors) in the form of a G(M)ANO with assignment of movable and immovable property to them (subject to the established conditions of transformation).
Thus, the main difference between the legal status of a state (municipal) autonomous non-profit organization and the status of an autonomous institution is that the former has property by right of ownership.
Transformation of institutions into business companies intended to be used in exceptional cases. An exceptional case in the project is understood as a situation where a budget institution (or its divisions) has actually been operating as a commercial organization for many years. When transforming an institution into economical society the decision to withdraw property from the operational management of the institution is made simultaneously with the decision to transform it.
At the same time, it was considered advisable to transform into all the forms considered, partly by force, and partly to be converted on the initiative of the institution’s staff and by decision of the founder.
The possibility of making a decision on the transformation of the institution was preceded by compliance with the following mandatory conditions:
– the institution being converted does not have accounts payable for obligations overdue for more than three months as of the date of the decision on transformation (established on the basis of the financial statements as of the last reporting date);
– transition of the institution to financing based on the results of work and (or) provision of services.
The federal government may establish additional conditions to make a decision on conversion.
However, the promotion of the bills encountered certain problems, not least related to the need for quite serious adjustments to industry legislation and changes (to a certain extent, turning point) to fundamental norms in the civil sphere.
In addition, there was no consensus of opinion among leading experts and scientists on the advisability of adopting a new law: some believed that the introduction of a new organizational form of institutions would be a positive step in the modernization of healthcare, some allowed their introduction with reservations (or if new types of institutions were introduced, then it is enough to provide only one norm of the most general content in the Federal Law “On Non-Profit Organizations”, and the specifics of the legal status of autonomous institutions should be regulated by special legislation in relation to the relevant field of activity (education, culture, physical education and sports, etc.), or it was believed that the transformation of medical institutions will be possible only when the medical institution, having replaced the strategy of survival with a strategy of stabilization and development, feels the need for further transformations and changes, on the one hand, and greater freedom, on the other), and some are categorically against such transformations in medical institutions.
Obviously, these circumstances played a role in the fact that, despite the presence of positive aspects of the transfer of institutions to G(M)ANO (expansion of independence of autonomous non-profit organizations, the emergence of the possibility of timely and rapid response to changing conditions of the organization’s economic activity, departure from the costly estimate mechanism financing and strict budget expenditure schedule, material interest workers in the quality of their work and in their decent differentiated wages without using a single tariff scale; independent regulation of paid medical and related services, taking into account their demand in the market, seasonality and competitiveness, as well as the possibility of actively attracting capital from outside, using leasing, investing available available funds in the development of the organization itself and other organizations, acquisition valuable papers etc.), in the Action Plan of the Government of the Russian Federation for the implementation of the Program of Socio-Economic Development of the Russian Federation for the medium term (2006–2008), only the bill on autonomous institutions remained named.
As a result, the above-mentioned law was adopted, but it imposed a ban on changing the type of existing state and municipal health care institutions. Thus, only newly formed healthcare organizations received the right to exist in a new organizational and legal form.
Despite this, it seems that the organizational and legal reform of health care institutions should be continued in the previously proposed direction, which is caused by a number of legal, economic, organizational and other problems that indicate the currently formed conditions for reforming the existing organizational system in the field of health. Among these I would like to highlight the following.
1. Deficit in the allocation of funds from the budget system, at a time when one of the most important conditions for the effective functioning of health care institutions is timely, uninterrupted and sufficient budget financing. As a consequence we have: low quality available medical services, destruction of material and technical funds, lack of medical personnel and their insufficient qualifications, and, accordingly, deterioration in the quality of functioning of the overall state and municipal healthcare systems.
2. Unsettled relations between state institutions and the owner, which is associated, first of all, with the specific design of the right of operational management, which predetermines the originality of the content of the property rights of the institution. In addition, there is an inconsistency between the provisions of budget legislation and the norms of the Civil Code of the Russian Federation regarding the authority of institutions to independently dispose of funds acquired by them with income from activities permitted by the charter.
3. The presence of subsidiary liability of the owner for the obligations of the institution largely deprives the institution of incentives for the rational use of allocated funds, and has the consequence budget restrictions financial and economic activities, since any obligations of the institution must ultimately be covered by the owner. In turn, this entails the need for strict control on the part of the owner over the institution’s obligations (estimated financing broken down by items of economic classification). At the same time, the estimated financing procedure hinders the introduction of new economic mechanisms and more efficient use of existing state resources. Ultimately, due to the inherent shortcomings of the institution, there is an irrational allocation of state financial resources, often ineffective use of state (municipal) property and a deterioration in the quality of services provided by institutions.
4. There is a need for control by the relevant authorities over the activities of health care institutions. In addition to licensing the activities of medical institutions, control is exercised by the owner (state or municipal entity) over their own property. In this case we're talking about on control of the financial and economic activities of institutions, as well as on control of the content of their activities. However, detailed control over the activities of institutions still seems impracticable due to the variety of services produced and the scale of their production.
Undoubtedly, the proposed options for new forms of medical institutions left many issues unresolved.
Thus, it is not clear how many institutions the reorganization and reduction should affect, what specific changes need to be made to the legislative framework; whether the reorganized organizations are subject to uniform standards of medical care, what requirements will be imposed on their material and technical equipment, personnel etc. Therefore, it is advisable to more strictly stipulate positions on the need for the Government of the Russian Federation to develop additional conditions to make decisions on the transformation of an existing health care institution, as well as on the mandatory development of a List of institutions that are not subject to transformation.
The issues of ensuring the activities of health care institutions that retain the status of budgetary ones remain open. Will they retain the right to provide paid services, carry out entrepreneurial and other income-generating activities, which is permitted by the Civil Code of the Russian Federation, as well as the right to independently dispose of extra-budgetary income? If these norms are not maintained, then we can conclude that in conditions of constant underfunding, the state completely deprives budgetary institutions of the right to seek and use additional sources of financing. This can be interpreted in such a way that the prerequisites are forcibly created for a significant reduction in the number of budget institutions, since institutions capable of providing competitive services, including on a paid basis, are considered to have actually left the budget financing regime according to the estimates of income and expenses and , accordingly, must be reorganized into other organizational and legal forms. The relevant law or regulations should also consider the fact that reforming the network of institutions may lead to the release of a large number of industry workers, whose retraining, employment and social development will require a significant amount of financial resources.
It is necessary to take into account that legislative and regulatory acts on remuneration, pension provision, utility and other benefits apply only to employees of state (municipal) institutions.
It is also possible that a decrease in the number of state budgetary medical organizations, i.e. organizations for whose main activities the state is responsible, may lead to the fact that medical institutions remaining in state (municipal) ownership will not have enough capacity to full provision of citizens with free medical care, which can lead to limited availability of medical care and the impossibility of realizing the constitutional rights of citizens to receive it and, in general, to increased social tension in the country.
In addition, it should be noted that concerns have been expressed regarding the bill “On Autonomous Institutions”, which boil down to the fact that it opens up many opportunities for hidden privatization and privatization through artificial bankruptcy.
Formally, the new organizational and legal forms have nothing to do with privatization: property remains state (municipal). In addition, according to current legislation, privatization of medical institutions is not permissible in the following forms:
– sale of the institution;
– buyout of an institution by a collective;
– rent with subsequent purchase.
However, prerequisites for privatization through deliberate bankruptcy remain. The fact is that state (municipal) autonomous non-profit organizations will be liable for their debts with all their property, and autonomous institutions - with all their property, with the exception of real estate and especially valuable movable property.
To avoid the possibility of deliberate bankruptcy, it is necessary, in our opinion, to legislate a provision according to which property classified as fixed assets (both movable and immovable) should be provided to institutions transformed into an autonomous non-profit organization either on a lease basis or on the terms of an agreement for the gratuitous use of property (urgent or unlimited). Both proposed options are already in practical use.
Thus, autonomous institutions and autonomous non-profit organizations that do not have property classified as fixed assets by right of ownership cannot be declared bankrupt.
In addition, according to opponents of the reorganization of medical institutions, other privatization options remain (theoretically possible even now), which are still rarely used, since the reorganization of any budgetary medical institution attracts close attention from the press, the public and local political forces. In the conditions of mass reorganization of institutions, the facts of privatization will not be striking. Privatization of medical institutions is possible, in their opinion, by closing an existing institution (under the plausible slogan of restructuring the network of medical institutions, etc.) and creating a new legal entity on its basis. Another possible option for privatization through reorganization is that the institution can be transformed into a foundation, an autonomous non-profit organization (not necessarily a state or municipal one, as the new bills suggest), or a business company.
To refute the concerns expressed, it is necessary to indicate the following.
In accordance with paragraph 1. Art. 57 of the Civil Code of the Russian Federation and clause 2 of Art. 61 of the Civil Code of the Russian Federation, reorganization (merger, accession, separation, transformation) or liquidation of a legal entity can be carried out by decision of its founders (participants) or a body of the legal entity authorized to do so by the constituent documents.
The founders of both currently operating state (municipal) medical institutions and supposed autonomous institutions are state and municipal entities represented by authorized bodies.
The proposed draft law imposes certain restrictions on the reorganization of autonomous institutions. So, in accordance with Art. 19 of the draft law “On Autonomous Institutions”, the reorganization of autonomous institutions can be carried out in the form of: a merger of two or more autonomous institutions; joining an autonomous institution of one or more such institutions; dividing the AU into two or more institutions; separation of one or more autonomous institutions from an autonomous institution; transformation of AC into G(M)ANO.
Thus, the restrictions provided in the draft laws in the choice of organizational and legal forms of newly formed organizations completely exclude the possibility of their privatization.
In addition, it is possible in the legislation to establish a ban on the privatization of existing state (municipal) medical institutions in the form of transformation, i.e., to provide for the possibility of reorganization only in AU and G(M)ANO.
In order to avoid the above problems and concerns, we can conclude that the conditions for carrying out organizational and legal reform of healthcare institutions, taking into account the task of implementing national projects, should be:
1) the formation of a regulatory framework regarding the transfer of medical institutions to the category of autonomous institutions and relationships with such institutions.
At the same time, the regulations must provide for:
– guarantees of maintaining for a certain period the specifics and volumes of activity of an autonomous institution, as well as the staffing of employees of the reformed institution;
– a set of measures for the retraining of released workers, their social and living arrangements;
– requirements for a specialist to occupy the position of a manager, executive governing body;
– protection of the rights and interests of employees of transformed institutions. A possible option for protecting the rights of workers may be the establishment of a moratorium on reducing the number of employees of a transformed legal entity for a certain period (or the establishment of a requirement for agreement with the owner (founder) of relevant changes in the staffing structure), the mandatory extension of guarantees and benefits to employees of newly created autonomous institutions and organizations and compensation currently established for employees of institutions budgetary sphere. Such conditions can be specified in the decision on transformation, however, when fixing the relevant provisions, it should be taken into account that the moratorium cannot be of an indefinite nature, since in this case the freedom of economic activity of the legal entity will be violated. To protect the rights of employees of the created organizations, it is advisable to provide for the inclusion of a representative from the industry trade union body in the Board of Trustees.
The relevant law or by-law must provide for a special status for medical workers, similar to the status of civil servants, military personnel, etc.
– the need to coordinate the appointment of governing bodies with the relevant territorial sectoral health care management body.
It should be noted that many regulatory legal acts in the field of healthcare have such shortcomings as: insufficient financial support, declarative provisions, inconsistency separate standards, insufficient clarity in matters of distribution of powers between different levels, etc. It is obvious that a kind of revision of legislation in the field of health care is required. Not the least role in this is played by the constant development of public relations regulated by regulatory legal acts. There are fears that the idea of these laws will be watered down by legislators. Speeches in the press by a number of deputies provide grounds for this. Therefore, those who look forward to these laws may be disappointed by the attempt to force new organizational and legal forms into the mainstream of current powerless institutions. But even acceptance good laws does not guarantee effective work medical organizations that have received a new organizational and legal form. Numerous questions will arise regarding the conditions for the provision of buildings, the allocation of land, and the financing of implementation targeted programs and other cases of direct budget financing, provision of benefits for utility and rental payments, etc. To solve these problems, it will be necessary to make changes to whole line laws (primarily the Civil and Budget Codes, the law “On Non-Profit Organizations”). Therefore, when developing a new bill, the authors must take into account many nuances, in particular: linking the regulation of the new organizational and legal form (autonomous institution) with civil and budget legislation, including defining the nature of the property right to the property of autonomous institutions and its difference from the right of operational management and economic management; install (at least in general view) forms of owner control over the use of property; define clear conversion criteria; resolve a number of procedural issues;
2) reassessment of the existing relations between the state and healthcare institutions (budgetary institutions) in the field of their financing. First of all, it is necessary to remove the contradictions between budget and civil legislation. In addition, the mechanism for financing institutions itself must be reviewed. Obviously, a special law on budgetary institutions could help clarify the contradictory situation with the financing of institutions, in which it would be possible to provide comprehensive solution problems of their functioning and financing;
3) transition from estimated to normative-targeted financing. The latter represents reimbursement to government agencies for the costs of providing specific services to specific categories of consumers according to uniform standards established administratively. Thus, funding will be made dependent on the volume of services provided by the institution, and not on the staff, operating costs and purchase of materials. The literature also discusses several types of regulatory-targeted financing: payment according to standards for completed treatment; payment for agreed volumes of medical care; payment according to standards for the number of citizens attached to the institution, etc. However, the main problem comes down to overcoming duplication of funding from the budget and through the insurance system;
4) to convert, you must perform the following steps:
– on the part of the autonomous institution – to develop standards for the provision of medical care; conduct training for the management and staff of the medical institution to work in new conditions; bring the material and technical base of a healthcare institution in line with modern requirements as part of the implementation of the institution’s strategy; conduct an analysis of the financial, economic and personnel situation of the medical institution; formulate the institution’s budget; prepare and conclude agreements with local authorities (receiving an order for treatment of the population), medical insurance organizations and branches of the compulsory health insurance fund, public utilities, other legal entities, patients, etc.; develop investment policy, etc.
– on the part of government authorities and healthcare authorities – to develop a regulatory framework in in this direction; formulate a state order for medical care; formulate budget and tax policies in relation to the autonomous institution; develop medical and social programs in which autonomous institutions could participate on a competitive basis; develop new regulations on healthcare management bodies in connection with changes in the status of medical institutions; carry out explanatory work in the media with the population regarding the change in the status of medical institutions; develop an investment policy in healthcare; conclude agreements with an autonomous institution, etc.;
– on the part of the compulsory health insurance fund and the medical insurance organization – to develop standards for the provision of medical care; conduct an audit of existing medical and economic standards; conclude agreements with an autonomous institution; develop investment policy, etc.;
– on the part of patients and their relatives – to select an autonomous institution and conclude an agreement with it; take part in the activities of the institution (medical and sociological surveys, investing, etc.);
– on the part of other legal entities and individuals – enter into agreements with an autonomous medical institution, invest funds in this institution;
5) improving the existing procedure for compulsory health insurance. This requires: increasing the responsibility of compulsory health insurance funds for the results of their activities, as well as ensuring transparency in the financing of health care institutions. The insurance system should also be revised in order to eliminate duplication of funding for institutions in the estimate and insurance system;
6) competent division of powers regarding the provision of free medical services to citizens between levels of government. However, such a distinction must not only be correct from a constitutional point of view, but also justified from the point of view of financial security, in order to prevent the derogation of the right of citizens to medical care;
7) The Government of the Russian Federation or an authorized government body of a constituent entity of the Russian Federation should normatively establish lists of institutions that are not subject to transformation.
Thus, it seems that not any institutions can be subject to transformation, but only those institutions that meet the following criteria.
Economic criteria assumes that only those institutions that have a sufficiently high share of extra-budgetary revenues can be transformed, that is, those whose income from paid services and other services outside the framework of the Program of State Guarantees for the provision of free medical care to citizens of the Russian Federation is significantly higher than those allocated according to the estimate.
Social criterion means that those institutions whose activities are the only possible instrument for ensuring citizens’ access to certain species medical care (for example, obstetrics, high-tech medical care).
Geographical criterion does not allow the transformation of those medical institutions that are the only source of medical services for citizens living in sparsely populated, hard-to-reach and other similar areas.
In order to achieve positive result and at the same time avoiding the negative consequences of the reform, at the first stage it is also advisable to work out a mechanism for creating autonomous non-profit organizations on the basis of self-supporting dental institutions, or create such organizations in several regions (pilot projects), with subsequent study and generalization of this experience. In addition, it makes sense to carefully study the experience of non-profit organizations that have already been created on the basis of budgetary institutions, as well as the forms of interaction between government agencies and private organizations.
It seems more rational and less labor-intensive to carry out reforms to provide independence to budgetary institutions by maintaining the organizational and legal forms of budgetary institutions in their current form (state non-profit institutions) and making appropriate changes to the existing regulatory and legal documents regulating the financial and economic activities of these institutions, with with the aim of giving them greater economic independence.
The implementation of these proposals will relieve the founders of autonomous organizations from both additional organizational costs (change of signage, documentation, registration fees, etc.), and from the need to develop new regulatory documents and the same introduction of appropriate changes to existing regulatory and legal documents, with the purpose of regulating newly created institutions and organizations and bringing their activities in accordance with the law.
