Application No. 1
approved
by order of GBUZ JSC "GKB No. 4"
dated ____________ No. _
Rules for providing paid medical services population
1.1. These Rules for the provision of paid medical services to the population (hereinafter referred to as the Rules) in the state budgetary healthcare institution of the Astrakhan Region "City Clinical Hospital No. 4 Named" (hereinafter referred to as the institution) are developed in order to fulfill the following main tasks:
More fully meet the needs of citizens in quality medical care in excess of the established types and volumes of medical services established by the territorial program state guarantees providing citizens Russian Federation approved annually in accordance with the established procedure (hereinafter referred to as the Program) and / or not funded from the budget of the Astrakhan Region and the Astrakhan Regional Territorial Compulsory Medical Insurance Fund;
Provision of services within the scope of the main activity of the institution;
Provision of services;
Attraction of additional financial resources for the material and technical development of the institution and material incentives for its employees for the purposes provided for by the Charter of the institution;
Streamlining the provision of paid medical services by the institution.
1.2. These Rules are developed in accordance with:
Civil Code of the Russian Federation;
Federal Law Law of February 7, 1992 No. 2300-I "On Protection of Consumer Rights";
1.4. A health care institution has the right to provide non-medical services for a fee (additional household and service services, including stay in enhanced comfort rooms; additional care not due to medical indications; additional meals and other services) in accordance with applicable law, if this does not contradict the Charter of the institution healthcare. At the same time, obtaining a special permit from the Ministry of Health of JSC for the provision of non-medical services is not required.
2. Grounds for the provision of paid medical services
2.1. The grounds for the provision of paid medical services are:
Lack of appropriate medical services in the Program, financed from the funds of compulsory medical insurance, the budget of the Astrakhan region and funds from targeted programs;
Absence of obligations to pay for this type of medical care (medical service) from the budget and off-budget funds in excess of the established state task, as well as in cases determined by federal laws, within the established state task for the provision of services (performance of work), in excess of the established types and volumes of medical services established by the Program, as well as on the basis of standards and procedures approved by the Ministry of Health and social development of the Russian Federation, MZ AO, based on them - medical and economic standards;
Anonymity of treatment (except as provided by the legislation of the Russian Federation);
Provision of medical assistance to military personnel and other persons in accordance with Decree of the Government of the Russian Federation dated December 31, 2004 No. 911 “On the procedure for providing medical assistance, sanatorium and resort support and making certain payments to certain categories of military personnel, law enforcement officers and members of their families”;
The absence of an insurance medical policy for the patient, or the patient's treatment without a referral from a doctor of the territorial polyclinic;
Provision of medical services to citizens of foreign states in the manner and on the terms established by the legislation of the Russian Federation, unless otherwise provided by international treaties;
Voluntary desire of the patient to receive medical care with an increased level of service and personal care;
Voluntary desire of the patient during the period of treatment to receive medical care using alternative medicines, consumables and medical products that are not included in the lists of vital and essential medicines, medical devices necessary for the provision of medical care, approved by the Program;
Other conditions, including the waiting periods for medical care provided in a planned manner, than those established by the Program, targeted programs(with the prevention of deterioration of the conditions for the provision of medical care to persons entitled to free medical care).
2.2. Paid medical services to the population are provided by a healthcare institution in the form of preventive, advisory, medical and diagnostic assistance, namely:
Methods of diagnostics and treatment permitted on the territory of the Russian Federation;
Carrying out preventive vaccinations at the request of citizens (with the exception of measures for immunoprophylaxis carried out in accordance with applicable law);
Diagnostic, rehabilitation, preventive, consulting, health-improving and other services provided on the basis of the personal initiative of citizens;
Medical support for sports and other events;
Diagnostic studies, procedures, manipulations, consultations and courses of treatment carried out at the patient's home, as well as in other cases at the request of the patient.
3. Procedure for the provision of paid medical services
3.1. The health care institution is obliged to ensure the conformity of the medical services provided by law with the requirements for methods of diagnosis, prevention and treatment permitted in the territory of the Russian Federation.
When providing medical services (works) in an institution, the following must be applied:
Medicines, immunobiological preparations and disinfectants, other Consumables, medical devices registered in the Russian Federation;
Methods of prevention, diagnosis, treatment, rehabilitation, medical technologies permitted for use in the manner prescribed by the legislation of the Russian Federation;
Established federal and regional standards for the provision of medical care.
3.2. The provision of paid medical services by an institution is carried out only if:
3.11. The consumer of paid medical services is obliged to pay for the services rendered to him in the manner and within the time limits established by the contract with the contractor.
The consumer is obliged to pay for the service provided by the contractor in full after it is accepted by the consumer. With the consent of the consumer, the service can be paid by him at the conclusion of the contract in full or by issuing an advance.
3.12. When providing paid medical services, medical documentation is filled out in accordance with the established procedure. At the same time, a record is made on the medical card of an inpatient or outpatient patient that the service was provided on a paid basis.
The refusal of the patient from the opportunity offered to him to receive this type of medical care free of charge, if there is one in the Program, is recorded in writing in the contract for the provision of paid medical services.
The contract, receipt of strict accountability or cash receipt reflects the cost of the service according to the price list valid in the institution.
3.13. In case of non-observance by the institution of obligations on the terms of the performance of services, the patient has the right, at his choice:
Appoint new term provision of a service;
Request a reduction in the cost of the service provided;
Request the performance of the service by another specialist;
Terminate the contract and claim damages.
3.14. The institution is responsible to the patient for non-fulfillment or improper fulfillment of the terms of the contract, non-compliance with the requirements for methods of diagnosis, prevention and treatment permitted in the territory of the Russian Federation, as well as in case of harm to the health and life of the patient.
4. Organization of the provision of paid medical services in the institution
4.1. The health care institution is obliged in a visual form (on stands, posters placed in public places) to provide citizens with free, accessible and reliable information of the following content:
Location of the institution (place of its state registration);
Working hours of the institution, departments for the provision of paid medical services;
Having a license for medical activity and a certificate of conformity for other services (works) in cases established by the legislation of the Russian Federation;
Types of medical services provided free of charge under the Program;
List of paid medical services with indication of their cost (tariffs);
Conditions for the provision and receipt of paid medical services;
Benefits for certain categories citizens whose services can be provided at a discount;
The form of the contract;
Information on the qualifications and certification of specialists providing paid medical services, at the request of the patient;
Rights, obligations, responsibility of the patient and institution;
Contact numbers of the administration of the healthcare institution and persons responsible for the provision of paid medical services;
Other information in accordance with the Law of the Russian Federation "On Protection of Consumer Rights".
4.2. The provision of paid medical services in an institution is regulated by the current regulatory legal acts of the Russian Federation, the Charter of the institution, these Rules and local acts of the institution.
4.3. Contracts concluded with individuals are kept by the heads of departments in which paid medical services were provided for three years, with their subsequent submission to the archive for storage.
4.3.1. Agreements concluded with legal entities are stored in the accounting department of the institution for three years, with their subsequent submission to the archive for storage.
4.4. When providing paid medical services to inpatients, sheets of temporary disability may be issued in accordance with the established procedure.
4.5. A patient wishing to receive paid medical services applies to the medical registrar for the provision of paid medical services to get acquainted with the conditions for the provision and receipt of paid services. If the patient agrees to a paid examination and treatment in the registry, an outpatient medical card is issued and he is sent to a general practitioner, doctor general practice or a medical specialist.
4.6. Doctors examine the patient, determine the amount of necessary diagnostic, consultative and therapeutic measures and refer the patient to the administrator to draw up a contract for the provision of paid services.
4.7. If an inpatient examination or treatment is necessary, in agreement with the head or doctor of the department in which the patient will be examined or treated, the full scope of diagnostic, consultative and therapeutic measures, the duration of his stay in the hospital are determined for him, which is recorded in the referral to determine the cost of treatment , the subsequent conclusion of an agreement for the provision of paid services.
4.8. According to the results of the provision of paid medical services, an act of work performed is drawn up, and according to the results of treatment and examination of outpatients and inpatients, an extract from the medical card of the outpatient (inpatient) patient is issued.
4.9. When working with legal entities, the representative of the legal entity, together with the deputies of the chief physician authorized by the head of the institution, prepares a package of documents (examination and treatment program, contract, amount of funding, etc.). After signing the contract and paying for it in accordance with the terms of the contract, services are performed in accordance with the contract, with the subsequent execution of an act of work performed and other necessary documentation.
5. Accounting and reporting
5.1. The institution is obliged to keep statistical and accounting records of the results of paid services provided to the population, draw up reports and submit them in the manner and within the time limits established by the current legislation of the Russian Federation.
5.2. An institution providing paid services to the population is obliged to keep statistical and accounting records and reporting separately for the main activity and paid services.
5.3. Funds received by bank transfer and cash for the provision of paid services are credited to the institution's accounts from income-generating activities with subsequent transfer to the account of the Ministry of Finance of the Astrakhan Region in accordance with the budget classifier and current regulatory documents
5.4. The head of the healthcare institution is responsible for organizing accounting and reporting in a healthcare institution, including for paid services, for compliance with the law when performing financial and business operations. Responsible for accounting, timely submission of complete and reliable financial statements, including for paid services, is the chief accountant of the healthcare institution.
6. Settlements in the provision of paid medical services
6.1. Payment for the rendered paid medical services is carried out by consumers by bank transfer or in cash.
6.2. In the case of making payments through the cash desk, the health care institution applies cash registers. In some cases, an institution may use a form (receipt) approved by the Ministry of Finance of the Russian Federation, which is a document of strict accountability.
6.3. When paying in cash, the healthcare institution is obliged to issue to citizens a cash receipt or one copy of the completed receipt form confirming the receipt of cash.
6.4. Citizens have the right to make claims for compensation for losses caused by non-fulfillment of the terms of the contract, or for a reasonable return of funds for the services rendered, which is drawn up in the prescribed manner (a statement indicating the reason for the return, an act or other documents) with the subsequent return of funds to them.
7. Prices for medical services
7.1. The cost of medical services is determined based on the calculation of economically justified costs of material and labor resources associated with the provision of these services.
7.2. The price of a medical service is formed on the basis of the cost of providing a paid service, taking into account the market situation (supply and demand for a paid service), the requirements for the quality of a paid service in accordance with the indicators of the state task, and also taking into account the provisions of industry and local regulatory legal acts to determine settlement and standard costs for the provision of paid services.
8. Price list for paid services
8.1. The price list of a health care institution for paid services includes all services (medical and non-medical) that the institution is entitled to provide for a fee.
8.2. Prices for medical and non-medical services are indicated in rubles.
8.3. To ensure a unified regulatory framework works and services in health care throughout the Russian Federation, including patient management protocols, methods for performing complex and complex medical services, licensing requirements and conditions, including for the formation of uniform approaches to the creation of price lists of medical services in the CHI and VHI system, the Nomenclature of Works and services in health care (approved on 12.07.2004 by the Deputy Minister of Health and social development RF), which includes the sectoral classifiers "Simple medical services" and "Complex and complex medical services" (introduced respectively by orders of the Ministry of Health of the Russian Federation of 01.01.2001 N 113 and of 01.01.2001 N68).
All names of medical services in the price lists must strictly comply with the requirements of industry classifiers and the Nomenclature of Works and Services in Healthcare.
9. Use of income received from the provision of paid
medical services
9.1. Sources of financial resources in the provision of paid medical services are:
Personal funds of citizens;
Funds of organizations;
Other sources permitted by law, including voluntary health insurance.
9.2. The funds received for the provision of paid services are independently distributed and used by the institution in accordance with the estimates of income and expenses approved in the prescribed manner, in accordance with the Regulations on the remuneration of employees of the institution at the expense of funds received from the implementation of income-generating activities.
Restrictions may only apply to the use of income from the provision of paid medical services for purposes not provided for by applicable law.
9.3. The basis for staff remuneration are documents confirming the hours worked, the amount of work performed, signed by the heads of departments, payrolls approved by the head physician of the institution.
10. Responsibility for the provision of paid medical services
10.1. The institution is responsible to the patient for non-fulfillment or improper fulfillment of the terms of the contract, non-compliance with the requirements for methods of diagnosis, prevention and treatment permitted in the territory of the Russian Federation, as well as in case of harm to the health and life of citizens in accordance with the current legislation of the Russian Federation.
10.2. Claims and disputes arising from the provision of paid medical services by the institution to the population are considered in accordance with the current legislation of the Russian Federation.
10.3. Control over the organization and quality of paid medical services provided by the institution is carried out by the Ministry of Health of JSC, as well as others. authorized organizations, which, in accordance with the current legislation of the Russian Federation, are entrusted with checking the activities of health care institutions of the Astrakhan region.
10.4. Control over the organization and quality of the provision of paid medical services, as well as prices and the procedure for collecting funds from citizens, is carried out and bears for this personal responsibility head of a healthcare facility.
The limited resources in health care are the most important factor in the development of paid services. Budget financing and the possibilities of compulsory medical insurance funds do not allow meeting the needs of the population in the growing volumes of medical care. Despite state guarantees for the provision of free medical care, enshrined in the Basic Law (Constitution) of the Russian Federation, the private sector is becoming a reality in healthcare.
The prerequisites for the development of paid services have developed in the industry. These include: the desire of the state to develop along the path of a socially oriented market economy, integration of the national economy into world economy, change in the ratio of production wealth and provision of services in favor of the latter, the availability of world experience in the development of industries providing services, including in the field of medicine.
To the general prerequisites can be added the possibility of providing services without attracting limited public funds, the existence of legislative basis development of medical services, meeting the demand of the population for Additional services. In addition, new opportunities are opening up for creating additional jobs, introducing new scientific developments and technologies for treating patients, and improving material well-being. medical staff, increasing incentives for the growth of the qualifications of workers, improving the quality of medical services.
At the same time, the development of this sector of the health care economy requires a balanced approach, understanding all the possibilities of the state, society, and the population when making decisions in the field of socio-economic reforms. This requires a clear understanding not only of the problems of providing medical services, but also knowledge of the categories and concepts that employees of health authorities, medical institutions, and the country's population as a whole constantly face. First of all, you should dwell on the content of paid medical services.
A broad understanding of a paid service involves its provision for a fee, i.e. for a fee, in the narrow sense - the implementation of entrepreneurial activities. Medical institutions are non-profit organizations that do not have profit making as the main goal of their activities. They can carry out entrepreneurial activity aimed at achieving the goal for which they were created. In the process of providing paid medical services, the main goal of medical institutions is realized, therefore they have the right to provide services on a paid basis.
Paid medical services can be provided in the private practice system. In Art. 55 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, the following definition of private medical practice is given: “This is the provision of medical services by medical workers outside state and municipal systems health care at the expense of personal funds of citizens or at the expense of enterprises, institutions and organizations, including medical insurance organizations, in accordance with the concluded agreements.
TO private healthcare system include therapeutic and prophylactic pharmacies, whose property is in private ownership, as well as persons engaged in private medical practice and private pharmaceutical activities.
Paid medical service- this is a type of medical activity that includes preventive, medical diagnostic, rehabilitation, prosthetic and orthopedic, dental care and social care, provided in excess of the guaranteed volume of free medical care. They can be provided by organizations that relate to state, municipal and private medicine.
The main principles for the provision of paid medical services are: voluntariness, accessibility and safety, compliance with the quality of the service established requirements and standards, observance of the patient's rights and responsibility for their violation.
The development of paid services has its own history. Paid medical care in Russia has existed for a long time in the form of independent self-supporting institutions in Moscow, Leningrad, and Kyiv.
Since the end of the 1980s, in order to improve the use of equipment, sometimes very expensive and unique, to provide additional preventive, diagnostic and therapeutic care, a number of important government documents have been adopted to stimulate medical care on a self-supporting basis. Medical institutions were able to increase wages personnel, rather low compared to other industries, as well as direct additional funds for the development of the material and technical base. The amount of paid assistance was very small. In the future, as the economic situation in the country worsened, the sharp deterioration in the financing of the industry, paid services began to develop rapidly. They have become a fairly significant source of funding for hospitals.
The situation with the provision of paid services in the Sverdlovsk region is characterized by the following data. In 1993, services were rendered to the population of the region in the amount of 131.4 billion rubles; in 1994 - already by 1008.1 billion rubles. Further, the volume of paid services increased rapidly: in 1995 they amounted to 4204.4; in 1996 - 6117.9; in 1997 - 7835.4 billion rubles. According to the Committee of State Statistics, in 1999 paid services were rendered to the population of the region in all sectors of implementation in the amount of 10385.1 million rubles, while in the organized sector of the economy - 79.6% of their total volume.
In the Ural region in 1999, paid services were provided to the population in the amount of 40,983 million rubles. The population of the Sverdlovsk region received the largest volume of paid services; it is followed by the Chelyabinsk region, the Republic of Bashkortostan, the Perm region. The least paid services were provided to the population of the Kurgan region.
The structure of paid services to the population of the region for 1999 was characterized by the following data: domestic services were 10.6%; passenger transport services - 24.3; connections - 9.7; housing and communal services - 18.5; tourist and excursion - 4.6; medical - 6.6; educational - 7.1; others - 18.3%. The spread of indicators characterizing the volume of paid medical services is very large: from a few percent to 70% in institutions providing diagnostic and health services. In the Sverdlovsk region, the volume of paid medical services in 1999 amounted to 8%, in 2000 - 10%.
World practice shows that over the past decades, the market for services has developed dynamically, especially such as computer, information, and management services. At the same time, they were observed more high efficiency compared to industrial sectors of the economy. The share of services in household spending exceeds spending on short-term and long-term goods. Growth rates of prices for services are higher than for other household expenditure items.
In our country, the service sector is also developing rapidly, so it is very important to work out a clear mechanism for providing paid services to the population. In healthcare, it includes: the rules for the provision of paid medical services, their list, organization, calculations, pricing, organization of accounting, use of funds received, control over compliance with the rules for the provision of services on a paid basis and their quality.
The general rules for the provision of paid services by health care institutions of all forms of ownership are regulated by Decree of the Government of the Russian Federation dated January 13, 1996 No. 27 “On Approval of the Rules for the Provision of Paid Medical Services to the Population by Medical Institutions”. In the Sverdlovsk region, government decrees were adopted on July 16, 1997, No. 595 “On paid services of healthcare institutions in the Sverdlovsk region”, and on May 5, 1999, No. 544 “On paid services provided in state and municipal healthcare institutions in the Sverdlovsk region”. They contain forms of special permission for the right to provide paid medical services, basic requirements and marginal tariffs for services.
When concluding contracts, medical institutions must provide the client with information on the types of medical services provided free of charge under the territorial programs of compulsory medical insurance and targeted comprehensive programs, on the cost of services, including information on benefits for certain categories of citizens.
The most important element in the implementation of paid services to the population is pricing. Currently, healthcare is represented by free and paid medicine, so prices are formed in accordance with the above two forms. In the healthcare market sector represented by commercial organizations, prices are determined taking into account the supply and demand for services. The provider of services - the health care institution forms the offer, and the buyers - the demand. The seller tries to recoup the costs and make a profit, and the buyer is interested in bringing the price closer to the costs of the service. In conditions of significant competition, a price is set that satisfies the interests of the seller and the buyer.
As you can see, in the process of price formation there is much in common with pricing in the services market. However, there are also differences. They are due to belonging to social sphere, priorities in the values of people and their attitude to health, the level of income of the population, etc. As a rule, these factors help to keep the price at an acceptable level for the population.
The main volume of services (both within the framework of the system of compulsory medical insurance and paid medical services) is provided by state and municipal medical institutions. They sell services at prices greater than, equal to or less than cost. In the first case, the price is formed on the basis of the full cost and the planned percentage of profit. Percentage of profit or profitability justified by data economic analysis activities of the institution, its development programs aimed at improving the material and technical base, ensuring financial stability, increasing the salaries of medical personnel.
Earlier it was said that prices do not always reimburse the cost of providing paid services. A striking example is a diagnostic study on magnetic resonance imaging. This study is very costly. Typically, only one-third of the costs are reimbursed, but hospitals continue to provide this service, because it gives a high diagnostic effect, which is achieved through the use of advanced equipment. Diagnostic centers, municipal hospitals among paid services are planning services for partial reimbursement of costs.
Pricing in healthcare is one of the most difficult problems. There is currently no ideal methodology for pricing medical services. Prices and tariffs are influenced by the level of financing of medical institutions, which, as a rule, does not cover the needs for medical services. This feature of the industry determines the nature of pricing, and in general the pricing policy of medical institutions.
The choice of pricing methodology depends primarily on the purpose and objectives of the institution, which are achieved in the process of implementing paid services. If the goal is to compensate for insufficient funding, then prices and tariffs may be below market rates. If the goal is to find the reserves necessary for the development of a medical institution, then prices should reflect all costs for the production of services and include profit.
The procedure for pricing a medical service is influenced by such factors as the type of service (simple or complex), the existence of an agreement between the producer and consumer of services.
In accordance with Art. 38 of the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens, citizens have the right to free medical care only at the place of residence. Patients can receive medical services that are not included in the compulsory health insurance program for a fee. When providing a comprehensive service, part of which is guaranteed by the state, its cost may be different for residents attached to the hospital and for other consumers of the service. In addition, prices depend on the solvency of enterprises with which contracts for medical care have been concluded. In this case, prices can be as close as possible to market prices.
The procedure for setting prices is very diverse in different territories. Prices for paid services are set by the authorities of the constituent entities of the Federation, health authorities, local authorities government, medical institutions. As a result of the simultaneous regulation of prices by the listed authorities, specific medical institutions are under pressure from conflicting management decisions regarding the provision of paid medical services. This complicates the activities of medical institutions, which are left alone with economic problems and the population of the territory, as a rule, disapproving of the development of paid services. During the period of numerous election campaigns, political factors are added to the economic aspects, which have a significant impact on the formation pricing policy for medical services.
Currently, when paying for services, internal prices, tariffs and contract prices are used. The internal price is characteristic of the system budget financing. It provides for strict regulation of costs for specific cost items and does not include overheads and profitability.
Tariffs for paid services- monetary value of the cost of a medical service, calculated in accordance with the legislation of the Russian Federation and other subjects of the Federation. Tariffs can reimburse costs (in whole or in part) or provide expanded reproduction. They can be developed on the basis of actual and standard costs. In the first case, we can talk about a cost economy with prices above the market. The transition to the formation of tariffs according to norms and standards provides science-based calculations of the volume of healthcare financing, taking into account all the costs provided for by the classification.
It is more convenient for medical institutions to work at their own prices for paid services, for health authorities - at prices calculated according to a single methodology. At the same time, real prices in individual institutions differ significantly from each other, since all types of resources are used to varying degrees. In addition, the level of government (federal, regional, municipal) is also reflected in the cost of paid services. The destruction of the vertical of healthcare management has led to the fact that different branches of government form prices for services differently. Often, a patient pays more or less for a similar service in a regional medical institution than in a municipal one.
Negotiated prices for medical services are widely used in settlements in the system of voluntary medical insurance, in non-commercial and commercial medical institutions. They take into account supply and demand, information about prices in competing organizations providing similar services. Such prices take into account the full cost of medical services and related work, as well as profit. As a rule, the price is set by the cost method, taking into account the cost of wages, overhead, profitability at the discretion of the leaders of the organization.
In general terms, the price of a medical service is determined based on the cost and profit, expressed through the rate of return.
The costs included in the cost price include:
- costs for salaries of medical personnel and accruals;
- straight material costs(the cost of medicines, dressings, food; depreciation of equipment and much more);
- overhead costs (salaries of administrative and management personnel, office and household expenses, travel expenses, overhaul buildings and structures, public utilities etc.).
At the same time, income and expenses are recorded in accordance with the economic classification of expenses of the budgets of the Russian Federation.
Particular attention in the pricing process is paid to the price structure for paid medical services. It is known that the provision of medical services is a very laborious process, which employs mainly highly qualified workers. Therefore, significant specific gravity in the cost of a paid service include the cost of wages with accruals. When choosing methods of remuneration, it is necessary to take into account working conditions and technologies for the provision of services, the functions of wages - reproductive, stimulating and social, labor standards. The current procedure for remuneration of medical personnel in accordance with the Unified Tariff Scale does not reflect the complexity and responsibility of labor, its social significance, therefore it should not be used in pricing.
Hospitals try to use market categories such as “cost” and “price” when calculating prices. work force”, “costs for the production of services”, “profit”, “profitability”, etc.
On further development The market of medical services is greatly influenced not only by the methods of generating incomes of medical institutions, their structural divisions, but also by their distribution. The participation of medical personnel in the distribution of income received by a particular unit of the hospital contributes to the improvement economic indicators team work.
Income from paid services is usually used as additional source funding that contributes to the effective functioning of the institution. They allow you to increase the wages of staff and thereby reduce the tension in the workforce caused by low wages.
As economic growth, improving the well-being of the population, strengthening legislative framework, increasing state responsibility for the health of the population, the problems of paid services in healthcare will be resolved in favor of the citizens of the Russian Federation. At the same time, society should be aware that there can be no free medicine. The problem is to establish the share of responsibility for people's health on the part of the state and the population and answer the question: who and how much should pay for the most important human value, what is health?
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PROCEDURE AND TERMS OF PROVIDED PAID SERVICES 1. The provision of paid medical services is carried out in all medical and diagnostic structural divisions institutions. 2. Paid medical services provided to the population must comply with the requirements for methods of diagnosis, prevention and treatment permitted for use on the territory of the Russian Federation in accordance with the procedure established by law. 3. Paid medical services in GBUZ "City Clinical Hospital No. 29 DZM" can be provided in full standard of medical care or as one-time consultations, procedures, diagnostic tests and other services, including in excess of the standards. 4. The institution is liable to patients for non-fulfillment or improper fulfillment of the conditions for the provision of paid services, non-compliance with the requirements for methods of diagnosis, prevention and treatment, as well as for causing harm (damage) to the patient's health in accordance with the current legislation of the Russian Federation. 5. Paid medical services to the population are provided in the form of: advisory, preventive, treatment and diagnostic, rehabilitation, inpatient and inpatient care. 6. Paid medical services to the population are provided according to the approved price list within the framework of agreements concluded with individuals (patients) and legal entities (insurance companies and organizations). 7. Paid medical services are provided after the execution of the contract in a simple writing, which regulates the subject, conditions and terms for the provision of paid medical services, as well as the calculation procedure, the rights, obligations and responsibilities of the parties. The document is filled in in 2 copies and signed by both parties (a copy is pasted into the medical record of an inpatient or outpatient card). 8. When concluding an agreement for the provision of paid medical services, the patient’s informed consent is prescribed in the agreement: at the time of signing this Agreement, the Patient is informed about the procedure for providing free medical care under the compulsory medical insurance program under the Territorial Program of State Guarantees for the provision of free medical care to citizens of the Russian Federation. By signing this agreement, the Patient gives his voluntary consent to the provision of paid medical services. The patient is familiar with the current price list, terms of payment and agrees to pay the cost of medical services at his own expense to the hospital's cash desk. The patient is notified that the paid cash under this agreement are not subject to compensation at the expense of compulsory medical insurance. 9. Medical services in the consultative and diagnostic center are provided to Patients by appointment during the hours of admission of paid patients (with the exception of emergency conditions). 10. Hospitalization of patients to the hospital is carried out through the admission department of the hospital: DISCOUNTS FOR PAID SERVICES The provision of medical care to these persons is free of charge. 10% discount on the cost of the service: SOCIAL TAX DELEGATION A patient who has spent money on paid treatment, medicines, voluntary health insurance can receive a social tax deduction. A social tax deduction for treatment can be obtained if a number of conditions are met at the same time: Conditions for obtaining a tax deduction for medical treatment. To receive this deduction, you must submit a 3-NDFL tax return along with an application for a social deduction. Supporting documents must be attached to the declaration: Social tax deduction can be received only in tax office by residence. Receiving a social deduction from the employer is not provided by law. This follows from paragraph 2 of article 219 and paragraph 2 of article 229 tax code RF. Therefore, in practice, the right to receive a social deduction can only be exercised by citizens registered in Russia at their place of residence (letters of the Federal Tax Service of Russia dated June 8, 2006 No. 04-2-03 / 121 and dated June 2, 2006 No. GI-6-04 / 566). a certificate of payment for medical services for submission to the tax authorities can be obtained at the planning and economic department (building 39, 2nd floor)
One of the sources of financial support for state and municipal health care institutions is income from the provision of paid medical services.
Legal basis for the provision of paid medical services in healthcare institutions
Health care institutions are non-profit organizations, and non-profit organizations, in accordance with Art. 50 of the Civil Code of the Russian Federation, can provide paid services, if it is provided for by their constituent documents, only insofar as it serves to achieve the goals for which they were created, and if it corresponds to such goals.
The right and conditions for the provision of paid services by medical organizations
One of the sources of financial support for state and municipal health care institutions is income from the provision of paid medical services. Health care institutions are non-profit organizations, and non-profit organizations, in accordance with Art. 50 of the Civil Code of the Russian Federation, can provide paid services, if it is provided for by their constituent documents, only insofar as it serves to achieve the goals for which they were created, and if it corresponds to such goals.
In practice, this means that in all documents regulating the provision of paid medical services, it is necessary to indicate in the preamble that such activities are carried out with the aim of wider coverage of the population with quality medical care, the introduction of advanced medical technologies, etc. The provision of paid medical services should never be justified. medical services by insufficient financial support of the health care institution.
From January 1, 2015, one more condition appears for non-profit organizations that carry out income-generating activities in accordance with the charter - their property, with the exception of property of state institutions, must have a market value of at least minimum size authorized capital provided for limited liability companies, i.e. today - 10 thousand rubles.
The right of citizens to receive paid medical services provided at their request when providing medical care, and paid non-medical services (household, service, transport, etc.), is enshrined in the Federal Law of November 21, 2011 No. health of citizens in the Russian Federation" (hereinafter - Law No. 323-FZ). At the same time, paid medical services are provided to patients at the expense of their personal funds, employers' funds and other funds on the basis of contracts, including voluntary medical insurance contracts.
Despite the fact that, according to the Accounts Chamber of the Russian Federation, standards of medical care are approved only for 17% of diseases in which medical care is provided in a hospital, paid medical services can be provided both in the full scope of the standard of medical care, and in the form of individual consultations or medical interventions, including in excess of the standard.
For medical organizations participating in the implementation of the state guarantees program free provision citizens of medical care and territorial programs of state guarantees of free provision of medical care to citizens (hereinafter referred to as the SGBP), Law No. 323-FZ states that they have the right to provide paid medical services to patients:
On other terms than those stipulated by the SGBP and (or) targeted programs;
When providing medical services anonymously, with the exception of cases provided for by the legislation of the Russian Federation (HIV, AIDS, tuberculosis, etc.);
Citizens of foreign states, stateless persons, with the exception of persons insured under compulsory health insurance, and citizens of the Russian Federation who do not permanently reside on its territory and are not insured under compulsory health insurance, unless otherwise provided by international treaties of the Russian Federation;
When applying for medical services on your own, with the exception of the possibility of choosing a doctor and a medical organization in accordance with Art. 21 of Law No. 323-FZ.
It is important to note that the provisions of the Law of the Russian Federation of February 7, 1992 No. 2300-1 “On Protection of Consumer Rights” (hereinafter - Law No. 2300-1) apply to relations related to the provision of paid medical services. So, by the decision of the Plenum Supreme Court RF dated June 28, 2012 No. 17, it was established that consumer protection legislation also applies to the provision of medical services to citizens provided by medical organizations within the framework of compulsory health insurance.
Federal Law No. 7-FZ dated January 12, 1996 “On non-profit organizations”(Clause 4, Article 9.2) establishes the right for budgetary institutions in excess of the established state (municipal) task (as well as in cases determined by federal laws, within the established state (municipal) task) to perform work, provide services related to its main activities, individuals and legal entities on a paid basis and on the same conditions for the provision of the same services.
Let us give an example of the provision of paid medical services within the state assignment.
State state-financed organization health care "Observation Polyclinic" conducts different kinds medical examinations: preliminary, periodic, pre-trip, pre-flight. In accordance with Art. 213 Labor Code RF inspections are paid at the expense of the employer. The body that performs the functions and powers of the founder provides the polyclinic with a subsidy for the maintenance of the institution and, within the framework of the state task, obliges it to provide services to employees of organizations financed from the regional budget at reduced prices.
In accordance with Art. 84 of Law No. 323-FZ, on October 4, 2012, Decree of the Government of the Russian Federation No. 1006 “On Approval of the Rules for the Provision of Paid Medical Services by Medical Organizations” (hereinafter referred to as the Rules) was signed, which entered into force on January 1, 2013.
The Rules for medical organizations participating in the implementation of the SGBP define the conditions for the provision of medical services on a fee basis, including clarification of what “other conditions” are than those stipulated by the SGBP:
In case of inpatient treatment - the establishment of an individual post of medical observation;
The use of medicines that are not included in the List of Vital and Essential Medicines, if their appointment and use is not due to vital indications or replacement due to individual intolerance to medicines included in the specified list, as well as the use of medical devices, medical nutrition, including specialized health food products that are not provided for by the standards of medical care.
In addition, the Rules repeat the conditions for the provision of paid medical services, established by law No. 323-FZ: when providing medical services anonymously, in the absence of a compulsory medical insurance policy, self-applying for services, with the exception of the conditions provided for in Art. 21 of Law No. 323-FZ.
In fact, the list of conditions is open. That is, the provision of medical services out of turn, at a convenient time for patients, etc., can still be carried out on a paid basis.
The Rules do not state that, in addition to the types and volumes of the SGBP, medical services are provided only on a paid basis, but in practice this is exactly what happens.
Informing consumers of paid medical services.
Since, we recall, medical services are now covered by Law No. 2300-1, the Rules contain requirements to provide information to consumers in accordance with this law (Articles 9 and 10).
The rules require that the necessary information be posted on the website of a medical organization on the Internet, as well as on information stands(racks) of a medical organization. The obligation of the institution to provide patients with a copy of the license with applications, addresses and telephone numbers of regulatory authorities, information about the working hours for review existed before. But from January 1, 2013, it became mandatory to provide a copy of the documents on entering into the Unified State Register legal entities, indicating the body that carried out state registration; price list - a list of paid medical services with prices in rubles; information about the conditions, procedure and form of providing medical services and the procedure for their payment. As well as the obligation to inform patients about the procedure and conditions for the provision of medical care in accordance with the SGBP, to provide information about medical workers involved in the provision of paid medical services, about the level of their professional education and qualifications. This is due to the fact that Law No. 2300-1 requires the provision of information about the person who will provide the service and information about him, since this is of significant importance to the patient and affects the quality of the service.
Information posted on information stands should be available to all visitors of the institution during the entire time of the medical organization. Information stands should be located in a place accessible to visitors and designed in such a way that it is possible to freely familiarize themselves with the information posted on them. No references to the fact that there are many services, that their prices can be found in the department of paid services or at the cash desk of the institution, which, of course, may not release the institution from the obligation to post the price list on the stand or next to it, even if it is a whole book and visitors periodically "borrow it forever for better study".
The absence in a visual and accessible form on the website of a medical organization in the information and telecommunication network Internet, as well as on information stands (racks) of all the information provided for in clause 11 of the Rules, as well as the text of the Rules themselves and Law No. 2300-1, entails a warning or imposition administrative fine from 3 thousand to 4 thousand rubles. - on officials; from 30 thousand to 40 thousand rubles. - for legal entities. This is provided for in Art. 14.5 of the Code of the Russian Federation on administrative offenses, which establishes such responsibility for the provision of services by the organization in the absence of information, the obligation to provide which is provided for by the legislation of the Russian Federation.
For familiarization, the consumer (customer), at his request, must be provided with a copy of the charter, memorandum of association, regulations or regulations on the branch, i.e. the constituent documents of that legal entity or its branch that directly provides paid services, as well as information on the entry of the institution into the Unified State Register of Legal Entities.
Informed voluntary consent of the patient
The rules determine that paid medical services are provided with the informed voluntary consent of the patient (clause 28) or his legal representative. Informed consent, which is a prerequisite for any medical intervention, refers to the voluntary decision of the patient to apply a course of treatment or use a diagnostic method after providing the doctor with the necessary amount of information.
Thus, the process of obtaining informed voluntary consent consists of two stages: providing the patient with information at his request and properly processing the patient's consent to receive services.
The patient has the right to receive the following information:
On the state of his health, including information about the results of the examination and the established diagnosis;
Treatment options and the risks associated with each;
Possible options and consequences of medical intervention;
About alternatives to medical intervention;
Expected results of treatment;
Medicines and medical devices used in the provision of paid medical services, including their expiration dates (warranty periods), indications (contraindications) for their use.
Taking into account the principle of voluntary receipt of information, the patient has the right to refuse to receive information or to indicate the person who should be informed about the state of his health instead of him. When providing the patient (his legal representative or another person specified by the patient) with information about the upcoming treatment, it is desirable to use a minimum of medical or technical terms, and also make sure that the information is correctly understood.
The obtained consent of the patient to medical intervention must be properly documented. Current legislation does not establish a mandatory written form for processing the consent of the patient. But in the event of a patient-physician conflict or litigation, the patient's written informed consent will protect the institution.
In order to eliminate or, at least, significantly reduce the claims of patients against institutions, it is advisable to develop and approve several forms of documents for various types of medical interventions, samples of which are available in specialized literature and on the Internet.
The document usually consists of two parts - the information part and the patient's own consent to medical intervention. The information part of the document is filled in by the doctor in the presence of the patient or his representative. In the informed voluntary consent (as well as in the contract) it is necessary to indicate that non-compliance with the instructions (recommendations) of the contractor ( medical worker provider of a paid medical service), including the prescribed treatment regimen, may reduce the quality of the medical service provided, make it impossible to complete it on time, or adversely affect the health of the consumer.
The document must contain the date of signing, as well as a handwritten transcript of the signature of the patient (his representative). A note is also made in the patient's medical record about the availability of informed voluntary consent to medical intervention. A document confirming the patient's informed voluntary consent to medical intervention may be stored in the patient's medical record or separately from it.
When providing paid medical services by medical organizations participating in the implementation of the SGBP, it is necessary to indicate in the informed voluntary consent the reasons why medical care is provided on a paid basis. For example: in excess of the scope of the territorial program of state guarantees of free provision of medical care to citizens; services not included in the SGBP; beyond the standards of treatment; services out of turn; on an anonymous basis, etc. It must be noted that this is done at the request of the patient.
Conclusion of an agreement for the provision of paid services
Please note that in the contract for the provision of paid medical services (which must be concluded only in writing), it is necessary to write “consumer” or “customer”, and not “patient”, as was done before.
For your information
The consumer is individual who intends to receive or is already receiving paid medical services personally in accordance with the contract. But a consumer receiving paid medical services is at the same time a patient covered by Law No. 323-FZ.
A customer is a natural or legal person who intends to order (purchase) or order (purchase) paid medical services in accordance with the contract in favor of the consumer.
At the conclusion of the contract, at the request of the consumer or customer, they must be provided in an accessible form with the following information:
On the procedures for the provision of medical care and the standards of medical care used in the provision of paid medical services;
Specific medical workers providing the relevant paid medical service (their vocational education and qualifications);
The methods of providing medical care, the risks associated with them, the possible types of medical intervention, their consequences and the expected results of the provision of medical care.
Consumers or customers may be provided with other information related to the subject of the contract.
It should be noted that prior to the conclusion of the contract, the institution is obliged to notify the consumer (customer) in writing that non-compliance with the instructions (recommendations) of the medical worker providing the paid medical service, including the prescribed treatment regimen, may reduce the quality of the provided paid medical service, entail the impossibility of its completion on time or adversely affect the health of the consumer.
If, in the process of fulfilling the contract, the contractor needs to provide additional medical services to the patient, the parties either sign additional agreement to the contract, which is his integral part or a new contract is signed.
It can be recommended, for example, for inpatient treatment, when the cost of providing medical care directly depends on the number of bed-days spent by the patient in the organization, to use the approximate price of the service in the contract.
Example
When treating in a hospital, the approximate price of the service is formulated in the contract after specifying the cost of treatment as follows: “the price of the service is approximate and can be changed upwards or upwards depending on the actual number of days the patient stays in the hospital.” Similarly, the approximate price is formulated for other services, the cost of which depends on the quantity, size, presence or absence of something that cannot be accurately determined before the start of the service.
In accordance with Law No. 323-FZ, if the provision of paid medical services requires the provision of additional medical services for emergency reasons to eliminate the threat to the life of the consumer in case of sudden acute diseases, conditions, exacerbations of chronic diseases, then such medical services are provided free of charge.
If the patient refuses to receive medical services after the conclusion of the contract, the contract is terminated. At the same time, the consumer (customer) is obliged, in accordance with the Civil Code of the Russian Federation, to pay the contractor for the expenses actually incurred by him related to the fulfillment of obligations under the contract.
New options for paying for medical services
Note that the Rules, in accordance with the current legislation, allow issuing not only checks cash register equipment but also other documents of the established form. In other words, when providing medical services at home, on the road, at a time when the cash desk is not working or not working cash machine, you can provide paid services and accept payment for them by issuing strict accountability documents equivalent to checks. At the same time, an agreement on full liability is concluded with employees who accept payment.
New technologies do not stand still, and mobile card readers have already begun to appear, which are connected to smartphones and iPhones, on which appropriate applications are installed and which allow you to pay for services. bank cards even at home and away.
The rules apply not only to services paid for at the expense of citizens' personal funds, but also at the expense of legal entities and other funds on the basis of contracts, including voluntary medical insurance contracts. They determine that the conclusion of voluntary medical insurance contracts and payment for medical services provided in accordance with such contracts are carried out in accordance with the Civil Code of the Russian Federation and the Law of the Russian Federation of November 27, 1992 No. 4015-1 “On the organization of insurance business in the Russian Federation”.
In conclusion, we note that the current legislation does not oblige state and municipal institutions to provide medical care on a paid basis, but enshrines the patient's right to receive such assistance, including in institutions operating under the program (territorial program) of state guarantees of free provision of medical care to citizens. help.
16.06.2017
Rules for the provision of paid medical services by medical organizations
The procedure for the provision of paid medical services is regulated federal laws“On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” and “On Protection of Consumer Rights”.
Internal regulations governing the provision of medical care on a reimbursable basis are signed by the head physician of the medical institution. The provision of paid services must be included in the Charter of the health facility. In addition, the organization must have a license for this type of activity issued by the relevant authority.
The rules for the provision of paid medical services by medical organizations are established at the level of the Government of the Russian Federation and are regulated by two fundamental documents - the Federal Laws "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation" and "On the Protection of Consumer Rights".
Provision of paid services: basic information
The main source of funding for healthcare facilities of the state and municipal level- budget. And therefore, they have the right to direct the funds received from paid services to satisfy own needs or for other socially useful purposes and activities.
Internal regulations governing the procedure are signed by the head physician of the health facility. In doing so, you need to remember that:
- conducting commercial activities must be included in the charter of the medical organization;
- prices and tariffs for medical services provided by budgetary health facilities are set by regional or federal health authorities.
From January 1, 2013, the basis for the provision of paid services by budgetary clinics and hospitals is the List of works (services) that make up medical activities and are specified in the license for medical activities.
The procedure and rules for the provision of paid medical services by medical organizations should be clearly and in detail communicated to their consumers. General provisions are posted on the official website of the institution on the Internet, as well as on information stands and racks in the public domain.
The consumer is provided with the following information about commercial services Oh:
- Conditions.
- Forms.
- Payment order
- Prices and tariffs.
Questions of conditions, forms, procedure for paying for paid medical services in a particular medical institution are established by its charter and are within the competence of the management. Organ executive power organizations can be sole chief physician) or collegiate (chief physician and his deputies).
Provision of commercial services in the main work time
The staff of the medical institution has the right to provide paid medical services during their main working hours. However, there are a number of nuances that cannot be ignored. The first and main one is that the management of the organization must adhere to the rules of remuneration for the provision of paid services during the main working hours.
State and municipal health care institutions perform state tasks, exceeding the volumes of which is the basis for the provision of services on a commercial basis.
In addition, the law does not prohibit additional activity during main business hours. Such activities include paid services that can be provided to citizens in addition to the main task.
Within the framework of compulsory medical insurance, only the volumes of medical care that were established by a state or municipal assignment or by a decision of the commission for the development of the compulsory medical insurance program are subject to payment.
It depends on the number of staff of the institution and the planned indicators of the work of physicians. If these indicators are exceeded, the suspension of the provision of medical care on a free basis is permissible.
Planned medical care
Planned medical care is provided to citizens as part of prevention, as well as in case of diseases and conditions that are not this moment life-threatening, and therefore do not require urgent intervention. Let's allow the transfer of planned intervention in terms of time.
For this reason, in some cases it is possible to provide during the main working hours. But at the same time, the duration of waiting for planned assistance cannot exceed the time limits established by the program of state guarantees.
For violation of this paragraph, an administrative fine may be imposed on the LPU.
emergency medical care
If a patient needs emergency intervention, the doctor does not have the right to refuse to provide paid services during his working hours. In this case, assistance to commercial patients is denied on a priority basis, but first they eat, and only then - free of charge.
Refusing to provide emergency care to a patient is against the law, and the availability of payment does not play any role here. The patient can pay for medical services at will or under a voluntary medical insurance contract.
In some cases, doctors are allowed to work during regular hours and when providing assistance to patients who are on inpatient treatment. For example, we can talk about combining positions, which is regulated by Article 151 of the Labor Code of the Russian Federation.
For example, nurse, along with 20 free hospital patients, can provide assistance to a patient occupying a paid bed.
Physician salary during regular working hours
According to the Labor Code of the Russian Federation, an employee, along with the main job in the specialty, may be entrusted with extra work in the same profession or another. Such work is paid separately.
It is possible to combine the main and additional activities, if we are talking about different specialties. Additional work in the same profession is carried out by increasing the volume of work or expanding service areas.
- The same rule applies to .
Any additional doctor's work must be paid. The amount of the additional payment is established by agreement between the chief physician and the specialist and depends on the scope and content of the work.
In order for the combination of positions to be possible, the staff of the medical institution must have a vacant wage fund, as well as vacant jobs financed through the provision of commercial services.
The staffing table is set by the head of the medical organization, so he has the right to lead the appropriate positions. This also applies to positions entered at the expense of services provided on a paid basis.
If there are no vacancies in the institution, it is permissible to issue payments for the provision of paid medical services in the form of incentive allowances. However, this possibility must be specified in the local regulations with reference that these payments are introduced under an effective contract.
According to the rules for the provision of paid medical services by medical organizations, payment for their provision both during regular and additional working hours is possible if the rights of citizens to free medical care are not violated. Therefore, it is always necessary to make sure that the provision of commercial services during regular business hours will not lead to possible violations.
For example, instead of patients who came for help under the state guarantees program, paid patients are accepted. As a result, the first ones are forced to sit in a queue or even go to another day or to another health facility.
- various financial violations - for example, remuneration from the funds of compulsory health insurance in case the doctor did not fulfill the plan, but at the same time accepts paid patients.
Restrictions on the provision of paid medical services
The head of the health care institution is responsible for organizing the provision of medical care. He decides whether or not to allow the provision of paid services, and also considers all existing restrictions.
Restrictions on the provision of paid services by a medical institution during working hours:
- if the doctor does not fulfill the plan for providing free medical care to the population, then additional charges may be reduced or not charged at all;
- the doctor is paid only for the work related to the provision of paid services that is performed in excess of the plan (in this case, the total number of services provided on a paid and free basis is summed up);
- if targets are not met, positions within the framework of compulsory medical insurance or the budget can be reduced;
- if the plan for the main position is not fulfilled, the provision of paid services to the doctor may be paid at reduced rates.
