2020 № 3 The problems of paying for medical care provided to residents of other subjects of the Russian Federation within the framework of compulsory medical insurance
The legislation guarantees citizens the right to receive medical care under a compulsory health insurance policy (CHI) throughout the Russian Federation. But in some cases, in accordance with current legislation, a referral is required to receive medical care. This also applies to situations where a citizen receives medical care outside of the subject of the Russian Federation where the citizen is insured. The system of such referrals to medical organizations located in another region is more or less regulated only when they are sent to Federal medical organizations. The situation is further compounded by the fact that the Supreme court contrary to law, making decisions, actually leveling a direction. At the same time, payment for medical care provided outside the region in which the MHI policy is issued depends on the payment of this assistance from the Territorial Fund of this region. This leads to numerous delays in payment and, as a result, reduces the interest of medical organizations in providing medical care to "nonresidents". Patients suffer as a result. All this raises the question of the need to improve the current mechanism for conducting inter-territorial settlements in the MHI system.
2020 № 4 The effect of coronavirus Сovid-19 on the situation in Russian healthcare
The relatively slow initial rate of spread of COVID-19 coronavirus in Russia has its own objective reasons related to the size of the territory, population density, tourist activity of the population, etc. They have played a positive role in making it possible to better prepare for the fight against it, taking into account, among other things, the experience of countries where the rate and scale of the spread of the coronavirus was much higher.
Despite the serious damage to the economy, there are no global financial threats to health care yet. However, it is important that resources arrive in time to medical organizations in the context of large-scale conversion of beds, etc. Unavoidable periods of downtime during periods of re-profiling, being in standby mode, etc., lead to the fact that many medical organizations risk finding themselves in a difficult financial situation, even with sufficient resources in the industry. Therefore, at this stage, it is sometimes more important than serious financial infusions, and mechanisms aimed at com- pensating for the loss of income.
2019 № 5 The procedure for co-financing of salary for newly hired employees in primary care
In his Decree No. 204 of May 7, 2018 “On the national goals and strategic objectives of the development of the Russian Federation for the period up to 2024”, the President set the task to ensure the achievement of a number of goals and targets in the health sector. These include the elimination of personnel shortages in medical organizations that provide primary health care.
To help solve this problem, a mechanism has been developed to co-Finance the salary costs of state (municipal) institutions, which provide an increase in the staffing of employees.
Corresponding changes were made to Federal Law of November 29, 2010 № 326-ФЗ “On Compulsory Medical Insurance in the Russian Federation” (Part 6.6. Of Article 26).
This article is devoted to the order of formation, the conditions of provision to medical organizations of the state health system and the municipal health care system, providing primary health care in accordance with the territorial programs of compulsory health insurance, the funds of the normalized insurance stock of the territorial Fund of compulsory medical insurance provided for co-financing of expenses of the medical organizations for compensation of doctors and average medical personnel.
2019 № 4 The review of judicial practice on the payment of over-planned volumes of medical care in the system of compulsory health insurance
Despite rather rigid legislative norms concerning payment of the medical care rendered over the volumes allocated by the Commission on development of the territorial program of CHI, and also the developed practice of rela- tionship between the medical organizations – on the one hand and the insurance medical organizations, territorial funds of CHI – on the other hand, judicial practice often demonstrates other approaches. Although the current legislation does not imply payment of over-planned volumes of medical care, the courts often take the side of medical organizations. Thus, the current judicial practice illustrates the existence of problems in this area. This article is devoted to the review of judicial practice in the matter of payment for over-planned volumes of medical care in the system of compulsory health insurance.
2020 № 4 Incentive payments to coronavirus medical workers
2020 № 3 The issues of pricing for paid medical services
2019 № 5 Issues of the documentation of paid medical services
2019 № 4 Some issues of the provision of payment medical services