All articles by Chililov A. M.
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2023 № 5 New rules for the provision of paid medical services: review and evaluation of the main innovations
The article discusses the change in the regulatory framework for the provision of paid medical services in connection with the adoption of the decree of the Government of the Russian Federation, which approved new rules for the provision of paid medical services. The reason for the adoption of the new rules is analyzed, as well as the content of its individual provisions. An assessment is given of how the new legal framework for the provision of paid medical services will affect the activities of medical organizations and how they will affect the interests of patients.
Special attention is paid to the emergence of a new – remote form of contract conclusion. -
2023 № 6 Payment methods for primary health care, specialized (including high-tech) medical care in the compulsory health insurance system: the logic of the most urgent changes in the tariff policy of 2023.
The article discusses new methodological approaches to the methods of paying for medical care in the compulsory medical insurance system for 2023, including those approved by recently issued regulatory legal acts, as well as joint recommendations of the Ministry of Health of Russia and the Federal Compulsory Medical Insurance Fund (FOMS).
The article analyzes the main reasons for changes in the tariff policy and their expected consequences in terms of increasing the motivation of medical organizations.
It is noted that there is a need to revise the remuneration systems of employees of medical organizations (primarily state and municipal) in order to more closely link incentive payments with performance indicators used in determining the amount of payment for medical care, which is intended to become an important motivation tool for improving the availability and quality of primary health care and, as a consequence, reducing the need for specialized medical care.
An overview of innovations in the payment of high-tech medical care is given. -
2022 № 7 Topical issues of organization and financial support of high-tech medical care
The article provides a historical overview of changes in approaches to the financial provision of high-tech assistance, analyzes the causes of these changes, shows the system that has developed at the moment.
Comments are given on the most relevant changes concerning the financial provision of high-tech medical care. -
2022 № 9 About some methodological approaches to the assessment of the salary level of medical workers.
The article deals with methodological issues of assessing the level of salaries of medical workers by official statistics bodies (Rosstat) and within the framework of surveys of medical workers themselves.
The main methodological differences are shown in the methods of calculating the indicators characterizing wages used by statistical authorities and survey organizers. The main reasons leading to the discrepancy between the results of such assessments are shown. Among them, first of all, it is necessary to name different approaches to accounting for personal income tax, restrictions in the sample, etc.
In addition, official statistics take into account not only wages, but also some other expenses in favor of employees. At the same time, the concept of "average number" is used, which is not taken into account in the framework of the conducted surveys.
At the same time, the salaries of medical workers in order to assess the achievement of the targets set by the May Presidential
Decrees should be correlated not with the average salary for the subject of the Russian Federation, but with the average monthly income from work.
Such methodological differences create an objective basis for the discrepancy between the survey results and official statistical data and should be taken into account when interpreting the data obtained. -
2022 № 8 About some methodological issues of remuneration of medical workers
The article discusses a number of methodological issues of remuneration that arose against the background of the suspension of special social payments for work with COVID‑19 and their replacement with compensation payments, as well as the postponement of pilot projects that were to be implemented in order to prepare for the introduction of a new system of remuneration for medical workers.
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2022 № 7 Issues related to the replacement of special social payments for work with COVID-19 with compensation payments
The article discusses issues related to the suspension of special social payments for work with COVID‑19 and their replacement with compensation payments. Problems such as the procedure for completing existing payments, lists of employees who are subject to compensation payments, measures that need to be taken by medical organizations in a new situation are considered.
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2022 № 6 Changes in the procedure for carrying out control measures in the compulsory health insurance system in 2022
One of the most important innovations in the system of compulsory medical insurance in 2021 was the change in the order of control measures. At the same time, both the participants of the MHI system, who have the authority to conduct control measures, and the procedure for conducting control have changed.
This paper analyzes the next, rather voluminous changes in the system of control measures that occurred already in 2022. An assessment of the impact of these changes on the effectiveness of control and on the work of medical organizations is given. -
2021 № 9 Labor rationing as one of the effective management tools of a medical organization.
Labor rationing is an important tool for managing the workforce of a medical organization, which is not limited to setting labor standards. Rationing has a number of potential opportunities, the competent implementation of which makes it possible to solve a number of urgent management tasks, including stimulating of employees.
The article discusses various aspects of the use of rationing in order to improve the efficiency of the medical organization. -
2020 № 2 The Main approaches to the evaluation of the effectiveness of the implementation of the “effective contract” in health care
The upcoming reform of the wage system involves a more detailed analysis of not only the advantages and disadvantages of the existing system (as well as previous ones), but also the practice of its application. The most obvious criterion for evaluating the effectiveness of the current wage system is to assess how well it has enabled the implementation of an effective contract and the tasks assigned to it. At the same time, it is necessary to analyze what were the problems of introducing an effective contract that are not directly related to a specific wage system.
One of the main methodological problems with the introduction of an effective contract is that the recommendations for its introduction, developed at the preliminary stage, were not revised following the evaluation of the implementation of an effective contract and its results. Best practices and mistakes were not taken into account, which made it impossible to adjust and specify approaches to the introduction of an effective contract.
In many ways, this is why many institutions have approached the introduction of an effective contract quite formally.
The proposed article is devoted to the criteria for evaluating the success of implementing an effective contract in state (municipal) health care institutions. -
2019 № 10 The main contours of the next reform of sectoral wage system in public health
The special attention paid to staffing is not accidental – it is a natural reaction of the state to the deterioration of the situation with the number of medical workers in state (municipal) institutions. In turn, the personnel deficit has increased due to the fact that in difficult economic conditions, many institutions have taken the path of reducing workers in order to increase the wages of the remaining. These steps directly contradicted the logic of the "May" presidential Decrees of 2012, but simplified the task of achieving the salaries of medical workers at the level stipulated by these Decrees. Therefore, a number of documents reflecting the strategy of development of health care, as well as the Instructions of the President contain measures aimed at correcting the situation, including by reforming the system of remuneration of employees of state (municipal) health care institutions. At the same time, it is important not just to implement the measures provided for in these documents, but also a specific implementation mechanism. Therefore, the article analyzes the possible positive and negative consequences of various options for the implementation of measures provided for by the Instructions and other documents.
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2019 № 2 About some practical aspects of application of professional standards in the field of health care
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2023 № 2 Issues of implementation of new special social payments to medical workers, including those working on an outpatient basis, from January 1, 2023
The article examines the mechanism of implementation of new special social benefits, which are introduced for a number of categories of medical workers from January 1, 2023.
These payments, as well as the previously existing special social benefits paid to persons providing medical care to patients with COVID‑19, will be carried out through a social fund – in this case, through the Pension and Social Insurance Fund. Such a mechanism, despite the long chain of financial flows, has its advantages, primarily concerning the possibility of personalized accounting of payments and minimizing the risks of misuse of funds.
At the same time, the implementation of special social benefits raises a number of questions concerning the payment of insurance premiums, etc., the answers to which are not always obvious, but can be obtained on the basis of consideration of the provisions of the current legislation. -
2021 № 5 New system of control measures in relation to medical organizations within the framework of compulsory health insurance
One of the most serious innovations in the system of compulsory health insurance is the change in the procedure for conducting control measures. In accordance with the new version of Federal Law No. 326-FZ (in accordance with the provisions of the Federal Law of December 8, 2020 № 430-FZ On Amendments to the Federal Law "On Compulsory Medical Insurance in the Russian Federation"), the procedure for monitoring the volume, timing, quality and conditions of providing medical care for compulsory medical insurance to insured persons, as well as its financial support, is now established not by the Federal Fund for Compulsory Medical Insurance, but by the Ministry of Health of the Russian Federation. At the same time, both the participants of the CMI system who have the authority to conduct control measures, and the procedure for conducting control, are changing.
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2021 № 4 NEW SYSTEM OF CONTRACTS WITHIN THE FRAMEWORK OF COMPULSORY HEALTH INSURANCE
The system of compulsory health insurance is regulated by a large number of regulatory legal acts. Nevertheless, many issues related to the relationship between the participants of the MHI system, and above all – financial, are determined by the content of the contracts concluded between them. This article analyzes the new system of contracts that has developed in the system of compulsory medical insurance in connection with the adoption of Federal Law No. 430-FZ of December 8, 2020 “On Amendments to the Federal Law “On Compulsory Medical Insurance in the Russian Federation”, as well as other related regulatory legal acts. There have been changes not only in the content of the contracts, but also in the composition of their participants. In addition, there is a new, previously absent type of contract. The purpose of the work is to analyze changes in contracts in the MHI system and their possible consequences.
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2020 № 8 Changes in the procedure for financial support of medical organizations in the system of compulsory medical insurance at the present stage of the spread of coronavirus infection
In the context of the spread of coronavirus infection, the main problem of medical organizations is not an obvious increase in the cost of providing medical care associated with ensuring the sanitary and epidemiological regime (personal protective equipment, disinfection, etc.), but a decrease in income due to a drop in the volume of planned medical care, suspension of preventive measures, downtime (during the period of re-profiling, etc.).
The state quickly responded to this situation by making changes to the relevant legislation and adopting a number of special regulatory legal acts. However, the implementation of these rather varied measures tied to a number of factors, such as the presence or absence of restrictive measures on the territory of the Russian Federation; participation or non-participation in the care of patients with coronavirus infection; periods within which the one or the other order advances, etc.
All this causes difficulties in understanding what financial security mechanism is applied to this particular situation, what should be the actions of medical organizations.
This article is devoted to the analysis of ways of financial support of medical organizations in the system of compulsory medical insurance at various stages of the fight against coronavirus infection. -
2022 № 9 Issues related to the powers of state (municipal) healthcare institutions in the field of labor rationing
The presented material concerns the rights and obligations of state (municipal) healthcare institutions in matters of labor rationing. It examines the scope of authority of the heads of these institutions as employers for the organization of rationing.
With reference to the Labor Code of the Russian Federation and other normative legal acts devoted to this topic, various aspects of labor rationing are analyzed. In particular, the degree of completeness of the coverage of labor standards of all employees of medical organizations, the identity of load indicators and labor standards, etc. -
2022 № 7 Issues related to changing the procedure for providing state guarantees to employees of medical organizations working with COVID-19
Emergency and rather extraordinary measures aimed at increasing the degree of social protection of medical workers in connection with the spread of COVID‑19 have been repeatedly changed. At the current stage, characterized by a decrease in the spread of coronavirus infection, these measures have undergone quite drastic changes, the essence of which is discussed in this article.
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2022 № 6 Issues of distribution of the cost of medicines and other consumables by sources of financing in the provision of paid medical services
In the article, on the basis of regulatory legal acts and explanations of the Ministry of Finance of the Russian Federation, possible ways of distributing medicines by sources of financing are substantiated.
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2022 № 5 Issues of introduction of electronic personnel document management in medical organizations
Informatization is gradually spreading to all new areas of labor relations. Therefore, it is logical to switch from the transfer to electronic form of individual documents (electronic sick leave, electronic workbooks, etc.) to the comprehensive automation of the entire personnel document flow.
The proposed material presents an analysis of changes in labor legislation devoted to this area. -
2022 № 2 Issues of healthcare informatization
The proposed material presents an analysis of changes in the requirements for a unified state information system in the field of healthcare in connection with the adoption of a new decree of the Government of the Russian Federation regulating this area. The analysis of the causes and consequences of the most significant changes in the regulation of health informatization is carried out.
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2021 № 8 Questions implementation of incentive payments to medical workers for vaccination against Covid -19
In order to financially support medical workers and further motivate them to increase the rate of vaccination against COVID‑19, the Russian Government has introduced special incentive payments for additional workload for medical workers. The established mechanism of financial support and the procedure for making payments is quite complex, since it is aimed at achieving specific practical vaccination indicators. This publication explains some of the issues that arise in connection with the implementation of these payments.
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2020 № 5 Issues of application of labor legislation during the period of combating coronavirus
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2020 № 2 The transition to electronic work book
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2020 № 1 Incentive Payments for the detection of cancer