Articles from rubric: «Focus of the problem»
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2023 № 7 New rules of paid medical services: is a medical organization required to have an official website.
The Rules for the provision of paid medical services by medical organizations, approved by Government Decree No. 736 dated May 11, 2023, significantly expand the requirements that provide for an increase in the amount of information about the contractor and the paid medical services provided by him, which the medical provider must provide to the consumer. organization. Taking into account these requirements, the article considers in detail the question of whether medical organizations providing paid medical services are required to have their own official website. The authors substantiate that all medical organizations providing paid medical services, but not participating in the implementation of the State Guarantees Program, are required to post the information provided by law about themselves and about
the paid medical services they provide on the Internet. At the same time, the specified information may be posted on the official website on the Internet and (or) in other information systems on the Internet. At the same time, all medical organizations providing paid medical services must take into account the risks associated with the use of information systems owned by foreign legal entities and citizens, the use of which is subject to the prohibitions established by Part 8 of Art. 10 of the Federal Law “On Information, Information Technologies and Information Protection”. One way to account for these risks is to create or develop your own official sites on the Internet. -
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. -
2023 № 6 On the need to improve federal legislation in terms of clarifying and fixing the legal status of junior medical personne.
Currently, in the legislation of the Russian Federation, the legal status of persons from among the junior medical personnel in terms of classifying them as medical workers is not clearly defined. This is due to the fact that junior medical personnel do not pass the accreditation of a specialist and, in accordance with the requirements of Part 1 of Art. 69 of the Federal Law of November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” (hereinafter referred to as the Fundamentals) does not have the right to carry out
medical activities. This circumstance significantly reduces the social security of junior medical personnel and requires mandatory legal correction.
The article presents a detailed analysis of the legislation, which substantiates in detail the need to clarify and consolidate the legal status of junior medical personnel. To this end, the legislator is invited to state part 1 of Art. 69 of the Fundamentals as follows: “Persons who have received medical or other education in Russian organizations engaged in educational activities and who have been accredited by a specialist, as well as persons filling other positions of medical workers specified in the nomenclature of positions, have the right to carry out medical activities in the Russian Federation medical workers and pharmaceutical workers, approved by the authorized federal executive bodies. -
2023 № 4 Problematic issues of contractual relations between a medical worker and a medical organization: what needs to be paid attention to the head of a medical organization and a medical worker
The “Guidelines for Compliance with Mandatory Requirements in Carrying Out Medical Activities” approved by Roszdravnadzor on November 11, 2022, noted that the most common violations include the licensee’s lack of employment contracts with employees performing work (services) permitted by the license. In this regard, the article substantiates in detail the need to conclude an employment contract with every medical worker working in a medical organization, regardless of whether this organization is his main place of work or not.
The authors show that when a medical organization engages a medical worker from another medical organization to consult patients on a regular basis, it is also necessary to conclude an employment contract with him. At the same time, when a medical organization engages a medical worker of another medical organization on a paid basis for one-time/separate consultations, a civil law contract can be concluded with him. The article emphasizes that the concepts of “consultant” and “medical consultation” require their disclosure in the legislation, which determine the legal status of specialists involved in consultations and give a detailed description of medical consultations. -
2023 № 2 Periodic accreditation by order of the Ministry of Health of Russia dated 10.28.2022 No. 709n: which option of professional development is more preferable for a doctor
The article analyzes in detail the possible options for training a doctor, offered by order of the Ministry of Health of Russia dated October 28, 2022 No. 709n in order to prepare for periodic accreditation. The authors substantiate in detail that in order to pass periodic accreditation, the most high-quality, reliable, safe and least expensive training option for a doctor is the development of advanced training programs, the total development period of which is at least 144 hours over 5 years. The following are named as the main reasons for this: in the domestic legislation, advanced training of a doctor is understood exclusively as the development of relevant educational programs; due to the numerous requirements of the legislation for the content and development of educational programs, the requirements for
scientific and pedagogical personnel and for educational organizations implementing these programs, it is the development of advanced training programs that ensures the training of a specialist of the proper quality, which determines his admission to the profession; in accordance with the Labor Code of the Russian Federation, the employer is obliged to conduct additional professional education for a doctor, i. e. including to promote the training of a doctor specifically for advanced training programs. -
2022 № 7 Prospects and possible options for the development of continuing medical education in Russia
The article analyzes the prospects and possible options for the development of continuous medical education (CME) in Russia. Currently, the most realistic and preferable option is the development of CME based on improving the quality and increasing the volume of implementation of additional professional medical education programs. It is noted that one of the most important factors of national security is the constant maintenance of a high professional level of medical workers, which can be ensured within the framework of the CME, first of all, by implementing additional professional programs of appropriate quality and the necessary volumes.
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2022 № 6 Features of inspection in 2022: what medical organizations need to be prepared for
The article shows that the decisions adopted in March 2022 on a moratorium on scheduled inspections until the end of 2022 not only do not mean a complete stop of measures for monitoring (supervision) of medical activities carried out by medical organizations, but also actively stimulate the practical implementation of a number of basic provisions of the reform of control and supervisory activities. Medical organizations, despite the moratorium on scheduled inspections announced by the end of 2022, need to ensure strict compliance with the requirements of legislation to ensure and control the quality and safety of medical activities; constant readiness for the implementation by the supervisory authorities of new control (supervisory) measures without interaction with the controlled person, as well as professionallactic events.
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2022 № 1 Portrait of regional health authority manager
Competent management is crucial condition for the development and functioning and requires qualified managers. In the Russian Federation over the past few years Federation there were many rotations in management of regional health authorities. These changes will be followed by lack of continuity in management decision-making, high degree of uncertainty and a low level of population and professional community trust.
T h e a i m o f t h e s t u d y was to give a detailed information about regional health authorities managers in Russian Federation.
M a t e r i a l s a n d m e t h o d s . This research was designed as observational study with the use of questionnaire which included the characteristics of the age and gender of the respondents, the level of their basic and additional education, additional competencies, occupational background in leadership position.
R e s u l t s . We achieved a response from 81 respondents. We founded that rotation of managers and extremely short occupation period had significant impact on managers’ qualifications. The culture of purposeful formation of the professional skills by the respondents was poor. Only 7% of managers paid attention to their education. About 40% did not have professional retraining for management in healthcare.
C o n c l u s i o n s . It is necessary to develop a standard set of Russian region health managers competencies and responsibilities. -
2021 № 9 What has changed for medical organization with the adoption of the new regulation on federal state control (supervision) quality and safety of medical activity
The article analyzes the Regulations on the Federal state control (supervision) of the quality and safety of medical activities, approved by the Decree of the Government of the Russian Federation № 1048 of June 29, 2021. The following is noted: The Regulation defines a broader list of issues that are now the subject of federal state control of the quality and safety of medical activities; The regulation ensures continuity with the Federal Law № 248-FZ of 31.07.2020 «On State Control (Supervision) and Municipal Control in the Russian Federation», on the one hand, and with the Requirements for the organization and Conduct of internal quality control and Safety of Medical Activities approved by the Decree of the Ministry of Health of the Russian Federation № 785n of 31.07.2020, on the other hand; for the first time, the risk profile of causing harm (damage) to the life and health of citizens is fixed for supervisory
authorities as the most important area of work in the field of state control of the quality and safety of medical activities. -
2020 № 9 On the implementation of certain “medical” amendments to the constitution of the Russian Federation
The article suggests legislative implementation of certain “medical” amendments to the Constitution of the
Russian Federation. The authors propose to add two articles to the Federal law “on the basics of public health protection in the Russian Federation” dated 21.11.2011 N323-FZ. In one article, it is proposed to reveal and specify the
content of the newly introduced in the Constitution of the Russian Federation concept “unified legal bases of the health
care system”. Another proposed article reveals the forms and content of work on the coordination of health issues,
again referred by the Constitution of the Russian Federation to the joint responsibility of the Russian Federation and the
subjects of the Russian Federation. According to the authors, the proposed changes in legislation will allow to ensure
in practice the proper implementation of “medical” amendments to the Constitution of the Russian Federation, which in
turn will ensure the improvement of legal regulation of the organization and activities of health care, and strengthen its
material and technical base. -
2019 № 9 To the question of training of medical workers within internal control of quality and safety of medical activity
Changes in the legislation concerning the organization of internal control of quality and safety of medical activity put forward new requirements to training of medical workers. These requirements concern the mandatory training on early detection of cancer, ensuring the provision of medical assistance to citizens in emergency form, the use and operation of medical devices. The article deals with the practical implementation of these requirements at the level of the medical organization.
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2018 № 10 About terms and order of provision of information constituting a medical secret to the institution of inquiry and investigation, the court, on request of the prosecution and of the criminal-executive system
The article shows and justifies which bodies in accordance with the legislation of the Russian Federation belong to the bodies of inquiry and investigation. The authors pay attention to a number of important features that need to be taken into account by medical organizations when working with requests for information constituting medical secrecy, the bodies of inquiry and investigation, the court, at the request of the Prosecutor’s office and the body of the penal system, as this activity is regulated not only by the legislation in the field of health, but also by regulatory legal acts regulating the activities of these bodies.
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2018 № 10 About the transparency of compulsory health insurance
The problem of insufficient information openness in the system of compulsory medical insurance in Russia is considered. The non-transparency of the procedures of planning and execution of its budget of the Federal Fund of obligatory medical insurance. Distribution of subventions is carried out by mathematical formulas, the principles of calculations are not defined, and the coefficients used - closed. Financing the high-tech health sector is becoming unregulated. The list of new expensive medical services includes operations performed in the middle of the last century. In the system of obligatory medical insurance it is necessary to provide a clear and open mechanism for the development, adoption of and implement solutions related to common health problems
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2017 № 4 Mortality rate in the Russian Federation in 2006-2015
Aim-сomparative analyses of age peculiarities and nosological structure in mortality causes in 2006 and in 2015 in the Russian Federation. Rosstat’s data of male and female population size and the number of dead as well in 5-years age groups for the years 2006 and 2015 were used. Standardised all-causes mortality coefficients were calculated using Kitagava’s formulae, comparison in 5yaers age groups was conducted. Nosological mortality structure based on Rosstat’s mortality causes nomenclature analyses was made. Percentage of each mortality cause was assessed; level of increase/ decrease was calculated for the completely identical groups. The mortality rate decreased by 13,6% in 9 years, the standardized rate dropped by 25,9%. The main decline was at the age of 25-29 (by 46,6%) and an the age of 1-4 (by 45,7%). The less change was an the age 90-94 (by 9,5%). More intensive dynamics in male was determined by the initial male «overmortality». The percentage of diseases of the circulatory system in all death’ cases was 48,7% in 2015 comparing to 56,9% in 2006; external causes had 7,7% and 9,9%; Neoplasms - 15,7% and 13,1%; diseases of the respiratory system - 3,97% and 3,8%; diseases of the digestive system - 5,3% and 4,1% respectively. The percentage of the mortality causes as «Senility» increased in 2,7 times. The highest percentage in the mortality causes in 2006 as well in 2015 falls on «Atherosclerotical heart disease» (12,5%). Mortality rate decline was determined, among others, by the realization of the state demographic policy and the task programs in health care. The mortality causes structure has changed because of the significant decline in the portion of diseases of the circulatory system and of external causes. Rosstat’s additional list of mortality causes which had no defined clinical criteria for the diagnosis had a certain influence, and MoH RF recommendations to use the «Senility» code as a cause of death since 2014, as well.
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2015 № 4 Safety of medical activity: what is it and how the Chief doctor should provide it
The article deals with the contents of medical organization working to support and monitor the safety of medical activity. Priorities that should be decided by each head of the medical organization in this field. Emphasized that the main body of the medical organization for addressing issues and making decisions on ensuring and monitoring the safety of medical practice must be a medical Commission.
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2015 № 3 Standards of medical aid — meaning of the definition for specifying state guarantees of free drug medical aid
There is analyzed an issue of specifying state guarantees for free medical aid provided to citizens with in the standard medical aid system, clinical recommendations, lists of medications. State guaranteed free medications for citizens are those mentioned in the List of vital and life critical drugs.
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2015 № 1 Reforms in the sphere of healthcare: problems with implementation
The protests of medical aid workers, which spread across the country last year amid a growth in their wages level, demonstrate that the dissatisfaction unlike in previous times is not linked to the poor financing, low salaries, but rather to disappointment with the reforms, which failed to deliver the results expected by many. Given that overall reform strategy is relatively rarely criticized it is evident that dissatisfaction is caused by the way these reforms are implemented in various concrete cases.
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2014 № 12 Regarding the project dedicated to «decrease of hospital beds and physicians numbers» in healthcare institutions in Moscow — from the FIRST SOURCE
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2014 № 8 Position of Ministry of Healthcare of Russian Federation in the questions of developing state-private partnership
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2013 № 4 Regarding the set of regulations on delivery of medical goods for state and municipal needs