How paid medical services are provided. Rules for the provision of paid medical 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.

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 in so far 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 in so far 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 the minimum amount of the 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 Federal Law 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, the standards of medical care are approved for only 17% of diseases in which medical care is provided in a hospital, paid medical services can be provided both in full 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 program of state guarantees of free provision of medical care to citizens and territorial programs of state guarantees of free provision of medical care to citizens (hereinafter - 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. Thus, Resolution No. 17 of the Plenum of the Supreme Court of the Russian Federation dated June 28, 2012 established that consumer protection legislation also applies to the provision of medical services to citizens provided by medical organizations within the framework of compulsory medical insurance.

The Federal Law of January 12, 1996 No. 7-FZ “On Non-Commercial Organizations” (clause 4, article 9.2) enshrines 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) tasks) to perform work, provide services related to its main activities, to 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.

The state budgetary health care institution "Observation Polyclinic" conducts various types of medical examinations: preliminary, periodic, pre-trip, pre-flight. In accordance with Art. 213 of the Labor Code of the Russian Federation, examinations 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 h. specialized medical nutrition products 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. 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 mode of operation existed before for review. But from January 1, 2013, it became mandatory to provide a copy of the documents on entering into the Unified State Register of Legal Entities, indicating the body that carried out the 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 the imposition of an administrative a 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 Administrative Offenses of the Russian Federation, which establishes such liability for the provision of services by an 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, constituent agreement, regulation or regulation on the branch, i.e., the constituent documents of the legal entity or its branch that directly provides paid services, as well as information on the introduction of the institution into 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 by 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 his state of 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 advisable 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 facility.

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 providing paid medical services), including the prescribed treatment regimen, may reduce the quality of the medical service provided, entail the inability 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.

Note

A consumer is an individual who intends to receive or is already receiving paid medical services in person 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 professional 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 an additional agreement to the contract, which is an integral part of it, or a new contract is concluded.

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 of cash registers, but also other documents of the established form. In other words, when providing medical services at home, at the exit, at a time when the cash desk is not working or the cash register is not working, it is possible to provide paid services and accept payment for them by issuing strict accountability documents equated 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 with 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.

All state medical organizations, regardless of the organizational and legal form, have the right to provide paid services to the population and legal entities, the main differences being only in the right to dispose of the income received from their provision. In table. 1 presents the rights of medical organizations of various organizational and legal forms in terms of income-generating activities.

Table 1

The rights of medical organizations of various organizational and legal forms in terms of income-generating activities

	Autonomous non-profit institution	State budgetary healthcare institution	Government institution
The right to carry out income-generating activities		The right to carry out income-generating activities only in so far as it serves the achievement of the goals for which it was created, and corresponding to these goals, provided that such activities are indicated in its constituent documents	Can carry out income-generating activities in accordance with its constituent documents
The right to dispose of income received from income-generating activities	The income received from such activities and the property acquired at the expense of these incomes shall be placed at the independent disposal of the autonomous institution.	The income received from such activities, and the property acquired at the expense of these incomes, are placed at the independent disposal of a budgetary institution.	Incomes received from the specified activity go to the appropriate budget of the budgetary system of the Russian Federation

The analysis of the system of paid medical services showed that, along with certain achievements (expanding the medical services market, increasing the competitiveness of medical organizations and specialists, generating income for these organizations from the provision of paid medical services, expanding the right of patients to choose medical organizations and specialists, etc.), there are a number of problems. These, first of all, include the problems of imperfection of the legislative and regulatory framework for the provision of paid medical services. In our opinion, the main problems here are:

1) the absence of legally fixed responsibility of patients for providing comprehensive information known to them about their own state of health and the presence of possible contraindications to certain types of medical interventions;

2) insufficient elaboration at the federal level of methods and recommendations for organizing paid medical services in state and municipal medical organizations, incl. recommending the procedure for dividing the flow of patients receiving paid and free medical services, as well as organizing the work of medical specialists and the use of medical equipment and apparatus;

3) the lack of clear professional recommendations on the formation of a market for medical services, taking into account the proposal of a wider range of preventive, treatment, diagnostic and rehabilitation programs, including those not included in the program of state guarantees and territorial programs for free provision of medical care to citizens;

4) insufficient elaboration of the methodology for the provision of paid medical services in medical organizations, taking into account their specifics and increasing the satisfaction of producers and consumers of medical services;

5) lack of organizational and functional models for the organization and provision of paid medical services in state medical organizations;

6) the imperfection of the methodology for calculating tariffs for medical services, the lack of sufficient flexibility in approving tariffs, taking into account the changing economic situation and effective demand of the population.

The following can be predicted as possible threats, also associated with the lack of development of the regulatory legal framework:

1. Unreasonable growth in the volume of paid medical services to the detriment of the volume and level of medical services provided without charging patients.

2. Incorrect use of the resource base of state medical organizations for the provision of paid medical services.

3. Violation of financial reporting and settlements in the provision of paid medical services.

There are a number of other problems that manifest themselves in the process of activities of organizations and specialists of state organizations in the provision of paid medical services. First of all, these include the lack of evidence-based structural and organizational models for the activities of state medical organizations and specialists working in them to provide paid medical services, a system for training managers and specialists in this area of activity, as well as an insufficient study of patients' opinions on the degree of satisfaction with medical services. provided on a paid basis in state medical organizations.

All of the above often contributes to the adoption of immature managerial decisions on the organization and improvement of the system for the provision of paid services, creates prerequisites for inequality in the provision of paid medical services and services provided free of charge, as well as other organizational, financial and legal violations. This indicates the expediency of a deeper study of the practice of activities of producers of paid medical services and assessment of these activities by consumers of these services.

An analysis of the existing options for the organization and provision of paid services in state medical organizations, carried out according to the literature data and according to the reporting data of state medical organizations of the Moscow Department of Health, showed that the following are the most in demand and more often used (Table 2):

table 2

Options for organizing and providing paid services in state medical organizations

First option

Organization and provision of paid medical services in separately allocated or leased units; specialists employed at work in these divisions at the main place of work or part-time work; using own or rented equipment and other resources.

Second option

Organization and provision of paid medical services without the allocation of separate units on the basis of existing ones, by specialists employed at work in these units, often during regular working hours, using the main equipment of the organization and other resources of the organization

Third option

Mixed approach from separate aspects of the first and second options

All of these options have a number of advantages, disadvantages and features. Their choice depends on many factors, including the territorial location, profile and organizational structure of a medical organization, its capacity, staffing and other resources, etc.

When implementing paid medical services using the approaches indicated by us as the first option, a specialized unit that exists in excess of the established staffing table is independent within its competence in the structure of a medical organization. At the same time, extra-budgetary components are not only the staff and allocated space, but also medical equipment, medicines and other consumables.

Consideration of the main advantages, problems and features of the listed options indicates the following (Tables 3, 4)

Table 3

Description of the main advantages, problems and features of the first option for the organization and provision of paid services

Main advantages

Main problems

Peculiarities

1) the possibility of complete autonomous accounting of all resource costs (staff working hours, equipment depreciation, utility costs, funds for the purchase of medicines, soft inventory, detergents and disinfectants, etc.);

2) the convenience of maintaining separate statistical, accounting and tax records, which eliminates the possibility of violating financial discipline and reporting data, as well as double payment for services from various sources, i.e. minimizing the risk of violation of the law;

3) the possibility of providing the necessary attention to patients who have paid for services, minimizing the queue and waiting time for services.

1) lack of space required to create separate units;

2) the need to attract additional human resources in the face of the existing staff shortage of key workers;

3) financial costs, including resource support, for example, the purchase of expensive equipment, staff salaries, and other expenses that can become catastrophic if there is not enough flow of patients.

Work efficiency requires:

1) implementation of the marketing concept, taking into account market conditions, the possibility of producing demanded and competitive medical services and other aspects;

2) formation of a sufficient and constant flow of patients;

3) creating a favorable image of a medical organization.

Table 4

Description of the main advantages, problems and features of the second option for the organization and provision of paid services

Main advantages

Main problems

Peculiarities

1) no need at the initial stage to invest additional material, technical, financial and other resources, attract additional personnel, etc.

1) a significant increase in the risk of violations of legislation on income-generating activities;

2) the complexity of maintaining separate statistical, accounting and tax records;

3) more intensive use of the resource base of a medical organization, often without its proper compensation at the expense of incoming extrabudgetary funds;

4) the complexity of separating flows and routing patients receiving paid medical services and compulsory medical insurance services, which causes conflict situations;

5) the likelihood of a reduction in guaranteed medical care to the population due to an increase in the volume of paid services in a medical organization;

6) the emergence of a possible inequality in relation to medical personnel to patients receiving medical care on a paid basis and within the framework of compulsory medical insurance;

7) the lack of sufficient comfort in the organization and provision of paid services (separate registration, registration, admission and individual treatment of patients), which negatively affects consumer activity and the quality of medical services provided.

Work efficiency requires:

1) constant organizational efforts of managers and executors of medical services to solve current problems in the provision of paid services and services for compulsory medical insurance, reduce the tension that arises;

2) constant and effective control of the organization and quality of the provision of all types of medical services, compliance with the current legislation by all authorized organizations and specialists.

The approach to the provision of paid services in state medical organizations, in which a separate staff is formed and areas (offices, departments) are allocated for this purpose - option N 1, is relevant for large treatment and prevention centers or highly specialized polyclinics.

The second option, most often used in state medical organizations, is the provision of paid services by medical personnel (approved by the staffing table), during their main working hours, without the allocation of independent structural units. It also has a number of advantages, problems and features.

The use of this option is relevant with a small number of services provided in a medical organization, as well as during the formation and development of income-generating activities.

The choice of a specific option in a medical organization depends on many factors and may vary depending on the stage of development of this area of activity.

With the increase in the volume of services provided, there is a need to review and optimize their provision. The prerequisites for organizing an independent organizational and functional model are the following factors:

1) an increasing demand for medical services provided by insurance companies within the framework of VHI;

2) transition to single-channel financing, with a continuing financial deficit;

3) changes in the legal framework governing this type of activity of the institution, with the expansion of the rights and opportunities of managers in this area;

4) the accumulated experience of medical organizations in this field of activity.

Thus, the analysis of options for the provision of paid medical services in state medical organizations indicates that it is necessary to develop unified organizational and functional models for improving these activities in order to increase the volume and quality of medical services provided and minimize risks.

The government of Moscow
MOSCOW CITY HEALTH DEPARTMENT

ORDER

On approval of the Rules for the provision of paid services to citizens and legal entities by state organizations of the health care system of the city of Moscow

Document as amended by:
by order of the Department of Health of the city of Moscow dated September 9, 2015 N 764;
by order of the Department of Health of the city of Moscow dated March 2, 2017 N 148;
;
by order of the Department of Health of the city of Moscow dated June 14, 2017 N 427.
____________________________________________________________________

In pursuance of the Decrees of the Government of the Russian Federation of October 4, 2012 N 1006 "On Approval of the Rules for the Provision of Paid Medical Services by Medical Organizations" and of August 15, 2013 N 706 "On Approval of the Rules for the Provision of Paid Educational Services", as well as the Decree of the Moscow Government of December 21, 2010 N 1076-PP "On the procedure for the exercise by the executive authorities of the city of Moscow of the functions and powers of the founder of state institutions of the city of Moscow"
(Preamble as amended by order of the Moscow Department of Health of April 14, 2017 N 283.

I order:

1. Approve the Rules for the provision of paid services to citizens and legal entities by state organizations of the health care system of the city of Moscow (hereinafter referred to as the Rules) (annex to this order).

2. When providing paid services, the heads of organizations of the state healthcare system of the city of Moscow should be guided by the rules approved by the Decrees of the Government of the Russian Federation of 04.10.2012 N 1006, of 15.08.2013 N 706.
by order of the Department of Health of the city of Moscow dated April 14, 2017 N 283.

3. Head of the Department of Affairs and Coordination of Activities E.L. Nikonov ensure that this order is posted on the official website of the Moscow Department of Health.
(Clause as amended by order of the Department of Health of the city of Moscow dated April 14, 2017 N 283.

4. To consider invalid the orders of the Department of Health of the city of Moscow:

- dated December 9, 2011 N 1608 "On approval of the rules for the provision of paid services to citizens and legal entities by state institutions of all types of the Department of Health of the City of Moscow";

- dated 04.07.2013 N 677 "On amendments to the order of the Department of Health of the city of Moscow dated 09.12.2011 N 1608"

5. The control of the execution of this order shall be entrusted to the First Deputy Head of the Department of Health of the City of Moscow V.V. Pavlov.
(Clause as amended by order of the Department of Health of the city of Moscow dated April 14, 2017 N 283.

Minister of the Government of Moscow,
head of department
health care of the city of Moscow
G.N. Golukhov

Appendix. Rules for the provision of paid services to citizens and legal entities by state organizations of the health care system of the city of Moscow

Appendix
to the order of the Department
health care of the city of Moscow
dated October 2, 2013 N 944

These Rules establish the procedure for the provision of paid services to citizens and legal entities by medical, educational and other state organizations of the healthcare system of the city of Moscow.

The rules are developed in accordance with the current legislative and regulatory acts of the federal and regional levels.

1. Paid services are provided by medical, educational and other state organizations of the healthcare system of the city of Moscow (hereinafter referred to as state organizations) to citizens and legal entities in accordance with the legislation of the Russian Federation and types of income-generating activities permitted by the charters of state organizations. The provision of paid medical, educational and other services subject to licensing is carried out on the basis of a list of works, services that make up medical, educational and other activities and specified in the license for activities issued in the prescribed manner.

The Moscow City Health Department maintains a register of subordinate state organizations providing paid services (official website www.mosgorzdrav.ru)."

2. The date of commencement of the provision of paid services, the list of paid services provided by the state organization, prices (tariffs) for paid services, as well as changes in the list of paid services and changes in prices (tariffs) for paid services are approved by order of the state organization. Lists of paid services and price lists (tariffs) for paid services are compiled indicating the codes of the paid services provided in accordance with the approved nomenclature of medical and educational services.

Prior to the issuance of an order by a state organization to approve the list of paid services or to amend this order, the list of paid services that the state organization is going to provide is subject to approval by the Moscow City Health Department.

In case of termination of the provision of paid services, state organizations send relevant information to the Moscow City Health Department within 3 days in order to make changes to the register of state organizations providing paid services on the official website of the Moscow City Health Department.

3. The provision of paid services to citizens is carried out with the voluntary informed consent of the patient. The fact of voluntary informed consent to the provision of paid medical services is recorded in the patient's medical record.

4. State medical organizations of the Moscow Department of Health (hereinafter referred to as medical organizations) that provide the relevant types and volumes of medical care without charging a fee under the Program of State Guarantees of Free Provision of Medical Care to Citizens and the Territorial Program of State Guarantees of Free Provision of Medical Care to Citizens (hereinafter - respectively Program, Territorial Program), have the right to provide paid medical services:

a) on other terms than provided by the Program, territorial programs and (or) target programs, at the request of the consumer (customer), including but not limited to:

- establishment of an individual post of medical supervision during treatment in a hospital;

- the use of drugs that are not included in the list of vital and essential drugs, if their purpose and use is not due to vital indications or replacement due to individual intolerance to drugs included in the specified list, as well as the use of medical devices, medical nutrition, in including specialized health food products that are not provided for by the standards of medical care;

b) when providing medical services anonymously, with the exception of cases provided for by the legislation of the Russian Federation;

c) 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;

d) when applying for medical services on your own, with the exception of cases and the procedure provided for in Article 21 of the Federal Law of November 21, 2011 N 323-FZ "On the Basics of Protecting the Health of Citizens in the Russian Federation", and cases of providing an ambulance, including an ambulance specialized medical care and emergency or emergency medical care.

5. Medical organizations can provide medical services for a fee: an individual medical post, the provision of medical services at home (except for cases when medical care at home is provided for medical reasons), medical and social assistance and other services, as well as additional services , provided in the process of providing medical care, including household and service: delivery of medicines, rental of medical products, individual preparation or ordering of dishes at the request of the patient, accommodation in a superior ward and other services provided additionally in the provision of medical care.

6. Paid services, their types, volumes and terms of provision must comply with licensing requirements, the terms of the Agreement, standards and procedures for the provision of medical care, educational and other services, regulatory documents (requirements) established by the Ministry of Health of the Russian Federation, the Ministry of Education and Science of the Russian Federation and other requirements established by law.

7. Paid medical and educational services may be provided to the full extent of the standard of medical care, state educational standards, or as one-time consultations, procedures, diagnostic studies and other services, including those in excess of the standards being met.

8. Requirements for the provision of paid services, including the content of the standards, procedures and conditions for the provision of medical care, service, educational and other services are determined by agreement of the parties and may be higher than provided for by the standards, procedures and other regulatory documents (requirements) approved by the Ministry of Health of the Russian Federation, the Ministry of Education and Science of the Russian Federation, as well as standards, procedures, conditions and requirements established on their basis by other federal and regional executive authorities.

9. When providing paid services, the mode of operation of a state organization may be established according to a separate schedule, subject to its agreement with the Founder.

At the same time, the availability, quality and volume of medical services provided under the Program, the Territorial Program of State Guarantees for the Provision of Free Medical Care to the Population of the City of Moscow, targeted comprehensive programs and, in terms of educational services provided free of charge in accordance with federal state educational standards, should not deteriorate.

10. The procedure for the provision of paid services in state organizations is regulated by the Regulations on the procedure and conditions for the provision of paid services in a state organization, developed on the basis of these Rules and approved by the head of the state organization, internal regulatory documents (orders, internal labor regulations, collective agreements, work schedules and etc.), as well as other requirements of the current legislation.

11. To provide paid services, taking into account the demand of the population for the relevant types of services and the availability of necessary funds, it is possible to organize special structural units (departments, chambers, offices for the provision of paid services), which are created by order of the head of the state organization. To carry out work on the provision of paid services, additional positions of medical and other personnel may be introduced, maintained at the expense of the sale of paid services, as well as specialist consultants from other medical institutions, research institutes, higher educational institutions with which labor contracts are concluded or civil contracts.

12. When providing paid medical services, methods of prevention, diagnosis, treatment, medical technologies, medicines, immunobiological preparations and disinfectants permitted for use in the manner prescribed by law must be used.

13. Paid services (works) are provided under contracts at the expense of personal funds of citizens, insurance premiums for voluntary medical insurance, funds of enterprises, institutions and organizations and other funds permitted by law.

14. The conclusion of contracts by state organizations for intermediary services to attract patients by third parties is not allowed.

15. Medical services cannot be provided for a fee in the provision of emergency medical care, which is provided immediately in conditions requiring medical intervention for emergency indications (in case of accidents, injuries, poisoning and other conditions and diseases); as well as when conducting a forensic medical examination and a forensic psychiatric examination (with the exception of examinations carried out in civil and arbitration cases, cases of administrative offenses); pathological and anatomical autopsy and military medical examination.

16. When receiving medical care under the Territorial Program for the provision of free medical care, the following services are not subject to payment:

- prescription and use for medical reasons of drugs (in cases of their replacement due to intolerance, rejection) that are not included in the list of vital and essential drugs;

- accommodation in small wards (boxes) of patients for medical and (or) epidemiological indications;

- joint stay of one of the parents (another legal representative) or another family member in a medical institution when providing medical care in a hospital with a child under the age of four years inclusive throughout the entire period of treatment, and with a child older than four years - if indicated;

- medical and transport services in the provision of medical care within the framework of the standards of medical care (examination and treatment of a patient in a round-the-clock hospital) in the absence of the possibility of their provision by a medical or other organization providing medical care to the patient;

- transportation, storage in the morgue of biological material received for examination, corpses of patients who died in medical and other organizations, disposal of biological material.

17. The provider of paid services is obliged to provide information about the provider of paid services and the services provided by him in accordance with the list approved by federal legislation on order of rendering paid medical and educational services.

Information posted on information stands (racks) should be available to an unlimited circle of people during the entire working time of a state organization providing paid services. Information stands (racks) are located in a place accessible to visitors and are designed in such a way that you can freely get acquainted with the information posted on them.

In addition, at the request of the consumer and (or) the customer, the service provider provides for review:

a) a copy of the constituent document of the state organization, the regulation on its branch involved in the provision of paid services;

b) a copy of the license to carry out medical, educational and other activities subject to licensing with a list of works (services) in accordance with the license.

At the conclusion of the contract, at the request of the consumer and (or) the customer, they must be provided in an accessible form with information on paid services containing the following information:

a) the procedures for the provision of medical care and the standards of medical care used in the provision of paid medical services;

b) information about a particular medical worker providing the relevant paid medical service (his professional education and qualifications);

c) information about the methods of providing medical care, the risks associated with them, possible types of medical intervention, their consequences and the expected results of the provision of medical care;

d) a list of categories of consumers entitled to receive benefits, as well as a list of benefits provided in the provision of paid medical, educational, including paid additional educational services in accordance with federal laws and other regulatory legal acts.

e) basic and additional educational programs, the cost of educational services for which is included in the basic fee under the contract;

f) additional educational programs, special courses, cycles of disciplines and other additional educational services provided for a fee only with the consent of the consumer.

The contractor is obliged to inform the consumer at his request of other information related to the contract.

18. Paid services cannot be provided by the contractor in exchange for services performed within the framework of the state (municipal) task.

19. State organizations are not entitled, without the consent of citizens, to provide additional services for a fee, as well as condition the provision of some services on the obligatory performance of others.

20. The procedure for concluding contracts for the provision of paid services and the requirements for their content are established by federal legislation on the procedure for the provision of paid services by state organizations.

21. When concluding an agreement, the consumer (customer) is provided in an accessible form with information on the possibility of obtaining the appropriate types and volumes of medical care, educational services without charging a fee within the framework of state guarantees established by the legislation of the Russian Federation.

The consumer's refusal to conclude a contract for the provision of paid services cannot be the reason for reducing the types and volumes of medical care provided to such a consumer without charging a fee.

22. The prices at which state organizations (except for autonomous ones) provide paid services, with the exception of those specified in paragraph 23 of these Rules, are set in accordance with the procedure approved by a separate order of the Moscow City Health Department.

23. Prices for orthopedic dental services provided in dental clinics and denture departments of medical organizations of the privileged category of citizens at the expense of the budget of the city of Moscow are subject to state regulation in the manner established by the Government of Moscow.

24. Payment for services is carried out by non-cash payments through credit organizations or by depositing cash directly to the cash desk of a state organization with the issuance to the patient, client of a document confirming payment (cash receipt, receipt or other form of strict reporting (document of the established sample).

25. At the request of the person who paid for the services, the medical organization is obliged to issue a Certificate of payment for medical services for submission to the tax authorities of the Russian Federation in the form established by order of the Ministry of Health of the Russian Federation and the Ministry of the Russian Federation for Taxes and Duties dated July 25, 2001 N 289 / BG-3-04 / 256 "On the implementation of the Decree of the Government of the Russian Federation of March 19, 2001 N 201" On the approval of lists of medical services and expensive types of treatment in medical organizations of the Russian Federation, medicines, the amounts of payment for which at the expense of the taxpayer's own funds are taken into account when determining the amount of social tax deduction".

26. Accounting for funds received by state organizations from the provision of paid services is carried out in accordance with the procedure established by the budgetary legislation of the Russian Federation, the Government of Moscow, and the provisions of the Budget Code of the Russian Federation.

27. State organizations providing paid services are required to keep accounting records separately for the main activity and for the provision of paid services.

28. State organizations have the right to carry out income-generating activities that correspond to these goals, only in so far as this serves to achieve the goals for which they were created, provided that such activities are indicated in their constituent documents.

Income received by a state-owned organization from this activity shall go to the budget of the city of Moscow.

Income received by state budgetary and autonomous organizations from these activities and property acquired at the expense of these incomes shall be at the independent disposal of the organization.

29. Item excluded - order of the Department of Health of the city of Moscow dated June 14, 2017 N 427 ..

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Clauses 29, 30 and 31 of the previous edition are considered, respectively, clauses 30, 31 and 32 of this edition - order of the Moscow City Health Department dated September 9, 2015 N 764.

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30. In accordance with the legislation of the Russian Federation, state healthcare organizations are liable 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, training, as well as for causing harm to the health and life of the patient.

31. The Federal Service for Supervision of Consumer Rights Protection and Human Welfare, the Moscow City Health Department, and other state bodies that, in accordance with laws and other legal acts of the federal and regional levels, are entrusted with checking the activities of state organizations.

32. The harm caused to the life and health of the patient as a result of the provision of low-quality paid medical services is subject to compensation by the contractor in accordance with the legislation of the Russian Federation.

Revision of the document, taking into account
changes and additions prepared
JSC "Kodeks"

1. These Rules determine the procedure and conditions for the provision of paid medical services to the population (in addition to the guaranteed volume of free medical care) by medical institutions, regardless of departmental subordination and form of ownership, including research institutes and state medical educational institutions of higher professional education ( hereinafter referred to as - medical institutions), and are binding on all medical institutions.

2. Paid medical services to the population are provided by medical institutions in the form of preventive, medical diagnostic, rehabilitation, prosthetic and orthopedic and dental care. Paid medical services to the population are provided by medical institutions under contracts with citizens or organizations for the provision of medical services to employees and members of their families.

3. The provision of paid medical services to the population by medical institutions is carried out if they have a certificate and license for the chosen type of activity.

4. State and municipal medical institutions provide paid medical services to the population by special permission of the relevant health management body.

5. Medical institutions are obliged to ensure that the paid medical services provided to the population comply with the requirements for methods of diagnosis, prevention and treatment permitted on the territory of the Russian Federation.

6. Medical institutions are obliged to keep statistical and accounting records of the results of paid medical services provided to the population, draw up the required reporting and submit it in the manner and within the time limits established by laws and other legal acts of the Russian Federation.

7. State and municipal medical institutions providing paid medical services to the population are required to keep statistical and accounting records and reporting separately for their main activities and paid medical services.

8. Control over the organization and quality of the provision of paid medical services to the population, as well as the correctness of the collection of fees from the population, is carried out within their competence by the health authorities and other state bodies and organizations, which, in accordance with the laws and other legal acts of the Russian Federation, are entrusted with the verification of activities medical institutions.

9. Prices for medical services provided to the population for a fee are established in accordance with the legislation of the Russian Federation.

10. Medical institutions are obliged to provide citizens with free, accessible and reliable information, including information about the location of the institution (place of its state registration), working hours, a list of paid medical services indicating their cost, conditions for the provision and receipt of these services, including information on benefits for certain categories of citizens, as well as information on the qualifications and certification of specialists.

11. The provision of paid medical services is formalized by an agreement that regulates the conditions and terms for their receipt, the payment procedure, the rights, obligations and responsibilities of the parties.

12. Payment for medical services is made in banking institutions or in a medical institution.

Settlements with the population for the provision of paid services are carried out by medical institutions using cash registers.

When making settlements with the population without the use of cash registers, medical institutions must use a form that is a document of strict accountability, approved in the prescribed manner.

Medical institutions are obliged to issue a (cash) receipt or a copy of the form confirming the acceptance of cash to the consumer.

13. Consumers using paid medical services have the right to demand the provision of services of adequate quality, information about the availability of a license and certificate, and the calculation of the cost of the service provided.

14. Consumers using paid medical services are obliged to:

pay the cost of the medical service provided;

fulfill the requirements that ensure the quality provision of paid medical services, including the provision of the information necessary for this.

15. In accordance with the legislation of the Russian Federation, medical institutions are liable to the consumer 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 consumer .

16. Consumers using paid medical services have the right to make claims for damages caused by non-fulfillment or improper fulfillment of the terms of the contract, compensation for damage in the event of harm to health and life, as well as compensation for causing moral harm in accordance with the legislation of the Russian Federation and these Rules.

17. In case of non-compliance by the medical institution with obligations on the terms for the performance of services, the consumer has the right, at his choice:

appoint a new term for the provision of services;

demand a reduction in the cost of the service provided;

require the performance of the service by another specialist;

terminate the contract and claim damages.

Violation of the terms established by the contract for the performance of services must be accompanied by the payment of a penalty to the consumer in the manner and amount determined by the Law of the Russian Federation "On Protection of Consumer Rights" or the contract.

By agreement (agreement) of the parties, the specified penalty can be paid by reducing the cost of the medical service provided, providing the consumer with additional services without payment, returning part of the advance paid earlier.

18. Claims and disputes that have arisen between the consumer and the medical institution are resolved by agreement of the parties or in court in accordance with the legislation of the Russian Federation.

19. A medical institution shall be released from liability for non-performance or improper performance of a paid medical service if it proves that the non-performance or improper performance occurred due to force majeure, as well as on other grounds provided by law.

20. For non-compliance with these Rules, a medical institution in the prescribed manner may be deprived of a license or the right to provide paid medical services to the population.

The definition of private medical practice is given in Article 56 of the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens (hereinafter - the Fundamentals). In accordance with this article, private medical practice is defined as the provision of medical services by medical workers outside state and municipal health care institutions at the expense of citizens' personal funds or at the expense of enterprises, institutions and organizations, including medical insurance organizations, in accordance with concluded agreements. This practice is carried out in accordance with the legislation on the protection of the health of citizens. Based on the above, the following conclusions can be drawn:

The right to engage in private medical activities is reserved exclusively for medical workers who must have:

a) higher or secondary medical and pharmaceutical education, as well as a special title; b) specialist certificate; c) a license for a selected type of activity included in the list established by the Ministry of Health of the Russian Federation.

Persons engaged in private medical practice and private pharmaceutical activities belong to the private health care system.

Private medical practice and private pharmaceutical activity are a type of entrepreneurial activity.

Thus, the main condition for the legality of these types of activities is obtaining an appropriate license, since these types of activities are classified by law as licensed (Article 17 of the Federal Law "On Licensing Certain Types of Activities"). Licensing, being one of the types of state regulation of the economy, involves the implementation by the state of a control function in relation to entities engaged in entrepreneurial activities, which, due to its specificity (affecting the interests of a large number of consumers of state and public security, health and morality of the population, etc.) requires such control. All of the above, of course, can be attributed to private medical practice and pharmaceutical activities. To obtain a license to carry out medical activities, persons who apply for it must meet certain requirements, namely:

Have relevant professional training or have employees with such training (if we are talking about legal entities)

Possess the necessary regulatory and methodological support, organizational and technical capabilities and material and technical equipment to perform the relevant types of medical activities.

As already noted, the professional training of persons engaged in private medical practice and pharmaceutical activities must be confirmed by a diploma of higher or secondary medical or pharmaceutical education, as well as a specialist certificate. Obtaining a license to carry out pharmaceutical activities is associated with the need to meet the following requirements for persons applying for one:

The presence of a specialist certificate or the presence of employees with such a certificate in the state (if we are talking about legal entities).

The presence of a technically prepared room for the storage of toxic and potent substances that meets the requirements of fire safety and sanitary rules, equipped with a burglar alarm.

Both for private medical practice and for pharmaceutical activities, there are general requirements for a specialist certificate. A specialist certificate is issued on the basis of:

postgraduate professional education (postgraduate studies, residency),

additional education (advanced training, specialization),

a screening test, conducted by commissions of professional medical and pharmaceutical associations, on the theory and practice of the chosen specialty, issues of legislation in the field of protecting the health of citizens.

In addition, for the implementation of both private medical practice and pharmaceutical activities, as well as for all licensed activities, the following is also required:

Registration as a legal entity or individual entrepreneur;

Tax registration;

Paying a fee for processing an application.

A specific requirement for private medical practice and pharmaceutical activities associated with the potential danger to humans of such activities is the need to obtain a sanitary and epidemiological conclusion on compliance with sanitary rules (clause 2, article 40 of the Federal Law of 30.03.99 No. 52-FZ "On Sanitary - epidemiological well-being of the population") License holders (licensees) may be:

Commercial organizations whose constituent documents and documents do not limit their legal capacity in terms of private medical practice and pharmaceutical activities

Non-profit organizations, if they are entitled to carry out entrepreneurial activities in accordance with the constituent documents

Individuals with the status of an individual entrepreneur.

The implementation of medical (pharmaceutical) activities without a license (lack of a license) can be considered in the following cases:

failure to obtain a license in the prescribed manner;

availability of a license for another type of medical (pharmaceutical) activity or for another type of licensed activity;

termination of the license;

suspension of the license (in this case, although the license formally exists, it does not grant the right to carry out the type of activity specified in it);

license cancellation.

A license is considered not received in cases when a person carrying out the type of activity subject to licensing:

a) did not apply to the licensing authority for a license;

b) received a license in an unspecified manner or from a body not authorized to carry out licensing;

c) applied for a license but was denied. Even in the event of an unlawful refusal to issue a license, the license applicant does not have the right to carry out the licensed type of activity until the final decision of this issue in court.

Article 235 of the Criminal Code of the Russian Federation.Illegal private medical practice or private pharmaceutical activity. 1. Engagement in private medical practice or private pharmaceutical activity by a person who does not have a license for the chosen type of activity, if this negligently entailed infliction of harm to human health, -

shall be punishable by a fine in the amount up to 120 thousand roubles, or in the amount of the wage or salary, or any other income of the convicted person for a period up to one year, or by restraint of liberty for a term of up to three years, or by deprivation of liberty for a term of up to three years.

2. The same act, which negligently caused the death of a person, -

shall be punishable by restraint of liberty for a term up to five years, or imprisonment for the same term.

Article 173 of the Civil Code of the Russian Federation. Invalidity of a transaction of a legal entity that goes beyond its legal capacity. A transaction made by a legal entity in contradiction to the objectives of the activity, specifically limited in its constituent documents, or by a legal entity that does not have a license to engage in the relevant activity, may be declared invalid by a court at the claim of this legal entity, its founder (participant) or a state body, exercising control or supervision over the activities of a legal entity, if it is proved that the other party to the transaction knew or obviously should have known about its illegality.

Article 169 of the Civil Code of the Russian Federation. Invalidity of a transaction made for a purpose contrary to the foundations of law and order and morality. A transaction made with a purpose that is obviously contrary to the foundations of law and order or morality is void. If both parties to such a transaction have intent - in the event that the transaction is executed by both parties - everything received by them under the transaction is recovered to the income of the Russian Federation, and in the event that the transaction is executed by one party on the other side, everything received by it and everything due from it is recovered to the income of the Russian Federation the first party in compensation received. If only one of the parties to such a transaction has intent, everything received by it under the transaction must be returned to the other party, and what the latter received or was due to it in compensation for what was performed shall be recovered to the income of the Russian Federation.

PRACTICAL PART

As an example, I will give a surgeon who has a higher education, as well as a special title and a certificate of a specialist who decided to engage in private medical activities without a license.

There are various options for liability that he may incur:

Administrative law today does not establish administrative responsibility for engaging in private medical practice or private pharmaceutical activity by a person in the absence of a license. Therefore, given the non-criminal nature of this act (the absence of harm to health caused by negligence), it cannot be considered as an administrative offense. The maximum possible legal consequences in this case are fixed in civil law- this is the recognition of transactions concluded by a person engaged in private medical practice or private pharmaceutical activity by a person in the absence of a license, invalid in accordance with Art. 173 of the Civil Code of the Russian Federation. A more stringent civil law consequence of carrying out such activities without a license is the recognition of such transactions as void as those made for the purpose contrary to the foundations of law and order and morality on the basis of Art. 169 of the Civil Code of the Russian Federation. (the texts of the articles are given in the previous part).

Criminal the same responsibility arises if the doctor in question causes harm to the health of his patients through negligence, or as a result of negligence, the death of his patient occurs (in accordance with Article 235 of the Criminal Code of the Russian Federation).

BIBLIOGRAPHY

Regulations:

The right and conditions for the provision of paid services by medical organizations.

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 Federal Law No. health of citizens in the Russian Federation” (hereinafter referred to as 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.

For medical organizations participating in the implementation of the program of state guarantees of free provision of medical care to citizens 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 conditions other 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 referred to as Law No. 2300-1) apply to relations related to the provision of paid medical services. Thus, Resolution No. 17 of the Plenum of the Supreme Court of the Russian Federation dated June 28, 2012 established that consumer protection legislation also applies to the provision of medical services to citizens provided by medical organizations within the framework of compulsory medical insurance.

Let us give an example of the provision of paid medical services within the state assignment.

Example

for inpatient treatment - the establishment of an individual post of medical observation;
the use of drugs that are not included in the List of vital and essential drugs, if their appointment and use is not due to vital indications or replacement due to individual intolerance to drugs included in the specified list, as well as the use of medical devices, medical nutrition, including h. specialized medical nutrition products 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. 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).

Informed voluntary consent of the patient

The patient has the right to receive the following information:

about the state of his health, including information about the results of the examination and the established diagnosis;
treatments 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.

The document usually consists of two parts - the information part and the actual consent of the patient 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 providing paid medical services), including the prescribed treatment regimen, may reduce the quality of the medical service provided, entail the inability to complete it on time or adversely affect the health of the consumer.

Conclusion of an agreement for the provision of paid services

Note

A consumer is an 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.

The customer is a natural or legal person who intends to order (purchase) or order (acquire) 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 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 professional education and qualifications);
methods of providing medical care, the risks associated with them, possible types of medical intervention, their consequences and the expected results of medical care.

Consumers or customers may be provided with other information related to the subject of the contract.

Note that before the conclusion of the contract, the institution is obliged in writing notify the consumer (customer) that non-compliance with the instructions (recommendations) of a medical worker providing a paid medical service, including the prescribed treatment regimen, may reduce the quality of the provided paid medical service, make it impossible to complete it on time or adversely affect on the consumer's health.

Example

When treating in a hospital, the approximate price of the service is formulated in the contract after indicating the cost of treatment as follows: “the price of the service is approximate and can be changed upwards or downwards 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 according to emergency 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 for free.