The procedure for the provision of paid medical services. The procedure for the provision of paid medical services under the OMS policy. The procedure for the provision of paid medical services

Decree 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"

In accordance with Part 7 of Article 84 of the Federal Law "On the Fundamentals of Protecting the Health of Citizens in Russian Federation"and Article 39.1 of the Law of the Russian Federation "On Protection of Consumer Rights" The Government of the Russian Federation decides:

2. Recognize invalid the Decree of the Government of the Russian Federation of January 13, 1996 N 27 "On approval of the Rules for the provision of paid medical services to the population by medical institutions" (Sobranie Zakonodatelstva Rossiyskoy Federatsii, 1996, N 3, Art. 194).

Rules
provision of paid medical services by medical organizations
(approved by Decree of the Government of the Russian Federation of October 4, 2012 N 1006)

I. General provisions

1. These Rules determine the procedure and conditions for the provision of paid medical services by medical organizations to citizens.

2. For the purposes of these Rules, the following basic concepts are used:

"paid medical services"- medical services provided on a reimbursable basis at the expense of personal funds of citizens, funds of legal entities and other funds on the basis of agreements, including agreements on voluntary health insurance(hereinafter referred to as the contract);

"consumer" - an individual who intends to receive or receives paid medical services personally in accordance with the contract. A consumer receiving paid medical services is a patient covered by the Federal Law "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation";

"customer" - an individual (legal) person who intends to order (purchase) or order (purchase) paid medical services in accordance with the contract in favor of the consumer;

"executor" - a medical organization providing paid medical services to consumers.

concept "medical organization" used in these Rules in the meaning defined in the Federal Law

3. Paid medical services are provided by medical organizations on the basis of the list of works (services) constituting medical activities and specified in the license for medical activities issued in the prescribed manner.

4. The requirements for paid medical services, including their volume and terms of rendering, are determined by agreement of the parties to the contract, if federal laws, other regulatory legal acts The Russian Federation does not provide for other requirements.

5. These Rules are brought to the attention of the consumer (customer) by the contractor in a clear and accessible form.

II. Conditions for the provision of paid medical services

6. At the conclusion of the contract, the consumer (customer) is provided in an accessible form with information on the possibility of obtaining the appropriate types and volumes 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 referred to as the program, territorial program, respectively).

The consumer's refusal to conclude a contract cannot be the reason for reducing the types and volumes of medical care provided to such a consumer without charging a fee within the framework of the program and the territorial program.

7. Medical organizations participating in the implementation of the program and the territorial program have the right to provide paid medical services:

a) on other terms than those stipulated by the program, territorial programs and (or) targeted programs, at the request of the consumer (customer), including but not limited to:

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

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 said list, as well as the use of medical devices, medical nutrition, including specialized medical nutrition 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 independently, with the exception of cases and the procedure provided for in Article 21 of the Federal Law "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation", and cases of emergency, including emergency specialized, medical care and medical care provided by in an urgent or emergency manner.

8. The procedure for determining prices (tariffs) for medical services provided by medical organizations that are budgetary and state-owned state (municipal) institutions is established by the bodies exercising the functions and powers of the founders.

Medical organizations of other organizational and legal forms determine prices (tariffs) for paid medical services provided on their own.

9. When providing paid medical services, the procedures for the provision of medical care approved by the Ministry of Health of the Russian Federation must be observed.

10. Paid medical services may be provided in full of the standard of medical care approved by the Ministry of Health of the Russian Federation, or at the request of the consumer in the form of individual consultations or medical interventions, including in an amount exceeding the scope of the standard of medical care being performed.

III. Information about the contractor and the medical services provided by him

11. The Contractor is obliged to provide, by posting on the website of the medical organization in the information and telecommunication network "Internet", as well as on the information stands (racks) of the medical organization, information containing the following information:

a) for a legal entity - the name and company name (if any);

for an individual entrepreneur - last name, first name and patronymic (if any);

b) the address of the location of the legal entity, the data of the document confirming the fact of entering information about the legal entity in the Unified State Register of Legal Entities, indicating the body that carried out the state registration;

the address of the place of residence and the address of the place of medical activity of the individual entrepreneur, the data of the document confirming the fact of entering information about the individual entrepreneur in the Unified State Register individual entrepreneurs, indicating the body that carried out the state registration;

c) information about the license to carry out medical activities (number and date of registration, list of works (services) that make up the medical activities of a medical organization in accordance with the license, name, location address and telephone number of the licensing authority that issued it);

d) a list of paid medical services indicating prices in rubles, information on the conditions, procedure, form of providing medical services and the procedure for their payment;

e) the procedure and conditions for the provision of medical care in accordance with the program and the territorial program;

f) information on medical workers involved in the provision of paid medical services, on the level of their professional education and qualifications;

g) the mode of operation of a medical organization, the work schedule of medical workers involved in the provision of paid medical services;

h) addresses and phone numbers of the executive authority of the constituent entity of the Russian Federation in the field of protecting the health of citizens, the territorial authority of the Federal Service for Supervision in the Sphere of Health Care and the territorial authority of the Federal Service for Supervision in the Field of Consumer Rights Protection and Human Welfare.

12. Information posted on information stands (racks) should be available to an unlimited number of people during the entire working time of a medical organization providing paid medical 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.

13. The contractor provides for review at the request of the consumer and (or) the customer:

a) a copy of the constituent document of a medical organization - a legal entity, the regulation on its branch (department, other territorially separate structural unit) involved in the provision of paid medical services, or a copy of the certificate of state registration individual as an individual entrepreneur;

b) a copy of the license to carry out medical activities with a list of works (services) that make up the medical activities of a medical organization in accordance with the license.

14. When concluding a contract, at the request of the consumer and (or) the customer, they must be provided in an accessible form with information on paid medical 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 specific medical worker providing the relevant paid medical service (his vocational education and qualifications);

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

d) other information related to the subject of the contract.

15. Prior to the conclusion of the contract, the contractor shall notify the consumer (customer) in writing that failure to comply with the instructions (recommendations) of the contractor (medical worker providing paid medical services), 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.

IV. The procedure for concluding a contract and paying for medical services

16. The contract is concluded by the consumer (customer) and the contractor in writing.

17. The contract must contain:

a) information about the performer:

name and company name (if any) of a medical organization - a legal entity, location address, data of a document confirming the fact of entering information about a legal entity in the Unified State Register of Legal Entities, indicating the body that carried out the state registration;

surname, name and patronymic (if any) of an individual entrepreneur, address of residence and address of the place of medical activity, data of a document confirming the fact of entering information about an individual entrepreneur in the Unified State Register of Individual Entrepreneurs, indicating the body that carried out the state registration;

the number of the license to carry out medical activities, the date of its registration, indicating the list of works (services) that make up the medical activities of the medical organization in accordance with the license, the name, address of the location and telephone number of the licensing authority that issued it;

b) last name, first name and patronymic (if any), residential address and telephone number of the consumer (legal representative of the consumer);

surname, name and patronymic (if any), address of the place of residence and telephone number of the customer - an individual;

the name and address of the location of the customer - legal entity;

c) a list of paid medical services provided in accordance with the contract;

d) the cost of paid medical services, the terms and procedure for their payment;

e) conditions and terms for the provision of paid medical services;

f) position, surname, name, patronymic (if any) of the person concluding the contract on behalf of the contractor, and his signature, surname, name, patronymic (if any) of the consumer (customer) and his signature. In case the customer is legal entity, the position of the person concluding the contract on behalf of the customer is indicated;

g) the responsibility of the parties for failure to comply with the terms of the contract;

h) the procedure for changing and terminating the contract;

i) other conditions determined by agreement of the parties.

18. The contract is drawn up in 3 copies, one of which is with the contractor, the second - with the customer, the third - with the consumer. If the contract is concluded by the consumer and the contractor, it is drawn up in 2 copies.

19. An estimate may be drawn up for the provision of paid medical services. Its preparation at the request of the consumer (customer) or contractor is mandatory, while it is an integral part of the contract.

20. If the provision of paid medical services requires the provision of additional medical services on a reimbursable basis that are not provided for by the contract, the contractor is obliged to notify the consumer (customer) about this.

Without the consent of the consumer (customer), the contractor is not entitled to provide additional medical services on a reimbursable basis.

21. 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, such medical services are provided free of charge in accordance with the Federal Law "On the Fundamentals of Protection health of citizens in the Russian Federation".

22. If the consumer refuses to receive medical services after the conclusion of the contract, the contract is terminated. The contractor informs the consumer (customer) about the termination of the contract at the initiative of the consumer, while the consumer (customer) pays the contractor the costs actually incurred by the contractor related to the performance of obligations under the contract.

23. The consumer (customer) is obliged to pay for the medical service provided by the contractor on time and in the manner specified by the contract.

24. In accordance with the legislation of the Russian Federation, the consumer (customer) is issued a document confirming the payment for the provided medical services (cash receipt, receipt or other form of strict accountability (standard document)).

25. After the execution of the contract, the Contractor shall issue to the consumer (legal representative of the consumer) medical documents (copies of medical documents, extracts from medical documents) reflecting the state of his health after receiving paid medical services.

26. The conclusion of a voluntary medical insurance contract and payment for medical services provided in accordance with the said contract shall be carried out in accordance with the Civil Code of the Russian Federation and the Law of the Russian Federation "On the organization of insurance business in the Russian Federation".

V. Procedure for the provision of paid medical services

27. The contractor provides paid medical services, the quality of which must comply with the terms of the contract, and in the absence of conditions on their quality in the contract, the requirements for services of the corresponding type.

If federal law, other regulatory legal acts of the Russian Federation provide for mandatory requirements for the quality of medical services, the quality of paid medical services provided must comply with these requirements.

28. Paid medical services are provided subject to the informed voluntary consent of the consumer (legal representative of the consumer), given in the manner prescribed by the legislation of the Russian Federation on the protection of the health of citizens.

29. The contractor provides the consumer (legal representative of the consumer) at his request and in a form accessible to him information:

about the state of his health, including information about the results of the examination, diagnosis, treatment methods, the risk associated with them, options and consequences of medical intervention, expected results of treatment;

about used in the provision of paid medical services medicines and medical devices, including their expiration dates (warranty periods), indications (contraindications) for use.

30. When providing paid medical services, the Contractor is obliged to comply with the requirements established by the legislation of the Russian Federation for the preparation and maintenance of medical records and accounting and reporting statistical forms, the procedure and deadlines for their submission.

VI. Responsibility of the contractor and control over the provision of paid medical services

31. For non-fulfillment or improper fulfillment of obligations under the contract, the performer shall be liable under the legislation of the Russian Federation.

32. Harm caused to the life or 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.

33. Control over compliance with these Rules is carried out by the Federal Service for Supervision of Consumer Rights Protection and Human Welfare within the established powers.

An important document for the medical community is being publicly discussed - the draft Rules for the provision of paid medical services by medical organizations. According to officials of the Ministry of Health, at the moment, some medical organizations impose paid services on patients, replacing them with free assistance. At the same time, the current regulatory legal framework does not allow a clear distinction between which services should be provided free of charge and which on a reimbursable basis. The amount of the cost of medical services provided by state institutions on a paid basis is also questionable.

The main provisions of the bill

Changes to the rules proposed by officials of the Ministry of Health will allow:

clearly distinguish between the conditions for the provision of medical care within the framework of territorial programs of state guarantees of free provision of medical care to citizens (hereinafter referred to as territorial programs) and paid medical services
prevent the replacement of free medical services with paid ones
to limit the unreasonable growth of citizens' expenses for paid medical services.

When determining tariffs for paid medical services, provide for cost-effectiveness of no more than 20 percent.
The list of paid medical services includes medical support of the patient by a doctor or nurse during transportation to the place of treatment, examination, rehabilitation and back. But this does not apply to those cases when the service is provided within the framework of the territorial CHI program.
Allow patients to be placed in small rooms in the absence of indications established by the Russian Ministry of Health.
Prohibit the provision of any paid medical services in the provision of emergency medical care in emergency and urgent forms.

How to distinguish between paid and free services

At present, in medical organizations of the state and municipal health care systems, paid medical services are provided, as a rule, using the infrastructure and material and technical base acquired for budgetary funds. At the same time, it is intended to provide medical care within the framework of territorial programs, including territorial programs of compulsory medical insurance.

The provision of paid medical services on equipment, on premises, using consumables intended for the provision of free medical services, may lead to the replacement of free medical services by paid ones and an increase in the waiting time for patients to receive free medical care.

Often, medical workers are simultaneously involved in the provision of paid and free appointments, as a result of which patients wait longer for free medical care.

Purpose of the amendments to the new Rules- delimit the conditions for the provision of medical care within the framework of territorial programs and paid medical services and prevent the replacement of free medical services with paid ones.

Separate accounting for the use of drugs and consumables

The problem of paid and free services relevant especially for level III institutions in the constituent entities of the Russian Federation, as well as for Federal specialized medical institutions subordinate to various ministries and departments of the Russian Federation. Almost all surveys and some interventions are carried out in them on a paid basis, referring to the lack of volumes under the territorial program or due to quotas. At the same time, most of the equipment was purchased and is being purchased at the expense of budget allocations from the federal budget or the budgets of the subjects of the Russian Federation. Also, the basic salary is paid at the expense of compulsory medical insurance.

Reference. Medical organizations of the third level are organizations in the structure of which there are units that provide high-tech medical care.

To solve these problems, it is necessary for medical organizations to conduct separate accounting and control of the use of medicines and consumables in the provision of medical care within the framework of territorial programs and paid medical services.

Free medical care in excess of the established volumes and paid services

In the process of discussing the amendments, the medical community points to the need to develop clear criteria for the provision of paid medical care, especially in excess of the established volumes within the framework of territorial programs for the provision of free medical care.

The annual reduction in the volume of medical care in the Program of State Guarantees of Free Provision of Medical Care to Citizens, approved by the Decree of the Government of the Russian Federation, leads to various kinds of abuse on the part of medical institutions.

However, the draft regulatory legal act does not provide for the establishment of criteria for the provision of paid medical care in terms of providing medical care in excess of the established volumes within the framework of territorial programs. This is due to the fact that during the year the volume of medical care for medical organizations can be adjusted taking into account the needs of the population and the volume of medical care actually performed.

Opinion of the medical community

The Bulletin of the Accounts Chamber No. 2 of 2019 published a report on the results of the expert and analytical event "Analysis of the formation in 2017 and 2018 and the implementation in 2017 of territorial programs of state guarantees of free provision of medical care to citizens, including their financial support."

The document says that there is an increase in accounts payable of medical organizations in the following regions:

Moscow,
Ulyanovsk region,
Leningrad region,
Kirov region,
Udmurt republic,
Kostroma region,
Mari El Republic.

The main reasons for accounts payable:

underfunding of Territorial programs at the expense of budget allocations from the budgets of the subjects of the Russian Federation;
low compulsory medical insurance tariffs that do not cover the real costs of providing medical care;
non-fulfillment of the volume of medical care;
the application of penalties by medical insurance organizations based on the results of an examination of the quality of medical care;
increase in the share of expenses on wages in order to implement the Decree of the President of the Russian Federation dated May 7, 2012 No. 597 “On measures to implement state social policy”;
non-compliance with the structure of spending funds of medical organizations working in the CHI system, including in terms of exceeding wage costs;
rising prices for medicines and consumables, food, fuels and lubricants, an increase in tariffs for energy resources.

If the above reasons are eliminated, then it will not be necessary to make changes to the Decree of the Government of the Russian Federation of October 4, 2012 No. 1006 “On Approval of the Rules for the Provision of Paid Medical Services by Medical Organizations”.

During the discussion of the amendments, experts expressed different opinions about whether there is a general need to adopt amendments and changes to the provisions of the above Resolution.

Were suggested other ways to solve the problem:

remove paid services from state and municipal medical institutions, since they do not solve the financial problems of medical institutions, but simply support the financial situation of medical workers in some respect;
to increase public health financing;
revise the new wage system;
deal with finances in health care, namely how much money came in, how much went out and where it went.

At the stage of development of amendments, 19 proposals were submitted, of which only 4 were taken into account, and 7 were partially accepted for consideration.

We invite heads of medical institutions and doctors to take a seminar on the CME system "".

When health problems arise, the need to consult a good, competent specialist who is able to listen, determine an accurate diagnosis and prescribe effective treatment. For some reason, many Russian patients are sure that a paid medical institution can provide them with better care. What are the advantages of such clinics over the state ones? What are their disadvantages? What are the rules for the provision of paid medical services?

Background

In Europe, paid medicine has long been popular. Services for which you need to give money, in Lately began to appear more in the domestic medical field. The population, on their own experience, appreciated the benefits that a paid polyclinic, an emergency room, and a private ambulance minibus have. All of them are equipped with the latest technology.

In Soviet times, the existence of "free" medicine guaranteed all citizens a certain average level quality. Few then understood that treatment in any case involves monetary waste. The whole question is who exactly pays for it: the patient himself, the employer or the state. With the collapse of the USSR, private hospitals, medical centers and clinics have become commonplace in the country. Paid medicine, having passed its own specific path of development since then, has settled quite firmly in the life of Russians. The provision of such services today is carried out not only by private medical clinics, but also by municipal and federal agencies. There are as many of them as mushrooms after rain.

And yet, the question of the need for paid medicine has not remained in the past. Despite the abundance of reputable private medical institutions, the market for such services today cannot still be called mature and civilized. Today, the problem of paid medicine is more relevant than ever. It is discussed at various levels.

Advantages of paid medicine

In the field of paid medicine, like any other service, there is competition. And, therefore, there is a desire to provide the highest quality service for the customer. This is the only way to bribe patients with paid medical services.

The advantages of such medicine, of course, are many:

Respectful and polite and attitude from administrators and doctors. Less paperwork, a higher salary of specialists, a relatively calm atmosphere, which distinguishes a paid clinic, have a positive effect on the mood and behavior of the staff.
Specialists treat the patient with great attention. All complaints in a private clinic will be treated with mandatory due attention. Examination and treatment here will be prescribed not according to a general scheme for everyone, but individually - in accordance with the diagnosis and characteristics of the patient.
The appointment time in a private clinic is not limited to a few minutes, as is usually the case in a municipal one. As a rule, a paid specialist takes about 20-40 minutes to examine and talk with a patient.
The client can choose the doctor that suits him.
A patient who comes to a paid medicine center will not have to sit in a queue. It is well known that making an appointment in state medical institutions does not at all guarantee that the patient will get to the doctor on time. On the contrary, in a paid clinic, even if the previous appointment is delayed for a short time, the administrator will definitely apologize to the visitor for the inconvenience caused.
Usually, in a private hospital, the equipment and interior are in many ways different from what we are used to in state institutions. The general dreary atmosphere of municipal hospitals and holes in the flooring could still be tolerated somehow, but the use of outdated appliances is frustrating. A private clinic or a paid emergency room, on the contrary, is usually equipped with technical innovations.
You can make an appointment with a doctor in a private institution as a matter of urgency. Sometimes a visit to a specialist is allowed on the day of the appointment. In the municipal clinic, you can get into the coveted office only after many hours of sitting in line. And the attitude towards the patient will be as if he was done a big favor.

The presence of a considerable list of benefits of paid medicine makes it surprising that many, even if they have the financial opportunity to receive paid medical services, do not use this chance. And they go to the usual state institution.

About the cons of paid medicine

Having a considerable number of significant advantages, paid medicine is far from ideal. The amounts spent (sometimes significant, given the prices for such services) do not guarantee receiving quality treatment. By the way, the pleasure of visiting private clinic often also questionable. So, the disadvantages of paid medicine include:

financial interest in the patient. The profit of the institution, whether it is a polyclinic or a paid emergency room, as well as the earnings of its staff depend on the number of patients who seek help. This is also affected by the number of services rendered to them. The more appointments and examinations, the greater the amount of money will be in the cashier. We have to state that doctors benefit from the patient's disease. They can prescribe the provision of completely unnecessary paid medical services (examinations, tests, etc.), scare the patient with an unreasonable multitude of diagnoses, and prescribe more expensive treatments than necessary in a particular situation.
The cost of treatment does not guarantee the professionalism and competence of a specialist. And often it is not so much a pity for the money spent as for the lost time. After all, often treatment does not allow for delay. Yes, and the price of services in paid clinics often unreasonably high.

Based on the results of public opinion polls...

The survey showed that almost half of the respondents from the number of citizens of various settlements surveyed had to apply for paid medical services. Most patients in private clinics are people with higher education, relatively high level income, often suffering from chronic diseases. The reasons for applying to such institutions are: a more worthy quality of service, greater comfort and service. The reason for the refusal of paid services is their exorbitant cost. About a third of the people surveyed are forced to refuse to purchase expensive medicines. Every tenth has to sacrifice diagnostics and consultations.

Paid services fully satisfy only 42% of citizens. But at the same time, the majority is ready to pay further - for home visits or without a queue, diagnostics, consultations, etc. Those who use the services of a medical institution on a paid basis involuntarily - 34%. Of these, older people account for 61%.

Rules for the provision of paid medical services: regulatory documents

The provision of paid medical services is regulated by regulatory documents. These include:

Decree of the Government of the Russian Federation "On approval of the Rules for the provision of paid medical services by medical organizations" (hereinafter - the Rules).
Federal Law "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens."
Federal Law "On the basics of protecting the health of citizens."
Federal Law "On Protection of Consumer Rights".

What does the law say?

Covered medical services are in addition to the list of free medical care. It is guaranteed by a program of state laws. Accordingly, it provides for the free provision of the following types of assistance to citizens of the Russian Federation:

outpatient clinic;
ambulance;
stationary: in case of acute illnesses, injuries, poisonings, etc.

In accordance with the Rules (clause 7), medical organizations can provide the following types of paid medical services:

Provision of an individual medical post in a hospital.
The use in the treatment of drugs that do not belong to the list of essential and vital drugs.
The use of non-standard drugs and medical nutrition.
The provision of services is anonymous.
Treatment of foreign citizens who do not have health insurance.
When handling independently. Cases of providing emergency, urgent and emergency medical care are excluded.

To avoid violations

The provision of paid medical services is possible only with the voluntary consent of the patient. In order to avoid violations, consumers should study the rules for providing such assistance. By law, a medical institution providing services must have a license for each type of activity. The contractor must provide the consumer with the following information:

The name of the legal entity, entering its data into the Unified Register, indicating the organization that has undergone state registration.
FULL NAME. entrepreneur, address of his place of residence and conduct of medical activities.
The date and number of registration of the license, information on the list of services that make up the content of the activity, the address of the location, as well as the telephone number of the licensing authority.
Information about the conditions and the form of providing medical assistance. List of services, prices for paid medical services. By the way, the cost is indicated in rubles.
Data on specialists providing medical services for a fee. Information about the level of their qualification and professional education.
Schedule (mode) of work of the institution and specialists providing paid medical services.
Addresses and telephones of controlling bodies.

The rules for the provision of paid medical services provide for the need to post the above information on the information stand in the institution itself and on the institution's website on the Internet. It should be located in a place accessible to visitors. And arrange accordingly for free familiarization with the information posted on it.

On the procedure for determining prices

In budgetary medical organizations, as well as state-owned state institutions, the procedure for determining the cost of paid medical services is established by their bodies. Usually the founders set the list and price. In non-budgetary medical organizations (CJSC, LLC, etc.), they are determined by the specialists of these institutions.

About the conclusion of the contract

The contractor and the consumer must conclude a written contract for medical services between themselves. It is better to make a document in two copies. It should indicate:

list of provided paid medical services;
prices, order and terms of payment;
conditions for the provision of services and terms;
stipulate the liability of the parties in case of failure to comply with the terms of the contract.

The agreement must also include information about:

about its executor - a legal entity or an individual entrepreneur: details of the existing license;
about the consumer: full name, place of residence, phone number;
on the procedure for changing and terminating the contract;
on other conditions determined by agreement of the parties.

At the request of the consumer, an estimate for the provision of assistance can be drawn up. The Contractor cannot provide additional medical services on a paid basis without the consent of the client. In emergency cases, in order to eliminate the threat to the life of the consumer, with the sudden development of acute or exacerbation of chronic diseases, paid medical care should be provided without a monetary penalty.

On the rights and obligations of the parties

Before the conclusion of the contract, the contractor must notify the consumer in writing about the nature of the consequences of non-compliance with the recommendations of a specialist providing paid medical services, as well as the prescribed treatment regimen. He is obliged to tell the client about the decline in the quality of the service provided, the impossibility of completing it on time, and warn about the deterioration of the consumer's health.

According to the Rules (clause 24), after the provision of paid medical services to the patient, he must be issued documents (extracts) reflecting his state of health. In addition, the consumer is obliged to receive a document confirming the payment for assistance: a receipt or a cash receipt. The patient may refuse the services provided after the conclusion of the contract. In this case, he must pay the costs incurred by the contractor.

In case of breach of contract

According to the law of the Russian Federation "On the protection of the health of citizens", in case of improper performance or non-performance of obligations under the contract, the consumer must apply to the contractor with a claim. it must be expressed in writing. This document must contain an indication of one of the requirements provided for by the Federal Law "On Protection of Consumer Rights". Patient rights are protected by law. The contractor who violated the contract must, at the request of the consumer, either correct the shortcomings of the assistance provided free of charge, or reduce the cost, or perform the work again, or reimburse the costs incurred to correct the shortcomings of the service provided. If the patient's rights are violated, in accordance with the Federal Law "On the Protection of Consumer Rights", the contractor is obliged to fully compensate for the damage caused to his life or health.

Supervisory authorities

If the rights of the consumer are violated, he can send a complaint to the Department of Health, which controls the quality and safety of the medical services provided. In addition, he is allowed to apply to the territorial bodies of the FS for supervision in the medical field and consumer protection, monitoring the quality and safety of medical activities, as well as local departments of the Rospotrebnadzor.

About the medical examination

According to the legislation of the Russian Federation, when applying for a job, as well as periodically, citizens must undergo a paid medical examination. The price list for services that are not included in the guaranteed list of free medical care must be placed on public display at the reception desk of the institution. Due to the fact that professional examinations are not covered by the health insurance system, the employer concludes an appropriate agreement in advance with a medical institution authorized to conduct medical examinations. Payment for the survey is entirely the responsibility of the director of the enterprise. In case of forced payment by the applicant, the cost of the procedures passed is returned to him upon employment.

Provision of paid services to organizations

Medical services for organizations are provided on a paid basis. These include a complex for sanitary and hygienic and medical services for the staff of a company:

conducting employee screenings;
ensuring the preparation of a production control program;
conducting laboratory research;
disservices to enterprises.

Passing a medical examination in a private clinic (when obtaining or changing a driver’s license, a weapon license, getting a job, issuing a medical book) for both one person and the entire team of the enterprise is carried out efficiently, quickly and relatively inexpensively. duplicates medical certificates drivers are not issued. Money is not returned in case of refusal to assign a category, refusal to admit to obtaining a license to carry weapons.

Private medical clinics, in accordance with the Order of the Ministry of Health and Social Development of the Russian Federation (04/12/2011), conduct medical examinations of workers employed in hazardous industries. When issuing personal sanitary and medical books, the reception of people is carried out with the whole range of necessary additional services. Employees of a private clinic in the shortest possible time can develop a "Program for the production control of the implementation of sanitary and anti-epidemic measures." They are carried out at enterprises, in accordance with the requirements of sanitary standards.

Qualitatively and in a short time, private organizations also carry out radiological and laboratory research air, water, soil, products, measurement of physical factors: noise, vibration, illumination, microclimate, etc. As well as disinfection services in accordance with the quality management system defined by the requirements of GOST.

Conclusion

More and more citizens of the Russian Federation trust their health to paid medicine. Carrying out a careful and thorough examination of the patient, convenient service, increased comfort of service, the possibility of establishing trusting and close relationships between the patient and the doctor, the high professionalism of specialists and modern medical equipment of private clinics make such treatment more and more popular. People need to know the rules for the provision of paid medical services. Acquaintance with them will help patients maintain their health in a quality manner and guarantee their rights.

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 government organizations Moscow healthcare system

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 Government of Moscow of December 21, 2010 N 1076-PP "On the procedure for the implementation 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. Heads of organizations state system health care of the city of Moscow, when providing paid services, 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 Moscow City Health Department";

- 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

Application. 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

Application
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 Department of Health.

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) providing 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;

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 medical care provided in an emergency or emergency form.

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 devices, 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 tests and other services, including those in excess of the standards being met.

8. Requirements for the provision of paid services, including the content of 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 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 the 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 funds from the sale of paid services, as well as specialist consultants from other medical institutions, research institutes, higher educational institutions with which employment contracts 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 rooms (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 over four years of age - 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 specific 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 eligible 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 a contract, 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 to be provided in tax authorities of the Russian Federation in the form established by the order of the Ministry of Health of the Russian Federation and the Ministry of the Russian Federation for Taxes and Dues of 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 approval of lists of medical services and expensive types of treatment in medical organizations of the Russian Federation, medicines, the amounts of payment of which at the expense of the taxpayer's own funds are taken into account when determining the amount of the 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 ..

____________________________________________________________________
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.

____________________________________________________________________

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. Control over the organization of work on the provision of paid services and the quality of the performance by state organizations of paid services to the population, prices and the procedure for collecting Money from the population is carried out by the Federal Service for Supervision of Consumer Rights Protection and Human Welfare, the Department of Health of the City of Moscow, as well as other state bodies, which, 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"

Rules for the provision of paid medical services by medical organizations

I. General provisions

1. These Rules determine the procedure and conditions for the provision of paid medical services by medical organizations to citizens.

2. For the purposes of these Rules, the following basic concepts are used:

"paid medical services" - medical services provided on a reimbursable basis at the expense of personal funds of citizens, funds of legal entities and other funds on the basis of contracts, including voluntary medical insurance contracts (hereinafter referred to as the contract);

"consumer" - an individual who intends to receive or receives paid medical services personally in accordance with the contract. A consumer receiving paid medical services is a patient covered by the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”;

"customer" - an individual (legal) person who intends to order (purchase) or order (purchase) paid medical services in accordance with the contract in favor of the consumer;

"executor" - a medical organization that provides paid medical services to consumers.

The term “medical organization” is used in these Rules in the meaning defined in the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”.

4. Requirements for paid medical services, including their scope and timing of provision, are determined by agreement of the parties to the contract, unless federal laws, other regulatory legal acts of the Russian Federation provide for other requirements.

5. These Rules are brought to the attention of the consumer (customer) by the contractor in a clear and accessible form.

II. Conditions for the provision of paid medical services

6. When concluding a contract, the consumer (customer) is provided in an accessible form with information on the possibility of obtaining the appropriate 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).

7. Medical organizations participating in the implementation of the program and the 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 observation during treatment in a hospital;

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 the number of 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;

d) when applying for medical services independently, with the exception of cases and the procedure provided for in Article 21 of the Federal Law “On the Basics of Protecting the Health of Citizens in the Russian Federation”, and cases of emergency, including emergency specialized, medical care and medical care provided by in an urgent or emergency manner.

Medical organizations of other organizational and legal forms determine prices (tariffs) for paid medical services provided on their own.

9. When providing paid medical services, the procedures for the provision of medical care approved by the Ministry of Health of the Russian Federation must be observed.

III. Information about the contractor and the medical services provided by him

a) for a legal entity - the name and company name (if any);

for an individual entrepreneur - last name, first name and patronymic (if any);

the address of the place of residence and the address of the place of medical activity of the individual entrepreneur, the data of the document confirming the fact of entering information about the individual entrepreneur in the Unified State Register of Individual Entrepreneurs, indicating the body that carried out the state registration;