Open your mouth, say: “When?”

Where federal subsidies are deposited, which are sent to the regions for the salaries of health workers

Question-task on two "why". Why aren't doctors' salaries growing, as the President and Minister of Health have promised? Because the Compulsory Medical Insurance Fund (FOMS) stopped paying for medical examinations and day hospitals. Why did you stop? Because the Ministry of Health forced all medical institutions to reissue licenses that used to be unlimited...

Question-task on two "why". Why aren't doctors' salaries growing, as the President and Minister of Health have promised? Because the Compulsory Medical Insurance Fund ( FOMS) stopped paying for medical examinations and day hospitals. Why did you stop? Because the Ministry of Health forced all medical institutions to reissue licenses that used to be unlimited. If you don't re-register, you won't get any money. And shoals of doctors stretched out to beat the thresholds of permitting institutions ...

The Ministry of Health has announced an all-Russian medical examination. A third of Russian citizens this year must undergo medical examinations and examinations. Over the next three years, they decided to examine all Russians. But the widely announced campaign stumbled over Order No. 121n issued by the same department in March of this year, which re-regulates the licensing of medical activities. In this order, medical examinations are a special type of work.

And nothing if it was only necessary to make an addition to the license. But Roszdravnadzor explained that the entire license should be reissued as not complying with the new order. Rospotrebnadzor also immediately made its contribution: it also demands that the sanitary and epidemiological conclusion required for the license be reissued. The fact that preventive examinations were carried out by any doctor before does not count. Those medical institutions that have not yet reissued licenses for the sake of this innovation cannot receive money for preventive examinations - that is, for the entire large-scale medical examination - from the MHIF.

The same stumbling block in the way of money from the Compulsory Health Insurance Fund to a medical institution has become another type of work - medical services in a day hospital. They are also not paid today if the license is not reissued. Even those crumbs that go specifically to pay, the fund does not pay. A nurse from the city polyclinic of Elista writes to us: “We have never received less than now. Now the clinic is undergoing medical examination, but we do not receive money for it.”

The rule-making of the Ministry of Health turns out to be strange. When regulating wage increases, they go down. When licensing is regulated, institutions will no longer be paid for services.

But what does it mean to renew all the licenses issued to hospitals, clinics, outpatient facilities in Russia? We have about 19,000 state institutions (by the way, their number has decreased significantly over 10 years - optimization!), About 50 thousand more private ones, and all of them together have 90 thousand licenses (according to the register of Roszdravnadzor). The amount of work is gigantic!

But maybe they missed the shaft: since November 2011, according to the law, licenses have become perpetual? The order of the Ministry of Health came in handy.

Now no one will be bored: neither the administration of hospitals and clinics, nor the licensing authorities, nor Roszdravnadzor, nor Rospotrebnadzor, nor regional health departments. Algorithm for issuing a license: Rospotrebnadzor - 60 days, licensing authority - 30 days. In total, 3 months of bureaucratic red tape due to the new order of the Ministry of Health.

But if you enter the words “license for medical activity” in any Internet search engine, a lot of firms and firms offering their services pop up. These candle factories promise to do everything "quickly, without problems and with a guarantee."

The director of a private medical clinic operating in Moscow calls one such company in my presence. Issue price - 250 thousand rubles. At the same time, money is not taken for paperwork, but only for the correct "skidding" of the documents collected by the applicant himself to the licensing authority - such that after which there will be no nit-picking.

One gets the impression that licensing was invented precisely to prevent the work of officials from being transferred. But this is a false impression: the law says that licensing is carried out "in order to prevent damage to the rights, legitimate interests, life or health of citizens ...".

But if a hospital or clinic worked with a license before the new order, it means that once it was already recognized that they have the right to medical activities. They have a license! The types of work and services they perform are specified in the appendix to the license. The institution has not changed anything in its activities. But the officials in the order changed the name of the service, attributed it to “day hospital”, and it turned out that the license needed to be reissued.

The noise about the re-registration of licenses was raised by private traders. The administrators of state hospitals are silent: they have been taught to obey. The private sector is outraged. Surprisingly, representatives of the licensing authorities also cried out. Mikhail Shapran, chairman of the board of the regional Krasnoyarsk organization of entrepreneurs Medaliance, says: “It is in Moscow that the subway runs, and driving from end to end of the city is available. And in the Krasnoyarsk Territory? For example, a dental office in Norilsk. Licensing authorities need to get there with a check. And not only in Norilsk, but all over the region, and this is 10 France! But first, administrators of institutions must arrive from all over the region with documents. Arrived, but not all the papers are in order - fly back. At the same time, the money is spent not on raising the salaries of doctors, but on paying for plane tickets - to meet the needs of officials.

Private clinics and centers are united much more strongly than public ones. Their lives forced them to unite. Representatives of the Association of Private Clinics and Centers appealed to the Federal Antimonopoly Service (FAS) with a request to regulate the situation with licensing in healthcare and bring this process in line with the requirements of the law, and not with the rule-making of officials.

Timofey Nizhegorodtsev, Head of the Social Sphere and Trade Control Department of the Federal Antimonopoly Service of the Russian Federation, supported the appeal at the FAS expert council. He said that now, first of all, state institutions, which do not receive payments for the work done from the MHIF, are in a difficult situation.

Sergei Lazarev, a member of the board of the National Union of Regional Associations of the Private Health System, argues that a situation has developed when a license for medical institutions is issued according to concepts, and not according to the law. The Licensing Law does not provide for any order from the Ministry of Health. But after its release, any institution falls under the millstones of legal collisions. It is impossible to stop the activity, but, if something happens, the court will approach not according to concepts, but according to the law: it considers that the institution worked without a legitimate license, the head will be doubly responsible. In this case, neither the needs of the doctor nor the needs of the patient are taken into account at all. There are administrative games. And these are games for money.

Lazarev says that representatives of the ministry object: it has been like this all his life. That is, whenever the orders of the Ministry of Health were changed, institutions had to reissue licenses. “Indeed, it was. But not by law! - retorts Lazarev. — Because licenses today are perpetual. Received once, and work. If they provide the same assistance to the population that they provided. Why do administrators have to go off their feet or look for intermediaries, spend a lot of money? This will definitely not affect the safety of patients.”

The money spent on the circulation of papers and payment of intermediaries is just a part of those percentages of GDP that are not enough for the development of healthcare.

Sergey Misyulin, chairman of the board of the National Union of Regional Associations of the Private Health System, explains the current situation simply: officials need to be constantly bowed to, because these meetings can be beneficial. Which one is clear.

PS: Recently, the Ministry of Health issued a letter of instruction that eliminates the need to reissue the entire license when changing certain types of work or services. This is a success in the fight of doctors against the Ministry of Health with the support of the Federal Antimonopoly Service of the Russian Federation. But this once again proves that the licensing of medical activities is based on concepts, and not according to the law. Why else would there be letters from the Ministry of Health explaining how to apply the orders of the Ministry of Health?