Non-state medical institutions. Main types of health care facilities

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Questions considered in the material:

• What kind of medical institutions are there
• What are the advantages of private medical centers
• Is it worth opening a private medical Center
• What franchises of medical institutions are popular in Russia

In Russia today the trend towards the gradual transition from the entire public health to commercial or public-private. Paid medical services are becoming more and more profitable business. If you are interested in this industry and you are a novice entrepreneur, then our material will be useful for what types of medical centers exist and which of them are most in demand and beneficial.

Medicine is growing rapidly, which cannot but affect the methods of therapy and diagnosis: they are improved and multiply. It is logical that the number of medical centers providing certain types of health services is also growing.

The modern medical center is a combination of medical equipment, created by the latest technology, and professionalism of medical staff. These institutions come in various types and species and carry out different activities.

All medical centers and other medical institutions are classified primarily on the basis of their principle of operation and are divided into two large species:

1. State medical institutions. The patient does not pay medical inspection and diagnosis, but is forced to stand in a long queue.
2. Private. All services of the medical centers of this species are paid: reception, diagnosis, destination, etc. The advantages of these institutions are in an individual approach to each client and more detailed inspection.

People all higher appreciate their own free time and the ability to consult with a specialist, so commercial medical centers are increasingly in demand. By the way, they also have different types.

Classification of state medical institutions

• (from Greek. Polis is a city and klinike - the art of treatment). This is an independent urban medical and prophylactic institution that can be specialized or multidisciplinary, but sometimes polyclinics are part of the combined hospitals or medical schools. It provides qualified assistance to coming patients and treats patients at home: those patients who are unable to get to the clinic, is able to call a doctor and get help of the house. If necessary, patients are hospitalized.

Polyclinic services usually cover the whole set of medical and preventive MerSince the reception does doctors of all specializations, the clinic has therapeutic and diagnostic cabinets, its own laboratory. There are in the clinics and office receptions: there are measured by patients arterial pressure And the temperature (this is engaged in this nurse).

• (from Lat. Ambulatorius - moving, mobile). This type of LPU is designed to provide medical care (outside the hospital) to residents of a small settlement, like a city type village or village, or an industrial enterprise.

Unlike a polyclinic at ambulatory, the spectrum rendered medical services It is limited, as well as the number of full-time employees: usually no more than five specialists (therapist, surgeon, pediatrician, obstetrician-gynecologist) are working in rural outpatabilities. This type of LPU serves less patients.

In rural areas, the ambulatory function is performed by the Feldsher-obstetric items - the main structural units of the health care system in villages. The precinct principle of service of the population allows you to detect patients, provide them with a qualified medical assistance, observe the incidence in the region, to carry out the prevention of diseases and lead sanitary and educational work.

• For large industrial enterprises with a large staff, there is own an analogue of the ambulance - medical grade. LPU of this species may include health-leaps, clinic, hospital and profilators. The activity of this type of medical centers is subject to the needs of the main enterprise.
• Healthy health It is an element of other types of LPU - medical schools or a clinic established under industrial enterprises, at a construction site, at school, school or university.

In addition to the provision of first medical care, suddenly sick, gained injuries or poisoning, health-proof activities (therapeutic and preventive and sanitary and hygienic), aimed at preventing diseases and a decrease in the incidence rate. Swells can be headed by doctors (and then called medical), paramedics or medical examinations (paramedic).

• - A highly specialized type of medical center. In LPU of this type, only gynecological diseases are treated and carried out, and also monitor the condition of pregnant women.

Medical employee of the middle link - the midwife helps a doctor in the process of reception of patients, engaged in the patronage of pregnant women and conducts training for them (for child care, personal hygiene measures, etc.), sanitary and educational work is responsible for performing medical purposes.

• To provide urgent medical care in emergency cases exist ambulance stationsoperating 24 hours a day. The head of the ambulance brigade is usually a paramedic. He traveled independently for challenges to the patient, makes hospitalization and has emergency assistance.

If a specialized medical assist is required, a brigade of the emergency departments under the guidance of a qualified doctor goes to the patient. Feldscher contributes to him in the transportation of a patient and providing urgent help.

Most ambulance stations have their own vehicles equipped with the latest technology, and can emerge qualified medical Help, including special and resuscitation, right at home in a patient or on the road to the hospital.

All these types of medical centers and LPU form an outpatient polyclinic link that performs the following tasks:

1. The provision of qualified medical care outside the hospital (under the conditions of polyclinic or at home).
2. Conducting the population's closerization.
3. The implementation of prevention in order to reduce the level of morbidity, preventing deaths and disability.
4. Conduct examination of temporary disability.
5. Conducting educational work, sanitary and hygienic education.
6. Popularization healthy image Life.

Where outpatient medical care is not enough, stationary types of medical centers are connected.

• (from lat. Dispense - distributed) is called independent LPU, which has a special specialization and working in a dispensary format.

This type of LPU performs the following functions: detection on early stages and accounting for patients suffering from diseases of a particular group; regular dynamic observation of them; providing them with special medical assistance; Development of recommendations for patients with the improvement of the situation in everyday life and in the workplace; Research of morbidity, search for its causes; preventive actions; Sanitary and educational activities.

That is, the dispensary is designed to observe and treat a certain contingent of patients.

The Russian health care system provides such types of dispensaries as anti-tuberculosis, endocrinological, cardiological, psycho-neurological, oncological, drug-skinned, skin-venereological, controversial, medical and physical education.

• Hospital - Large stationary type LPU, offering patients highly qualified treatment and care using the newest achievements of medicine, technology and pharmaceuticals.

Hospitals are urban, regional, republican, etc. City hospitals can be:

1. Multidisciplinary (intended for the treatment of patients with various diseases).
2. Specialized (a certain species-oriented disease, be it tuberculosis, infectious, mental, etc.).

Countryside residents serve Republican and regional hospitals providing them with specialized, polyclinic, stationary medical care, as well as consultation.

• Clinic It differs from other types of stationary medical centers by the fact that it is engaged in not only the treatment of patients, but also scientific research, as well as training of medium medical staff and doctors.
• Hospital The hospital serves only military personnel and disabled of war.

• Sanatorium (Lat. SANATUM - heal, treat) - stationary LPU specializing in patient fogging. As a rule, the sanatoriums are arranged in resort locations, in regions with a favorable climate, in places where there are sources of mineral waters and healing mud.

Types of Commercial Medical Centers

As for private medical centers, the following types of these LPU are most common:

1. Multidisciplinary clinics providing a full range of medical services within a certain specialization. The choice of those who need a comprehensive survey of the body usually fall into multidisciplinary clinics.
2. Specialized clinics. They are engaged in problems belonging to one specific direction of medicine: gynecological, cardiological, etc.
3. Centers of one doctor - These are medical centers in which the admission of patients is leading one famous famous doctor.

Some people who had a negative experience of interaction with paid clinics belong to them extremely hostile - as to organizations going to all for their profits. However, among the commercial medical centers there are institutions for which the patient's help and solving its problems are primarily important.

Therefore, for the patient, it is so important to choose the right clinic. Pay attention to how long it works, what are the reviews of customers about it. And, of course, do not consider the private medical center with something like a collection of wizards who can instantly be heal from any diseases as soon as you pay money.

Advantages of private medical centers

The times when people were forced to be treated in district clinics, have long passed: today we have a choice between state and private medicine. Consult about poor well-beingYou can also be examined and obtaining appointments now in private clinics, which are presented in a wide variety.

Private medical centers are gaining popularity, as people pay more attention to their health and quality of life. The success of commercial medical institutions depends on the effectiveness of the methods and technologies used, the competence of workers and care for each client.

There are a lot of private clinics specializing in female reproductive problems, family planning, treating congenital deviations, aesthetic and cosmetic services. Centers of obstetrics and gynecology, family medicine clinics go in a separate category.

In such medical centers, patients can count on examination by all experts, analyzes and other types of procedures at a convenient time and without any queues.

Many clinics are not limited to narrow specialization and are multidisciplinary, providing services to both adults and children. In the state of such medical centers there are doctors of various directions: therapists, surgeons, traumatologists, otolaryngologists, etc.

Among the commercial clinics there are round-the-clock and working without days off. The ambulance brigade leaves at the specified addresses at any time of the day and night to assist the patient and, if necessary, to hold hospitalization.

Among the representatives of the finest, the clinics are very in demand aesthetic medicine. In addition to plastic surgery, rejuvenation procedures, etc. These medical centers, for example, solve problems with the condition of the hair. Trichology is a relatively young industry of medicine, actively developing and developing its own technologies.

For commercial medical centers of any species, one thing is important - polite and attentive attitude towards each patient. The clinic interaction with the clinic begins with the administrator, which must comply with the professional ethics of communication. As for doctors, their duty is to clarify all the symptoms as soon as possible and appoint a suitable treatment. The conditions of detention in the clinic are also important: patients strive for safety and comfort.

How to provide paid medical services

The paid services of medical centers are several species - this is rehabilitation, preventive, medical and diagnostic assistance.

If desired, the patient concludes a contract for the provision of any of these services. Usually the appeal to the paid clinic is happening like this:

1. In a day primary reception For a new patient, a medical card is set in the clinic receipt and sign the contract for the provision of paid services in two copies, as well as all the required applications to it and consent to the processing of personal data.
2. During the reception by the doctor, a physical examination of the patient and his survey on the symptoms is carried out. The doctor then explains how diagnosis and what are the likely treatment programs, which will be, if not being treated, what complications and risks need to be afraid, from which stages will be therapy, how much it costs (approximately). After that, informed informed consent to treatment and, if necessary, approve a preliminary treatment plan.
3. In a document on the agreement and the client's medapation, it is described in detail all services provided.
4. The patient with the participation of a nurse and doctors takes place in the medical center all kinds of procedures prescribed by its plan in the premises of the medical center and using the necessary equipment.
5. If the safety of certain measures and procedures in question (for example, in a patient allergic to any drugs, he is drunk or suffering from acute infectious disease), the medical center does not provide him with services.
6. If during treatment or diagnostics it is found that the treatment plan needs to be changed or supplemented according to medical reasons, then the patient has a preliminary agreement on this. The failure of a patient from additional interventions also documented, explaining the possible consequences.
7. The patient signs medical care and annexes to the Agreement, where all the features and conditions for providing him with help are reflected.
8. After that, the patient must pay in the registration paid services (or make a debt receipt, if at the moment it does not have the entire amount). In commercial medical centers, no type of services is not allowed to do with doctors personally.
9. The primary reception ends with issuing a reminder to the next or repeated reception, with a date and time (if this technique is necessary).
10. If the patient's condition changes during the therapy, he must inform about this doctor and appear on the reception as soon as possible to eliminate the problems.

Certificates on a commercial basis always completes payment through the registry and signing the form of strict reporting. If the patient, making an advance in advance, refuses to continue treatment, the clinic makes recalculation for the services already rendered and returns it to the balance of money for ten working days (in the same way that the patient made payment, or otherwise - by mutual agreement).

Medical Center: how to open and do not burn

The preservation of health remains one of the most important issues today, therefore the opening of medical centers (any species) is a relevant and demanded direction of business.

Public LPUs - and adults, and children's - two main pain points: low level of service and insufficient comfort.

Wine all the limited budgets that are missing for the purchase of new modern equipment, repair of the cabinets, etc. Due to the wear of the technique, diagnostics becomes less accurate and reliable, and this is very critical when it comes to human health or even life. In addition, the public patients are forced to idle in the queues, penetrating the oppressive mood.

Customers of private medical centers are mostly secured people who can afford to overpay for the service to get quality service, accurate diagnosis and attentive care.

Therefore, one of the main issues in creating a private medical center is the formation of a favorable, comfortable environment for patients. The clinic development plan should include appropriate measures and steps.

1. Is it worth doing this?

Assessing the level of free medicine, you will be sure to relevant the private clinic. Most of the Russian population is ready to invest in their health and use paid medical services.

Your goal as a business manager is to provide potential consumers a high level of service, comfortable conditions and competent doctors. The medical institution that has a license and qualified doctors in the state will never remain without customers, especially if we competently compile and systematically implement a business plan.

Almost all: the size of the room, the types of equipment and materials, personnel specialization will depend on the choice of the type of medical center.

The most demanded today the following highly specialized commercial clinics:

• dental;
• urological and gynecological;
• cosmetology;
• narcological.

However, it is possible to approach the selection of directions more creatively and opening such a specific LPU, such as, for example, an acupuncture office or a clinic of hirudotherapy. One of the promising niches is Pediatrics actively developing in the past few years.

Medical centers of a wide profile are also popular - their target audience includes people suffering from a variety of illnesses. But the discovery of such a medical center will require more solid investments.

3. Premises for medical center

Search for clinic - a very responsible step for business creator. It is better to choose central areas, highways with a dense flow of people, buildings near metro stations, city transport stops. At the same time, be prepared for the fact that rental in the center is more expensive than on the outskirts.

The area of \u200b\u200bthe room is determined by the profile of the medical institution. For example, for a dental office, it is enough for 25-30 m 2 (of which 14 m 2 will take the Cabinet itself, 6 m 2 -Cerizational, and the rest of the space will remain for visitors awaiting admission). On the area of \u200b\u200bthe room there are special sanitary standards, complying with observance.

The room can be rented or acquired. The purchase of real estate for the opening of the medical center will cost Nedlyozy (from 10 to several hundred million rubles).

The optimal room size for the medical center is 150-200 m 2. It must be electrified, equipped with ventilation and water supply systems, have a bathroom.

In addition to medical and procedural offices, the clinic must necessarily have a reception and a corridor, which can be free to walk to anyone.

One of the most significant costs of expenses is the acquisition of medical equipment. different species. High-quality medical equipment has never been cheap. Thus, prices for ultrasound devices begin from 160 thousand dollars, and 10-70 thousand dollars will have to put 10-70 thousand dollars.

Patients expect competent and accurate diagnostics, so do not save on equipment. However, it is possible to purchase foreign second-hand equipment. She will serve your clinic for many years.

Here is an exemplary list of hardware, without which a multidisciplinary medical center will not work offering different types Services:

• instruments analyzers;
• libra;
• magnetic hanger;
• thermostat;
• centrifuge;
• water bath;
• drying cabinet;
• tile with heating surface;
• shakers;
• microscopes;
• devices for measuring physical parameters;
• mixing devices;
• muffle furnace, etc.

Multidisciplinary medical center offering the population in the field of therapy and diagnostics, needs the following types of special equipment:

• Tomograph for MRI, with which the internal fabrics and organs explore.
• Angiographic installation (to study the state of vessels and hearts).
• X-ray apparatus for layer-by-layer shooting that does not require patient turning (needed during examination of patients with severe injuries).
• Ultrasound device that allows you to make an inspection of any internal organs and get three-dimensional images.
• Digital mammographer, with the help of which the contrast diagnosis of the mammary glands during suspected pathology.
• Electroencephalograph for the study of the cortex of the brain and finding the amazed plots.
• Endoscope required for inspection of organs for pathologies and obtaining color shots. With it, they check the effectiveness of therapy.
• The system of artificial ventilation to maintain the respiration of patients who are affected by lungs. In modern devices, there is the possibility of dosing oxygen supplied to the lungs (in order to prevent overdose), and add medicines in the form of fine mixtures.
• Holter heart monitor, with which blood pressure, heart rhythm and other indicators measure the blood pressure. The device accurately displays all existing rhythm disorders, which is necessary for setting the correct diagnosis.
• Dialysis machines.
• The electrocardiograph, ideally, the newest three-channel, writing three lines at the same time (this allows you to put a more accurate diagnosis).
• Defibrillator.

This is the most basic set of equipment. In addition to him, the clinic for the full work of the clinic may also require banking (with adjustable height), medical chairs, racks for drippers, gynecological tables (equipped with electric regulators of the patient's body). If the LPU is held surgical operationsMake a modern operating table.

And, of course, no medical center can do without special storage cabinets. medicinal preparations and tools, without surgical lamps and some other auxiliary types of accessories and equipment.

The main thing is to watch when recruiting staff in the medical insurance - this is the presence of a specialized diploma and medical category. If a candidate for the position has experience abroad and knows foreign languagesThis will be an additional advantage.

A qualified health worker possesses at least three years of employment. Professionals, whether doctors or nurses, are valued high: as a rule, patients go to the clinic just for the sake of a good doctor, and not for the sake of equipment, etc., and the level of personnel is determined by the reputation of the medical center. To collect the team of real professionals, it will take a couple of weeks at best, but be prepared for the fact that you have to pick up staff for several months.

In parallel, the recruitment of personnel needs to be scheduled work. Note that the influx of customers in different time The day is uneven.

When employees were taken to the staff, a new task arises to the head of the clinic - to keep qualified employees (through decent salaries and other motivation methods).

6. What are the documents for the legitimate opening of the medical center?

When the premises of the desired size corresponding sanitary standards, It is selected, it is still to get a license for the provision of medical services.

To make it possible, the medical center must purchase certified equipment and hire specialists with the corresponding level of qualifications.

After that, you need to collect the following package of documents:

1. The contract of the founder of the enterprise.
2. Charter of the company in which all its owners are indicated.
3. Receipt about the payment of state duty.
4. Application for registration of the company in the tax inspection.

Obtaining licenses for conducting activities and on medical maps Patients cost from 50 thousand rubles.

The license design process may take up to the year. If you contact a lawyer with experience in such affairs, the issuance of a license can be accelerated.

To reduce the tax burden on a healing institution, you can provide benefits to pensioners (this is also an additional way to expand the clientele: Elderly patients will be interested in the clinic, where they promise discounts).

Taking into account all this, the total costs of registration, the launch and the beginning of the development of the medical center can be up to 25 million rubles. If the founder of the clinic is not enough for its own funds, he can take a loan for business development or contact investors. In both cases, it will have to be a detailed business plan, which includes all the costs of expenses and profit forecasts.

8. Additional features and risks

The Financial Clinic Development Plan must certainly include risk assessment. If you remember about them at every stage of work and take them into account in the business plan, the risks will not turn into headache supervisor and threatening the further existence of a business.

So, what can represent the risk for the Private Medical Center:

• There is no room with the desired characteristics.
• Investments and buying equipment will be too expensive.
• Competition in the market will be very fierce.
• Not enough competent doctors and especially - younger medical personnel.
• The population will not go to a private clinic because of distrust of paid medicine.

All these risks are not fatal, it is quite possible to work with them if you think about in advance your actions and reflect them in the marketing strategy.

Franchise Medical Center

Creating a medical center by buying a franchise is one of the reliable ways of opening a business. Risks are minimal here.

The owner of the firm working under the already promoted brand can immediately count on customers, even in the first months of work.

The franchisor provides support for all species - from consultation and financial planning to advertising, training and building business processes. Frequisces require only compliance with agreements recorded in the contract.

One of the mandatory conditions for opening a business on a franchise (in particular, a medical center for a particular type) is to maintain branded brand style, a certain set of services provided and most often - pricing policy. Of course, these requirements impose some limitations on the franchisee, but they guarantee it a stable result and assistance in the development of a business from the franchisor.

4 most famous franchises in Russia:

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Order of the Ministry of Health and Social Development of the Russian Federation of October 7, 2005 No. 627 approved Single nomenclature of state and municipal institutions Health . Today, the names of all health facilities must comply with this nomenclature.

Single nomenclature includes four types of health care facilities:

Medical and prophylactic;

Special type institutions;

Institutions for supervision in the field of consumer rights and human well-being;

Pharmacy institutions.

To therapeutic and preventive institutions include:

1) hospital institutions;

2) dispensary: \u200b\u200boncological, tuberculous, etc.;

3) outpatient polyclinic institutions;

4) centers, including scientific practical;

5) emergency medical institutions;

6) institutions for the protection of motherhood and childhood;

7) Sanatorium-resort institutions.

Clinical agencies are therapeutic and preventive institutions (hospitals, dispensaries, maternity hospitals and other institutions) used for the purpose of teaching by higher medical educational institutions (faculties) or for scientific purposes with medical scientific organizations.

Hospitals . The following types of hospitals distinguish: land, district, urban (including children), and other species. Hospital institutions are intended for the treatment of patients in a hospital (from lat. Stationarius - standing, motionless). Hospitals may have a polyclinic in their composition (ambulatory). There is emergency medical care, as well as assistance to patients who need to monitor or apply treatment methods, impossible or difficult in outpatient conditions - at home or in a clinic (operations, frequent intravenous, intramuscular and other injections and other manipulations).

Distinguish monopropyl (specialized) hospitals intended for the treatment of patients with any such disease (for example, tuberculosis) and multi-profile - These are hospitals, to the composition of which include various departments (for example, surgical, neurological, therapeutic, etc.).

The structure of the hospital usually includes a reception office, medical and diagnostic, medical departments, pharmacy, sophisticated, and others. Functional responsibilities Medical sister in the hospital depend on the branch profile and the specifics of its work in it (medical sister of the reception office, surgical department, procedural office, a steady medical sister, etc.).

Specialized hospitals, including regenerative treatment, gynecological, geriatric, infectious, drug treatment, oncological, ophthalmologic, psycho-neurological, psychiatry, and tuberculosis.

Hospital - (from Lat. Hospitalis, hospitable) Medical institution intended to provide medical assistance to military personnel. In a number of countries, civilian medical institutions also call hospitals.

Medical and prophylactic polyclinic type facilities - these are polyclinics and ambulance.

Polyclinic - multidisciplinary medical and prophylactic institution, intended to provide medical care to patients, including specialized; If necessary, for examination and treatment of patients at home.

In the clinic, the doctors of various profiles (therapists, surgeons, oculists, otolaryngologists, cardiologists, etc.), and also function diagnostic cabinets (endoscopic, radiological, functional diagnostic cabins), laboratory, physiotherapy compartment, procedural account.

The main principle of the work of the polyclinic is the territorial-precinct. The territory serviced by the clinic is divided into areas behind which the district doctor and the local medical sister are fixed, with a certain amount of population.

The district policeman and the nurse are responsible for carrying out all therapeutic and preventive measures in the territory of this site. In addition, the population's closerization is attached great importance.

Dispensarization -this is the organization of systematic observation of the health of the population, the study of working conditions and life, identification of patients with chronic diseases.

Local medical sister Polyclinic helps a doctor during the reception of patients, conducts various documentation, explains to patients how to collect one or another material for laboratory researchhow to prepare for instrumental and x-ray studies, Fills statistical coupons, forms, directions to the study, performs the appointment of a doctor at home, Ori necessity teaches patient's relatives to elements of care.

In addition to the precinct, in the clinic there are procedural medical sisters, medical sisters of physiotherapy offices, etc. Currently in the clinics work prefigure: Here, a medical sister measures the patient the body temperature and blood pressure.

Ambulatory - this is a medical and prophylactic institution, which, as well as the polyclinic, provides medical care to patients in rural areas. The work of the ambulance, kaki polyclinic, was built on a district-territorial principle, but in contrast to the polyclinic, there is a smaller amount of medical care. There are usually no more than five doctors in the ambulatory.

The work of the Medical Sister of the ambulance reminds the work of the Pole Medical Sister Polyclinic, but requires it even greater independence and responsibility.

Medicine - a specialized health care institution, intended for the organization of the preliminary (upon admission to work) and periodic (during the work) of medical examinations of workers with harmful and hazardous working conditions at large enterprises. Their activity is based on the principle of workshop.

The structure of health-sanitary parts is different, their composition may include a clinic or an outpatientation, hospital, healthy, dental clinic, pretractories, sanatoriums, children's health camps, etc.

Functions of medical and sanitary parts are diverse. In addition to providing outpatient medical care, treatment of patients in the hospital, the staff of the health parties carry out great jobs but dispensary observation of the health of workers and employees by conducting systematic preventive inspections, identify individuals suffering from chronic diseases, all diseased in outpatient conditions or hospital.

Plot (workshop) doctors and medical sisters, the medical school of health care products study the working conditions of workers and directly in the workplace, reveal professional harm and participate in the development of the complex preventive eventsaimed at improving the working conditions and life of employees of the enterprise.

Healthy health (Medical, Feldsher) are structural units of health institutions or organizations and are intended to provide first aid to workers, employees and students. Sweell is not an independent medical and prophylactic institution, and is usually part of the polyclinic or the health part of the enterprise. Medical Human Resources (Doctor, Feldscher, Medical Sister) Provides a prefiguration and first medical assistance, conducts the necessary procedures appointed by a doctor of clinics or health care (injections, dressing), makes vaccinations, performs sanitary and educational work.

Ambulance stations- these are therapeutic institutions designed for round-the-clock emergency medical care to patients at a pre-hospital stage with all life-threatening states (injuries, injuries, poisoning, bleeding), as well as during childbirth. At ambulance stations, personnel works by brigades consisting of 2-3 people (doctor and one or two paramedics).

TO maternity and childhood protection institutions fee female consultations and maternity hospitals. Women's consultations, like polyclinics, work on a precocional territorial principle. Here they carry out closerization, reveal and treat women with gynecological diseases, and also lead dispensary observation For pregnant women.

Female consultation staff and maternity homes conducts great sanitary and educational work with pregnant and maternity hospitals. Medical sisters Usually working in the procedural offices of women's consultations and maternity hospitals, as well as in the operating, children's departments of the maternity hospitals as store nurses.

TO institutions of sanatorium type refines the sanatoriums (from Lat. Sanare - treat, heal), pretractor, recreation camps for children, sanatorium health sites. The activity of these medical and preventive institutions is based on the use of patients for the treatment of predominantly natural healing factors (mineral waters, mud), as well as phytotherapy, physiotherapy and therapeutic physical education.

In sanatoriums, patients undergo a course ambulatory treatment. The presences, organized at large industrial enterprises, are used to treat and carry out preventive measures, as a rule, in its free time.

The work of nurses in the medical and prophylactic institutions of a sanatorium type resembles the work of nurses in clinics, hospitals, dispensaries, etc.

Home (Hospital) Nursing Care - health care institution to ensure qualified care of the elderly and senile agesuffering from chronic diseases and the state of health does not need active treatment.

Hospice - health care institution for the provision of medical, social, spiritual, psychological and legal care Incurable (not amenable to therapeutic effects) oncological patients and their families, both during the period of the disease and after the loss of their loved ones.

Leprosorii (from Late. LergoSus - Legged). Therapeutic institution for patients with leprosy. In some countries (Brazil, India) is treated outpatient.

Clinic - Medical and preventive institutions (hospitals, maternity hospitals and other health facilities), which are members of the highest medical educational institutions, medical scientific organizations or subordinate to medical universities and scientific organizations are their structural divisions.

Questions for self-preparation for practical lesson:

1. Structural levels of health care system in the Russian Federation.

2. State organizational structures dealing with sister affairs.

3. Purchase LPU outpatient and stationary type.

4. Home types of hospital medical documentation.

Legislative regulation of the legal status (status) of a medical institution is carried out by both federal laws and by the sub-banner regulatory legal acts.

The fundamental norms that determine the legal status of the institution (the general legal status of institutions in Russia) are contained in the Civil Code of the Russian Federation, which under the establishment understands the unitary non-profit organization created by the owner for the implementation of management, socio-cultural or other functions of a non-commercial nature (Article 123.21). The institution can be created by a citizen or legal entity (private institution) or by the Russian Federation, the subject of the Russian Federation, the Municipal Education (State Institution, Municipal Institution).

Medical institutions as non-profit organizations, firstly, are designed to carry out socially significant functions, secondly, they do not have the extraction of profits as the main goal of their activities. Nevertheless, these institutions can implement entrepreneurial activities aimed at obtaining profit, but only inspired, since this serves as the achievement of the goals for which they are created.

In this way, medical institution - This is a non-profit organization established by the Russian Federation, the subject of the Russian Federation or by municipal education, which provides medical activities as the main (statutory) type of activity on the basis of a license issued in the manner prescribed by law.

Types of medical institutions:

1) Kazennye,

2) autonomous

3) budget.

Medical institutions of state, municipal, private health systems can carry out their activities only if there is a license for an elected type of activity. The purpose of medical licensing is an assessment of the capabilities of a medical institution (organization) in terms of medical care in the scope and functions adequate to the level of personnel training, the state of the material and technical base of the institution and its equipment.

Mandatory state licensing is subject to all medical institutions Regardless of the forms of ownership and organizational and legal status (federal, municipal, all subjects of private medicine).

The legal status of a medical institution defines various legal guarantees of its activities, a place, role and position of a medical institution in the health care system and industry management, as well as its basic rights and obligations.

The structure of the legal status of a medical institution includes:

a) goals and objectives of the medical institution;

b) the functions of a medical institution;

c) the creation, reorganization and liquidation of a medical institution;

d) organizational structure of a medical institution;

e) guarantees of the rights of the medical institution.

AT modern conditions the main taskwhich is designed to solve medical institutions in their activities is to ensure the constitutional right of citizens to protect health and medical care, which is expressed in providing timely, accessible, high-quality medical care.

Efficiencythe work of medical institutions is largely determined by the security of medical personnel, their professional training, rational arrangement and use, organization of doctors, secondary medical professionals and other personnel.

Legislation Russian Federation, regulatory legal acts and internal documents of medical institutions are positioning the chief physician as an official person who presents its medical institution in all legal issues. In practice, the chief doctor often gives his main powers to the substitute, remaining only a formal figure in the process of managing a medical institution.

One of the conditions for the effective functioning of medical institutions is budget financing in the required amount. For medical institutions of the budget sector, the presence of a deficit of the allocation of funds is characterized, which is associated with the dependence of budget financing from numerous factors of a political, economic, legal nature.

As a result, the low quality of available medical services, a lack of medical personnel and its insufficient qualifications and, accordingly, deterioration in the quality of the functioning of the state and municipal health system.

Competence of a medical institution. The medical facility in the process of its activities is not only as a medical and prophylactic unit, but also as an economic entity that has a material and technical base for the implementation of the main activity, in connection with which it must have the appropriate volume of rights and the implementation of the functions duties. Rights and obligations are one of the most important elements of the administrative and legal status of a medical institution.

Rights of the medical institution With regard to higher authorities and health organizations are mainly due to the functions to improve the work of all its structural units and medical organization as a whole. In this regard, the administration of a medical institution has the right to send applications to higher sectoral institutions with proposals for the creation of new and transformation of existing structural units, services, specialized departments and cabinets, allocations of full-time units, obtaining limited medical equipment, funds and limits for design work and construction New capacities, the direction of highly qualified specialists to provide the population with specialized medical care, the direction of medical staff for specialization and advanced training.

With regard to subordinate medical structures, the right of a medical institution is mainly implemented in the process of providing them with organizational and methodological and advisory assistance.

The administration of a higher medical institution with respect to the subordinate medical institutions has the right to: give orders and instructions, to selection and placement of leadership personnel, organize and conduct work testing, to encourage or impose disciplinary recovery on managers.

The peculiarity of the medical team is that, as a rule, the main doctors, heads of departments, except managerial, organizational work carry out execution of management decisions, i.e. Directly provide medical care. At the same time, the activities of officials as participants in the management process are governed by administrative and legal norms, and as participants in the medical and prophylactic process - labor law norms.

Problems of the effectiveness of medical institutions. In modern conditions, the main task that medical institutions are intended to solve in their activities is to ensure the constitutional right of citizens to protect health, which is expressed in the provision of timely, accessible, high-quality medical care.

In order to ensure the rights of citizens to health care, a state, municipal and private healthcare agencies, which are implemented by the realization of citizens to protect health and medical care.

Unlike private (commercial) medical organizationspossessing general (unlimited) legal capacity, government medical institutions are endowed with special (limited) legal capacity, i.e. A combination of only such rights and obligations that are provided for by the constituent documents.

The activities of state medical institutions are not only carried out in accordance with the legislation of the Russian Federation, but also is constantly monitored by the regional authorities (committees) of health.

These institutions provide their services in both budget and a commercial basis depending on the type of medical service and the need for a patient. Scroll free services Adjusted annually by federal laws on compulsory medical insurance, as well as the internal charter of each state medical institution.

To date, state medical institutions of federal and regional importance have a number of flawsrelated to their legal regulation and problems in the management to which include:

Insufficient financing of medical institutions from the federal budget, which leads to low wages medical workers, the lack of the possibility of expanding the material and technical and technological base of a medical institution, a decrease in the quality of medical services due to the above factors;

Failure to comply with many state medical institutions of the Mandatory Medical Insurance Program, which entails discontent of patients with the volume of services provided, mass treatment of patients into commercial medical institutions, the increase in mortality among socially unprotected categories of patients;

Reducing the fertility due to disbelief of health and social policy state as a whole;

High level Corruption among management by large state medical institutions; As a result, the irrational distribution of labor time of medical workers, the lack of material and technical means and medicines for individual categories of patients due to the commercial implementation of medical services, not included in the requirements of the regulatory framework of the medical institution.

The activities of municipal medical institutions are similar to the activities of federal institutions with one amendment alone: \u200b\u200bMunicipal medical institutions finance the power of a particular region, which increases the likelihood of more rational use of budgetary funds.

(Organizations), which are a public joint-stock company (PJSC), are few in the overall share of medical facilities of the Russian Federation. Observations show that it is precisely such medical institutions to provide patients with the highest quality medical services.

Medical centers created with large enterprises - municipal or federal significance are fully funded by these enterprises and therefore in their interests to carry out their activities qualitatively not to lose the source of financing. In such centers, the whole range of medical services is most often provided. Employees who use the services of the Center are the annual medical examinations here, and if necessary, therapeutic and surgery Both outpatient and hospital. At the same time, such centers rarely take patients who are not employees of the head venture, if they did not receive the appropriate license. Such medical facilities cannot be discharged to the category of commercial, since they do not charge with patients for the provision of medical services.

Among the shortcomings of the choice of medical institutions of such a legal form, as an open joint-stock company, we note the following:

The risk of abolition in the event of the liquidation of the parent company. This is due to the fact that not every PJSC has the opportunity to change its organizational and legal form shortly, while it is not enough material and technical base and personnel potential in order to carry out activities independently;

Limit of the target audience with high quality medical services. This problem is relevant to a greater extent for patients who do not have the opportunity to take advantage of medical services in such centers. A situation in which the most qualified medical workers are not allowed to mass practice, which has a detrimental effect on the overall level of health care.

Medical institutions, which are non-public joint-stock companies (NAO), are also minor. You can highlight two main types of such medical institutions:

Specialized centers

Stationary multidisciplinary clinics.

Specialized centers, among which may include narcological, ophthalmic, centers infectious diseases, allergology centers, etc., provide patients with a limited spectrum of medical services, which is planned as part of a specific medical specialization. Such centers have specific regulatory legal documents that regulate their activities. Here, the main question is whether the center is commercial since its foundation or the reorganization of the state-owned enterprise to non-state.

We note a number of shortcomings of the choice by medical institutions of such a legal form as a non-public joint-stock company:

Instability of the organization's activities due to internal problems of management and division of authority;

Danger of bankruptcy in global financial crises;

Labor intensity in the compilation of statutory documents.

Private medical institutions (Organizations), which are a limited liability company (LLC), are most common in the territory of the Russian Federation. Their mass appearance was due to the transition of Russia to a market economy, which made it possible to turn qualified medical care in a method of making money.

To date, this organizational and legal form is chosen for their activities for the most part those medical facilities that have a small room, a limited personnel composition, and also offer services that do not require long-term hospitalization.

There are a number of shortcomings of the choice by commercial medical institutions of such an organizational and legal form:

Incomplete compliance with the requirements of regulatory documents developed for all medical institutions of the Russian Federation due to the lack of some control components. For example, we can say that the oversight (SES, Fire Inspectorate) limited liability companies are imposed less requirements due to the fairly common practice of corruption actions of medical LLC;

The inconsistency of the quality of medical services to the expectations of patients, overestimated prices for ordinary medical services, which leads to the depreciation of the professionalism of medical personnel, as well as to reduce the image of the health system as a whole. For example, many dental clinics They form a mark-up for materials that are incommensurable with their cost. Also, multidisciplinary medical centers, in order to expand the target audience, often offer those medical services for the implementation of which they do not have qualified personnel or sufficient material and technical base;

A high level of competition, leading to a frequent reorganization or liquidation of a medical institution due to bankruptcy or imposing administrative responsibility for poorly provided service. The instability of medical Ltd. in the medical services market leads to a decrease in the level of responsibility for the life and health of patients, which destructively affects the overall level of health care.

Medical services provided by private medical institutions (organizations) are regulated mainly by civilian impact methods within civil proceedings with reference to consumer protection legislation. This provision can be explained by the fact that in the field of private medicine it is planned to create competitive internal requirements of medical institutions (organizations) to the quality of medical services provided by them, which should ensure an increase in the effectiveness of patient treatment.

Thus, we can conclude: Modern organizational and legal forms of medical institutions require correction due to the fact that none of the above forms of institutions is ideal for medical activities in the Russian Federation.

The development of an innovative model of the organizational and legal form of a medical institution is the most relevant task of the Ministry of Health of the Russian Federation for the following years.