There are many problems here. The first problem is the rather condescending attitude of our Ministry of Health towards the sanatorium stage of treatment. When it comes to the post-clinical stages of rehabilitation, the sanatorium stage of treatment, this is their task, they take it upon themselves. Everything else is up to the market. We have a brilliant institute in Moscow, this is the Russian Scientific Center for Medical Rehabilitation and Balneology. They are engaged in techniques and methods of using natural healing factors for treatment. But there is one caveat, there are two key stages in such sanatorium treatment as part of medicine.
The first stage is sending a potential patient to where he is shown. Stage of referral, selection and referral.
And the second stage is treatment. Everyone is engaged in developing methods of treatment in sanatoriums or resort clinics, and so on. And practically nobody is engaged in a stage of the direction, it from the market.
In general, this is a market industry, because today only a few dozen out of a huge conglomerate of sanatoriums are directly under the control of the Ministry of Health. Everything else is either private or departmental or something else. And this is the market. Even what the social insurance fund does, the state pays money to these people, this is also a market. And the right direction of a person can be influenced by up to one and a half hundred factors. These factors are associated with forms, phases, stages of the underlying disease. For example, there is a person with ischemic disease who needs to urgently treat his joints, there are two points and a bunch concomitant diseases. And it influences the choice of place and time of treatment, season of treatment forums, phases, stages and nature of the course of these diseases. This is influenced by the parameters of the place of treatment itself, the sanatorium. There are natural healing factors. But most importantly, a sanatorium for a particular patient must have undeniable properties, it must have as its main profile what concerns the underlying disease of a person. And he must have specialists, related profiles, who, if something happens, will help a person with his concomitant diseases.
The first problem that was noted by the state at the suggestion of the resort association, on the topic of which was the presidium of the state council on August 26 last year. It is dedicated to how to increase the investment attractiveness of our sanatorium complex. It is clear that many sanatoriums are old and poorly equipped. As a rule, the medical base is decent, but the location is far behind. It was strange for me that the presidium was devoted only to this. We decided to allocate serious money for re-equipment, about 37 billion rubles, all this was from the perspective of tourism. But they did not say how to organize and attract people to the sanatorium. It is clear that investing money in improving the sanatorium base will lead to an increase in the price, but this is one side of the issue. But to motivate people to go somewhere to relax, sunbathe, and at the same time take massages is one approach. But from the point of view of the real effectiveness of improving health, this is a key point. And here the key point is the referral to the sanatorium stage of treatment. Today we know how to do it. We have made technologies that are not in the world, it is built on information technology. How to provide qualified support to the doctor in choosing the place, time and treatment and determine the prohibitions, restrictions, recommendations for each personal person. As soon as online information and cloud technologies appeared in the world, there are no analogues in this part of the world. As soon as it became possible to link medical institutions in the polyclinic where referrals are made with the tourist complex, we also understand how to do this. In theory, the doctor should not indicate the place of treatment, he should determine the restrictions, recommendations, prohibitions. Because there are prohibitions for people with serious diseases thyroid gland, treatment during the hot season is prohibited.
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- Batysheva T.T., Bykova O.V., Platonova A.N., Amcheslavskaya E.V. Perinatal risk factors for childhood neurological disability and methods for their correction. Pharmateka. 2014:1:81-86.
- Batysheva T.T., Bykova O.V., Klimov Yu.A., Smetankina E.V., Shioshvili V.A., Vinogradov A.V. Role physical factors in the rehabilitation of children with cerebral palsy. Child and adolescent rehabilitation. 2014;2:5-14.
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- Analytical data of the Ministry of Labor and Social Protection at the request of the Federal State Budgetary Institution RRC MRiK.
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Introduction
The choice of the topic of this course work "Sanatorium treatment: the concept, meaning and legal regulation" is associated with great relevance at the present time. The significance of this work lies in the fact that from the transition of the USSR, and then Russia to market economic relations, there was a turning point in the economic system of the country, new elements began to appear in various spheres of life, of course, this also affected the service sector. Theme "Sanatorium-resort treatment: concept, meaning and legal regulation» is very extensive, in this area there are contradictions of a social, economic, resource, environmental, and most importantly, civil law nature.
The sanatorium and resort business, which is carried out by many institutions in Russia, is integral part state policy and an important section of the national health care system, which allows targeted and effective prevention of diseases and rehabilitation treatment of patients, and their rehabilitation.
The organization of health resort care is based on the principles of preventive and rehabilitative orientation.
Russian resorts have almost all types of medical treatment known in the world. mineral waters, therapeutic mud and other natural healing factors, including those that have no analogues in the world, the resources of which provide for the existing need and prospects for the development of the resort complex.
Federal Law No. 23.02.95 26-FZ “On natural healing resources, health-improving areas and resorts”, it is determined that natural healing resources, health-improving areas and resorts are the national treasure of the peoples of the Russian Federation, are intended for the treatment and recreation of the population and are accordingly classified as specially protected natural resources. objects and territories that have their own characteristics in use and protection.
Spa treatment combines many functions:
- preventive health improvement of the population;
- rehabilitation of patients;
- animation and leisure activities.
Preventive health improvement of the population in sanatorium practice is carried out using two main forms:
- compensatory-extended restoration of the physical strength of a person, carried out in daily treatment in sanatoriums-dispensaries;
- extended recovery of physical strength and health in the process of sanatorium treatment during the vacation period.
The beneficial effect of spa treatment is due to the effect on the patient of the entire environment. During the stay in the resort per person, in addition to the local medicinal products(mineral springs, climate, mud), other conditions also influence: rest, change of scenery, medical nutrition, as well as a certain regimen, which is the basis of treatment and rest.
Comprehensive health-improving and preventive measures, as research results show, improve the health status of citizens by 1.7 times. The use of therapeutic factors of the sanatorium-natural complex and modern low-cost medical technologies based on them increases the efficiency of health improvement and rehabilitation of citizens by 25-30%, reducing the cost of treatment in polyclinics and hospitals by 10-15%.
In the course work, it is necessary to achieve the following goal - to analyze the treatment and prevention activities of resort institutions.
It is necessary to solve a number of the following tasks:
- to give the concept of sanatorium treatment;
- consider the importance of spa treatment;
- to study the legal regulation of spa treatment.
The course work consists of an introduction, two chapters, a conclusion, a list of references.
The first chapter discusses the concept of sanatorium treatment and some problems associated with the provision of sanatorium treatment
The second chapter contains the legal regulation of sanatorium treatment
When writing the work, the regulations governing the industry were investigated.
An important role in writing this work was played by the works of scientists such as: Budarina A.A., Berezovsky D.P., Misnik N.N., Kuznetsova E.V. Generalov A.V., Erofeev Yu.B. Podkopaev M.V. and others.
Chapter 1. The concept and significance of spa treatment
The service sector for the provision of spa treatment is a broad and voluminous institution. This concept covers the sphere of production of both tangible and intangible goods. The service sector is expressed in the totality of various branches of management, each of which carries out its activities by providing certain services, thereby satisfying the needs of citizens.A common feature of spa treatment is the provision of medical care, treatments, consultations and so on 1 . The Civil Code of the Russian Federation gives a significant place to services as an independent object of civil law. Chapter 39 of the Civil Code is devoted to the compensated beginnings of the provision of services.
It is well known that the health of the population is the most visible indicator of social well-being, the normal functioning of society, the most important prerequisite for ensuring the security of any country.
In accordance with Article 41 of the Constitution of the Russian Federation, everyone has the right to health care and medical care. Medical care in state and municipal health care institutions is provided to citizens free of charge at the expense of the relevant budget, insurance premiums, and other revenues. The state guarantees the protection of the health of every person in accordance with the Constitution of the Russian Federation and other legislative acts of the Russian Federation, constitutions and other legislative acts of the constituent entities of the Federation, generally recognized principles and norms international law and international treaties of the Russian Federation.
It should be noted that for the system social security characteristic is that in this area there are a large number of laws and there is no single codification source that regulates the whole range of relations included in this area. So, today the rights of citizens to one or another type of social security, as a rule, are regulated by different laws. Nevertheless, “the Fundamentals of the legislation of the Russian Federation “On the protection of the health of citizens” can be considered as a codification act in the field of social security in the Russian Federation. This normative act enshrines the right of citizens to health care, as well as guarantees for ensuring this right, including the right to receive free various kinds medical and social assistance. This document defines the basic principles of protecting the health of citizens, the obligations of state bodies and medical institutions: observance of human and citizen's rights in the field of health protection; priority of preventive measures in the field of protecting the health of citizens; access to health care; social protection of citizens in case of loss of health; responsibility of public authorities and administration, enterprises, institutions, organizations, regardless of the form of ownership, officials for ensuring the rights of citizens in the field of health protection”.
The protection of the health of citizens is a set of measures of a political, economic, legal, social, cultural, scientific, medical, sanitary-hygienic and anti-epidemic nature, aimed at preserving and strengthening the physical and mental health of each person, maintaining his long-term active life, providing him with medical care in case of loss of health.
Sanatorium treatment also serves the cause of protecting the health of citizens and is closely related to medical care.
Sanatorium-and-spa treatment is an effective form of improving the health of the population, including privileged categories. However, it is an independent type of social security and involves the provision of citizens with vouchers for sanatoriums. spa treatment free or at a discount. Compensatory social security payments are one of the types of social security for citizens, which consists in cash payments (one-time and periodic), which have a clearly defined nature of compensation in cases provided for by applicable law. Among the various types of compensation payments, there are, for example, cash payments to certain categories of disabled people for sanatorium-and-spa treatment 2 .
The procedure for providing preferential sanatorium-resort treatment and financing the corresponding expenses is regulated by the decrees of the Government of the Russian Federation, regulations of the federal executive authorities and the Social Insurance Fund of the Russian Federation.
The organization of work to provide sanatorium and resort treatment to the privileged category of citizens is entrusted to the Social Insurance Fund of the Russian Federation and is due to:
1) the Fund has an extensive centralized structure in the constituent entities of the Russian Federation;
2) an effectively functioning Unified Information System of the EISS “Social Insurance”, which allows you to quickly transfer and receive and process the necessary information within the framework of the Fund's system throughout the country;
3) extensive experience in organizing sanatorium treatment and rehabilitation of working citizens and members of their families, as well as citizens who have received damage to their health due to accidents at work and occupational diseases.
The Social Insurance Fund of the Russian Federation has approved a list of sanatorium-resort institutions, on the basis of which an information base has been formed, taking into account the profile of treatment, organizational and legal form, the number of beds, and the degree of workload in health resorts. The Social Insurance Fund of the Russian Federation is working out a model for selecting health resorts on a competitive basis. Sanatorium-resort institutions of the Russian Federation can take part in the competition.
In order to effective solution tasks of sanatorium treatment of privileged categories of citizens, an automated information system (AIS) is being developed. Based on the information obtained from the Register of persons entitled to receive unified cash payments, as well as data from the social protection authorities of the population of the constituent entities of the Russian Federation, the bodies of the Medical and Social Expertise, medical and preventive institutions, it is planned to maintain a personalized register of privileged categories of citizens entitled to sanatorium - spa treatment.
The Fund can take on a much larger number of preferential categories that apply for spa treatment. The Fund has a well-established and effective information system that can serve to solve a wider range of problems.
In accordance with Part 3 of Article 13 of the Federal Law "On natural healing resources, health-improving areas and resorts" sanatorium- resort organizations specializing in the treatment of citizens who have benefits established by the Government of the Russian Federation for sanatorium and resort services, taking into account the volume of services provided, are equated in terms of payment for utilities to medical institutions subordinated to local governments.
According to Article 15 of this Federal Law, sanatorium-and-spa organizations that carry out the treatment process have the status of medical and preventive organizations and operate on the basis of a state license granted in the prescribed manner 3 . The reorganization of sanatorium-resort organizations is carried out with the preservation of their medical and health-improving specialization.
1.1. Some problems associated with the provision of sanatorium treatment
In this paragraph, I would like to briefly highlight some of the problems that currently exist in the field of social security. “Since January 1, 2005, 30 million beneficiaries had the right to use the social package and receive monthly cash payments. Why was it necessary to cancel the system of benefits familiar to everyone? What is the essence of the law? Did it manage to replace in-kind benefits with cash payments in the right proportion? Time will tell the answers to these and other questions. The reform of preferential social security will be phased. In 2005, free medicines, sanatorium treatment and free travel in transport were kept for all beneficiaries in the form of social services. Since 2006, they have been given the right to choose. Keep these services, or take the money. Heroes of the USSR, Russia, socialist labor, full cavaliers of the Orders of Glory and Labor Glory are withdrawn from this law. The most resource-intensive benefits, including spa treatment, are preserved in kind.”
“In the public consciousness today there is a fear of transformations in the social security system. It is difficult to take the first steps of the reform given the extremely low level of public confidence in the authorities, the reasons for which are well known. Many are very sensitive to the replacement of benefits with cash payments. It is possible to restore people's trust only when they feel that they are better provided with sanatorium treatment, medicines, and so on.
According to the Minister of Health and social development Russian Federation Mikhail Zurabov, “the problems discussed today are extremely important and relevant, they will face the social sphere in the coming months and years. The most complex tasks facing the authorities are of an absolutely technological nature 4 . Thus, it will be necessary to organize sanatorium treatment of privileged categories of citizens at a completely different qualitative level. The system of sanatorium and resort services itself needs modernization, which in last years experienced by no means the best of times. And an additional direction in 2004 10 billion rubles. on the development of the health resort network - this is a new stage in its development. Social security authorities are going to buy vouchers for a period that has never been in demand, which should lead to a noticeable reduction in the cost of vouchers for other seasons, when citizens are forced to fully or partially pay for them at their own expense.
It is necessary to properly finance the transportation costs of the privileged categories of the population, this will slow down the growth of tariffs, and possibly completely stop it. After all, inflation has completely understandable economic forms. If the service is not paid for, if the health resort network is not loaded, then the economy will inevitably force tariffs to be increased to compensate for the losses. You have to pay for everything, and the state must pay for it so that a person wins. This applies to both beneficiaries and those who pay for services at their own expense. wages. Therefore, the essence of the government approach to providing preferential categories of citizens is to significantly increase the allocation of financial resources, it is not going to cancel the system of benefits familiar to people, but to change and significantly improve the mechanism for their financing.”
Chapter 2. Legal regulation of sanatorium treatment
Currently, the Russian Federation has changed the mechanisms for organizing and financing sanatorium treatment of insured working citizens due to the need for sanatorium aftercare immediately after inpatient treatment of diseases, as well as the rehabilitation of children of insured citizens when they are sent to children's sanatoriums and sanatorium health camps all year round 5 .
Until 2010, compulsory social insurance funds were allocated for these purposes in accordance with federal laws on the budget of the Social Insurance Fund of the Russian Federation for the corresponding year. Payment for vouchers for sanatorium treatment and health improvement of employees and their families was insurance coverage for certain types of compulsory social insurance.
etc.................
To date, the system of health resort care in the country does not have a single structure and is dispersed between ministries, departments, public organizations, joint-stock companies, which determines the development sanatorium institutions taking into account the interests and capabilities of the owner. Regardless of the form of ownership and departmental subordination, the sanatoriums of Russia in the decision common task constitute a single complex that requires management and organizational and methodological support.
The lack of a unified structure of sanatorium care, the difficult economic situation and the peculiarities of the tax policy affected the state of the country's resorts.
One of the main factors ensuring the competitiveness of the "pre-reform" domestic sanatorium and health services was relatively low level prices. As a result of the introduction of free prices with a worsening economic situation For the vast majority of the population, primarily those in need of health improvement, price competitiveness has been lost. Lack of effective state control behind the rise in prices, including the rise in prices for products and services of natural monopolies, and led to the fact that sanatorium and health services have become uncompetitive and unclaimed. The relative stabilization of the sanatorium and resort complex and its “survivability” at the beginning of the reform period were achieved largely due to the state-implemented system of financing the purchase of sanatorium and health services through extrabudgetary funds, which can be considered as a temporary measure of state influence on the sanatorium and resort market.
During the period of new economic relations, despite the increase in the general morbidity of the population, the number of sanatorium-resort institutions has significantly decreased.
Even a cursory, superficial analysis of the development of the sanatorium and resort complex during the period of reforms indicates the complexity of the socio-economic processes taking place in it. Despite the signs of the beginning of stabilization that emerged after the 1998 crisis, such as a gradual slowdown in the intensity of the decline in production and the provision of sanatorium and health services, the state of the sanatorium and resort complex continues to be extremely difficult. To a large extent, this is facilitated by the practical implementation of the state's intentions to reduce its presence in the market of sanatorium and health-improving services, the refusal of the state to provide significant support for the sanatorium-resort complex as a socially oriented economic sector. The depth and scale of the crisis is largely due to the fact that until 1992 the sanatorium and resort complex served a closed economy and therefore, without significant restructuring, turned out to be incapacitated in relation to the nature and structure of demand for sanatorium and health-improving services in market conditions.
By the beginning of market transformations, the basis of the historically established sanatorium-resort complex was large and medium-sized sanatorium-resort organizations with a high degree of concentration of specialized production, with an extensive, centralized, well-established network of services and their demand. The forced nature of the ongoing measures to establish market relations that are not provided with an appropriate regulatory and legal framework, effective government regulation, including the protection and support of the interests of domestic producers of sanatorium and health-improving services, the absence of an independent executive body dealing only with the issues of the sanatorium-resort complex, gave this process an unacceptably destructive character.
At the moment, most Russian health resorts have to operate in an oligopolistic market, that is, a market consisting of a small number of sellers who are sensitive to pricing policies and marketing strategies of competitors. Under these conditions, the enterprise must have an orderly methodology for setting the initial price for their goods and services.
Naturally, it is impossible to make decisions on setting a price for a particular product only from a financial point of view. It is important to keep in mind at all times that cost information must be used in conjunction with non-financial information, such as customer preferences, competitors' prices and quality, product mix, demand, trends, and even fashion, to achieve maximum results. In this sense, costs often serve as a limiting factor in decision making rather than a driving force.
Weakened control over the state of resort resources. There is a seizure and damage to the lands of resorts and health-improving areas, taking away and not rational use natural healing resources, leading to the depletion and pollution of mineral waters and therapeutic mud and, as a result, to the loss of the medical base of resorts.
For sanatorium-resort institutions, one of the most difficult is the problem of land use efficiency. Currently, the issues of resort business in the country are included in the list of instructions of the President of the Russian Federation. According to the results of the meeting of the Presidium of the State Council of Russia (July 23, 2004), the main direction in the work of the resorts was formulated as a question of “development and implementation of a set of measures aimed at preserving the potential of the sanatorium and resort sector and forming a system of modern sanatorium-resort complexes, increasing the efficiency of land use and property management, developing the infrastructure of resorts, and forming the industry of resort business”.
The concern of many workers in the resort sector about the "land issue" was not perceived by the developers of the Land Code. From January 1, 2006 the law obligated non-state health-improving institutions to redeem land plots transferred to them earlier (Federal Law No. 26-FZ of February 23, 1995 “On natural healing resources, health-improving areas and resorts” states that these objects are the national treasure of the peoples of Russia and require special conditions land use and protection).
Today, economic entities must make a choice between receiving land for perpetual use by these institutions and its lease. Dimensions rental payments, depending on the area of the territory, the location of health resorts and the coefficient that regions can set, are very significant. For example, in Novomoskovsk, the rent set for a sanatorium-dispensary (and the area of institutions of this type is usually much smaller than that of sanatoriums) reaches 950,000 rubles. in year. Such expenses are unbearable for most industrial organizations, so they refuse to maintain health resorts. In recent years, this network has suffered the most significant losses, having decreased by 2.5 times.
If you insist on amending the land legislation on preferential provision of land plots to health resorts, then you should decide on the norm of land “allots”. Apparently, it is necessary to clarify the possible amount of “free” or “preferential” land, and for this it is necessary to develop and legalize scientifically based standards for standard areas for health resorts located in different natural and geographical conditions and with different infrastructure support.
In addition, at present, in connection with the transfer of most of the deposits for use and development to various joint-stock companies the cost of natural healing factors (mineral waters, therapeutic mud, etc.) sold for the needs of sanatorium-and-spa institutions has risen sharply unreasonably.
overdue urgency substantiation of the Concept for the development of resort business in Russia, in which all links must be thought out health resort system- from the central department to the municipal sanatorium.
What are the main problems of the sanatorium-resort sector in Russia today that need to be addressed?
§ Problems of quality of service in Russian resorts
§ Problem pricing policy Russian resorts as the main factor in the outflow of tourists
§ The problem of lack of related services.
§ Today there is no system government controlled resort, there is no federal executive body, which at the governmental level needs to determine the main directions of state policy in the field of sanatorium treatment and recreation.
First of all, there is an urgent need to adopt a federal law "On the fundamentals of resort business in the Russian Federation."
Currently, the material and technical base of sanatoriums is 70% outdated, many buildings are in urgent need of repair and reconstruction. The situation is aggravated by the fact that the need for sanatorium-resort treatment has not yet been determined in accordance with the structure of the incidence of Russians (including in the regional context) and for such population groups as participants in the Second World War, the disabled, children, residents of environmentally disadvantaged areas and etc. Their sanatorium-and-spa treatment is provided at the expense of state appropriations and funds from the FSS of Russia. Uncertainty of the target need leads to irrational use of financial resources, reduces the effectiveness of treatment.
Despite the fact that certain documents regulating the organization of the provision of health resort care by health resorts of the Federal Agency for Health and Social Development were adopted after 2000, they are based on technologies Soviet period based on 100% planned budget financing. Serious problems, Related spa treatment privileged categories of citizens, arose during the implementation of Federal Law No. 122-FZ of August 22, 2004. The issue of paying for the travel of beneficiaries who received vouchers for sanatorium-resort treatment to institutions of federal subordination through territorial executive authorities remains unresolved to a proper extent.
The documents regulating sanatorium and resort care for the population are of a long-term nature and do not provide for the redistribution of vouchers either between territories (even if they turned out to be unclaimed), or during the year. This is largely due to the fact that the territories report to sanatoriums and territorial zonal administrations only at the end of the year, and therefore Roszdrav can receive information on underutilization or shortage of vouchers in the territories only at the beginning of next year. This procedure needs to be changed: it is necessary to form an automated system of signaling information about requests and selection of vouchers to sanatorium-resort institutions by territories, and those categories of citizens who are provided with sanatorium-resort treatment on the basis of health resorts of Roszdrav should issue vouchers through authorized federal state institutions.
So far, there has not been a legal obligation to use natural healing factors by sanatorium-and-spa institutions. The unresolved issue emasculates the principles of classical Russian balneology, based on the inclusion in the healing process of diverse domestic natural healing resources, many of which are unique. We are talking about licensing requirements for sanatorium-resort institutions and systems of voluntary certification of services for sanatorium-and-spa treatment. Relevant documents could be adopted by the Federal Service for Supervision of Health and Social Development. In addition, the use of natural healing factors should be fixed within the pricing system for spa services.
During the licensing process, sanatorium-and-spa institutions “behind the scenes” stopped issuing licenses for stationary activities, thereby cutting them off from the financial flow of insurance money that is significant for them. Voluntary health insurance was left behind overnight. It is necessary to form a regulatory framework that will allow the provision of services to sanatorium-resort institutions of various forms of ownership on insurance principles, provided that the criteria-based assessment of such services becomes transparent and unified.
For the development of resort and recreational services, including sanatorium and resort services, it is necessary to fundamentally change the work of research organizations. Planning scientific research should be linked to the demand for finished scientific products, while the demand should be regulated not only by market mechanisms for the “acquisition” of new technologies, but also by a system of state requirements for licensing (permitting function), certification (assessment of the quality of services provided), accreditation of institutions (state recognition) . In addition, a mechanism is needed to update the delivery standards. medical services taking into account new medical technologies.
When planning research work in the field of healthcare, special attention should be paid to the transition of medical institutions to insurance principles of work, taking into account the changes caused by the reform of the industry. We are talking about a fundamentally new financial management based on the implementation of interbudgetary relations and work both with the state insurer and with insurance medical organizations.
In recent years, there has been a need for shorter (7, 14, 18 days) treatment courses in health resorts. Their introduction is due objective reasons: on the one hand, reduced vacations for wealthy clients from commercial structures, on the other hand, the financial insolvency of the majority of citizens who are unable to pay for the full course of treatment. This requires the creation of evidence-based effective short treatment courses, their legalization in the relevant regulations.
Most Russian health resorts do not have specially trained balneologists in their staff. True, certain progress has begun: the Ministry of Education and Science of the Russian Federation approved the corresponding medical specialty, but the industry will receive those trained in it only after six years. In this regard, the need to organize a retraining system is obvious. medical staff(at medical universities or basic sanatoriums). Moreover, the heads of sanatorium-resort institutions have realized the urgency of this problem - it is not for nothing that they seek to send their specialists for advanced training to various educational and methodological centers.
It is necessary to establish an information and advertising business only through the efforts of a capable industry management body, both at the federal and regional levels. An information center should operate within the structure of this body or under it, accumulating information both on the industry as a whole and on individual resorts.
The main goal of the state health policy for the period up to 2015 is to improve the health status of the population by increasing the availability and quality of medical care, preventing diseases by creating legal, economic and organizational conditions for the provision of medical services, the types, quality and volumes of which correspond to the level of morbidity and the needs of the population, the current level of development of medical science and technology.
As part of the implementation of measures to modernize health care, it is necessary to legislate state guarantees for the provision of medical care to the population to continue improving the health insurance system.
Reorientation of part of the volume of medical care to the outpatient stage, strengthening the preventive focus of health care, conducting dispensary observation, improving and correcting the identified changes in the health status of the population; wide introduction of resource-saving, hospital-replacing technologies; expansion of the range of medical services
Within the framework of the priority national project "Health", municipal outpatient and polyclinic institutions will be equipped with modern diagnostic equipment, ambulance stations - ambulance vehicles.
The provision of local general practitioners per 10,000 people will increase in 2015 with an increase in the cost of a birth certificate by 4,000 rubles, taking into account the allocation of part of these funds to children's clinics that monitor children under the age of 1 year.
In 2013-2015, the state policy will be aimed at preserving the potential of the sanatorium and resort sector and creating a system of modern resort complexes, rational use of natural and medical resources, carrying out structural changes in the network of sanatorium and resort institutions in order to improve the economic independence of sanatorium and resort organizations. The organization of year-round health improvement of children and elderly citizens will be continued.
The main task of social services for the elderly and disabled in 2013-2015 will be to provide them with equal opportunities with other citizens in the exercise of civil, economic, political and other rights and freedoms.
In our opinion, it is resort industry is able to take on some of the tasks of improving the health of the nation, which the city medical network cannot cope with.
In order to understand the state of affairs in the field of sanatorium enterprises in St. Petersburg, some statistical data for the past few years were analyzed.
Currently, within the administrative boundaries of St. Petersburg there are 63 resort organizations with over 16,000 beds. At the same time, 61% of organizations are state-owned, and 39% are privately owned.
In terms of the number of organizations in the sanatorium and resort sector in St. Petersburg, there is a clear trend of their decrease from year to year. This is in line with the general trend across the country.
Table 1. Comparative dynamics of the main indicators of the sanatorium complex of the Russian Federation
The experience of domestic balneology is almost 300 years old, however, at present, the volume and quality of sanatorium-resort services and treatment has significantly decreased due to a decrease in budgetary allocations for health care and the amount of funds allocated by the FSS for these purposes. Thus, according to statistics, from January to September 2014, only 4.6% of disabled people over the age of 15 used the right to spa treatment, 61.1% of disabled people have never been to spa treatment more than 5 years ago - 22.2%, from 2 to 5 years ago - 9.5%. At the same time, the incidence rate of the population is growing, from 2002 to 2014 the number of registered patients with a diagnosis established for the first time increased by 8661 people, from 1990 to 2014 the incidence rate increased from 96322 people to 114989 people, despite the development of medicine. The total number of disabled people has slightly decreased since 2009, but at the same time, an increase in the number of disabled children and disabled since childhood is noticed - from 2012 to 2015, 44,428 people joined this category. In the field of injuries during the performance job duties the situation is also developing not in the best way, against the background of deteriorating working conditions and hiding the facts of accidents at work.
Benefits for sanatorium treatment are established by the legislation of the Russian Federation as a measure of additional medical care. social assistance population. Subsidies for a preferential stay in a sanatorium are due to certain groups of citizens who are recognized as in need of sanatorium treatment for medical reasons.
The fundamental regulatory framework that establishes the procedure for providing this type of subsidy is:
Order of the Ministry of Health and Social Development of Russia dated December 29, 2004 No. 328 "On approval of the procedure for providing a set of social services to certain categories of citizens."
The issuance of preferential vouchers to a sanatorium is a declarative process. That is, the person himself must express a desire and request the provision of a voucher. Sometimes the attending physician independently recommends the passage of sanatorium treatment, but this is not a mandatory and sufficient condition.
In order to receive a subsidized ticket to a sanatorium, the applicant must simultaneously meet two requirements:
Belonged to a group of persons entitled to such a subsidy by law; He had a medical condition.
Many people mistake such subsidies for free vacation packages. In fact, spa treatment benefits are directly related to the applicant's health status. To receive a subsidy, you must obtain a certificate 070 / U-04. The doctor issues it if he comes to the conclusion that a stay in a sanatorium is really necessary. In addition, not earlier than 2 months before departure to the resort, the applicant must receive a resort card. It is issued by the same doctor that issued the certificate 070 / U-04.
It is important to remember that Form 070/U-04 has a 6-month validity limit. After this period, the certificate will need to be issued again.
After receiving certificate 070 / U-04, a citizen must write an application for a subsidy at the local branch of the FSS (Social Insurance Fund), where he will be issued a ticket.
You must bring the following documents with you to the sanatorium: Voucher;
Medical policy;
Sanatorium card; Passport.
In some cases, the conclusion of a medical and social examination is also required. As a rule, this applies to people with disabilities, since some diseases imply contraindications to sanatorium treatment in medical institutions of a certain type. In addition, in some regions, in order to obtain a voucher, they may be asked to present a certificate of the amount of the pension.
Due to the fact that since 2005 a system of monetization of benefits has been operating in Russia, in order to receive free voucher in a sanatorium, a pensioner must issue an official refusal to provide monetary compensation for this type of social assistance.
The decision to grant a voucher or to refuse to issue it must be made within 20 working days from the date of receipt of the application and the documents attached to it. It will not be possible to get a ticket right away - the direction to the sanatorium is carried out in the order of priority.
Russian legislation distinguishes two types of persons entitled to sanatorium and resort subsidies. The right to visit once a year for free medical sanatorium have:
Disabled people and participants of the Great Patriotic War;
War veterans;
Disabled people of 1,2,3 groups and disabled children;
Residents of besieged Leningrad (you must have an award badge); Home front workers during the Second World War;
Affected by radiation as a result of the disaster at the Chernobyl nuclear power plant.
Family members of the disabled and veterans of the Great Patriotic War.
Along with the right to receive a free referral to a sanatorium, these persons have the right to:
Free travel to the sanatorium by ground transport. (Railway transport, except for branded trains and luxury cars; Economy class of air transport; Water transport; Road transport common use(buses, etc.).
A voucher for the purchase of a reduced ticket is issued at the FSS office along with a ticket. In regions where it is impossible to leave by land transport, the FSS also pays for air tickets.
For disabled people of the 1st group and disabled children, the law provides for the right to take one accompanying person with them free of charge.
In addition to the social groups mentioned above, the legislation of the Russian Federation also provides for: Benefits for military pensioners for sanatorium treatment;
Benefits for pensioners for sanatorium treatment;
Benefits for spa treatment labor veterans;
Benefits for reserve officers for sanatorium treatment;
It is important to remember that the sanatorium does not provide the necessary medicines except for those that will be discharged at the institution itself. All necessary medicines must be obtained according to available prescriptions in advance at the place of residence.
Order of the Minister of Defense of the Russian Federation of March 15, 2011 No. 333 "On the procedure for sanatorium resort provision in the Armed Forces of the Russian Federation" established the procedure and grounds for the provision of health resort treatment to servicemen.
Benefits for military pensioners for sanatorium treatment are also provided to members of their families. Issued preferential voucher by the decision of the Department of Sanatorium-Resort Treatment of the Ministry of Defense of the Russian Federation. To receive a subsidy, a military pensioner must apply directly to the Main Military Medical Directorate of the RF Ministry of Defense or to the administration of the sanatorium. The application must be accompanied by a certificate in the form 070 / U-04, confirming the presence of medical indications.
Benefits for reserve officers for sanatorium-and-spa treatment are provided according to a similar scheme, provided that the term of service of the retired officer on a preferential basis is at least 20 years.
The Law "On State Social Assistance" provides pensioners with the opportunity to refer to sanatorium-and-spa treatment no more than once every 2 years. The exception is the disabled and disabled children, who are provided with vouchers to the sanatorium once a year, and even more often if there are special medical indications.
In law preferential categories Citizens entitled to state social assistance in the form of a set of social services can choose to receive NSI in kind or in cash, in full or in part.
The right to receive a set of social services have:
disabled people and participants in the Great Patriotic War; disabled and combat veterans;
soldiers who served in the military military units, institutions, military educational institutions that were not part of the active army, in the period from June 22, 1941 to September 3, 1945 for at least six months, military personnel awarded orders or medals of the USSR for service in the specified period;
persons awarded with the badge "Inhabitant of besieged Leningrad";
family members of the dead (deceased) war invalids, participants of the Great Patriotic War and combat veterans;
disabled people and children with disabilities, citizens exposed to radiation and other categories of citizens.
The set of social services includes:
provision of necessary medicines medicines, medical products, specialized medical nutrition products for disabled children;
providing a voucher for sanatorium treatment (SCR) for the prevention of major diseases;
free travel on suburban railway transport, as well as on intercity transport to the place of treatment and back.
From February 1, 2016, the cost of NSU is 995 rubles. 23 kop. Distributed as follows:
provision of necessary medicines - 766 rubles. 55 kopecks;
provision of a voucher for sanatorium treatment - 118 rubles. 59 kopecks;
free travel on suburban railway transport, as well as on intercity transport to the place of treatment and back - 110 rubles. 09 kop.
If the beneficiary has already submitted an application refusing to receive NSO in kind and intends to receive the cash equivalent in subsequent years, then there is no need to apply to Pension Fund until the decision changes.
If a citizen wants to use a set of social services again from January 1 of the next year, or if he has the right to receive them for the first time, then before October 1, you need to submit an application to the Pension Fund.
It is important to note that the previous legislation on medical care and treatment provided for the provision of vouchers for sanatorium treatment to all employees of state enterprises in order to prevent and prevent general and occupational diseases to maintain their normal physical activity and working capacity. However, the transition to market relations, with the emergence of a variety of types of enterprises of various forms of ownership, has drastically reduced the possibility of providing this type of health improvement for employees.
Considering the existing problems of health resort services in modern Russia, we come to the following conclusions:
1. The need for the formation of an independent preventive direction in the form of Restorative Medicine (hereinafter RM) manifested itself in Russia against the background of the outbreak of the socio-economic crisis that affected all spheres of society, including the healthcare system.
In this regard, factors such as:
A) non-realization of the previously declared priorities of preventive medicine;
B) the focus of the existing legal, economic, social, medical institutions of health management on the treatment of patients and the rehabilitation of the disabled, but not on the prevention of the disease;
C) the lack of a comprehensive infrastructure for preventive medical organizations, training systems for relevant specialists.
2. In the process of developing VM as a branch of medicine, gradually, based on the needs of practical healthcare and the need to integrate various preventive technologies, the scope of this new direction was expanded from restoring health to healthy person before recovery essential functions organism at all stages of prevention.
Restorative medicine is currently understood as a system of scientific knowledge and practical activities aimed at restoring the functional reserves of a person, reduced in the process of adverse effects of environmental factors and activities, or as a result of an illness - at the stage of recovery (remission).
3. Resort medicine is considered as an independent section of the CM, with the aim of maintaining, restoring health or medical rehabilitation of patients based on the use of healing natural factors. It is assumed that in the future, resort medicine should expand the scope of spa care - from rehabilitation treatment sick and disabled people to recreational activities.
Combining the concepts of restorative and spa medicine aims to emphasize their methodological unity and independent practical significance in such an important and staff-intensive section of the CM as resort medicine.
4. Installed size today cash payment in exchange for a voucher for a spa treatment (in the amount of 118 rubles. 59 kopecks) is unreasonably low and cannot really compensate necessary treatment citizen.
5. It is necessary to expand the circle of persons entitled to sanatorium-and-spa treatment by providing tax incentives both to organizations that provide their employees with vouchers, and medical institutions accepting these workers for treatment.
Implementation in practice of all the listed projects for the development of restorative medicine, supported by a system of social, legal, economic, moral and ethical, cultural accents, affirming the priorities of preventive medicine, will make it possible to take an important step towards the creation in Russia of a fundamentally new effective system management of population health dynamics. This system, built on a preventive principle, will require the participation of all state, public institutions of the country and will be able, under these conditions, to become the basis for maintaining and developing domestic healthcare in the 21st century, in pursuance of the state strategy for protecting the health of the population of the Russian Federation for the period 2013-2020 and subsequent years.
Medico-social expertise and social services for the disabled. Official site of the Federal State Statistics Service.
2 Morbidity of the population by main classes of diseases in 200-2014. Official website of the Federal State Statistics Service.
3 Morbidity of the population by main classes of diseases in 1990-1998. Official website of the Federal State Statistics Service.
4The level of disability in Russia. Official website of the Federal State Statistics Service.
6 http://subsidii.net
7: http://www.soiuz.ru/
Literature and legal framework
1. Federal Law No. 326-FZ dated November 29, 2010 “On Mandatory health insurance in the Russian Federation" (as amended on 03.07.2016) // "Collection of Legislation of the Russian Federation", 06.12.2010, No. 49, Art. 6422.
2. Federal Law of November 21, 2011 No. 323-FZ “On the basics of protecting the health of citizens in the Russian Federation” (as amended on July 3, 2016) // “ Russian newspaper”, No. 263, 11/23/2011.
3. Order of the Ministry of Health and Social Development of Russia dated December 29, 2004 No. 328 (as amended on March 1, 2012) “On approval of the procedure for providing a set of social services to certain categories of citizens” (Registered in the Ministry of Justice of Russia on February 7, 2005 No. 6303) // “Rossiyskaya Gazeta”, No. 31, 16.02.2005.
4. Order of the Ministry of Health of Russia dated December 10, 2013 No. 916n “On the list of types of high-tech medical care” (Registered in the Ministry of Justice of Russia on December 25, 2013 No. 30804) // Rossiyskaya Gazeta (special issue), No. 22/1, 03.02.2014.
5. Fundamentals of balneology, ed. V. A. Aleksandrova, vol. 2, M., 1959 p.
6. Belyaninova Yu.V. Commentary on federal law dated July 17, 1999 No. 178-FZ “On State Social Assistance” (item-by-article) // SPS ConsultantPlus, 2009.
7. The right of social security in Russia: textbook. / M.O. Buyanova, K.N. Gusov (and others); resp. ed. K.N. Gusov. - 4th ed., revised. and additional - Moscow: Prospect, 2012. - 640 p.
8. The right of social security: textbook. allowance for universities / M.O. Buyanova (and others); ed. Yu.P. Orlovsky. - M.: Yurayt Publishing House, 2014. - 539 p.
9. The right of social security: textbook./M.O. Buyanova, S.I. Kobzeva, Z.A. Kondratiev - Moscow: Knorus, 2017.
