Complex- a set of simple medical services, which requires for its implementation a certain composition of personnel, complex technical equipment, special premises, etc., corresponding to the formula (Diagram 4)
Comprehensive- a set of complex and (or) simple medical services ending with either prevention, or diagnosis, or the end of a certain stage of treatment (inpatient, rehabilitation, etc.) according to the formula:
“Patient” + “simple + comprehensive services” = “Carrying out prevention, establishing a diagnosis or completing a certain stage of treatment.”
Medical services, in essence, are based on manipulation.
Manipulation- separate medical event, research aimed at providing medical procedure(assistance), described by the requirements for the technologies for their implementation, but not having an independent complete preventive, diagnostic, therapeutic or rehabilitation value, which is an auxiliary element of the medical service.
Classification of medical services according to functional criteria(Scheme 5).
Treatment and diagnostic- aimed at establishing a diagnosis or treating a disease, including providing assistance during physiological childbirth and in neonatology in the absence of pathology on the part of the newborn;
Preventive- clinical examination, vaccination, physical education and health activities, sanitary and educational work;
Recovery and rehabilitation– related to social and medical rehabilitation of patients;
Transport- transportation of patients using the ambulance service and air ambulance”, providing emergency medical care during transportation.
Classification of medical services according to conditions of provision(diagram 6) .
Industry classifier of simple medical services provides for a three-stage hierarchical classification of medical services, carried out at each level of classification according to significant classification criteria.
At the first stage of the classification there are types of simple medical services, at the second - classes of simple medical services, at the third - types of simple medical services. Thus, each simple medical service has a seven-digit digital code the following structure (Scheme 7).
Characteristics of the type of service (X). Currently, 25 codes for standard service sections have been introduced. Sections are a list of various research methods used by medical workers in their professional activities.
For example.
Section 01 concerns methods of functional examination without the use of devices or instruments. In class sections of this type, services for collecting anamnesis, conducting a visual examination, palpation, percussion, and auscultation are recorded.
Section 02 is a list of the simplest diagnostic services, which use elementary instruments: tonometry, pulse rate counting (watch), thermometry (thermometer), etc. A significant difference from the previous section is the impossibility of performing techniques classified as this type, without the use of instruments and devices.
Characteristics of class divisions (XX). In each typical section, simple medical services are divided into classes. The division is based on an anatomical and functional principle. The classifier provides 31 class sections. The following class sections are distinguished:
01. Skin, subcutaneous - fatty tissue, skin appendages;
02. Muscular system;
03. Skeletal system etc.
Characteristics of species sections (XXX). Each class section lists specific simple medical services. The main principle of identifying and including a simple medical service in the OK PMU was to satisfy the definition of a simple medical service and the ability to describe the technology for performing the service.
Since, for example, there is no description of the technology for performing the service “Appointment with a local therapist, medical and diagnostic, primary outpatient.” This appointment is broken down into a number of specific simple medical services (history taking, physical examination, tonometry, heart rate measurement, etc.). As a result of completing each element, a primary diagnostic hypothesis can be formulated.
Each of the listed simple medical services can have a complete diagnostic or therapeutic value, which fully corresponds to the formula of a simple medical service. Each simple medical service has a clear description of the technology for performing it, and several methods (techniques) for performing the service are allowed.
The study of hemoglobin levels, the phenomenon of erythrocyte sedimentation, the number and composition of leukocytes is summarized in general analysis blood, which cannot be classified as a simple medical service, since it is no longer an indivisible procedure with an independent, complete meaning.
The operative benefit, despite its complexity, is a simple medical service. Each element of the operation - anesthesia, extracorporeal blood flow, vascular coagulation, etc. - has no independent meaning. Only together do they satisfy the patient’s consumer expectations for medical care. It should be taken into account that the operation is performed by one surgeon, regardless of the auxiliary and assisting personnel involved in it, which also satisfies the definition of a simple medical service. The technology for performing each operation can be described, although several technology options - methods for performing the operation - can exist simultaneously.
In addition to simple medical services, during the provision of medical care to the patient, medical personnel provide complex and complex medical services.
Complex medical service- a set of simple medical services that require for their implementation a certain composition of personnel, complex technical equipment, special premises, etc., corresponding to the formula “patient” + “complex” simple services” = “stage of prevention, diagnosis or treatment.”
Comprehensive medical service- a set of complex and (or) simple medical services that end with either prevention, diagnosis, or the end of a certain stage of treatment according to the formula “patient” + “simple + complex services” = “prevention, diagnosis or end of a certain stage treatment."
The classifier of complex or complex medical services contains 5 standard sections:
I - medical and diagnostic services of a doctor(the section contains a list of treatment and diagnostic services that form the stages of the process of providing medical care);
II - services nursing care (section contains a list of medical services performed medical personnel with a high school diploma in patient care);
III - comprehensive diagnostic services(research methods: laboratory, functional instrumental, X-ray radiological, etc.). This section contains a list diagnostic complexes, including laboratory (research biological fluids, morphological examination of tissues, etc.), functional instrumental (ultrasound examinations, electrocardiography, phonocardiography, the use of fiber optics, etc.), X-ray radiological, performed at the stage of diagnostic search.
IV - preventive medical services(the section contains a list of preventive services, such as dispensary observation, vaccination, medical sports and recreational activities);
V - medical rehabilitation services(V this section contains a list of services related to social and medical rehabilitation of patients).
In each model section, complex and complex medical services are divided into classes. The division occurs in accordance with the established list medical specialties. The OK SKMU has 69 class sections. The following class sections are distinguished:
001 - obstetrics and gynecology;
002 - allergology and immunology;
003 - anesthesiology and resuscitation, etc.
Each complex and complex health services class section lists specific complex and complex health care services. The main principle for identifying and including a complex or complex medical service in an industry classifier is the ability to describe the composition of the service.
Each of the listed complex and complex medical services can have a complete diagnostic or therapeutic value, which fully complies with the definition of a complex and complex medical service.
So, for example, a simple medical service “palpation for diseases of the liver and biliary tract” is important only in conjunction with simple medical services “collection of anamnesis and complaints for diseases of the liver and biliary tract”, “visual examination for diseases of the liver and biliary tract”, “ percussion for diseases of the liver and biliary tract”, etc. This approach forms a complex medical service “primary appointment (examination, consultation). In the future, to form a diagnostic stage of medical care, it is necessary to connect complex medical services “general (clinical) blood test”, “general therapeutic biochemical blood test”, “ ultrasonography organs abdominal cavity”, simple medical services “radiography of the gallbladder”, “radiography of the liver”, etc., which leads to the emergence of a complex medical service “complex of studies for the diagnosis of liver failure”.
The use of medical services in practical healthcare requires compliance with certain legal, organizational, methodological and other requirements for their quality. In this regard, before introducing various preventive, diagnostic and therapeutic procedures into the work of health care institutions, they are all in mandatory undergo standardization. The standardization system in healthcare provides for the development and adoption of standards and protocols for the implementation of medical care.
Medical service standards
In the process of standardization of medical services, it is envisaged to formulate requirements for the conditions for their implementation, medical technologies(protocols for patient management) and results (outcomes) that make it possible to objectify the assessment of the quality of medical care. At the same time, regulatory documents may contain both the minimum necessary and recommended level of requirements.
Standard- normative document, developed by consensus and approved by a recognized body, in which rules are established for universal and repeated use, general principles or characteristics concerning various types activities or their results, and which is aimed at achieving the optimal degree of order in a certain area.
To receive a social tax deduction for treatment, you must provide the Federal Tax Service with a certificate of payment for medical services, which contains the “service code” field. When filling out a certificate form or checking its correctness, the question arises:
What service code is 1 or 2 on the certificate of payment for medical services?
Codes in the certificate of payment for medical services: tax deduction amount
Medical service codes for submission to the tax authorities show what treatment the medical services relate to and what amount of deduction you are entitled to:
- Routine care (medical services code 1). The amount of tax deduction is limited to a limit of 120,000 rubles. The tax refund will be a maximum of 13 percent of RUB 120,000. (RUB 15,600).
- Expensive treatment (code 2). The amount of the tax deduction is equal to your expenses for such treatment (limited only by your income - you cannot return more tax than was withheld from your salary). The tax refund will be 13% of the cost of treatment for service code 2.
Code 1 and code 2 in the certificate of payment for medical services: What is included?
We found out how code 1 differs from code 2 in the tax certificate. An employee of a medical organization fills out the “service code” field in accordance with the list of medical services and the list of expensive treatment (approved by Decree of the Russian Government of March 19, 2001 No. 201).
List of medical services (code 1):
- Diagnostic and treatment services when providing emergency medical care to the population.
- Services for diagnosis, prevention, treatment and medical rehabilitation when providing outpatient medical care to the population (including day hospitals and general (family) practitioners), including medical examination.
- Services for diagnosis, prevention, treatment and medical rehabilitation when providing inpatient medical care to the population (including in day hospitals), including medical examination.
- Services for diagnosis, prevention, treatment and medical rehabilitation in providing medical care to the population in
- Health education services provided to the public.
The list of expensive types of treatment (code 2), the amount of actual expenses incurred for which are taken into account when determining the amount of tax deduction, is presented in.
Code 1 and 2 in 3 personal income tax declarations
The tax refund occurs after filing a 3rd personal income tax return, which indicates the amount of treatment expenses. It is necessary to fill out exactly the 3-NDFL declaration form that was valid in the year in which you received and paid for treatment.
Expenses for code 1 and code 2 are reflected in different fields on the sheet Appendix 5. “Calculation of standard and social tax deductions, as well as investment tax deductions established by Article 219.1 of the Tax Code Russian Federation»:
- expensive treatment (code 2) in clause 2.3 “Amount of expenses for expensive types of treatment”;
- medical services (code 1) in clause 3.2 “Amount paid for medical services (excluding expenses for expensive types of treatment) and for medical use.”
Service code 1 or 2 in the certificate of payment for medical services: dental treatment
Dental services can be quite expensive. But only a few qualify for expensive dental treatment under code 2. For more information about the service code in the certificate of payment for medical services in dentistry, see
Order of the Ministry of Health and Social Development of Russia No. 1664n dated December 27, 2011
On approval of the nomenclature of medical services
In accordance with Article 14 Federal Law dated November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, No. 48, Art. 6724) order:
Approve the nomenclature of medical services in accordance with the appendix.
Minister T.A. Golikova
www.minzdravsoc. ru/docs/mzsr/spa/117 (date of access: 01/30/2012)
Appendix to the order
Ministry of Health
And social development
Russian Federation
dated___________ 2011 No. ___
Nomenclature of medical services
1. Nomenclature of medical services(hereinafter referred to as the Nomenclature) is a list of medical services.
The Nomenclature is presented in the diagram:
The service code consists of an alphanumeric code from 8 to 11 (12*) characters. The first character indicates the class of service, the second and third characters - the section (type of medical service), the fourth and fifth (sixth*) characters - the subsection (anatomical-functional area and/or list of medical specialties), from the sixth to the eleventh characters (from the seventh to twelfth*) - serial number (group, subgroup).
* - for class “B”
3. The list of medical services is divided into two classes: “A” and “B”, built on a hierarchical principle.
Class "A" includes medical services that represent certain types medical interventions aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation and having an independent complete meaning.
Class “B” includes medical services, which are a complex of medical interventions aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation and having an independent, complete meaning.
4. Class "A":
4.1. Class “A” sections designate a specific type of medical service:
4.2. Subsections of class “A” (from 01 to 31) indicate the anatomical and functional area:
01 Skin, subcutaneous fat, skin appendages
02 Muscular system
03 Skeletal system
04 Joints
05 Hematopoietic system and blood
06 The immune system
07 Oral cavity and teeth
08 Upper Airways
09 Lower respiratory tract and lung tissue
10 Heart and pericardium
11 Mediastinum
12 Large blood vessels
13 Microcirculation system
14 Liver and bile ducts
15 Pancreas
16 Esophagus, stomach, duodenum
17 Small intestine
18 Large intestine
19 Sigmoid and rectum
20 Female genital organs
21 Male genital organs
22 Glands internal secretion
23 Central nervous system and brain
24 Peripheral nervous system
25 Hearing organ
26 Organ of vision
27 Olfactory organ
28 Kidneys and urinary system
29 Mental sphere
30 Other.
The subsection is identical in all sections. If a specific service is not allocated for a subsection in a certain section, then this subsection is not registered, while its serial number is retained.
The “Other” subsection includes medical services that cannot be classified in the corresponding anatomical and functional subsection (for example, performed during pregnancy, childbirth, newborns, diagnostic laparoscopy, overview shot abdominal organs, etc.).
4.3. Group serial number(001 to 999) denotes medical services that have a complete diagnostic or therapeutic value.
Some groups may not contain subgroups.
5. Class "B":
5.1. Class “B” sections designate a specific type of medical service:
5.2. Subsections of class “B” (from 001 to 069) indicate a list of medical specialties:
001 - obstetrics and gynecology
002 - allergology and immunology
003 - anesthesiology and resuscitation
004 - gastroenterology
005 - hematology
006 - genetics
007 - geriatrics
008 - dermatovenereology and cosmetology
009 - pediatric oncology
010 - pediatric surgery
011 - pediatric endocrinology
012 - diabetology
013 - dietetics
014 - infectious diseases
015 - cardiology, pediatric cardiology
016 - clinical laboratory diagnostics
017 - clinical pharmacology
018 - coloproctology
019 - laboratory genetics
020 - physiotherapy and sports medicine
021 - social hygiene, sanitation and epidemiology
022 - manual therapy
023 - neurology
024 - neurosurgery
025 - nephrology
026 - general medical practice(family medicine)
027 - oncology
028 - otorhinolaryngology
029 - ophthalmology
030 - pathological anatomy
031 - pediatrics
032 - neonatology
033 - occupational pathology
034 - psychotherapy
035 - psychiatry and forensic psychiatric examination
036 - psychiatry-narcology
037 - pulmonology
038 - radiology and radiotherapy
039 - radiology
040 - rheumatology
041 - reflexology
042 - sexology
043 - cardiovascular surgery, X-ray endovascular diagnosis and treatment
044 - emergency medical care
045 - forensic examination
046 - audiology-otorhinolaryngology
047 - therapy
048 - toxicology
049 - thoracic surgery
050 - traumatology and orthopedics
051 - transfusiology
052 - ultrasound diagnostics
053 - urology, pediatric urology-andrology
054 - physiotherapy
055 - phthisiology
056 - functional diagnostics
057 - surgery, surgery (organ and tissue transplantation) and combustiology
058 - endocrinology
059 - endoscopy
060 - bacteriology
061 - virology
062 - epidemiology
063 - orthodontics
064 - dentistry and pediatric dentistry
065 - therapeutic dentistry
066 - orthopedic dentistry
067 - surgical dentistry
068 - Maxillofacial Surgery
069 – others.
The subsection is identical in all sections. If a specific service is not allocated for a subsection in a certain section, then this subsection is not registered, while its serial number is retained.
The “Other” subsection includes medical services that cannot be classified in the corresponding subsection (for example: medical psychologist services).
5.3. Group serial number(001 to 099) denotes medical services that have a complete diagnostic or therapeutic value.
The subgroup serial number (from 001 to 999) designates medical services depending on the methods of their implementation.
Some groups may not contain subgroups.
Any service can be called useful activity, satisfying the need of those in need. However, the following formulation will be more economically and legally correct.
A service is any activity or benefit that one party can offer to another, which is largely intangible and does not result in ownership of anything. The production of services may or may not be associated with a product in its material form. However, economic utility makes a service tradable.
A service, including a medical one, is a material production with the production of its intangible product.
In economic In the aspect of this relationship, the production and consumption of services by the subjects of such a relationship - the producer and the consumer (client) - take place.
In a legal sense specified parties are presented respectively as a performer (medical business entity) and a customer (citizen).
Professionally The parties are represented by a medical professional (health care institution) and a patient. In these relations, the actions of the doctor or nurse is considered the actions of his employer (medical institution).
Medical service
is a type of professional service. When providing services, the law imposes increased requirements on the qualifications of the performer. Legislation establishes special legal capacity not only for the business entity carrying out such activities, but also for the service provider.
This is the basis for the procedure for issuing a license to carry out medical activities and certificates confirming the professionalism of the provider of medical services. Only doctors or nurses with appropriate qualifications are allowed to perform medical activities.
Medical workers deal mainly with a sick person, for the treatment, restoration and promotion of whose health special activities are carried out, including invasive and non-invasive methods of influencing the patient’s body.
The human body as a subject of medical activity and the targeted impact on health as an object significantly distinguish a medical service from other professional services.
There are a number of classifications of medical services. The most complete is the following:
- By nature: preventive, expert, organizational, statistical, diagnostic, therapeutic, combined, rehabilitation.
- By segment of the healthcare structure: sanitary and hygienic, epidemiological, outpatient, polyclinic, inpatient.
- By level of medical care: pre-medical, medical, qualified, specialized.
- By intensity over time: ambulance, emergency, planned.
- By qualification of the source of medical services: low, medium, high.
- By technology: routine, high-tech.
- By invasiveness: non-invasive, invasive.
- According to compliance with the standard: compliance with the standard, non-compliance with the standard (justified, unjustified, erroneous).
- By time of achievement final result: corresponding to the terms, not corresponding to the terms.
- According to the final result: adequate, partially adequate, inadequate.
- According to compliance legal norms: corresponding to the functions of the performer, not corresponding to the functions of the performer, erroneous, negligent (resulting in damage to the health or death of the consumer).
This classification can serve as a guide for managers, healthcare organizers and insurance company experts in their work.
To simplify the work with the classification, taking into account the marketing nature of the study, it is advisable to give a marketing interpretation of some main categories.
Prevention-oriented health care system various diseases, preventing the spread of diseases, maintaining the level of health of the population, consumer groups - these are preventive medical services.
A system of actions of a highly qualified specialist (manager, doctor, nurse), ordered in established by law or a regulatory act in order to study the degree of perfection of the quality of organizational, statistical, diagnostic, therapeutic and other medical services in the process of their implementation or their final result, ending with a documentary statement of their assessment, is called expert medical services.
Independent expert medical services – health care attribute with various forms property. The economic equivalent of expert services is determined based on the total time and funds required to organize the examination, the tariff rate of experts, economic efficiency the result of implementing an expert solution.
Organizational medical services are always a consequence of expert medical services; they change the existing system of medical care in order to improve its quality and increase the efficiency of using funds and healthcare resources.
The effectiveness of organizational medical services is assessed by quantitative changes in health indicators (population groups, region). A positive change in the quantitative health indicator indicates the correctness of the organizational medical service, the objectivity of the expert opinion, and the solvency of the manager.
The lack of dynamics in the quantitative indicator of health as a result of the action of an organizational medical service and financial injections during its implementation, on the contrary, emphasizes its ineffectiveness. The competence of the experts and healthcare leaders who prepared its implementation is called into question.
Expert and organizational services- products intended in the market of the seller of medical services for group use.
Actions medical worker(doctor, nurse) in order to establish a correct and dynamically changing diagnosis of the disease and its complications, prognosis of the course of the patient’s (consumer) illness – diagnostic service.
Diagnostic medical services of a clinician and an instrumentalist should be distinguished. The services of the first are the product of constant observation and study of the consumer. The product of the second is a reflection of anatomical and functional changes in the consumer’s body at the time of the study.
A clinician is a customer of the medical services of an instrumentalist. Unlike a clinician, an instrumentalist uses diagnostic devices (radiation), electrophysiological, and laboratory to perform the ordered service. The clinician forms a diagnosis based on cumulative information and determines the tactics of the diagnostic process.
Curative medical services are inextricably linked with diagnostic ones and are focused on restoring anatomical and functional changes, concomitant diseases in optimal short time. They are diverse (psychotherapeutic, surgical, medicinal, etc.).
The implementation of medical services can be direct (medical), indirect (doctor - medical device - patient), group healing. In the public health care system, the seller of treatment services is the state. The volume of treatment services is regulated by the financing of health care and medical institutions.
The customer of medical services of the state health care system is the clinician, and the consumer is the patient. It should be noted that medical services of the state health care system depend on the adopted schemes for organizing the diagnostic and treatment process, the standard of the market segment, and are characterized by rigidity in limiting the possibilities of choosing medical services for both their “seller” (clinician) and for the “buyer” ( patient). Patient's desire to purchase medical services in another market sector public health in a planned manner, as a rule, was decided at the health care level and in each case required a certain amount of effort for the consumer.
For a year now, the new Nomenclature of Medical Services has been in effect, approved by Order of the Ministry of Health of Russia dated October 13, 2017 No. 804n (hereinafter referred to as the Nomenclature, or Nomenclature of Medical Services, or Order No. 804n).
Of course, we have already written about this Nomenclature - read our article “”. In this work, we mentioned that at the legislative level there are no requirements for mandatory compliance of the price list of a medical organization with the Nomenclature of Medical Services. However, due to the fact that we often receive questions of this kind from medical organizations (hereinafter - MO), and also in connection with the publication of the letter of the Ministry of Health of Russia No. 17-2/10/2-4323 dated July 4, 2018, we decided return to this topic once again.
Please pay attention! In this paper, the issue of compliance of the price list with the Nomenclature of Medical Services is considered for the most part in relation to medical organizations private system healthcare providers that provide paid medical services and do not participate in the state guarantee program. However, we will also briefly touch upon government institutions.
First, let's look at the provisions of the legislation that in one way or another speak about the Nomenclature, its purpose and application.
Of course, first of all we will turn to the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (hereinafter referred to as Federal Law No. 323) and we will find that the Nomenclature is mentioned in it “as much as once.” Namely, Part 4 of Art. 37 Federal Law No. 323 states that “the standard of medical care is developed in the manner established by the authorized federal body executive power, in accordance with the range of medical services...". But as you can see, this requirement applies to our bodies - the creators of normative legal acts.
Let us turn directly to Order No. 804n of the Russian Ministry of Health, which approved the Nomenclature. At the very beginning we see the definition of Nomenclature - this is a systematic list of codes and names of medical services in healthcare. And nothing more. The previously effective Order of the Ministry of Health and Social Development of Russia dated December 27, 2011 No. 1664n defined the Nomenclature as a “list of medical services.”
On July 12, 2004, the Ministry of Health and Social Development of the Russian Federation approved the Nomenclature of Works and Services in Healthcare. This document (and it has not been cancelled) can currently be taken into account and used, for example, as a classifier (especially relevant for “work in healthcare” because the current nomenclature contains only services). But, of course, it does not have priority over the currently operating Nomenklatura. We will not dwell on the status of this act in more detail - let’s move on to the main thing.
IN this document(the only one of all) talks about the purpose of the Nomenclature. So the purpose of developing and implementing the Nomenclature is to ensure a unified regulatory framework works and services in healthcare throughout the Russian Federation, including protocols for patient management, methods for performing complex and complex medical services, licensing requirements and conditions, equipment sheets medical institutions. The Nomenclature has been developed to solve the following problems:
- Ensuring the development and functioning of the classification and coding system in healthcare;
- Ensuring interaction between entities involved in the provision of medical care;
- Formation of unified approaches to the creation of price lists for medical services in the system of compulsory and voluntary health insurance;
- Security unified system assessing the economic characteristics of medical services;
- Development of criteria and methodology for assessing the diagnostic and treatment capabilities of medical institutions and the availability of medical care.
But this is only a definition of the Nomenclature, its goals and objectives. And here There is no direct indication of the obligation of medical organizations to use the Nomenclature in one way or another in their activities (including approving price lists in accordance with the Nomenclature).
Let's move on to the Rules for the provision of paid medical services by medical organizations, approved by Government Decree No. 1006 dated 04.10.2012 (hereinafter referred to as the Rules or PP No. 1006). In them, alas, we also will not find instructions on the mandatory compliance of the price list of medical services with the Nomenclature. In addition, in paragraphs. 7 clause 11 of the Rules states that MO is obliged to provide consumers (patients) with information (among others) about “ a list of paid medical services indicating prices in rubles, information about the conditions, procedure, form of provision of medical services and the procedure for their payment" As you can see, the Rules do not establish other requirements, including compliance of the list of paid medical services with the Nomenclature.
The rules remind that the Ministry of Defense must comply with the procedures for providing medical care. But the current regulations also do not contain requirements for the Moscow Region price list.
As for the standards of medical care, paid medical services can be provided in full to the standard of medical care, or at the request of the consumer in the form of individual consultations or medical interventions, including in a volume exceeding the scope of the standard of care provided.
Nota bene: The standards specifically include codes and names of medical services from the Nomenclature, which is logical, since the standards according to Art. 37 Federal Law No. 323 are developed in accordance with the nomenclature of medical services. All standards were published when the old Nomenclature of Honey was in force. services (approved by Order No. 1664n). There are practically no changes to the standards. As a result, the code and name of the service in the standards corresponds to the nomenclature that has already expired. However, some service codes in Order No. 804n differ from Order 1664n. For example, genetic research in the new Nomenclature are allocated to a separate type of medical service “27”. In the old Nomenclature, genetic studies were classified as other types of honey. services - “08” (morphological studies of tissues), “12” (studies of the functions of organs and tissues using special procedures, devices and techniques).
From all of the above it follows that even the standards of medical care do not correspond to the currently valid range of medical services, despite Part 4 of Art. 37 Federal Law No. 323. Then why should the price lists of medical organizations impeccably correspond to the range of medical services? In our humble opinion, they shouldn’t, because the legislation does not contain this imperative norm. However, we still think so boldly only in relation to the price lists of private clinics.
It would be fair to explain why. The fact is that some regulatory legal acts still contain instructions on the need for the price list to comply with the Nomenclature. However, they do not apply to “private” medical organizations, but relate exclusively to medical organizations of the state and municipal health care system.
For example, Order of the Moscow Department of Health of October 2, 2013 No. 944 “On approval of the Rules for the provision of paid services to citizens and legal entities by state organizations of the Moscow healthcare system” (hereinafter referred to as Order No. 944) contains a direct indication that lists of paid services and price lists of prices (tariffs) for paid services are compiled indicating codes (Please note that we are talking only about the service code, and not about its name) paid services provided in accordance with the Nomenclature.
Similar requirements for medical organizations state form property also contain other acts, for example, Order of the Ministry of Economic Development of Russia dated May 25, 2015 No. 309, Order of the Minister of Defense of the Russian Federation dated December 15, 2016 No. 822, etc.
We are talking here about a price list (=price list), but current legislation in the healthcare sector rarely uses such a concept. There is also no official definition of what is considered a price list for a medical organization.
The definition of the concept “price list” appears in various GOSTs. From their combined analysis, we can conclude that a price list is a systematic list of goods, services, etc., indicating prices and sometimes brief characteristics.
At the same time, we all understand perfectly well, even without definitions, that the Moscow Region price list is (at a minimum) a list of medical services with prices indicated. We will stop here, since we believe that going into depth in the terminology is unnecessary here.
Another question is whether it is possible to put an equal sign between the “price list” and the “list of paid medical services”. At the everyday level, we can safely say that these are one and the same. However, DZM Order No. 944 (the only one discussed above) is confusing, for some reason separating these concepts. The order means that " lists of paid services and price lists(tariffs) for paid services are drawn up indicating the codes of the paid services provided in accordance with the approved nomenclature...” At the same time, in other regulatory legal acts(the above-mentioned Order No. 822, Order No. 309 and others) only mentions “lists of paid medical services”. It is possible to assume that DZM meant that the price list (tariffs) is just indication of prices in rubles for medical services.
Obviously, we could not ignore existing realities. After all, regulatory authorities, and sometimes even courts, are still more of the opinion that the price list must comply with the Nomenclature. What kind of “compliance” are we talking about? Taking into account judicial practice we can say that compliance lies in the use in the price list of the names of medical services (and sometimes codes of medical services) indicated in the Nomenclature.
Non-compliance of the price list with the Nomenclature is considered a violation of legislation in the field of consumer protection, namely a violation of the consumer’s right to necessary and reliable information:
Default decision of the Vakhitovsky District Court of the Republic of Tatarstan dated June 18, 2017. in case No. 2-5411/2017
Rospotrebnadzor appealed to the court in the interests of an indefinite number of persons to LLC “Clinic of Aesthetic Medicine “Melissa” to stop illegal actions, which were expressed (among other things) in the fact that the clinic’s price list contained the names of paid medical services (mesooxygen therapy, bioreparation, biorevitalization, etc. .), which are not included in the Nomenclature of honey. services. These actions of the clinic, according to the authority, are a violation of legislation on the protection of consumer rights, namely the right to necessary and reliable information. The court upheld the claim and ordered the clinic to stop illegal actions. At the same time, the court, in relation to the topic with the price list, did not provide any arguments regarding what the violation of the law was.
Default decision of the Privolzhsky District Court of the city of Kazan, Republic of Tatarstan dated June 22, 2018. in case 2-3837/2018
Rospotrebnadzor filed a claim in defense of an indefinite number of persons against Tan-Dent LLC to compel compliance with the requirements of the order. The authority indicated that during a routine inspection, violations of legislation in the field of consumer protection were identified, namely: in the provision of paid medical services. services to the consumer in a clear and accessible form the necessary and reliable information about the services provided is not provided. One of the violations, according to Rospotrebnadzor, was that in the company’s price list the names of honey. services do not comply with the Nomenclature. The court satisfied the requirements, obliged the company (among other things) to bring the names of medical services in accordance with the Nomenclature.
Resolution of the magistrate of court district No. 6 in the Ordzhonikidze district of Ufa dated July 17, 2018. in case No. 5-364/2018
The general director of the clinic was prosecuted under Part 4 of Art. 14.1 Code of Administrative Offenses (implementation entrepreneurial activity without state registration or without special permission (license)). One of the violations identified by Roszdravnadzor was that the price list of the clinic did not include codes and names of medical services according to the Nomenclature.
The “problem” with all these examples from judicial practice is that the discrepancy between the price list and the Nomenclature is not the only violation that appears within the framework of the case. And the court does not consider, let’s say, “separately” each of the alleged violations, but evaluates them in their entirety. Unfortunately, there is judicial practice, where they would be held accountable only for non-compliance of the price list with the Nomenclature of Medical. We did not find any services. In addition, the cited judicial practice is “blind”, since it does not contain price lists assessed by the court, and often proper extracts from them.
Indeed, at times it seems that our authorities adhere to precisely this logic when they try to provide arguments to justify their position, holding the organization accountable. This is what happened in one of the cases:
Decision of the Arbitration Court of the Republic of Tatarstan dated May 25, 2016. in case No. A65-3996/2016, Resolution of the Eleventh Arbitration Court of Appeal dated August 18, 2016. in case No. A65-3996/2016.
Euromedklinik LLC applied to the court to declare the decision of Rospotrebnadzor illegal, unfounded and subject to repeal. The company was brought to administrative liability by the authority under Art. 14.4 Code of Administrative Offenses (provision of services poor quality or in violation of the requirements established by law). Rospotrebnadzor identified as one of the “violations” the discrepancy between the price list and the Nomenclature (the price list contained two names of services: one for clients, the other according to the nomenclature). At the same time, it is absolutely not clear what has to do with the two names of services in the price list and the provision of services of inadequate quality. Fortunately, the court drew attention to this and satisfied the society’s demands. The appellate court left the decision unchanged.
As you know, court decisions must be taken into account, and not as the ultimate truth. In addition, there are cases when courts still focus attention not on the name, but on the factual component:
Decision of the Arbitration Court of the Perm Territory dated July 28, 2014. year in case No. A50-9943/2014(the case is not directly related to the issue of compliance of the price list with the Nomenclature).
Rospotrebnadzor went to court to hold the individual entrepreneur administratively liable for providing medical services without a license. The individual entrepreneur insisted that the services he provided were not medical, since the name of the services did not correspond to the name of the medical services from the list. The court noted that in itself Some difference in the name of the service does not change its actual content and the possibility of being assigned to one or another service code according to the Nomenclature.
At the same time, it is still important to assess the legality of decisions made by the court, as well as the powers of supervisory authorities when conducting inspections.
The main “player” in this matter is Rospotrebnadzor, so let’s pay attention to its powers. The Regulations on Rospotrebnadzor were approved by Decree of the Government of the Russian Federation dated June 30, 2004 No. 322, which states that Rospotrebnadzor exercises control and supervision (among other things) in the field of consumer rights protection, including compliance with regulations governing relations in the field of consumer rights protection. Thus, Rospotrebnadzor is not authorized to inspect a medical organization for compliance with the requirements established by acts of the Ministry of Health (for example, compliance with the procedures and standards of medical care, etc.). We are now talking specifically about the acts of the Ministry of Health, and not the Ministry of Health and Social Development, which were issued by the united ministry before Rospotrebnadzor left its department, although this is also not without nuances.
That is, Rospotrebnadzor does not have the right to inspect a medical organization for compliance with the requirements established by Order of the Ministry of Health No. 804n, since this normative act does not regulate relations in the field of consumer rights protection. And moreover, as we have already found out, it does not contain any requirements at all.
However, as can be seen from examples from judicial practice, Rospotrebnadzor charges medical organizations with violating the law on the protection of consumer rights, namely violating consumer rights to necessary and reliable information. At the same time, the authority specifies that this violation was expressed (including) in the discrepancy between the price list of the Moscow Region and the Medical Nomenclature. services. Moreover, sometimes RPN demands in court to oblige the Moscow Region to bring the price list in accordance with the Nomenclature.
The obligation to provide the consumer with the necessary and reliable information is indeed established by the Law of the Russian Federation of 02/07/1992 No. 2300-1 “On the Protection of Consumer Rights”(hereinafter referred to as ZPP). So Art. 8 PZPP speaks of the right of the consumer (in our case, we mean the patient) to demand the provision of necessary and reliable information about the contractor, his mode of work and the services he provides. In turn, the performer ( medical organization) is obliged to promptly provide the consumer with the necessary and reliable information about services, ensuring the possibility of their the right choice. At the same time, the PZPP does not explain what is considered necessary and reliable information, how the boundaries and criteria of reliability and necessity are determined.
Apparently, Rospotrebnadzor evaluates the “necessity and reliability” of information about medical services in terms of its compliance with the Nomenclature. However, we believe that the Nomenclature is not a proper “barometer”. The need for such information is determined by RF PP No. 1006 (in relation to the powers of Rospotrebnadzor during inspections), which was adopted in pursuance of Part 7 of Art. 84 Federal Law No. 323 and Art. 39.1 ZPP. The rules determine what information the Moscow Region is required to provide. Among such information is mentioned list of paid medical services indicating prices in rubles. At the same time, as we have already said, the Rules do not indicate that the list must correspond to the Nomenclature.
As for the reliability of information about medical services, Rospotrebnadzor has the right to use various evidence to justify the opposite. In our opinion, the discrepancy between the price list and the Nomenclature can only be interpreted as providing the patient with unreliable information when the name of the service proposed by the medical organization can mislead the patient or exclude the possibility of a correct understanding of the medical services offered. Moreover, informing the patient about medical services is clearly not limited to the stage of familiarization with the price list, therefore Rospotrebnadzor needs to stock up other arguments in favor of the clinic violating the rights of the consumer to receive necessary and reliable information about services at all stages of providing him with medical care. And a formal discrepancy between the name of a service and the Nomenclature cannot and should not be interpreted as a violation, since, firstly, Order of the Ministry of Health No. 804n does not regulate the sphere of consumer protection, and secondly, it does not postulate the services named in it as the only proper and reliable information consumer about services, and, thirdly, the Nomenclature contains only generalized names of medical services and is not exhaustive, as the Ministry of Health itself admitted this summer (more on this below). It is obvious that such a generalized, non-exhaustive and essentially technical and statistical document, and even not mandatory today for the use of MO, cannot serve as an indicator of the reliability of information about medical services. Moreover, looking at the “reliability of information” only at the level of the name of the service is not, in our opinion, at least somewhat conclusive.
Regarding such a strange phenomenon as Roszdravnadzor checking the price list of a medical organization for its compliance with the Nomenclature during licensing control (and information about this case is given above), we allow ourselves to express the following thought. Checking the price list is not a subject of licensing control, and even if we assume that it “sits” in the check for compliance with Rules No. 1006 (is a legal part of licensing control), then let us recall inadmissibility of inspections of compliance with the same mandatory requirements by several supervisory authorities in relation to one legal entity or one individual entrepreneur (Article 3 of the Federal Law of December 26, 2008 No. 294-FZ “On the Protection of Rights legal entities And individual entrepreneurs in the exercise of state control (supervision) and municipal control”). Thus, checking the price list of a medical organization for its compliance with the Nomenclature can be carried out either by Rospotrebnadzor or Roszdravnadzor, but not by two departments simultaneously/in parallel. Moreover, checking the price list (except for the fact of its existence as a certain list of medical services indicating prices in rubles) is not “sit” in Rules No. 1006, therefore, after all, such a check is the “diocese” of Rospotrebnadzor, which is authorized to check compliance with consumer rights to necessary and reliable information.
As we already wrote at the beginning, in July the Russian Ministry of Health issued a letter No. 17-2/10/2-4323 dated 07/04/2018 “On the application of the Order of the Russian Ministry of Health dated 10/13/2017 No. 804n “On approval of the nomenclature of medical services”, which explains the nuances ( It should have explained the nuances more precisely, but alas) regarding the indication in the price list of services in accordance with the Nomenclature.
First of all, the ministry indicated that the nomenclature contains generic names of medical services, and the provided list of medical services is not exhaustive. This is enough to conclude that a medical organization can definitely go beyond the Nomenclature. At the same time, the absence of a medical service directly in the Nomenclature does not mean that it is automatically outside the legal framework, that is, it does not indicate its dubious legal status as a medical service.
According to the Ministry of Health, a medical organization can, by indicating the medical service provided in accordance with the Nomenclature, additionally specify depending on performance features. In addition, the Ministry of Defense may expand the list of medical services relative to those provided for by Order No. 804n, if services are provided not included in the Nomenclature.
Despite the fact that such a statement by the authority does not contain an indication specifically of the “obligation” (the ministry uses the verb “may” and not “must”), in general the letter is perceived to a greater extent as an indirect indication of the need for the price list to comply with the Nomenclature. Thus, the Ministry of Health noted that when forming a list of medical services, a medical organization should be based on the List ( FMP note: this means the List provided for by the Government Decree of April 16, 2012. No. 291) and Nomenclature. However, the ministry has not indicated by what standards this “duty” is defined. The authority mentioned procedures and standards, but this in no way automatically gives rise to the obligation of the Ministry of Defense to bring the price list into strict compliance with the Nomenclature.
In addition, there is another flaw in the letter from the Russian Ministry of Health. The fact is that the ministry in the letter uses the expression “ medical organizations providing paid medical services" At the same time, firstly, the medical organization has a form of ownership (which is certainly important and can radically change the meaning of the letter). Secondly, the provision of paid services does not yet indicate that the medical organization belongs to the private healthcare system. Paid services can be provided by medical organizations of the state and municipal healthcare system, which, as we have already mentioned, have their own “rules of the game.”
The letter from the Ministry of Health rather confused things further than allowed us to draw clear conclusions. The constant transition “from can to must”, the absence of specific arguments regarding the “obligation” of the Ministry of Defense to create a price list based on the Nomenclature, the recognition that Order 804n provides for all existing and possible names of honey. services, etc. - all this allows us to conclude that the Moscow Region has no obligation to create a price list based on the Nomenclature, nor to bring it into compliance with it. Of course, the main problem is that all that remains is to explain this to the supervisory authorities.
And as a “logical” conclusion, we recommend that our dear readers still adhere to this, excuse me, damn Nomenclature when developing price lists. Yes, yes, that’s right, we recommend doing just that, despite the absence of a direct obligation (we clarify that we are talking about the MO of a private healthcare system). Firstly, as they say, sometimes it’s easier to give to our bodies than to explain why you don’t agree. Secondly, adherence does not mean “a step to the right, a step to the left - execution.” IN in this case The Ministry of Health rightly noted that the medical organization can further specify the medical service depending on the specifics of execution, and also, if necessary, expand the list of services if they are not in the Nomenclature. Perhaps in real life this is really justified.
Such measures will definitely protect the organization from attacks by regulatory authorities. And trials and attempts to prove one’s “innocence” take a lot of effort, money and time from medical organizations.
On the other hand, we definitely do not mind if a medical organization decides to fight and prove its case, especially with our help.
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