It is true that the ambulance will be paid. "Ambulance" in Russia becomes paid: true or not? Ambulance law changes

The source checked the information about the appearance of a paid ambulance in Russia.

Since the beginning of May, there has been panic on the Internet. The message about the appearance of paid ambulances scattered across social networks instantly. “The President did sign the decree. Starting June 20, an ambulance can be called free of charge only four times a year. And on the fifth - either pay or die. Such information is now published in many forums and even in some media.

The message refers to a certain decree of President Vladimir Putin. Meanwhile, the Kremlin's official website has information that the president instructed the Russian Ministry of Health, together with the authorities of the Kirov region and some other regions, to analyze the results of the project, which involves the transfer of medical transport services by private organizations. This is the so-called outsourcing.

What is outsourcing?
In the Kirov region, the motor transport services of the ambulance station were outsourced in 2013. What does it mean? The station enters into a contract with private transport companies. Those, in turn, provide new cars for use by the ambulance, and also take care of all the maintenance and repair of cars.

“Since then, it has been possible to significantly reduce the cost of renting cars,” Dmitry Matveev, deputy chairman of the regional government, told reporters. - When the cars were on the balance sheet of the budget, their mileage was recorded many times more for obvious reasons. Today we pay specifically for the hour of the machine. Not for an oil change, not for repairs, but for work.

For clarification, the deputy chairman gave an example: in one of the hospitals, two UAZ vehicles were on the balance sheet. Two drivers worked in shifts on each of them per day. Each driver according to the documents drove 180 km a day.

“After switching to outsourcing, it turned out that the real need for a medical institution is only 30 km per day,” Matveev said. Do you know where the rest of the money went? "Budget means no one" - such an attitude is unacceptable, it must be fought.

"Mercedes" replenished the fleet
At the end of 2015, the regional Ministry of Health signed a new contract for a period of 5 years with Effective Health System LLC. The company has already completely renewed the ambulance fleet. 43 Mercedes cars were delivered, 5 of which are reanimobiles. Four cars (one of them is an ambulance) are on standby, and 39 are constantly responding to calls from substations of the regional center.

All cars are equipped with new modern equipment, including an electrocardiograph, a defibrillator and a ventilator.

“There is no talk of any paid ambulance calls and limiting the number of calls per year,” the regional Ministry of Health notes. This service has always been and will always be free. The hysteria raised by some federal media is just the result of poor orientation in the matter.

After the elections, the ambulance will become paid, it will be free to call it no more than 4 times a year - such rumors have been circulating in social networks since the end of last year.

Apparently, in a number of regions they caused such a wide resonance that the other day the Ministry of Health of Yakutia issued a special clarification on this matter: providing free ambulance services. According to the decree under discussion, it will be possible to call an ambulance free of charge no more than four times a year. The Ministry of Health of Yakutia informs that this information is false.

The regional ministry noted that the debatable surge in social networks and instant messengers could be caused by a new version of the order of the Ministry of Health of Russia dated January 22, 2016 N 33n “On Amendments to the Procedure for Providing Emergency, talks about the introduction of payment for calling an ambulance, whatever it may be on the bill.

Meanwhile, the introduction of a paid ambulance was indeed discussed. Two years ago, the Ministry of Finance, or rather, a research institute subordinate to it, proposed that the Ministry of Health charge patients for calling an ambulance more than 4 times a year. An exception was supposed to be made for the disabled, pensioners and children.

Discussion among physicians about this has been going on for a long time. The arguments of supporters of the introduction of ambulance fees look like this: the ambulance spends significant resources on drunk calls, on pranksters and grandmothers who prefer to relieve pressure under the supervision of professionals. They call an ambulance to ask, “how to treat snot?”, And lonely elderly people often call doctors just to chat.

As reported in the media, a similar experiment was staged in Stavropol several years ago. As a result, two months later, the number of ambulance calls per day decreased from 465 to 330, respectively, and the waiting time for the brigade was reduced. However, in the end, the experience was declared illegal by the local prosecutor's office ...

- Indeed, according to Roszdravnadzor, about 37% of ambulance calls are non-core - not requiring emergency assistance, but this does not mean that they are false, - says Alexander Seversky, head of the Patient Protection League. - What is with a person - a doctor can recognize, and the one who has something hurts does the right thing, what causes it. This problem must be treated with understanding.

Of course, it happens that patients try to use the ambulance as a taxi or they are called by fun companies, but in these cases, the insurance companies still have the right to bring a claim. There is no need to change the law here. And I have not heard of any regulatory initiatives in this area. According to the Constitution, we have free medical care, especially emergency. Any attempt to change something will be contrary to the Constitution.

"SP": - It seems that people are afraid that they may return to the proposal for a limited number of ambulance trips. After all, patients are now everywhere forced to apply for paid services. Here in social networks, people share rumors: not only will it be possible to call an ambulance only 4 times for free, but they are going to limit visits to a therapist - 8 times a year, and a hospital can be treated no more than 2 times a year ...

- We are introducing capitalist values, health is turning into a market category. State municipal institutions are renamed into all sorts of public-private partnerships, in which citizens lose the right to free assistance. They say that it is necessary to divide the services into those that are included in the program of state guarantees and those that are not included. But what is this additional medical care? What, you can additionally cure appendicitis, pneumonia, what is it all about? It is nonsense. In addition, it turns out that people pay for medical services twice: once in the form of taxes, and the other time out of their own pocket.

And the doctor also does not understand - whether he should treat a person, or earn money, and these are two completely different tasks, often contradicting each other. So there is a bargain: if you want drugs that heal, not cripple - pay, if you want help today, and not in a week - pay, if you want a modern operation - pay. Hence the endless conflicts.

Last year there were 1,200 attacks on doctors, which is a lot. People do not get what they expect, and this causes such aggression. Both doctors and patients have become hostages of this market policy.

"SP": - And in the West, how does the "ambulance" work?

- Paramedics come to America, their task is simply to deliver the patient. There are few places where qualified medical care goes home, like in our country, when an ambulance really saves people. This is an expensive pleasure. In countries where capitalism rules, human health is considered not a resource of the state, but the sphere of interests of the person himself - you need it, you pay. The USSR in this sense stepped forward 50 years, which our officials do not understand. After all, creating a public health system for any country is very expensive, not all countries have it. And we, having such an already built system, are now trying to make it “how it is”. Although most of the countries are now moving towards our model.

The reason for the surge of discussions on this issue was the proposal of the Ministry of Finance six months ago, made to the Ministry of Health. The Ministry of Finance, or rather, a research financial institution subordinate to it, proposed to charge patients for calling an ambulance more than 4 times a year. An exception was proposed to be made for the disabled, pensioners and children. In addition, it was proposed to pay for more than 8 visits per year to therapists in polyclinics, service during non-working hours, treatment by a highly qualified specialist. By June 1, the results of the experiment in Mariy El, Chuvashia and other regions, where paid ambulances had been working since the beginning of the year, were to be summed up. Here, the network people also were excited. The question why the Ministry of Finance made such a proposal, I think, does not require explanation. It is more interesting why the Ministry of Health did not support it. The most obvious reason for the refusal to introduce a new standard is not fear of growing social tension, but purely financial and practical considerations. Calculations showed that a partial rejection of the practice of calling an ambulance free of charge would save from 2 to 7.9 billion rubles a year. This is 0.62% of the cost of the basic program of state guarantees. The sums are scanty to reorganize the established practice. However, the discussion about the justification of a gratuitous ambulance for everyone has long been ongoing in professional circles. The ambulance spends significant resources on drunk calls, on pranksters and grandmothers who prefer to relieve pressure under the supervision of professionals. Ten years ago, the city of Stavropol, taken separately, set up a similar experiment. For all the debatability of the method, which was confirmed by the current Facebook, it turned out that a wisely differentiated approach to calling an ambulance does not infringe on the interests of citizens. Then, in all polyclinics of Stavropol, emergency rooms were resumed, in fact, restoring the old Soviet practice in which the ambulance went only to emergency accidents and fires, and the ambulance to the sick at home. They explained to the Stavropol residents that, of course, an ambulance can also be called, but if the doctor considers the call unreasonable, then they will have to pay. This experiment did not cause a surge of social tension in Stavropol, although in the end it was declared illegal by the local prosecutor's office. The effect of two months of work is this - the number of ambulance calls per day decreased from 465 to 330. The waiting time for the brigade was automatically reduced. Even then, experts from the Ministry of Health and Social Development recognized that paying for an ambulance call in non-life-threatening situations was the only optimal way out. I think this model - and not 4 calls for nothing, and the rest for a fee can be considered as the most promising for optimizing the work of the ambulance. In any case, it is for her that ambulance workers vote on their professional forum feldsher.ru. But with all the evidence of such an approach, even professionals doubt whether such a formula can work effectively. Here is an excerpt from one post: In big cities - a lot of false emergency calls by drug addicts, people in a state of intoxication, to "snot", and also - "just talk", as older people often do. However, the farther the settlement is from civilization, the fewer such "tricks" from patients. “We are for the Israeli model of calling an ambulance,” Russian doctors say unanimously. - While the ambulance is flying to the hangover drunk, someone is dying of a heart attack! I called on the case - the insurance pays, just like that - pay yourself. The Israeli model of calling an ambulance, of course, does not involve calling idle (fine - 1,000 shekels, almost $ 250!). However, if the patient was taken to the hospital, received assistance in the emergency room and was not hospitalized, then he will still have to pay. Strictly speaking, the call was not false, but the patient could not objectively assess the severity of his condition. The situation with false calls is also far from always unambiguous. When my father had a pre-infarction condition in Moscow, we called an ambulance twice, which stated that he had the flu. The paramedic was advised to drink vitamins. And as a result, he was taken to the hospital by the same brigade on a second call only after 6 hours: with a diagnosis of extensive myocardial infarction. The paramedics apologized, but the condition was already critical and was stopped in cardio resuscitation. Being engaged in reforming, it would be good to establish objective control over calls, and over erroneous diagnoses, and over the upcoming fines for a false call. Fines, by the way, back in November 2015 were offered by that Ministry of Finance. It is clear that the ambulance staff will try to fix their mistakes to a minimum, without normal control, patients will again suffer. According to Russian doctors, about two-thirds of the ambulance calls to the elderly are the lack of adequate therapy for their chronic diseases. District therapists, who sometimes have 70 house calls, simply have no time to do this. I think if we take the rural sector, then there will be even more aggravated neglected chronicles. And field diagnostic teams will not improve the situation much. FAPs should be reopened with targeted and regular visits by specialists. An ambulance is often called by citizens with mental disorders, who do not want to be hospitalized in a specialized hospital. At the same time, the Ministry of Health is stubbornly reducing the number of employees in psychiatric clinics and dispensaries. Consequently, this category of persons will continue to chaotic calls, and will not even think about paying for it. In the meantime, everything in the work of the ambulance remains unchanged. Medics will be free to save people and come to calls. This was stated to Novaya Gazeta by the Ministry of Health and the Moscow Department of Health.

By June 1, the results of the experiment in Mariy El, Chuvashia and other regions, where paid ambulances had been working since the beginning of the year, were to be summed up.

Here, the network people also were excited.

The question why the Ministry of Finance made such a proposal, I think, does not require explanation. It is more interesting why the Ministry of Health did not support it.

The most obvious reason for the refusal to introduce a new standard is not fear of growing social tension, but purely financial and practical considerations. Calculations showed that a partial rejection of the practice of calling an ambulance free of charge would save from 2 to 7.9 billion rubles a year. This is 0.62% of the cost of the basic program of state guarantees. The sums are scanty to reorganize the established practice.

However, the discussion about the justification of a gratuitous ambulance for everyone has long been ongoing in professional circles.

The ambulance spends significant resources on drunk calls, on pranksters and grandmothers who prefer to relieve pressure under the supervision of professionals.

Ten years ago, the city of Stavropol, taken separately, set up a similar experiment. For all the debatability of the method, which was confirmed by the current Facebook, it turned out that a wisely differentiated approach to calling an ambulance does not infringe on the interests of citizens.

Then, in all polyclinics of Stavropol, emergency rooms were resumed, in fact, restoring the old Soviet practice in which the ambulance went only to emergency accidents and fires, and the ambulance to the sick at home. They explained to the Stavropol residents that, of course, an ambulance can also be called, but if the doctor considers the call unreasonable, then they will have to pay. This experiment did not cause a surge of social tension in Stavropol, although in the end it was declared illegal by the local prosecutor's office. The effect of two months of work is this - the number of ambulance calls per day decreased from 465 to 330. The waiting time for the brigade was automatically reduced.

Even then, experts from the Ministry of Health and Social Development recognized that paying for an ambulance call in non-life-threatening situations was the only optimal way out.

I think this model is not 4 calls for free, and the rest for a fee can be considered as the most promising for optimizing the work of the ambulance.

In any case, it is for her that ambulance workers vote on their professional forum feldsher.ru. But with all the evidence of such an approach, even professionals doubt whether such a formula can work effectively. Here is an excerpt from one post:

In big cities, there are a lot of false emergency calls by drug addicts, people in a state of intoxication, to “snot”, and also “just to talk”, as older people often do. However, the farther the settlement is from civilization, the fewer such "tricks" from patients.

“We are for the Israeli model of calling an ambulance,” Russian doctors say unanimously. - While the ambulance is flying to the hangover drunk, someone is dying of a heart attack! I called on the case - the insurance pays, just like that - pay yourself. The Israeli model of calling an ambulance, of course, does not involve calling idle (fine - 1,000 shekels, almost $ 250!). However, if the patient was taken to the hospital, received assistance in the emergency room and was not hospitalized, then he will still have to pay. Strictly speaking, the call was not false, but the patient could not objectively assess the severity of his condition.

The situation with false calls is also far from always unambiguous. When my father had a pre-infarction condition in Moscow, we called an ambulance twice, which stated that he had the flu. The paramedic was advised to drink vitamins. And as a result, he was taken to the hospital by the same brigade on a second call only after 6 hours: with a diagnosis of extensive myocardial infarction.

The paramedics apologized, but the condition was already critical and was stopped in cardio resuscitation.

Being engaged in reforming, it would be good to establish objective control over calls, and over erroneous diagnoses, and over the upcoming fines for a false call. Fines, by the way, back in November 2015 were offered by that Ministry of Finance. It is clear that the ambulance staff will try to fix their mistakes to a minimum, without normal control, patients will again suffer.

According to Russian doctors, about two-thirds of the ambulance calls to the elderly are the lack of adequate therapy for their chronic diseases. District therapists, who sometimes have 70 house calls, simply have no time to do this.

I think if we take the rural sector, then there will be even more aggravated neglected chronicles. And field diagnostic teams will not improve the situation much. FAPs should be reopened with targeted and regular visits by specialists.

An ambulance is often called by citizens with mental disorders, who do not want to be hospitalized in a specialized hospital. At the same time, the Ministry of Health is stubbornly reducing the number of employees in psychiatric clinics and dispensaries. Consequently, this category of persons will continue to chaotic calls, and will not even think about paying for it.

In the meantime, everything in the work of the ambulance remains unchanged. Medics will be free to save people and come to calls. This was stated to Novaya Gazeta by the Ministry of Health and the Moscow Department of Health.

On June 20, 2016, a new Decree of the Ministry of Health "On Amendments to the Procedure for Providing Emergency Medical Care to Russian Citizens" came into force. The corresponding order No. 33 was signed by Russian President Vladimir Putin on January 22 this year. The text of the new document caused a mixed reaction among all segments of the population. First of all, people were outraged by the fact that, according to the new law, an ambulance team can go to a person for free no more than four times a year. If a citizen suddenly calls doctors for the fifth time in a year, this call will already be paid. Let us consider in more detail what other changes were made to the federal law and how they will affect the quality of emergency medical services provided to citizens.

Law on paid ambulance from June 20, 2016

The text of the law on ambulance dated June 20, 2016 states that a free ambulance remains available only for the disabled, minors and the elderly, all other citizens will be able to call doctors free of charge only 4 times a year. In addition to this, the service, according to the new decree, will already be paid. The Government explains this limitation by the need to save money and a large number of worn-out machines. Among other things, the Ministry of Health proposed to fine people for unreasonable (false) calls.

Ambulance law 4 calls for free?

The law on paid ambulance services after the changes and the release of the decree in June 2016 implies 4 free calls per year. Further, if a person needs urgent medical support, he must already pay for the arrival of a medical team.

Changes in the acquisition of ambulances according to the law

In addition, in the updated order - resolution, part of the equipment of the "ambulance" was transferred to the category "on demand". This item means that medical teams will now be equipped with only the necessary equipment, depending on the regional characteristics of settlements (epidemiological, demographic, and so on). Excess, according to legislators, the equipment will need to be removed from the machines.

Change in the composition of the ambulance brigade - decision of June 20

As for the staffing of the brigade, here too, in accordance with the decree on emergency medical care, significant changes were made. So, if earlier the brigade included the positions of a paramedic-driver and an orderly-driver, but there were no nurses, then in the updated rules of the decree, the possibility of connecting nurses again appeared. However, orderlies and paramedic drivers have now been abolished, and instead there is only a driver who performs his direct duties as an ambulance driver, who is obliged to obey a doctor or paramedic.

In addition, now all brigades will be delimited, according to their profile, into:

pediatric;
resuscitation;
emergency advisory;
psychiatric.

So when making a call, it is important to clarify what exactly is happening with the patient, to describe his condition.

In a number of localities of the country, this list can be supplemented by specific teams, for example, arriving on a call by helicopter. If possible, rapid neurological or cardiac care teams will be created.

How long should an ambulance arrive according to the new law of June 2016

In settlements with a population of more than 100 thousand people, in accordance with the order of the Russian Ministry of Health, emergency medical substations are being organized with the calculation of a 20-minute transport accessibility.

If a metropolis has between 50,000 and 100,000 people, a quick support station is created in it, which operates around the clock as an independent medical facility. This innovation is also spelled out in the resolution.

In small villages and villages, branches of emergency care at local hospitals should be organized. In any case, the district authorities must provide anyone who calls the number "03" with the arrival of a team of doctors from the station (substation) or from a nearby medical facility.

Every person, regardless of age and gender, can apply for paid ambulance services. Services are provided without established service standards. That is, doctors stay with patients for as long as their condition requires.

On June 20, 2016, a new Decree of the Ministry of Health "On Amendments to the Procedure for Providing Ambulance to Russian Citizens" came into force. The order was signed by the President of the Russian Federation Vladimir Putin. The content of the document caused a different reaction among the population of Russia. First of all, people were outraged by the condition according to which the brigade can visit a person free of charge no more than four times a year. If a citizen needs an overtime call (the fifth in a year), he will have to pay for the services rendered.

The content of the recently adopted legislation states that only the elderly, minors and the disabled can count on free ambulance. Other residents of the country will not be able to use free services. With this decision, the Government will save money, which will be used to buy new ambulances. In addition, the Ministry of Health proposed to fine citizens for making false calls to the crew of doctors.

Changes in the law on the provision of emergency medical care

The new law changes the composition of the team of doctors

According to the resolution issued in 2016, a significant change affected the composition of the brigade. Previously, the ambulance team consisted of a driver and paramedic driver. There were no nurses. The new rules allow nurses to join the staff. Additionally, paramedics-drivers and orderlies-drivers have been abolished. Now there are duties only for the driver, who, in case of an emergency state of health, must obey the doctor.

All teams are now divided according to their professional activities:

resuscitation;
Pediatric;
Psychiatric;
Advisory emergency.

Therefore, before dialing 03, specify the state of the patient. Depending on the settlements of the Russian Federation, ambulance crews can also stay by helicopter. This is possible if it is far from the district center to the settlement or public roads were blocked due to a natural disaster. If necessary, doctors will be required to quickly create teams of cardiac or neurological care.

Ambulance arrival time

If more than 100 thousand citizens live in a settlement, then, in accordance with the order of the Ministry of Health of the Russian Federation, medical ambulance substations are created with a twenty-minute calculation of transport accessibility.

If there are from 50 to 100 thousand people in the city, according to the order, a special medical facility with round-the-clock quick support is created. A similar condition is also spelled out in the new resolution.

In small villages and villages, ambulance units should be built close to local hospitals. District authorities are required to provide medical services to anyone who calls 03.

In metropolitan areas with a population of more than 100 thousand people, an ambulance should arrive at the address within 20 minutes. Standards for the time of non-deferred support for other settlements are not established. The general rule is that the medical service is provided immediately. If doctors did not arrive at their destination within half an hour or refused medical assistance, a citizen can call 02. The illegal actions of doctors entail criminal liability (articles 124 and 125 of the Criminal Code).

How many times can you call an ambulance?

As mentioned above, a resident of the Russian Federation can call an ambulance no more than four times within one year. If you exceed the number of allowed calls, you will have to pay for the services.

Composition of non-deferred service machines

Now cars are equipped with new models of medical equipment that contribute to the use of modern technologies. There are devices that allow you to do an indirect heart massage with voice accompaniment. Artificial lung ventilation devices for newborns and children are also being installed.

The ambulance is equipped with a navigator and a video recorder. In 2017, more than 20,000 ambulances were equipped. In the northern regions, device navigators (video recorders and navigators) are in all medical aid vehicles.