What does specialized medical care mean? Organization of specialized medical care for the population. Centers for specialized medical care, types, tasks, structure
Specialized medical care is provided by specialist doctors in specialized medical institutions front with the use of the necessary types of honey. equipment. Specialized medical care - supreme view qualified medical care, which provides for the most complete and widespread use of the latest achievements of a particular field of medical science in the practice of treating the affected and sick.
During the Great Patriotic War, a harmonious, scientifically based system of specialized medical care was created in the USSR. In the post-war period, based on the study and critical analysis of the experience gained, further development and improvement of specialized medical care takes place.
In connection with possible application weapons of mass destruction, completely new contingents of the affected and sick may appear in need of specialized medical care.
The provision of specialized medical care can be carried out in field mobile hospitals (surgical, therapeutic, infectious diseases, neurological), in a hospital for the lightly wounded and in evacuation hospitals. Depending on the number of incoming injured and sick people in need of one form or another of specialized medical care, and the number of medical institutions available at the moment, hospitals can be created that are entirely specialized in one profile or have specialized departments in their composition.
Specialization of hospitals is carried out both by introducing specialists and the necessary equipment into their staffs, and by giving surgical and therapeutic field mobile hospitals specialized medical reinforcement groups from a separate detachment of specialized medical care.
One of the main requirements for the organization of honey. assistance in military field conditions, are continuity and consistency in the conduct of medical and preventive measures on the basis of uniform principles for the provision of honey. help the injured and the sick. Continuity in treatment is achieved primarily by a common understanding of the pathological processes that occur in the human body during lesions and diseases, and by uniform methods for the prevention and treatment of lesions and diseases in wartime. At the same time, the continuity of medical care and treatment can be carried out only if, at each subsequent stage, honey. evacuation will know what was done at the previous stage, what kind of medical care and when was provided to the injured or sick. This is achieved by a clear management of honey. documentation, in particular, by carefully filling out the primary medical card and maintaining medical histories (see Medical and evacuation support for troops, Staged treatment).
An important requirement for the organization of medical care in military field conditions is also the timeliness of its provision. Medical assistance should be provided at the most favorable time for the subsequent restoration of the health of the injured or sick person. Of particular importance is the timely implementation of urgent measures of first medical and qualified medical care.
The timeliness of the provision of medical care is achieved by including the necessary regular forces and means of the medical service in the troops of the active army, the fastest removal and removal of the injured and sick from the battlefield or from the centers of mass destruction and their transportation to the stages of honey. evacuation, clear organization of work at stages. Equally important is the rational arrangement of the stages of honey. evacuation.
See also Civil Defense Medical Service.
Types of medical care (first medical, pre-medical, medical, qualified, specialized)
Federal Agency for Health and Social Development of the Russian Federation
GOU VPO Altai State Medical University of Roszdrav
Department of Faculty Therapy
Speciality
- Economics and management in a healthcare enterprise
course work
in the discipline "Modern medical technologies"
on the topic: Types of medical care (first medical, pre-medical, medical, qualified, specialized)
Barnaul - 2011
Introduction
1. First aid
2. First aid
3. First aid
4. Qualified medical care
5. Specialized medical care
6. Development of medical care
Conclusion
Bibliography
INTRODUCTION
General concept"medical assistance" to a person in a state of danger to life and health" means therapeutic and preventive measures carried out in order to save the life of the wounded or sick, as well as to speedy recovery their health.
Medical care is a set of therapeutic and preventive measures carried out in case of diseases, injuries, pregnancy and childbirth, as well as in order to prevent diseases and injuries.
Distinguish next levels medical care:
· First aid · First aid · First aid · · First aidcarried out by people who do not necessarily have special medical education. The first aid level does not involve the use of any special medical instruments, medicines or equipment. First aidturns out to be persons with special training for the provision of medical care. This is the average medical staff (paramedic, nurse) or pharmacist, pharmacist. This is their level of knowledge and skills. First aidis provided by a doctor who has the necessary tools, medicines, and the amount of such assistance is regulated by the conditions for its provision, i.e. where she ends up - outside of hospital conditions or in a clinic, an ambulance, in admissions office hospitals. Qualified medical careturns out specialist doctors high qualification in conditions multidisciplinary hospitals or trauma centers; Specialized medical carecan be rendered directly high level in the conditions of specialized clinics, institutes and academies. A feature of medical care is the combination of treatment and prevention, as a result of which it is called treatment-and-prophylactic. The same name is given to institutions that provide medical care to the population. Medical institutions include hospitals, polyclinics and outpatient clinics, dispensaries, women's consultations And maternity, medical and sanitary units and health centers, sanatoriums, feldsher-obstetric stations, etc. The theme of my work is "Types of medical care (first medical, pre-medical, medical, qualified, specialized)". In the literature, even in regulatory documents, the concepts of first aid, first aid, ambulance. It's not the same thing. These are completely different sometimes even legal concepts. In my work, I will try to reveal them as fully as possible. 1. FIRST AID
The health and life of victims and suddenly ill often depends on the timeliness and quality of the assistance provided by people who usually have nothing to do with medicine, but they are more often than doctors or paramedics are nearby. This is first aid. It depends on the level of medical knowledge, skills and abilities of witnesses and participants in the incident. First aid - a type of medical care, including a complex of protozoa medical events performed directly at the scene or near it in the order of self - and mutual assistance. First aid- a set of urgent simple measures to save a person's life and prevent complications in the event of an accident or sudden illness, carried out at the scene by the victim himself (self-help) or by another person nearby (mutual assistance). First aid includes measures to stop the impact of factors that can aggravate the condition of the injured (sick) or lead to death, eliminate phenomena that directly threaten their lives (bleeding, asphyxia, etc.), taking measures to prevent complications and ensure the evacuation of victims (patients) without a significant deterioration in their condition. First aid can be provided at the site of injury by the victim himself (self-help), his comrade (mutual assistance), sanitary combatants. First aid measures are: temporary stoppage of bleeding, application of a sterile dressing on the wound and burn surface, artificial respiration and indirect heart massage, administration of antidotes, administration of antibiotics, administration of painkillers (in case of shock), extinguishing burning clothing, transport immobilization, warming, shelter from heat and cold, putting on a gas mask, removing the affected from the infected area, partial sanitization. First aid is aimed at maintaining the life of the injured (patient) and preventing the development of complications. It includes the extraction of victims from the seats of fire, from under the rubble; extinguishing burning clothes and incendiary mixture that has fallen on the body; a temporary stop of bleeding, the imposition of a sterile dressing on the wound (burn) surface; the use of antidotes in case of damage by toxic substances; elimination of asphyxia by freeing the upper respiratory tract from mucus, blood and foreign bodies, fixing the tongue when it retracts; applying an occlusive dressing using a rubberized shell of an individual dressing bag; the introduction of an anesthetic using a syringe tube; immobilization using improvised means; the use of antibiotics and certain other drugs; partial special treatment of open areas of the body and clothing adjacent to them. First medical (paramedic) assistance includes the following three groups of activities: ) Immediate cessation of exposure to external damaging factors (electric current, high or low temperature, compression by weights), removal of the victim from adverse conditions. ) Providing first aid to the victim, depending on the nature and type of injury, accident or sudden illness (stopping bleeding, bandaging a wound, artificial respiration, heart massage, etc.). ) Organization of the speedy delivery of the victim to a medical institution. First aid includes, if necessary, the simplest measures to revive the body (first aid resuscitation). It is known that after the moment of death of a person, various organs and tissues of his body do not die immediately, but gradually, therefore, their functions, including blood circulation and respiration, in some cases can be restored. Revival is possible in short span time after the onset of the so-called. clinical death, i.e. after respiratory and circulatory arrest: usually within 6-8 minutes. Later, biological death occurs, and the probability of revival decreases sharply, and the full restoration of life, including mental activity, is practically impossible (with the exception of those frozen or drowned in cold water). Clinical death can be caused by trauma, poisoning, hypothermia, electrical injury, myocardial infarction, etc. The “lifeless posture” helps to determine the fact of the absence of breathing and cardiac activity, that is, the position of the body, which is not characteristic of a living person; respiratory movements chest absent, the pupils are wide, the heartbeat is not audible. To restore breathing, you must first free the body from restrictive clothing and ensure the patency of the upper respiratory tract so that air can freely pass into the lungs. Artificial respiration in the absence of medical instruments and devices is carried out using the mouth-to-mouth or mouth-to-nose methods, i.e. air is blown into the victim's lungs. Requires a rhythmic repetition of vigorous breaths at a frequency of 12-15 times per minute. An indirect heart massage is performed with a complete cardiac arrest and with agonal disturbances in the rhythm of its contractions. Artificial ventilation of the lungs provides ample oxygen saturation of the blood, so the task of a heart massage is to ensure the movement of blood through the body, deliver oxygen to the vital organs of a person, and thereby restore independent cardiac activity and respiration. An indirect heart massage is performed as follows: by sharp pressure of the palm on the sternum of the victim, the assisting person causes squeezing of the stopped heart between the sternum and spine and reduces it in volume, which leads to the release of blood into the aorta and pulmonary artery. The cessation of pressure leads to the expansion of the chest, the heart restores its volume, is again filled with blood coming from the vessels. Thus, artificially induced contractions of the heart occur, ensuring its work as a pump, and artificial circulation. It should be remembered that the provision of artificial circulation and artificial respiration, even if they do not lead to the restoration of spontaneous heartbeat and respiration, prolong the state of clinical death and delay biological death, this can be crucial for the effective action of the ambulance team. Providing first aid as soon as possible early dates is crucial for the further course and outcome of the defeat, and sometimes saving lives. At heavy bleeding, electric shock, drowning, cessation of cardiac activity and respiration, and in a number of other cases, first aid should be provided immediately. When providing first aid, personal and improvised means are used. First aid equipment is dressing- bandages, medical dressing bags, large and small sterile dressings and napkins, cotton wool, etc. To stop bleeding, hemostatic tourniquets are used - tape and tubular, and special tires for immobilization - plywood, ladder, mesh, etc. When providing first aid some medicines are used - a 5% alcohol solution of iodine in ampoules or in a vial, a 1-2% brilliant green alcohol solution in a vial, validol in tablets, valerian tincture, ammonia in ampoules, sodium bicarbonate (baking soda) in tablets or powder, petroleum jelly, etc. For personal prevention of lesions by radioactive, toxic substances and bacterial agents in the lesions, a first-aid kit is used
individual (AI-2). The general principles of first aid for injuries and acute illnesses are as follows: stop and prevent further impact on the victim of the damaging factor, while ensuring the safety of the rescuer; take measures to restore and maintain vitality as quickly and fully as possible. important functions the victim's body. It is important at the same time to observe the postulate of Hippocrates - "do no harm." Therefore, it is necessary to clearly master not only the correct sequence of actions, but also what absolutely cannot be done in this or that state. After providing the necessary medical assistance, you should quickly deliver the victim to a medical facility or call an ambulance to the scene. The sooner medical assistance is provided, the greater the chance of saving the victim. First of all, do not rush to act, first assess the situation, determine priority tasks, and then act. The first is administrative action. Ensure the safety of yourself and the victims: drive away the dog, separate the fighters, call the police, firefighters, extinguish the flames, mark the scene of the incident on the roadway, help get out or pull the victim out of the broken car ... Second, evaluate real threat for the life of the victim (impaired consciousness, difficulty breathing, weakness of cardiac activity, bleeding, pain shock) and take immediate action. Third, after making sure that the victim is in a safe place and his life is not threatened by blood loss or airway obstruction, wait for the ambulance to arrive and start providing first aid. If a person's life is not threatened by any real danger, that is, he is conscious, the injuries received are minor, breathing and pulse are easily recognized. Remove restrictive clothing, give sedatives and painkillers, treat the wound, comfortably lay a limb with signs of a fracture or dislocation in an elevated position, apply cold to the injured area. Do not forget about the possibility of taking some drugs "under the tongue" (sublingually), as they act faster and with less harm to the gastrointestinal tract (especially important for abdominal injuries). Read the instructions for use. These drugs include analgin and valocordin - they are in every first aid kit. If the injury is serious, active movements, consciousness is fuzzy to give the victim a safe position. Help the victim to take a comfortable position, in which the pain is the least. If consciousness is absent or confused, put the victim on his side, if breathing is difficult to throw back his head, make sure that breathing is free. For example, with a fracture of the pelvis and hip joints, you should take the frog pose. To do this, the victim must be laid on his back on a hard, flat surface, bending his legs at the knees, slightly spreading them to the sides and placing a roller under his knees Stop bleeding from a wound. To do this, apply a pressure bandage or tourniquet if blood flows in a pulsating stream from a wound on the leg or arm. The pressure of the tourniquet should be sufficient for you to observe the cessation of bleeding. After 2 hours (not later!) Relax the applied tourniquet, if bleeding continues, tighten it again. With a sudden cessation of cardiac activity, the signs of which are the absence of a pulse, palpitations, pupillary response to light (dilated pupils), immediately proceed to indirect massage heart and artificial lung ventilation. In case of fractures of the limbs, use transport splints that fix two adjacent to the broken segment of the joint. Do not allow support on the "broken" leg, you can use improvised means of additional support (cane, crutch). Fourth. If calling an ambulance is not possible, consider ways to deliver the victim to the nearest medical facility (on their own, in a car unsuitable for ambulance transportation, on a stretcher, in a prone position, sitting, standing ...). Transportation itself can lead to even greater traumatic injuries, therefore, correlate the nature of the injury and the means of evacuation available to you. So, for example, the transportation of victims with a spinal injury should be carried out only in the supine position on a hard shield, and with a chest injury only while sitting. It is necessary to monitor the tourniquet and the bandage. The swelling that grows on the first day can lead to tissue compression, the bandage must be cut and replaced with a new one. Periodically, after 2 hours (not later!) after application, relax the tourniquet, to do this, slowly relax the applied tourniquet, wait 5 minutes if the bleeding continues and it has clear signs arterial bleeding, - tighten it again. When injured, the victim is given first aid. The task of first aid is to save the life of the victim by carrying out the simplest measures, reduce his suffering, prevent the development of possible complications, and alleviate the severity of the injury or illness. 2. FIRST AID Conventionally, pre-medical care can be divided into assistance provided by paramedical staff: paramedic, midwife, nurse, and assistance provided by people who do not have special medical training, in the order of first aid. First aid is the beginning of the treatment of injuries, because. it prevents complications such as shock, bleeding, infection, additional displacement of bone fragments and injury to large nerve trunks and blood vessels. It should be remembered that the timeliness and quality of first aid largely depends further state health of the victim and even his life. For some minor injuries, medical assistance to the victim may be limited to only the volume of first aid. However, with more serious injuries (fractures, dislocations, bleeding, injuries internal organs etc.) first aid is initial stage, since after its provision, the victim must be taken to a medical institution. First aid is very important, but will never replace qualified (specialized) medical care if the victim needs it. The first pre-medical emergency aid is a complex of the simplest measures aimed at saving lives and preserving human health, carried out before the arrival of a doctor or the delivery of the victim to the hospital. First aid turns out to be a paramedic with standard medical equipment. It is aimed at combating the life-threatening consequences of injuries (diseases) and preventing serious complications. In addition to first aid measures, it includes: elimination of asphyxia by introducing an air duct, artificial ventilation lungs using portable devices, inhalation of oxygen, control over the correct application of the tourniquet, correction or, if indicated, the application of the tourniquet again; applying and correcting bandages; reintroduction painkillers, antidotes, the use of antibiotics, cardiovascular and other medicines available on the equipment of the paramedic; improvement of transport immobilization using standard and improvised means; partial special treatment of open areas of the body and degassing of clothing adjacent to them; if possible, warming the affected and sick. The main tasks of first aid are: a) holding necessary activities to eliminate the threat to the life of the victim; b) prevention of possible complications; c) ensuring the most favorable conditions for the transportation of the victim. First aid to the victim should be provided quickly and under the guidance of one person, since conflicting advice from outside, fuss, disputes and confusion lead to the loss of precious time. At the same time, the call of a doctor or the delivery of the victim to the first-aid post (hospital) must be carried out immediately. The algorithm of actions to save the life and preserve the health of the victim should be as follows: a) the use of personal protective equipment by a paramedic or nurse (if necessary, depending on the situation); b) elimination of the cause of the impact of threatening factors (withdrawal of the victim from the gassed area, release of the victim from the action of electric current, extraction of the drowning person from the water, etc.); c) urgent assessment of the condition of the victim ( visual inspection, inquire about well-being, determine the presence of signs of life); d) call for help from others, and also ask to call an ambulance; e) giving the victim a safe position for each specific case; f) take measures to eliminate life-threatening conditions (resuscitation, stop bleeding, etc.) g) do not leave the victim unattended, constantly monitor his condition, continue to support vital functions his body before the arrival of medical workers. The first aid provider should know: basics of work in extreme conditions; signs (symptoms) of violations of vital systems of the body; rules, methods, techniques for providing first aid in relation to the characteristics of a particular person, depending on the situation; methods of transporting victims, etc. The caregiver must be able to: assess the condition of the victim, diagnose the type, features of the lesion (injury), determine the type of necessary first aid, the sequence of appropriate measures; correctly carry out the entire complex of emergency resuscitation care, monitor the effectiveness and, if necessary, adjust resuscitation taking into account the condition of the victim; stop bleeding by applying a tourniquet, pressure bandages, etc .; apply bandages, scarves, transport tires for fractures of the bones of the skeleton, dislocations, severe bruises; provide assistance in case of electric shock, including in extreme conditions (on power transmission poles, etc.), in case of drowning, thermal, sunstroke, in acute poisoning; use improvised means when providing PDNP, when transferring, loading, transporting the victim. Medical institutions providing first aid are feldsher health centers at enterprises and feldsher-obstetric stations in countryside. The decisive role in the provision of first aid at industrial enterprises belongs to health centers. However, it is not always possible for a health worker to provide needed help during. Due to this great importance has self-help and mutual help. First aid provided by people who do not have special medical training consists in carrying out the simplest measures at the scene of the incident (in the workshop, on the street, at home) before the arrival of the paramedic. Training of the population in some methods of medical care according to special programs is carried out by organizations of the Red Cross, as well as in courses at enterprises. These programs include training in the application of a tourniquet, pressure bandage, compression of large vessels, application of simple dressings, artificial respiration techniques, splinting for fractures. Particular attention should be paid to the practical demonstration of first aid. The system of organizing self-help and mutual assistance includes training workers in the rules for providing first aid in relation to production conditions, and the creation of sanitary posts. Sanitary posts for the provision of first aid in the shops are created from among well-trained workers; these posts are especially necessary in the areas of the workshop, remote from the health center. The sanitary post should be equipped necessary materials for first aid: stretchers, individual aseptic bags, cotton-gauze dressings, splints, hemostatic tourniquets, iodine alcohol solution, ammonia, tincture of valerian, etc. It is important that each worker of the shop is aware of the location of the sanitary post. Workers should be familiar with safety regulations. In rural areas, the organization and provision of first aid is carried out by the FAP. During the period of sowing and harvesting campaigns, sanitary posts are organized in each brigade; tractor and combine operators are provided with individual aseptic bags and are trained to use them. Along with the training of agricultural workers and collective farmers in the rules of self-help and mutual assistance, they should also be introduced to the rules of agricultural labor safety and the most common causes injuries. 3. FIRST AID
First aid -a type of medical care that includes a set of therapeutic and preventive measures performed by doctors (as a rule, at the stage of medical evacuation) and aimed at eliminating the consequences of injuries (diseases), directly life threatening the affected (sick), as well as the prevention of complications and the preparation of the affected (sick), if necessary, for further evacuation. First aid is provided by a doctor at the first-aid post and is aimed at eliminating or mitigating the consequences of injuries (lesions), life-threatening diseases, preventing the development of complications or reducing their severity, as well as preparing the injured and sick for further evacuation. It includes such medical measures as stopping external bleeding by applying a clamp, eliminating acute respiratory failure, anti-shock measures, transport immobilization, measures to prevent wound infection, puncture Bladder, the use of symptomatic medications and etc. 4. QUALIFIED MEDICAL CARE
Qualified medical care -a type of medical care, including a complex of comprehensive therapeutic and preventive measures performed by medical specialists of various profiles, in specialized medical institutions using special equipment, the main types of specialized medical care provided in various emergency situations, is neurosurgical, ophthalmological, traumatological, toxicological, pediatric, etc. Qualified help carried out in individual medical institutions. It is aimed at eliminating the life-threatening consequences of lesions and diseases, preventing the development of complications and preparing those in need for further evacuation and is divided into surgical and therapeutic. Skilled surgical care includes final stop bleeding; complex therapy acute blood loss, shock, traumatic toxicosis; elimination of asphyxia; primary surgical treatment of wounds; laparotomy in case of damage to the abdominal organs; decompressive craniotomy; amputation with detachments, crush injuries and ischemic necrosis of the limbs and others urgent measures. Qualified therapeutic assistance includes complex therapy cardiovascular insufficiency, violations heart rate, acute respiratory failure; the introduction of antidotes; the use of painkillers, desensitizers, antiemetics, anticonvulsants and bronchodilators, as well as tranquilizers, neuroleptics and other medications. 5. SPECIALIZED MEDICAL CARE
most characteristic current trend in the development of medical care is specialization. Outpatient and inpatient medical care is provided not only in the main specialties: therapy, surgery, traumatology, pediatrics, neuropathology, ophthalmology, otorhinolaryngology, dentistry, obstetrics and gynecology, but also in many specialties: cardiology, rheumatology, gastroenterology, pulmonology, endocrinology, oncology, allergology, urology, nephrology, proctology, etc. Specialized medical care -a type of medical care that includes a complex of comprehensive therapeutic and preventive measures performed by medical specialists of various profiles in specialized medical institutions using special equipment for patients with a certain pathology. Specialized care provided by specialist doctors in specialized hospitals specially designed for this purpose and having the appropriate equipment is exhaustive. The main types of specialized medical care are: surgical, including neurosurgical, ophthalmological, maxillofacial, otorhinolaryngological, thoracoabdominal, urological, care for burned and lightly injured; therapeutic, including radiological, toxicological, psychoneurological, dermatovenereological, assistance to patients with somatic diseases and infectious patients; assistance to patients with tuberculosis, mildly ill. The specialization of medical care is the result of scientific and technological progress and a historically determined process of the development of medical science and healthcare practice, which led to the separation of separate specialties. Specialized medical care is an integral part of the organization of medical and preventive care and the entire health care system, which largely determines the path of its development. Specialization in Medicine Leads to Differentiation medical specialties, scientific substantiation of the principles of organizing medical care, changing the functions of medical institutions, their typification and structure, strengthening the material, technical and personnel base of healthcare, etc. From the level of specialization, forms and methods of organization specialized types medical care depends on the quality of prevention, diagnosis and treatment various diseases and efficiency of rehabilitation of patients. Simultaneously with the differentiation of scientific knowledge and practical medicine the integration process is also developing, contributing to the complexity of the diagnostic and treatment process. Specialization and integration in practical healthcare largely determine the improvement of the organizational forms of specialized types of medical care. The creation of specialized offices, departments, institutions, diagnostic centers, the introduction of a team method of work, the principles of stages and medical zoning, as well as other organizational forms and methods, are a reflection of these processes. 6. DEVELOPMENT OF MEDICAL CARE
The development of medical care in present stage characterized by a constant trend towards specialization in both community and inpatient care, expressed in the expansion of the network of specialized institutions, an increase in the number of specialist doctors of various profiles, outpatient appointments, departments and beds in hospitals. Various specialized teams function in the ambulance service, which contributes to the expansion of the volume and nature of the assistance provided by doctors on the spot and during the transportation of the patient to a medical institution, and most importantly, to improve the quality of medical care. A network of emergency hospitals is developing, the main tasks of which are to provide specialized emergency inpatient medical care to the population. Importance is given to the development of diagnostic and laboratory services, where specialization also takes place, new diagnostic areas are constantly highlighted, new rooms and laboratories are being created. Trends in the development of specialized medical care at the present stage are characterized, first of all, by the construction of large multidisciplinary and specialized hospitals, specialized centers, dispensaries, etc., which allows them to create specialized structural units equipped with modern equipment and provided with highly qualified specialists. The organization of specialized departments, centers contributes to the improvement of the qualifications of medical staff, the quality of medical care, the more rational use of the bed fund, personnel of specialists and medical equipment. In modern city multidisciplinary hospitals, medical care is provided to the population in all major specialties. There is a development and strengthening of regional (regional, republican) hospitals, where qualified highly specialized medical care is provided. A special role in the provision of certain types of specialized care belongs to dispensaries (cardiological, narcological, oncological, dermatovenerological, anti-tuberculosis, psycho-neurological, endocrinological, medical and physical education), which can provide both out-of-hospital and inpatient medical care, as well as specialized hospitals - infectious diseases, ophthalmological, psychiatric, tuberculosis, etc. The development of out-of-hospital specialized medical care requires appropriate conditions and organizational forms. The experience of Russian and foreign health care shows that in order to provide highly qualified out-of-hospital specialized medical care, it is necessary to rationally locate specialized rooms, departments, institutions, taking into account the phasing in the organization and the principle of medical zoning. At the same time, it is necessary to provide for the approach to the population of the main and centralization of highly specialized types of medical care. At the first stage, in medical outpatient clinics, territorial polyclinics, medical and sanitary units, the following main medical profiles should be received: therapeutic, surgical, obstetric-gynecological, pediatric, dental. At the second stage in polyclinics of central district hospitals, large urban polyclinics, diagnostic centers organize appointments in narrower specialties (neurology, traumatology, cardiology, ophthalmology, otorhinolaryngology, etc.). The third stage is highly specialized departments, centers created to provide allergological, gastroenterological, nephrological, pulmonological, rheumatological, endocrinological, urological and other types of medical care on the basis of large city multidisciplinary and regional (regional, republican) hospitals, to-rye can also perform the functions of interregional , inter-republican. The fourth stage - all-Union and republican specialized centers, organized, as a rule, on the basis of clinics of institutes, providing organizational, methodological and advisory assistance to the population of a union republic or the whole country. A special role in the development of specialized medical care belongs to the chief specialists of health departments, regional (territorial, district) and city health departments (general practitioners, surgeons, pediatricians, obstetrician-gynecologists, etc.). Their importance is especially great in rural areas, where the chief specialists of the central district hospitals are an important part of the healthcare management system. They, besides diagnostic and treatment, do a lot of work as organizers, consultants and methodologists of the relevant specialized services. Their main tasks are the development and implementation of measures aimed at preventing diseases, improving the efficiency and quality of medical care, and putting into practice medical and preventive institutions. latest methods diagnostics, treatment and rehabilitation of patients, rational and efficient use of human and material resources of health care. The specialization of medical care, among others, put forward the problem of training the appropriate personnel of specialists. The changes made to the system of medical education were due to the need to combine specialized training with general medical education on a broad natural science and socio-hygienic basis. In Russia, a harmonious system of specialization and improvement of doctors has been created, which is carried out by institutes for the improvement of doctors, faculties of improvement at medical universities, bases of primary specialization at large republican, regional, regional and city hospitals, as well as a system of clinical residency. At different stages of the development of health care, in accordance with its tasks, at each stage the forms and methods of medical and preventive care were improved and improved, however, the fundamental foundations and the socialist nature of its organization remained unchanged, thanks to which the modern one system organization of specialized medical care. Great attention is paid to the further development of specialized medical care in the national project "Health", which notes that an indispensable condition for further reducing the incidence and mortality of the population, improving the quality of medical care is the development and strengthening of its specialized types. It is planned to create a network of interregional (regional) centers with departments and branches for microsurgery, pacing, joint prosthetics, organ and tissue transplantation, cardiovascular surgery, for the treatment of patients with chronic renal failure, etc.; to increase the number of inter-district specialized hospitals, dispensaries, departments in order to meet the needs of the rural population in specialized care. In particular, inter-district ophthalmological departments will be developed, the provision of medical care to patients with eye diseases will be improved. Cardiology dispensaries are being modernized in all regional and regional centers, the number of cardiology rooms in polyclinics and departments in hospitals has been expanded. The work of oncological centers is being improved, the construction of oncological dispensaries and radiological buildings is being expanded. In order to improve the level surgical care cardiosurgical, vascular, orthopedic, traumatological, neurosurgical, urological, proctological, burn and other highly specialized surgical departments are developing and strengthening. The task was set to radically improve the provision of dental care population, especially children, to ensure full satisfaction of needs in all its forms. Allergological rooms and immunological laboratories should be organized in each region and territory. It is planned to implement extensive measures to prevent the most common diseases nervous system And mental disorders: further organization and improvement of the work of departments for patients with acute disorders cerebral circulation, the creation of centers in large cities rehabilitation treatment for the rehabilitation of people with diseases of the nervous system, expansion of the network of neuropsychiatric dispensaries, hospitals and their departments in rural areas. There must be a fundamental improvement in the work on early detection And effective treatment persons suffering from alcoholism and drug addiction. It is planned to strengthen and develop pulmonological, gastroenterological, endocrinological, hematological and other assistance. paramedic medical assistance medical A large role in the provision of specialized medical care belongs to the nursing staff working in specialized rooms, departments and institutions. This imposes certain requirements on the training of nursing staff and the organization of their work. For example, a nurse working in surgical department must have completed an appropriate specialization in surgery. She must know desmurgy well, master the technique of subcutaneous, intradermal and intravenous injections, temporary stop of bleeding, be able to properly carry out immobilization, master the plaster technique, know how to sterilize syringes, material, tools, storage rules and their expiration dates. Nurses of various specialized offices (otorhinolaryngological, ophthalmological, infectious diseases etc.) must be proficient in certain methods of examining patients of the appropriate profile and performing procedures, etc. CONCLUSION
Medical assistance to the population is based on the territorial-district and production principles. The district principle ensures continuity in the observation of the patient by the same doctor, active identification of patients with initial forms of the disease, and comprehensive preventive measures. The leading method of work of medical institutions is dispensary. In the system of organizing qualified free public medical care, there are therapeutic and preventive care for the urban population, including medical care provided in medical units and health centers; medical assistance to the rural population; medical care for children; obstetric and gynecological care, etc. By its nature, medical care can be out-of-hospital (including home care), inpatient and sanatorium-resort. One of the important links of community care is emergency and emergency medical care, which is organically linked with polyclinics and hospitals. To provide this type of medical care, a wide network of specialized institutions has been created - stations, substations, departments and hospitals. Emergency medical care, in addition, should be provided by any medical institution, regardless of departmental affiliation. Inpatient medical care is provided in general, multidisciplinary and specialized hospitals, maternity hospitals, hospitals of medical units, dispensaries, research medical institutes, as well as in clinics of medical universities. In the general complex of health-improving and preventive measures, sanatorium-resort care is of great importance. Medical assistance, with the exception of cases of self-help and mutual assistance, is provided only by persons with a special medical education, while an important role belongs to the nursing staff. The high qualification of paramedical personnel is a necessary condition for the effective functioning of the medical care organization system. BIBLIOGRAPHY
1.Evdokimov N.M. Provision of first medical aid. -M., 2001 2.Eliseev O.M. Handbook for the provision of ambulance and emergency care. - St. Petersburg: Ed. LLP "Leyla", 1996. .Zhdanov G.G., Zilber A.P. Resuscitation and intensive therapy. - M.: Publishing Center "Academy" 2007.-400s. .Brief Medical Encyclopedia. M .: / Publishing house "Soviet Encyclopedia", second edition, 1989. 6.Directions, main activities and parameters of the priority national project "Health". Approved by the Presidium of the Council under the President Russian Federation on the implementation of priority national projects (minutes No. 2 of December 21, 2005) 7.Organization and tactics of the medical service. / Ed. N.G. Ivanova and O.S. Lobastova, St. Petersburg, 1988. 8.First aid: reference book M., 2001 .Order of the Ministry of Health and Social Development of the Russian Federation (Ministry of Health and Social Development of Russia) dated April 16, 2010 N 243n M. / On the organization of the provision of specialized medical care. 10.Safonov A.G., Loginova E.A. Inpatient medical care (basics of organization). M., 2003. -180s. .Sumin S.A. Urgent conditions - M .: Litera, 1997. 12.Federal law "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens", M., 2006 .#"justify">.http://extreme.aplus.ru
Specialized medical care is such services that a citizen of our country in need of medical care can count on if he has a disease from a certain list. Assistance is expected, including high-tech, using the most modern means and approaches, techniques and preparations. It can be counted on in the diagnosis, treatment of pathologies using medical technologies requiring significant investments and resources. The citizens of our country have access, including to unique technologies.
Appearances and passwords
Specialized health care is a service that is the responsibility of a specialist in a specific medical field. This applies only to doctors working in a strictly defined number of institutions providing thematic services to the population. These organizations are not only medical, but also engaged in the prevention of various pathologies.
Specialized medical care is the services of medical institutions, which all citizens of our country can count on. The system also includes some other organizations responsible for health protection, including the municipal level. There are several private institutions - all of them have previously received a license in the prescribed form and can legally provide medical services to the population from the specialized class. Such activities require a special permit.
Who is supposed to
Specialized medical care is a complex that a person can count on if it is necessary to formulate a final diagnosis, while it is clear that the course of the disease is atypical, and the currently practiced therapeutic program does not work. Also, such services can be provided if repeated courses of treatment also do not show a good result, but doctors reasonably assert that the use of more modern approaches will allow a positive effect to be obtained. This applies to surgical interventions and the provision of medical services using the most modern and sophisticated technology.
You can contact a specialized medical care center if necessary. surgical intervention, but its implementation is associated with an increased risk of complications provoked not only by the main pathology, but also by additional ones identified in a particular patient. Patients requiring rehospitalization may be eligible for assistance under such a program if recommended by a federal government agency.
When else?
The current laws establish that the provision of specialized medical care should be provided if the case is recognized as difficult to diagnose and additional measures are required to complete the work on formulating the specifics of the situation. Similar conditions apply to comprehensive training to surgical intervention, if the patient's condition is complicated additional factors, associated pathologies.
If it is assumed that the only effective therapy in a specific case - a surgical intervention using particularly modern and precise technology, then as a preliminary preparatory phase the organization of specialized medical care is used to identify all aspects, features of the condition of a particular patient.
How to find out the details?
In our country, an order on specialized medical care was issued that applies to all subjects and regions. It follows from it that in state institutions included in the list of those responsible for this type of medical services, the staff undertakes to provide timely information about the service to all citizens who apply. The data must be transmitted immediately at the time of the application of the applicant or the person representing him.
No less important financial aspect. As determined by law, all information about the healthcare of specialized medical care should be transferred to interested parties completely free of charge, it is prohibited by law to take money for this. Not only citizens of our country can count on this, but also persons who have citizenship of another power or do not have any at all.
How to get a?
Currently, specialized medical care for children and adults is provided only if the person concerned complies with the letter of the law. In particular, it is necessary to provide a complete list of the documentation specified in the regulations, otherwise the medical institution simply does not have the right to include the applicant in the list of those to whom the service will be provided.
IN without fail you must present a copy of the referral issued by the doctor for special assistance. In this paper, doctors indicate information about a person’s state of health, mention which diagnostic measures were carried out, which therapeutic methods were applied and what results it brought. The pathology profile is also mentioned. In some cases, there is no profile information. There is a possibility that the applicant does not even have a referral. If this is not available, but the service is required, you must contact the responsible institution for clarification of the details of participation in the program.
What can be added?
Normally, all types of specialized medical care established by the current legislation are provided to applicants with or without a referral, but it is obvious that the need to provide timely assistance. At the same time, the tendency of many institutions in the state to bureaucracy encourages applicants to collect additional documentation to draw attention to their case: the more pieces of paper, the more serious the situation.
As additional documentation support in accordance with the current standards of specialized medical care, the following can act:
- compulsory medical insurance policy;
- SNILS;
- documentation from which the powers of the representative of the person in need of the service follow;
- documentation confirming the identity of the representative.
Regulations
The procedure and rules for the provision of specific medical services are stipulated in an order of the Ministry of Health issued seven years ago. The document was issued in April under the number 243n. It also discloses aspects of financing institutions providing this kind of medical service.
It is officially stated that in some cases on the territory of a particular subject there may be a lack of funding opportunities for medical institutions capable of providing special services to the population. In such a situation, citizens in need of therapeutic, diagnostic, surgical care can apply to institutions located in other regions, as well as to other federal health, various medical organizations, having the appropriate capabilities, technical capacity and qualified personnel.
When to pay, when not?
The order of the Ministry of Health states that special assistance can be not only free, but also provided at the expense of private individuals, any interested organizations. The option that does not require payment must satisfy the requirements of the federal program, which considers aspects of state guarantees to individual citizens of the state in relation to medical care. In this case, funding is organized from specific thematic budgets collected under the program compulsory insurance funds.
High technologies to help people
High-tech is a special assistance service that involves the use of the most complex techniques, often unique approaches. The methods used in such research are resource intensive. An important condition for the inclusion of a technology in the list of high-tech technologies is the proven effectiveness of its application, which should be confirmed not only clinical trials, but also scientific calculations.
One of the important areas of high-tech special assistance is cellular development. No less significant is another thing that has been promoted recently - robotic technology. Active use of the latest information technologies available scientific community approaches of genetic modification, engineering. In a word, all more or less developed methods created within the framework of medical science and related industries are used.
Some specific documents
In some cases, the provision of special assistance is possible if the applicant has a referral within which he must lie on planned hospitalization. Such a paper can be signed by the attending doctor, who is assigned the area where the sick person lives. In some cases, the paper is prescribed by other doctors who have the right to do so in accordance with their official duties, if the patient contacts them directly.
If the consultation is carried out in absentia, then get special services in medical institution it is possible if there is a special protocol confirming that this particular candidate was selected by the commission from the entire proposed list of patients. If a disabled citizen applies for medical assistance, it is necessary to attach an ITU certificate to the general package of documents.
Additional official papers
In most modern medical facilities, the applicant will be asked to provide a copy of the passport pages confirming the registration information, as well as personal data (including a photograph). If a representative of a minor patient who is under the age of 14 and for this reason does not yet have a passport applies for help, it is worth providing a birth certificate to make a copy of it, and the parent will need to present an identity document where the child is entered. When applying for a guardian, you should have a certificate confirming guardianship, as well as documentation identifying the person (passport).
It will not be superfluous to attend to the execution of an extract from the medical card so that there are no additional questions. It is worth remembering that the indications for hospitalization in accordance with the plan are, first of all, the responsibility of the doctor who is assigned to the area where the patient is registered.
What to expect?
On the territory of each federal subject, documents are annually adopted that set out the framework for financing under special programs. Accordingly, it can be expected that CHI will cover those costs of treatment that meet the standards specified in such documentation. If this limit is exceeded, you will probably have to pay extra from your own funds or ask for help from some organization. In addition to the current standards for the current year, planning documents are also regularly adopted. This allows patients to orient themselves in their possibilities of receiving free treatment in the near future.
Specialized medical care
With the entry into force of the Federal Law "On the General Principles of Organization of Legislative (Representative) and Executive Bodies of State Power of the Subjects of the Russian Federation" of October 6, 1999 N 184-FZ (as amended by the Federal Law of July 4, 2003 N 95-FZ), which established that to the powers of the bodies state power of the subject of the Russian Federation, the subjects of joint jurisdiction include the organization of the provision of specialized medical care in dermatovenerological, tuberculosis, narcological, oncological dispensaries and other specialized medical institutions, several issues have acquired particular relevance in the professional community:
what is specialized assistance;
what medical organizations are specialized;
whether only specialized medical organizations provide specialized medical care or, in other words, whether specialists from outpatient clinics and multidisciplinary hospitals at various levels provide specialized medical care;
Who owns the specialized medical organizations and, therefore, who bears the expenditure obligations to finance the medical care provided in them?;
Article 40 of the Fundamentals of Legislation on the Protection of Citizens' Health (as amended by N 122-FZ of August 22, 2004) establishes that "specialized medical care is provided to citizens with diseases that require special methods of diagnosis, treatment and the use of complex medical technologies.
Specialized medical care is provided by specialist doctors in medical institutions that have received a license for medical activities.
Types and standards of specialized medical care provided in health care institutions are established by the federal executive body responsible for legal regulation in the field of health care.
Financial provision of activities for the provision of specialized medical care in dermatological, venereological, anti-tuberculosis, narcological, oncological dispensaries and other specialized medical organizations (with the exception of federal specialized medical organizations, the list of which is approved by the Government of the Russian Federation) in accordance with these Fundamentals, is an expenditure obligation of the subject of the Russian Federation Federation.
Financial provision of measures for the provision of specialized medical care provided by federal specialized medical organizations, the list of which is approved by the Government of the Russian Federation, in accordance with these Fundamentals, is an expenditure obligation of the Russian Federation.
The law determined that, unlike primary health care, specialized medical care is provided in accordance with the standards that, along with the types of medical care, are established by the federal executive body responsible for legal regulation in the field of health care.
Federal Law N 122-FZ eliminated the contradictions in the Fundamentals regarding the delegation of powers to establish standards for specialized medical care by the constituent entities of the Russian Federation, equalizing the rights of the republic within the Russian Federation, the region, the territory, the cities of Moscow and St. Petersburg, excluding the very possibility of such delegation.
However, the provision of specialized medical care in accordance with the standards is limited to state and municipal health care institutions. The legislator did not oblige private medical organizations and persons engaged in private medical activities to provide medical care in accordance with the standards of medical care.
This contradicts the provisions of the Constitution of the Russian Federation (Article 71) on the assignment of standardization to the competence of the Russian Federation, the establishment of equal rights for organizations of various organizational and legal forms and forms of ownership, equal rights of citizens to receive medical care.
Contradictory provisions of the articles of the Law regarding licensing have also been preserved. The legislator retained the norm establishing that institutions providing specialized medical care are licensed. At the same time, there are no instructions on licensing institutions whose medical activities are related to primary health care. The legislation on licensing establishes the norm on licensing medical activities without dividing it into types. In this regard, it is necessary to make appropriate amendments to the sectoral legislation.
Thus, this article of the law also does not answer the questions, but only confirms their validity.
The medical community expected to find answers to these questions in Orders of the Ministry of Health and Social Development of Russia dated October 7, 2005 N 627, which approved a new nomenclature of healthcare institutions and dated October 13, 2005 N 633 "On the organization of medical care."
At the same time, these Orders further complicated the understanding and implementation of the legislation on the division of powers.
So, new order about the unified nomenclature of state and municipal health care institutions is not much different from the old one. In the Order of 03.06.2003 N 229 (hereinafter - the Nomenclature 2003) all types of children's medical institutions are named in a separate line, and in the Order of 02.10.2005 N 627 (hereinafter - the Nomenclature 2005) they are indicated "including", which is not changes things. Excluded from the list of institutions, as an independent type of institution, the Russian Children's Clinical Hospital of the Ministry of Health of Russia and included in the republican hospitals, including children's. The 2005 Nomenclature excludes central district hospitals (former hospitals of "vodniks"), as well as all types of hospitals on railway transport, since they do not belong to either the state or municipal health care system.
At the same time, the Ministry of Health and Social Development of Russia is a federal body of state power that implements state policy and carries out regulatory legal regulation in the field of healthcare. Based on the vested powers, he must determine the nomenclature of healthcare organizations for all departments, levels of government, as well as healthcare systems, including private ones.
In addition, the 2005 Nomenclature clarified the name of the medical institution providing nursing care - home (hospital) nursing care, the type of hospitals "1.2. Clinics" is excluded, which is completely legitimate.
Section "1.1.2. Specialized hospitals" has not changed.
From this design of the Order, it follows that the regional, republican, regional hospitals included in section 1.1.1. are not specialized and cannot be financed from the budget of a constituent entity of the Russian Federation. Also, the Order does not include leprosariums as specialized institutions, which is not correct in fact, as well as hospitals. At the same time, Order No. 633 states that hospitals provide specialized medical care.
From the edition of N 95-FZ and the Order of the Ministry of Health and Social Development of Russia, it follows that the constituent entities of the Russian Federation can only finance dispensaries and specialized hospitals named in section 1.1.2. Nomenclature 2005 and centers of specialized types of medical care, named in the section "Centers, including scientific and practical" (section 1.4).
In the logic of the Order, diabetological, drug rehabilitation centers, also named in section 1.4 of the 2005 Nomenclature, are not specialized healthcare organizations, while drug treatment and endocrinology dispensaries are classified by law, and therefore by the Order, as healthcare organizations providing specialized medical care.
A number of special type healthcare institutions are excluded from the "centers" section: the National Medical and Surgical Center of the Ministry of Health of Russia, the regional center for the prevention and control of AIDS and infectious diseases, a clinical center, an outpatient dialysis center as an independent institution.
The word “organizations” has been removed from the names of the centers for specialized types of medical care, rehabilitation centers have become one of the types of healthcare institutions, and not an exclusive healthcare institution of the Administration of the President of the Russian Federation, the centers of the district medical and medical centers of the Ministry of Health of Russia have become district medical centers.
Ambulance and emergency stations were excluded from the section "Institutions of emergency medical care and blood transfusion", the Russian rehabilitation center "Childhood" of the Ministry of Health of Russia was excluded from the section "Establishments for the protection of motherhood and childhood", a new type of health care institution "Center for the Reproductive Health of Adolescents" was introduced . Children's homes are united, specialized ones are listed as well. At the same time, paragraph 8 of the Note contains a list of specialized orphanages, from which it may follow that they are specialized healthcare institutions and should be attributed to the expenditure authorities of the constituent entities of the Russian Federation. In pursuance of this paragraph, these orphanages were transferred to the jurisdiction of the constituent entities of the Russian Federation.
Let's try to find in the Order of the Ministry of Health and Social Development of Russia dated October 13, 2005 N 633 "On the organization of medical care" the answer to the question of what refers to specialized medical care and what to primary health care?
The order divides medical care into primary health care, medical care for women during pregnancy, during and after childbirth, emergency medical care, specialized medical care, emergency specialized care (sanitary and aviation) and high-tech (expensive) medical care.
Particular attention is drawn to the fact that the Order classifies 31 types of medical care as primary health care, ranging from therapy to cardiovascular surgery, which are referred to as specialized types of medical care in the "Specialized Medical Care" section.
The Order also contains a list of institutions providing primary health care. These include - outpatient clinics (at the same time, they are excluded as an independent type of institutions from the Nomenclature 2005), general medical centers ( family practice), district hospitals, district hospitals, central district hospitals, nursing homes, hospices, polyclinics, including children's, city polyclinics, including children's, centers, medical units, city hospitals, orphanages, antenatal clinics, maternity hospitals, hospitals ambulance, perinatal centers.
In order to understand the concept of primary health care, one should refer to the norms of the law of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens.
Thus, article 38 of the Fundamentals defines: “Primary health care is the main, accessible and free type of medical care for every citizen and includes: treatment of the most common diseases, as well as injuries, poisonings and other emergency conditions; medical prevention of major diseases; sanitary hygienic education, carrying out other activities related to the provision of health care to citizens at the place of residence.
Primary health care is provided by the institutions of the municipal health system. Public and private healthcare institutions may also participate in the provision of primary health care on the basis of contracts with insurance medical organizations.
The volume and procedure for the provision of primary health care is established by legislation in the field of protecting the health of citizens.
Financial provision of activities for the provision of primary health care in outpatient, inpatient and hospital facilities, medical care for women during pregnancy, during and after childbirth in accordance with these Fundamentals, is an expense obligation of the municipality.
The provision of primary health care may also be financed from the funds of compulsory medical insurance and other sources in accordance with the legislation of the Russian Federation.
In Article 13 of the Fundamentals of the "Municipal Health System", the legislator once again fixes the sources of financing of primary health care.
Financial support for the activities of organizations of the municipal health care system is an expenditure obligation of the municipality.
The provision of medical care in organizations of the municipal health care system may also be financed from the funds of compulsory medical insurance and other sources in accordance with the legislation of the Russian Federation.
It follows from these norms that the main source of funding for the activities of organizations of the municipal health system that provide primary health care, emergency medical care, as well as medical care for women during pregnancy, childbirth and after childbirth, should be the budget of the municipality, and compulsory medical insurance is not an obligatory source of financing and can, "as well" as other sources, be used by decision of local governments. Such consolidation of funding sources is absolutely contrary to the basic principles of compulsory health insurance and the legislation governing it. It is primary health care that should be financed from the funds of compulsory medical insurance, since it is the main, affordable, free type of medical care. The main source of its funding is compulsory health insurance, based on the joint financial responsibility of the healthy in favor of the sick, the young in favor of the old, the rich in favor of the poor.
In addition, the legislator, for the sake of delimiting financial powers between levels of government, excluded from the concept of health care, such its most important components as the implementation of sanitary and hygienic and anti-epidemic measures. It is difficult to agree with such changes. The exclusion of sanitary and hygienic and anti-epidemic measures from primary health care may lead to the fact that medical institutions will not carry out such important measures as vaccination, measures to isolate infectious patients and establish quarantine, sanitary and hygienic treatment within the framework of this form of organization of medical care. in the foci of infections, etc. There will be no proper coordination of actions in carrying out these measures between municipal medical institutions and institutions and bodies of the sanitary and epidemiological service, which fall within the competence of the federal center. This will lead to a deterioration in the implementation of preventive measures.
In the edition of the Fundamentals of 1993, primary health care included measures to protect the family, motherhood, fatherhood and childhood, which are excluded by Federal Law N 122-FZ. The complete exclusion of these measures is unjustified. Primary health care should include measures to protect the health of the family, motherhood, fatherhood and childhood. And this should be enshrined in law.
It should be noted that when amending this law in the summer of 2004, it was necessary to replace the concept of "medical care", the legal and organizational meaning of which is poorly understood, with the constitutional concept - medical care.
In addition, it should be noted that the definition of specialized medical care refers to diagnostic and treatment technologies, while primary health care refers only to prevention and treatment technologies.
Previously, the Basics fixed the establishment of the volume of primary health care by local administrations in accordance with the territorial program of compulsory medical insurance.
The order of provision was instructed to establish the governing bodies of the municipal health care system on the basis of the regulations of the federal and regional executive authorities in the field of health care. Federal Law No. 122-FZ excluded these norms, the establishment of the volume and procedure for the provision of primary health care in the law is defined in a fairly general form - "in accordance with the law."
The procedure for organizing the provision of primary health care is determined by the Order of the Ministry of Health and Social Development of Russia dated July 29, 2005 N 487. The specified procedure regulates issues related to the organization of the provision of this type of medical care. Institutions providing primary health care must carry out their activities in accordance with the established procedure. According to the Order, primary health care includes, among other things, medical care for women during pregnancy, during and after childbirth. Primary health care is provided by institutions of the municipal health care system mainly at the place of residence, namely outpatient clinics, which are specifically listed in the Order: an outpatient clinic, a center for general medical (family) practice, a district (including central), a city polyclinic, a children's city polyclinic, female consultation.
The order duplicates the norm of the law on the participation in the provision of primary health care of public and private health care institutions on the basis of contracts with insurance medical organizations.
It should be noted that the Order (paragraphs 8 and 9) defines in detail the structure of outpatient and inpatient care, and in relation to inpatient care it is specified that it is provided to the population of municipalities in hospitals and inpatient polyclinics without specifying their types defined by the Nomenclature-2005 .
Thus, only the Order of the Ministry of Health and Social Development of Russia dated October 13, 2005 N 633 defines a list of institutions providing primary health care in hospitals - district, district and central district hospitals, nursing homes and hospices, centers, medical units, city hospitals, children's homes, maternity hospitals, emergency hospitals, perinatal centers. However, there is no reference to the previous Order.
The order (clause 7) clarifies that the obligation of institutions to provide primary health care is performed by medical workers of these institutions: district therapists, district pediatricians, general practitioners (family) obstetrician-gynecologists, other medical specialists, as well as specialists with secondary medical and higher education, in accordance with the established procedure.
From this definition It follows that medical specialists provide primary health care in accordance with their specialty and position. Specialists of the same specialties also provide specialized medical care in 31 specialties. That is, in 31 specialties, medical care can be specialized and primary health care, and only in 16 specialties is medical care specialized. So, for example, cardiovascular surgery provided by an emergency hospital of an urban district refers to primary health care, and cardiovascular surgery organized in healthcare institutions of the constituent entities of the Russian Federation - a hospital, center, regional regional, republican, district hospital , is a specialized cardiovascular surgery.
Hematological, dermatovenerological, diabetological, coloproctological, neonatological, oncological for adults and children, specialized medical care for infectious diseases, psychiatric, psychiatric-narcological, dental, urological-andrological, phthisiatric, medical genetic medical care (total 16) are specialized.
The question arises about the difference between these two types of medical care provided within the same specialty. Is it possible to distinguish between diseases, standards of medical care, technologies used, the level of training of specialists, and other criteria. Theoretically, you can justify anything. It's practically impossible. The distinction established by this Order is artificial and does not at all solve the issues of delimiting powers in the healthcare sector and fixing sources of funding by levels of government.
At the same time, it should be noted that this Order completely deprives the population of municipalities of affordable TB medical care, since it can only be provided in a specialized dispensary and a specialized hospital. The population of rural areas will have to go to these specialized institutions. The logic of the Order does not allow to have a phthisiatrician and a phthisiatric department on the staff of the central district hospital. This management decision was immediately realized in the stagnation of tuberculosis incidence rates and an increase in mortality rates.
A similar situation develops with the availability of other types of medical care.
Separately, it is necessary to dwell on the availability of dental care, which is referred by the Order only to specialized medical care provided in healthcare institutions of the constituent entity of the Russian Federation: regional, regional, republican hospital, dispensary, specialized hospital, hospital (from which it follows that it is a specialized medical institution, together however, in the 2005 Nomenclature it does not apply to those), in a center without specifying a specialized or other types, and most importantly in a polyclinic (without specifying its profile), which does not belong to specialized healthcare institutions.
The result of such an artificial division of medical care may be the destruction of relevant medical care services, a decrease in the availability and deterioration of its quality, a decrease in morbidity rates and an increase in mortality rates. Most importantly, this does not comply with the legislation on the division of powers.
The order also clarifies that citizens are entitled to free medical care in the state and municipal health care system in accordance with the legislation of the Russian Federation, the legislation of the constituent entities of the Russian Federation and the regulatory legal acts of local governments.
A guaranteed amount of free medical care is provided to citizens in accordance with the Program of State Guarantees for the Provision of Free Medical Care to Citizens of the Russian Federation. It follows from these norms that primary health care is included in the program of state guarantees.
At the same time, the legislator allowed that public and private healthcare organizations can provide primary health care under contracts with insurance medical organizations, without specifying what type of insurance they will carry out - compulsory or voluntary medical insurance. Thus, in this definition there is no clarity in the delimitation of powers for the implementation of financing.
This duality in defining the types of medical care leads to different understandings in determining measures for the restructuring of medical care. There is one more question. What is included in primary health care?
According to N 131-FZ and the Fundamentals, as amended. N 122-FZ is the entire volume of medical care provided by medical organizations of municipalities - a municipal district and an urban district, which provide both outpatient and inpatient medical care. At the same time, among many specialists in the field of domestic healthcare organization, the opinion is firmly entrenched that primary health care is exclusively outpatient medical care provided at the place of residence by district doctors. The last interpretation is connected with drawing parallels with foreign analogues in determining this type of care. Indeed, in healthcare systems of foreign countries, with a developed system of general medical (family) practice, a general practitioner provides a fairly wide range of medical services and refer the patient for an outpatient consultation with a hospital specialist or for hospitalization. Quite rarely, hospital specialists consult patients with a general (family) practitioner or in group practice.
I believe in federal law it is advisable to consolidate the concept of primary health care, taking into account the recommendations of the Alma-Ata conference, the legislation on the delimitation of powers and the historical features of the national health care system in the following edition:
"Primary health care is guaranteed for every citizen, an accessible and free type of medical care provided to a citizen by medical organizations of a municipal district or city district, as well as to certain categories of citizens in medical organizations of the constituent entities of the Russian Federation or the Russian Federation, licensed to provide medical care .Primary health care includes:
primary medical care provided using simple medical technologies at the outpatient stage by doctors with a medical specialty as a district doctor, general practitioner (family doctor) in medical organizations of municipalities;
specialized medical care of the first and second levels, provided by doctors, specialists of outpatient and hospital healthcare organizations of municipalities;
primary medical care and first-level specialized medical care provided to certain categories of citizens in accordance with the law in outpatient organizations of a constituent entity of the Russian Federation and the Russian Federation.
Primary health care is provided in accordance with the standards of medical care and includes prevention, diagnosis, treatment and rehabilitation of the most common diseases (conditions), as well as injuries, poisoning, sanitary and hygienic education; carrying out measures to protect the health of the family, motherhood, fatherhood and childhood, other measures related to the provision of medical and sanitary assistance to citizens, including sanitary and hygienic and anti-epidemic measures.
