§ 3.1. Administrative- legal status medical institution
Before proceeding to the consideration of the concept and main elements of the administrative and legal status of a medical institution, it is necessary to clarify what should be understood as a medical institution.
Hospitals, clinics, etc. are collectively referred to as health care facilities. The term "medical institution" or "health institution" can be found in many regulations. In by-laws, you can find another name - a medical institution. However, the definition of the concept of “health care institution” (medical, medical and preventive institution) does not contain any current regulatory legal act.
At the sub-legal level, the concept of a medical institution serves the purpose of generalizing medical institutions "regardless of departmental subordination and form of ownership", which is legally incorrect: an institution is a kind of organization that exists in other organizational and legal forms that are different from the institution ( business partnerships and societies, cooperatives, etc.).
The fundamental norms that determine the legal status of an institution are contained in the Civil Code of the Russian Federation, which recognizes as an institution an organization created by the owner (founder) to carry out managerial, socio-cultural or administrative-political functions of a non-commercial nature and financed by him in whole or in part (Article 120) . Consequently, medical institutions how non-profit organizations, firstly, they are called upon to perform socio-cultural functions, and secondly, they do not have profit making as the main goal of their activities. Despite this, medical institutions can also carry out business activities aimed at making a profit, but only insofar as this serves to achieve the goals for which they were created.
Yes, Art. 2, 72 projects federal law"About healthcare in Russian Federation» gives the concept health organizations- these are enterprises, institutions and organizations of the healthcare system, regardless of the form of ownership.
Thus, the concept of a healthcare organization (medical organization) is broader in relation to the concept of a healthcare institution (medical institution).
Despite this, today the institution (state and municipal) remains the predominant organizational and legal form of healthcare organizations. The main factors influencing the choice of this particular form are: the traditional nature of use and, as a result, the established normative legal framework governing the functioning of institutions (to a large extent this is facilitated by the norms of the Civil Code of the Russian Federation, which provide as one of the forms of organizations created to achieve specific non-commercial purposes, institution); the optimality of this design for the introduction into civil circulation of entities that require "a limited amount of rights necessary only for the material and technical support of their activities"; ensuring a balance of interests of the owner (the state) and the organization, due to the clarity and, to a certain extent, transparency of the financing mechanism.
Since the ongoing study involves the study of the administrative and legal status of institutions that directly provide medical care to the population, the concept of "medical institution" or "health care institution" will be used in the future.
Thus, under medical institution should be understood as institutions and organizations, regardless of the form of ownership, departmental affiliation and organizational and legal status, providing medical care, covering a certain territory with health care activities and comprising a share of the health care budget based on this territory. AT this concept persons engaged in unincorporated medical activities, both individually and collectively, should also be included.
For departmental purposes, health care institutions, in the process of almost thirty years of changing their nomenclature, acquired a division into treatment and prevention, health care institutions of a special type, health care institutions for supervision in the field of consumer protection and human well-being, and pharmacies.
From this list of institutions, directly medical (treatment) activities are carried out only by medical and preventive institutions (hospital institutions; dispensaries; outpatient institutions; centers, including scientific and practical ones; emergency medical care institutions and blood transfusion institutions; institutions for the protection of motherhood and childhood ; sanatorium-resort institutions), which are an obligatory component of all three health care systems. A medical and preventive institution is a complex, dynamic socio-economic system, representing a systematically organized and relatively isolated independently functioning link in the non-productive sector of the economy, in which medical and preventive activities are carried out in order to ensure a system of public, collective and personal economic interests, characterized by technological and organizational unity and socio-economic ties.
Criteria should be established for the classification of health facilities. Thus, all healthcare institutions can be subdivided: depending on the industry, forms of ownership, categories of the population served, the structure of the medical institution, the profiling of the bed fund, the availability of the right to provide paid services and some other classification grounds.
By industry affiliation departmental and territorial medical institutions can be distinguished.
As noted earlier, a number of ministries and departments (the Ministry of Transport and Communications of the Russian Federation, the Ministry of Defense of the Russian Federation, the Ministry of Internal Affairs of the Russian Federation, etc.) have a network of departmental medical institutions - hospitals. The division of medical institutions on a territorial basis makes it possible to single out republican (federal and within the Russian Federation), regional (territorial), city, district, district.
By forms of ownership medical institutions are divided into state (federal and subjects) and municipal institutions, unitary enterprises, private organizations. State and municipal medical institutions are created by the owner to carry out socio-cultural or other functions of a non-commercial nature and are financed by him in full or in part. In respect of the property assigned to them, institutions exercise the right of operational management. State hospitals are republican (territorial, regional, district) hospitals. They are owned by the subject of the federation and are not subject to privatization.
Private institutions include medical institutions, the property of which is privately owned, as well as persons engaged in private medical practice.
For the purposes of social medicine and healthcare organization, institutions of state and municipal property are distributed according to types (branches) of health care activities: treatment and prevention, health protection (medical care) for women and children, sanitary and anti-epidemic, medical and pharmaceutical, medical and educational and research, sanatorium and resort, pathoanatomical (including forensic medical and forensic psychiatric examination), as well as or health insurance (CHI). / Ed. Yu.P. Lisitsyna. - M .: Prior-izdat, 1999. - P. 321.]
By categories of population served medical institutions can be classified into institutions providing medical care to adults and children; residents of cities (city hospitals) and rural areas (rural hospitals); employees of all professional groups and the non-working population and only employees of one or a group of enterprises (medical units), geriatric medical institutions, institutions for war veterans, internationalist soldiers.
By structure medical institutions are divided into united (a hospital with a polyclinic) and non-unified (having only a hospital).
The classifying feature is bed fund profiling medical institution: single-profile (specialized), dual- and multi-profile institutions.
AT modern conditions medical institutions can also be divided into free and paid. Formally, all state and municipal medical institutions are classified as free, in fact, free medical institutions practically do not exist today, since paid departments and wards are organized everywhere as part of multidisciplinary and specialized institutions on the basis of self-sufficiency.
The most complex, taking into account many features of the classification (including the features of the structure of the institution, specialization, profiling of the bed fund) is nomenclature of medical institutions.
Health care institutions providing medical care to the population have the same rights and bear the same responsibility for the quality of care, regardless of their legal and organizational structure.
Traditional for administrative law is the position that "each institution is a unity of three parties: organizational, economic, legal". In our opinion, this provision is fully applicable to medical institutions.
It appears that organizational side each medical institution is made up of a team of specialists and attendants, headed by the chief physician and his administration, the subordination of the medical institution to a higher health management body and the availability of operational independence of the medical institution within a certain autonomy.
Economic sign a medical institution is determined by the presence of a separate property complex (material and technical base).
Legal characteristic a medical institution is formed by a combination of its legal features: 1) the regulatory framework for its formation and activities; 2) the ability of a medical institution to participate on its own behalf in administrative and other legal relations; 3) subordination to management bodies of general and sectoral competence; 4) the existence of a regulation on a medical institution (charter of a medical institution).
It should be noted that a modern medical institution, which is a complex medical and economic complex, along with the main, medical and diagnostic function, performs economic, supply, operational and other functions that are the subject of legal regulation of various norms of various branches of law. In their totality and in interaction, it is they who provide the medical institution with a legal basis, in other words, a legal status, for its functioning.
The concept of "status" ( lat. - state, position) means "a set of general rights that determine legal capacity, and fundamental rights and obligations that are inseparable from persons, bodies, organizations, legal entities." Legal status is the legally fixed position of the subject in society. This is a set of rights and obligations of subjects recognized by the constitution and legislation, as well as the powers of state bodies and officials through which they fulfill their social roles.
Thus, the legal status of a medical institution is its legal status, which determines the legal guarantees of activities, the place, role and position of a medical institution in the healthcare system and sectoral management, its basic rights and obligations.
The legal status of a medical institution is a complex category, consisting of many sectoral legal statuses. Its core is the administrative-legal status. The concept of "administrative-legal status", not being practically developed, nevertheless manifests itself as a complex of interrelated elements. This concept "reflects both the advantages and disadvantages of the actual political and legal system, the principles of democracy, the state foundations of this society." The definition under study contains at its core the norms of administrative legislation, since only these norms are able to give the institution legal certainty and ensure legal conditions management of its activities. The legal basis for the administrative and legal status of a medical institution is the provision on the health care institution of the corresponding type and the regulatory legal acts of the executive authorities regulating the legal regime management activities administration of a medical institution. As the leading function of administrative and legal norms, one can single out the function of organizing and regulating legal relations in the management process. It is supported by three general functions lower level: organization and regulation of the activities of management entities; organization of regulation of managerial relations between the subject and the object of management; organization and regulation of the activities of control objects.
Consequently, the administrative-legal status of all types of medical institutions includes the totality of all rights and obligations exercised by them in managerial administrative-legal relations, which are formed primarily in the relationship of medical institutions with state and municipal executive authorities.
The basics of the content characteristics of the administrative and legal status of medical institutions are the following relationships that develop between the executive authorities and the medical institutions subordinate to them in the sectoral, functional and territorial respect: management decisions on the creation, reorganization, liquidation of medical institutions, determination of the subject and goals of their activities, corresponding to the goals of the state; relations in connection with and regarding the approval of the statutes of institutions by the executive authorities and local government as well as accounting state cadastre registered and operating medical institutions - legal entities; relations on the conclusion by the executive bodies of state and municipal authorities of various kinds of administrative agreements and contracts with subordinate institutions, the issuance of state and municipal orders for the provision of medical services; relations related to state registration and licensing of activities carried out; relations for the coordination of proposals for the disposal of state and municipal property and the implementation of other decisions in accordance with the powers of the owner; numerous relationships generated by the implementation state control and supervision over the observance by all institutions of the established rules of business, their implementation various kinds activities and many other rules for the protection of state, public order and public security in all its varieties.
Peculiarities The administrative and legal status of a healthcare institution is predetermined by the fact that: firstly, it has never been considered in an independent sense, in isolation from the healthcare system, an element of which it is recognized; secondly, the administrative-legal status of medical institutions consists of state-defined properties (rights and obligations) of the institution as a subject of administrative law, characterizing the potential of the institution itself to enter into administrative-legal relations within the framework of its legal personality and the competence of state bodies that they possess in areas of establishing and ensuring the implementation by the organization of its administrative and legal status; thirdly, the administrative and legal status of medical institutions is characterized by the presence of a number of elements.
It should be noted that medical institutions of various types have significant differences in the content of status elements. For example, the administrative and legal status of state (municipal) and the administrative and legal status of non-state medical institutions has a number of features.
Institutions state system health care, regardless of their departmental subordination, are legal entities. They act in accordance with the regulations on health issues, taking into account the acts of which authorities apply to them (for example, federal agencies- on the basis of federal acts, etc.)
Institutions of the state health care system are usually under the authority of higher health authorities that direct and control the activities of these institutions. They are the property of the state, state governing bodies act as founders of this type medical institutions, approve their statutes (regulations on them) and terminate their activities. The management of state (municipal) medical institutions is carried out by officials appointed by the competent state bodies and having state powers.
A feature of the administrative and legal status of non-state medical institutions is that they are managed by the owners (founders) or bodies authorized by them that do not have state powers. The procedure for the formation and liquidation of a non-state medical institution is regulated by the legislation governing relations in the field of licensing and accreditation of medical institutions. They can be created by the decision of the owner or the authorized body. The charter (regulations) of a non-state medical institution is approved by its founders (participants). Thus, the influence on them from the side of the state is limited. It does not manage them, but only regulates certain aspects of the activity (registers, licenses, implements regulation, sanitary and epidemiological surveillance, etc.).
Based on the above, administrative and legal status of any medical institution can be formulated as a set of rights and obligations of a medical institution, providing for, within the limits of administrative legal personality, the independent solution of the goals and objectives inherent in a particular medical institution, the implementation of the functions necessary for this, participation in managerial administrative legal relations that develop primarily in the relationship of medical institutions with state executive bodies and municipal authorities.
This definition of the administrative and legal status of a medical institution allows, in our opinion, to distinguish five of its main elements:
- goals and objectives of the medical institution;
– functions of a medical institution;
- powers (rights and obligations) that make up the main content of the administrative and legal status of a medical institution;
– organizational structure of a medical institution;
– creation, reorganization and liquidation of a medical institution;
– guarantees of the rights of the medical institution.
These elements of the administrative and legal status of a medical institution can be grouped into blocks. Based on the statement of Yu.A. Tikhomirov, who classifies normatively established goals, subjects of jurisdiction, objects of influence and powers of authority as elements of competence, we propose to unite the first three elements of the administrative-legal status (goals, tasks, functions and powers) into the so-called "competence block"; include the organizational structure in the "intraorganizational block"; to present the creation, reorganization and liquidation of a medical institution as an “external organizational block” and form a block of administrative and legal guarantees of the rights of medical institutions.
It seems that such a structure of the administrative and legal status of medical institutions will contribute to the optimization of the legal regime for solving managerial problems, since it involves the formation of the content of the work of a medical institution, the creation legal basis its activities, the existence of an organizational structure that ensures the performance of the functions inherent in a medical institution, the procedure for the functioning of a medical institution, endowing it with a set of rights and obligations, as well as the availability of guarantees for these rights.
So, let's consider each of the named blocks of elements of the administrative and legal status of medical institutions
Competence block includes the goals and objectives of the activity, functions and powers of the medical institution.
Improving the activities of medical institutions is directly dependent on the compliance of the goals and objectives of the medical institution with the level of satisfaction of the modern needs of the population in medical care. Moreover, one of the important conditions for the successful organization of the work of a medical institution is the existence of unity of goals and objectives.
Target as a category of a higher order determines the content and direction of tasks. Having recognized the purpose of the activity of a medical institution as an ideal, the governing body, the collective, society will find in it the means of regulating their own activities to improve the level of work of the medical institution as a whole. Considering that the goal means the result that the actions are aimed at, the goal of a medical institution (its creation, functioning), obviously, is to reduce the losses of society from morbidity, disability and mortality of the population with available resources. The purpose (goals) of the activities of each medical institution is fixed in the relevant legal act - the Charter (Regulations) on the medical institution of the corresponding type.
In modern conditions the main task which medical institutions are called upon to solve in their activities is to ensure the constitutional right of citizens to health protection and medical care, which is expressed in the provision of timely, affordable, high-quality medical care. The main task determines the general direction of activity of subjects and objects of management to meet the needs of the population in medical care and therefore implies the presence of a complex of tasks of an auxiliary order that contribute to the implementation of the main task. Such tasks can be divided into main and current. The main tasks are designed to determine the most important directions in the development of medical activity and are of a long-term nature (tasks for active use all medical institutions of progressive forms of organization of medical care, modern and effective methods and means of prevention, diagnosis and treatment, the accelerated creation of a solid modern material and technical base of medical institutions and its continuous further improvement). Enshrined in legal norms, they are a legal obligation for medical institutions of all types. The current tasks of a medical institution are, as a rule, of a private nature, they are solved by a medical institution at a particular moment, depending on the regional situation, the level and structure of the incidence of the population, the possibilities available to the medical institution and other factors. Their implementation is usually designed for short periods of time. They are part of the program-target administrative and legal status of each medical institution, since for certain subjects and objects of management they have normative value and actively contribute to the practical implementation of the main, and through the latter, the general task facing the medical institution.
An important element of the administrative and legal status of a medical institution is its functions and the legal provisions that govern them. The meaning of the definition of functions is to fix in a normative manner what the administration and staff of a medical institution must perform in order to achieve the goals and objectives. Implementing the same tasks, the team and the administration perform different functions. The staff of a medical institution directly performs the functions of treating patients, diagnosing diseases, carrying out preventive work among the population, using medicines, dressings and other medical devices, medical diagnostic and other medical equipment and equipment, caring for hospital property, etc. The administration of the medical institution provides the necessary conditions for the performance of the specified functions by the team. This is achieved through the implementation by the administration of its managerial functions (organization of the provision of medical care to the population; implementation in healing process progressive forms and methods of work, achievements of science, technology and medical practice; selection, placement and improvement of professional and business qualifications of personnel; conducting preventive measures hostility; analysis of morbidity and development of measures to reduce it; material and technical support of medical and other activities of a medical organization; accounting and control over the correct use of funds, rational operation of medical equipment and equipment; standardization of terms and establishment of rules for the use of medical property; control over compliance with the norms for the expenditure of medicines, medical preparations and materials; financing the activities of structural units and the implementation various works; planning social development team).
Along with this, in health care, the functions, tasks, volume and nature of the work of hospital institutions in connection with the process of differentiation and integration, as well as due to the improvement of the forms and methods of health management, have expanded significantly. Each type of hospital is characterized by certain functions, the normative fixing of which is carried out in the regulations on hospitals. These provisions are approved by orders of the Ministry of Health and Social Development of the Russian Federation and, along with the charter, determine the legal status of institutions.
In the course of its activities, a medical institution acts not only as a medical and preventive unit, but also as an economic entity that has the material and technical base for carrying out its main activities, and therefore, it must have an appropriate volume for solving its inherent tasks and performing functions. rights and obligations. Rights and obligations are one of the most important elements of the administrative and legal status of a medical institution.
Unlike commercial organizations that have a general (unlimited) legal capacity, a healthcare institution is endowed with a special (limited) legal capacity, i.e., a set of only such rights and obligations that are provided for by the constituent documents. For example, in paragraph 4 "Organization of activities" of the decision of the Saratov City Duma dated April 29, 1999 No. 30-289 "On model charter municipal medical institution” provides that the institution has the right in the prescribed manner: to conclude contracts with institutions, organizations, enterprises and individuals for the provision of works and services in accordance with the activities of the institution; involve other institutions, organizations, enterprises and individuals; acquire or lease in the course of business the main and working capital due to his financial resources, temporary financial assistance and received for these purposes loans and credits; plan their activities and determine development prospects in agreement with the Health Committee, as well as based on the demand of patients for services.
It should be noted that the rights belonging to a medical institution are mainly exercised by its administration. The administration of a medical institution is vested with legal powers to express these interests. Nevertheless, its staff also takes part in the implementation of the rights to manage a medical institution. The participation of the collective in the management of the medical institution is carried out mainly through the trade union organization. The trade union of a medical institution represents and protects the interests of the team in the field of medical activities, working conditions and socio-cultural issues. In this regard, the trade union of a medical institution, together with its administration, participates in the implementation of the rights of this institution.
The duties of a medical institution may be: submitting to the health authority the necessary cost estimate and financial documentation in full, approved forms and for all types of activities; coordination with this body of the structure of the Institution; ensuring the safety, efficiency and intended use of property; creation of safe working conditions for its employees and liability in accordance with the established procedure for harm caused to an employee by injury, occupational disease or other damage to health associated with the performance of job duties; bearing responsibility in accordance with the law for violation of contractual, credit, settlement obligations, business rules; compensation for damage caused by the irrational use of land and other natural resources, pollution environment, violation of production safety rules, sanitary and hygienic standards and requirements for protecting the health of workers, the public and consumers of products (works, services); etc.
The rights and obligations of medical institutions are enshrined in numerous regulations. In general terms, the administrative legal personality of medical institutions is determined by their regulations (charters). However, these acts do not contain norms that would comprehensively define the entire scope of the rights and obligations of medical institutions. Therefore, today many issues of managing the activities of medical institutions, including the problems of administrative legal personality, have turned out to be unregulated.
Content intraorganizational unit includes the formation of a body managing the affairs of a medical institution. The formation of the body for managing the affairs of a medical institution - the administration - is carried out by the owner or founder in the manner prescribed by the Charter of the institution. The governing body of the health care organization of the state-municipal sector is the head, who is appointed by the founder and is accountable to him. The highest official of the hospital is its head - chief physician appointed and dismissed by the health authority. In accordance with the Regulations on the chief physician of the regional (regional, republican) hospital, the chief physician organizes and controls the correctness and timeliness of the examination and treatment of patients, their care, dispensary care, preventive and anti-epidemic measures in the area of activity, advanced training of medical personnel, correctness keeping medical histories, providing the hospital with medical and household equipment. He systematically analyzes the performance of the hospital, approves the work plan and budget of the hospital, controls the correct use of materials and medicines, is responsible for the sanitary condition of the hospital, the selection and placement of personnel.
He carries out the current management of the hospital on the principles of unity of command; is responsible for the organization, level, quality of the treatment and diagnostic process in the hospital in accordance with accepted standards, modern requirements science and practice; responsible for safety and compliance with sanitary and anti-epidemic requirements, etc.
The chief physician of the united hospital has deputies for medical, polyclinic and administrative work.
The deputy chief physician for the medical part (medical work) is responsible for the quality of all medical activities of the hospital; directly supervises the treatment-and-prophylactic and sanitary-anti-epidemic work of the hospital; checks the effectiveness of therapeutic and preventive measures; analyzes each case of death in hospital and at home; provides proper organization medical nutrition and exercise therapy; organizes consultations for patients.
The deputy chief physician for the polyclinic directly supervises the work of the polyclinic and organizes polyclinic care for the population; develops plans for treatment, diagnostic and anti-epidemic measures of the polyclinic and ensures their implementation; appoints the control and expert commission and manages its work; organizes dispensary observation of the established contingents of the population and exercises control over its quality and efficiency; systematically studies the incidence of the population of the service area.
The deputy (assistant) chief physician for the administrative and economic part manages all the administrative and economic activities of the hospital, ensures the supply of household equipment and inventory, food, fuel, hot water, lighting, organizes meals for patients, heating, repairs, fire fighting measures, linen economy, transport, etc.
External organizational unit represents a set of powers of state authorities in relation to a medical institution and includes such elements as the creation of a medical institution, state registration, licensing of activities, liquidation and reorganization of medical institutions.
Creation (institution) medical institution is carried out by decision of the owner of the property or a body authorized by him. The procedure for creating a hospital is provided for by the norms of civil law, since the hospital is a legal entity that takes an active part in civil circulation. The founding document of the hospital is the charter, which determines the general legal status, name, address, management and control bodies, sources of funding, conditions for reorganization and liquidation. For the purpose of a unified approach and to avoid discrepancies in the constituent documents of healthcare institutions at the federal and local levels, a joint letter from the State Property Committee of the Russian Federation of December 29, 1995 No. OK-6 / 10860 and the Ministry of Health and Medical Industry of the Russian Federation of December 28, 1995 No. 2510 / 3499-95-19 was recommended for use Model charter of the state (municipal) health care institution.
As practice shows in most regions of the Russian Federation, the decision to create regional medical institutions is made by the governors of the region or regional governments in agreement with the regional legislative bodies.
The decision to create municipal medical institutions is made by the head of the municipality in agreement with the representative body of local self-government of this municipality. For example, the Saratov City Duma adopted a decision dated April 29, 1999 No. 30-289 “On the Model Charter of a Municipal Medical Institution”, which includes: general provisions, goals and subject of the Institution’s activities, property and finances of the Institution, organization of activities, management of the Institution, reorganization and liquidation of the institution. State registration of a healthcare institution is carried out at its location by a local government body.
Considering the issue of establishing a medical institution, it is necessary to indicate the need for control by the relevant authorities over the activities of health care institutions. Control affects the direct content of the activities of medical institutions that perform not only a socially significant function, but also activities that require special knowledge and skills. One of the tools of this kind of control is the licensing of health care institutions.
According to the current legislation, enterprises, institutions and organizations of the state, municipal and private healthcare systems can carry out their activities only if having a license for the chosen activity.
The very first legislative definition of medical licensing was proposed in Art. 21 of the Law of the RSFSR "On the health insurance of citizens in the RSFSR", according to which "licensing is the issuance of state permission to a medical institution to carry out certain types of activities and services under compulsory and voluntary medical insurance programs."
Another definition was given in the order of the Ministry of Health of the RSFSR dated March 20, 1992 No. 93 “On measures to implement the law of the Russian Federation“ On the medical insurance of citizens in the RSFSR “, according to which “Licensing is the issuance of a state document (license) for the right to engage in certain types of medical activities “.
Licensing can be characterized as “a form of control over the legality of the alleged actions of a citizen or organization, permission to perform only unconditionally legal actions and refusal to perform illegal actions, which determines the type and extent of permissible activity, as well as the implementation of supervision over actually carried out actions.”
A permit to engage in medical activities (license) is issued by the relevant executive authority of the subject of the Russian Federation, authorized to license this type of activity, in order to assess the capabilities of the subject (medical organization) in terms of providing medical care in the amount and functions adequate to the level of training of personnel, the state of financial technical base of the organization and its equipment.
Based on the foregoing, we can formulate the concept licensing of medical activities, by which it is proposed to understand the activities of licensing public authorities, which is expressed in the implementation of measures to provide a permit (license), which is the basis for the implementation of a certain type of medical activity, as well as in exercising control over this type of activity.
To date, the general provisions on the licensing of medical activities in the Russian Federation are regulated by the Federal Law "On Licensing certain types activities”, adopted on July 13, 2001.
The procedure and conditions for issuing a license to carry out medical activities are defined in the relevant Regulation, approved by Decree of the Government of the Russian Federation of July 4, 2002 No. 499.
Reorganization institutions (merger, accession, separation, separation, transformation) can be carried out by decision of the founder in the manner and in cases provided for by applicable law. With voluntary liquidation institution, the liquidation commission is created by the founder, in case of compulsory - the commission is appointed by the court and carries out work on the liquidation of the institution in accordance with applicable law.
During liquidation and reorganization, dismissed employees are guaranteed the observance of their rights in accordance with the legislation of the Russian Federation.
The property of the liquidated Institution, after settlements made in the prescribed manner, with the budget, creditors, employees of the institution, remains in municipal ownership.
During the reorganization of an institution, all documents (management, financial and economic, personnel, etc.) are transferred in accordance with the established rules to the successor institution.
When an institution is liquidated, documents of permanent storage are transferred for state storage to the city archival funds, documents on personnel (orders, personal files, etc.) are transferred for storage to the archival fund. The transfer and ordering of documents are carried out by the forces and at the expense of the Institution in accordance with the requirements of archival authorities.
An institution is considered to have ceased to exist after its exclusion from the unified state register of legal entities.
Administrative and legal guarantees of rights LPU are:
- possibility of recognition judicial order invalid (in whole or in part) normative acts of state bodies that do not comply with laws and other legal acts and violating the rights and legitimate interests of a medical institution;
- compensation for damage caused to the institution as a result of illegal actions (inaction) of state bodies or their officials, including as a result of the issuance of an act that does not comply with the law or other legal act government agency;
- Guaranteeing by the state of compliance with the conditions established by law for the activities of medical institutions.
It should also be noted that an indispensable component of the administrative and legal status of a medical institution is its administrative, supervised subordination to administrative supervision bodies for compliance with legislation on taxes and fees, land use rules, sanitary and epidemiological rules, rules fire safety, occupational safety, etc.
Thus, the administrative and legal status of a medical institution guarantees its stability and provides a flexible organizational and legal basis for performing its inherent functions, solving its inherent tasks and achieving its goals.
In the process of studying the administrative and legal status (its individual elements) of healthcare institutions, it was found that there is no single regulatory act regulating the activities of medical institutions. We consider its adoption necessary, since today there are many regulations that fix the goals and objectives, rights and obligations, the structure and organization of the activities of medical institutions. In general terms, these elements of the administrative and legal status of medical institutions are determined by the regulations (charters) on them. However, these acts do not contain norms that would comprehensively define all the elements of the administrative and legal status of medical institutions. Therefore, today many issues of managing the activities of medical institutions, including the problems of administrative legal personality, have turned out to be unregulated.
Based on the foregoing, in our opinion, it is necessary to develop and adopt a federal law "On the basics of the organization and activities of a medical institution" to combine the elements of the administrative and legal status of a medical institution into one legislative act.
The structure of this law should include the following main sections:
Section 1. General provisions ( Scope of this Federal Law, basic concepts, principles of legal regulation of the activities of medical institutions, the basics of the activities of medical institutions of various organizational and legal forms of the healthcare system of the Russian Federation).
Section 2. Organization of activities ( Basic rights and obligations, the right of non-profit medical institutions to exercise entrepreneurial activity, provision of paid medical services, responsibility of medical institutions for obligations, relations with state bodies).
Section 3. Creation, reorganization and liquidation of a medical institution ( founders of medical institutions, statutory documents, conditions and procedure for acquiring the right to carry out medical activities).
Section 4 At management of a healthcare facility the highest official of the institution, its functions, powers and responsibilities).
Section 5. Legal status of a medical worker(rights, duties and responsibilities of persons engaged in medical activities).
Section 6. Property and f medical institution finances(sources of financing, property and funds of a medical institution, accounting, reporting, control of the obligations of a medical institution in relation to the property assigned to them).
Section 7. Types of activities of medical institutions(features of activities in the state-municipal sector; features of activities in the private sector; conditions for opening and implementing private medical practice; procedure for concluding and content of an agreement with a consumer of medical services (contract for the provision of medical services); quality control of medical care in the system of private medical practice.
Section 8. Liability for Violation of this Law.
Final provisions.
The adoption of this law will make it possible to fill in the gaps in the legislation regulating relations that develop in the course of the activities of medical institutions, and will also supplement the provisions of the fundamentals of the legislation of the Russian Federation on the protection of the health of citizens regarding the organization of the protection of the health of citizens in the Russian Federation.
Chapter 3
Chapter 3
The protection of the health of citizens is an obligatory and inalienable condition for the development of a civilized society. In Russia, the state assumes responsibility and guarantees the protection of the health of every person. These provisions are enshrined in the Constitution of the Russian Federation and other legislative acts. All aspects of public health protection are most fully reflected in the Basic Laws of the Russian Federation on the Protection of Citizens' Health adopted in 1993 (taking into account the changes made in 1998, 1999, 2000).
According to this legislation public health is a set of political, economic, legal, social, cultural, scientific, medical, sanitary-hygienic and anti-epidemic measures aimed at preserving and strengthening the physical and mental health of each person, maintaining his long active life, providing him with medical care in case of loss health.
3.1. HEALTH SYSTEMS
The fulfillment of the tasks of protecting the health of the population cannot be entrusted only to public health. This is the business of the state and society as a whole, but health care should play a leading and coordinating role in solving these problems.
Depending on the forms of ownership and sources of funding, there are three health care systems:
1) state;
2) municipal;
3) private.
To the public health system include federal executive authorities in the field of healthcare, healthcare management authorities of the constituent entities of the Russian Federation, the Russian Academy of Medical Sciences, as well as state-owned
medical and preventive, research, educational, pharmacy, sanitary and preventive institutions and some other federal institutions.
To the municipal health system include municipal health authorities and municipally owned medical and preventive, research, pharmacy, educational and other institutions.
Toward a private healthcare system include healthcare entities whose property is privately owned, as well as persons engaged in private medical or pharmaceutical activities.
The subjects of the private healthcare system have the right, along with state and municipal healthcare institutions, to participate in the implementation of state policy in the field of healthcare, the formation of a market for medical services, and the solution of the problem of providing citizens with qualified medical care. The activities of private healthcare organizations are based on the principles of applying uniform legal acts in the field of healthcare, standards of medical care and ethical norms.
The distinction between state, municipal and private health care systems is rather conditional, therefore it is more correct to assume that the Russian Federation has a unified health care system that is subordinate to the solution of a whole range of tasks, and within this system there are three sectors: state, municipal and private.
The right of citizens to health protection is enshrined in the following the main principles of national health care:
Observance of human rights in the field of health protection and provision of state guarantees related to these rights;
Priority of preventive measures in the field of public health protection;
Availability of medical and social assistance;
Social security of citizens in case of loss of health;
Responsibility of public authorities, heads of organizations regardless of the form of ownership, as well as officials for the implementation of the rights of citizens in the field of health care.
However, it should be noted that at present these principles are more of a declarative nature and are not fully observed.
3.2. TYPES OF MEDICAL CARE
The institutions that are part of the healthcare system of the Russian Federation provide various types of medical care to the population. There are several principles for classifying medical care to the population. According to Art. 38-42 "Fundamentals" distinguish:
Primary health care;
emergency medical care;
specialized medical care;
Medical and social assistance to citizens suffering from socially significant diseases;
Medical and social assistance to citizens suffering from diseases that pose a danger to others.
Taking into account the nomenclature of health care institutions, as well as the tasks they face, the following types of medical care are distinguished:
outpatient (out-of-hospital) medical care;
Hospital (inpatient) medical care;
emergency medical care;
Sanatorium-resort medical care.
In addition, medical care, taking into account the stages of its provision and the level of specialization, can be classified as follows:
First;
pre-medical;
First medical;
Ambulance;
Specialized;
High tech (expensive).
Separately allocate primary health care(PHC), which is the main type of medical care available and free for every citizen and includes the treatment of the most common diseases, as well as injuries, poisonings and other emergency conditions, the implementation of sanitary and hygienic and anti-epidemic measures, medical prevention of major diseases, sanitary and hygienic
education, carrying out measures to protect the family, motherhood, fatherhood and childhood, other activities related to the provision of health care to citizens at the place of residence.
Primary health care is provided to residents of the municipal district and urban district by institutions of the municipal health system. PHC is provided to the population within the framework of the territorial Program of state guarantees for the provision of free medical care to citizens of the Russian Federation. In the provision of PHC, institutions of the state, municipal and private healthcare systems can participate, individual entrepreneurs who have the appropriate license for this type of activity.
3.3. NOMENCLATURE OF HEALTH CARE INSTITUTIONS
The main structural element in the system of providing medical care to the population is healthcare facility, the list of which is approved by the relevant order of the Ministry of Health and Social Development of the Russian Federation (MHSiSR RF).
Currently, the “Unified nomenclature of state and municipal health care institutions” is in force, approved by order of the Ministry of Health and Social Development of the Russian Federation No. 627 dated October 7, 2005.
1. Medical institutions. 1.1. Hospital institutions.
1.1.1. Hospitals, including:
♦ precinct;
♦district;
♦ urban ambulance service;
♦central (city, district);
♦regional, including children's (regional, republican, district).
1.1.2 Specialized hospitals, including:
♦ rehabilitation treatment, including children's;
♦gynecological;
♦geriatric;
♦infectious, including children's;
♦narcological;
♦oncological;
♦ophthalmic;
♦psycho-neurological, including children's;
♦psychiatric, including children's;
♦Psychiatric (hospital) specialized type;
♦Psychiatric (hospital) of a specialized type with intensive supervision;
♦ tuberculosis, including children's.
1.1.3 Hospital.
1.1.4. Medical and sanitary unit, including the central one.
1.1.5 Nursing home (hospital).
1.1.6.Hospice.
1.1.7. Leper colony.
1.2.Dispensaries:
♦ medical and physical education;
♦cardiological;
♦ dermatovenerological;
♦ mammological;
♦narcological;
♦oncological;
♦ophthalmic;
♦anti-tuberculosis;
♦psycho-neurological;
♦endocrinological.
1.3. Outpatient clinics.
1.3.1. Outpatient clinic.
1.3.2. Polyclinics, including:
♦urban, including children's;
♦ central district;
♦dentistry, including children's;
♦consultative and diagnostic, including for children;
♦ psychotherapeutic;
♦physiotherapy.
1.4. Centers, including scientific and practical:
♦rehabilitation therapy for soldiers-internationalists;
♦ restorative medicine and rehabilitation;
♦geriatric;
♦ diabetic;
♦narcological rehabilitation;
♦medical, including district;
♦professional pathology;
♦ prevention and control of AIDS and infectious diseases;
♦clinical diagnostic;
♦pathology of speech and neurorehabilitation;
♦rehabilitation;
♦ medical and social rehabilitation;
♦general medical (family) practice;
♦consultative and diagnostic, including for children;
♦rehabilitation of hearing;
♦ physiotherapy exercises and sports medicine;
♦ manual therapy;
♦therapeutic and preventive nutrition;
♦specialized types of medical care;
♦psychophysiological diagnostics.
1.5. Emergencies and blood transfusion facilities.
1.5.1. Ambulance station.
1.5.2. Blood transfusion station.
1.5.3. Blood center.
1.6.Institutions for the protection of motherhood and childhood.
1.6.1. Perinatal center.
1.6.2. Maternity hospital.
1.6.3.Women's consultation.
1.6.4. Center for family planning and reproduction.
1.6.5. Adolescent Reproductive Health Center.
1.6.6. Children's home, including a specialized one.
1.6.7. Dairy kitchen.
1.7. Sanatorium-resort institutions.
1.7.1. Balneological clinic.
1.7.2. Mud bath.
1.7.3. Resort polyclinic.
1.7.4. Sanatorium, including children's, as well as for children with parents.
1.7.5. Sanatorium-dispensary.
1.7.6. Sanatorium health camp of year-round action.
2. Healthcare institutions of a special type.
2.1 Centers:
♦ medical prevention;
♦disaster medicine (federal, regional, territorial);
♦medical mobilization reserves "Reserve" (republican, regional, regional, city);
♦licensing of medical and pharmaceutical activities (republican, territorial, regional);
♦ quality control and certification of medicines;
♦medical information and analytical;
♦information and methodological for examination, accounting and analysis of the appeal;
♦Means of medical use.
2.2 Bureau:
♦medical statistics;
♦pathoanatomical;
♦forensic medical examination.
2.3. Control and analytical laboratory.
2.4. Military medical commission, including the central one.
2.5. Bacteriological laboratory for the diagnosis of tuberculosis.
3. Health care institutions for supervision in the field of consumer protection and human well-being.
3.1.Centers for hygiene and epidemiology.
3.2. Centers of state sanitary and epidemiological surveillance.
3.3 Anti-plague center (station).
3.4. Disinfection center (station).
3.5. Center for hygienic education of the population.
4.Pharmacy establishments.
4.1 Pharmacy.
4.2 Pharmacy.
4.3 Pharmacy kiosk.
4.4 Pharmacy store.
Note. Feldsher-obstetric stations (FAP), health centers (medical, feldsher) are structural divisions healthcare institutions.
The departmental affiliation of a state institution is determined quite simply. It is important to understand what area the organization belongs to, then it can be easily attributed to the committee or ministry that manages it on behalf of the state. A vivid example is that the school belongs to the field of education, since it is under the jurisdiction of the relevant ministry of the Russian Federation.
With state structures, there is no particular difficulty in determining this parameter, since all of them are one way or another subordinate to various ministries that are part of the government of the Russian Federation. But with private entrepreneurship, everything is not so simple, since they can be subordinate to several state structures at once.
The Importance of Researching a Question
The question of the departmental affiliation of certain enterprises to a particular state structure is very important, since the legislation at the moment does not give a specific answer to this question. Most of the existing industrial plants and factories were created back in the days of the Soviet Union, and then their ownership was formed in accordance with the legislation in force at that time. There were no particular difficulties, since the legislation formed the procedure for changing such an affiliation for certain organizations.
After the collapse of the USSR this topic at some point in time it was forgotten, as the government of the country was forced to deal with more important pressing issues. However, already in the early 2010s, when reorganizations and changes began throughout the country that affected the executive branch, we had to return to it and begin to understand the situation and the accumulated problems. Since at the moment there is a need to determine the affiliation of the overwhelming number of organizations to the relevant ministries, the issue has actively begun to be worked out by the government of the Russian Federation.
The current state of the issue
The legislation of the Russian Federation as of 2017 does not give a clear definition of how exactly the departmental affiliation of certain organizations should be determined. Lawyers who prepare documentation on this topic most often refer to Article 114 of the Constitution of the Russian Federation, as well as Article 14 of the law "On the Government of the Russian Federation", since it is thanks to these two documents that federal property is managed and controlled.
When reading data legislative documents it can be concluded that only the elected federal body carries out the procedure for managing a state enterprise. It is this body that should determine the appropriate affiliation and jurisdiction of a single enterprise and take it under general control.
How to determine ownership?
The current legal practice suggests that it is possible to determine the departmental affiliation of objects, organizations and various entities by the presence of a special register of legal entities. This document should indicate all the relevant persons who are subordinate to one or another executive authority. Simultaneously with this, a regulation must be approved within this body, in which the data of the organization will also be indicated. The problem is that registries in most cases simply do not exist.
If an enterprise has lost its affiliation due to past reorganizations, then certain difficulties may arise with its legal definition. In particular, it will be necessary to find a successor to the previously existing body, which will receive its rights and powers to manage organizations. If it was found, then the enterprise should initiate the entry of data about itself into the list of organizations that are subordinate to it.
How about in practice?
In the theoretical part, everything looks quite transparent and understandable, but in practice the situation with the definition of departmental affiliation is often quite different. The successor of the abolished federal body often simply cannot be identified. The reasons for this can be very different, most often we are talking about the fact that the reorganization was carried out in a rather complicated way and during its implementation the powers and areas of control of the newly formed bodies that belong to the executive power were not immediately formed.
Another reason for the inability to establish a successor may even be the disinterest of higher authorities. As a rule, line ministries do not need a headache in the form of a new subject that needs careful monitoring. Often, this is why some may report to several executive authorities at once, or none of them at all.
Territorial affiliation
Most often, the question arises of the departmental affiliation of the territory to one or another federal body. At first glance, this seems to be a fairly simple undertaking, but in reality it is necessary to use a large number of cadastral documents in order to determine this. At the same time, legal entities are often forced to spend a lot of time trying to find out this information.
If you are planning to purchase land plot in a quiet and dense forest, you will also have to find out its affiliation. In this case, it will be much easier to get cadastral maps, since they are published even on Internet portals that are open to the public. However, to register it, you still have to contact the appropriate regional representative office.
What can help determine belonging?
The legal address is one of the main means that can help to understand to which executive authority this or that institution belongs. In any case, you can definitely determine the regional affiliation, and this is already half the battle. In general, you can use absolutely all open information about the organization, this is not prohibited by law and can help resolve the issue as soon as possible.
Information about the founders can also help you determine this affiliation, their professional activities in any case must be related to a certain industry that is controlled from above. However, such information is not always in the public domain, and it can be difficult to get it.
Educational institutions
It is quite simple to determine the departmental affiliation, each of them is subordinate to the regional representative office of the Ministry of Education. The latter, in turn, is controlled directly by the ministry itself, and control is carried out at the highest level. This applies to both municipal and private educational organizations.
The latter are obliged to constantly submit reporting documentation on their activities to the controlling organization, in case of its absence, no one will allow them to carry out teaching activities. That is why many businessmen are in no hurry to open educational institution for fear of strong pressure from the supervisory authority.
Ownership and affiliation: IP
When considering departmental affiliation, the form of ownership plays a rather important role. This is especially often manifested in the conduct of various lawsuits, one of the main differences is that an individual entrepreneur is liable with all his property, and a legal entity - authorized capital, which may be relatively small.
As a rule, individual entrepreneurs are subject to the tax inspectorate, but this only applies to taxation issues. In the event that we are talking about the production of any goods or services, they previously had to report on the quality of their product to the state, the latter had to put a mark on its compliance with the generally accepted standard. Now this is no longer happening.
Ownership and affiliation: LLC
It is also quite difficult to determine the departmental affiliation of an LLC. One of the reasons for this is the lack of a fixed definition of this term. Some interpret it as a state structure, which should be engaged in the maintenance of the institution and control its correct operation. In this sense, we are talking about a higher organization, which is also not entirely true.
The concept of belonging is more characteristic of budgetary and government organizations because they are controlled by committees and ministries. It is with the help of departments that the state regulates, controls and coordinates the activities of controlled institutions and organizations.
What should I do if I can't determine ownership?
Departmental affiliation, the types of which are the subject of controversy among legal theorists, can be quite difficult to determine. If you cannot do this on your own, you will need to send requests to all executive authorities, which, according to your assumption, may be the controlling body of the institution you are interested in.
The answers received by you must be in writing and have the seal of the ministry, only in this case they will be valid. Please note that a response to a written request may take 2-4 weeks after sending, such a long processing time is associated with a large amount of correspondence received by these organizations.
And if that didn't work either?
If, nevertheless, it was not possible to establish jurisdiction and even the legal address did not help you with this, you need to redirect your request to a higher authority - the Federal Agency that manages federal property. You must enclose in your letter all the official responses you have received from all the ministries you have previously applied to.
In turn, the agency must redirect your letter to the government of the Russian Federation and attach its own request to it, according to which it will have to acquire its own regulatory body. This will be carried out on the basis of a decree of the Russian government, which was adopted back in 1998, according to which it is the federal bodies that should exercise control over the existing federal property.
In the event that you have not received a timely response to your own request, you can contact the supervisory authority to which you sent it and clarify its fate. In the event that the letter was not received, you can check the reason for this in the post office where it was sent. Please note: it is best to send a letter with this increases the chances that it will reach the addressee.
Conclusion
The exact wording of what departmental affiliation means does not exist today. According to lawyers, this significantly complicates the work of a number of departments responsible for monitoring budgetary and private organizations. Their long labor activity often nullified due to different interpretations of terminology by different figures in the legal field.
Please note that the controlling body and the body in whose departmental subordination the structure is located may not coincide. This phenomenon arises from the division of leadership into administrative and functional. For example, employees of schools, universities and institutes may be administratively subordinate to the district administration, and functionally - to the Ministry of Education. However, for public institutions such a division is not typical, it is more typical for private organizations.
The status of departmental organizations today is little regulated, and the presence of similar institutions still requires contentious issues in society. Departmental healthcare organizations include medical and preventive organizations, pharmaceutical institutions and organizations, pharmacy organizations founded by ministries, departments, state enterprises, institutions and organizations of the Russian Federation in addition to the Ministry of Health and Social Development of the Russian Federation and the Ministries of Health and Social Development of subjects within the Russian Federation. Federation.
Enterprises, institutions and organizations of the state healthcare system, independently of their departmental subordination, are legal entities and carry out their activities in accordance with the legislation of the Russian Federation, the republics that are part of the Russian Federation, legal acts of independent entities, territories, regions, Moscow and St. Petersburg, normative legal acts of the Ministry of Health of the Russian Federation, ministries of health of the republics within the Russian Federation, health authorities of autonomous entities, territories, regions, Moscow and St. Petersburg.
At the municipal level, the provision of public health protection is performed by the municipal health authorities, which are responsible within the limits of their own competence. Namely, they are responsible for the sanitary and hygienic education of the population, ensuring the availability of a guaranteed volume of medical and social assistance to the population, the development of the municipal health care system in the territory under their jurisdiction, they perform quality control of the provision of medical, social and drug support by enterprises, institutions and organizations of state, municipal and private health care systems, as well as private medical practitioners.
A feature of municipal health care today is the emergence in its system of many new types of institutions or structures: day hospitals, micro-clinics, nursing homes, hospices, units of general practitioners, etc. - outpatient care. As a result, the domestic health care system met with a number of the following questions:
The quality and accessibility of medical care to the population has decreased;
Low funding for health care is associated with low efficiency in the use of resources and an imbalance in the structure of medical care;
The program of state guarantees for the provision of free medical care to citizens is largely declarative in nature, since it is not fully funded;
The problem of equal access to medical care for residents of various territories of the country, as well as the rural and urban population, has not yet been resolved;
Expenses of budgets and funds of compulsory medical insurance in some regions, and municipalities per inhabitant are recognized dozens of times, which violates the principles of social justice;
The unsatisfactory state of the material and technical base of medical institutions.
Thus, a set of problems national system health care, including the low socio-economic impact of its activities, is becoming the main driving force behind its reform. The task of modernizing health care set by the President of the Russian Federation has found its concretization in the ongoing national projects, a special place among them is occupied by the national project in the field of health care (National Health Project).
The goal of the healthcare reform is to increase the availability and quality of medical care for the general population, as evidenced by the statement of the government of the Russian Federation.
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