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Autonomous health care institution. Autonomous institutions - one of the forms of improving the activities of medical organizations

As subjects of health insurance, the Law of the Russian Federation "On health insurance of citizens Russian Federation» a citizen, an insured, an insurance medical organization, a medical institution are identified.

The insured under CHI (payer of insurance premiums for CHI) of the non-working population are the executive authorities of the constituent entities of the Russian Federation;

working population - organizations, individuals registered as individual entrepreneurs, private notaries, lawyers, individuals who have entered into an agreement with employees, as well as paying remuneration under civil law agreements, on which, in accordance with the legislation of the Russian Federation, taxes are charged in the part to be credited to compulsory medical insurance funds.

Insurance medical organizations (insurers) are legal entities that provide medical insurance and have a state permit (license) for the right to engage in compulsory medical insurance.

Medical institutions in the health insurance system are licensed medical institutions, research institutes, other institutions providing medical care, as well as persons providing medical activity both individually and collectively.

Responsibilities of the health insurance company:

inform the insured about the rights to receive free medical services provided under the CHI program, about the list of medical institutions operating within the CHI system, about the procedure for organizing the reception of the insured, about the patient's rights;

· to issue medical insurance policies from the moment of conclusion of the medical insurance contract to the insured (or insured). The HMO employee must provide the insured with the address and phone numbers of the HMO reference and information service, which is obliged to advise the patient in case of conflict situation upon receipt medical care and protect the rights of the patient. Registration of applications for medical care under the CHI policy is carried out, which allows you to properly and fully finance a medical institution operating within the CHI system;

control the volume, timing and quality of medical care provided;

· to receive applications from insured citizens. If the citizen's appeal contains a complaint about the lack of provision or non-compliance with the conditions for the provision of medical care, the medical insurance organization is obliged to resolve the issue of the timing, place and type of provision of the necessary medical care to the citizen, or give a reasoned refusal;

Consider citizens' claims to the quality of medical care and to the collection of Money during treatment under the MHI policy. If the patient has complaints about the work of the CMO, it is necessary to contact the territorial CHI fund in the department for the protection of the rights of insured citizens.

Familiarize yourself with the territorial CHI program, specific types and volumes of medical care, lists of vital and essential medicines and a list of health care institutions that operate in the CHI system of each specific subject of the Russian Federation, you can also in the territorial fund of compulsory medical insurance

Problems and prospects for the development of the CHI system in the Russian Federation. In the context of a severe budget deficit, the organization of a system of compulsory medical insurance (CHI) was an effective political and economic decision that initiated the formation of a fundamentally new system legal and financial relations in the field of providing medical care to the population, as well as more rational use of available health care resources.

For 5 years, the system of compulsory medical insurance has been organizationally formed and is functioning throughout the country practically from scratch. It consists of 90 territorial CHI funds, 1176 branches, 424 insurance medical organizations(SMO), 18092 LPU.

More than 82% of the population of the Russian Federation are provided with compulsory medical insurance policies. A system has been created and is functioning for collecting insurance premiums, recording and registering premium payers, the number of which amounted to 3.7 million.

In less than 5 years of implementing the law on health insurance, more than 90 billion rubles have been collected. Of this amount, insurance premiums for employees amounted to almost 56 billion rubles, payments from the budget for compulsory medical insurance of the non-working population - more than 21 billion rubles. Nearly 13 billion rubles were attracted through the collection of fines, penalties from payers, income from the use of temporarily free funds.

In total, more than 84 billion rubles were allocated to the healthcare system over 5 years in addition to budgetary funds, which is more than 30% of all healthcare expenditures. The main part of the funds (72.4 billion rubles) was used to finance medical care under the territorial programs of compulsory medical insurance. Over the past three years, more than 50% of these funds have been spent by healthcare institutions on wages medical workers, more than 18% - to pay for medicines.

In the current year alone, the Federal Compulsory Medical Insurance Fund provided financial assistance in the form of subventions to 88 constituent entities of the Russian Federation for a total amount of more than 900 million rubles. In addition, taking into account the particular complexity and uniqueness of federal healthcare institutions, they received assistance in the amount of more than 107 million rubles.

It should be noted that the Federal Fund has had a new regulation on the work of the Subvention Commission for about 3 months. Meetings of the Commission are held at least once every 10 days. In crisis conditions, we decided to temporarily stop the investment activities of the Federal Fund, so all the money accumulated over a short period of time is quickly distributed to the regions.

The main strategic direction of the work of the Federal and territorial funds has been and remains to ensure the implementation of the Law of the Russian Federation "On the medical insurance of citizens."

However, even in those territories where the law is enforced, impermissible liberties are allowed in its implementation. And in a number of territories (Kirov, Smolensk regions, Evenk Autonomous Okrug), the law is still being implemented only in terms of collecting insurance premiums. In many ways, this situation is due to the policy pursued by the authorities at all levels. If at the first stage of the implementation of the law this situation could be assessed to a certain extent as positive, because. she gave me a choice best options, then at present it is a brake on the development of the compulsory health insurance system and complicates the adoption of effective management decisions. In view of this, the problem of implementing the law remains the number one task today.

Recently, mainly from the territories, voices have been persistently heard about the need to revise the law on health insurance. In these statements, the Federal Fund sees political short-sightedness, since consideration of these changes, in a crisis and in conditions of incomplete implementation of the law, in the State Duma of the Russian Federation can cause the opposite effect. Any changes in legislation at the present time will not be constructive, but leading to a restructuring of the system with a break in all established ties. Needless to say, how this restructuring will affect medical institutions. We recognize that the legislation in the field of health insurance needs to be improved, but this process must be progressive.

One of the strategic tasks in CHI is to ensure the constitutional right of citizens to free medical care. To this end, the Government of the Russian Federation approved the Program of State Guarantees for Provision of Citizens of the Russian Federation with Free Medical Care. This program for the first time at the level normative document the concept of a per capita standard of healthcare financing is introduced.

The implementation of territorial programs in the constituent entities of the Russian Federation will make it possible to start a real restructuring of medical care.

A significant brake on the effective functioning of the compulsory health insurance system is the extremely insufficient level of financial support for the system. The provision of one resident with all compulsory medical insurance funds in 1997 amounted to an average of 199.9 rubles in the Russian Federation, while the receipt of insurance premiums per employee was 269.8, and payments from the budget per non-worker - only 81.2 rubles. The demand under the State Guarantee Program is set at 316.0 rubles, i.е. the actual supply is almost 40% lower than the need. And this despite the fact that for the first time in 1997 the growth in the provision of the population with the means of compulsory medical insurance exceeded the pace of inflationary processes.

The amount of the deficit of funds to finance compulsory health insurance is increasing every year. As a result of an acute shortage of funds, the actual financing of the territorial programs of compulsory medical insurance amounted to 9 months. 1998 only 37.5% of the approved annual volume.

This situation predetermines the imbalance in the volume of medical care provided to the population under the program of state guarantees, deprives the majority of the country's population of the opportunity to receive affordable medical care, which leads to an increase in social tension.

It should be noted that in the face of a threatening increase in the financial deficit of the compulsory medical insurance system, out of 17 territorial funds, in which, during the checks of the KRU of the Federal Fund, misappropriation of funds was revealed, only one fund fully restored the money spent. The Federal Fund will continue to strictly control the territorial funds for the return of funds from compulsory medical insurance for misuse.

The main reasons for the created financial position are:

· non-compliance by the executive authorities of the constituent entities of the Russian Federation with the law regarding the transfer of payments for compulsory medical insurance of the non-working population;

· destabilization of the financial and economic situation in the country;

· low level of insurance contribution rate for compulsory health insurance of working citizens (3.6% against the need of 7.2%).

At the same time, the State Tax Service and the Ministry of Finance submitted to the government, and then to the State Duma, draft federal laws that provide for a reduction in the employers' insurance contribution rate to 3.4%. The Federal Fund sent reasoned objections to the government with the support of the Ministry of Health this bill. However, they were not accepted.

One of the solutions to the above problem could be the approval of a differentiated standard and the granting of the right to the constituent entities of the Russian Federation to approve the insurance premium rate within the limits of the minimum and maximum amounts established by law.

Another, more rigid socially, the option of developing the compulsory medical insurance system in conditions of a shortage of funds requires a detailed preliminary study. As rightly noted by the State Tax Service, an increase in the insurance rate only leads to an increase in the tax burden on employers with doubtful financial results. Hence a proposal arose, the essence of which is to reduce the Basic Compulsory Medical Insurance Program for a certain contingent of highly wealthy citizens who have the financial ability to pay medical services at the expense own funds. Naturally, the reduction of the Basic Program should not affect the non-working population. The most difficult question is the definition of the contingent with high level income, although the relevant developments should exist with the bodies of the State Tax Service. As a criterion for assessing the level of income of citizens, an indicator of the cost of the minimum consumer basket can be used.

Medical assistance, which for the specified contingent will not be included in the reduced compulsory medical insurance program, can be provided on the principles of voluntary medical insurance. Naturally, strict control should be established both over the system of voluntary medical insurance itself and over the methods of pricing in medical institutions. According to the research institute. ON THE. Semashko, share of official and "shadow" paid services in healthcare institutions currently reaches 30-40% of all funding. The question arises of the need to legalize paid medical services.

About payments. Of particular concern is the situation with payments for compulsory medical insurance of unemployed citizens of the Russian Federation.

1. Improving the financial and credit mechanism for the stability of the system "On payments". Of particular concern is the situation with payments for compulsory medical insurance of unemployed citizens of the Russian Federation.

Considering that non-working citizens exceed 60% of the total population of the Russian Federation, payments directed to the compulsory medical insurance funds for insurance of non-working citizens should be at least 60-70% of all system revenues. The real situation is the opposite: the flow of budgetary funds not only to compulsory medical insurance, but also in general, is constantly declining, and the insurance premiums of employees become the main ones instead of additional ones.

Implementation strategic directions The development of the system was sharply complicated by the crisis in the financial sector, which affects all aspects of the health care system and compulsory health insurance.

In connection with the freezing of the GKO market, the crisis of the financial and banking systems, and the sharp depreciation of the ruble in August-September 1998, the safety stock practically collapsed. System losses are estimated at about 200 million rubles. At the same time, there was an increase in the cost of medical care due to rising prices for medicines, food, etc. There is no need to emphasize that the financial destabilization of the compulsory health insurance system entails the financial destabilization of medical institutions. The Federal Fund is completing work with the Russian Ministry of Finance on the early redemption of GKOs in cash.

In a crisis situation, the Federal Compulsory Medical Insurance Fund considers financing the salaries of medical workers a priority task.

Now the Federal Compulsory Medical Insurance Fund, together with the Ministry of Health, is coming close to implementing the resolution of the Second All-Russian Meeting of Heads of Health Administration Bodies and Directors of Territorial Funds on the introduction of differentiated remuneration for medical workers employed in the compulsory health insurance system, in terms of the volume and quality of their work.

In the context of the activation of the activities of the territorial funds of compulsory medical insurance and insurance medical organizations for the protection of the rights of the insured, destabilization of the work of medical institutions is not ruled out. In this regard, the Federal Compulsory Medical Insurance Fund has developed a number of materials on the issues of insurance of civil liability of medical workers. Further successful solution of this problem largely depends on the joint efforts of the Ministry of Health of Russia, the Federal Compulsory Medical Insurance Fund, medical associations and trade unions, of course, provided that the sources of funds for insurance are determined.

One more problem of the current period should be noted: without a unified approach to the personification of the insured population, without a unified classifier of medical services, without unified medical standards and invoices for paying for medical services, as well as a unified pricing policy - further progress along the path of reforms based on the principles of compulsory medical insurance is very debatable. Lack of technical and economic standards for medical institutions different levels makes the procedure for their licensing and accreditation a formality. In the short term, it is the solution of these problems that is put at the forefront of joint actions of the Ministry of Health of Russia and the Federal Fund.

According to the data of the first half of 1998, the share of expenditure of compulsory medical insurance funds for drug provision in various subjects of the Russian Federation varies from 8.0% (Lipetsk region) to 65.2% (Magadan region), averaging 20%.

Due to this great importance acquires the analysis of territorial models and the development of unified approaches to the problem of organizing drug supply, taking into account the accumulated experience of the territories, which is necessary for the effective and rational use of funds allocated for the purchase of medicines and medical products from local budgets and compulsory medical insurance funds.

Improving the provision of medicines in the system of compulsory medical insurance in the near future will be carried out in the following areas: development of a list of medicines payable from compulsory health insurance funds; organization of control over the movement of medicines; introduction of measures to limit the cost of medicines paid from the funds of the CHI system.

The solution of these problems is facilitated by the formation of a new information and analytical support for the compulsory medical insurance system based on a comprehensive program of informatization of the industry.

The main tasks of the Federal Compulsory Medical Insurance Fund for 1999 are:

The main objectives of the Federal Compulsory Medical Insurance Fund for 2010 are:

1. Improving the financial and credit mechanism for the sustainability of the CHI system:

raising financial stability systems by increasing the insurance premium rate;

· creation and implementation of measures to eliminate the shortage of funds to finance the Basic Compulsory Medical Insurance Program by ensuring a stable receipt of insurance premiums and minimum guaranteed payments for compulsory medical insurance of non-working citizens to territorial funds;

control over the targeted and rational use of CHI funds;

· Allocation of a targeted transfer from the Federal budget for the insurance of unemployed citizens;

· Improving the provision of financial assistance (subventions) to territorial funds to equalize the conditions for financing territorial CHI programs.

2. Improvement legislative regulation in the field of providing medical care to the population at the federal and regional levels, the implementation of measures to implement the law on health insurance in the constituent entities of the Russian Federation:

· revitalization of the activities of territorial funds and insurance medical organizations to protect the rights of the insured;

· Establishment of responsibility of executive authorities for non-compliance with the law on health insurance in terms of mandatory payment for mandatory medical insurance for non-working citizens and its exclusion from the items of expenditure subject to sequestration by referring it to protected items;

improvement state regulation in the field of providing the population with medicines;

· increasing the social and legal protection of insured citizens and medical workers.

3. Improving measures to improve the quality and accessibility of medical care to the population:

Ensuring the personification of the insured population and the volume of services provided on the basis of a unified compulsory medical insurance policy;

Adoption of a unified classifier of medical services;

· Adoption of unified medical standards and a unified form of invoices for payment of medical services.

4. Implementation of the main directions of informatization of the CHI system:

· Creation of an information-analytical system of the industry;

· Creation automated system financial control;

· Creation of a centralized branch information and reference system;

provision of all territorial CHI funds and branches email and access to the Internet, as well as standardization and unification of information software.

In conclusion, it is necessary to note the importance and relevance of educational support for the reorganization of the medical care system as CHI. For the public, including the medical community, the goals and paths of the transition to compulsory health insurance are still largely unclear. It is necessary to change the situation as soon as possible, to be heard and understood by millions Russian citizens in all Russian regions without exception. Ordinary citizens representing their interests public organizations and associations, political parties and movements, representatives of state authorities at the federal level and, above all, Russian legislators should understand with our help: why CHI is the real driving force behind health care reform, why without CHI it is impossible to seriously protect the interests of citizens in the field of health protection.

In our country, there is probably not a single person who would not come across state institutions in one way or another. We all went to school, visited polyclinics, stood in long lines at the tax office or the social security. At least one of these places, but certainly familiar to the citizens of Russia. And everyone has heard a lot, and many personally know about the by no means exorbitant salaries of public sector workers. But now it's not about that. For a long time, the concept of "state institution" was identical to the concept of "budgetary institution". However, recently there have been some changes in our legislation. Currently, municipalities state organizations are divided into state-owned, autonomous and In this article we will talk about one of these types.

An autonomous institution is one established by the Russian Federation, its subject or municipality. Its purpose is to provide services or perform work in scientific, educational activities, in the areas of healthcare, social protection, ensuring employment of the population, culture, sports and others.

The state can be created in two ways:

Establishment of a new organization.
Changing the type of an existing organization, i.e., the transformation of a budgetary or state institution into an autonomous one. This procedure requires the decision of the executive authorities. Moreover, when changing the type of institution, the founder, as a rule, does not change.

Why is this procedure necessary? What does the organization get as a result?

An autonomous institution is an organization that has access to most of the benefits due to a budgetary institution, but does not have the same restrictions. Let's try to explain. A budgetary institution receives certain funds from the state according to the expenditure schedule. It can only be used for strictly defined purposes.

By the way, the same applies to his extrabudgetary activities. Moreover, for all expenses and receipts, it must be fully accountable to the Federal Treasury of the Russian Federation. An autonomous institution is an organization with greater financial and economic freedom. It receives funding from the state, which can be spent on expenses for its main activity, on the maintenance of property or the payment of taxes. But she can also receive income from the property assigned to her, for example, by renting out premises. At the same time, the organization itself will determine what to spend the funds received on, and has the right to adjust costs if necessary. She can unite budget resources and funds received from extrabudgetary activities. An autonomous institution has the right to allocate funds to receive thereby. In addition, it can take out loans. The reporting to the Federal Treasury of institutions of this type has been simplified.

An autonomous institution is an organization that has the opportunity to increase its profitability, as well as the quality of services due to the factors listed above.

Characteristics of organizational and legal forms of the medical organizations
Kuznetsova T.V.
Peoples" Friendship University of Russia

This article discusses various organizational and legal forms of medical organizations and also provides a detailed description of each of the considered commercial and non-commercial forms medical organizations. Detailed characteristics includes various comparative aspects legal status, managerial, property and economic nature, the content of constituent documents, the right to operate in the CHI system, depending on the organizational and legal form of the medical organization. The most common form of non-profit medical organization today is characterized in detail - the state (municipal) medical institution, as well as the most promising form, taking into account the realities of today - the state (municipal) autonomous non-profit medical organization.

In the present article, various organizational and legal forms of medical organizations are considered; the detailed characteristic of each commercial and noncommercial forms of medical organizations considered is also given. The detailed characteristic includes various comparative aspects of legal status, administrative, property and economic characters, contents of constituent documents, the right to provide activity in the MHI system depending on the organizational and legal form of the medical organization. The detailed consideration is given to the most widespread form for today of noncommercial medical organization state (municipal) medical facility, and also to the most perspective, in view of today’s realities form state (municipal) autonomous noncommercial medical organization.

The main criterion for the classification of organizational and legal forms is the purpose of creating a medical organization. According to this criterion, all organizations are divided into two categories: commercial and non-profit.

commercial organization is a legal entity created for the purpose of entrepreneurial activity. The main objective of the activities of such an organization is to make a profit. Commercial organizations can be both private (economic companies and partnerships, production cooperatives), and state and municipal (unitary enterprises). A unitary enterprise is a commercial organization that is not endowed with the right of ownership of the property assigned to it by the owner. The property of a unitary enterprise is in the state or municipal property and belongs to a unitary enterprise on the right of economic management. Right of economic management- this is the right to own, use and dispose of property within the limits determined in accordance with the civil code. An enterprise is not entitled to sell property belonging to it under the right of economic management, to lease it, to pledge it, to contribute to the authorized capital business companies and partnerships or otherwise dispose of property without the consent of the owner.

One of the forms of unitary enterprise - state enterprise, which differs in that the property is transferred to it not for economic management, but for operational management. The right of operational management- this is the right to own, use and dispose of property within the limits established by law, in accordance with the goals of the enterprise, the tasks of the owner and the purpose of the property. The owner of property assigned to a state-owned enterprise has the right to withdraw excess, unused or misused property and dispose of it at his own discretion.

Thus, unitary enterprises own and use someone else's property - state or municipal: the owner of the property does not lose rights to it, creating a unitary enterprise and endowing it with the necessary material resources.

The executive body of a unitary enterprise is the head, who is appointed by the owner or a body authorized by the owner (in our case, the health management body) and is accountable to him.

A unitary enterprise is not liable for the obligations of its founder, and the founder is not liable for the debts and obligations of a unitary enterprise. At the same time, the responsibility of a unitary enterprise to a certain extent depends on the scope and nature of the rights to property assigned to it by the owner - on the right of economic management or on the right of operational management.

A unitary enterprise is quite independent in its activities: it is not financed according to the estimate, the founder can pay for its services on the basis of concluded agreements. This provides the possibility of operational resource maneuver, and the absence of restrictions on the wage fund creates commercial incentives for the team of a unitary enterprise.

Despite the fact that the activity of a unitary enterprise is subordinated to making a profit, its constituent documents should also contain substantive goals - for example, meeting the needs of the population in certain types of medical care, which makes it possible to keep a unitary enterprise within certain boundaries of activity. However, within these boundaries, a unitary enterprise behaves like a commercial organization. His desire for profit may be in conflict with the objectives of the activity. For example, a medical unitary enterprise may refuse to provide unprofitable types of services, to comply with part of the obligations to the attached population. It may be interested in replicating more profitable proven medical technologies, artificially narrowing the choice of services. Therefore, if a unitary enterprise operates in the MHI system, additional costs will be required to organize control against these negative trends. This limits the use unitary enterprises to realize the rights of citizens to free medical care.

The same restrictions exist for the use of private commercial medical organizations in the CHI system: companies with limited liability, open and closed joint-stock companies and others.

However, sometimes work in the MHI system can be beneficial for a commercial organization - even if, on formal grounds, the services provided are unprofitable, and commercial enterprise will strive to be given the task of providing medical assistance within the framework of compulsory health insurance - in particular, by offering assistance at affordable prices. Therefore, the possibility of using such organizations in the CHI system should not be completely rejected.

Non-profit organization is a legal entity that does not set profit making as the main goal of its activities and does not distribute profits between participants.

Both public and private medical organizations can be non-profit.

All non-profit organizations have special legal capacity, the content of which depends on the purpose of creation. specific organization and its organizational and legal form. The purpose of a non-profit medical organization is to protect the health of citizens. Realize commercial activity non-profit organization can only to the extent that it corresponds to the goals of its creation. Such activity for a medical organization, for example, may be the provision of profitable paid medical services in addition to the CHI program.

A non-profit organization owns or manages separate property, is liable for its obligations with this property (with the exception of institutions that are liable for obligations only with their own money), may, on its own behalf, acquire property or non-property rights, incur obligations, be a plaintiff and a defendant in court.

Public authorities and local government within their competence, they can provide economic support to non-profit organizations in various forms, including:

Provision in accordance with the legislation of benefits for the payment of taxes, customs and other fees and charges (taking into account the legal form of a non-profit organization):

full or partial exemption from fees for the use of public and municipal property;
placement among non-profit organizations on a competitive basis of state and municipal social assignments;
providing, in accordance with the law, tax benefits to citizens and legal entities that provide financial support to non-profit organizations.

At the same time, it is not allowed to provide tax benefits on an individual basis to individual non-profit organizations, as well as to individual citizens and legal entities that provide material support to these non-profit organizations.

The dominant form of non-profit medical organization is currently institution.

An institution is an organization created by the owner of property, including the state, local governments, legal or individuals, for the implementation of managerial, socio-cultural or other functions of a non-commercial nature and financed by the owner in whole or in part.

The founder-owner (or a body authorized by him) appoints the head of the institution as the sole executive body.

The owner finances the activities of the institution in whole or in part, transferring funds to it or assigning other property to it on the basis of the right of operational management, which imposes significant restrictions on the institution to own and dispose of this property. The institution is not entitled to alienate or otherwise dispose of property assigned to it or acquired at the expense of funds allocated by the owner according to the estimate.

The institution is responsible for its obligations with the funds at its disposal. In case of their insufficiency, the owner of the relevant property bears subsidiary liability.

The articles of association or bylaws of an institution may permit certain types of profitable activities (i.e. entrepreneurial activity). Incomes from entrepreneurial activity, as well as property acquired at their expense, are the property of the founder and come only to independent disposal, but not to the property of the institution. Thus, an institution under no circumstances can become the owner of its property.

The liquidation of the institution is carried out according to general rules civil legislation, and the rest of the property always becomes the property of the founder.

The state (municipal) institution is still the most common form of state non-profit organization. However, this form of organization is not the only acceptable one; moreover, it has a number of significant drawbacks, the main of which is that this organizational and legal form does not stimulate the desire to efficient use resources. The reason for this is the use of the principle of maintenance by the owner, rather than payment for final services, restrictions on the maneuvering of resources, and strict regulation of financial and economic activities. The property is assigned to a state (municipal) institution on the basis of the right of operational management; financing, according to Article 161 of the Budget Code, can only be carried out according to the estimate. This does not create incentives, for example, to introduce new medical technologies that would reduce general expenses for treatment by exceeding the costs of any individual item (for example, the cost of medicines and Consumables). Subsidiary liability of the owner-state for obligations medical institution creates dependency of institutions.

The introduction of compulsory health insurance has significantly changed the activities of medical institutions. Increasingly, they are financed on a service-by-service basis rather than on an estimate of income and expenses. The basis of their relationship with the insurer is a contract for the provision of medical services, according to which the medical institution undertakes to provide services of a certain volume and quality to the insured contingent, receiving payment at tariffs for this. At the same time, the independence of medical institutions expanded. Receiving financial support based on the volume of medical care provided to the population, they use non-budgetary sources of funding, which allows them to quickly resolve medical and economic issues. There was a real opportunity to ensure the dependence of the amount of remuneration on the volume and quality of work performed.

Incomes received as payment for medical care from insurers and other sources are used by medical institutions at their own discretion to solve statutory tasks.

Thus, the nature of the activities of medical institutions is increasingly acquiring the features inherent in autonomous non-profit organizations. This organizational and legal form is incompatible with a rigid administrative hierarchy and operates on the basis of contractual relations. The activities of such an organization are not aimed at fulfilling the tasks of the founder, but at achieving the statutory goals.

Legislative consolidation The independence of state and municipal medical institutions, assumed when creating new organizational and legal forms, requires their legislative consolidation. The relevant bill is currently under consideration.

The bills propose to add to existing form public institution two more forms. This autonomous institution And state (municipal) autonomous non-profit medical organization.

According to the bills, property autonomous institution belongs to him on the right of operational management. The owner of the property of an autonomous institution is the Russian Federation, a subject of the Russian Federation or a municipality. An autonomous institution is not entitled, without the consent of the owner, to dispose of immovable and especially valuable movable property assigned to it by the owner or acquired by an autonomous institution at the expense of target funds allocated to it by the owner for the creation (acquisition) of immovable and especially valuable movable property. The types of especially valuable movable property, which an autonomous institution has the right to dispose of only with the consent of the owner, are determined by the Government of the Russian Federation. At the same time, an autonomous institution independently disposes of property (including real estate) acquired by it with the income from its activities. The property of an autonomous institution may be used by it exclusively for the purposes determined by its charter.

Unlike an autonomous institution, property state (municipal) autonomous non-profit organization, including transferred to it by the founder during its creation, belongs to this organization on the basis of ownership. At the same time, a state (municipal) autonomous non-profit organization, as well as an autonomous institution, may use its property exclusively for the purposes determined by its charter.

An autonomous institution is liable for its obligations with all the property belonging to it, with the exception of immovable and especially valuable movable property, which an autonomous institution is not entitled to dispose of without the consent of the owner. A state (municipal) autonomous non-profit organization is liable for its obligations with all its property.

The owner of the property of an autonomous institution shall not be liable for the obligations of an autonomous institution, except for the cases provided for by the surety agreement. An autonomous institution shall not be liable for the obligations of the owner of the property assigned to it. In the same way, a state (municipal) autonomous non-profit organization is not liable for the obligations of its founder, and the founder is not liable for the obligations of the state (municipal) autonomous non-profit organization created by him, except for the cases provided for by the surety agreement.

An autonomous medical institution carries out its activities in accordance with the goals defined by law and the charter by providing medical services to the population.

An autonomous institution has the right, with the consent of the owner of its property, to act as a founder (participant) of other legal entities whose activities correspond to the goals of the activities of the autonomous institution, if participation in these legal entities can contribute to the quality provision of services (performance of work) by the autonomous institution.

Income of an autonomous institution and state (municipal) autonomous organization come at their independent disposal and are used to achieve the goals for which they were created. The owner of the property of an autonomous institution, as well as the founder of an autonomous non-profit state (municipal) non-profit medical organization, does not have the right to receive income from the use of property and activities of an autonomous institution (non-profit medical organization).

An autonomous institution, like a state (municipal) non-profit organization, is obliged to annually publish reports on its activities and the use of its property in the manner determined by the Government of the Russian Federation; maintain accounting records and provide accounting and statistical reporting in the manner prescribed by the legislation of the Russian Federation; provide information about their activities to authorities state statistics, tax authorities, state authorities or local governments and other bodies and persons in accordance with the legislation of the Russian Federation and its charter.

Information on the size and composition of the property of an autonomous institution, a state (municipal) autonomous non-profit organization, the size and structure of their income and expenses, the number and composition of employees, the average level of remuneration, the use of free labor of citizens in the activities of these organizations cannot be trade secret. Organizations of both organizational and legal forms provide open access, including access to the media to the following of their documents:

charter (including amendments and additions to the charter);
certificate of state registration;
decision of the founder on the creation of an autonomous institution;
regulations on branches and representative offices;
documents containing information about personnel board of trustees and executive body;
information on the size and composition of the property on the balance sheet of the autonomous institution and documents confirming its rights to this property;
plan of financial and economic activity;
annual reports O financial activities, financial statements;
auditors' conclusions.

The main activity of an autonomous institution, a non-profit state (municipal) organization is recognized as an activity directly aimed at achieving the goals for which the autonomous institution was created (in the case of an autonomous medical institution, a non-profit medical organization - to protect public health).

An autonomous medical institution, in accordance with the tasks of the founder and obligations to the insurer for compulsory medical insurance, carries out activities for the provision of services (performance of work) free of charge or partially paid for the consumer, provided with funding from the relevant budget, off-budget funds or funds of the insurer for compulsory health insurance. The state (municipal) non-profit medical organization has the right to provide the same services on the basis of the instructions of the founder.

In addition to these volumes of these services, an autonomous institution and a state (municipal) medical organization are also entitled, at their discretion, to provide services (perform work) related to their core activities, for a fee for any citizens and legal entities, in compliance with the rules of civil law on public contract. At the same time, these organizations must ensure the proper fulfillment of tasks and obligations aimed at fulfilling the statutory goals. Under the same conditions, an autonomous institution, a non-profit medical organization has the right to perform work (provide services) that are additional in nature in relation to the main activity defined by the charter. All these additional types activities must be fully specified in the charter.

The decision to establish an autonomous institution on the basis of federally owned property shall be taken in accordance with the procedure established by the Government of the Russian Federation.

The decision to create an autonomous institution on the basis of property owned by a constituent entity of the Russian Federation or owned by a municipal formation is taken by a state authority of a constituent entity of the Russian Federation or a local self-government body within their competence established by acts defining the status of these bodies.

The decision to grant the status of an autonomous state (municipal) institution to an existing institution is made if the following conditions are met simultaneously:

such a decision will not entail a violation of the rights of citizens provided for by law, including the right to receive free medical care and free education;
as of the date of the decision, the state (municipal) institution has no accounts payable overdue by more than three months.

The Government of the Russian Federation may establish additional conditions for making a decision on granting the status of an autonomous state (municipal) institution to an existing state (municipal) institution.

The Government of the Russian Federation or an authorized body of state power of a constituent entity of the Russian Federation or a local self-government body may determine lists of state (municipal) institutions that are not subject to the status of an autonomous institution.

The adoption of a decision to grant the status of an autonomous state (municipal) institution to an existing state institution entails the introduction of changes to its charter and state registration of these changes in the prescribed manner.

On the same grounds, a decision is made to establish a state (municipal) autonomous non-profit organization. The only difference is that an autonomous non-profit medical organization can be formed either through its establishment or through the transformation of a state (municipal) medical institution, including an autonomous one.

The founder of both organizational and legal forms is the Russian Federation, its subject or municipality. founding document is the charter approved by the founder. Mandatory state registration these organizations.

The highest body in both an autonomous institution and a non-profit organization is the board of trustees, the decision on the appointment of members of which is made by the founder. The current management is carried out by the sole executive body (in the case of a medical organization - the head physician), the decision on the appointment of which is made by the Board of Trustees.

The liquidation of an autonomous institution, as well as a non-profit organization, is possible on the grounds and in the manner prescribed by Civil Code Russian Federation. Claims of creditors of a liquidated state (municipal) autonomous non-profit organization shall be satisfied at the expense of property belonging to it by right of ownership, and claims of creditors of an autonomous institution - only at the expense of that part of the property that can be foreclosed.

The property of any of these organizations remaining after satisfaction of creditors' claims shall be transferred by the liquidation commission to its founder.

Thus, two new forms are added to the existing form of a medical institution: an autonomous state (municipal) medical institution and a state (municipal) medical organization.

An autonomous institution differs from an institution in the following main points:

have a broader content right of operational management of property transferred to them by the founder and acquired as a result of income-generating activities permitted by them (the right of autonomous operational management);
the owner-state does not bear subsidiary liability for the obligations of an autonomous institution, while the collection of creditors cannot be levied on buildings and high-tech equipment, that is, an autonomous institution is liable for its obligations independently, but within the limits of its available funds and part of the equipment;
in an autonomous institution, a board of trustees is created, which primarily performs supervisory functions.

The state (municipal) autonomous non-profit organization is characterized by the following features:

the organization is the owner of the property transferred to it by the founder and earned independently:
the transfer of property by the owner to the ownership of the organization upon its creation is not privatization, since the organization remains state (municipal): the founder can transfer part of the property on a lease or gratuitous basis, in which case the property remains in state (municipal) ownership, and the threat of its alienation does not occur;
organization bears full responsibility for its obligations with all the property that is in its ownership;
The supreme body of the organization is the Board of Trustees, empowered to resolve key issues of the organization's activities.

Private non-profit organizations may also exist in the form non-profit partnership or an autonomous non-profit organization. The founders and participants of both of these organizational and legal forms can be any individuals and legal entities, and for a non-profit partnership, at least two founders are required, for a non-profit organization, the number of founders can be any. The activity of these organizations determined by the statute is aimed at achieving public benefits. The supreme governing body in the case of a non-commercial partnership is the general meeting of participants and the executive body - collegiate or sole. In an autonomous non-profit organization, a supreme collegial body (such as a supervisory board) and an executive body - a collegial or sole individual - are created. The rights of the founders in the first case are exercised by participating in general meeting. In the second - participation in the formation of the highest collegial governing body. Both organizations enter into contractual relations with clients, both bear responsibility for their obligations within the limits of their property. The reports of these organizations are not published, but are provided to the founder and other bodies provided for by law.

All types of non-profit organizations, both public and private, can be involved in the provision of medical care in the CHI system. With sufficient independence, such organizations seek to increase local (within their institution) economic efficiency providing medical care, and the presence of competition in the struggle for tasks can also be used to increase structural (within the entire health care system) efficiency. The presence of independence stimulates the activity of the organization in the provision of new services, earning money for the purchase of more modern equipment, increasing wages depending on the results obtained. However, in order to effectively take advantage of the existing advantages, the leaders of these organizations must have certain methods and tools that allow them to choose the right way increase efficiency.

List of used literature:

Kucherenko V.Z., Vyalkov A.I., Denisov I.N. and others. Organization and analysis of the activities of medical institutions in the conditions of compulsory medical insurance.-M .: FFOMS, 2000.
Health Economics / ed. THEM. Sheiman / - M. Tasis, 2001.
Kucherenko V.Z., Flek V.O., Vyalkova G.M. Evaluation of the effectiveness of medical organizations / ed. A.I. Vyalkova / - M., GEOTAR-MED, 2004.
Health care management at the present stage: problems, their causes and possible solutions/ ed. IN AND. Starodubova, D.V. Pivenya, / - M .: Publishing House "Health Manager", 2006.

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On the basis of the regional clinical hospital, a conference was held dedicated to a very topical issue of improving the legal status of state and municipal medical institutions, which was attended by almost all the chief doctors of various medical institutions of the region and nearby regions.

Since January 1, 2011, many chief physicians have decided to transfer their medical institutions to autonomous status. All of them believed that this organizational and legal form would give medical facilities the opportunity to earn money through the provision of paid medical services and would allow them to bring the salaries of doctors and other medical personnel to a decent level.

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Information sources

See for example: Zalessky V.V. New legal entity (autonomous institution) // Journal of Russian law. 2007. No. 4;
Rybalchenko I.E. New forms of intensification of the activities of a medical institution in the field of paid services // Healthcare Manager. 2005. No. 11;
Selyukov A.D. Legal aspects of financial support budget institutions// Law and education. 2002. No. 3;
Siburina T.A. Future directions of institutional development of health care // Manager of health care. 2005. No. 7;
Starodubov V.I., Tikhomirov A.V. Institution: pro et contra // Chief Physician: economy and law. 2004. No. 1;
Stetsenko S.G. Paid medical services: topical issues of legal regulation // Medical Law.2003. No. 1.

1. An autonomous institution is a non-profit organization established by the Russian Federation, a constituent entity of the Russian Federation or a municipality to perform work, provide services for the purpose of exercising the powers of state authorities provided for by the legislation of the Russian Federation, the powers of local governments in the fields of science, education, healthcare, culture, mass media, social protection, employment, physical education and sports, as well as in other areas in cases established by federal laws (including when carrying out activities to work with children and youth in these areas).

2. An autonomous institution is legal entity and on its own behalf can acquire and exercise property and personal non-property rights, bear obligations, be a plaintiff and a defendant in court.

3. An autonomous institution created on the basis of property owned by the federal government, an autonomous institution created on the basis of property owned by a constituent entity of the Russian Federation, an autonomous institution created on the basis of property owned by the municipality shall have the right to open accounts with credit institutions and (or) personal accounts, respectively, in the territorial bodies of the Federal Treasury, financial bodies of the constituent entities of the Russian Federation, municipalities.