THIS IS AN UNFINISHED TRANSLATION – all text
is included and improvements will be uploaded as they are completed.
To Managing directors of territorial funds of obligatory medical
insurance:
-
4355/36
On direction of joint order of the Ministry of Health Russia and Federal
Fund OMS "On improvement of checking the quality of medical treatment to
population of the Russian Federation"
Federal fund of obligatory medical insurance directs a joint order of
the Ministry of public health of the Russian Federation and of the Federal
fund of obligatory medical insurance dated 24 October 1996. "On improvement
of checking the quality of medical treatment to the population of the Russian
Federations" for the management and use in work.
Simultaneously ask You bring the contents of given order before insurance
medical organisations, participating in the obligatory medical insurance
system.
Exhibits: mentioned order on 24 l.
Managing director V. V. Grishin
Isp. Kirii K. A.
tel. 973-49-14
Ministry of public health of the Russian Federation - Federal fund
of obligatory medical insurance:
DECREE
24 October 1996 Moscow 363/77
On improvement of checking of quality of medical treatment to population
of Russian Federation
In accordance with and on the basis of:
legislation of the Russian Federation on protection health of people
the Law of Russian Federation "On personal medical insurance in the
Russian Federation"
and with the purpose of improving checking of the quality of medical
treatment to population of Russian Federation
and in consultation with Fund of social insurance of Russian Federation
CONFIRM:
1. Position on the system of departmental checking of quality of medical
treatment in establishment public health of the Russian Federation (exhibit
1).
2. Position on the system of external checking of quality of medical
treatment in the Russian Federation (exhibit 2).
3. Position on independent medical experts (exhibit 3).
4. Position on experts of insurance medical organisations (exhibit 4).
ORDER:
1. Leaders of management bodies in public health sectors of the Russian
Federation to develop an organisation system and procedure for checking
the quality of medical treatment in subdepartmental medico-preventive institutions.
2. Leaders of management bodies in public health sectors of the Russian
Federation and territorial fund of obligatory medical insurance:
2.1. To organise a system for checking the quality of medical treatment
to the population in accordance with the present order.
2.2. In consultation with interested organisations and establishments,
to develop and confirm the order of external checking of the quality of
medical treatment on Russian Federation territory.
3. Control scholastic management of the Ministry of Health Russia (N N
Volodin) and Control scientifically-methodical provision and preparing
a personnel (frames) of Federal fund OMS to develop and in accordance with
the established order confirm the programme for preparing independent medical
experts and experts of insurance medical organisations, realising checking
the quality of medical treatment to the population.
4. Governing an organisation of medical treatment to the population
Of the Ministry of Health Russia (A A Karpeyev) and Governing an organisation
of obligatory medical insurance of Federal fund OMS (N D Tegai) ensure
organising-methodical help to organs establishment public health, territorial
funds of obligatory medical insurance, insurance medical organisations
on questions of organisations of checking the quality of medical treatment
to the population.
5. Checking for the performance of the order is entrusted to the undersecretary
of public health of the Russian Federation V I Starodubov and first deputy
managing director of Federal fund of obligatory medical insurance V U Semenov.
Minister of public health / Managing director of the Russian Federation
of Federal fund of obligatory medical insurance:
T B Dmitriyev / V V Grishin
Exhibit 1 to order
Ministries of public health of Russian Federation and Federal fund OMS
dated 24 October 1996. 363 / 77
POSITION
SYSTEM OF DEPARTMENTAL CHECKING OF THE QUALITY OF MEDICAL TREATMENT
IN ESTABLISHMENT PUBLIC HEALTH IN THE RUSSIAN FEDERATION
1. GENERAL PROVISIONS.
1.1. The present position is designed in accordance with Bases of
legislation of Russian Federation on the protection health of people, Laws
of the Russian Federation "On the medical people insurance in Russian Federation",
"On protection of rights of users" and other normative acts. It installs
general organising and methodical principles of departmental checking of
the quality of medical treatment provided to the population in establishment
public health, regardless of departmental subordination and the form of
property on the territory of Russian Federation.
1.2. Aiming at realisation of departmental checking of quality of medical
treatment, ensuring the rights of patients to receive medical treatment
of necessary volume and requisite quality on the base of optimum use of
personnel and material and technical resources of public health and using
the appropriate medical technologies.
1.3. With the object of checking medical treatment, seen as a complex
of preventive, medico-diagnostic and rehabilitation actions, producing
practical results in line with current technology.
1.4. The system of departmental checking of the quality of medical treatment
includes the following elements:
-
an evaluation of condition and use of personnel and material and technical
resources of the medico-preventive institution;
-
examination of processes for rendering medical treatment to actual patients;
-
study of the satisfaction of patients concerning their interactions with
the public health system;
-
calculation and analysis of factors characterising quality and efficiency
of medical treatment;
-
discovery and investigation of defects, medical mistakes and other factors
with negative results or causing quality reduction and inefficiency of
medical treatment;
-
preparing recommendations for leaders medico-preventive establishment and
management bodies in public health, issuing of warnings about medical mistakes
and defects in work and promotion of increased quality and efficiency of
medical treatment;
-
a choice of the most rational management choices and undertaking operation
of corrective influences;
-
checking implementation of management decisions.
2. ORGANISATION AND PROCESSES OF DEPARTMENTAL QUALITY CHECKING OF
MEDICAL TREATMENT.
2.1. Departmental checking of the quality of medical treatment is realised
by expert executives in the medico-preventive establishment and management
bodies of the public health, clinic-commissions of experts and main staff
and independent specialists of all public health levels. Employees of BUZs,
scientific centres, OMS and other establishment in the contractual system
are to be involved in the processes necessary to carry out examinations.
2.2. For medico-preventive establishment within the scope of the Health
Ministry order for Russia dated 13.01.95. "On measures on the improvement
of examination of temporary disability", the quality of the examination
of medical treatment is the responsibility of managing subdivisions (first
level examinations), deputies of leader of establishments for clinic-expert
work, medical work, dispensary-polyclinic help (second level examinations),
clinic-commission of experts of establishment s (third level examinations).
2.3. Examination of the process of rendering medical treatment is
evidenced by the finished outcome. Examination, as a rule, is based on
assessment of medical documentation (inpatient medical card, outpatient
card and others). As necessary, it can be conducted by expert visual inspection.
2.4. Expert checking in every case as follows:
-
events with lethal outcome;
-
events of secondary infections and complications;
-
events resulting in invalidity of persons of able-bodied age;
-
events of recurrent hospitalisation caused by the same disease within a
year;
-
events of diseases needing lengthy treatment (or long term care);
-
events with divergent of diagnoses;
-
events resulting in complaints by patients or their relatives.
All other events in rendering medical treatment must also be subject to
expert evaluation on the basis of selection by statistical random sampling.
2.5. The managing subdivision conducts reviews of not less than 50%
of finished events within a month. Deputy leaders of establishments in
clinic-expert work, medical work, dispensary-polyclinic treatment conduct
not less than 30-50 examinations during the quarter. The volume of work
of a clinical-commission of experts is defined by the tasks necessary to
ensure quality and efficiency of medical treatment, as allocated by the
medico-preventive establishment, and by higher management bodies by the
public health. The volume of work of managing dispensary-polyclinic subdivisions
is based on the regional level.
2.6. The quality of examination of medical treatment to actual patients
should be consistent with standards, which, as a rule, assume uniform equipment
and volumes of diagnostic and treatment actions, as well as requirements
in terms of treatment for the actual nosological forms of diseases presenting
and the results.
The leading role in quality examination of medical treatment derives
from the conclusions of the expert, who takes all circumstances of the
individual event into account, against the background of performance standards.
2.7. During examination of the quality medico-diagnostic process, an
expert:
-
has regard to completeness and timeliness of diagnostic actions, adequacy
of choice and observance of treatment procedurs, correctness and accuracy
of diagnosis;
-
reveals defects and investigates their cause;
-
prepares recommendations on rectifying and avoiding revealed defects.
2.8. On each occasion of expert evaluation a "Card of quality evaluation
of medical treatment"is completed. As a result statistical processing,
factors are developed characterising quality and efficiency of medical
treatment.
2.9. A strategy for expert quality evaluation of medical treatment and
sets of factors, and their characterisation, are developed, confirmed
and agreed on the regional level.
2.10. Study of satisfaction for medical treatment is also included for
acceptance in the regional strategy.
2.11. In preparing the analytical framework for evaluation of medico-preventive
establishments, as well as the public health of region, quality factors
and efficiency of medical treatment are complemented by activity factors
of the public health establishment and features of the health population,
such as the distribution and incidence of socially-significant diseases,
indicators of invalidity and death-rate of people of working age, invalidity
of infants, efficiency of rehabilitation of sick and invalids, including
newborn screening or phenylketonuria and innate hypotereos for young children
- audiological screening, abortion factors, infant and baby death-rate
and others.
2.12. Information received as a result of quality evaluations on the
efficiency of medical treatment is provided for to the information of leaders
of establishments and public health management bodies and is a point at
issue amongst employees.
3. CONCLUSION
3.1. Departmental checking of the quality and efficiency of medical
treatment is a vital activity, the closest to the performers of medical
services. Its results are used and compared with given external examinations.
3.2. Quality Factors and efficiency of medical treatment are to be used
to differentiate labour payment of medical workers.
First Director for organisation of medical treatment to population, Ministry
of Health of Russia
A A Karpeyev
MACHINE TRANSLATION
Exhibit 2 to order of Ministry of public health of the Russian
Federation and Federal Fund OMS dated 24 October 1996. 363 / 77
POSITION
ON SYSTEM OF EXTERNAL CHECKING THE QUALITY OF MEDICAL TREATMENT IN THE
RUSSIAN FEDERATION
1. GENERAL PROVISIONS.
The system of external checking of the quality of medical treatment
is established in the Russian Federation in accordance with effective legislation
in order to defend the rights of people to health protection and give assistance
to organs of state control in deciding tasks in improving activity in public
health establishments.
Included in the competence of the external checking system is the quality
evaluation of medical treatment not within the state public health system.
Powers for undertaking external checking are derived from the legislation
of the Russian Federation on the protection health of people, the Law of
the Russian Federation "On the medical people insurance in Russian Federation",
the resolution of Government of the Russian Federation "On approving a
Position on the licensing of medical activity", the Instruction on the
order of issue of documents certifying temporary disability, and Standard
obligatory medical insurance rules.
The present Position establishes united organisational and methodological
principles for external supervision of the quality of medical services,
provided by a public health establishment regardless of departmental subordination
and form of ownership, as well as persons involved in private medical practice,
in the territory of Russian Federation.
External supervision the quality of medical treatment is carried out
on the basis of the evaluation resources and personnel availability in
the medico-preventive establishment, applicable technologies, as well
as volume factors and the outcomes of their activity.
To raise the efficiency of expert activity on the territory of the Russian
Federation, the professional medical association (or the license-accreditation
commission) maintains a register of independent experts in consultation
with the territorial fund of obligatory medical insurance, the executive
organ of the Fund of social insurance of the Russian Federation and the
management body of the public health.
Responsibility for the organisation and condition of external supervision
of the quality of medical treatment is held by leaders and executives of
organisations and establishments, eligible on its undertaking, in
accordance with duty regulations and effective legislation.
2. ABOUT SYSTEMS OF EXTERNAL SUPERVISION OF THE QUALITY OF MEDICAL TREATMENT
AND THEIR COMPETENCE
External supervision of the activity of establishments of public health,
as well as of physical persons, is carried out by:
-
license-accreditation commission;
-
insurance medical organisations;
-
territorial funds of obligatory medical insurance (in the event of execution
by them of the functions of an insurer);
-
underwriters;
-
executive organs of Fund of social insurance of the Russian Federation;
-
professional medical associations;
-
associations protecting the rights of users.
The primary task in external supervision of the quality of medical treatment
is the organisation, within its competence, of medical and physician-economic
examination to ensure the rights of people to receive the medically necessary
quality of help and checking the efficiency of using public health resources,
as well as the financial facilities of OMS and social insurance.
External supervision of quality is achieved in the following ways:
-
analysis of results of providing medical treatment to the population;
-
preparing recommendations on the improvement of organisations and raising
the quality of medical treatment and supervision of its execution;
-
study of the satisfaction of patients with the medical treatment provided;
-
checking fulfilment of ontractual obligations between public health establishments
and insurance medical organisations;
-
checking fulfilmentc of ontractual obligations between the underwriter
and insurer;
-
observance of rules for issue of documents certifying temporary disability;
-
evaluating the capability of public health establishments to guarantee
the required quality level of medical treatment;
-
correctness in using the tariffs and invoicing for the volume of medical
treatment carried out;
-
other types of supervision on subjects within its competence.
Competency license-accreditation commission
In accordance with its own authority, the license-accreditation commission:
-
supervises safety of medical services for patients and personnel and their
compliance with relevant standards when undertaking licensing and accreditation
of public health establishment and certificated specialists;
-
supervises execution by public health establishments and physical persons
of license terms;
-
issues licenses and certificates to legal entities and individuals;
-
participates in planning external medical examinations and the register
of experts in the territory of the Russian Federation.
Competence of insurance medical organisations.
(applies also to territorial OMS funds when they perform the functions
of insurer).
-
organisation and delivery, within the framework of relevant agreements
on obligatory and voluntary medical insurance, of supervision of the quality,
volume and means of providing medical treatment by staff experts, as well
as by registered independents in the contractual system;
-
audit of accounts and invoices for medical provision in respect of true
volume and quality, and for obligatory medical insurance - and the territorial
OMS, also with the power to withhold payment in whole or in part for the
medical services rendered;
-
presenting claims and legal actions to medico-preventive establishments
for indemnifying damage caused to insureds;
-
reporting to management bodies of public health and license-accreditation
commissions on the findings of expert work about defects in the activity
medico-preventive institutions;
-
conclusion of agreements on performing medical quality examinations with
competent organisations and specialists;
-
participation in the development of tariffs for medical facilities;
-
participation in licensing and accreditation of medico-preventive establishment
and physical persons;
-
applications in accordance with established rules to the license-accreditation
commission for stay or cancellation of a licence
-
deciding conditions for renewal of contracts for provision of insured
medical services, in the event of disclosures of repeated and serious failures
in providing insured medical treatment.
Competence of underwriter.
-
Carrying out supervision of compliance with contractual terms of medical
insurance;
-
obtaining necessary information from territorial organisations, arising
from the right of carrying out quality examination of medical treatment
to the population, and review of their activity;
-
obtaining information from insurers about the state of medical treatment
for insureds and measures to improve it;
-
compilation of information about completed results of expert quality evaluations
of medical treatment and agreed measures for its improvement;
-
deciding conditions for renewal of contracts for medical insurance,
in the event of repeated and serious failures in providing insured medical
treatment.
Competence of executive organs of the Fund of social insurance
of the Russian Federation.
Supervising within the limits of their own competence procedures for
and accuracy of documentation certifying temporary disability, including
circumstances where:
-
length of disability resulting from long stays in hospital exceeding average
stays by 30% or more;
-
events themselves resulting in invalidity;
-
improper events during the physician-social examination.
Competence of professional medical associations, deriving from
their internal Constitution or Charter
-
organisation of quality examination of medical treatment provided to people
by medico-preventive establishments and by individual members of the said
Associations in private practice;
-
participation in the development of quality standards for medical treatment,
programs and criteria for training and qualification of medical personnel,
agreements on tariffs for medical facilities;
-
participation in maintaining the register of experts;
-
participation in workings of the commissions on qualification of medical
workers, accreditation and licensing of the activity of public health establishments,
and the qualification of examination commissions.
Competence of associations protecting rights of users
-
study of public opinion on the quality of medical treatment provided;
-
reporting, in the context of external supervision of quality in public
health management bodies, on defects in providing medical treatment;
-
protection of rights of patients by offering to pursue matters on their
behalf with administrative and judicial uthorities.
3. ORGANISATION OF INTERACTION an SUBJECT of EXTERNAL SUPERVISION the
quality With Public health establishment ON REALISATION OF QUALITY EXAMINATION
OF MEDICAL TREATMENT
On the subject of External supervision the quality in events of revealing
the defects in the process of rendering a medical treatment on its competencies:
-
plainly state questions, requiring deciding when undertaking a medical
examination;
-
organising an undertaking an additional examination.
For perfecting an interaction of departmental and external quality examination
of medical treatment on the subject of external supervision realise a request
in the clinic-commission of experts medico-preventive establishment or
corresponding management body by the public health on results of undertaking
a departmental examination on put (deliver) questions, value results of
the departmental examination, and, in the event of the consent with them,
take necessary deciding or corresponding measures without undertaking an
additional examination.
Main reasons of purpose of the external medical examination For insurance
medical organisations:
-
complaints of patients or underwriters on the quality and culture of rendering
a medical treatment.
-
disadvantage upshot of disease, straight connected with defects in undertaking
the medical actions;
-
discrepancy of represent counts on the payment of medical services territorial
physician-economic standards or cut-in in the count of medical services,
not fall into the territorial program OMS;
-
presence of multiple defects in rendering a medical treatment beside separate
specialists, subdivisions, institutions;
-
discrepancy of conducting treatment to the diagnosis a disease, influence
upon the treatment cost;
For executive organs of Fund of social insurance of the Russian Federation:
-
presentation to the document payment, certify temporary disability of people,
executed with breaking an install order;
-
doubts in validity issues of the documents, certify temporary disability
of people, terms of time disability, terms of directions on the physician-social
examination.
For license-accreditation commissions:
-
need of undertaking a licensing and accreditation of legal and physical
persons and certificating specialists with attraction of independent experts;
-
ensuring a supervision for performing the license terms with undertaking
of departmental and external examination.
Organisations and establishment, eligible for undertaking a external
medical examination, are obliged:
-
to realise an interaction with organs and public health establishment on
questions of organisations of medical treatment to the population;
-
to keep count all present claims, results of their analysis and expert
supervision;
-
to organise within competencies a development and performing the own actions
on the improvement of organisations of medical treatment to the population
and its quality raising, realise a supervision for their execution.
Organisations and establishment, eligible for undertaking a external
examination, can:
-
to participate in the offer development on the improvement of organisations
and raising the quality of medical treatment to the population and contribute
them on consideration to the competent body;
-
to assist training and raising a qualification of personnel (frames) medico-preventive
institutions;
-
to get from medico-preventive establishment an information, required for
permits of disputable events;
-
to conclude agreements on undertaking an examination with interested persons,
organisations and institutions;
-
to organise counsels on questions of improvement to organisations of external
supervision the quality of medical treatment.
4. ORGANISATION And ORDER of UNDERTAKING a EXTERNAL QUALITY SUPERVISION
OF MEDICAL TREATMENT
On the subject of External supervision the quality organise its expert
activity in accordance with legislation of Russian Federation, departmental
normative acts and the present Position. Undertaking a external quality
supervision of medical treatment realise staff experts, as well as independent
experts, fall into the register and allow to expert activity in accordance
with the established order.
Quality Examination of medical treatment in the external supervision
system shall be conduct on the territory subject Russian Federation on
united methodological principles and technologies, co-ordinated with all
subject external supervision.
Financing of expert activity in the system of external supervision the
quality is realised to the account of facilities these subjects, as well
as part of penalty sanctions, imposed on legal and physical persons in
accordance with the Position on the order of medical service payment in
the obligatory medical insurance system.
External supervision can be realise in the manner of:
-
preventive supervision;
-
supervision a result;
-
target supervision;
-
planned supervision.
Preventive supervision is realised license-accreditation by the commission
before undertaking a licensing and accreditation of medical establishment
or physical person.
Aiming to a preventive supervision is a determination of possibilities
of medical establishment or physical person to render the declare types
of medical treatment, as well as correspondences to their activity install
to standards.
Preventive supervision is call to value the quality and safety level
of working a medical establishment for the patient before getting by it
permits on rendering the medical services to the population.
In the course of preventive supervision are value:
1. Structure of medical establishment, including evaluation:
-
organisations of working the structured subdivisions of medical establishment
and organisations of working a personnel;
-
qualifications of medical personnel;
-
material and technical resource maintenance;
-
financing.
2. Quality medico-diagnostic process, including evaluation:
-
organisations of examination, treatments and care for sick, volume of activity
and interactions medical and para-clinical subdivisions;
-
scientifically-technological level medico-diagnostic process;
-
qualities of conduct of medical documentation;
-
upshots and results of treatments.
Preventive supervision is realised on the base of standards, for what
as an instrument of evaluation use:
-
state educational standards;
-
technological standards;
-
standards of equipping;
-
standards of volumes medico-diagnostic and rehabilitation actions and terms
of treatments under different presentations of forms of diseases.
In events of absence of federal standards are used territorial standards,
confirmed by the management body by the public health subject Russian Federation.
Supervision a result realise subject of external supervision.
Aiming to a supervision a result is an evaluation of quality executed
medical facilities to the concrete patient. In the course of quality examinations
medical facilities are value:
-
medical efficiency of service;
-
economic its efficiency;
-
correspondence to chosen medical technology to the pathological process,
its gravity and current.
Under medical efficiency is understood degree of achievement put (deliver)
purposes. Medical efficiency that above, than closer medical workman on
results of treatments approaches to criteria and parameters of productivity
of treatments, scheduled in the standard for given pathology.
Cost-performance is valued on the base of economic standard, characterising
greatly possible expenses on the treatment of typical event for each medical
condition. If execution medico-diagnostic process and achievement herewith
greatly possible, for the case in point, medical efficiency of expenses
do not exceed maximum borders of rate, follows to consider a cost-performance
reach.
Quality medico-diagnostic process is valued on the standard, comprise
of itself main elements:
-
qualitative collection information on sick (diagnostic actions for given
medical condition);
-
correct production and motivation of diagnosis;
-
qualitative executed medical action.
Except this subject, implementing external supervision, has the right to
study an opinion of patients on the quality provided to medical services,
as far as opinion of patient is one of forming notions "qualitative medical
service".
Supervision a result, as well as preventive supervision, is found on
the conclusion of examination.
As required for the permit of disputable event subject external supervision
can come to a conclusion on undertaking a target supervision with attraction
of independent experts.
Indemnifying medical organisation has a right of check of only events
of rendering a medical treatment to patients, having policy OMS, issued
given by the insurance organisation and on types of medical treatment,
fall into the territorial program OMS.
On results of check is arrange "Act of expert supervision" install forms.
Planned supervision the quality of medical treatment on the part of
insurance medical organisations is realised in accordance with the agreement
on granting medico-preventive help (medical services) on the medical insurance.
In these cases indemnifying medical organisation forms a schedule of planned
supervision the medical establishment, which is carry to the information
last.
Schedule of planned supervision is form with the payment, to within
a year each medical institution was subjected to a planned supervision
not less 1 times per annum. For the reason reducing an amount of planned
check, conduct in medical establishment, advisable, to subject of external
supervision co-ordinated its work and, as far as possible, realised united
check.
Disputes between parties on questions financial-economic examination
are decided in the interdepartmental authorised tariff commission, medical
examination - in authorised joint committee subject Russian Federation
in accordance with the position on working these commissions.
Disputable questions, appear beside parties on the given level, are
to be consider in the court in accordance with the established order.
Chief of Governing an organisation a Chief of Governing an organisation
of medical treatment to population obligatory medical Of the Ministry of
Health Russia of insurance of Federal fund OMS
A.A.Karpeyev I.D.Tegai
MACHINE TRANSLATION
Exhibit 3 to order of Ministry of public health of the Russian
Federation and Federal fund OMS from 24 October 1996. 363 / 77
POSITION
ON INDEPENDENT MEDICAL EXPERTS
1. GENERAL PROVISIONS
Expert can be a specialist with high medical formation, get training
on a medical speciality and having length of service of work on her not
less than 10 years, high qualification category or scientific degree, passed
special training on the examination and a get license of the right of realisation
of expert activity.
Expert carries out some work on the quality examination of medical treatment
on the grounds of agreement with organisations and establishment, eligible
on the realisation of expert activity.
Expert in its work follows acting legislative acts of the Russian Federation,
other is normative-legal documents, adjusting legal relations in the system
of quality examination of medical treatment, Position on the system of
external supervision the quality of medical treatment in Russian Federation
and the present Position.
Order and amounts of payment of labour of experts are defined at a rate
of subject Russian Federation in accordance with the established order.
Actions of expert are to not disagree a professional honour and medical
ethics.
Expert for the acknowledgement of their own authorities shall have a
certificate with the instruction of term of its action and prescription
on undertaking an examination.
Primary task of expert is an evaluation of correctness of choice of
medical technology, terms and qualities render medical services install
standards and terms of agreement.
2. ORGANISATION OF WORKING AN EXPERT.
Expert works with organisations and establishment, eligible on the realisation
of expert activity, on the contractual base.
Time of working an expert on the agreement will an organisation, enter
into agreement with the expert, with establishment administration on the
main place of working an expert.
At need for a time of undertaking an examination an expert is dispense
from main work on the grounds of the order of leader of establishment on
the request of organisations, attracting expert to undertaking an examination.
Expert realises an examination in accordance with the received prescription
on undertaking an expert check with observance of united principles and
technologies of external supervision the quality of medical treatment,
accepted on the territory subject Russian Federation.
Expert can conduct an examination only on its main medical profession
within competencies, determined by the certificate of specialist.
Expert conducts an examination individually or with other experts.
Expert has the rights to realise an examination in medical establishment,
with which bases in labour or contractual relations, and participate in
the analysis of expert events, when patient is its relative or sick, in
the treatment which expert took part.
On the completion of undertaking an examination an expert represents
"Act of expert supervision" upon the terms according to the agreement.
Medico-Preventive institution is obliged to ensure an expert free familiarisation
with establishment activity, connected with the performance of terms of
agreement.
3. THE RIGHTS, DUTIES AND LIABILITY OF EXPERT
an Expert has a right:
-
to conduct an examination on places in accordance with the install order
and terms of agreement;
-
use the documents, required for evaluations of expert event;
-
to abandon to undertaking an examination before its beginning, not motivating
cause of failure;
-
to abandon to further undertaking an examination with the notice direct
parties on concrete reasons of its failure;
-
to participate in preparation of proposals and suit materials for consideration
their additional examination;
-
when working in the group of experts to arrange a particular opinion, distinguish
from the opinion of other experts, on results of supervision the quality
of medical treatment and require an undertaking an additional examination;
-
to contribute offers in competent bodies on perfecting the organisations
and raising the quality of medical treatment;
-
to get information on performing their own recommendations and, if their
non-execution threatens health or lives of patients, inform corresponding
locations;
-
regularly raise its professional level.
Expert is obliged:
-
to conduct an expert evaluation in presence of the authorised representative
expert within the public health establishment;
-
to give competent and objective quality evaluation of medical treatment
on the base of studying medical documentation, but in necessary events
- a personal checkup of patients;
-
at need to petition on attraction to the examination of other experts;
-
to discuss with treating physician and manual of public health establishment
preliminary results of examinations;
-
to prepare recommendations on raising a level and quality of rendering
a medical treatment, perfecting a work of specialists and public health
establishment, including on eliminating the reasons, caused rendering to
patients of medical improper quality help;
-
to prepare on results of examinations corresponding conclusion, arrange
results of checking by the act of the install form and afford a copy of
act to the manual of public health establishment on the completion of check;
-
to report a leader direct organisations on results of work with the presentation
of act of expert supervision.
Expert in accordance with the established order has responsibility within
their own authorities and competencies for the quality and objectivity
of conduct examination.
In the event of the discrepancy of expert activity to professional requirements,
organisation, enter into agreement with the expert, is obliged to report
on this in the organ, forming register of experts, and organ, issuing license
of the right of realisation of expert activity, for settle a problem on
possibility of continuing by it this activity.
Chief of Governing an organisation a Chief of Governing an organisation
of medical treatment to population obligatory medical Of the Ministry of
Health Russia of insurance of Federal fund OMS
A.A.Karpeyev I.D.Tegai
MACHINE TRANSLATION
Exhibit 4 to order of Ministry of public health of the Russian Federation
and Federal fund OMS from 24 October 1996. 363 / 77
POSITION
ON EXPERT OF INSURANCE MEDICAL ORGANISATIONS
1. GENERAL PROVISIONS
Expert can be a specialist with high medical formation, having length
of service of work on a medical speciality not less than 5 years, specialisation
on organisations of public health and social hygiene, passed special training
on the examination.
Expert is a staff employee to insurance medical organisations and will
comply with its leader.
Expert in its work follows acting legislative acts of the Russian Federation,
other is normative-legal documents, adjusting legal relations in the system
of quality examination of medical treatment, Position on the system of
external supervision the quality of medical treatment in Russian Federation
and the present Position.
Purpose and sacking an expert is produce in accordance with the established
order.
Expert for the acknowledgement of their own authorities have a document,
confirming its attitude to insurance medical organisations.
Actions of expert are to not disagree a professional honour and medical
ethics.
Primary task of expert is an organisation of supervision and evaluation
of volume, terms and qualities of rendering a medical treatment when arising
an expert event in accordance with terms of agreement of medical insurance.
2. ORGANISATION of WORKING an EXPERT
In accordance with tasks and order of undertaking a external quality
supervision of medical treatment on the territory subject Russian Federation
by main functions of expert are:
In accordance with tasks and order of undertaking a external quality
supervision of medical treatment on the territory subject Russian Federation
by main functions of expert are:
2.1. Revealing the defects in the process of rendering a medical treatment
to insureds, including:
-
disadvantage upshots of diseases, connected with defects in undertaking
the medical actions;
-
complaints of patients or underwriters on the low quality and culture of
rendering a medical treatment.
-
discrepancy of present counts on the payment of medical services territorial
physician-economic standards or cut-in in the count of medical services,
not fall into the territorial program OMS;
-
presence of multiple defects in rendering a medical treatment assured separate
specialists, subdivisions, institutions;
2.2. Motivation of need of expert evaluation in accordance with reveal
defects, precise wording of whole and tasks of forthcoming examination
and co-ordination it with the manual medico-preventive institution.
2.3. Preparing documentation, necessary independent expert for undertaking
an additional examination.
2.4. Evaluation of results of departmental and additional medical examination.
2.5. Familiarisation of manual of public health establishment with results
of the medical examination.
2.6. Training on results of examinations of offers to the manual of
insurance medical organisation on using the penalty sanctions to the medical
institution.
3. RIGHTS, DUTIES AND LIABILITY OF EXPERT
3.1. Expert has a right:
-
motivate need of undertaking an additional examination;
-
to require in accordance with the established order undertaking a departmental
medical examination on facts of reveal defects in rendering a medical treatment
insure;
-
to consider and value results of the medical examination, take part in
preparing a total conclusion;
-
to contribute offers a competent body on the improvement of organisations
and raising the quality of medical treatment to the population;
-
to use necessary medical documentation during undertaking a medical examination;
-
regularly raise its professional level;
-
at presence of corresponding license to conduct an examination in the same
way, as a independent medical expert.
3.2. Expert is obliged:
-
to organise an undertaking an examination and realise a supervision an
expert work, conduct by independent medical experts on the correspondence
to technologies of examination, approved on the territory, bring its results
before the manual of medical institutions;
-
to represent an used strategy of quality examination of medical treatment
to physicians of medical establishment, explain an order of its using and
term of using the results;
-
to conduct an event selection of rendering a medical treatment, subject
to examination, in accordance with requirements, approved by the Position
on the system of quality examination of medical treatment of territory;
-
to agree upon the data and order of undertaking an examination with the
medical institution administration;
-
to represent for getting an agreement signature on the part of administrations
of medical establishment "Acts of expert supervision" on results of quality
evaluations of medical treatment;
-
to keep count all present claims, penalty and other sanctions on results
of the analysis and expert supervision;
-
to represent the generalise information on reveal breaking in rendering
a medical treatment, results of consideration of complaints in the professional
medical association, territorial fund of obligatory medical insurance and
management body by the public health a territory;
-
to inform territorial license-accreditation commission on reveal breaking,
in accordance with execution by medical establishment the licensed types
of medical activity;
-
not to allow a divulging the information, forming medical secret and become
him known when undertaking a medical examination, as well as results of
examinations, except the install law of events.
3.3. Expert in accordance with the established order has responsibility
for the organisation of medical examination, as well as excess of their
own authorities, afford him legislative and normative acts.
Chief of Governing an organisation of medical treatment to population
- Chief of Governing an organisation obligatory medical Of the Ministry
of Health Russia of insurance of Federal fund OMS
A.A.Karpeyev I.D.Tegai
/ENDS