The Ministry of Health will approve recommendations for the creation of new medical facilities

The department sent a letter with a draft of methodological recommendations signed by the First Deputy Head of the Ministry of Health Viktor Fisenko to professional medical organizations, including the National Medical Chamber. The Analytical Center under the Government of the Russian Federation is a co-author of the letter.

The recommendations themselves were developed by a team of authors from the Central Research Institute of Health Protection. The experts step by step explain how to determine the need for healthcare facilities and plan a network of medical organizations based on a comprehensive assessment of the medical and demographic situation, the level and structure of morbidity in the population, the activities of medical organizations, climatic and geographical parameters, road and transport infrastructure, the established prospective urban development structure, an assessment of the use of existing healthcare resources and the optimal operation of specialized facilities.

A significant portion of existing clinics in Russia are over 30 years old, explains the motivation for developing the document at TsNIIOIZ, and “taking into account the volume of financing for the construction of new facilities, the feasibility of creating each of them should be determined using a standardized assessment tool.”

When deciding on the feasibility of creating facilities, it is necessary to evaluate statistical information in dynamics over the past five years and follow several basic principles. Among them are the principles of significance (for the emergence of a new facility), objectivity (data on the situation in the region), predictable development, alternativeness (consideration of several options), a single space (accounting for all medical organizations in the territory), a single strategy (accounting for national programs and goals), and staffing.

The authors of the recommendations call on responsible persons to use, among other things, the principle of "reasonable economic efficiency", including loading the facility with volumes of medical care in the future. Priority is proposed to be given to facilities with a high concentration of buildings (medical, auxiliary) in one place, rather than single buildings.

It is important to identify what current problems in the organization of medical care the new clinic will solve, experts from the Central Research Institute of Occupational Healthcare believe. In their opinion, it is necessary to assess the coverage of the population with medical care, the place of the new facility in territorial planning and routing, the costs of maintaining the facility, a description of the preliminary staffing schedule and bed capacity.

The recommendations offer algorithms for identifying the feasibility of constructing facilities based on the levels of medical care and the parameters of the territory’s population, starting with a FAP and ending with a high-tech medical center at the interregional level.

In the module for opening facilities in populated areas with a population of up to 2 thousand people, for example, the emphasis is on the population level; if there are less than 100 people, it is recommended to consider organizing mobile team visits. The distance to the nearest hospital also affects the opening of an organization (FAP or general medical practice center). Similar criteria have been developed for populated areas with a population of up to 10 thousand people with the prospect of creating a polyclinic or repairing existing facilities.

According to recommendations, a polyclinic may appear when the population exceeds 10 thousand people. The Central Research Institute of Oncology and Microbiology of the Russian Federation describes in detail the composition of the polyclinic's offices, depending on the number of the assigned population up to 100 thousand people and above - an oncology office, a women's consultation, and others.

A separate module contains an algorithm for assessing an existing clinic, its reconstruction and major repairs instead of building a new facility - primarily when the facility's depreciation is less than 80%.

Similar schemes are also described for the creation of hospitals for the provision of inpatient specialized or high-tech medical care (HTMC). According to experts, a center for the provision of HTMC can be organized if the number of people served exceeds 200 thousand people in the absence of clinics of the same level or their insufficient capacity, as well as if it is impossible to provide the same care in federal medical centers.

Modules have also been developed for emergency medical care (EMC) and palliative care facilities. When opening new EMC departments, the methodological recommendations suggest assessing both the need for public service and transport accessibility.

Today, the location of medical facilities, the composition of their divisions, departments, capacity and personnel reserve are regulated by a number of federal documents. Among them are the procedures for providing medical care according to the conditions of provision (primary, specialized) and profiles of medical care (oncology, endocrinology , palliative care and others), standard provisions on hospitals and other types of medical facilities.

The most general criteria for the territorial placement of state facilities are contained in the order of the Ministry of Health of the Russian Federation No. 132n of February 27, 2016 "On the Requirements for the Placement of Medical Organizations of the State Healthcare System and the Municipal Healthcare System Based on the Needs of the Population". Also close in content to the prepared draft methodological recommendations is the order of the Ministry of Health of Russia No. 182 of April 20, 2018 "On approval of methodological recommendations on the application of standards and norms for resource provision of the population in the field of healthcare".

In fact, the placement and creation of new hospitals, clinics and FAPs is influenced by several factors at once. The main one is the inclusion of objects in various federal financing programs, such as targeted investment programs , the program for modernization of primary health care, specialized federal projects to combat various diseases. Regional authorities often request support from the Ministry of Health of the Russian Federation and federal budget funds for the construction of objects through direct appeals to the ministry, the Federation Council, the State Duma, personal communication with the president and the chairman of the Government of the Russian Federation.

Until 2030, for example, infrastructure expenditures for the national project “Long and Active Life” are estimated at 650 billion rubles.

The Ministry of Healthcare, starting in 2023, has repeatedly warned about the reduction of the federal budget's capacity for the construction of new regional non-program facilities, and Viktor Fisenko publicly called on healthcare organizers in the regions to responsibly approach the development of the economic feasibility and demand for new medical facilities. He asked colleagues from the territories to "count money" and warned against situations where construction begins only because it was once included in the state program, or because of public promises from the authorities.

Earlier, at the National Medical Research Center for Therapy and Preventive Medicine, also with the participation of Fisenko, recommendations were developed for the organization of primary health care with detailed algorithms, as well as examples of the external appearance of clinics and staff .