Журнал «Медицина неотложных состояний» 8 (55) 2013

Introduction. Occurring at present time structural changes in the system of emergency medical care, particularly changeover of emergency medical service to compulsory health insurance, and also in-patient care reorganization of emergency medicine, required study of basis of legal regulation of emergency medical care.

Methdology/approach. The regulation of emergency medical care on the territory of the Russian Federation is studied by means of analysis, legal and linguistic methods.

The results. Entering into force of the Federal Law from 21.11.2011 № 323 “On fundamental healthcare principles in the Russian Federation” laid the foundation for the changes of the legal regulation for the effective use of health care resources. According to regulation emergency medical care is rendered in case of diseases, accidents, injuries, poisoning and other conditions requiring urgent medical intervention; in form of urgent and emergency medical care in various conditions: outpatient and hospital care.

The reforming the health care system caused placing of responsibilities on the executive authorities of the Russian Federation for medical care in accordance with the territorial program of state guarantees (PHG) of free medical care, responsibilities for the development of a network of medical institutions of regions of the Russian Federation on the basis of the territorial principle, the organization of compulsory health insurance in the regions of the Russian Federation.

The capacity of medical care is defined on the basis of capitation standards for financing of program of state guarantees in the regions of the Russian Federation, including the territorial program of compulsory health insurance. In this case, the average ratio of emergency medical care per capita according to this program can be varied taking into consideration transport accessibility to medical establishments, residential density in the regions of the Russian Federation, demographic characteristics of the region and other factors.

Medical care delivered in the emergency departments is paid by means of compulsory health insurance. At present time the payment is occurring in accordance with the normatives of specialized medical care delivered by diseases and injuries, depending on bed-days according to the compulsory health insurance. The normatives for capacity of medical care in emergency department does not have approved by the time.

The following criteria of availability and quality of medical care are defined through the program of state guarantees:  population satisfaction of medical care, the death rate from traffic accidents, number of legitimate complaints; the number of calls to the EMS per 1 inhabitant, the number of persons having got an emergency medical assistance, the proportion of persons having got an emergency medical assistance during 20 minutes after the call.

The changeover to financing within the compulsory health insurance will cause the changes in the system of accounting and control of EMC organization that will increase the efficiency and quality of medical care and efficiency of resources use.

One of the ways of optimizations of EMC in the hospital is the formation of ED in the basis of admission rooms of multifield hospital according to the Order of the Ministry of Health and Social Development of the Russian Federation from 02.08.2010 № 586n "On amendments to Order of emergency medical care, approved by Order of the Ministry of Health and Social Development of the Russian Federation from 01.11.2004  №179”. The criteria of reorganization of admission rooms in hospitals, the new definitions “emergency department”, “physician of emergency medical care in ED”, “dynamic observation and short term treatment on EMC bed in ED” were introduced newly through this order.

The following gaps in regulation of emergency medical care in hospital are evidentiated: competences of a doctor of emergency medicine (The Order of the Ministry of Health and Social Development of the Russian Federation from 23.07.2010 no. 541n «On approval of Unifi ed Managers, specialists and workforce qualification reference book») leave out the extension of his functions in hospital, particularly dynamic observation and short term treatment on EMC bed in ED. Besides that emergency medical care in ED are not regulated, because of absence of standards (guidelines) emergency medical care, approved by the Ministry of Health and Social Development of the Russian Federation.

The state program “Development of Health Care” 2013-2020 was approved by the government decree from 24/12.2012 № 2511. The main program purpose was access to health care, increase the efficiency of medical care services, the indicators of which should appropriate to the level of morbidity and needs of population.  

With a view to achieving the results of the program is planning 1)  to create  the Unified Dispatch Emergency Medical Service in each region of the Russian Federation and to increase the number of emergency stations with  automated control system of call receipt and processing (from 14% in 2011 to 100%); 2) EMS car fleet replacement and to decrease of the quantity of ambulance cars with operating life for over 5 years from 42% in 2011 to 0%; 3) to create EDs in the regions of the Russian Federation  by 2018 based on the comprehensive program of health care development in the regions of the Russian Federation considering the real needs for EDs.

Conclusions. The research presents that the current legislative base provide the development of EMC in Russia. The plan of development allows in the future to improve health care of the population through the access to medical care of high quality with the view of social and economic, legal factors.