No abstract

The imperfection of the normative legal acts regulating legal relations between participants and subjects of obligatory medical insurance (OMI) inevitably leads to the impossibility or difficulties for the parties to fulfill their obligations in provision of medical care to insured persons within the framework of OMI programs. Medical organizations included in the unified register of medical organizations operating in the field of OMI are limited in providing medical care to citizens under the state guarantees program in the case of excess of the volume of medical services provided from the planned services provided for by the OMI agreement. The “forced” provision of “supervolume” medical care is primarily aimed at meeting the actual need of patients for this service. This fact neglect by medical organizations is unacceptable and contradicts the basic principles of protecting the health of citizens, namely, the priority of its provision in the field of health protection, since malignant neoplasms are classified as socially significant. The inadmissibility of refusal to provide medical care and the revision of legal instruments for its provision in order to avoid a negative impact on patients suffering from oncopathology and on the performer represented by a medical organization is the topic of this discussion. Contractor’s submission of payment for medical care in excess of the distributed volume and (or) financial security established by the medical organization in accordance with the legislation on obligatory medical insurance should not be a reason for refusing to provide medical services at the time of the consumer's request and in the future. At the same time, acts of medical and economic control were drawn up based on the results of examinations conducted by insurance medical organizations for monitoring the volume of medical care for identified cases of medical care in excess of the distributed volume established by the decision of the commission for the development of the territorial program. Non-payment by insurance medical organizations of bills for the rendered medical services, motivated by the excess of volumes and financial support established by the territorial OMI program, serves as the basis for the medical organization to file a lawsuit.

РАЗДЕЛ III. МЕДИЦИНА Эштрекова А.М. Тенденции распространенности злокачественных новообразований молочной железы у женщин в Кабардино-Балкарской республике Высшая школа управления здравоохранением Института лидерства и управления здравоохранением Первого Московского государственного медицинского Университета им. И.М. Сеченова