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Подписано соответствующее постановление Правительства РФ от 7 декабря 2019 г. № 1610. Программа государственных гарантий бесплатного оказания гражданам медицинской помощи на 2020 год и на плановый период 2021 и 2022 годов (далее – Программа) подготовлена Минздравом России в целях обеспечения конституционных прав граждан на медпомощь за счет бюджетных средств.
Программой1 установлены:
перечень видов, форм и условий оказываемой бесплатно медицинской помощи;перечень заболеваний и состояний, медицинская помощь при которых оказывается бесплатно;категории граждан, которым медпомощь оказывается бесплатно;средние нормативы объема медпомощи и средние нормативы финансовых затрат на единицу объема медпомощи (определены в расчете на одного жителя в год, а в рамках базовой программы ОМС – на одно застрахованное лицо);средние подушевые нормативы финансирования;порядок и структура формирования тарифов на медпомощь и способы ее оплаты;требования к территориальным программам госгарантий бесплатного оказания гражданам медпомощи в части определения порядка и условий ее предоставления, критериев доступности и качества.
Как и ранее, в рамках Программы предусмотрено бесплатное предоставление: первичной медико-санитарной помощи, в том числе первичной доврачебной, врачебной и специализированной помощи; специализированной, в том числе высокотехнологичной, медпомощи; скорой, в том числе скорой специализированной, медпомощи; паллиативной медпомощи, в том числе паллиативной первичной медпомощи, включая доврачебную и врачебную, и паллиативной специализированной медпомощи. Сохранены и формы оказания медпомощи: экстренная (оказываемая при внезапных острых заболеваниях, состояниях, обострении хронических заболеваний, представляющих угрозу жизни пациента), неотложная (оказываемая при тех же заболеваниях и состояниях, но без явных признаков угрозы жизни), плановая (при проведении профилактических мероприятий, при заболеваниях и состояниях, не сопровождающихся угрозой жизни пациента, не требующих экстренной и неотложной медпомощи).
В числе заболеваний и состояний, являющихся основанием для предоставления бесплатной медпомощи, указаны: инфекционные и паразитарные болезни; новообразования; болезни эндокринной системы; расстройства питания и нарушения обмена веществ; болезни нервной системы; болезни крови; болезни глаза, уха, органов дыхания, органов пищеварения; болезни кожи, костно-мышечной системы; травмы, отравления и некоторые другие последствия воздействия внешних причин; врожденные аномалии; беременность, роды, послеродовой период и аборты; психические расстройства и т. п. Отдельным приложением утвержден перечень видов высокотехнологичной медпомощи, содержащий в том числе методы лечения и источники финансового обеспечения такой медпомощи.
В правительственной справке к документу выделены некоторые нововведения Программы, а именно:
конкретизация прав пациентов, находящихся в стационарных организациях соцобслуживания, на получение медпомощи, включая проведение диспансеризации с привлечением близлежащих медорганизаций и диспансерного наблюдения;закрепление прав беременных женщин, обратившихся в медорганизации, оказывающие медпомощь по профилю «акушерство и гинекология» в амбулаторных условиях, на получение правовой, психологической и медико-социальной помощи, в том числе по профилактике прерывания беременности;приоритетность финансового обеспечения первичной медико-санитарной помощи, а также приоритетный порядок индексации зарплаты медработников, оказывающих первичную медико-санитарную и скорую медпомощь и т. д.
Что касается нормативов объема медпомощи, то в условиях дневного стационара он увеличен на одно застрахованное лицо с 0,062 в 2019 году до 0,06296 случая на 2020 год, 0,06297 случая в 2021 году, 0,06299 случая в 2022 году. В свою очередь, норматив объема медпомощи, оказываемой в стационарных условиях, на одно застрахованное лицо повышен с 0,17443 случая госпитализации в 2019 году до 0,17671 случая госпитализации в 2020-2022 годах. Наконец, средние подушевые нормативы финансирования, предусмотренные Программой (без учета расходов федерального бюджета), составят: за счет бюджетных ассигнований соответствующих бюджетов (в расчете на одного жителя) в 2020 году – 3621,1 руб., 2021 году – 3765,9 руб. и 2022 году – 3972,7 руб.; за счет средств ОМС на финансирование базовой программы ОМС за счет субвенций ФФОМС (в расчете на одно застрахованное лицо) в 2020 году – 12 699,2 руб., 2021 году – 13 461,6 руб. и 2022 году – 14 193 руб.
Региональным органам власти рекомендовано разработать с учетом положений федеральной Программы территориальные программы госгарантий бесплатного оказания гражданам медпомощи на 2020 год и на плановый период 2021-2022 годов и утвердить их до 30 декабря текущего года.
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1 С текстом постановления Правительства РФ от 7 декабря 2019 г. № 1610 «О Программе государственных гарантий бесплатного оказания гражданам медицинской помощи на 2020 год и на плановый период 2021 и 2022 годов» можно ознакомиться на официальном сайте Правительства РФ.
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