Basic principles of public health protection.

Section 4. Organization of medical and social expertise

Topic number 1. The concept and types of medical expertise. General theoretical foundations of ITU.

1. The concept of health. Protection of the health of citizens.

2. Basic principles of protecting the health of citizens.

3. The concept and types of ME.

4. The role of the ITU in the implementation of the constitutional rights of citizens to health care and social security.

5. The concept of disability, the degree of its violation.

The concept of health. Protection of the health of citizens.

In accordance with the Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” No. 323-FZ dated November 21, 2011. Health is a state of physical, mental and social well-being of a person, in which there are no diseases, as well as disorders of the functions of organs and systems of the body.

Health is an essential condition for the life of society, therefore the health of the population should be the highest social goal of any state. The state of health is influenced by such factors as the ecological situation, living conditions, the level of economic development of society, the level of development of medicine, etc. In this regard, measures to protect the health of citizens play an important role. In accordance with Article 1 of this law, health protection is understood as a system of measures of a political, economic, legal, social, scientific, medical, including sanitary and anti-epidemic (preventive) nature, carried out by state authorities of the Russian Federation, state authorities of the constituent entities of the Russian Federation , local governments, organizations, their officials and other persons, citizens in order to prevent diseases, preserve and strengthen the physical and mental health of each person, maintain his long-term active life, and provide him with medical care.

Basic principles of public health protection.

Article 4 of the Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” establishes the principles of protecting health (Scheme):

1) observance of the rights of citizens in the field of health protection and provision of state guarantees related to these rights;

2) priority of the patient’s interests in the provision of medical care;

3) the priority of protecting the health of children;

4) social protection of citizens in case of loss of health;

5) responsibility of public authorities and local governments, officials of organizations for ensuring the rights of citizens in the field of health care;

6) availability and quality of medical care;

7) inadmissibility of refusal to provide medical care;

8) the priority of prevention in the field of health protection;

9) observance of medical secrecy.

Observance of the rights of citizens in the field of health care and provision of state guarantees related to these rights .

Measures to protect health should be carried out on the basis of the recognition, observance and protection of the rights of citizens and in accordance with the generally recognized principles and norms of international law. The state provides citizens with health protection regardless of gender, race, age, nationality, language, presence of diseases, conditions, origin, property and official status, place of residence, attitude to religion, beliefs, membership in public associations and other circumstances. The state guarantees citizens protection from any form of discrimination due to the presence of any disease.

The priority of the patient’s interests in the provision of medical care is implemented by (methods of implementation):

1) compliance with ethical and moral standards, as well as respectful and humane attitude on the part of medical workers and other employees of a medical organization;

2) provision of medical care to the patient, taking into account his physical condition and observing, if possible, the patient’s cultural and religious traditions;

3) providing care in the provision of medical care;

4) organizing the provision of medical care to the patient, taking into account the rational use of his time;

5) establishing requirements for the design and placement of medical organizations, taking into account compliance with sanitary and hygienic standards and ensuring comfortable conditions for the stay of patients in medical organizations;

6) creating conditions that ensure the possibility of visiting the patient and the stay of relatives with him in the medical organization, taking into account the patient’s condition, compliance with the anti-epidemic regime and the interests of other persons working and (or) staying in the medical organization.

The state recognizes the protection of children’s health as one of the most important and necessary conditions for the physical and mental development of children .

Children, regardless of their family and social well-being, are subject to special protection, including care for their health and proper legal protection in the field of health protection, and have priority rights in the provision of medical care.

Medical organizations, public associations and other organizations are obliged to recognize and observe the rights of children in the field of health protection.

State authorities of the Russian Federation, state authorities of the constituent entities of the Russian Federation and local governments, in accordance with their powers, develop and implement programs aimed at prevention, early detection and treatment of diseases, reduction of maternal and infant mortality, formation of motivation in children and their parents to healthy lifestyle, and take appropriate measures to organize the provision of children with medicines, specialized health food products, and medical devices.

The state authorities of the Russian Federation and the state authorities of the constituent entities of the Russian Federation, in accordance with their powers, create and develop medical organizations that provide medical care to children, taking into account the provision of favorable conditions for the stay of children, including children with disabilities, and the possibility of staying with their parents and (or) other family members, as well as social infrastructure focused on organized recreation, improvement of children and restoration of their health.

Social protection of citizens in case of loss of health is ensured by establishing and implementing legal, economic, organizational, medical, social and other measures that guarantee social security, including through compulsory social insurance, determining the citizen’s need for social protection in accordance with the legislation of the Russian Federation. Federation, in rehabilitation and care in case of illness (condition), establishment of temporary incapacity for work, disability or in other cases determined by the legislation of the Russian Federation.

Speaking about the responsibility of state authorities and local governments , officials of organizations for ensuring the rights of citizens in the field of health care, it should be noted that state authorities and local governments, medical organizations and other organizations interact in order to ensure the rights of citizens in the field of health care .

State authorities and local self-government bodies, officials of organizations shall, within their powers, be responsible for ensuring guarantees in the field of health protection established by the legislation of the Russian Federation.

The availability and quality of medical care are ensured by :

1) organizing the provision of medical care on the principle of proximity to the place of residence, place of work or education;

2) the availability of the required number of medical workers and the level of their qualifications;

3) the possibility of choosing a medical organization and a doctor;

4) application of procedures for the provision of medical care and standards of medical care;

5) provision by a medical organization of a guaranteed volume of medical care in accordance with the program of state guarantees of free provision of medical care to citizens;

6) establishing, in accordance with the legislation of the Russian Federation, requirements for the location of medical organizations of the state healthcare system and the municipal healthcare system and other infrastructure facilities in the healthcare sector based on the needs of the population;

7) transport accessibility of medical organizations for all groups of the population, including the disabled and other groups of the population with limited mobility;

8) the possibility of unimpeded and free use by a medical worker of means of communication or vehicles to transport a patient to the nearest medical organization in cases that threaten his life and health.

Refusal to provide medical care in accordance with the program of state guarantees of free provision of medical care to citizens and collection of fees for its provision by a medical organization participating in the implementation of this program, and medical workers of such a medical organization are not allowed.

Medical assistance in an emergency form is provided by a medical organization and a medical worker to a citizen without delay and free of charge. Refusal to provide it is not allowed.

For violation of the stipulated requirements, medical organizations and medical workers are liable in accordance with the legislation of the Russian Federation.

The priority of prevention in the field of health protection is ensured by :

1) development and implementation of programs for the formation of a healthy lifestyle, including programs to reduce alcohol and tobacco consumption, prevent and combat the non-medical consumption of narcotic drugs and psychotropic substances;

2) implementation of sanitary and anti-epidemic (preventive) measures;

3) implementation of measures for the prevention and early detection of diseases, including the prevention and control of socially significant diseases;

4) carrying out preventive and other medical examinations, clinical examination, dispensary observation in accordance with the legislation of the Russian Federation;

5) implementation of measures to preserve the life and health of citizens in the process of their education and work in accordance with the legislation of the Russian Federation.

Information about the fact that a citizen applied for medical assistance, his state of health and diagnosis, other information obtained during his medical examination and treatment, constitute a medical secret.

It is not allowed to disclose information constituting a medical secret, including after the death of a person, by persons to whom they became known during training, performance of labor, official, service and other duties, except for the following cases:

A) With the written consent of a citizen or his legal representative, it is allowed to disclose information constituting a medical secret to other citizens, including officials, for the purpose of medical examination and treatment of a patient, conducting scientific research, publishing them in scientific publications, using them in the educational process and for other purposes.

B) Providing information constituting a medical secret without the consent of a citizen or his legal representative is allowed:

– in order to conduct a medical examination and treatment of a citizen who, as a result of his condition, is not able to express his will;

– with the threat of the spread of infectious diseases, mass poisoning and lesions;

– at the request of the bodies of inquiry and investigation, the court in connection with the investigation or trial, at the request of the body of the penitentiary system in connection with the execution of a criminal sentence and the exercise of control over the behavior of a conditionally convicted person, a convicted person in respect of whom the serving of a sentence has been suspended, and a person released on parole;

– in the case of providing medical assistance to a minor in some cases (for example, a drug addict), as well as to a minor who has not reached the age of 15 years.

– in order to inform the internal affairs authorities about the admission of a patient in respect of whom there are sufficient grounds to believe that harm to his health was caused as a result of unlawful actions;

– for the purpose of conducting a military medical examination at the request of military commissariats, personnel services and military medical (medical-flight) commissions of federal executive bodies in which military service and equivalent service are provided for by federal law;

– for the purpose of investigating an accident at work and an occupational disease;

– when exchanging information by medical organizations, including those placed in medical information systems, in order to provide medical care, taking into account the requirements of the legislation of the Russian Federation on personal data;

– for the purpose of accounting and control in the system of compulsory social insurance;

– for the purpose of monitoring the quality and safety of medical activities in accordance with this Federal Law.

The concept and types of ME.

Expertise is the process of research by a specialist of any issues that require special knowledge in the field of science, technology, art, etc.

Expertise can be carried out in various spheres of human activity. The result of the examination is evidence-based conclusions and recommendations.

In case of loss of health, a medical examination is carried out.

A medical examination is a study conducted in accordance with the established procedure, aimed at establishing the state of health of a citizen, in order to determine his ability to carry out labor or other activities, as well as to establish a causal relationship between the impact of any events, factors and the state of health of a citizen.

The following types of medical examinations are carried out in the Russian Federation (Scheme):

1) examination of temporary disability;

2) medical and social expertise;

3) military medical expertise;

4) forensic medical and forensic psychiatric examinations;

5) examination of professional suitability and examination of the connection of the disease with the profession;

6) examination of the quality of medical care.

In addition, citizens have the right to conduct an independent medical examination in the manner and in the cases established by the regulation on an independent medical examination, approved by the Government of the Russian Federation.

1. Examination of temporary disability of citizens due to diseases, injuries, poisonings and other conditions associated with temporary disability, aftercare in sanatorium organizations, if necessary, care for a sick family member, in connection with quarantine, for the duration of prosthetics in a hospital , in connection with pregnancy and childbirth, when adopting a child, is carried out in order to determine the ability of the employee to carry out labor activities, the need and timing of the temporary or permanent transfer of the employee for health reasons to another job, as well as making a decision on sending a citizen for a medical and social examination.

Examination of temporary incapacity for work is carried out by the attending physician, who single-handedly issues certificates of incapacity for work to citizens for a period of up to fifteen calendar days inclusive, and in cases established by the authorized federal executive body, by a paramedic or dentist, who single-handedly issues a certificate of incapacity for work for a period of up to ten calendar days inclusive.

With an obvious unfavorable clinical and labor prognosis, no later than four months from the date of the onset of temporary disability, the patient is sent to undergo a medical and social examination in order to assess disability, and in case of refusal to undergo a medical and social examination, the disability sheet is closed. With a favorable clinical and labor prognosis, no later than ten months from the date of the onset of temporary disability in a condition after injuries and reconstructive operations and no later than twelve months in the treatment of tuberculosis, the patient is either discharged for employment or sent for a medical and social examination.

2. A medical and social examination is carried out in order to determine the needs of the person being examined for social protection measures, including rehabilitation, by federal institutions of medical and social examination based on an assessment of disability caused by a persistent disorder of body functions.

3. Military medical examination is carried out in order to :

a) determining suitability for military service (service equated to it), training (service) in specific military specialties (specialties in accordance with the position held);

b) establishing a causal relationship of injuries (wounds, injuries, contusions), diseases in military personnel (persons equated to them, citizens called up for military training) and citizens dismissed from military service (service equated to it, military training), with the passage of military service (service equated to it);

The conclusions of the military medical examination are mandatory for execution by officials on the territory of the Russian Federation.

If citizens do not agree with the conclusion of the military medical examination, an independent military medical examination is carried out on their application. The regulation on an independent military medical examination is approved by the Government of the Russian Federation.

An examination is recognized as independent if the expert or members of the expert commission conducting it are not in official or other dependence on the institution or commission that conducted the military medical examination, as well as on the bodies, institutions, officials and citizens interested in the results of an independent military medical examination. .

In cases established by the legislation of the Russian Federation, the passage and conduct of a military medical examination are mandatory.

4. Forensic medical and forensic psychiatric examinations are carried out in order to establish the circumstances to be proved in a particular case, in medical organizations by experts in accordance with the legislation of the Russian Federation on state forensic activities.

5. An examination of professional suitability is carried out in order to determine the compliance of the employee’s health condition with the possibility of performing certain types of work.

Examination of professional suitability is carried out by the medical commission of a medical organization with the involvement of specialist doctors based on the results of preliminary medical examinations and periodic medical examinations. Based on the results of the examination of professional suitability, the medical commission issues a medical opinion on the suitability or unfitness of the employee to perform certain types of work.

Examination of the relationship of the disease with the profession is carried out in order to establish a causal relationship between the disease and professional activities.

According to the results of the examination of the connection of the disease with the profession, a medical conclusion is issued on the presence or absence of an occupational disease.

6. Examination of the quality of medical care is carried out in order to identify violations in the provision of medical care, including assessing the timeliness of its provision, the correct choice of methods for prevention, diagnosis, treatment and rehabilitation, the degree of achievement of the planned result. (effective from January 1, 2015)

Criteria for assessing the quality of medical care are formed by groups of diseases or conditions on the basis of the relevant procedures for the provision of medical care and standards of medical care and are approved by the authorized federal executive body.

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