Provision

on procedure of paid medical services at the Children’s Surgery National Applied Research Hospital

1. General Provisions

1.1. The present provision is developed in accordance with the Republic of Belarus of June 18, 1993, No. 2435-XII On Health Care (as amended and supplemented), the resolution of the Council of Ministers of the Republic of Belarus of 10.02.2009. № 182 “On provision of paid medical services by republican health institutions” (with amendments and additions), Instruction on conducting clinical investigation of medical devices and medical equipment approved by the Decree of the Ministry of Health of the Republic of Belarus dated December 18, 2008 No. 216 “On some issues of clinical investigation of medical devices and medical equipment”, Resolution of the Council of Ministers of the Republic of Belarus of 19.07.2013. No. 641 “On approval of the regulations on the procedure for the formation of extra-budgetary funds, cost incurrence related to income-generating activities, directions and procedures for using funds remaining at the disposal of the organization”, as well as in accordance with the requirements of other regulatory legal acts of the Republic of Belarus regulating provision of paid services at the Children’s Surgery National Applied Research Hospital (hereinafter – the CSNARH).

1.2. Paid medical services to the population and legal entities are provided by CSNARH in excess of the established republican minimal social standards in the field of health care.

1.3. Paid medical services are additional to the state-guaranteed free medical care services and are introduced to improve medical care for the population and to attract additional financial resources for CSNARH material, technical and social development.

1.4. Paid medical services are carried out in accordance with the licenses of CSNARH for the corresponded activities.

1.5. This Regulation is applied to all structural departments of CSNARH.

1.6. In CSNARH, paid medical services can be provided by:

• full-time employees using equipment and inventory, as well as other material assets purchased from the budget, and in premises held at the expense of the budget, both during the working time and in extra time in accordance with the approved schedule of work. At the same time, the implementation of this activity should not adversely affect the quality of providing the population with similar types of services provided free of charge;
• employees who are in the staff of the structural unit, which is held at the expense of income received from the provision of paid medical services, in the premises and with the equipment provided by extra budgetary funds.

1.7. The specialists of CSNARH whose qualification corresponds to the nature of the work performed, with at least 3 years of experience in the field of specialization, have the right to participate in extra budgetary activities in the provision of medical services.

1.8. The Head of the Extra Budgetary Activities Department manages work on the conclusion of agreements and approval of price lists for paid medical services.

1.9. The Chief Accountant of CSNARH provides arrangement of income and distribution of funds for rendered paid services.

1.10. The right to sign agreements for the provision of paid medical services with individuals and legal entities belongs to the Director, and in his absence, to the person performing his duties or on the basis of a power of attorney to another responsible person.

2. Procedure for the provision of medical paid services

2.1. Paid medical services are rendered to all residents of the Republic of Belarus, as well as to foreign citizens, stateless persons residing in the territory of the Republic of Belarus wishing to receive paid medical services in the absence of medical necessity (at the request of the patient) or without referral of a doctor, in accordance with the procedure established by law;

2.2. Paid medical services are provided in the form of inpatient and outpatient care.

2.3. Persons wishing to receive paid medical services are to get acquainted with the procedure for providing paid medical services, their cost, the conditions for granting, receiving and paying for these services, the qualifications of specialists, benefits for certain categories of citizens, the working hours of departments, consulting rooms.

2.4. Paid medical services to the population are provided by CSNARH on the basis of an application or under a guarantee obligation of the sending organization on payment in accordance with agreements concluded in writing with natural or legal persons for the provision of paid medical services.

2.5. An agreement concluded between CSNARH and an individual or between CSNARH and a legal entity for the provision of paid medical services is the basis for the provision of a paid service or a set of services.

2.6. The agreement defines the scope and cost of paid medical services, the terms and conditions for their provision, the procedure for settlements, the rights, duties and responsibilities of the parties.

2.7. Single (one-time) services are provided only after full payment of the cost of the service in accordance with the current price list.

2.8. Complex medical services (inpatient care) are provided after the prepayment, including the cost of hospital stay and the estimated cost of treatment, followed by a final calculation after the patient’s stay in the hospital.

2.9. The basis for issuing the final invoice to inpatient patients is the act on the volume of medical work (list of medical services).

2.10. A specific list of paid medical services provided by CSNARH is determined by an agreement with the Heads of Departments and approved by the Director of CSNARH.

2.11. Information on the procedure for providing paid medical services, including a list of services with cost, conditions for granting, receiving and paying for these services, qualifications of specialists, benefits, the time of CSNARH work is communicated to the public in the form of a poster, booklet, and on CSNARH website.

2.12. Provision of paid medical services is arranged without limiting access to patients, who can be provided with paid medical services, and the volume of medical services.

3. The procedure for providing services in case of provision of other products of medical use and medical equipment, medicines for medical purposes at the request of citizens instead of available and purchased at the expense of budgetary funds in accordance with the clinical protocols, with payment by citizens only the cost of above mentioned products of medical use and medical equipment, medicines

3.1 According to the list of paid medical services rendered to the citizens of the Republic of Belarus by state health institutions approved by Resolution No. 182 of the Council of Ministers of the Republic of Belarus of 10.02.2009 (Edited on October 18, 2012 No. 947) On rendering paid medical services by republican health institutions except consultative and diagnostic services rendered on a fee basis, the list of medical services for citizens of the Republic of Belarus includes the provision of other products of medical use and medical equipment, medicines for medical purposes at the request of citizens instead of available and purchased at the expense of budgetary funds in accordance with the clinical protocols, with payment by citizens only the cost of above mentioned products of medical use and medical equipment, medicines.

3.2. The reason for rendering the service in case of provision of other products of medical use and medical equipment, medicines for medical purposes at the request of citizens instead of available and purchased at the expense of budgetary funds in accordance with the clinical protocols, with payment by citizens only the cost of above mentioned products of medical use and medical equipment, medicines is the conclusion of the agreement on a written application of the patient (if there is a medical opinion of a specialist).

3.3. The agreement is made in two copies – one copy of the agreement remains in the Department of Paid Services, the other is given to the patient.

3.4. After the conclusion of the agreement, the patient makes an advance payment for medical products and medical equipment, medicines intended for use instead of those available and purchased at the expense of budgetary funds in accordance with the clinical protocols stipulated by the agreement, by cash in CSNARH cash desk or in a non-cash form on the settlement account of the Center in the nearest branch of JSC ASB Belarusbank in accordance with the specified cost of necessary medical products and medical equipment, medicines in accordance with the procedure established by law.

3.5. Sources of financial resources are:

• personal funds of citizens;
• funds of enterprises, organizations, institutions;
• funds of insurance companies;
• other sources authorized by law.

3.6 Medical services are provided within the agreed time limits.

4.1. CSNARH (hereinafter referred to as the “Executor”) shall:

• inform the patient about the possibility of performing a medical examination free of charge in the organization of health care at the place of residence in the presence of medical grounds;
• provide the patient with the medical services agreed in the application and paid for in full in accordance with the schedule of work of the specialists involved and the internal labor schedule established by the Executor;
• issue to the customer a document confirming the receipt of cash in accordance with the legislation of the Republic of Belarus;
• monitor the quality of paid medical services within the limits of the duties of the responsible persons;
• ensure timely consideration of claims from the Customer;
• keep statistical records of paid medical services and provide the necessary information in a timely manner.

5.1. The patient (hereinafter – the Customer) is obliged to:

• apply in writing to provide medical services on a fee basis;
• require the Executor to provide a permit (license) for the relevant type of activity;
• require the provision of paid medical services in accordance with the protocols of examination and treatment;
• ask for clarification the Hospital’s administration in case of any questions;
• give consent to a new term for the provision of paid medical services or to demand execution of a paid medical service by another specialist in case of non-compliance by the Executor with the obligations on the terms of execution of paid medical services;
• present claims for compensation for actual damage caused by non-performance or improper fulfillment of the terms of the agreement, compensation for damage in the event of harm to life or health, compensation for causing moral damage in accordance with the legislation of the Republic of Belarus;
• get an advisory opinion or an extract from the medical history, indicating the results of the examination and treatment after consulting and examinations, inpatient treatment.

5.2. The Customer has the right to:

• apply in writing to provide medical services on a fee basis;
• require the Executor to provide a permit (license) for the relevant type of activity;
• require the provision of paid medical services in accordance with the protocols of examination and treatment;
• ask for clarification the Hospital’s administration in case of any questions;
• give consent to a new term for the provision of paid medical services or to demand execution of a paid medical service by another specialist in case of non-compliance by the Executor with the obligations on the terms of execution of paid medical services;
• present claims for compensation for actual damage caused by non-performance or improper fulfillment of the terms of the contract, compensation for damage in the event of harm to life or health, compensation for causing moral damage in accordance with the legislation of the Republic of Belarus;
• get an advisory opinion or an extract from the medical history, indicating the results of the examination and treatment after consulting and examinations, inpatient treatment.

6. Rights of Administration of CSNARH

6.1. The Administration has the right to:

• attract the staff of CSNARH with their consent for the provision of paid services in accordance with the labor legislation of the Republic of Belarus;
• conduct periodic and selective quality control of paid medical services within the limits of the duties of responsible persons;
• require the staff to fully comply with the existing directive documents regulating the provision of medical care to the population;
• make an expert assessment of the work of medical personnel participating in the provision of paid medical services;
• suspend from work on providing paid services employees who violate the implementation of this Regulation;
• terminate agreements with a patient if the agreement is not complied with or improperly executed by him in accordance with the current legislation of the Republic of Belarus.

7. Dispute settlement procedure between the Customer and the Executor, control over CSNARH and quality of performing paid medical services

7.1. Disputes between the Customer and the Executor on the agreement execution are resolved by consent of the parties or in a judicial procedure in accordance with the legislation of the Republic of Belarus.

7.2. Control over CSNARH and quality of paid medical services, as well as the correctness of the collection of fees from the Customer, is carried out by the Ministry of Health and other republican organizations within the limits of their competence determined by the legislation of the Republic of Belarus.

8. The payment procedure of paid medical services

8.1. Sources of financial resources in case of provision of paid medical services are:

• personal funds of citizens;
• funds of enterprises, organizations, institutions;
• funds of insurance companies;
• other sources authorized by law.

8.2. Prices for performing paid medical services should be economically justified and supported by calculations. They (prices) are formed by CSNARH independently, after which they are approved or agreed with the higher organization (Ministry of Health of the Republic of Belarus), unless otherwise stipulated by normative legal documents.

8.3. The cost of paid services rendered to citizens of the Republic of Belarus, foreign citizens, stateless persons permanently residing in the territory of the Republic of Belarus is determined in accordance with the approved prices and the volume of services rendered and the legislation of the Republic of Belarus.

8.4. Payment for paid medical services can be made in bank institutions by cashless transfer to the off-budget settlement account of CSNARH or in cash at CSNARH cash desk in accordance with the procedure established by law.

8.5. The basis for payments for paid medical services is an agreement.

9.Treatment of funds received from the provision of paid medical services

9.1. The procedure for spending extra-budgetary funds is determined by CSNARH, taking into account the approved cost estimates and the actual receipt of revenues.

9.2. The funds received by CSNARH for paid services are taken into account as an extra budgetary source and reflected in the accounting records on a separate account with the bank.

9.3. According to the Decree of the Council of Ministers of the Republic of Belarus of July 19, 2013. No. 641, expenses related to the implementation of income-generating activities should be financed from extra budgetary funds.

9.4. The amount of funds received for paid medical services to the population, as well as other types of income-generating activities, is distributed in accordance with the accounting policy established by CSNARH and Resolution of the Council of Ministers of the Republic of Belarus No. 641 of July 19, 2013.

9.5. The profit from paid medical services is an additional source of funds and is channeled to the production and social development fund (development of the material and technical base, purchase of supplies, payment of utility expenses, transportation services) and a material incentive fund (material incentives and social support for workers, remuneration payment to the jubilee dates).

9.6. The profit from paid medical services is defined as the difference between the total amount of incomes and expenses, taxes and deductions in accordance with the current legislation. The profit tax is paid in accordance with the legislation of the Republic of Belarus.

9.7. Excess of income over expenses remaining at the disposal of CSNARH is distributed according to the approved and current Regulations on treatment of funds received by CSNARH from income-generating activities.

10. The order of training in clinical residency and postgraduate study at CSNARH  on a fee basis for foreign citizens

10.1. Enrollment and training in clinical residency and postgraduate study at CSNARH on a fee basis for foreign citizens is carried out in accordance with the approved order of enrollment and training on a fee basis for foreign citizens in clinical residency and postgraduate study at CSNARH.

10.2. Training of foreign citizens in the clinical residency of CSNARH is carried out on a contractual basis.

10.3. The cost of training is formed by drawing up an estimate of income and expenditure approved by the Director of CSNARH.

10.4. Tuition fee in clinical residency is carried out according to the terms and in the amounts stipulated in the contract.

10.5. The Director’s order appoints responsible persons from among the staff of CSNARH for training clinical residents.

10.6. Postgraduate education includes: in-depth study of general scientific disciplines, general theoretical and special courses, determined candidate examinations and tests, mastering the methods and means of scientific research, performing scientific research in accordance with the chosen specialty of the relevant branch of science on the most relevant issue, systematization and generalization of the obtained results with the purpose of preparation and defense of the thesis for obtaining the scientific degree of Candidate of Sciences.

10.7. Postgraduate education is provided by full-time or part-time forms.

10.8. The term postgraduate study full-time form of training should not exceed three years, part time – four years. Part-time postgraduate study is arranged in accordance with the rules and programs approved for the full-time postgraduate study, taking into account a longer training period.

10.9. Postgraduate students are accepted with a diploma of higher education (with the exception of a bachelor’s degree), with a propensity for scientific research, supported by scientific publications, participation in research projects, scientific and practical conferences, seminars or other materials, as well as practical work experience (no less than two years), or the recommendation of the Council of a higher educational institution (hereinafter – the university) or the faculty of the university. Persons who have a corresponding higher education are admitted to postgraduate study in the specialties of the medical profile. Foreign citizens enrolling in postgraduate school must have a higher education at the level of the Master of Sciences.

10.10. Persons entering the postgraduate program on referral, including those of foreign organizations, present additionally the document on referral for postgraduate study and the agreement between the sending party and the organization that carries out the training of scientific personnel of the highest qualification.

10.11. By the order of the Director of CSNARH , which carries out the training of scientific personnel of the highest qualification, the scientific supervisor from among the Doctors of Sciences for the postgraduate student is appointed. According to the decision of the Scientific (scientific and technical) Council, scientific candidates, who are engaged in scientific activity for at least three years after the defense of the candidate’s dissertation and published in the last three years at least six papers in scientific publications included in the list of scientific publications of the Republic of Belarus, or in foreign scientific publications, could be involved to academic advising of the postgraduate students (adjuncts).

10.12. Control over the quality of academic advising of postgraduate students is carried out by the Head of the organization.

10.13. The total number of postgraduates, which can be simultaneously assigned to one scientific leader, cannot exceed four people.

10.14. Postgraduate students who are trained in the postgraduate program in the direction of foreign countries are required to fulfill additional requirements, if established by international treaties.

10.15. Training of foreign citizens in the postgraduate program of CSNARH is carried out on a contractual basis.

10.16. Payment for training in CSNARH postgraduate program is carried out according to the terms and in the amounts specified in the contract.

10.17. The training of foreign citizens in clinical postgraduate program is carried out according to the income and expenditure estimates approved by the Director of CSNARH .

11. Procedure for conducting clinical investigation of medicines, medical equipment and medical devices in CSNARH 

11.1. Conduction of clinical investigation of medicines, medical equipment and medical devices in CSNARH is carried out in strict accordance with the current legislation of the Republic of Belarus and international norms and approved standards of operational procedures (SOP). The work is carried out according to the approved Program (protocol) of the clinical investigation (study).

11.2. Monitoring of ethical standards in conducting clinical investigation is carried out by the Ethics Committee of CSNARH.

11.3. Clinical investigation of medicines, medical equipment and medical devices is carried out on the directions of the Republican Unitary Enterprise Center for Expertise and Testing in Health Care on a contractual basis.

11.4. Marketing research of registered medicines, medical equipment and consumables for the purpose of collecting information on their effectiveness is carried out on a contractual basis with the Customer of the study, after consideration of the documents by the Ethical Committee (if necessary).

11.5. The persons responsible for arrangement and conduction of investigation (the leader and the members of the group) are appointed by the order of the Director of CSNARH.

11.6. Members of the group fill out applications for participation in clinical investigation with the indication of personal data (length of service and place of work, position, address, passport data, academic degree, rank (if available)).

11.7 The work on carrying out clinical investigation (studies) is carried out by employees within the framework of labor contracts, the amount of remuneration is established depending on the labor spent on conducting clinical investigation (studies), the contribution to the achievement of the result of specific employees, including actually spent time for the performance of this work or in the framework of civil law contracts with payment of remuneration based on the results after the parties signed the acts of work performed.

11.8. The transfer of medicines, medical equipment and medical devices to the disposal of the Contractor, as well as the return to the Customer of the samples to be returned, is carried out by a consignment note or an act of acceptance-transfer.

11.9. Completion of works under the contract is formalized by work acceptance certificate.

11.10. The results of clinical investigation are documented by a protocol of acceptance of clinical investigation, an act of acceptance of clinical investigation, a summary report of the established form.

11.11. The cost of the performed work is agreed by the parties and fixed in the contract price schedule.

11.12. The cost of work on clinical investigation of medicines, medical equipment and medical devices is formed on the basis of cost estimation approved by the Director of CSNARH.

11.13. The distribution of remuneration between the members of the group, taking into account the personal contribution of each to the performance and organization of work, is carried out at the general meeting of the group and fixed by the meeting protocol approved by the Director of CSNARH. In case of work performance under subcontracts, remuneration is paid in accordance with the contractual terms, after the signing of the work acceptance certificate.

12. Distribution of responsibilities of CSNARH leading staff in the arrangement of paid medical services

12.1. The duties of the staff of the Extra Budgetary Activities Department are regulated by the job descriptions approved by the Director of CSNARH.

12.2. The duties of CSNARH employees, who facilitate the provision of paid services:

12.2.1. Deputy Director of Medical Services

Control over the work of medical personnel who directly provide paid services and employees who assist in their performance in the framework of their duties.

12.2.2. Chief Accountant:

Control and arrangement of accounting in the Extra Budgetary Activities Department.

12.2.3. Head of Planning and Economic Department:

Control and analysis of the financial and economic activities of the Extra Budgetary Activities Department, the correctness of the formation of the wage fund, the approvement of allowances, surcharges, the calculation of bonuses and remuneration, the formation of tariffs for the provision of paid medical services.

12.2.4. The Legal Adviser:

Legal control over the work of the Extra Budgetary Activities Department.

12.2.5. Heads of structural subdivisions:

Organization and control of the treatment process of patients on a paid basis undergoing diagnostics and treatment in subdivisions under their direct supervision; Compiling a report on the volume of paid medical services provided and report submission to the Extra Budgetary Activities Department.

12.2.7. Head of the Department of Material and Technical Support and Head of the Pharmacy

Arrangement of timely purchases of consumables and medicines for the provision of paid medical services.