Is it possible to take sick leave in a paid clinic: all the nuances of this issue

Everyone may need a certificate from the clinic. According to statistics, approximately every fifth consultation with a therapist in Moscow is attended specifically for the purpose of obtaining one or another certificate. Numerous public and private clinics issue a wide variety of categories of medical documents: certificates for study, work, child care institutions, sports competitions. Some people need a medical certificate for a swimming pool, others for a car inspection.

There are two ways to get the coveted document from the doctor. The first is to make an appointment at the regional public clinic. The second is to turn to the so-called “private providers,” that is, to a clinic that provides services on a paid basis.

At the same time, every year in the capital the number of people who prefer to take the second route is growing - that is, obtaining certificates from paid clinics. What explains such a high interest in private medicine in this case? In this article, we tried to weigh all the factors that testify in favor of paid certificates, as well as those that oppose them.

What is a medical license

“License” is literally translated from Latin as “right”.
In its modern meaning, it is a documented permit issued by authorized executive authorities to perform a certain type of work or provide services. Medical activities include activities aimed at changing the state of human health.

A medical license is a properly executed and certified written permission to practice professional medicine, issued by the state.

Is it profitable to open a medical center today?

For a long time, our country has had strict government control in all areas of activity. Medical services provided by health care institutions were the same for all patients. They were provided free of charge, but the quality was not always high.

And although in the 90s. XX century Private business in the field of medicine began to take shape; today, after almost 30 years, one cannot speak of a high level of development of private medical practice in Russia.

The key problems of the medical business in its modern form are the following:

1. Government regulation of the industry is not transparent.
2. There are not enough highly qualified specialists.
3. People do not trust doctors practicing in private medical centers.
4. Services from private clinics have high costs.

It is easy to see that the problems do not include a high level of competition and low demand for services. The reason is that this market is just beginning to develop and the formation of its main levers (demand and competition) has not yet been completed.

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There are businessmen who consider this situation favorable for opening a medical center from scratch. However, you need to remember: since the market is not developed, there are no clear rules of the game. Therefore, entrepreneurs who decide to open a private medical center in Russia take risks.

Success is most likely when choosing the following directions:

• cosmetology and aesthetic medicine;
• dentistry;
• reproductive medicine;
• laboratory and hardware diagnostics.

In addition, more and more people are becoming interested in receiving a range of medical services in private centers, which is explained by the possibility of not having to wait in line for a long time in this format. In addition, private clinics guarantee the competence of their staff, and medical procedures are carried out using new equipment.

It is best at present to open a private medical institution in one of the following formats:

• specialized medical center;
• private clinic;
• specialist's medical office.

If someone is ready to invest in the implementation of your ideas for opening a medical institution, then we recommend that you choose exactly one of the proposed organizational structure formats for a private medical practice.

Materials for download:

How to open a medical center - business plan (example 1)

How to open a medical center - business plan (example 2)

Who issues, grounds, validity period

In order to streamline licensing, on January 26, 2015, Order No. 21n of the Ministry of Health of the Russian Federation was issued, approving the regulations for the provision of services. According to this regulation, permits are issued by the Federal Service for Surveillance in Healthcare.

Important! Information about the addresses and telephone numbers of territorial bodies of Roszdravnadzor, where you can apply for a special permit and for clarification on the provision of services, is given in Appendix 1 to Order of the Ministry of Health of the Russian Federation No. 21n dated January 26, 2015. The names of their official websites and email addresses are also indicated there.

The basis for the licensing bodies of Roszdravnadzor to begin work is the receipt of an application filled out in the form approved by Appendix 1 to Roszdravnadzor Order No. 3166 dated 05/05/2014. Documents are added to the application, the list of which is given in the inventory filled out in accordance with Appendix 2 of the Order.

Additional Information! The service is provided for a fee, the amount of which is determined by paragraphs. 92 clause 1 art. 333.33. Tax Code of the Russian Federation. As of 2020, the state duty is:

• for issuing a license for the first time - 7,500 rubles;
• for re-registration (if information about the licensee and/or the types of work performed by him changes) - 3,500 rubles;
• for re-registration without making significant changes, issuing a duplicate - 750 rubles.

Provided that all licensing requirements are met, the permit is issued without specifying a validity period (indefinitely).

The legislative framework

The basis for the legal regulation of granting rights to carry out certain types of activities in medicine is provided by federal laws:

• No. 323-FZ of November 21, 2011 “On the fundamentals of protecting the health of citizens in the Russian Federation”;
• No. 99-FZ dated 05/04/2011 “On licensing of certain types of activities”,

as well as Government Decrees:

• No. 957 of November 21, 2011 “On the organization of licensing of certain types of activities;
• No. 291 of 04/16/2012 “On licensing of medical activities (with the exception of the specified activities carried out by medical organizations and other organizations included in the private healthcare system in the territory of the innovative one).”

Interesting! Medical organizations operating on the Skolkovo territory do not require a license. The innovation center is designed to become a self-developing and self-regulating system. As an experiment, organizations engaged in medical and educational activities receive special permission to work in the management company.

How to correctly draw up a certificate of incapacity for work

There is no difference between sick leave issued in a public and private clinic. Hospitals use a single form, which is established by law. Usually this is always a blue document, where the fields required to be filled out are printed on the computer. The doctor is obliged to fill them out correctly, taking into account the legislation and the requirements of the Ministry of Health.

Main design rules:

• The front side of the form is filled out on a computer or manually;
• You need to write clearly and clearly by hand, usually in capital block letters;
• You can use black color; you can use a fountain pen, gel pen, or capillary pen;
• The time for renewal of documentation must comply with the law;
• The sheet can only be issued within a period of 3 to 15 days, this is due to what illness happened to the patient;
• An employer does not have the right not to pay sick leave only on the grounds that it was issued by a paid clinic;
• If the certificate of incapacity for work is filled out correctly, if it is not a fake document, the employer is obliged to pay for it, taking into account the law of the Russian Federation.

What types of activities require obtaining a license for medical activities?

Persons who, in the course of their activities, perform manipulations that affect or can affect the somatic or mental state of a person must have a license. Pre-medical manipulations, diagnostic, emergency, emergency or palliative care, as well as actions carried out in outpatient and inpatient settings, are licensed. Special permission for the activities of sanatorium-resort, pharmaceutical, expert (medical types of examination) institutions, laboratories must also be obtained.

Approximate schedule for opening a medical center

The business plan must contain a opening schedule. That is, when developing it, you need to determine the approximate time frame within which the project will be implemented. Here is an example of such a graph:

1. Market analysis, business plan development – ​​1 month.
2. Finding an investor or bank that will approve the required loan amount takes 1 month.
3. Search for premises – 2 weeks.
4. Registration with the tax office, preparation of all necessary documents – 2 weeks.
5. Obtaining a license – 2 months.
6. Repair of premises and purchase of furniture – 1 month.
7. Equipment purchase – 1 month.
8. Search for specialists – 2-3 months.

Requirements for a licensee

The holder of a license to provide medical services can be an individual entrepreneur or a legal entity of any form of organization.

Staff

A personal file must be created for each employee of the organization.

Resolution of personnel issues in healthcare is assigned to the personnel management service, the organizational form of which depends on the number of employees and the scale of the organization’s activities.

HR management work includes:

• selection of qualified personnel that meets the licensee’s requirements;
• monitoring of personnel, implying accounting and analysis of personnel, training of reserves;
• ensuring timely certification of employees.

Equipment

To obtain the right to operate in the field of medicine, the applicant submits to the licensing authority documents for equipment that will be used in the process of providing services. The main condition is that the equipment must be registered in accordance with the rules for state registration of medical devices, approved on December 27, 2012 by Decree of the Government of the Russian Federation No. 1416. The applicant must also present:

• passport for equipment;
• warranty service agreement;
• certificate of conformity;
• performance characteristics, etc.

Education

Higher medical education and a certificate of postgraduate training in “health care organization and public health” are the main requirements for the candidacy of the head of a legal entity directly responsible for the volume and quality of services provided.

The head of an organization from the state sanitary and epidemiological surveillance system can only be a person with training in the specialty “social hygiene and organization of the state sanitary and epidemiological service.”

Requirements for the level of education of employees are determined by the content of their job responsibilities.

Secondary medical education is the minimum threshold for an individual entrepreneur who intends to provide pre-medical care.

The work experience of specialists is also required:

• from 5 years for those with a higher education diploma;
• from 3 years for middle staff.

Premises

Premises used for the provision of healthcare services must comply with the conditions specified in sanitary rules and regulations 2.1.3.2630-10, approved on May 18, 2010 (as amended on June 10, 2016)

Additional Information! The potential for demand for the clinic will increase if transport and pedestrian accessibility to the building in which the organization is located is ensured. Having your own parking lot and a presentable appearance will add to its popularity.

Clinic

When licensing a clinic, you need to make sure that the premises intended to house it comply with all SanPiN standards. The rights to the premises must be documented by a lease agreement or a certificate of ownership. Additionally, contracts must be concluded for disinfection, garbage removal, disposal of fluorescent lamps, maintenance of the ventilation system, and laundry.

Beauty salon

The room in which it is planned to locate a cosmetology room must meet sanitary standards. The main thing is that the surfaces of walls, ceilings, and floors should be easy to clean, wear-resistant and resistant to the absorption of pollutants. The functioning of power supply, ventilation, hot and cold water supply systems must be uninterrupted and safe.

Fine for absence

In Russia, various types of liability are provided for working without a license in the medical field, from administrative to criminal:

• Fine to the manager up to 50 thousand rubles with confiscation of property;
• A fine of up to 40 thousand rubles with a ban on practicing medicine for 90 days for individual entrepreneurs;
• A fine of up to 250 thousand rubles and a ban on medical practice for up to 90 days for legal entities.

If the services provided caused serious damage to the economy of the region/country and patients, then criminal liability is possible. It includes:

• Imposition of a fine of up to 24 minimum wages;
• Mandatory work up to 480 hours;
• Arrest for up to 6 months;
• Imprisonment for up to 3 years.

It is important! The choice of punishment should only occur in court. If you disagree with the decision, you must file an appeal in accordance with the procedure established by law.

If the patient died as a result of careless actions, then imprisonment for up to 5 years with deprivation of the right to practice medicine is possible.

Thus, it is profitable to work in accordance with the requirements of the law. It is possible to become eligible to work in the healthcare field fairly quickly. The law also allows you to issue a general power of attorney to a law firm that will collect, prepare and submit the necessary documentation.

How to get: algorithm of actions

Terms of consideration

The period for consideration of an application for a license depends on the final purpose specified in the request for the provision of services:

• obtaining a license for the first time - 45 working days;
• re-issuance of a license, if the need for this is caused by the cessation of work at one of the addresses, the cessation of the provision of one or another type of service - 10 working days;
• renewal of a license, if it is planned to supplement an already issued license with a new type of work or service, as well as to make changes to the address for carrying out medical activities - 30 working days;
• provision of a duplicate – 3 working days.

Methods for submitting documents

The applicant can contact the licensing authorities:

• in person;
• send a request by mail;
• through the official website;
• through the State Services portal.

Submission stages

1. Applying to Rospotrebnadzor for a sanitary and epidemiological report.
2. Formation of a package of documents, drawing up an inventory of them and contacting Roszdravnadzor.

How to determine whether a clinic operates under the compulsory medical insurance program

On the TFOMS website there is a list of private clinics that accept compulsory medical insurance. For example, Moscow residents can be served in medical centers that are listed on the website of the Moscow City Compulsory Medical Insurance Fund. There is also an option available to download the entire registry. The list will include both private and municipal clinics.

The list of paid clinics providing services under the compulsory medical insurance policy is regularly updated. Some institutions are being added, others are leaving the system. Such changes occur 1-3 times a month, so it’s worth checking out the TFOMS website. Up-to-date information is always presented there.

Note! A clinic that has started operating under compulsory health insurance cannot leave the system for a year. This is a must.

You can also get information about clinics participating in compulsory medical insurance on the website omsdir.ru. If the patient is interested in a specific organization, you can enter its name in the search field or download the entire list of medical institutions operating in the city or region.

There is another way to understand whether a medical center operates in the compulsory medical insurance system or not. You can call the insurance company or the clinic directly and clarify this information.

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Procedure for re-issuing a license

Changing the name of an organization, its address, or other information about a legal entity or individual entrepreneur requires a preliminary amendment through the MIFTS in the Unified State Register of Legal Entities or the Unified State Register of Individual Entrepreneurs. Then you need to contact the territorial body of Roszdravnadzor. If the need for re-registration is dictated solely by adjusting the list of services, there is no need to contact the tax service.

How to open a medical center: choosing a concept and direction of activity

When thinking about how to open a medical center from scratch, immediately decide what list of services your clinic will provide. This is what will largely influence the size of the required initial capital.

Before you start analyzing the project, study whether there is competition in the chosen direction and what its level is. Also check out your competitors' pricing policies. Let us note that the main components of success are: the list of services, equipment and professionalism of the staff. If you take them into account and implement them correctly, you can take a leading position in the market.

Before opening a clinic, think through all the details. You won't miss anything if you develop a business plan for the project in advance. In this case, the organization of your business will be competent. In a business plan, outline the overall concept of the enterprise. It must also contain a description of the production part, all technical and organizational issues, and a detailed and accurate calculation of each cost item. After all, only after summing up the financial results is it possible to determine the size of the required investments and assess how profitable the business will be.

If you are going to open a medical center from scratch, then initially the scale of the project should not be huge. Don't try to make your business multifunctional right away. Focus on a specific type of service that will be provided at your center.

Clinics are of the following types:

1. Preventive department: in this case, neither the age nor gender of the patients matters.

Such centers do not treat serious diseases, but only carry out preventive measures to prevent various diseases.

1. Therapeutic department: the patients of such institutions are mainly adults.

Specialists examine them, diagnose diseases, prescribe treatment, keep a medical history, and issue referrals.

The following departments are also therapeutic: oncology, gynecology, surgery, neurology and therapy.

1. Pediatric department: provides the same medical services as the therapeutic department, but its patients are children (from birth to 15 years).
2. Department of Alternative Medicine: is not officially a medical institution.
3. Dental department: its specialists treat teeth, as well as some diseases of the oral cavity.

The greatest profits come from dental clinics and offices, as well as therapeutic centers that use various methods to diagnose diseases.

It is possible to position your medical center depending on the cost of the services provided. You can open a clinic of premium class, economy class or mid-price category.

As a rule, most private medical centers are premium.

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Frequently asked questions: Do I need a license?

For sale of medical equipment

The production of medical equipment is licensed, but sales are not.

For disinfection activities

Disinfectology, as a type of primary health care for the population, must be licensed. This is explained by the potential danger of causing harm due to inept actions when using biological, chemical, physiological methods of disinfection, and therefore requires the application of state regulation and control.

To conduct pre-trip medical examinations of drivers

Pre-trip medical examinations are part of medical activities. According to clause 8 of the Appendix to Order No. 835n, issued on December 15, 2014 by the Ministry of Health of the Russian Federation, persons or organizations authorized to allow drivers to work must have a license.

For the disposal of medical waste

Persons authorized to work on waste collection and disposal must undergo special training.

SanPiN requirements No. 2.1.7.2790-10 specify the conditions for working with medical waste.

In accordance with clause 8 of the Rules for the destruction of medicines attached to the Decree of the Government of the Russian Federation No. 674 of 09/03/2010, an organization claiming to dispose of medicines of inadequate quality must have a license to work with waste of hazard classes I-IV.

For a massage

From 01/01/2018, the nomenclature of medical services approved on 10/13/2017 by order of the Ministry of Health of the Russian Federation No. 804n is applied. It describes in detail all types of massage, reflexology, manual therapy, which are classified as medical types of influence.

Persons planning to provide massage services must obtain special permission for this activity, because mechanical and reflex effects on human tissues and organs affect his health.

When needed

The full list of services that are subject to licensing is indicated in Order of the Ministry of Health No. 142 of April 29, 1998. This regulatory act specifies exactly what you need to obtain a license for.

Insurance companies that supervise the work of medical organizations do not require a specialized license. Also, this permission is not needed for companies that provide services not included in this table.

Let's sum it up

Existing judicial practice shows that when controversial situations arise about whether a particular type of massage belongs to medical services, the court proceeds from the essence of the manipulations performed, and not from the formal name of the procedure. Therefore, you should not take the conscious risk of working without a license when actually providing services that could affect a person’s well-being.

Next

For medical workers Obtaining a license for pharmaceutical activities: regulations and regulatory documents, resolution 1081

How to apply for sick leave in a private clinic

The process of issuing a certificate of incapacity for work is no different from the procedure for issuing it in a government agency. The algorithm is like this:

1. Call a paid institution and find out whether it has a license, that is, whether it issues sick leave.
2. If the answer is positive, feel free to make an appointment with a doctor or call him at home.

The patient management scheme is standard. The doctor observes the patient until he recovers. After recovery, he receives a document of the required sample, which indicates the reason for the disability, how many days the person was sick, and when he can start working.

Concept development

In order to open a medical clinic, entrepreneurs do not need to have any special education, but at the initial stages of business they need to decide on the direction of activity. A medical center can be multidisciplinary or offer clients only one type of service. When choosing a specialization, you should focus on such criteria as the level of competition, consumer demand and expected profit margins. The most popular areas in medicine include:

• dentistry;
• urology;
• gynecology;
• plastic surgery and cosmetology;
• sexopathology;
• ophthalmology.

How much does it cost to open a medical center?

When starting to develop a business plan for a medical center, remember that you will have to include detailed calculations for each item. Let's summarize the example we considered in the article. How much money will you need to invest in opening a private clinic? Approximate costs:

• paperwork – 100,000 rubles;
• purchase of a plot, construction and finishing of a building, premises – RUB 18,500,000;
• purchase of equipment and furniture – RUB 19,700,000;
• purchase of consumables, instruments and medicines – RUB 3,000,000;
• other expenses – RUB 700,000.

The total amount of required investment will be approximately 42,000,000 rubles. Without a doubt, it is better to open a medical center together with partners, then the amount of investment for you will be smaller. You also need to calculate what your annual costs will be. Here are their approximate meanings:

• purchase of consumables and medicines – RUB 500,000;
• payment of utilities – 150,000 rubles;
• employee salaries – RUB 4,932,000;
• taxes and fees – 2,000,000 rubles;
• unaccounted expenses - 118,000 rubles.

In total, to maintain a medical center, you will need to spend about 7,700,000 rubles. in year. Now let’s calculate the profitability of the clinic. If your specialists see 50 patients every day, then the monthly revenue will be 50,000 rubles. only from initial consultations. If you add the cost of treatment or surgery, then another 950,000 rubles will be a plus.

That is, having an income of 1 million rubles every month, you will receive 12,000,000 rubles annually. Subtracting from this amount the amount of annual costs for maintaining the center, we arrive at the amount of net profit - 4,700,000 rubles. Thus, your investment will pay off within 9 years of successful operation of the clinic. Of course, this calculation is conditional. If you acquire a good reputation, you will achieve a higher annual income, while the payback period may be reduced to 5-6 years.

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Finding a location for a medical center

Experts say that a good option is to buy a separate building in any residential area of ​​the city. Please note that the advisability of renting premises in such cases is highly questionable, since you will need to radically reconstruct it to ensure compliance with the requirements of all authorities.

In addition, conducting operations and placing hospitals in residential buildings is punishable by law, so it will be impossible to complete your project if you want to place a clinic on the ground floor.

If you still choose the rental option, then expect that it will cost you at least 150,000 rubles, which depends on the features of the building and its location.

We recommend considering premises located in the city center and in plain sight. Of course, renting in such a place will be more expensive for you, but only in this case can you count on a large flow of customers. To open a center with a therapeutic department, you will only need one or two floors in a non-residential building. The minimum required area is 200 m2.

When choosing a room, pay attention to the bathroom, the design and serviceability of the ventilation system, and the presence of three-phase electricity.

To renovate the premises, you will need a lot of money: at least 6,000,000 rubles. for 200 m2. First of all, decorate the reception area: it will be the first thing visitors see. The corridor should be spacious. To make waiting for patients comfortable, be sure to install small sofas. It is not recommended to use bright colors for decoration: they do not inspire confidence. Opt for calm shades.

Taking these nuances into account is mandatory when drawing up a business plan for your medical center. We give an example for a clinic that will be located in a separate building with an area of ​​250 m2.

We list the premises required for the center:

• reception;
• 2 examination rooms;
• 2 rooms for manipulations;
• operating room;
• laboratory;
• 6 sterilization rooms;
• hospital (6 rooms, each must have a bathroom);
• resident;
• premises for domestic purposes;
• 2 toilets;
• shower for employees.

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