Президент підписав закон, що дав старт медичній реформі, а Уряд ухвалив ключові документи, які дозволять розпочати системні зміни. Основне завдання на перше півріччя 2018 року — реорганізувати заклади первинної медичної допомоги з бюджетних установ на комунальні некомерційні підприємства. Іншими словами — автономізуватися.
Для чого медзакладам автономізуватися
Автономізація — це обов’язкова умова, оскільки тільки медичні заклади у статусі комунальних некомерційних підприємств зможуть укласти договори з Національною службою здоров’я України та отримувати пряме фінансування за надані послуги з Державного бюджету.
Комунальні некомерційні підприємства є неприбутковими, тобто метою їх діяльності є не отримання прибутку, а надання послуг з охорони здоров’я населенню.
Як неприбуткові підприємства, заклади не будуть платниками податку на прибуток і зможуть самостійно розпоряджатися отриманими коштами. У тому числі, вільно встановлювати розмір заробітної плати для медичних та інших працівників.
Як відбуватиметься перехід від субвенції до прямих виплат
Перший квартал 2018 року — час для місцевої влади та медичних закладів первинної ланки на підготовку до впровадження нової моделі фінансування та нових стандартів надання послуг.
Депутати Верховної Ради вирішили на перехідний період (2018-2019 роки) залишити обидві системи фінансування — медичну субвенцію і прямі виплати за договорами з НСЗУ. Тому до початку прямих виплат з державного бюджету за договорами з НСЗУ заклади первинної ланки (в тому числі автономізовані) будуть фінансуватися за рахунок медичної субвенції, як і раніше.
Заклади, які не автономізуються та не укладуть договори з НСЗУ, будуть до кінця 2018 року фінансуватися за рахунок медичної субвенції. Відповідно заробітні плати лікарів будуть прив’язані до тарифної сітки.
Медичні заклади зможуть приєднуватися до реформи тільки групами — тобто одразу весь район, місто або ОТГ. Це зумовлено тим, що субвенція виплачується на бюджет, і відповідно може бути скасована повністю для цього бюджету, а не окремого закладу.
Отже, для приєднання до реформи всі заклади охорони здоров’я, які фінансуються з бюджету району, міста або ОТГ мають бути автономізовані, підключені до електронної системи охорони здоров’я і відповідати Табелю оснащення для надання ПМД.
Приватні практики первинної допомоги (лікарі-ФОП та приватні заклади) можуть укласти договір та розпочати роботу з НСЗУ в будь-який момент з моменту запуску роботи Служби.
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