Compulsory Medical Insurance Research Articles

The role of changes in the Tariff agreement in the field of compulsory health insurance for assessing the effectiveness of medical organizations

The development of an evaluative approach to determining the effectiveness of medical organizations, the introduction of various indicators for assessing the provision of medical care is one of the mechanisms for improving its quality and accessibility for the population. Correction of regulatory legal documents regulating the activities of the sphere of compulsory medical insurance, taking into account changes, including those taking place in the healthcare of the Russian Federation as a whole, is a necessary requirement for updating approaches to the selection of adequate assessment criteria.

Editorial Comment on the Article by Belenkiy I.G. et al. “Strategies of Osteosynthesis: Problems and Perspectives”

The commentary discusses the advantages and disadvantages of the model proposed by the authors of the article for performing osteosynthesis for urgent indications within 24 hours after the patients admission to the hospital, and also focuses on the need for comprehensive assessment of treatment outcomes and financial costs of the healthcare system. The determination of indications for emergency osteosynthesis and the identification of patients groups depending on the pattern and localization of the fracture are also important issues in justifying the shortening of the time before surgery. It is necessary to justify the priority localization of fractures for urgent fixation based on the analysis of the authors own experience and literature data. Changes in the system of emergency trauma care will require a revision of the standards of staffing and financing in the system of compulsory medical insurance. Therefore, the commentary emphasizes the expediency of a preliminary assessment of the new model effectiveness in some medical institutions by comparing it with the traditional system.

EE467 Recovid Study. Cost-Effectivness Analysis of Using Nutridrink 200 ML in the Treatment of COVID-19 in the Hospital

EE467 Recovid Study. Cost-Effectivness Analysis of Using Nutridrink 200 ML in the Treatment of COVID-19 in the Hospital

Барьеры телемедицины и пути их преодоления.

The ongoing discussion of telemedicine suggests that there are barriers to the widespread adoption of telemedicine technologies in clinical practice. The article is the first to classify the barriers of the introduction of telemedicine technologies into practice. There are 4 main barriers: technological, legal, economic and methodological. At the end of the description of each barrier, ways to overcome them are given. The technological barrier includes: the inconvenience of using existing tools, poor integration of telemedicine platforms with existing medical information systems (MIS), Poor standardization of information exchange protocols between sources (devices), information systems from different manufacturers, a small amount and low quality of digitized information about the state of human health and others. In the legal barrier, it is prohibited to make a diagnosis and prescribe treatment when providing medical care using telemedicine technologies, and also there are requirements for the workplace of a doctor providing TM-consultation. Financial barriers are represented by the difficulties of financing telemedicine - the lack of compulsory medical insurance tariffs, the erroneous opinion that telemedicine should reduce healthcare costs or does not require separate financing at all. The lack of methodological support for telemedicine - clinical studies, publications, methodological and clinical recommendations, training courses and programs on telemedicine for students, leads to a low commitment of doctors to use telemedicine in their work. The process of implementing telemedicine technologies is unavoidable. However, there is no doubt that telemedicine will eventually become a familiar and indispensable tool in the hands of doctors. Sooner or later, even without our active participation, these barriers will be overcome.

Изменения в порядке проведения контрольных мероприятий в системе обязательного медицинского страхования в 2022 году

One of the most important innovations in the system of compulsory medical insurance in 2021 was the change in the order of control measures. At the same time, both the participants of the MHI system, who have the authority to conduct control measures, and the procedure for conducting control have changed. This paper analyzes the next, rather voluminous changes in the system of control measures that occurred already in 2022. An assessment of the impact of these changes on the effectiveness of control and on the work of medical organizations is given.

The Quality of Medical Care and the Quality of Medical Services under the Legislation of the Russian Federation: General and Different

The article is devoted to theoretical and practical problems of distinguishing the concepts of “medical services” and “quality of medical services”, which in turn is important for clarifying the relationship between the concepts of “quality of medical services” and “quality of medical care”, as well as for distinguishing contractual and tort liability of medical organizations for the quality of medical services. Based on a comparison of the legislation on the provision of services, on health protection, on consumer protection and taking into account its interpretation given by the highest judicial authorities, the author comes to the conclusion that the subordinate regulatory legal acts on the provision of medical services are not in full compliance with the legislation on consumer rights, recommends using the experience of health authorities and the system of compulsory medical insurance for the examination the quality of medical care during the consideration of criminal and civil cases by the courts, related to the violation of the requirements for the quality of medical care.

Shoulder surgery in the trauma department of a small city multidisciplinary hospital

Issues of shoulder joint surgery, in particular, with recurrent instability and pathology of the rotator cuff, especially with its «irrecoverable» injuries, are currently of considerable practical interest to traumatologists and orthopedists. In this article, we will present our experience in treating patients with this pathology in the period 2020-2021. The results of treatment were assessed by the DASH-score scale, were evaluated at 6 and 12 months after the operations. Arthroscopic and open surgery of the shoulder joint are popular and effective methods of treating patients. The number of these interventions is steadily increasing. The problematic issue remains the ignorance of outpatient doctors, and the fact that arthroscopic surgery of the shoulder joint is a rather expensive method in terms of consumables, equipment, which is hardly covered by means of compulsory medical insurance.

Integration of military medical services and civilian health careas a key condition for the provision of medical care to military personneland the population in the event of a large-scale military conflict.

The escalation of the military conflict in Ukraine threatens with a shortage of resources for the military medical service. The solution may be the integration of civil and military medicine - it is provided for by the military medical doctrine of NATO, but does not have a systematic implementation in the Russian Federation, which even in peacetime limits the availability of medical care to military personnel, and in the event of an escalation of the conflict in Ukraine threatens to overload the military medical service . Attempts to integrate civilian and military medical infrastructure were unsuccessful due to the lack of a systematic approach to their interaction and the inability of the departments concerned to reach an agreement on the mechanisms and sources of funding.The authors propose to return to the principles of organizational integration between military and civilian medicine, which were first proposed in the ХIX century by N.I. Pirogov, successfully used by the health care of the USSR during the civil and second world wars and forgotten after the collapse of the Soviet Union. For financial and economic integration, it is proposed to include military personnel in the CHI system for medical care that military medical institutions cannot provide due to their overload, remoteness or lack of necessary specialists.It is proposed to solve the problem of paying compulsory medical insurance contributions for military personnel by replacing the compulsory medical insurance contributions paid by employers (for employees) and the subjects of the Federation (for the non-working population) with a universal compulsory medical insurance contribution automatically withheld at the same rate for all legal entities and individuals from all non-cash transactions - thereby financing additional medical guarantees for military personnel, leveling the “free rider effect” in the CHI system.

Ademetionine treatment cost analysis of patients with intrahepatic cholestasis and non-alcoholic fatty disease

Relevance . Ademetionine is a hepatoprotective drug, is included in the draft Russian clinical guidelines for the diagnosis and treatment of non-alcoholic fatty liver disease (NAFLD) and in the clinical guidelines for treating intrahepatic cholestasis (ITH), the cost analysis of treating patients with ITH and NAFLD is topical. Aim . The cost analysis of treatment with ademetionine for ITH and NAFLD in the Russian Federation. Methods . This clinical and economic analysis was conducted in accordance with the requirements of GOST R 57525–2017 and the methodological recommendations of the Center for Expertise and Quality Control of Medical Care. At the first stage, to determine the structure and number of costs, a review of legal acts and publications on the pharmacoeconomic analysis of clinical situations and drugs of interest in the e-Library and ConsultantPlus databases was carried out. The source of prices for medical services was the tariffs of the compulsory medical insurance system and data from the tariff agreement in Moscow within the framework of the compulsory medical insurance system, and in the absence of tariffs, the prices for paid medical services. Prices for drugs were obtained from an open source — the Russian Pharmaceutical Portal (Pharmindex.rf). In the absence of data on the cost structure, a survey of physicians conducted through a questionnaire. Results . Because of the literature review, 34 publications were found in the e-Library database on the use of ademetionine in NAFLD and ITH. Additionally, outside the scope of the literature review, a study was found in 2011, which provides a comparative clinical and economic analysis of the use of ademetionine (Heptral®) and essential phospholipids (Essentiale) in alcoholic liver damage and in infectious hepatitis. A review of legal acts in the ConsultantPlus database initially identified 93 documents, of which 25 turned out to be irrelevant to the current purpose of the study, that is, they didn’t allow analyzing the costs of ademetionine therapy. Of the 20 identified standards of medical care, only 2 are devoted to diseases of the liver and biliary tract. Because of the analysis, it was revealed that the cost per case of NAFLD treatment in a round-the-clock hospital amounted to 24.6 thousand rubles; in a day hospital, the cost per case of both NAFLD and ITH in adults amounted to 19.8 thousand rubles each. The average total cost of treating one patient during the year on an outpatient basis for NAFLD amounted to 65.3 thousand rubles, of which only 14.3 thousand rubles. covered by the compulsory medical insurance system, 16.9 thousand rubles outside the compulsory medical insurance system and 34.1 thousand rubles — drug costs. The average total costs for treating one patient during the year on an outpatient basis from ITH amounted to 65.4 thousand rubles, of which 23.9 thousand rubles. covered by the compulsory medical insurance system, 17.6 thousand rubles outside the compulsory medical insurance system and 23.9 thousand rubles — drug costs. Conclusion . Because of the study, the average costs for treating patients with NAFLD and ITH were calculated, which can later be used to conduct other types of pharmacoeconomic analysis.

Modern approach to automation of internal control of quality and safety of medical care

Introduction. Heads of medical organizations operating under the Moscow Healthcare Department are the ones who take care of internal control of quality and safety of medical care [1-7]. However, once the healthcare system in Moscow switched to the Unified Medical Information Analysis System (UMIAS), abandoning all the other automated information systems the city had previously used (such as Medialog, Megaklinika, Asklepios etc.), Moscow’s medical workers found it impossible to automatically unload certain statistical (analytical) reports. They have to use paper medical records and logs to register the results of the medical care quality control [1, 2, 6]. Many engineers and programmers working in Moscow’s medical system organizations attempted uploading the medical record data and create automated logs within the UMIAS system; however, they failed [4, 8, 9, 10]. That is why they started creating intranet web portals, integrating them with various internal Moscow healthcare systems (such as UMIAS etc.) as well as well as external Federal Compulsory Medical Insurance Fund systems (like the PUMP system for personalized medical care records). This allowed logging in the results of internal quality control and automatically creating statistical and analytical reports, as well as monitoring the document exchange between various offices of Moscow healthcare organizations [11-14]. To ensure the efficiency of these intranet web portals, medical workers responsible for quality control develop checklists that feature pre-approved criteria for evaluating the results of treatment for certain diseases (conditions) in accordance with medical care provision standards and clinical recommendations. Moreover, the comprehensive introduction of intranet web portals helped ensure that clinical recommendations are followed in Moscow healthcare organizations. In fact, it allowed conducting an automated medical and economic examination, similar to the ones carried out by health insurance organizations within the framework of the compulsory medical insurance system as part of state oversight. Goal. To identify the main issues in organizing internal control of quality and safety of medical care associated with the introduction of intranet web portals in Moscow healthcare system’s organizations. Materials and methods. We identified the main issues in organizing internal control of quality and safety of medical care associated with the introduction of intranet web portals in Moscow healthcare system’s organizations. Moreover, we also examined the requirements for checklist development, as well as the difficulties that arise when compiling analytical reports on following the expert criteria and standards of medical care provision and clinical recommendations. Findings. The list of the main issues associated with the introduction of an automated system for organizing internal control of quality and safety of medical care via multi-user intranet web portals includes: training heads of structural units responsible for organizing and carrying out the internal control of quality and safety of medical care; developing checklists using the pre-approved criteria, rules and requirements for providing medical care in accordance with standards and clinical recommendations; and developing an activity plan for organizing various checks (audits) and compiling analytical (statistical) reports to assess the activities of the Moscow healthcare organizations’ structural units (or employees). The checklists must feature codes of MES (medical and economic standards), ICD-10 (10th revision of the International Statistical Classification of Diseases and Related Health Problems) and medical services, as well expert criteria mentioned in acting legal documents. This is complicated by the fact that the codes of medical services in the UMIAS system differ from the codes featured in the approved medical service nomenclature, whereas expert criteria undergo frequent updates. Conclusion. To ensure the successful implementation of management responses, one needs to regularly host internal meetings with heads of structural units as well as employees responsible for organizing and carrying out internal control of quality and safety of medical care, and timely develop checklists in accordance with pre-approved standards, assessment criteria, rules and requirements of enforcement authorities while taking into account the latest clinical recommendations. To ensure proper control over following medical care provision standards in accordance with clinical recommendations and, therefore, avoid deductions and fines issued by oversight bodies, one needs to adopt a comprehensive approach to internal control of quality and safety of medical care at every level (stage), including heads of department, deputy chief doctors, deputy heads for clinical expert work etc.

Государственно-частное партнерство в обеспечении устойчивого развития регионов России: современное состояние, проблемы и перспективы

The purpose of the article is to study the current state, current problems and prospects of public and private partnership as a way to ensure the sustainable development of Russian regions. The paper draws conclusions about significant achievements in the field of sustainable development of the regions of Russia, obtained through the use of public and private partnership. As an example, the high results in healthcare and ecology achieved through public and private partnership are presented. Based on the identified organizational, economic, financial, and legal issues of public and private partnership in healthcare, practical recommendations for their elimination are given (development and implementation of a federal model and uniform standards for the implementation of public and private partnership in healthcare at the regional level; development and application of economically sound ways to ensure the return on investment due to income from the guaranteed flow of patients and the tariff of compulsory medical insurance, etc.). With regard to public and private partnership in ecology, conclusions are drawn about the need to improve legislation in the regulating directions of public and private partnership models, developing methodological, informational and other support for public and private partnership, taking into account the specifics of environmental science. The mentioned above, together with the analysis of the structure of the Russian public and private partnership market, allowed us to identify the principles of sustainable regional development based on public and private partnership (compliance, transparency, stability, etc.), as well as growth points (formation of a systematic approach to the development plans of public and private partnership, increase in information openness of sustainable public and private partnership projects, etc.) and public and private partnership prospects (in particular, due to the need to improve the quality of urban infrastructure and the development of digital technologies). The methodological basis of the study was the general scientific method of dialectical cognition of economic and financial phenomena. The methods of analysis, synthesis, expert evaluation, etc. are used in the article. The practical applicability of the materials presented in the article lies in the possibility of their use in decision-making to ensure the sustainable development of Russian regions with the help of public and private partnership.

Clinical and demographic analysis of telemedicine «doctor-patient» consultations at the Endocrinology Research Centre

The COVID-19 pandemic has accelerated the development of telemedicine technologies. Today there is evidence of the successful use of telemedicine in various fields of health care, in particular in endocrinology. At the same time, there is not enough information for effective integration of telemedicine into the management of patients with various endocrinopathies. The aim of this study is a clinical and demographic assessment of the structure of telemedicine consultations (TMC) conducted at the Endocrinology Research Centre in 2020-2021. A single-stage, single-center retrospective study was conducted. The study included all patients who received at least one TMC at the Endocrinology Research Centre in 2020-2021. Clinical and demographic information was analyzed (gender, age of patients, region of residence, ICD-10 code). All patients signed voluntary informed consent for TMC. The obtained data were processed using the Microsoft Office 2013 software package. In 2020, 1,548 TMC were held, in 2021 - 4180 TMC. Among adults, women predominated in the structure of referrals (83-86%), among children there is a tendency towards equivalent referrals for boys and girls (in 2021 - 45% and 55%, respectively). The median age of adult patients in 2021 was 38 years [31; 53], among children - 11 years [7; 14]. In 2020, residents of 74 regions of the Russian Federation applied for TMC, in 2021 - of 82 regions. There is a tendency towards theprevalence of patients from the Central, Volga, Southern and North Caucasian federal districts in the TMC structure. Diseases of the thyroid gland predominated in the nosological structure of TMC. TMC turned out to be in demand in patients with a wide variety of endocrinopathies. It is important to conduct further analysis of both the TMC market and the effectiveness of remote counseling for various nosologies to determine the place of telemedicine in the modern healthcare structure and to introduce TMK into the system of clinical guidelines and programs of territorial compulsory medical insurance funds.

Вопросы организации помощи пациентам с регматогенными отслойками сетчатки в условиях региональной медицины

The aim of the work was to analyze the features of the organization of care for patients with regmatogenic retinal detachment in regional medicine. Material and methods. Our clinic performs all the necessary types of surgical treatment for retinal detachment. Part of the ophthalmological services is paid from the funds of the compulsory medical Insurance for CSG. Results. The incidence of regmatogenic retinal detachment varies at the level of 11–12 per 100 thousand population. The analysis showed that during retinal detachment surgery, when payment is made according to the rates of the compulsory medical insurance, there are nuances of purchasing special equipment and consumables for VRH. In addition, the issues of surgery are ambiguous and due to the lack of approved clinical recommendations for retinal detachment and clearly established guidelines, as a result of which the terms of hospitalization and treatment of patients with these diseases are blurred, there are problems of interchangeability of surgeons. Conclusion. The provision of surgical care in the Kirov region to patients with retinal detachment at the expense of the CHI Fund ensures the availability and timeliness of medical services. The clinic is equipped with modern equipment, the provision of highly qualified specialists allows us to provide high-quality care even in the most difficult cases. Extrascleral surgery does not lose its relevance, despite the rapid development of endovitreal techniques. Keywords: retinal detachment, organization of care, regional medicine.

Healthcare Development Based on Public-Private Partnership: Opportunities and Limitations

Currently, the Russian healthcare system is in critical condition. And for many years, the limited financial resources of the state have significantly aggravated this problem. Therefore, it is necessary to search for effective ways to resolve this problematic situation. One of these methods is public-private partnership (hereinafter – PPP), which ensures the attraction of private investment in the healthcare system, contributing to the provision of high-quality medical services. The purpose of the article is to study the possibilities and limitations of the development of the Russian healthcare system based on PPP. The conducted research allowed us to draw conclusions, firstly, about the significant results in the development of the Russian healthcare system achieved through the implementation of PPP projects. Secondly, about the existence of tripartite opportunities for the development of healthcare based on PPP, identified through the use of a combined approach that combines the interests of stakeholders (a stakeholder approach) and a targeted orientation towards human development (a person-centered approach). Along with this, it is emphasized that there are a number of limitations that hinder the effective implementation of these capabilities. This implies the importance of implementing a number of practical measures, in particular: the development and implementation of a federal model and uniform standards for the implementation of PPP in healthcare at the regional level; assistance from the federal budget to the regions for the implementation of capital-intensive projects in healthcare; development and application of economically sound ways to return investments by generating income from the guaranteed volume of the customer base and the tariff of compulsory medical insurance. The methodological basis of the article is the general scientific method of dialectical cognition of economic and financial phenomena in their interrelation and interdependence. The methods of analysis, synthesis, expert evaluation and others are used in the work. The materials presented in the article can be used in decision-making in the Russian healthcare system in order to ensure its sustainable development using the PPP.

Health managers: insurance representatives in medical organizations

Many citizens are still not sufficiently informed about their rights in the field of obtaining medical care under compulsory medical insurance. The SOGAZ-Med insurance representatives, the employees of the insurance medical organization with special training who represent the interests and provide individual support in the provision of medical care guaranteed by law, will be able to help them.

The problems of realization of the patient’s right to choose a medical organization and the doctor in contracts for the provision of medical services according to programs of compulsory and voluntary medical insurance

The article analyses the current legislation and law enforcement practice on patient’s right to choose a medical organization and to choose a doctor under contracts for the provision of paid medical services in the sphere of voluntary health insurance. The efficiency of the realization of patient’s right to health protection and medical care largely depends on the opportunity to properly use the right to choose a doctor and medical organization. The norms of the federal law regulate the procedure for choosing a doctor and a medical organization only when providing medical care to a patient under the program of state guarantees of free provision of medical care to patients. Therefore, when exercising the right to choose a medical organization and a doctor under contracts for the provision of paid medical services within the framework of compulsory medical insurance and within the framework of voluntary medical insurance, patients may encounter practical problems. When providing paid medical services under voluntary health insurance programs, the patient according to the rules has the right to choose a doctor, taking into account his consent. The service of choosing a doctor under contracts for the provision of paid medical services is considered as an additional service.

Финансовое обеспечение системы обязательного медицинского страхования в 2022 году

The most important factor affecting the amount and methods of financial support of the compulsory medical insurance system, as in the last two years, continues to be the spread of coronavirus infection COVID‑19. In the proposed paper discusses not only the indicators of the budget of the Federal compulsory medical insurance Fund, but the dynamics of indicators, including, in comparison with the rate of inflation, and other factors. New directions of the use of compulsory medical insurance funds are identified, the reasons for their appearance are considered.

Features of the Hospitalized Incidence and Prevalence of Pediatric and Adolescent Endocrine Disorders in the Orenburg Region

Background: The incidence of endocrine diseases, eating and metabolic disorders has been increasing recently. The prevalence and structure of pediatric and adolescent endocrine disorders are significantly different from those in adults and have specific regional features. Objective: To study the frequency, structure, and long-term changes in the rates of hospitalization of the child population for diseases of the endocrine system in the Orenburg Region and to assess local features of disease incidence and prevalence. Materials and methods: We analyzed data on all pediatric cases (aged 0–18) of hospital care for endocrine disorders provided by the regional office of the Federal Compulsory Medical Insurance Fund for 2016–2020. We also applied the Ward’s hierarchical clustering method to establish local peculiarities and to group municipalities by the rates and dynamics of endocrine diseases in children. Results: The average rate of hospitalization for endocrine disorders was 3.8 cases per 1,000 children and accounted for almost 3.9 % of all types of hospital care. The proportion of inpatients among children aged 0 to 14 years was higher than that among adolescents. Metabolic disorders (34.0 %), insulin-dependent diabetes mellitus (22.3 %), hypofunction and other pituitary disorders (12.6 %), obesity and other types of overnutrition (7.1 %), and undernutrition (5.7 %) prevailed in all hospitalized children. The patterns of pediatric and adolescent inpatients differed significantly. The analysis of the prevalence of endocrine disorders in children and its long-term changes enabled clustering of the territories of the Orenburg Region.Conclusions: Three distinct clusters of territories were established in the analysis of local rates of endocrine diseases in children. The first cluster was characterized by moderate disease rates, while the second and the third clusters demonstrated high and low incidence and prevalence rates of pediatric and adolescent endocrine disorders.

ASSESSMENT OF THE EFFECTIVENESS OF MANAGEMENT OF THE ACTIVITIES OF A MEDICAL ORGANIZATION TO REDUCE MORTALITY FROM DISEASES OF THE CIRCULATORY SYSTEM BASED ON THE ANALYSIS OF DATA ON THE ACTIVITIES OF MEDICAL ORGANIZATIONS OF THE SVERDLOVSK REGION FOR THE PERIOD 2018-2020

The purpose. It is advisable to assess the effectiveness of the activities of a large number of medical organizations with varying degrees of achievement of target indicators by ranking by the totality of achieving several indicators based on a multivariate analysis. Materials and methods. The regulatory legal acts of the Russian Federation and the Sverdlovsk region regulating the provision of medical care to patients with cardiovascular diseases were studied. The data of official forms of statistical observation and information on medical care provided to insured citizens of the Sverdlovsk region within the framework of compulsory medical insurance are analyzed. In the process of working with information, a calculation methodology was developed and for the first time applied to form a rating of medical organizations that provide medical care in the profile of cardiology in outpatient and inpatient settings, taking into account the magnitude of deviations from the target values for five groups of indicators, using the principles of the point ranking method. Outcomes. In the course of the work, a list of key indicators for assessing the effectiveness and efficiency of medical organizations in the profile of cardiology was determined, the relationships between these indicators were established, ratings of medical organizations were formed according to the degree of achievement of target indicators in the chosen direction. As a result of the ranking, lists of medical organizations of the Sverdlovsk region have been identified, which may be subject to further thematic audit and in-depth study of both positive and negative of their experience in organizing processes in this area. Conclusion. Assessments of the effectiveness of the activities of a large number of medical organizations with varying degrees of achievement of target indicators are carried out by ranking by the totality of achieving several indicators based on a multivariate analysis.

Features of Determination of Criminal Behavior of Doctors in Providing Services in Compulsory Health Insurance

The reasons and conditions for committing crimes in the field of compulsory medical insurance, committed by special subjects in the process of medical examination of citizens, are investigated. An attempt has been made to correlate the set of determinants and subsequent consequences of these crimes for the sphere of compulsory medical insurance. The materials of criminal cases on the fact of fraud, forgery, abuse of authority committed in the process of medical examination of the population are analyzed. Based on the results of scientific analysis, an assumption was made that the organizational and material dependence of a doctor on an employer – a medical organization, is one of the main factors that determine the basis of the criminal behavior of an individual in this area of public relations. The role of selfish motive is estimated. An analysis of the legal status of a doctor under Russian law (in terms of studying the conditions for committing a crime) showed that a doctor, first of all, has a special legal and labor status, hence the dependence of his medical actions on disciplinary pressure from the employer. The analysis of specific ways of protecting the rights of Russian health care doctors in the system of crime prevention in the field of compulsory medical insurance has been carried out.