Clinics are grabbing for ultrasound

Operators of private clinics have asked the federal government to cancel the restrictions imposed by the Ministry of Health since the beginning of this year on the use of compulsory medical insurance funds (CHI) to pay for the leasing of medical equipment. State medical institutions will also suffer from the new rules. The ministry makes it clear that in this way they are trying to stop the practice of unreasonably overstating the cost of rented equipment. However, market participants believe that the restrictions are contrary to the order of the President of the country, who demanded to increase the volume of leasing in public procurement.

As it became known to Kommersant, private clinics are asked to cancel the restrictions imposed by the Ministry of Health on January 10 this year on covering leasing payments for medical equipment at the expense of compulsory medical insurance. President of the National Association of Non-State Medical Organizations (NANMO; unites private clinics) Ilya Shilkrot sent a letter with this content to Prime Minister Mikhail Mishustin. Kommersant has a copy of the document.

On December 13, 2022, the Ministry of Health amended the compulsory medical insurance rules, according to which annual payments for the rental of medical equipment at the expense of compulsory medical insurance, which were previously not limited in any way, should now be no more than 1 million rubles. per unit of equipment, if organizations do not have accounts payable, and not more than 100 thousand rubles, if any. The new rules apply not only to private clinics that accept patients with compulsory medical insurance policies, but also to state medical institutions. In addition to the funds received under compulsory health insurance, private clinics can cover the leasing of equipment at their own expense, while state clinics can request funds from regional and federal budgets.

NANMO informs Mikhail Mishustin that the restrictions imposed by the Ministry of Health “contradict the provisions of Federal Law No. 326-FZ (“On Compulsory Medical Insurance.”—”Kommersant“)” and the ministry “exceeded its powers.” The prime minister’s office told Kommersant that the NANMO letter had been redirected to the Ministry of Health. The ministry told Kommersant that the measure “will make it possible to spend MHI funds more efficiently.” They added that in a number of regions the authorities “remove themselves from providing hospitals with equipment at the expense of budgetary funds”, leaving it to the heads of medical organizations, who “unreasonably overestimate the cost of rent”.

At the same time, according to the calculations of the analytical center Vademecum, it is the state clinics that have a large volume of medical equipment leasing. In 2020, a total of 4.09 billion rubles was spent for these purposes, in 2021 – 6.2 billion rubles. The decline was observed only in 2022 – up to 4.5 billion rubles. The largest number of orders for equipment leasing in 2022 was observed in the Kaliningrad (by 551 million rubles) and Kemerovo (242 million rubles) regions. The health ministries of these regions did not respond to Kommersant’s requests.

According to Valentina Sokolova, sales director of Leasing-Medicine LLC, the volume of compulsory medical insurance funds in leasing payments of state clinics is significant. Now they are forced to cut back on equipment upgrades, as “budgetary funds for this, most likely, will not be enough,” Ms. Sokolova notes. According to her calculations, taking into account the current interest on leasing and the restrictions imposed by the Ministry of Health, medical institutions will no longer be able to rent equipment for more than 3 million rubles at the expense of compulsory medical insurance, and these are ultrasound machines, sterilizers and laboratory systems.

In terms of heavy and expensive equipment, for which high lease payments, private medical institutions will suffer more, said the chairman of the board of the Medical Institute. S. M. Berezina (MIBS) Arkady Stolpner. MIBS leases MRI, CT, PET machines, the cost of which exceeds 50 million rubles. Medicina JSC reported that they recently leased equipment for more than $92 million for a new oncology center in Khimki with a significant share of coverage from compulsory medical insurance. Vladislav Sherstoboev, General Director of the network of medical centers “Expert”, notes that the company for three years out of a total investment of 4 billion rubles. only a twentieth part was directed to equipment leasing. Nevertheless, he sees in the actions of the Ministry of Health another attempt to “force private clinics out of the compulsory medical insurance segment.”

Restrictions on the rental of medical equipment will complicate its renewal in private and public clinics, especially against the backdrop of sanctions and higher equipment prices, which can lead to a deterioration in the quality of medical care, experts interviewed by Kommersant believe. They say that the new rules contradict the statements of Vladimir Putin, who instructed to expand the use of medical equipment leasing in 2020, especially in public procurement. Now a number of clinics interviewed by Kommersant fear that the restrictions will affect equipment already leased and it will have to be returned to lessors. But the Moscow Health Department assured Kommersant that contracts concluded before January 10, before the new rules come into force, are not subject to restrictions.

Olga August