"There's no need to escalate the situation": private medical centers intend to remain in compulsory health insurance.

      The Ministry of Health of the Russian Federation has tightened the inclusion of commercial clinics in the register of participants in compulsory health insurance (CHI) seeking budget funding.

      Photo: Dmitry Reznov

      Private medical centers in Tatarstan participating in the territorial CHI program worth 80 billion rubles are alarmed by federal legislative innovations. In the fall, the competition commission of the Ministry of Health of Tatarstan may refuse to include them in the CHI for 2027 if it believes that state clinics and hospitals can provide the services. The redistribution may affect residents of the Novosavinovsky and Aviastroitelny districts of Kazan — residents of the latter are cautiously being offered to attach themselves to state institutions. "If a clinic has the resources to provide qualified medical care, what difference does it make whether it is private or state? On the contrary, we should strive to use the resources of the entire healthcare infrastructure of the republic so that assistance is provided in a timely manner," believes the owner of the "Zvezda" network, Arthur Urazmanov. However, the CHI fund promises to manage without global upheavals and to resolve complex issues by September 1 of this year.

      Are private medical centers in a hurry to submit applications?

      The Compulsory Health Insurance Fund of Tatarstan has announced the start of accepting applications from medical institutions for participation in the regional CHI program for 2027. According to the regulations, any medical institution, regardless of ownership, can notify its desire to provide services within the framework of the state assignment, after which it is included in the fund's register, and then the volumes of medical assistance funded from the CHI budget are distributed on a competitive basis among the applicants. Municipal and state organizations must submit notifications by September 1, while private ones can do so from July 1 to September 1. If in previous years the selection among private centers was quite smooth and calm, this time they risk facing significant cuts in limits in favor of state medicine.

      Dinar Fatyhov / realnoevremya.ru

      Private medical centers in Kazan and the residents attached to them are seriously concerned about the threat of redistribution of CHI volumes. Fears about forced transfers from private clinics to state ones have arisen among residents of the Aviastroitelny district, who are served by the LLC "Consultative Diagnostic Center of the Aviastroitelny District." Within the framework of the republican CHI program, the private center provides primary medical care (therapist consultations, referrals to specialists, health screenings, vaccinations, etc.). According to official data, the center serves about 20,000 residents of the microdistrict. Most of them work at the Kazan Aircraft Plant named after Gorbunov.

      Dinar Fatyhov / realnoevremya.ru

      The population of Aviastroya is worried about the information that the management of the CDC of the Aviastroitelny District allegedly does not plan to submit an application for participation in the CHI program for 2027, and insured residents will supposedly be offered in the fall to transfer to GAUZ "City Hospital No. 11" or GAUZ "City Clinical Hospital No. 12." If this were confirmed, they would indeed have to choose a new place of attachment. "Currently, no application has been received from the CDC of the Aviastroitelny District," the republican CHI fund told "Real Time."

      A similar situation may unfold in the Novosavinovsky district of Kazan. The "Consultative Diagnostic Center on Chetayeva," owned by the same private owner, has also not yet submitted an application to the CHI fund for inclusion in the register. The private center serves 12,000 residents of the microdistrict. Theoretically, they could switch to service at City Hospital No. 7.

      "CDC on Chetayeva": "We are working, and we will continue to work next year."

      The "Consultative Diagnostic Center on Chetayeva" is preparing an application for participation in the territorial CHI program for 2027. The center's director, Rustem Shaidullin, denied rumors about a reluctance to participate in the CHI. He called the talks that residents of the Novosavinovsky district would allegedly have to switch from a private center to a state clinic "unfounded gossip." "There is no need to escalate the situation. We are working, and we will continue to work next year," he assured.

      According to the director, the application preparation process is proceeding normally. The clinic has long been operating within the CHI system and fully complies with the requirements of the Ministry of Health of Tatarstan and the Health Department of Kazan.

      Mikhail Zakharov / realnoevremya.ru

      "We do not see difficulties in preparing the application, as we strictly follow all the guidelines and orders of the relevant authorities," Shaidullin noted. "Every year we submit an application to the republican CHI fund. They check our licenses, staffing, equipment, and then allocate a quota for the provision of services under CHI."

      The center's director hopes that the volume of state funding in 2027 will remain at the level of previous years. After all, the basic principle of CHI is "money follows the patient," and attached residents do not switch to other clinics. "Hypothetically, a reduction (in quota) is possible," he reflects. "But in previous years, the volumes of medical assistance did not change, as they directly depend on the number of attached residents." In any case, there is time until September 1, and the centers intend to submit applications.

      Residents of Aviastroya do not want to return to hospitals with queues.

      However, he does not rule out that surprises may occur in the distribution of CHI volumes. "If we are told that we do not meet the requirements, then we will switch to providing purely paid services. And it will be a private clinic," he summarized.

      Residents attached to the private CDC are not happy with either the prospect of transferring under the wing of state clinics or paid services. They currently receive medical assistance in comfortable conditions. In the Aviastroitelny district, the owner of the CDC built a modern clinic building, equipped it with high-tech diagnostic equipment, and regulated patient flows. There are almost no crowds of patients "storming" the doctors' offices, residents report. "We do not want to exchange a spacious clinic for an outdated hospital with long queues and overworked, tired doctors," they say.

      Screenshot from Yandex Maps

      What caused the upheaval in the distribution system of medical assistance under CHI? As explained by the Territorial CHI Fund of Tatarstan, the transformations are related to legislative changes. The State Duma approved amendments to law No. 326-FZ "On Compulsory Medical Insurance in the Russian Federation" at the end of July this year. Their essence boils down to tightening the conditions for including private medical organizations in the regional CHI system. This year, private clinics, along with state and municipal ones, can submit notifications of their desire to join the register of CHI participants, but getting into it does not guarantee the provision of the previous volume of funding.

      The scale will be determined by the regional commission for the development of the territorial CHI program, based on the needs of the population, the clinic's license, staffing, and technical equipment. However, the amendments to the law have not yet come into force: they must be approved by the Federation Council, then signed by the president, and officially published, as previously reported by specialized media. The Ministry of Health of the Russian Federation has developed mandatory requirements for private organizations.

      Requirements for private medical organizations:

      - Availability of a license.

      - Informational openness: the presence of an official website indicating types of activities, work experience, reception schedule, and conditions for providing medical assistance.

      - Work experience: at least three years in the market (for organizations applying for the first time).

      - Reputation: absence of violations regarding volumes, deadlines, quality, and conditions of assistance under CHI in the last two years (for those who have already participated in the state guarantees program).

      Those providing specialized, including high-tech medical assistance in inpatient and day hospital settings must prove the provision of services in a volume of at least 150 cases for the reporting year or 300 cases over three years. If these requirements are followed, most private clinics should remain in the CHI, creating competition for state institutions.

      "Razumed": There is still time until September 1.

      Nevertheless, most private medical clinics are concerned about receiving previous volumes under CHI. According to the director of the "Razumed" network of centers, Olga Afanasyeva, the CHI program annually increases in volume, but the presence of private business in it does not grow.

      "Private entities are not given much, and now they say they will give nothing at all," she worries, adding that the network is currently preparing an application for 2027 but has not submitted it yet — "There is still time until September 1."

      "Razumed" performs surgical operations under CHI in proctology, oncology, urology, and gynecology. This year, the network has completed its annual assignment. The company is ready to handle large volumes in the field of gynecology, which is in growing demand among women of different ages.

      Ruslan Ishmukhametov / realnoevremya.ru

      The redistribution of CHI volumes in favor of state clinics is associated with significant investments in their modernization and re-equipment. At the same time, private entities see their niche in providing treatment and surgeries under CH