Medical firmware: the property of state clinics will be banned from renting
Private businesses will be prohibited from renting space and equipment from medical state institutions that operate in vital fields (oncology, surgery, infectious diseases) and are the only ones in their municipality. The relevant amendments to the draft law on public-private partnership (PPP) were approved by the Cabinet of Ministers. The initiative is designed to eliminate scenarios in which residents of entire districts may be left without help due to a change in the management of the facility. See the Izvestia article about how the innovation will affect investors.
Where it will be forbidden to rent medical equipment
The rental of property of state medical institutions will become partially inaccessible to private companies. Such amendments to the draft law of the Ministry of Economic Development on Tuesday, February 24, were approved by the government commission on legislative activity. This was reported to Izvestia by sources in the Cabinet of Ministers.
The principle of PPP is based on business participation in the creation and management of infrastructure facilities, explained Sofya Lukinova, Head of the Legal Department at VMT Consult.
The changes will create a balanced mechanism for government and business cooperation in healthcare, said Vladimir Gruzdev, Chairman of the Board of the Russian Bar Association. Their main goal is to attract private investment in infrastructure while maintaining the availability and quality of medical care.
— An important innovation is the establishment of strict social guarantees, — said Vladimir Gruzdev. — The bill explicitly prohibits the transfer to private investors of the property of those medical institutions that are the only ones in the municipality in vital fields such as oncology, surgery or infectious diseases. This eliminates the risks that residents may be left without vital assistance due to a change in the management of the facility.
In addition, the document equalizes the requirements for public and private clinics operating under PPP agreements. Investors will be required to comply with all state standards for the provision of medical care and provide reports to the same extent as budget institutions, the Chairman of the Board of the AYR emphasized.
"The amendments also reduce the administrative burden on businesses," he added. — Now, approval with the Federal Antimonopoly Service will be required only for those changes in agreements that lead to an increase in budget expenditures. Previously, any changes to the terms had to be negotiated.
The date of entry into force of the law is proposed to be postponed to September 1, 2026, which will allow all market participants and authorities to adapt to the new legal conditions without prejudice to current projects, said Vladimir Gruzdev.
Why do we need a bill?
The amendments, developed on behalf of the Russian government, were approved by the State Duma in the first reading in December 2024. They are designed to eliminate the risks of Russians not receiving free medical care. The Russian Ministry of Health will evaluate and coordinate concession agreements and PPP agreements in the healthcare sector.
"The government will prepare a draft resolution that will approve the procedure for evaluation and approval, the specifics of PPP projects: the maximum amount of financial participation by the public side, the requirements for the provision of medical services by a private partner, and the conditions under which the concessionaire will be able to involve public medical organizations," Maxim Kolesnikov, First Deputy Minister of Economic Development of Russia, said in 2024.
According to him, these decisions will adjust the terms of agreements, due to which budget funds are inefficiently used, medical institutions are closed and the amount of free medical care available to citizens is reduced.
At a meeting of the State Duma Committee on Health Protection on October 30, 2024, it was explained: the materials of the Prosecutor General's Office became the reason for the development of the bill. The agency revealed violations in the implementation of single‑industry PPP projects in several regions at once.
One of the latest cases was the recovery of 38.2 million rubles in penalties from Seventh Concession Company LLC under the claim of the Ministry of Health of the Novosibirsk Region.
In 2019, the Ministry of Health of the Novosibirsk Region and Seventh Concession Company LLC (VIS Group of Companies) agreed to build seven polyclinics as part of a public-private partnership. The facilities were planned to open in 2022, and in 2023 they were supposed to start serving patients. The initial cost of construction was 6.5 billion rubles, but later it increased to 19.5 billion rubles. However, the commitments were never fulfilled.
What are the risks of PPP in medicine?
The bill under discussion will help to better control PPP projects in the field of medicine. He tightens the requirements for projects with state support, strengthens control over their implementation and introduces additional restrictions on the conclusion of agreements on such a mechanism, believes Sofya Lukinova.
"This is how the government reacts to the key problems of such projects — insufficient control over financial flows in the implementation of PPP projects and countering the monopolization of medical services," the expert noted. — Increased control will be manifested, in particular, through the introduction of a mandatory state reporting system "Management" and mandatory evaluation of the project by a relevant federal body.
However, according to her, there are also risks associated with restrictions. In particular, if the bill is approved, it will become even more difficult to conclude contracts, the implementation of such projects will be delayed, and their overall investment attractiveness will decrease.
The restrictions will also affect the medical equipment market.
— In projects that meet the requirements, investors, in order to return their invested funds as soon as possible, will prefer renting or leasing expensive medical equipment, — says Sofya Lukinova. — Also, participation in a PPP project imposes restrictions on budgets, including the purchase or rental of equipment.
Therefore, we can definitely talk about an increase in costs that will entail new requirements.
Alexey Starchenko, a medical lawyer, noted that there are situations when chief physicians can cooperate with private medical organizations that do not have the proper equipment. They rent out their own equipment to them, and then send some of the patients to be examined for a fee in order to speed up the process.
Nikolay Prokhorenko, an expert in the field of domestic healthcare, believes that the main focus of the initiative is to ensure that the state system of medical care is self-sufficient in each territory and does not depend on the private sector.
"Dependence on another organization is fraught with loss of self—sufficiency and can turn into a serious social problem," he said, and recalled a situation when, due to the actions of one of the partners, a Russian city was almost left without a purulent therapy unit — it was redeveloped. — But if you specify clear volumes in the lease agreement that should cover the need, then the risks can be avoided, the expert said.
In addition, Nikolay Prokhorenko noted, there are risks of equipment failure if insufficiently trained specialists work on it, and a private company does not have the funds for subsequent repairs.
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