Strengthening medical rehabilitation services in health system: a situation analysis

Abstract

Objective: to evaluate the effectiveness of changes in the legal framework that regulates medical rehabilitation (MR) in the Russian Federation.Material and methods. We analyzed the valid Order of the Ministry of Health of the Russian Federation of June 31, 2020 No. 788n “Organization of medical rehabilitation of adults”, which came into legal power on January 1, 2021. It was proposed for public discussion on the introduction of amendments (project of amendments). The changes proposed in the project were compared with the original text of the document. Besides, other legal documents on the organization of medical rehabilitation were analyzed.Results. Order No. 788n regulates the stages of MR, specifies the formation and realization of an individual plan for a multi-disciplinary rehabilitation team based on the evaluation by Rehabilitation Routing Scale. The document includes in-house protocols of profile inpatient and outpatient departments of medical institutions, standards for doctor’s offices equipment, organization of day-time inpatient department, and regulations for MR centers. The project of amendments contains a variant of involvement of the existing additional Groups 1 and 2 medical divisions for the organization of MR, and limitation for the Stage 2 of MR in inpatient settings, which is now possible only for patients who need 24-hour care.Conclusion. The proposed changes have evolutionary character. A lot of issues in the regulatory framework of MR remain unsolved. It is necessary to improve the state policy for MR and perform further clinical studies of its benefits.

Keywords

• medical rehabilitation
• legal framework
• stages of medical rehabilitation
• routing of patients
• personalized program of complex rehabilitation