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ПРИЛОЖЕНИЕ
ления для критичных БП: БП7 - удельный вес пациентов в ремиссии (от 1 до 3 лет) - не менее 40% пролеченных; БП9 - удельный вес удовлетворенных пациентов (готовых воспроизвести услугу) -не менее 85%; БП13 - коэффициент качества оказания медицинской помощи не менее 0,95.
Заключение. Операционализация стратегии консультативно-диагностического подразделения позволяет оптимизировать деятельность, а также повысить эффективность управления в медицинской организации.
Zwinkels D.P.
The effect of customs on medical equipment pricing
NHTV Breda University of Applied Sciences, Netherlands
Medical equipment is one of the most important parts of treatments of any form however due to the price their accessibility is reduced making treatments possibly to expensive which leads to choosing cheaper equipment lowering the treatment quality. This text shows how customs authorities influences the price of medical equipment and how this can be reduced by using ways such as FTA's.
Where would the world be without microscopes, MRI scanners and other medical equipment? Understanding the importance of the equipment doctors and specialists use in their ever lasting endeavor to heal the injured is without a doubt engraved in everyone's mind who has been in a hospital. Few however, realise how expensive this equipment is and why they are so expensive. The intention of this work is to show how the importation of medical equipment makes medical equipment needlessly more expensive. Medical equipment in Russia is mostly imported from other regions, this results into the need for the equipment to pass customs and pay tariff. Customs is an authority, with multiple responsibilities which can be divided in two categories: fiscal and non-fiscal. The fiscal tasks of the customs authorities all over the world can be described as the collection of tariffs as well as the handling of export documents. Tariff is the collective name of Value Added Tax (VAT), customs duty and excises. The non-fiscal tasks include the controlling of the flow of goods, which means they check products on possible risks for national security, health, environment and economy. To explain how this works one should take of a normal product for instance a chair produced in Russia. If one is to buy a chair they have to pay VAT on top of the normal price of the chair, this is often included in the price for consumers. Businesses are different, they pay for the chair including the VAT and can reclaim, official term is deduct, the VAT they paid from the government this saves them up to 18% of the price. If this chair would be imported from Europe one has to pay this VAT as well as duty which is often around 15%, in this case the VAT can be deducted however the duty cannot. This means that a chair produced in Russia is at least 15% cheaper when not taking into account the process of importation and transportation which again adds a possible fee. Medical equipment is a bit different, one has to know that every product has a different VAT and duty rate which, in Russia, can either be 0%, 10% or 18% for VAT whereas duty rates vary from 0% until 20%. It would take several pages to list the specific rules and how these rates are determined, if one is interested they could research commodity codes and tariff rates themselves which are publicly available on the internet. The most important piece of information is that these extra costs of VAT and duty can be bypassed. This bypassing is the key element which could greatly improve the availability and affordability of medical equipment in Russia. One should know that several pieces of equipment are exempt from the initial import VAT by the russian government and that VAT generally is no problem for businesses as they can deduct it, this could at most result into a cash flow problem as the amount is most of the time paid back in a month of two. Duty is different, as aforementioned it cannot be deducted thus will increase the price of the equipment by generally 5-15%. This might sound low but if a hospital were to buy 20 pieces of equipment each being $40.000 the worst case scenario would be that it would cost
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Журнал для непрерывного медицинского образования
ТЕЗИСЫ IV МЕЖДУНАРОДНОЙ КОНФЕРЕНЦИИ «ОРГЗДРАВ-2016. ЭФФЕКТИВНОЕ УПРАВЛЕНИЕ МЕДИЦИНСКОЙ ОРГАНИЗАЦИЕЙ» (26-27 МАЯ 2016 г., МОСКВА)
$120.000 on import duties. The fact remains however, that this duty payment can be avoided or reduced in several ways. The three most well-known are: suspensions, free trade agreements (FTA) and goods of preferential origin. Suspensions are the (partial) suspension of duties on certain goods. Examples include military goods or products which are not available in Russia. Free trade agreement are agreements with Russia about free trade between countries. Furthermore, these agreements are about the reduction or total abolition of import duty for all products unless otherwise noted. And finally preferential origin: Goods with a preferential origin benefit from trade agreements between countries. Heavy criteria are to be met for a good to be preferential. Requiring that a product is wholly obtained or processed enough in one country. If a good is preferential it can be imported at a reduced or zero duty rate These three methods are the general ways duty can be reduced or avoided. Out of these possibilities FTA's are the most common and reliable option. In the current period Russia only has a few FTA's with few countries such as Armenia, Serbia and the Kyrgyz Republic but is in negotiation with the EU and New Zealand. If this FTA was to come in effect the duty rate for medical equipment imported from these countries is sure to be reduced to possibly 0%. To conclude this text it should be said that in the current market it is impossible to get the rates to 0% which would create more accessible medical treatments for people. However in the coming years if Russia were to follow through with the negotiations it would surely open up possibilities for hospitals to get new equipment at a better price increasing the quality of treatments.
ОРГЗДРАВ: новости, мнения, обучение №2 2016
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