Hospitals and clinics in Russia

Main article: Healthcare in Russia

• Antenatal clinics

2024: The Ministry of Health of the Russian Federation named the leading regions in terms of the volume of hospital debts

On July 2, 2024, the Ministry of Health of Russia presented data on payables of medical institutions in the regions of the country, identifying leaders in the volume of hospital debts. This information was announced during a meeting of the Federation Council Committee on Social Policy.

Deputy Minister of Health Volodymyr Zelenskyy said that as of April 1, 2024, the total volume of overdue payables of medical institutions decreased from 20 billion to 17 billion rubles. However, three regions are distinguished by especially large debts: the Magadan region, the Nizhny Novgorod region and the Republic of Karachay-Cherkessia.

𝓲

unsplash

Zelensky noted that in the Nizhny Novgorod region, overdue debt was formed mainly under the item of expenses for medicines, and not under the wage fund. The Ministry of Health, together with the regional government and the territorial compulsory medical insurance fund, are working to clarify the procedure for the purchase and consumption of medicines.

The situation in the Magadan region is of particular concern: the accounts payable of medical organizations exceeded 2.5 billion rubles. In relation to the regional hospital, enforcement proceedings were initiated to recover debts on taxes and fees in the amount of over 1 billion rubles, which led to the blocking of the clinic's accounts.

Despite the presence of problem regions, the Ministry of Health assesses the general situation with the debt of medical institutions as stable. As of May 1, 2024, almost 241 billion rubles were in the accounts of medical organizations, which is approximately a monthly reserve of funds.

True, there is a question with the uniformity of the distribution of funds among institutions. But the regions have the right to set coefficients that adjust tariffs in order to distribute funds evenly, "Zelensky explained.[1]

2023

In Russia, the number of beds in hospitals decreased by 20 thousand - to 1.14 million units

By the beginning of 2023, there were approximately 1.14 million inpatient beds in Russia. For comparison, a year earlier their number was 1.16 million. Thus, over the year, the fall amounted to about 20 thousand, as evidenced by the data of the Federal State Statistics Service (Rosstat), published in early January 2024.

It is noted that the number of beds in hospitals in the Russian Federation has been decreasing since 2008. So, in 2010, it was estimated at 1.34 million, while by 2015 it decreased to 1.22 million, and by 2019 - to 1.17 million. In 2020, a short-term increase was recorded - up to 1.19 million beds, which may be explained by the COVID-19 pandemic. But then the indicator again declined. In general, the number of beds decreased mainly due to a reduction in infectious capacity, as well as retired psychiatric, drug and tuberculosis beds.

in Russia there were approximately 1.14 million inpatient beds

The Rosstat data notes that out of 1.14 million inpatient beds at the beginning of 2023, approximately 248.5 thousand belong to the therapeutic profile, 217.6 thousand to the surgical profile. Another 47.3 thousand places are intended for cancer patients, 43.7 thousand - for gynecological. 61.6 thousand beds have been allocated for patients with tuberculosis. Approximately 72.9 thousand places are in infectious diseases departments. In addition, there are 128.4 thousand psychiatric beds, 20 thousand - narcological, 70.9 thousand - neurological. 52.3 thousand beds are provided for pregnant women, women in labor and maternity patients. The number of dermatovenereological sites is estimated at 10.3 thousand.

The study also says that by the beginning of 2023, out of the total number of beds for children, 149.6 thousand are accounted for. For 10,000 people of the population there are 78 places in hospitals. For comparison: a year earlier, this figure was 79.1, and in 2010 - 93.8.^[2]

Mishustin allocated 168.2 billion rubles for medical facilities in 15 Far Eastern cities

At the end of December 2023, Prime Minister Mikhail Mishustin approved long-term plans for the integrated socio-economic development of 16 Far Eastern cities until 2030. Among other things, the documents say about the allocation of 168.2 billion rubles for the construction of medical institutions.

Nine facilities will be built in Yakutia - the Republican Infectious Diseases Clinical Hospital with 250 beds (worth 8.9 billion rubles), a neuropsychiatric dispensary with 620 beds (4.4 billion rubles), inpatient emergency department with the burn center of the Republican Hospital No. 2 (1 billion rubles), polyclinic building No. 1 (3 billion rubles), building for the Center for the Prevention and Control of AIDS, Yakutsk Republican Narcological Dispensary (2.8 billion rubles), Interregional rehabilitation center with 130 beds (2.3 billion rubles), geriatric center of clinical hospital No. 3 (888 million rubles), a building for the Republican Bureau of Forensic Medical Examination (595.7 million rubles). In addition, the government will allocate 5.1 billion rubles for the technical re-equipment of the Yakutsk Republican Hospital No. 1. 2.5 billion rubles will be allocated for the construction of the Polyarnaya Zvezda children's sanatorium.

The government allocates 168.2 billion rubles for the construction of medical institutions in Yakutia

4 billion rubles were allocated for the modernization of infrastructure, overhaul, technical re-equipment and reconstruction of three facilities of the Neryungrinsky Central Regional Hospital in Yakutia, of which 541.1 million rubles - for overhaul and new equipment for an adult clinic, 1.1 billion rubles - for block A of the medical building, 336.9 million rubles - for block B, 155.1 million rubles - for the infectious diseases department No. 1, 188.3 million rubles - for the ambulance department, 14.2 million rubles - for the pathological and anatomical department. Also, part of the funds will go to the modernization of the catering unit (26.9 million rubles), the narcological dispensary (107 million rubles), the obstetric building (356.1 million rubles), the neuropsychiatric dispensary (96 million rubles), the TB dispensary (107.9 million rubles). The buildings of the antenatal clinic (209.4 million rubles), block B of the hospital complex (302.4 million rubles), a skin and venereological dispensary (456.7 million rubles) will be reconstructed.

Government of the Russian Federation Order of December 29, 2023 No. 4073-r

Private clinics in Russia were obliged to transfer information about patients to military registration and enlistment offices

Private clinics operating in Russia will have to transfer information about patients to military registration and enlistment offices, in the future this information will be used to form a single register of conscripts. About this in early October 2023, the head of the State Duma Committee on Defense Andrei Kartapolov.

Information about people will also be collected for military registration and enlistment offices, and Tax Service Rosobrnadzor MINISTRY OF INTERNAL AFFAIRS employers.

Private clinics will have to transfer information about patients to military registration and enlistment offices

Military registration and enlistment offices will have the opportunity to know exactly what status this or that conscript is - whether he works or not, and if he works, then where, where he is registered, whether he has any serious diseases, "Kartapolov explained in an interview with Parlamentskaya Gazeta.

According to him, the innovation will help, on the one hand, to remove the extra load from the military registration and enlistment offices, since they will not have to independently engage in updating data, on the other hand, to avoid misunderstandings when presenting summons.

This is necessary in order for a person not to pull once again, so that he does not think about whether to go to the military registration and enlistment office or not, and if you go, what documents to take with you, "the parliamentarian said.

Kartapolov also called the purpose of creating a single register of conscripts the convenience of the citizens themselves, so that "a person does not pull once again, so that he does not think about whether to go to the military registration and enlistment office or not, and if you go, what documents to take with you."

According to him, the register should start working in full no earlier than 2025. The Ministry of Digital Development of Digital Science in September 2023 also announced that the Unified Register of Military Registration will work fully from 2025. At the same time, the department plans to launch a pilot system in one or two regions of Russia by the end of 2023. A unified register of military prisoners is necessary to systematize information about Russians who are registered with the military, as well as the ability to update data on them online, the Ministry of Digital Development explained.^[3]

Rosstat reported the loss of a third of medical organizations in the Russian Federation

In Russia, there are 36.4% of unprofitable medical organizations. Rosstat announced this in its study for January-May 2023. The document was published in early August 2023.

According to the "Medical Bulletin" with reference to the materials of Rosstat, the total profit of Russian medical institutions in the first five months of 2023 reached 35.8 billion rubles, losses - 11.7 billion rubles. The profit and loss balance shows a 124.9% increase over the same period in 2022.

36.4% of medical organizations in Russia are unprofitable

It also follows from the Rosstat report that the volume of paid medical services to the population amounted to about 112.2 billion rubles in June 2023, which did not much exceed the indicators of the same period of the previous year. In total, for the first half of 2023, the population paid 639.8 billion rubles for medicine.

According to the draft budget, government spending on health care from all sources will increase in 2023 compared to 2022 at current prices by 4% (211 billion rubles). In 2019 constant prices, they will decrease by 2%, provided that inflation does not exceed 6%.

From autumn in Russia, some medical services will become paid, primarily for a number of types of emergency care. Irina Gritsenko, medical lawyer of the Legal Policy Bar Association, told the Prime agency about this. The expert refers to the decree of the Russian government No. 736, which comes into force on September 1, 2023 and is valid until September 1, 2026.

According to the document, now citizens will be able to charge money for emergency medical care for sudden acute diseases and exacerbation of chronic diseases if it does not threaten the patient's life. In addition, the decree approves a paid examination and hospitalization not as prescribed by the doctor, but at the request of the patient. Gritsenko explains that if a citizen asks a therapist to appoint him a study from a narrow specialist, and the doctor does not see the indications for this, the patient will have to pay for the service.^[4]

Mishustin ordered to equip medical institutions with automatic power outage devices during a short circuit

At the end of March 2023, Prime Minister Mikhail Mishustin signed a decree according to which social institutions in Russia will be gradually equipped with arc breakdown protection devices - automatic power outage devices in the event of sparking in the power grid.

The document approved by the head of the Government of the Russian Federation makes appropriate changes to the rules of the fire regime. Devices for protection against arc breakdown will appear in hospitals and clinics, kindergartens and schools, boarding schools and nursing homes after major repairs or reconstruction. In addition, the equipment will necessarily be installed during the construction of buildings for social institutions. This will reduce the risks of fires due to malfunction of electrical equipment and wiring, the Cabinet said in a statement.

Russian Prime Minister Mikhail Mishustin

The decree will come into force on March 1, 2024. In the facilities introduced before this date, additional equipment will be installed during reconstruction or overhaul. In state medical institutions, such equipment will be installed at the expense of budget trenches, and private clinics will have to introduce devices at their own expense.

Mikhail Mishustin instructed the Ministry of Emergencies and the Ministry of Economic Development to ensure amendments to the rules of the fire regime, providing for the mandatory use of arc breakdown protection devices in electrical installations of buildings and structures located at socially significant facilities, following his working trip to the Voronezh region in January 2022.

According to statistics from the Ministry of Emergency Situations, 63% of all fires at facilities arise due to violation of the rules for the design and operation of electrical installations. The implementation of the initiative will cost almost 80 billion rubles, of which 75 billion rubles were allocated from the budget.

Government of the Russian Federation Resolution of March 30, 2023 No. 510

The first "SOGAZ-Polyclinic" is open in Moscow

The first SOGAZ-Polyclinic began work in Moscow. The medical center is located on Malaya Polyanka Street, 2. This was announced by the Gas Industry Insurance Society (SOGAZ) on March 30, 2023. Read more here.

A 7-story clinic was built in the north of Moscow, which will serve 750 patients a day

At the end of January 2023, the construction of a new adult polyclinic in the Dmitrovsky district of Moscow was completed. The 7-story building is located at: Dmitrovskoye shosse, house 107. The medical institution will accept the first patients in March 2023. Read more here.

3 new children's clinics opened in Moscow

In January 2023, 3 new children's clinics were opened in Moscow. According to the mayor of the capital, Sergei Sobyanin, in the Beskudnikovsky district, the first patients began to be admitted to the new building of the children's polyclinic in Rogachevsky Lane, and in two institutions - branch No. 1 of PDH No. 48 in Kuzminki and branch No. 3 of PDH No. 125 in Bibirevo - the reconstruction was completed. Read more here.

2022

76.3% of polyclinics in Russia received additional funds for effective work

In 2022, three of the four polyclinics received additional funds for effective work. On average, they were paid 5.6 million rubles from the Compulsory Medical Insurance Fund. This was announced by the Federal Compulsory Medical Insurance Fund in mid-June 2023 at the event "Compulsory Medical Insurance in the Russian Federation."

According to Olga Tsareva, deputy chairman of the Federal Compulsory Medical Insurance Fund (MHIF), in just 2022, territorial compulsory medical insurance funds (TFCMI) provided medical organizations with an additional 10.8 billion rubles, 76.3% of clinics received stimulating funds. An additional 5.6 million rubles were transferred to each medical organization that completed more than 60% of the indicators.

Three out of four clinics received additional funds for effective work

The total volume of incentive payments sent to medical organizations in accordance with the established methodology amounted to 10.8 billion rubles in 82 constituent entities of the Russian Federation (with the exception of Moscow, the Republic of North Ossetia - Alania, the Chechen Republic), which is about 2.3% of the total amount of funds received by medical organizations of these constituent entities of the Russian Federation for soulful financing, or about 1.3% of the amount of funds planned to pay for medical care on an outpatient basis:

• Medical organizations that fell into Group I at the end of the year - 0.03 billion rubles (0.3%);
• Group II medical organizations - 3.9 billion rubles (36.3%);
• Medical organizations of the III group - 6.8 billion rubles (63.4%).

According to Nikita Veselov, head of the tariffs department of the Department for the Modernization of the Compulsory Medical Insurance System, thus, the implementation of the methodology makes it possible to ensure the direction of incentive payments in a larger amount to medical organizations that fulfill a larger number of performance indicators. Medical institutions receive funds if they have completed a minimum of 40% of 28 indicators. Funds for bonuses are added to the amount of per capita funding for the institution for the attached population.

According to the MHIF, the increase in the level of insurance premiums and the adoption of the law on insurance premiums for compulsory medical insurance of the non-working population provided financial guarantees to equalize the conditions and volumes of medical care in the constituent entities of Russia. This ensured, among other things, the annual growth of the subvention: if in 2013 it amounted to 985 billion rubles, then in 2023 it is already 2.7 trillion rubles. For 2022, the basic compulsory medical insurance program is already more than 90% of the total amount of medical care under the state guarantee program and more than 70% of its financial support.^[5]

In Moscow, a children's and adult clinic was built, designed for 750 visitors per shift

On December 21, 2022, it became known about the completion of the construction of an adult clinic in Sviblov (northeast of Moscow). It is located on Urzhumskaya Street and has become the largest polyclinic in the area. Read more here.

The number of hospital beds in Russia for the year decreased by 26.7 thousand.

By the end of 2021, there were 1.16 million hospital beds in Russia, which is 26.7 thousand less than a year earlier. Such data in December 2022 was published by Rosstat.

According to the statistics of the department, despite the general decline in places, there are more beds of therapeutic, surgical, gynecological and neurological profiles. The provision of beds for pregnant women, for patients with cancer, ophthalmological diseases has almost not changed. A significant decrease - by 54.7 thousand beds in 2021 - in the infectious diseases network is explained by the change in the nature of the course of COVID-19 to mainly outpatient, but 166.1 thousand beds remained for the treatment of infections, which is significantly higher than the "pre-pandemic" (COVID-19 coronavirus pandemic) indicator of 58.5 thousand beds.

Dynamics of the number of hospital beds in federal districts in 2020 - 2021, thousand beds

The strongest reduction in the number of hospital beds in Russia in 2021 occurred in the central federal district - by almost 20 thousand. In the capital region, the number of beds decreased by 10.4 thousand (-11%). The number of beds of infectious and tuberculosis profiles decreased most noticeably - by 25 and 7%, respectively. The bed capacity of gynecological, surgical and therapeutic profiles has increased more than the rest.

The number of hospitals in 2021, on the contrary, has grown. In the Central Federal District, there are 48 more such institutions, the largest increase is in Moscow. At the end of 2021, there were 172 hospitals in the capital, a year earlier there were 146. In the North-West, North Caucasus, Ural and Far Eastern federal districts, the number of hospitals has decreased. The most noticeable in the Urals is 14 less than in 2020.

In September 2021, the Accounts Chamber of the Russian Federation announced that Russia is in third place in the world in providing hospital beds for 1,000 people.^[6]

Free Wi-Fi has already been launched in more than 60 renovated Moscow polyclinics

Over 200 metropolitan polyclinics, which will be built or put in order as part of the overhaul program according to the latest standard, will be equipped with free Wi-Fi. This was announced on September 22, 2022 by the deputy head of the city Health Department Ilya Tyrov.

All polyclinics in Moscow, which are being modernized according to the new standard, will be equipped with access points to the Wi-Fi network. In total, free and high-speed Internet will appear in more than 200 institutions - these are clinics that are part of the overhaul program, and new buildings under construction. Free Internet contributes to improving the quality of communication in Moscow medical institutions and makes staying there more comfortable. What is important, it also allows you to always have access to all the digital capabilities of Moscow polyclinics: an electronic medical record, electronic prescriptions, a chat bot, an appointment service and others, - said Ilya Tyrov.

As of September 2022, more than 60 updated medical institutions have free Wi-Fi. They serve 1.3 million people. The metropolitan Department of Information Technology noted that to connect to the network, you need to go through identification on the urban Wi-Fi authorization platform using an account on the mos.ru or via SMS, and then click on the "Log in to the Internet" button. Reauthorization will not be required.

Thanks to the updated Moscow standard, clinics will have a similar appearance, interior decoration, and functional filling. They create convenient waiting areas, lounges and meals for staff. Play areas are made in children's departments. Navigation and compliance with uniform color solutions simplifies the search for specialist offices.

Polyclinics are redeveloping premises, changing engineering systems. This allows you to create comfortable conditions for the provision of medical care. In addition, analog equipment is replaced with modern digital equipment, the latest technique for the diagnosis and prevention of diseases is installed. Branches are equipped with mammographs, X-rays, ultrasound devices and equipment for functional diagnostics, and head units are equipped with bone examination devices, MRI, CT, ultrasound of expert class and equipment for monitoring the condition of patients with coronary heart disease, after a heart attack or surgery on heart vessels.

Patients of those clinics where repairs are underway can temporarily receive services in other institutions. You need to pay attention to the address that is indicated when recording^[7].

Mishustin allowed to build hospitals in a simplified manner

At the end of July 2022, the Government of the Russian Federation expanded the list of objects that are being built in a simplified manner. Now it includes hospitals.

We are expanding the list of objects, the construction and registration of which can be carried out in a simplified manner. Now it will include schools, hospitals, sports facilities and many other social organizations. This will speed up their commissioning by an average of one year by reducing the number of permits and administrative procedures, "said Prime Minister Mikhail Mishustin at a meeting with ministers on July 28, 2022.

Mikhail Mishustin

He stressed that the new order will be extended to social, medical and sports infrastructure.

According to the Chairman of the Government of the Russian Federation, President Vladimir Putin constantly draws attention to the need to reduce excessive regulation in the construction sector. The Cabinet of Ministers continues to work consistently in this direction, he stressed.

We will continue to make decisions that help people and their families receive the necessary services and care and enable businesses to reduce costs, and industries to better adapt to external sanctions, the prime minister assured.

The new SanPiN entered into force on January 1, 2021 and will be valid until 2027. The document developed as a result of the implementation of the "regulatory guillotine" mechanism also concerns the provision of medical care, in particular, the requirements for minimum premises have been reduced.

For example, neurosurgical, trauma, radiological, burn (except for intensive care units), restorative treatment, medical and social (including hospices), diagnostic wards, wards for patients moving using wheelchair seats for adults and children over 7 years old, can now be 8 square meters. m instead of 10 square meters. m.^[8]

2021

The share of private clinics in compulsory medical insurance has hardly increased since 2017

By the end of 2021, there were 3692 private clinics participating in compulsory health insurance (compulsory medical insurance) programs in Russia. In 2020, there were 3484 of them, in 2019 - 3048, in 2017 - 3618. Such data on February 20, 2023 was cited by Svyatoslav Sorokin, Director of the Department for the Development of the Social Sphere and the Sector of Non-Profit Organizations of the Ministry of Economic Development, at a meeting of the Council for the Development of Social Innovations of Subjects in the Federation Council. Read more here.

The number of clinics in Russia decreased by 1.3 thousand over the year.

By the end of 2021, there were 21.6 thousand clinics in Russia against 22.9 thousand a year earlier. The fact that the number of outpatient organizations in the Russian Federation decreased by 1.3 thousand is evidenced by the data of Rosstat, published in December 2022.

In the Central District, the number of clinics decreased in eight regions. Moscow and the Moscow region were especially distinguished: in the capital over the year there were fewer such institutions by 1243 (-49%), in the Moscow region - by 312 (- 20%). In the North Caucasus Federal District, the number of clinics in the Republic of Dagestan decreased as much as possible - by 102 (-38%) and in the Stavropol Territory - by 25 (-6%).

Dynamics of the number of outpatient organizations in federal districts in 2020-2021, thousand

In 53 subjects, the number of outpatient institutions has increased. Maximum in the Krasnodar Territory (+ 71 organizations) and the Republic of Bashkortostan (+ 61).

Subjects with the maximum reduction in the number of outpatient organizations in 2020 - 2021, units

Against the background of a decrease in the number of outpatient clinics and clinics in 2021, their attendance increased by 106 thousand people per shift on average in the country. In the Central District, the capacity of such organizations increased by almost 8%, in the Far Eastern - by 5%.

The busiest were the polyclinics of the Ryazan region, where attendance increased more than twice compared to 2020, the Amur (by 42%) and Lipetsk (by 21%) regions, according to Rosstat data.

Dynamics of the capacity of outpatient organizations in federal districts in 2020 - 2021, thousand visits per shift

According to the Ministry of Health of the Russian Federation, by 2021, more than half (58.9%) of the paid medical services provided to Russians in medical institutions fell on the outpatient segment. In second place is specialized medical care in the hospital: in 2021, its share in the structure of paid services reached 18.2% (in 2019 - 20.5%). In third place are other types of medical and other services - 18.2% (in 2019 - 16.7%).^[9]

2020

Regions with the largest debts of medical organizations

Auditors of the Accounts Chamber of the Russian Federation issued a report in which they reported an increase in overdue accounts payable of medical organizations in a number of Russian entities. Thus, in St. Petersburg by the beginning of 2020, the overdue debt of clinics increased by 304.4% - to 483.2 million rubles. In Udmurtia, the debts of medical institutions to counterparties increased by 322.8%, in the Omsk region - by 366.6%.

The five regions with the largest payables of medical organizations by the beginning of 2020 are as follows:

• St. Petersburg - 5 billion rubles;
• Omsk region - 1.33 billion rubles;
• Vologda Oblast - 1 billion rubles;
• Republic of Bashkortostan - 915 million rubles;
• Murmansk region - 839 million rubles.

St. Petersburg - the region with the largest payables of medical organizations

The largest growth rate of overdue accounts payable was noted in the first half of 2020 - and in some regions it quadrupled.

As the main reasons for accounts payable by medical organizations, the following are distinguished:

• a reduction in the population attached to health organizations located in rural areas, which leads to a decrease in funding according to the daily standard;
• understaffing by specialist doctors;
• insufficient material and technical equipment of medical organizations;
• poor quality of management of financial and economic activities of medical organizations (overfulfilling of medical care, irrational use of bed capacity, exceeding salary indicators established by the roadmap, etc.);
• inefficient spending of OMS Campus Management funds by medical organizations (duplication of payment for medical organizations);
• maintenance of unnecessary and unused areas of medical organizations;
• overestimation of the cost of purchasing goods, works and services within the framework of concluded contracts of individual medical organizations in comparison with other organizations;
• increase in the share of the wage fund.^[10]

Ministry of Health: 100 new hospitals and 500 clinics will be built in Russia

In October 2020, Deputy Minister of Health Igor Kargamanyan said that 24 district and 87 central district hospitals, 386 polyclinics, 136 polyclinic units, 303 offices of general practitioners, 1,071 medical outpatient clinics, 5887 feldsher-obstetric points will be built in Russia.

According to Kargamanyan, the primary health care program will be launched on January 1, 2021. 500 billion rubles were allocated from the federal budget for its implementation until 2024, 90 billion of these funds are planned for next year.

Even in the current difficult conditions, the priority remains the fulfillment of social obligations to citizens and the restoration of the Russian economy. Every ruble of budget money should go to improve the lives of people, solving the tasks facing the country and which are outlined by the president, - said Prime Minister Mikhail Mishustin, commenting on the allocation of 500 billion rubles for the development of primary medicine in 5 years.

The Ministry of Health reported that 100 new hospitals and 500 clinics will be built in Russia

The program also includes major repairs in health care institutions, retrofitting them with medical equipment, the purchase of vehicles for paramedics and outpatient clinics to deliver patients from remote areas and doctors' departures, and solving personnel problems in clinics.

The program was supposed to begin on July 1, 2020, but due to the pandemic, the deadlines for its implementation were postponed by six months. It is planned that the modernization of primary health care will help solve the most acute problems in the field of budget medicine. Among its principles are the availability and quality of primary health care, the priority of the patient's interests, the observance of his rights and the provision of state guarantees, the priority of disease prevention, the responsibility of bodies and officials for ensuring the rights of patients.^[11]

Notes