Rising prices for medical services. As a rule, medical institutions independently calculate the cost of medical services provided as part of income-generating activities. Crisis and reasons for market growth

Features of pricing and pricing for paid medical services

As already noted, at present, there are two parallel sectors in healthcare - market (commercial healthcare, entrepreneurial activities of budgetary medical institutions) and non-market or partially market (municipal and state healthcare facilities financed from the budget or operating in the system of compulsory medical insurance). Accordingly, there are two pricing principles. Market, based on supply and demand, calculated, based on the cost of providing services (cost level).

According to a number of authors, one of the features of pricing for paid medical services is the presence of a situation where state or municipal medical institutions have the opportunity, when providing paid services, to use part of the budgetary resources or compulsory medical insurance funds and set prices at a level below market or below the real level of costs. .

Rice. 1. The ratio of state, municipal institutions and private organizations in the whole of the Russian Federation

It is necessary to distinguish between the forms of payment for services in health care: the provision of services on a paid basis that are not financed from the budget and from the funds of compulsory medical insurance; surcharge for additional services provided (increased comfort or service, additional meals); surcharge as a form of cost recovery for services that are only partially funded from other sources. We are talking about prices that actually play the role of surcharges, when paid services are designed to compensate for the lack or lack of funding for certain items in a situation where it is impossible to provide the required services within the budget funds or CHI funds, and partial reimbursement of expenses at the expense of consumers of services is the only possible form of problem solving.

Speaking about the specifics of setting prices for paid services from the point of view of specific pricing methods, it should be noted that the peculiarities lie in the fact that pricing in the provision of paid services implies a real possibility of moving away from the costly method of setting tariffs (based on actual costs) and switching to tariff formation. according to regulations and standards. In other words, when setting prices for paid services, it becomes possible to include in tariffs not those costs that would reflect the meager budget financing of a medical institution, but the scientifically justified amount of healthcare financing for specific items. In particular, this concerns an increase in the cost of purchasing equipment - an item that is vital for modern healthcare, but suffered in the conditions of a budget deficit in the first place.

When calculating prices for paid services, the composition of expenses does not include the cost of purchasing equipment, but depreciation. For the purpose of cost recovery, when calculating prices, it is advisable to take the cost of equipment for which depreciation is charged not at book value, but at market prices.

Unlike prices for budget financing and in the system of compulsory health insurance, prices for paid services include profit. Moreover, there are no legally established restrictions on the level of profitability.

The cost of providing paid medical services may include interest for using the loan.

It should be noted that the market nature of setting prices for paid services of health care institutions does not negate the need to consider the principles of pricing, the features of accounting for specific items, ways to include various components in tariffs in relation to specific conditions and tasks.

Paid services can be paid directly to the contractor acting as an individual private entrepreneur or medical institution (to the cashier), or to an intermediary - through an agreement between medical institutions and insurance companies, as well as the so-called direct contracts with individuals and legal entities. And in the first and second cases, these contracts can be both individual and corporate. At the same time, it is indisputable that collective agreements, which bring much more income than individual ones, are preferable for medical and preventive institutions. Payment under the program of voluntary medical insurance occurs by issuing invoices to insurance organizations with attached registers of treated patients. Prices for voluntary health insurance are set in the same manner as prices for paid medical services paid through the cash desk. The medical institution of each insurance company provides a list of services provided with the corresponding prices in accordance with which payment for the services provided is made.

Many believe that “the state, in the name of the interests of the health of the nation, should establish strict centralized pricing for paid medical services of public and private health care and make them differentiated depending on the type and social significance of the medical care provided. Prices must include a profit that does not exceed the level of the average profit of industrial production. This is able to limit the ever-increasing mayhem of rising prices for medical services and medical care items.

The level of prices for paid services is often tried to be controlled, referring to the protection of the interests of the population. Ignoring market laws leads to the opposite situation. Thus, the requirements to include in the prices of paid services wages strictly according to the tariffing lead to underestimation of prices below the market level. The result of such regulation is: limited supply of paid services relative to the possible level; the desire to find ways to reimburse part of the costs of providing paid services at the expense of the budget and compulsory medical insurance; differentiation of prices and conditions for the provision of paid services for various contingents; high prices in cases where prices are not controlled (especially those provided by commercial institutions).

Ultimately, the population suffers from all this, and not state or municipal, but commercial medical institutions benefit. Nevertheless, in fairness it should be noted that the liberalization of tariffs for the services of medical institutions is justified only in the current conditions, when paid services to the population play a supporting role. In the case of mass denationalization (privatization) and the formation of a broad non-state healthcare sector by transferring many types of services to an exclusively paid basis, this can result in an extremely unfavorable situation caused by the uneven distribution of medical institutions and the emerging monopoly of many of them. Then the issue of regulating tariffs for paid services will really become relevant.

And what actually should be the procedure for approving prices for paid services? To answer this question, consider the legal basis of pricing.

By providing paid medical services, health care institutions thereby enter into contractual relations either with the patients themselves or with organizations or persons representing them (and it does not matter whether the contract is concluded in traditional written form or not).

In accordance with the current civil legislation, the performance of the contract is paid at the price established by agreement of the parties (Article 424 of the Civil Code of the Russian Federation). However, there are quite a few restrictions that do not allow medical institutions to fully exercise this right. Thus, in accordance with Articles 424 and 735 of the Civil Code of the Russian Federation, in cases provided for by law, prices established or regulated by authorized state bodies are applied. Therefore, if within the framework of the powers granted to them by state bodies a certain level of prices is established, then these prices should be indicated in the contract.

First of all, we point to the Decree of the Government of the Russian Federation of January 13, 1996 No. 27 “On approval of the Rules for the provision of paid medical services to the population by medical institutions. In accordance with this resolution, it is prescribed not to apply state regulation of prices (tariffs), allowances for all economic entities, regardless of their organizational and legal forms and departmental affiliation, carried out by setting fixed prices, marginal prices, allowances, marginal price change coefficients, marginal levels profitability, declaring price increases for all types of industrial and technical products, consumer goods and services, except for those provided for in this resolution. Among the types of products and services related to health care, only prosthetic and orthopedic products, trade mark-ups on the prices of medicines and medical products are indicated in this decree. Since paid medical services are not included in the lists given in the said resolution, state regulation of their level is not allowed.

In fact, this means that medical institutions have the right to decide on their own the issue of approving prices (tariffs) for paid medical services. And this is true, unless we forget that the activities of a medical institution are determined not only by the actions of its head, but also by the founder. As you know, the founders of state and municipal health care institutions are the authorities of the appropriate level. And as a founder, the authorities may resort to price (tariff) regulation. So, if the Charter of a medical institution, the founder of which is the relevant authority, enshrined the right of the institution to independently decide on pricing issues for paid medical services, this means that the authority, as the founder, has delegated its rights in this area to the medical institution. Naturally, when developing the Charter of a medical institution, this point must be taken into account. As for the claims to the regulation of tariffs for paid services by the health authorities, it should be noted that their status as a governing body does not automatically give them the right to regulate prices for paid services - this right should be enshrined in the Regulations of the governing body on the Committee for health or similar document. Therefore, sometimes it is enough to look at the Regulations on the regional health committee to make sure that their claims to regulate tariffs for paid services are unlawful.

Methodology for the formation of tariffs (prices) for paid services in health care

Formation of tariffs for paid medical services is carried out in accordance with the Methodological recommendations for calculating tariffs for paid medical services provided to the population in the territory of the Udmurt Republic, approved by order of the Ministry of Health of the Udmurt Republic. These methodological recommendations for calculating tariffs define a unified approach to the formation of tariffs for paid medical services and apply to medical institutions of the Ministry of Health of the UR, financed from the republican and local budgets.

The methodological recommendation is used in the economic justification of the need for medical institutions in financial resources when setting the value of the tariff for medical services provided to the population.

The need for financial resources for the provision of paid medical services is determined taking into account the funds attributable to the cost of the service.

The composition of the costs included in the cost

medical services

The cost of medical services is the valuation of materials, fixed assets, fuel, energy, labor resources used in the process of providing (production) services, as well as other costs for their production.

When determining the cost of any type of medical services, the following grouping of costs by economic elements is used.

Labor costs. These are the labor costs of health workers performing services, proportional to the time spent on the production of the service and the complexity of the service. To determine labor costs, the salaries of core and general staff are calculated separately. The main staff of a medical institution includes medical, middle and junior medical personnel providing medical services. General staff includes support staff, department heads, chief nurses, medical registrars, and so on.

Payroll charges.

They provide for the cost of paying insurance premiums for state social insurance.

Direct material costs.

This is the cost of material resources consumed in the process of providing a medical service (medicines, dressings, disposable supplies, food, etc.) or partially (wear and tear of medical equipment used in the provision of this medical service).

General business expenses (indirect or overhead costs).

These are all expenses that are necessary to ensure the activities of the institution, but not directly related to the provision of medical services (clerical and household expenses, depreciation of non-medical equipment, remuneration of administrative and managerial personnel, travel expenses, etc.).

Prices for medical services, of course, will rise. The reason is on the surface - the bulk of consumables and medicines, as well as medical equipment are imported. The greatest increase will occur in the field of dentistry, since the share of imported drugs is traditionally higher here.

But the increase in prices will be much less than the indicator of the dynamics of the exchange rate of the national currency, since the bulk of the costs (wages, rent) are not related to foreign exchange transactions.

At the same time, the business will try to contain the rise in prices as much as possible. Competition in almost all regions is extremely high, and now not only the quality, but also the cost of services will come to the fore for consumers. The increase in prices will be within the boundaries of general inflation in the economy.

Timur Nigmatullin

analyst at Finam investment holding

According to my estimates, the volume of the paid medical services market in Russia in 2014 amounted to about 700 billion rubles, which is 15 percent more than last year. In 2015, I expect similar growth rates, despite the negative economic environment. The key drivers of growth are the aging of the population and the reduction in government spending on healthcare. Price growth will be driven by services related to oncological, cardiovascular diseases and dentistry.

Stepan Firstov

CEO of FMC Medical Clinic

Our prices will rise by 15-20 percent due to an increase in the cost of consumables, in particular imported metal structures integrated into the body (these are precisely the positions that there is nothing to replace yet). Prices for diagnostics will also rise, because it is often outsourced to laboratories, and they have already raised the price by ten percent. As for major operations in traumatology and orthopedics, we will offer the patient (where possible) alternative options with Russian metal, warning of the risk.

But many positions will remain unchanged due to the fact that the number of domestic producers has increased over the past three years. For example, we purchased light, operating underwear, a digital X-ray machine, modern stretchers, operating and dressing tables, electrocoagulation devices for our new division from a domestic manufacturer. Therefore, there will be no surprises here.

Beauty industry

Elena Volodina

Injection procedures will rise in price the most (already now their cost has increased by 15-20 percent), as drugs are bought abroad. The only exception should be plasmolifting, if you do not add mesococktails to the plasma. Some clinics will try to make money on clients and raise prices even for those materials that they managed to purchase at the old prices: against the backdrop of a general rise in prices for services, this will not arouse suspicion. From the positive: hardware, including laser procedures, should not change in price. Firstly, they are not cheap anyway (for example, fractional resurfacing of the entire face costs from 20 thousand rubles), and secondly, they do not require additional expensive drugs.

The number of clients of beauty salons is unlikely to decrease: routine procedures (manicure, haircuts and coloring) will always be in demand. In a crisis, the “lipstick” effect works: women are wary of large expenses, but at the same time they are ready to spend money on pleasant little things that allow them not to lose face during a crisis.

Andrey Volkov

No Strategy

The last couple of beauty trade shows have seen an unprecedented demand for Asian cosmetics. I think that in the next two years we will see a 90% replacement of the usual Italian, French, Swiss and American professional brands. All participants are afraid to raise prices for services, but the prices for raw materials have already risen, so they are changing suppliers. Now we can say that there was almost no correction, five percent on the market. A slight decrease can be expected only in the segments of budget haircuts and nail design.

Education

Andrey Volkov

Head of consulting company No Strategy

Prices for education grew even without the crisis. The more prestigious the university, the faster the prices rose. For example, in-demand MBA programs become more expensive every year by 10-15 percent. It is likely that many parents will not be able to bear the financial burden, and the children will go to study in other institutions or other specialties. Or they won't go at all. But today the world formation is in a tectonic shift. Even the oldest universities in the world are rushing to stake out their place in the field of distance learning and launch online learning projects. Apart from all the other good things, these programs are much cheaper, and I think it will take no more than three to five years until society starts to accept them seriously along with the traditional format.

Olesya Gorkova

director of the language training center of the university "Synergy"

In the segment of additional education, prices will not only increase, but demand will also change. The increase in the cost of an hour of classes with a native speaker is offset by increased quality requirements. At the same time, interest in premium-format products will decrease: individual training, language support, and so on. Now we are seeing a trend of changing interests in the languages being studied: the demand for learning East Asian languages is increasing, that is, Chinese and Arabic languages are moving from the category of exotic to the category of applied business languages, nevertheless, English is 90 percent of the market.

Fitness

Andrey Volkov

Head of consulting company No Strategy

The most competitive market is St. Petersburg. It is estimated at 1.3 million subscriptions. For a city of five million! Fitness operators no longer have the ability to raise prices. What has already happened in St. Petersburg will spread throughout Russia. Installment payment, additional services, flexible day/night/freeze rates. Otherwise, the business will not be saved. According to the results of the last quarter of 2014, all operators note a sharp drop in sales of personal training - a very alarming signal. Tomorrow they may begin to refuse subscriptions.
Of course, there are alternatives to fitness. These are small specialized studios for cross-fit, cycling, aerobics, yoga, mixed martial arts and many others. And all-season outdoor training: running, walking, Nordic walking. Seasonal: bike, roller skates. Again, individual coaching programs of various formats. This year will be profitable for the fitness consumer, if, of course, nominal incomes remain.

According to the review " Analysis of the medical services market in Russia”, prepared by BusinesStat in 2017, in 2017 the natural volume of the market in the country amounted to 1,529 million appointments, which is only 0.4% higher than in 2016. In 2015-2016, there was a decrease in the indicator under the influence of the crisis and a decrease in real incomes of the population , as well as reducing the availability of medical care for the population as a result of optimizing the number of medical facilities. The growth of the indicator in 2017 was facilitated by the relative stabilization of the Russian economy after the crisis changes in previous years.

In 2013-2017, the average prices for basic medical services in Russia were growing. The average price of a medical appointment in the country over a five-year period increased by 37.6% and reached 1,511.1 rubles per appointment. Compared to 2016, the price of crown manufacturing increased the most - the price increase amounted to 13.9%. The average price increase was the least for ultrasound examination of the abdominal cavity - the price increase was 1.6%.

In 2018, the number of medical appointments is expected to increase by 0.5% compared to 2017 due to growth in all sectors of the medical services market, except for the public sector and the sector of voluntary medical insurance. The number of medical appointments in the public sector will be reduced due to the low growth rate of funding for state medical institutions, which will not allow covering the increase in prices for services. In general, in 2018-2022, an increase in the number of medical appointments in Russia is predicted at an increasing pace. In 2022, the indicator will reach the level of 1,601 million appointments, which is 4.7% higher than in 2017.

Growth in the natural volume of the medical services market, in particular, will be facilitated by the recovery of consumer demand for paid clinic services and the expansion of the range of services by commercial clinics. In addition, the provision of paid services in state medical institutions will be developed. An additional area in which an increase in the number of medical appointments is predicted is telemedicine - from January 1, 2018, a law came into force regarding telemedicine services that involve remote communication between a doctor and a patient.

Similar studies

Marketing research of the telemedicine market in Russia Guidemarket Company 45 000 ₽ Typical business plan of the Medical office (office). 90 sq.m. SYNOPSIS consulting&research 21 000 ₽ Sample Ambulance business plan with a ready-made financial model SYNOPSIS consulting&research 25 000 ₽ Sample Business Plan for an Ambulance Station SYNOPSIS consulting&research 21 000 ₽

Related materials

Article, February 13, 2020 ROIF EXPERT Dolomite market in Russia 2020: Equilibrium after powerful fluctuations According to a study by the marketing agency ROIF Expert, the production of dolomite decreased by 23.8%, but in monetary terms in 2019 the market grew by 3.3%.

According to the study “Dolomite market in Russia: research and forecast until 2024”, prepared by the marketing agency ROIF Expert in 2020, over the past 2019, dolomite production decreased by 23.8%, but in monetary terms the market grew by 3.3% and reached 4.7 billion rubles.

Article, February 12, 2020 BusinesStat Sales of beer and beer drinks in Russia for 2015-2019 decreased by 9.4%: from 10.28 to 9.32 billion liters. High excise rates, a ban on trading at night and in non-stationary trade facilities, and a ban on plastic containers contribute to a decrease in sales.

According to "Analysis of the market of beer and beer drinks in Russia", prepared by BusinesStat in 2020, sales of these products in the country for 2015-2019 decreased by 9.4%: from 10.28 to 9.32 billion liters. On the one hand, state regulation measures, such as high excise rates, increased state control over the circulation of alcoholic beverages, a ban on the sale of alcoholic beverages at night and in non-stationary trade facilities (kiosks), etc., contribute to a decrease in sales. On the other hand, a decrease in sales beer production is promoted by the desire of some Russians to follow the principles of a healthy lifestyle, which is associated with the refusal to drink alcoholic beverages.

Article, February 11, 2020 ROIF EXPERT Ammophos market in Russia 2019: domestic farmers won back half of the export losses of Russian ammophos producers Thanks to the growth in ammophos consumption in the domestic market, fertilizer producers managed to win back half of the export losses of ammophos abroad.

The growing consumption of ammophos by domestic farmers in 2019 allowed producers to minimize losses from falling exports of ammophos abroad.

At the end of last year, the Moscow Compulsory Medical Insurance Fund decided to raise tariffs for 29 medical services provided under the Compulsory Medical Insurance program in antenatal clinics.

Tariffs were increased for such services as the appointment of an obstetrician-gynecologist, both primary and repeated (on average by 18%), the cost of a cervical biopsy increased by 24% from 620.87 rubles. to 771.9 rubles, endometrial aspiration biopsy increased by 26% and cost 370.97 rubles. instead of 295.25 rubles.

In total, in 2015, over 12 million services were provided at these tariffs, of which 4.7 million services were provided in antenatal clinics, for a total amount exceeding 1.25 billion rubles.

The basic CHI program also includes pregnancy management, childbirth, the postpartum period, and, if necessary, hospitalization in a gynecological hospital or in the pregnancy pathology department of a maternity hospital. In 2014, the fund also indexed the tariffs for obstetric care, for example, the tariff for normal childbirth was increased 4 times from 6 to 24 thousand rubles, and in 2015 to 40 thousand rubles.

“Thus, the state pays for the entire period of a woman's pregnancy from the moment of registration to discharge from the maternity hospital. On average, pregnancy management costs the OMI system of Moscow about 65 thousand rubles, ”explains Vladimir Zelensky, director of the MGFOMS.

The increase in tariffs for services provided in antenatal clinics in Moscow is due to the fact that today not every polyclinic has full-time gynecologists. When applying for gynecological care for pregnancy or the presence of chronic diseases, a woman needs to get a referral from her therapist to the clinic where there is an appropriate specialist or department. Such a direction is issued once for the entire period of treatment, observation. If a woman seeks gynecological care at a time, then she needs to get a referral before each trip to a specialist in another medical organization.

Also, a woman has the right to independently choose a medical organization in which she wants to be observed. Moreover, this can be done not only on a territorial basis. In this case, she must also take a referral to her polyclinic and write an appropriate application addressed to the head physician of the polyclinic.

They do not have the right to refuse to issue a referral to the antenatal clinic or to register with the clinic itself, except in cases where all the doctors of the clinic have a workload that significantly exceeds what they are entitled to by law. In this case, the patient must be informed and explained that the high workload on the doctor, as a rule, affects the quality of observation and treatment.

It is important that when applying for medical assistance by referring a doctor to another clinic or antenatal clinic, they do not have the right to require you to join, pay for the prescribed tests or consumables.

For the provision of medical services not at the place of attachment, medical organizations make “horizontal” mutual settlements among themselves.

RBC analysts have studied the medical services market in Russia and present the main findings from the study: how much shadow payments fall on, why Russians are engaged in medical tourism, and how the sector managed not to sink into the crisis.

We publish the main thing, and you can get acquainted with the report in more detail.

People go to the regions for treatment because it is cheaper there - a study of the paid medicine market

Sergei Khitrov

Whom to pay money in medicine

The medical services market in Russia is divided into two main parts: insurance medicine, which is divided into compulsory and voluntary medical insurance, and commercial medicine.

According to Russian laws, all medical institutions have the right to provide paid services: state, departmental hospitals and medical units, representative offices of foreign medical institutions, private domestic clinics, private practitioners (individual entrepreneurs). Therefore, the Russian market, unlike the more developed European ones, has its own specifics - "shadow" payments.

So, there are three segments in the market:

"Legal" paid market with official cash payments;
Market of voluntary medical insurance (VMI);
The “shadow” market of paid medical services: this is money paid “into the pocket” of doctors past the cash desk or “gifts”, as well as funds from private clinics received officially, but withdrawn from taxes.

Dynamics of the market structure of paid medical services in Russia 2005-2016,%

Market structure

The share of the "shadow" segment of the market is declining every year. If in 2005 it accounted for more than half of the paid medical services market (51%), then by the end of 2016 it was only 22%.

The reason for the dynamics is the growth of salaries of doctors in public clinics, tighter controls in private health facilities, higher patient awareness, and an increase in the share of private clinics operating formally.

The share of the "legal" segment of the paid medical services market has almost doubled over the past 11 years - from 33% in 2005 to 64% in 2016. The growth of the segment will continue due to a decrease in the volume of "shadow" payments. The share of the VHI segment in the Russian market has not changed much over the past 11 years and is in the range of 14-16%.

According to RBC Market Research analysts, in 2016 the volume of the paid medical services market amounted to 732.4 billion rubles. It grew by 39 billion rubles. or 5.6% over the previous year.

Rice. 18. Dynamics of the market volume of paid medical services in Russia, 2005-2016, billion rubles, %

Source: RBC estimates Market research

Market Growth Dynamics

Over the past 11 years, the market for paid medical services has been growing (with the exception of a slight drop in the crisis year of 2009).

Since 2005 year the market has grown more than 3 times, and from 2006 to 2008 the sector grew by 18-22% per year.
Against the background of the crisis, the market stopped growing, and in 2010 year began to recover. The rate of growth in the volume of paid medical services was approximately equal to inflation, and the volume of services remained almost unchanged.
In 2012 year, the number of paid services began to grow - the main driver was the low quality of free medicine.
In 2014-2016 years, against the backdrop of a difficult macroeconomic situation in the country, a slowdown in market growth was expected. Some experts and analytical agencies predicted a decrease in healthcare costs for both the state and the patients themselves.

However, the situation was reversed. In 2014 the market grew by 12.8%: increased the number of services and their prices. In 2015-2016, the growth of the Russian paid medical services market continued. Growth rates (in nominal prices) amounted to 7.6% and 5.6%, respectively - this, however, became possible due to the increase in prices for services.

Crisis and reasons for market growth

So, at the height of the crisis of 2015-2016, the market developed according to the inflationary model and did not grow quantitatively (or in comparable prices). However, compared to many other consumer markets, which experienced a significant decline not only in current, but also in comparable prices, the situation in the medical services market was more optimistic.

There are several reasons. The most obvious is the increase in prices for many services in Russian clinics. There is also a specificity of the market: people cannot postpone or refuse certain medical services.

In addition, there was a so-called optimization in the healthcare sector: there were fewer public clinics, so the Russians had to go to private clinics or pay for additional services in public ones.

Medical tourism

According to the Russian Association of Medical Tourism (AMMT), domestic medical tourism grew by 16% in the previous year. If in 2015 in other cities of the Russian Federation 7-8 million people were treated, then in 2016 - already more than 9 million people. The volume of expenses for treatment in the regions of Russia of patients from other cities amounted to 240 billion rubles.

The most popular direction of domestic medical tourism is dentistry. According to AOMMT, the share of Russians seeking to save on treatment by traveling to the regions does not currently exceed 4-6%:

Dentistry accounts for 32% of all services provided to medical tourists,
23% for gynecology and urology,
12% - for cosmetology,
8% - for ophthalmology,
5% - for cardiology.

The main purpose of trips to the regions is to save money. People go to Moscow and St. Petersburg for complex treatment that requires the latest technologies and highly qualified doctors.

At the same time, the depreciation of the ruble led to an influx of foreign medical tourists into the country (mainly to Moscow and St. Petersburg). According to the Ministry of Health of the Russian Federation, inbound medical tourism to Russia increased by 56% over the previous year. According to the Russian Association of Medical Tourism, in 2016, about 20,000 tourists from other countries visited Russia to receive medical care.

Among the most popular areas are dentistry (implantation and prosthetics), urology and gynecology (mainly IVF), plastic surgery, traumatology, cardiovascular surgery, orthopedics and ophthalmology.

Forecasts

According to RBC Market Research forecasts, in 2017 the paid medical services market in Russia will continue to grow moderately – 7.3% compared to the previous year.

The main increase will be provided by the “legal” sector, which will grow to 526.2 billion rubles by the end of 2017. (that is, by 11.5% compared to 2016). In the last 2 years, the main reason for the growth in the nominal value of services in the "legal" sector was inflation, but in 2017-2018 other factors will come into play - for example, an increase in turnover.

In the coming years, some of the free ones will become paid. Thanks to this, the “legal” segment will grow and the volume of “shadow” payments outside the cash register will decrease.

Also, the growth of both the "legal" sector and the market as a whole will be affected by optimization. In 2017-2018, the real disposable income of the population, according to the forecasts of the MED, will finally stop falling and even show a slight increase: this means a gradual return of consumer confidence and a revival in many consumer markets.