Licensing of infirmaries and doctors conducting medical examination of drivers in Ukraine

New medical practice license regulations, which came into force on 22 of April, 2016, contains a number of positive changes for licensees compared to the old regulations. They include also amendments concerning the procedure of opening infirmaries at enterprises and organizations, as well as the pre- and post-trip medical examination of drivers.

In fact, these new provisions should be called innovations rather than changes, since the old license regulations did not actually regulate the procedure for the opening of infirmaries. You had to look for the relevant provisions in a number of regulations. In many cases, this fact often led to the illegal, or more frequently to semi-legal work of health workers at enterprises.

General forms of organization for a medical practice at enterprises

Today, we can finally say that there is a relatively detailed procedure for licensing health care services provided to employees of enterprises, institutions and organizations, as well as pupils and students of schools, vocational schools and universities.

Pursuant to clause 18 of the current medical practice license regulations, health care services for the above categories of persons shall be provided on the basis of:

• the relevant agreements concluded by and between enterprises and already licensed health care facilities of outpatient-polyclinic profile, according to which the latter will provide health care services through their separate structural subdivisions (including under the material and technical basis of the corporate customer);
• a doctor’s office opened by the licensed individual entrepreneur on the territory of the enterprise (as in the previous option, the health care services shall be provided on the basis of contractual relations between economic entities);

Alternatively, if the enterprise has sufficient resources, a healthcare facility can be established in the form of an infirmary, primary healthcare unit or even a health centre. Since these forms of health care services are considered to be health care facilities, it will be a bit more difficult to open them. At the same time, such health care facilities can provide health care services of both narrow and broad profile.

Opening a doctor’s office without the establishment of a healthcare facility

As for providing health care services at enterprises, a particular attention should be paid to the third paragraph of clause 18 of the new license regulations, which provides a fundamentally new option for organizing the health care services for employees and pupils/students/drivers. It suggests opening a so-called doctor’s office without creating a health care facility. In practice, this means that the license is issued directly to the enterprise/educational institution which employs the medical personnel. Such a doctor’s office operates under the relevant provision.

It should be noted that in this case, health care services can be provided to employees/pupils/students of the enterprise/educational institution only and such a license doesn’t provide for the possibility of an independent work under the agreement. Health care services may be provided to third parties only in case of medical emergencies

Introduction of the concept of a doctor’s office allows the company to break free from external contractors, who may refuse to prolong the agreement, change its price, change the business address, etc.

Pre- and post-trip medical examination under new license regulations

As noted above, the changes in the license regulations have also affected the medical examinations of drivers before and after the trip. In this case, it is necessary to elaborate on the medical practice license regulations and license regulations concerning passenger transportations and drivers.

So, the former regulations provide for the procedure of licensing the activity of employees carrying out the pre- and post-trip medical examination, which is similar to the general forms of organization of health care services at enterprises and the opening of a doctor’s office without  the establishment of a healthcare facility.

On the other hand, the license regulations governing the passenger and cargo transportation services stipulate that persons who perform medical examinations of drivers shall have the following qualification:

• a doctor with a therapeutic area of expertise (obviously, with any therapeutic specialty);
• a junior specialist with a medical degree in nursing (nurse) or general medicine (paramedic).

At the same time, such workers can be:

• employed by the enterprise (the enterprise opens a doctor’s office or health care facility);
• personnel of another enterprise (contractor) that has the appropriate medical practice license;
• self-employed persons (medical practice license is obtained by the individual entrepreneur (contractor)).

As we can see, license regulations governing medical practice and passenger and cargo transportations do not contradict each other, but even complement each other. That is why, today we can definitely conclude that regardless of the forms of organization of pre- and post-trip medical examinations, such activities are subject to licensing as medical practice.

It’s also worth noting that the Government planned to remove the requirement for mandatory medical examinations of drivers, but such plans haven’t been implemented.

To sum up, it should be said that all health care services provided to employees of enterprises, institutions and organizations, as well as to pupils and students of educational institutions of any form of ownership are currently subject to licensing. The only way to circumvent this requirement is to enter into appropriate agreements with third parties or individual entrepreneurs who have obtained a medical practice license in accordance with the established procedure. This rule also applies to the driver’s medical examination.

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