Analytical assessment of the legal regulation of the sale of professional services by average medical professionals as additional income.
Authors:   South Ural State Medical University of the Ministry of Health of the Russian Federation, Bezuglyy T.A. , Tyukov Y.A. ,   South Ural State Medical University of the Ministry of Health of the Russian Federation
Published: September 2024

In the Russian Federation, the practice of providing medical services at home by specialists with secondary medical education has developed. Despite the fact that there are currently no direct restrictions on entrepreneurial activity in the Russian Federation, the existing legal framework for the sale of professional services by secondary medical workers contains a number of lacunae that contribute to the development of the shadow economy of healthcare. According to expert estimates, the revenues of the shadow market of medical services in 2023 amounted to 215 billion in real terms. At the same time, services provided to patients outside the framework of the legislation of the Russian Federation may be of poor quality due to non-compliance by performers with standards of medical care, failure to comply with sanitary and epidemiological norms and rules, and lack of control by inspection bodies. The purpose of the study is to use international experience to conduct an analytical assessment of the legal regulation of the sale of professional services by secondary medical professionals as an additional income. Methods and materials. The study analyzed the legislation of six countries: the Russian Federation, the Republic of Kazakhstan, the Republic of Uzbekistan, the Federal Republic of Germany, the French Republic and the Kingdom of Belgium on the provision of paid medical services by specialists with secondary medical education. Results. One of the reasons for the growth of the shadow sector, it seems possible to highlight the problem of excessive legal regulation of the commercial activities of nursing staff. In the Russian Federation, the provision of «nursing» medical services refers to licensed activities. At the same time, the development of current legislation on «self-employment» with the addition of «services of secondary medical personnel» to the list of activities will allow legalizing part of the shadow sector of medical services. According to the above comparative legal analysis, nurses in Uzbekistan, Germany, France and Belgium can work in the statuses of «selfemployed», «Freiberufler», «Entreprise individuelle» and «self-employed», respectively. Each of the statuses allows specialists with secondary professional medical education to provide their services within the legal framework, conclude contracts with patients and maintain medical records without excessive licensing rules, which are presented in the Russian Federation or the Republic of Kazakhstan. Conclusion. Thus, both according to expert estimates and according to the results of a comparative legal study, in order to reduce the size of the shadow sector of medical services, in particular, to legalize the provision of nursing care «at home», it seems rational to add the services of specialists with secondary medical education to the list of activities provided by the self-employed in accordance with Federal Law «On conducting an experiment to establish a special tax regime «Tax on professional income».