Private entrepreneurship in Russia is developing and every year it conquers new branches of the service market. It is no longer a novelty to use a private bank, a security agency or an ambulance. Opening your own ambulance is difficult, as this type of activity requires licensing and large investments. But if you are not afraid of difficulties and you have a certain amount in the stash, then you can try. We will talk in more detail about the specifics of the business of providing medical services and organizing a private ambulance.

Business specifics

State bodies gave into private hands those areas that were previously inaccessible to entrepreneurs. These include housing and communal services, ambulance, education, medical services. Of course, there are many complaints about the high cost of services that people are used to receiving for free, but positive reviews prevail.

For example, by calling an ambulance by phone 03, you can wait for the doctors no earlier than in 20-30 minutes. A private ambulance will rush to the place in the shortest possible time - 5-10 minutes. It is the same distance to go to a sick state ambulance, but the staff is not always motivated, and they have much more challenges. In a private company, specialists receive a salary and a percentage for each call and service rendered, so a good goal and prosaic are intertwined. The doctor will rush to the patient and provide all the services he needs.

In addition, the Ministry of Health is less and less funded, and high-quality modern equipment can only be found in private clinics. A third of the success of treatment depends on its quality. Patients prefer to pay and receive high-level care than to use the policy and waste time in queues.

According to statistics, 70% of entrepreneurs who are engaged in the medical business in Russia have absolutely no medical education. Therefore, everyone can open their own medical care service to the population.

A private ambulance provides the following types of services to the population (the list in each private company may be supplemented or narrowed):

1. Examination and consultation of the patient, diagnosis of the disease - 500–800 rubles.
2. Transportation of a patient to a hospital or for diagnostics - 600-1000 rubles.
3. First aid on the spot for a diagnosed disease - 500-1500 rubles.
4. Patronage and monitoring of a patient who needs constant monitoring - 2500 rubles per day.
5. Detoxification of patients (measures necessary for withdrawal from drug or alcohol intoxication) - 2500-4000 rubles.
6. Accompaniment by medical staff of mass events or school trips - 3500-6000 rubles.
7. Additional services at the central ambulance office (ultrasound, ECG), consultation of narrow specialists, massage - from 1200 rubles.

Target audience - any person with an average and high income. The private emergency room is also often visited by people who want to get help incognito (for example, drug addicts or alcohol addicts).

A private ambulance can receive additional income by entering into contracts with the same entrepreneurs who provide medical services. But the patient is given the choice of which hospital to deliver him to - private or public.

The technical side of the business

To organize a medical business, you must have a license. But getting a document from Roszdravnadzor is difficult. You will have to pass a series of checks from various government agencies, as a result of which you will be issued written opinions. Only an LLC can obtain a license to provide emergency medical services. Therefore, a limited liability company is initially registered. When registering, the code for the type of activity of OKVED is selected - 85.14.4 "Activities of emergency medical institutions".

A package of documents is submitted to Roszdravnadzor:

1. Statutory documents of the company.
2. Application for a license. The form can be viewed on the website of Roszdravnadzor.
3. Certificate.
4. Copy of passports and TIN of all founders.
5. Certificate of ownership or lease agreement for the premises where the ambulance center is located.
6. Certificates of conformity for tools and equipment.
7. A copy of the conclusion from Rospotrebnadzor.
8. Copies of documents that confirm the education and qualifications of each employee of the company.

A detailed list of documents and requirements for medical equipment can be found in the SanPiN documents “On Approval of the Regulation on Licensing Medical Activities”. You can download the list.

Red tape with documents can drag on for six months. While you will be checked by visiting commissions and each will make its conclusion, more than one week will pass. Then a council meets, where a decision will be made on issuing a license.

Equipment "ambulance"

The most minimal configuration of a private ambulance will cost you at least 5 million rubles. Of course, you can start working with one car and a mobile team of several people, but such an “ambulance” may not be in time for all calls. Plus, if the team is busy on the road, there will simply be no one to send to your clients.

The best option is to start with four machines:

• Recovery vehicle.
• Pediatric team car.
• Two linear, for departure on normal calls.

Each vehicle contains the following standard equipment:

• Defibrillator - 78-100 thousand rubles.
• Cardiomonitor - 150-300 thousand rubles.
• Apparatus for artificial lung ventilation - 60-100 thousand rubles.
• Perfusor (electronic syringe pump), in each machine 2-3 pcs., - 100-150 rubles / pc.
• Oxygen apparatus - 30-150 thousand rubles.
• Mini-refrigerator for medicines - 20-40 thousand rubles.

A stationary refrigerator for storing medicines is installed in the company's office - 60-100 thousand rubles, a safe for storing drugs containing drugs - 50-100 thousand rubles. Each car is equipped with a walkie-talkie, a station is placed in the office - 90 thousand rubles. When equipping the center, the biggest expenses will be spent on a resuscitation vehicle, its price on the market in Moscow depends on the brand.

A car based on a foreign car like Mercedes-Benz Sprinter will cost 2 million 850 thousand. A car based on the GAZelle will cost a little cheaper - from 1 million 500 thousand. the reputation of the company and the lives of patients will depend.

Choosing staff

Personnel with medical education and work experience of at least 5 years are hired for departure. Newcomers can screw up, and one misdiagnosis will cast doubt on the reputation of a start-up company.

The work schedule of doctors does not differ from the state one - a day or three. You can hire part-time specialists from large public clinics. But a license is issued subject to permanent employees, so you must have 3 doctors on a permanent basis: the head physician, deputy and paramedic.

In addition to medical personnel, drivers with knowledge of the city and suburbs are required. How quickly the on-call team arrives depends on their experience. For a large project, an accountant is hired who will manage the financial part of the business, and dispatchers who receive calls. The role of the latter is suitable for medical students. Young professionals are familiar in theory with the symptoms of diseases and will be able to choose the right mobile team.

Eventually

When opening your own ambulance, you should understand that you will have to invest a lot in the business. The company will pay off not earlier than in 2-3 years. Recruiting regular customers is difficult, as trust in doctors comes with time. When investing 5-10 million rubles in a business, do not forget that first aid should serve people. Therefore, any savings can cost you the collapsed reputation of the company, and someone - life.

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Private provision of paid medical services is gradually replacing public medicine. There are many reasons for this, the main one is the low quality and inefficiency of municipal institutions, whose employees, due to low salaries, are infantile and indifferent in the performance of their duties. This also includes the general neglect and poor funding of the medical sector by the state, which forces staff to work on old and worn-out equipment, using cheap and low-quality drugs.

This did not pass by the ambulance, which is now represented by leisurely collapsing GAZelles, in which doctors and paramedics are forced to work for the minimum wage - it goes without saying that they have no motivation. Private medicine is flourishing, pensioners out of habit and the poor are turning to municipal institutions, while the middle class is actively beginning to use the services of private individuals. Entrepreneurs independent of the state are also beginning to open such an integral part of the healthcare system as an ambulance.

The biggest difficulty in such an undertaking is not the fight against competitors. No, of course they exist, especially in large cities, where you won’t surprise anyone with such a practice, but after having previously studied the situation on the market, you can decide whether it is worth doing such a thing; as a rule, private ambulance services are provided by only a few companies, the capacities of which may not be enough for the whole city; in smaller cities and provinces, such services are often not available at all.

Still, the most difficult thing is the clash with bureaucrats, who will have to obtain permission for such activities. You can not think that an ambulance requires fewer documents during registration, and registration is not so time-consuming. Here are the same requirements as for the opening of a private clinic.

The first step is to hire staff. It is optimal to have five teams that will be on duty around the clock waiting for calls, therefore, calculations are made for five ambulances. The schedule should be in shifts, it is supposed to work in two days, that is, you need to hire 15 fully equipped crews. Each of them has 3 people: a driver, a doctor and a paramedic.

Next, you need to hire dispatchers - 3-4 people, depending on the work schedule, while simply taking former taxi service employees or, in general, just people from the street is by no means possible; the dispatcher must be at least an experienced nurse or nurse in order to quickly assess the situation on the other end of the line and correctly complete the crew, understanding whether the person called with a real illness or the caller has problems with suspiciousness or hypochondria, and also filter out hooligan calls.

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Accounting can be transferred to third-party companies - it will be much cheaper, and accounting in the medical industry requires highly qualified specialists. In a stationary room, in addition to dispatchers, a mechanic and an orderly will have to be on duty, and the head physician, a person with a higher medical education who has worked in this field for at least five years, is obliged to manage the entire organization. The same applies to the doctors of the ambulance teams.

When contracts have been concluded with all medical employees, you can contact the Federal Service for Surveillance in Healthcare. After paying the fee for considering the possibility of obtaining a license (it is 6 thousand rubles), you will have to provide a full package of documents, namely:

Copies of employment contracts with employees who will provide medical services and hold managerial positions, copies of their work books or other documents confirming the employee’s five-year experience, copies of diplomas of graduation from a higher educational institution in a medical specialty.

Copies of all contracts for the sale or lease of premises and equipment, including ambulances, or other documents confirming the right to use them. For premises, in addition, there must be permits from the fire and sanitary and epidemiological services. Like the documents from the previous paragraph, these must be notarized.

Copies of the certificate of registration of a business entity; optimal registration of a limited liability company indicating the code (OKPD 2) 86.10 Services of hospital organizations.

The waiting period for a decision on granting a license can be up to forty-five days, which can negatively affect the staff, who wait for a long time with the entrepreneur for a decision, already being officially established, but not entitled to work. There is no official way to rush people from the ministry ...

We must not forget about the registration of cars in the traffic police, where they must not only be registered, but also given permission to use flashing beacons, which will give priority in traffic relative to other drivers. They will also require copies of certificates of registration of a legal entity, a copy of the medical license itself and check the compliance of the beacon and sound signal with the established standards. If the decision in both instances turned out to be positive, you can get to work.

To do this, there should be a small room where the teams are on duty. You won’t have to seriously equip the premises, a hospital in such a business is not expected, a small warehouse for equipment and medicines and a waiting room will be enough. But here the adjacent territory should be sufficient for parking and servicing five cars.

The rent of such buildings will cost at least 150 thousand rubles a month, this should also include utility bills (5-10 thousand, depending on the area of ​​\u200b\u200bthe parking lot and premises, as well as whether the reception and call waiting point is based on a territory secured by private enterprises) . In addition to the above, a bathroom must be organized on the territory of the enterprise, including in the garage, cars must be constantly kept clean, including the outside. In addition, every twelve hours they must be inspected by an experienced and employed mechanic for breakdowns and malfunctions, the car must be guaranteed to reach the client and, if necessary, take him to the place of further treatment. In case of detection of any deviations, the car mechanic must promptly eliminate the problem that prevents the vehicle from entering the line; if this cannot be done on site, the transport must be sent for repair as soon as possible. It is best to equip a full-fledged workshop, this will save you from unnecessary trouble and lost profits, not to mention the failure to provide assistance to those in need.

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The crews themselves are divided according to their functions, three cars must be linear, that is, provide standard emergency medical care, one more is allocated for resuscitation and intensive care brigade. But in the case of the employment of specialized teams, the linear ones must be quickly re-equipped in order to provide the necessary services. The team, and hence the entrepreneur, is responsible for the person at the time of his transportation, as well as for the treatment provided, but if the patient is transferred to the clinic, then all responsibility is removed from the team at the time the ambulance doctor signs the placement of the client in an inpatient medical facility.

The most careful consideration should be given to the equipment of cars. A novice entrepreneur has a choice: to purchase products from the Russian automobile industry or foreign ones. "GAZelles", "Sables" and similar products of the Russian genius of the automotive industry have a cost of 500 thousand rubles, while some companies offer to buy a car already painted and equipped with flashing lights. The quality of such cars is well known, but they are easy to repair, it is not difficult to find craftsmen to service this equipment, and spare parts are inexpensive.

However, potential clients will perceive the ambulance on the UAZ in the same way as the public service, that is, negatively, and there will be less trust in such doctors, which means they will call less often. Therefore, there is an alternative - chic-looking foreign-made cars, silent when driving, comfortable and respectable; but their cost starts from one million rubles for the simplest models (Peugeot Boxer, for example). What exactly the crews will drive is decided by the entrepreneur himself, Russian cars are savings, foreign cars are prestige.

It is necessary to point out one more important fact: when obtaining a medical license, this can play a role, the state requires a high level of services provided from private traders. When a fleet of vehicles has been identified and purchased, it is possible to proceed with the internal equipment of mini-hospitals on wheels. Here is what should be in a standard ambulance according to the legal documents of the Russian Federation:

Two medical boxes - the main one and with the birth and resuscitation kit.

Electrocardiograph.

Defibrillator with electrocardioscope.

Two ventilators.

Inhalation anesthesia device.

Glucometer or glucotest.

Tonometer and phonendoscope.

Sets of tires and head holders.

Vacuum mattress.

Two types of stretcher.

Wheel chair.

Receiving device with a stretcher.

Tripod and oxygen tank.

Aspirator and directional lamp.

In addition, a huge list of medicines will be required, the work of the ambulance is fully regulated by the Order of the Ministry of Health of the Russian Federation dated 03/26/1999 n 100 (as amended on 06/10/2010) "On improving the organization of emergency medical care for the population of the Russian Federation", which indicates not only the necessary equipment of the brigade, but and the requirements for its crew and ambulance work in general. It is best to recruit personnel who have experience working directly in the emergency ambulance service, especially for the driver, who must know and navigate the city perfectly.

In general, cars do not have to return to the base after a call, they can be dispersed throughout the city districts in order to promptly arrive at the client, and the dispatcher should monitor their location. In addition to the above equipment, the vehicle must be equipped with a walkie-talkie to communicate with the dispatcher and other vehicles, furniture for placing medicines and bedding: pillows, a blanket, a set of linen, which ideally should be changed every time after the next call.

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An important point is the equipment of the dispatcher, whose conversations with patients should be recorded, the dispatcher must work in a special program, where all data on incoming calls is entered. Both he and the ambulance team must keep strict records of the services performed, all this is transferred to higher medical institutions within the time limits specified by law, upon receipt of a license, it will be reported to which department the documents will have to be submitted.

Now you can calculate the initial investment:

Registration of the form of a business entity, obtaining a license for the provision of services of hospital organizations, registering cars with the traffic police and obtaining permits for using a flashing beacon - 50 thousand rubles (it is better to have additional funds in stock).

Renting a room with a garage and utility bills - from 160 thousand rubles.

Purchase and equipment of cars. If you buy foreign-made cars, then 5 million will be required only for the cars themselves, while another 100 thousand will have to be invested in each for equipment - 5 million 500 thousand rubles.

Staff salary. It comes from the calculation of fifteen teams (driver, doctor, paramedic), dispatchers, chief physician, mechanic, orderlies. Such a huge staff will require a significant material fund and will become the main item of expenditure every month - 1 million rubles.

Equipment of the rest room and receiving calls; this includes furniture, appliances, equipping the garage with the most necessary (one repair box is enough), establishing communication between all employees and with all medical institutions in the city, as well as buying a quick-to-remember phone number - 150 thousand rubles.

The total amount of the starting capital should be rounded 7 million rubles. The advertising campaign should be considered separately. The main clients of private ambulances are wealthy people who are ready to pay for quality services, so information should be conveyed to them first of all. These should be business cards in private and paid clinics, advertising posters in relevant medical institutions, as well as advertising in the city and on local television and radio. It’s not worth it to conduct a full-fledged marketing campaign in municipal hospitals, everyone who could afford it has long been treated in private clinics, but it’s still worth leaving information about yourself in public institutions - it will be enough information leaflets that will cover a certain percentage target audience.

An important point is cooperation with insurance companies, the revenue from the implementation of services included in the voluntary medical insurance package may exceed the income from ordinary calls. VHI policies are now issued by many enterprises to their employees, with all costs paid by the employer, which allows a large percentage of the population to be registered in such a program and receive free assistance for them. The entrepreneur will receive his funds from the insurance company, albeit with some delay, but steadily. At first, you will have to contact all insurance companies with a proposal for cooperation; if there are few competitors in the city, they will quickly conclude cooperation, but otherwise they may refuse, motivating them with already concluded contracts. An insurance company is unlikely to want to provide its policies with several ambulance services - it is not profitable.

In addition to the services of providing emergency care to patients, additional services can also be introduced: transportation of bedridden patients, including those outside the same locality, doctor's consultations, duty at various events and holidays. In the future, such a service can develop, turning into a medical consultation or even a treatment center.

Despite significant investments, such an undertaking, in the case of a competitive and competent organization, will pay off within a year or two. One ambulance team makes an average of five visits to patients per day, while in federal cities the amount of one call alone can reach four thousand rubles. In other cities, the prices for services are much lower, but it is quite realistic to receive at least two thousand rubles from one patient already in net income. Thus, the monthly amount will be one and a half million rubles, operating profit - 340 thousand rubles. If you use the program of the simplified taxation system, then the net profit per month will be about 290 thousand rubles.

Of course, it will be possible to receive such an amount only a few months after the start, and only if the level of competition is acceptable. Without a preliminary study of the market, you can be completely without orders, so before you start organizing a private ambulance, you should find out all possible information about customers and whether they fully satisfy the demand for this type of service.

Matthias Laudanum

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Paid ambulance Moscow and region. Call in Moscow - 3450 rubles.

Commercial ambulance in Moscow - always in touch

Paid ambulance SkyMed LLC is an independent specialized service that provides pre-medical and medical care in Moscow and the region. We are always in touch, you can call the brigade at any day and time of the day.

Despite the fact that calling a private ambulance is paid, if someone needs medical assistance on the way to the client, the doctors will provide it immediately and free of charge. In addition to standard services, the company can order:

• ambulance duty on holidays, competitions;
• transportation of patients.

The paid ambulance service includes 20 brigades, among which there are resuscitation teams specializing in neurological, traumatic and childhood diseases. The carriages are equipped with modern equipment to provide emergency medical care and resuscitation. Transport, on which private ambulance doctors go to a paid call, regularly undergoes maintenance, which eliminates the possibility of a breakdown on the way.

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For all doctors of SkyMed LLC

Very often in recent times from the media it has become audible about the development of private business in our country. About the conditions created for this, about supported projects, successful startups, etc. Is that how things really are? Private security services, private banks, private emergency medical services. What else can we expect in the future?

The state continues to give into private hands those types of business that, until recently, seemed to be considered under the "hood" of its monopoly. This is the case, for example, in housing and communal services, in the educational sector, the insurance system, in the provision of medical services, and in many other industries. What came of it? In some ways, people began to benefit from this, with something, on the contrary, it became much more difficult. Everyone decides this for himself. But one undoubted plus is still immediately visible - this is the development of private business.

If you look into the same area of ​​medical services: an ordinary ambulance is often in no hurry to come to calls (unfortunately, even emergency ones) to patients. But a private emergency medical service (be sure!) will be at your place within a few minutes after the call. But the road in most cases is exactly the same. The difference is only in the motivation of the staff. Well, in the organization of business, from the point of view of which we will consider this type of entrepreneurial activity.

What is a private emergency medical service

I think that we need to recognize that the health care system that we inherited from a “different” country is on the verge of decline. Private medical clinics have the most modern expensive equipment that meets world standards, private medical institutions employ more qualified personnel who are more responsible in their direct duties, as I said, even private ambulances arrive at incoming calls faster. I am writing all this not as a reproach to those people who selflessly work in state institutions. Thanks to them for their work!

In principle, a private structure is practically no different from a municipal one. It's just that here a noble goal is to help sick people, saving lives is organically intertwined with a more prosaic one - making a profit. By the way, almost a third of private medical institutions belong to people who are very far from medicine. It is not necessary to have a medical education to organize such a business.

Private ambulance services look something like this (the difference in different institutions is negligible):

• Providing medical consultations, examination of patients, diagnosis.
• Provision of emergency medical care on the diagnosis of the disease.
• Transportation of the sick who are unable to move independently.
• Observation of persons requiring vigilant medical attention.
• Carrying out procedures aimed at detoxification (withdrawal from alcohol binge, help to drug addicts).
• Servicing public events.
• Provision of additional medical procedures in the emergency center (electrocardiogram, ultrasound, appointment with specialist doctors, analysis of tests, some types of therapeutic massages, etc.).

Who uses private ambulance services

How to determine the target audience of your business can be read. The main clients of the private "ambulance" are people with high and middle incomes. This also includes those who are dissatisfied with the quality of services provided by the state structure. Plus those citizens who do not want to disclose their illness (this category includes alcohol and drug addicts).

And of course, people who want to be sure of the quality of medical services turn to "private traders". Among other things, a private emergency medical service may have contracts with many private clinics, so the patient himself can choose which “hospital” to take him to: private or public. Now let's move on to the "technical" aspects of organizing a business.

Obtaining a license to carry out medical activities

Medical services are a very sensitive "field" for doing business, so you need to prepare for thorough checks by the regulatory licensing authorities. The form of doing business in this case is only acceptable for an LLC (you can find out how to register a limited liability company).

Obtaining a perpetual license to provide medical services in our country is carried out by Roszdravnadzor. The required package of documents includes:

• Licensing Application.
• Statutory papers of LLC, certificate of registration, and other documents relating to organizational and legal activities.
• Certificate, confirming the right to own a room for an ambulance center.
• Register of medical special equipment, inventory, and tools, and certificates of conformity for all this.
• Copy of conclusion issued by Rospotrebnadzor.
• Documentation confirming education, qualifications, etc. for each employee.
• Proof of ownership to the car room.
• Payment receipt state duty.

A complete list of all necessary documents, requirements for equipment, maintenance, and operation of medical institutions can be found in the resolution "On Approval of the Regulation on Licensing Medical Activities" and in the SanPin document "Hygienic requirements for the placement, arrangement, equipment and operation of hospitals, maternity hospitals and other medical hospitals".

Organizational and technical aspects of a business idea

Without going into details of the purchase of specialized medical equipment installed at the stations of private ambulance medical centers, I will tell you about the minimum configuration of the fleet of private ambulance teams. You can start your own business with only one car in the garage, with the ability to quickly re-equip it for a specific call to a patient with a specific diagnosis.

But the best option is three cars: an ambulance, a pediatric one, and one for line crews, designed for general calls. The "standard" set of equipment for each ambulance contains:

• Apparatus for artificial lung ventilation.
• Mandatory defibrillator.
• Modern heart monitor.
• Perfusor (electronic syringe pump) in the amount of two or three pieces.
• Oxygen machines.

In addition to special equipment, you need:

• Mini-refrigerators for medicines.
• Safes for storing medicines subject to strict accounting.
• walkie-talkies which must be installed in every car.

A complete list of tools can be viewed in the "List of Equipment for the Mobile Ambulance Brigade".

Working staff of a private ambulance station

Usually, the work schedule of a private medical service does not differ from colleagues "in the shop" in the public health system: a day after three. In addition to physicians: medical specialists, nurses, paramedics, etc., who, by the way (most often it happens) can combine work in public medical institutions and private medical institutions, you will need:

• Drivers with excellent knowledge of the city (the best option is candidates who worked in a taxi or in an ambulance).
• head physician. This position requires knowledge of business administration, managerial abilities and extensive experience in this area.
• Accountant. Without him, nothing.
• Dispatcher that receive and record calls. Junior medical staff, students of medical universities are ideal for this position.
• Nurses and nurses.

A Brief History of the Ambulance

The state ambulance knew different times. In Soviet times, it was almost more difficult for a doctor to get a job in an ambulance than in the then prestigious Sverdlovka. In the post-perestroika period, cars with red crosses lined up in columns near the Smolny and honked so that it was audible on the Palace. During the crisis of 1998, specialists were fired from the state ambulance in droves, and cars stood idle near the walls of substations - there were not enough medical teams.

At the same time, at all times, ambulance doctors earned more than their colleagues, and they were the first to start the fight for the rights of medical workers, because they knew that no one could do without them. Of course, it was blackmail, but the authorities were forced to make concessions.

Perhaps, thanks to them, participants in the events of 10 and 15 years ago, today in St. Petersburg the state ambulance service is equipped with well-equipped medical transport, the salary of employees is almost the average in the city (paramedics have 16-18 thousand rubles, doctors - 25 thousand).

In parallel, back in 1996, a market for paid emergency services began to form in the city. Today there are four private ambulances in the city (Koris, Petersburg ambulance, EMC, Priority), another 12 ambulance services exist at commercial clinics, 3 at federal ones.

It is clear that the state-owned City Ambulance station is also working. If, according to rough estimates, there are a total of 60 cars in all the above-mentioned companies, then almost 200 cars go to the line in the city ambulance every day. Plus - about a hundred cars at the district ambulance offices operating at polyclinics.

When the ambulance is in a hurry, but not in a hurry

We have always had a difficult relationship with the state emergency service. We managed on time, saved a person, we state for granted. Late, not saved - we curse what the light stands on.

Doctors in the apartment do not put on shoe covers, refuse to carry a seriously ill patient into the car, they are hospitalized in the wrong hospital that they would like ... There is only one answer to all these claims - like everywhere else, it all depends on the human factor. In one case, two men will watch how a woman drags an emaciated, dying mother wrapped in a blanket into a car from the 6th floor, in another, two young paramedics carry an overweight woman with a stroke on a chair, because the stretcher cannot be deployed in a narrow flight of stairs ...

One ambulance will stop near a person lying on the sidewalk, and if the team is in a hurry to call, they will call another ambulance by radio, and it will either go to the call or pick up the patient from the street. Another team of doctors will rush past, because in the regulatory documents there is not a single line about the mandatory provision of assistance to a patient to whom no one called them.

Are you going to be taken to the Alexander Hospital, although the 31st is closer? This is not the machinations of doctors. Hospitals like the Center for Advanced Medical Technology do not always report free beds at the hospitalization desk, especially at night when there is a high risk of acquiring an alcoholic patient with a trauma. As a rule, they take you to the nearest hospital, but if instead of, say, the 20th hospital, you want to go to the Mariinsky hospital and there are free beds, you can persuade the brigade to take you to Liteiny. Sometimes, however, it is necessary to "compensate for the consumption of gasoline." (Just in case, a round-the-clock telephone for complaints from the Ambulance Service 571-45-04.)

The right to choose

In general, we are already used to the fact that calling an ambulance is a kind of lottery. And if we want to get it for free or shareware, then we put up with the footprints on the floor, and with the hospital to which they will be taken.

If you do not want to put up with this, there are two options. The first is for those who live next door to the hospital or can get to it faster than the ambulance arrives and figure out what happened. In a critical situation, you should contact the emergency room of the nearest hospital, in large hospitals they are now called emergency departments, and they are obliged to provide you with it. If trouble happened to a child, then in an adult hospital he should first be helped and only then sent (transported) to the nursery.

The second option is to contact the paid ambulance service. Strictly speaking, according to the law, emergency medical care on the territory of the Russian Federation is one of the state guarantees. It is provided free of charge, regardless of the presence of citizenship, identity documents, and a health insurance policy. Therefore, as Alexey Gaplikov, director of ER Service LLC (works under the Petersburgskaya ambulance brand), says, in fact, the patient pays for a commercial ambulance not so much for a medical service as for a service:

For the first time, a person begins to look for a telephone number for a commercial service after an unsuccessful experience of communicating with the public ambulance service. Someone was offended by her employees, someone was misdiagnosed or refused to be taken to a hospital ... Having used the services of a private service once, a person comes back to us again, because he knows exactly what he pays for. And this is not only a clean floor in the apartment (doctors always take off their shoes or put on shoe covers). The paid ambulance service provides a variety of services at home - from consultations of specialists (a surgeon, a traumatologist, a neuropathologist ...) and taking tests to medical support and transportation of patients to any hospitals in the city or delivering patients from other regions and countries home.

Moreover, if the dispatcher of the city ambulance suddenly decides that the call is non-core and should be served by the district ambulance, he will not accept it, but will send it to the district ambulance, and then send it to the local therapist. A commercial one will leave on any call, even if a person is panicked due to a cold (suddenly swine flu?). As for the qualifications of doctors, all services employ certified specialists who have worked for more than one year in the city or district ambulance services. Moreover, 60 percent of doctors in private services are part-time workers: they are on full-time duty in the state ambulance and part-time in the private one.

Few decide to go into a private structure - in this case, all according to the same law, they are deprived of benefits that attract specialists to this service no less than a decent salary.

Who drives faster

Since the ambulance service in St. Petersburg was divided into city and district, and the first is provided at the expense of the city budget, and the second at the expense of the Territorial Compulsory Medical Insurance Fund, ambulances at polyclinics, which were previously called ambulances, also work around the clock.

Doctors of the city service go to the patient only if he is in a state that threatens life and health. These are injuries, sudden acute illnesses - convulsions, coma, loss of consciousness, asphyxia, "acute abdomen", serious disorders of cardiovascular activity, poisoning, childbirth and any violations of the course of pregnancy, childhood diseases, mental disorders. It does not matter where the patient is: at home, on the street or at work.

In all other "home" cases, you should call the district "ambulance", which you can wait from morning to evening, because there are 2-5 medical and paramedic teams for each district in St. Petersburg. According to statistics, there are much more complaints from patients of district services than from patients of the city ambulance. And by and large, if we consider a private ambulance as an alternative to the state one, then it most often “replaces” the district service.

We do not consider ourselves competitors of the city ambulance station, says Lev Averbakh, director of the largest private company in Russia, KORIS-assistance. - If a person broke his leg on the street, we will not be able to arrive faster than the city ambulance. Or if the dispatcher of the insurance company receives a call from the insured under VMI and understands that the patient is in a crisis condition, he will first of all call “03”, and then send a private service team. The city ambulance has 27 substations in the city, and the likelihood that it will get to the patient faster is obvious. Even our company, which has 15 cars in different areas, does not always have such an opportunity. Our arrival time under the terms of the contract with insurance companies is 30 minutes, and the state should get to the patient in 15-20 minutes. But we have great advantages in comparison with the district "ambulance", which, for example, during a flu epidemic, you can wait for several hours. Another important advantage of private ambulances is that for us the territorial principle does not matter at all. Within half an hour, private teams of doctors will arrive where they need their help, and comfortably, under the supervision of a doctor, they will take them even to the Leningrad Region, even to Finland (although more often the opposite happens - we have to bring patients home from other regions and countries).

The market is big, there is enough work for everyone

The first private ambulance in St. Petersburg first appeared in 1996. The EMC company was created to serve VIP clients and foreigners. Since then, the situation in the medical services market has changed, and EMC now has its own outpatient clinic. Its director, Tatyana Romaniuk, says the emergency service is still her favorite brainchild: “We still focus on VIP service. But since large commercial centers (MEDEM, American Clinic, Euromed) have their own ambulance services focused on their patients, representatives of foreign corporations, this market segment has become extremely competitive, and we understand that the development of our service on such a narrow segment is impossible. In connection with the “restructuring” of the market and the crisis, solvent patients mostly go to VHI, and we are actively cooperating with insurance companies, although, as you know, their patients are different. Therefore, now we have changed our strategy and are entering other market segments.”

Probably, the company "Priority" in this sense is easier. It was created from scratch by doctors with experience in urban and commercial ambulance services, graduates of the Military Medical Academy just a year and a half ago. They do not know how it was when it all started, because Priority entered the market in a crisis, but today they are already thinking about purchasing a sixth car, and this is a very expensive pleasure.

The commercial director of the company, Roman Topolskov, believes that competition in the ambulance service market is not terrible - it is so great that there will be enough work for everyone: “Provided that public ambulance services do not dump, providing paid services similar to those provided by private companies” .

Business becomes unprofitable

Indeed, the competition in this market is still low. Until recently, the creation of emergency services at commercial clinics did not really scare the companies that made emergency medical care a business. Services with one car, created as auxiliary units to serve their own patients, at MEDEMA, the Polyclinic Complex, Skandinavia or the Admiralty Shipyards, firstly, will not occupy a large segment of the market, and secondly, their seeming lower cost simply “dissolves” into the cost of those medical services that a patient receives in a particular clinic.

Frightens another. The times when “anxiety on the face and magnesia in the syringe” were enough for the patient to “recover” remained in the memoirs of Alexander Rosenbaum. Public ambulance services are now equipped no worse than commercial ones. 2 billion 685 million 722 thousand rubles were allocated for the city program for improving and developing the material and technical base of the institutions of the ambulance service of St. Petersburg for 2007-2011. And today, city ambulance teams go to patients with defibrillators, ventilators and life support systems…

Commercial services invite doctors and paramedics to work, focusing on the salary in the state ambulance - after all, they must pay more, otherwise you will be left without good specialists. That is, now, in order to provide medical and service services of a better quality than in the state ambulance, a lot of money must be invested.

“This business has become unprofitable,” says Aleksey Gaplikov, director of Petersburg Ambulance. - It is created to work out and get tired.

Nevertheless, this does not stop state medical institutions that create their own ambulance units as self-supporting (paid) services. They work at St. Petersburg State Medical University. Pavlov, North-Western District Medical Center (former Chudnovsky Hospital), Consulting and Diagnostic Center under the Administrative Office of the President of the Russian Federation.

It is clear that the costs of creating and maintaining these services are much lower than those of commercial "ambulances", so they have the opportunity to set prices for their services even less than the cost. Just like the City Ambulance Station, which also has the right to provide paid services. If things go on like this, then private ambulances will have to adapt to work in conditions of fierce competition not among themselves, but with state institutions.

Tale of lost time

A global problem for any ambulance service is traffic jams and the lack of culture among our motorists who are not accustomed to skip an ambulance, even if it is driving with a flasher on. Therefore, the arrival time of a doctor during peak hours is impossible to predict. ER doctors have a professional term - "golden hour". So they call the most precious time during which one who is on the verge of death can still be saved. But if an ambulance arrives to a person who has fallen from a height or to a drug addict who has already turned green from an overdose after 40 minutes, the “golden hour” can be considered irretrievably lost - it should not be taken literally.

And today no one knows how to solve this issue of life and death. At first, there were proposals for the purchase of helicopters for the most urgent cases. But they are still forbidden to fly over the city. Then they decided to get boats to deliver patients by water. But this is expensive and inconvenient - there are no hospitals in the city that provide emergency care, which can be reached by water, which means that the patient must be delivered to them by car and on it - to get with the patient to the boat. The navigation period is only a few months a year, and the maintenance of this vehicle is not cheap. The idea to acquire fast boats was safely buried by the City Ambulance Station and the KORIS company.

So today there is only one way to reduce the idle time of the brigade in traffic jams - to let cars with a red cross pass on the roads. Maybe the hour is not far off when a motorist who refuses to do this will need an ambulance. Statistics show that every third Petersburger needs it during the year.

Top 10 private and public ambulance services in St. Petersburg

"Coris Assistance"

City ambulance station

"Petersburg ambulance"

"A priority"

"Ambulance" EMC

"Ambulance" St. Petersburg State Medical University. Pavlova

"Ambulance" of the North-Western District Medical Center

"Assistance Express"

"Ambulance" of the Consulting and Diagnostic Center under the Administrative Office of the President of the Russian Federation in St. Petersburg

"Ambulance" of the Road Clinical Hospital

Assessing the rating of companies providing emergency medical care is not the most rewarding business. For our metropolis, on the one hand, there are few of them, on the other, they are too different. But for the insurance companies we asked to evaluate the work of emergency services in the city, this did not seem to be a big deal. In their opinion, the second place among private and public ambulance services is firmly occupied by the City Station - it is named among the leaders even by those insurance companies that do not have contractual relations with it. And there is no getting away from this - a lot of money has been invested in the city service in recent years, it is well equipped and can compete with paid services in terms of the quality of the services provided.

The undoubted leader among private structures was the company "Coris Assistance". Almost all emergency companies that have disappeared from the market in recent years have been purchased by Koris. As a result, it has become the largest non-state paid ambulance company. It is chosen as a partner by almost all insurers also for the reason that Koris has its own trauma center. Surprisingly, in fourth place is one of the last companies that received a license in our city for the right to provide emergency medical care - Priority. Having started work in the conditions of the crisis, it became a partner of almost all insurance companies and continues to develop. With such a pace, the day is not far off when it will begin to step on the heels of Koris, in which, by the way, its creators worked as doctors of the Ambulance.

The top 10 includes all the ambulance services, which would be more correct to call departments created relatively recently at federal clinics. Even the ambulance service of the Consultative and Diagnostic Center under the Executive Office of the President of the Russian Federation, which still has very few patients. It is these services that are becoming the main competitors of the specialized ambulance services today, since the cost of their services at the expense of state funding is much lower, they are able to provide St. Petersburg residents with good quality emergency care at lower prices. And for insurers who save on everything in a crisis, this is an important argument.

Until recently, many managers of health insurance companies believed that the success of a business depends on the organization of a single chain - a polyclinic, patient care at home, plus an ambulance. But the top 10 did not include any insurance company that owns such a chain. Probably because they provide services mainly only for their insured. Not only state clinics have taken up the development of the emergency medical care market, but almost all the largest private clinics in St. Petersburg have introduced a service for transporting patients in their own cars. True, the scale is different for everyone. If "Admiralty Shipyards" and "BaltMed" have only one car each, in which the therapists of the same clinics mainly work, then the American Clinic and "Medem" have real teams of medical assistants. True, this does not change the main purpose - to work for their own medical institutions. And this creates problems for companies providing only ambulance services, as it deprives them of wealthy private customers. Namely, they bring the main income.

Today, private medical institutions, including those that provide emergency care, are fighting to abolish the right to provide paid services by public institutions. The main argument is the unfair rules of the game in the market, dumping by state-owned companies. But, judging by the rating, insurance companies (and ordinary St. Petersburg residents) do not care who provides them with this or that service, the main thing is that it be of high quality and the price for it low. Therefore, they stand aside from this struggle, and until it is completed, they willingly use the services of both public and private ambulance services.

Irina Baglikova

Dr. Peter