The Ministry of Health has updated the list of criteria for assessing the quality of medical care under the compulsory medical insurance system

The new list of criteria will come into force on September 1, 2025. According to the general provisions of No. 323-FZ "On the Fundamentals of Health Protection" and No. 326-FZ "On Compulsory Medical Insurance", this order is the main one for conducting medical care quality assessments (MCQA). These checks are carried out selectively by medical insurance organizations or TFOMS in relation to clinics operating under the compulsory medical insurance.

The verification of medical care according to these criteria is supplemented by another list of quality criteria and treatment parameters from clinical recommendations for specific nosologies. As in the 2017 version of the order, in the new document the criteria are formed based on clinical recommendations (in the case of the new regulations - those valid as of January 1, 2025).

The authors of the order have divided more than 4.2 thousand unique criteria into 21 general sections by groups of diseases and conditions, for example, sections for assessing the quality of treatment/diagnosis for infectious diseases, neoplasms, blood diseases, hematopoietic organs, mental disorders, diseases of the nervous system, eyes, circulatory system, and so on. Separate sections concern external causes of morbidity and mortality and factors affecting the health of the population and access to healthcare institutions.

The criteria are classified depending on the type of medical care, nosology, type of diagnosis, treatment or rehabilitation and have the form “Completed...” for examinations, tests, operations, “Prescribed...” for drug therapy.

At the stage of public discussion of the draft order, some professional, patient communities and doctors spoke out against the basic principles of the document or indicated that it lacked criteria. The regulator took some of the proposals into account. Thus, the Federal Scientific and Practical Center for Palliative Care of Sechenov University pointed out the lack of criteria for assessing the quality of palliative care for chronic pain syndrome in adult patients. The section was included in the final document.

However, claims concerning the quality assessment system based on the “completed/not completed” principle, as well as the lack of deadlines for the provision of medical care and specific markers of the success of medical procedures, remained unaccounted for.

The Ministry of Health started talking about updating the order on the eve of 2025, when, according to Federal Law No. 323, all medical care began to be provided "based on clinical recommendations." The order on quality criteria became necessary at least to legitimize the most general criteria of the CR, since the recommendations themselves are not formally regulatory acts.