Medical Control

Medical Control, a term meaning that part of medical care for insured individuals which is directed toward establishing the insured's illness, certifying the necessary period of exemption from work, indicating measures for restoring work capacity, and supervising the implementation of these measures. Medical control arises with the introduction of social insurance and is necessitated by the need to verify both the validity of the illness and its nature and duration, and to hasten the return to work capacity. Before the October Revolution, medical control in our country pursued purely fiscal goals of protecting the funds of sick benefit funds; in the first years of the revolution, the tasks of medical control were mainly reduced to combating absenteeism from production; subsequently, medical control becomes an organic component of protecting the health of the working person, preserving and restoring his work capacity, and thereby preserving the funds of social insurance. Abroad, medical control exists in more simplified forms. The physician of the fund only confirms the fact and nature of the illness. Since sick benefit funds in Europe to this day almost universally do not compensate patients for the first 3-4 days of illness, ambulatory patients are of no particular interest to European insurance. Both the tasks and organizational forms of medical control and the relationships between insurance and health authorities in this area have changed repeatedly after the revolution (for a more detailed history, see Social Insurance). At the present time, the tasks of medical control are formulated as follows: 1) establishing the presence of temporary loss of work capacity due to illness or injury and exemption from work for the period necessary to restore health; 2) resolving questions of the most rational system of measures aimed at restoring the work capacity of insured individuals; 3) supervising the exemption of the insured from work and the implementation of measures to restore work capacity. The right to grant leave to the insured is entirely in the hands of the treating physicians of health authorities. Supervision over the granting of leave is concentrated in the organs of social insurance (resolution of the CEC and Sovnarkom of the USSR of March 4, 1927). Short-term leaves for temporary disability of insured individuals are granted individually by treating physicians of medical and medical-prophylactic institutions of health authorities. The physician examining the patient for diagnosis and treatment simultaneously issues the examined person a certificate of disability in the form of a sick leave form (see). Long-term leaves (more than 5 days) are granted by medical consultations, i.e., specially organized for this purpose in medical and medical-prophylactic institutions by medical commissions consisting of the treating physician and a consulting physician (trusted physician) of the insurance fund. Medical consultations grant leaves for illness for a period of 5 to 10 days and leaves for pregnancy; examine cases that are doubtful for treating physicians and complaints of patients about the decision of the treating physician regarding leave; determine the need for additional methods of examining the insured, establish the presence of signs of persistent disability (invalidity, see) for referring insured individuals to medical expert bureaus (see Medical Expertise). Disagreements and doubts of physicians in medical consultations are resolved by physician-control commissions of insurance funds, consisting of a chairman and a consulting physician appointed by the insurance fund, and a physician representative of the local health authority. The physician-control commission also decides the question of sending the patient for special treatment in another city (according to the conclusion of the medical consultation); examines disabled persons undergoing treatment in stationary medical institutions; determines persistent disability (invalidity) in localities where there are no medical expert bureaus, and performs the functions of medical consultations in localities where the latter have not been established. An important component of medical control is home supervision over insured individuals on leave for temporary disability. Home supervision is carried out by members of physician-control commissions or special physician-supervisors of insurance funds. The physician-supervisor verifies the patient's compliance with the physician's prescriptions, clarifies the influence of the housing and living conditions of the insured on the causes of illness and the success of treatment, accepts complaints from the patient against social insurance (insurance fund) and health authorities, and determines the correspondence of the patient's condition to the period of leave granted to him.

M.

Zeldes.