How to get a quota for a free operation - tips on getting quotas for different groups of the population. Quota for cancer treatment How to get a quota for cancer treatment
The state provides assistance to citizens who are terminally ill dangerous illnesses. Yes, for treatment oncological diseases a quota is allocated that allows you to receive (GMP).
What is a quota and who is eligible for it?
The concept of “quota” refers to a service that represents the provision of medical care to a patient free of charge with the provision of a place in the hospital. People suffering from serious illnesses threatening their lives.
There is a special federal list diseases for which treatment benefits are provided. The list includes dozens of items, and cancer is one of them.
The list of types of VMP and the procedure for its provision is prescribed in the Decree of the Government of the Russian Federation of December 19, 2016 No. 1403, as well as in the order of the Ministry of Health of the Russian Federation No. 1248n.
In the presence of compulsory medical insurance policy assistance can be provided to any citizen of the country if there are medical indications.
The quota for cancer treatment is financed from federal and local budgets. The procedure for providing benefits is regulated by Order of the Ministry of Health No. 1248n.
How to get the service
The amount of financial assistance from the state is strictly limited. In addition, benefits for free treatment should be distributed among clinics throughout the country. How to get a quota for oncology treatment?
First of all, it is worth finding out how many quotas are allocated for the current year. To do this, you can contact the Department of Health. Information about the availability of benefits is also provided at the medical institution itself that provides services under the quota.
Quite often, situations occur when benefits end and a person is deprived of the opportunity to receive qualified assistance for a whole year. Do not despair - perhaps the quotas remain in another medical institution.
VMP is provided by federal centers and special clinics in various regions of the country. Order of the Ministry of Health of the Russian Federation No. 967n dated December 31, 2014 contains a list of federal centers providing medical assistance (not included in compulsory medical insurance) at the expense of the federal budget. On the website of the Compulsory Medical Insurance Fund you can find lists of all medical institutions (federal and private) operating in the compulsory medical insurance system and providing medical care.
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Where to start
An oncologist or therapist can provide such a document. The patient can contact both the local doctor from his clinic at his place of residence, and a specialist from the medical institution he is interested in.
If a decision has been made to conduct an initial examination with an oncologist, then you should decide on a clinic, prepare a passport and medical insurance. If the patient has already undergone any tests, the results will also be useful to him.
Having established an accurate diagnosis, the doctor will make an extract from the medical history and prepare a referral for issuing a quota.
Do you need information on this issue? and our lawyers will contact you shortly.
Required documents
- Application for assistance.
- Passport and medical insurance policy.
- SNILS.
- Consent to the processing of personal data.
- For pensioners - pension certificate (and photocopy).
If the patient is under 14 years of age, he will need a birth certificate and a copy of his mother or father’s passport to receive benefits.
Where to contact
All subsequent actions depend on whether the VMP required by the patient is included in the basic compulsory medical insurance program. You can find out about this from the list specified in Decree of the Government of the Russian Federation of December 19, 2016 N 1403.
If the required type of assistance is included in the list, the documents are sent to the medical institution (federal center) where the treatment will take place.
The documents are sent by the clinic or cancer clinic within three days.
If the necessary assistance is not included in the list, the documents are sent to the VMP department of the regional health department at the patient’s place of registration. The decision is made within 10 days. If the answer is positive, then the patient is given a coupon to receive VMP.
If necessary, the patient is sent for further examination.
I assign each coupon registration number, which allows you to track the status of the queue for high-tech medical services.
Do not forget that the provided benefit for medical care does not relieve the patient from waiting in line for hospitalization at the medical institution of his choice.
If all beds in the hospital are occupied, the patient is put on a waiting list. But thanks modern technologies, anyone can view the status of the queue for hospitalization and for receiving medical treatment on the Internet online.
What to do if they don’t give you a direction
Attending physician various reasons may refuse to issue a referral to the patient. In this case, the patient can independently contact the selected federal center for assistance. You need to take with you:
- medical documents confirming the diagnosis;
- extracts from specialists;
- results of studies (analyses).
The quota committee of the selected center makes a decision based on all documents. If the outcome is positive, the patient contacts the department of the Ministry of Health of his region for a coupon to receive VMP.
Contact the Ministry of Health directly possible in the following cases:
- The patient does not live in the Russian Federation.
- There is no registration at the place of residence.
- The regional Ministry of Health refused to issue a coupon.
Quota deadline
A quota for cancer treatment is provided using a special coupon, which is given to a person upon registration as a cancer patient. The period for receiving medical services using a coupon is not defined.
After receiving the quota, the medical center within 7 days makes a decision on hospitalization of the patient.
The date of hospitalization depends on several conditions:
- the patient’s condition and the need for urgent surgery;
- availability of budget (preferential) places.
If you don't currently have a cancer benefit, you may be able to get it in the future when benefits become available again. This is the rule - benefits are provided on a first-come, first-served basis.
Receiving a voucher for VMP does not mean that all services will be provided free of charge. Some services will need to be paid for by the patient himself. The patient should seek clarification from the regional department of the Ministry of Health or the insurance company that issued the compulsory medical insurance policy.
If the patient requires urgent Care and treatment, he can pay medical services on one's own. By then presenting certain documents to the responsible persons at the Department of Health, the citizen will be able to reimburse their costs.
March 20, 2017, 21:02 March 3, 2019 13:49 
What is high-tech medical care?
High-tech medical care (HTMC) is a treatment that uses new or unique methods, modern equipment, expensive drugs. Its provision requires highly qualified medical personnel.
It would be difficult to list all types of VMP; they are usually grouped by areas. It can be surgical operations on organs abdominal cavity And chest, neurosurgery, oncology, treatment of severe burns, cardiovascular, gynecological, gastroenterological, otolaryngological and eye diseases, organ and tissue transplantation, etc.
Since 2014, VMP began to be transferred to the compulsory health insurance system. In theory, this should make treatment more accessible to patients. However, in practice it is not so simple.
“There are many processes going on at the same time. Along with the transfer of primary care to the compulsory health insurance system, there is an optimization and reduction of beds, the president of the League of Patient Defenders told Miloserdiy.ru Alexander Saversky. “If previously the VMP was a completely independent branch of financing, now, when some were immersed in compulsory medical insurance, and some were left outside, uncertainty arose.”
64 vs 30
To date, the list of types of HFMP included in the basic compulsory medical insurance program consists of 30 groups, and 64 that are not included.
These lists are contained, for example, in government decree No. 1273 dated November 28, 2014
The Moscow City Compulsory Medical Insurance Fund does not recommend that patients independently figure out which list of treatment they need belongs to. “They use complex medical terminology,” the department explained, adding that the same operations for different diagnoses can be financed according to different schemes.
For example, types of treatment such as microsurgical operations on the pancreas, coronary myocardial revascularization, joint replacement, etc. are found in both lists. And the treatment vascular complications diabetes mellitus is divided into therapeutic (it is included in the basic compulsory medical insurance program) and combined (not included). That is, it’s all about the nuances: the use of specific techniques that take into account the condition of this patient. Moreover, each type of VMP has its own code according to the international classification.
For medical institutions, the difference in the provision of medical care from the first and second lists lies in the methods of financing. According to Alexander Saversky, the principle “money follows the patient” does not work in cases where the clinic provides medical care from the basic compulsory medical insurance program. “Therefore, medical institutions have no reverence for VMP, and the attitude towards patients is corresponding,” he added.
How to get VMP?
For patients, the two lists of types of VMP differ in the number of steps that must be overcome before treatment begins. If the disease can be managed without going beyond the compulsory medical insurance, the attending physician immediately gives a referral to a medical institution licensed to provide the desired type VMP. In this institution - be it metropolitan medical Center or a regional clinic - the patient goes through a commission that makes the final decision on hospitalization.
If you require treatment not covered by the basic compulsory medical insurance program, the doctor will first refer you to the territorial health department. A committee to select patients for VMP will be convened there. An extract from her protocol will be sent to the clinic that has not only a license, but also budget quotas for conducting required type treatment. And only after that you will be able to appear before the commission at the “host” organization.
What are quotas? These are funds allocated to certain medical institutions from the federal budget to provide specific types of medical care.
IN Lately the list of clinics entitled to provide high-tech care has expanded significantly. This was mainly due to regional medical centers. On the one hand, the total number of quotas has increased and the chances of timely hospitalization have increased. On the other hand, it has become more difficult to get into federal centers.
Alexander Saversky, President of the All-Russian public organization “League of Patient Advocates”. Photo from website nastroenie.tv
“The regions have a tendency not to release patients in order to keep the money themselves,” noted Alexander Saversky. According to him, federal medical institutions may even be underutilized. “Leapfrog is creepy,” he added.
A patient who definitely wants to be in the best medical center in the capital can directly contact there. Many such institutions have quota departments. They help prepare Required documents and pass the commission.
For example, in the quota department Science Center Cardiovascular Surgery named after. Bakulev was told that a resident of any region of Russia can contact them by providing only an extract about their state of health. If the center’s commission considers that his illness corresponds to the profile of the institution, it will send a call to the place of residence of the future patient. After which you can ask the attending physician for a referral, which you still cannot do without during hospitalization. However, quotas can be difficult: you have to wait for months for them. According to the department, the center was allocated nine thousand quotas for 2015; employees have not yet given forecasts for 2016.
Can they refuse?
A patient may be denied VMP if, in the opinion of the attending physician or the “receiving” clinic, he does not require it for health reasons. In this case, lawyers recommend filing an application with the territorial body of Roszdravnadzor or the Compulsory Medical Insurance Fund.
Another reason for refusal may be the lack of a compulsory medical insurance policy. Then you just need to start decorating it.
But more often than not, the provision of a certain type of assistance is postponed due to a lack of quotas. In such a situation, lawyers advise quickly preparing all the documents and receiving an electronic ticket in order to wait for the allocation of quotas, taking one of the first places in the queue.
If the patient does not want to waste precious time, he can pay for the treatment himself and then apply to government agencies for compensation.
Well, or contact the fund.
For example, in 2014 alone, the Gift of Life foundation spent 42.8 million rubles on treatment and diagnostic examination of children. The Children's Hearts Foundation paid for cardio during the same period surgery in the amount of 31.8 million rubles. Last year, the Zhivoy Adult Assistance Fund helped ten patients undergo expensive rehabilitation, spending more than 2 million rubles on it. In December 2015, Rusfond allocated more than 84 million rubles to help sick children aged from three months to seventeen years.
Even treatment under the basic compulsory medical insurance program or quotas for high-tech medical care requires certain expenses. The patient may need procedures, tests and examinations that are not funded by the government. The clinic may not have the necessary medications or materials, and then you will have to buy them yourself. If a child is sick, his parents will have to pay for their accommodation in the city where the clinic is located. Finally, travel to the place of treatment can sometimes be quite expensive. In this case, the help of charitable organizations may be the only salvation.
The operation quota applies to people who do not have enough money to live necessary treatment. It is issued in compliance with a strict procedure and is not available to everyone.
How can a Moscow resident get a quota for surgery in Moscow?
It is quite difficult for Muscovites and residents of the Moscow region to receive benefits, but if you know the procedure and rules for providing this type of service, then receiving help is possible. It should also be taken into account that priority is first given to a pensioner, a newborn child or seriously ill people.
The most qualified high-tech medical care can be obtained in large cities of Russia: Moscow and the Moscow region, Novosibirsk, Tyumen, Nizhny and Veliky Novgorod, Rostov-on-Don, St. Petersburg, Volgograd, Vladimir, Kaluga, Cheboksary, Kurgan, Vladivostok, Yekaterinburg, Penza, Novokuznetsk, Ulyanovsk, Stavropol, Murmansk, Astrakhan, Yaroslavl, Voronezh, Orel, Vologda, Belgorod, Smolensk, Irkutsk, Kaliningrad, Saransk, as well as Ufa, Krasnoyarsk, Krasnodar, Chelyabinsk, Orenburg, Kostroma, Kemerovo, Barnaul, Saratov, Kazan, Tambov, Izhevsk, Kursk, Kirov, Ryazan, Samara, Omsk, Perm, Ivanovo, Lipetsk.
What is an operation quota and how do I get one?
A quota is a monetary assistance that compensates for the costs of surgical treatment in Moscow or any other region. Quota diseases include:
- operations on the heart and brain (bypass surgery, etc.);
- gynecological and obstetric surgeries (fetal omphalocele, cervical oncology, etc.);
- transplants internal organs;
- transplants hip joint or its prosthetics;
- diseases of the neurosurgical field;
- interventions on the spine (scoliosis, bone fractures, etc.);
- interventions on the eyes (lens replacement, cataracts and other complex vision issues);
- groups of endocrine and hereditary pathologies.
For non-residents
Many are interested in how to obtain a quota for an operation in Moscow for nonresidents and temporary registration holders; this issue is complex and controversial. According to the law, it is possible to receive benefits only by registration, but not all regional centers have the appropriate level of staff, equipment and medicines. Therefore, in extreme cases, nonresident residents can obtain permission for preferential treatment in Moscow. The Ministry of Health also provides the opportunity to undergo treatment and examination abroad (in Israel and Germany).
How to get a quote for hip replacement surgery?
To apply for a quota for hip (or knee) replacement in Moscow, you need to collect documents and x-rays, proving the need for such an operation. At the clinic they issue a “Protocol of Quota Decision” and with it you need to visit the Ministry of Health, where they provide:
- quota protocol;
- passport;
- application for preferential treatment;
- compulsory medical insurance policy;
- GPS certificate;
- if the patient is disabled, a supporting certificate is provided;
- data from laboratory results.
How many times can I get a quota?
According to Russian legislation, the number of quotas for surgery per citizen in Moscow is not regulated. If a person needs VMP, he can have it done on a preferential basis.
Is it possible to receive a document retroactively?
If a situation arises in which the patient cannot wait for treatment under benefits, he can undergo it for a fee in Moscow. Then, after providing all necessary documentation to the Department of Health, you can return the money spent.
How to get a quota for eye surgery?
Diseases of the eyes, heart and spine are getting younger every year. However, most patients learn about their diagnosis only as a last resort, when complex and expensive intervention is necessary. Eye surgery can be performed in Almaty, St. Petersburg, Astana, Karaganda, St. Petersburg, Pavlodar, Tula, Krasnodar region, as well as in Rostov, Saratov, Tambov, Vologda, Kaluga, Leningrad regions and the cities of Bryansk or Tomsk.
Eye and heart surgery
Most eye and heart surgeries are high-tech medical care. Therefore, their implementation is financed by the state through the provision of benefits. To receive benefits, the patient must visit a doctor in the appropriate field (ophthalmologist or cardiologist), who will make a conclusion about the need for treatment. Next, the patient must have the report certified by the head physician of the hospital and send all documentation to the chief cardiologist or ophthalmologist of the Ministry of Health.
After which the person, if such a need is confirmed, is quickly sent for free treatment (to the Helmholtz Institute, Far Eastern Federal University, A. N. Bakulev Scientific Center for Agricultural Surgery, etc.). If there are no places in the hospital, the patient is enrolled in a special queue or sent for a quota in another city (if it is necessary to provide urgent help or treat cancer).
For removal of vertebral hernia
Sometimes situations arise when a seriously ill patient needs high-tech health care, but he does not have the necessary financial resources. It is for this category of citizens that the quota is designed - a document through which, at the expense of government funds, the patient is provided with surgical treatment.
This document applies only to government agencies.
What operations can you get a quota for - the main types of diseases that give you the right to receive a free quota
All points regarding the provision of quotas to the population for treatment are prescribed in Order of the Russian Ministry of Health of December 29, 2014 (No. 930n).
The list of ailments for which a patient can receive a quota is very long. You can find out more about this list from your doctor, or search online sources - Appendix 4 to the Order of the Ministry of Health and Social Development.
Quotas for treatment are provided only disabled people ! Those who do not have a group must first undergo a Medical and Social Examination.
In general terms, the pathologies for which benefits for surgical intervention are requested from the state can be characterized as follows:
- Serious malfunctions in the functioning of internal organs, which requires their transplantation.
- Various
- Carrying out manipulations on the open heart.
- Errors in the functioning of the brain, which can be eliminated through surgery.
- Congenital pathologies, diseases endocrine system, leukemia.
- Surgical procedures on the spine.
- Violation of the functions of the visual organs.
In the above mentioned Order of the Ministry of Health and Social Development There is a column about emergency situations.
For example, if a patient has an extensive myocardial infarction that requires the installation of a stent, but relatives cannot give the clinic guarantees about payment for this very operation, the administration of this medical institution does not have the right to refuse hospitalization.
The patient is required to provide necessary help with further informing the health authority (at the place of registration) about the procedures performed.
Full list therapeutic measures is formalized, and in the future the clinic is paid money for the work performed.
Preparatory examination for obtaining a quota - where to undergo a medical examination?
To obtain the quota in question, patients with a serious illness should visit several medical commissions:
1. Commission at the clinic at the place of registration
Here the relevant specialist prescribes an examination, after which a meeting of the first commission is held. At positive result the patient is given a document signed by the head physician of the clinic stating that the patient needs high-tech treatment. An extract from the medical history is attached to this document.
2.Commission of the regional health department
If the decision is made in favor of the patient, he is provided with a document-coupon with detailed information about the diagnosis and medical history.
3. Commission at the medical institution where they plan to provide treatment
The main points that are clarified during the meeting:
- Is this institution capable of providing the patient with the necessary medical care?
- Does the patient have any contraindications to hospitalization?
List of documents for obtaining a quota for a free operation
When planning to begin the procedure upon receiving a quota for surgical treatment, the patient should prepare the following documents:
- Statement , which contains the patient’s full name, home address, contact phone number, Email(if any), series and number of passport/birth certificate.
- Written consent to the processing of personal data .
- Photocopy of passport or birth certificate (if the patient is under 14 years of age).
- Extract from the patient's medical record about the history of his illness. This document is issued by the clinic at the place of residence on behalf of the head physician.
- Results of hardware and laboratory tests , on the basis of which the diagnosis was established. According to Russian regulations, the patient has the right to keep the originals of these documents with him, and the commission is provided with copies.
- Photocopy of compulsory health insurance and/or pension insurance policy . This applies to patients who have such evidence. In the absence of policies, the package necessary documents comes without them.
If the patient does not have the opportunity to personally prepare and submit documents, and uses the services legal representative, to the list discussed above are additionally attached:
- A copy of the legal representative's passport.
- Statement on his behalf.
- Official confirmation of representation. It may also be a duly certified power of attorney.
Instructions for obtaining a quota from the Department of Health - where to go and what will be needed?
The procedure in question is as follows:
- Visiting your doctor (at the clinic at the place of registration). The doctor decides what tests need to be taken and writes out a referral for diagnostics.
- Execution of an extract from the medical history by the doctor mentioned above. The results of the survey are also included here. The specified document must be certified by the signature of the head physician and the seal of the medical institution.
- Sending the prepared set of documentation to the local health department. This is done by the clinic staff upon completion of the medical examination. It would not hurt the patient to clarify and remember the date of dispatch. If a negative decision is made, the applicant is given a protocol explaining the reasons for the refusal.
- The Department of Health makes a decision on issuing a quota. In some cases, this procedure requires the patient’s personal presence, but often they do without it. All this takes 10 working days: after this period, the applicant must contact his clinic and find out about the answer. In emergency situations, when surgical intervention must be carried out urgently, the attending physician attaches a corresponding note to the package of documents: this speeds up the process of obtaining a quota.
- Sending documents to a specialized clinic. Often the patient has to wait in line for hospitalization. The date of appearance at the medical institution can be found on the website talon.gasurf.ru. Upon hospitalization, the patient must present originals medical documents.
Instructions for obtaining a quota in the clinic through the quota committee
This method of obtaining a quota is more preferable: the patient can personally choose a medical center for treatment, and the procedure itself lasts, on average, 2 weeks.
The algorithm of actions in this situation is as follows:
- After receiving the required package of documents from the clinic at the place of registration with a positive decision of the commission, the patient independently looks for an institution where he will be provided with high-tech treatment.
- Specialists from the specified medical institution consider the patient’s request, convene a “quota committee”, which considers the possibility of hospitalization under a quota.
- An officially issued decision, along with a list of other documents, is sent to the local health department.
Queue for quota surgery – what do you need to remember?
Those who are planning to receive a quota for surgical treatment need to remember the following points:
- It is better to start the procedure for obtaining a coupon at the beginning of the year. Nowadays, seriously ill people who need urgent operations quite a lot: quotas run out quickly.
- You can find out how the queue is progressing on special websites (one of them has already been mentioned above) or in the clinic where assistance will be provided.
- You can find out about the availability of quotas from your local health department or medical facility. , where high-tech treatment will be carried out. Each such institution has its own quota department, where specialists will tell you whether there are still coupons for free operations and how many are left.
- If surgery is needed urgently , and the quotas have ended, the patient can pay all expenses, and in the future - submit a set of documents to the health department. In this way, you can offset the costs of treatment.
- At difficult situations, when an operation is urgently needed and there is a quota, the clinic has no right to refuse help. In other cases, patients will wait their turn: the legislation does not provide for any benefits to help speed up the provision of treatment.
The most popular questions about obtaining quotas for free surgery - answered by specialists
— What is the best way to get a quota - in the department or through the clinic?
— It is definitely better to receive a quota through the clinic: the patient will have the opportunity to personally familiarize himself with the institutions, and processing the request will take less time than carrying out the same procedure through the department.
— How to find out about the availability of quotas and what to do if there are no longer quotas for the operation?
— Vouchers for free surgical intervention are distributed among several medical institutions. If some institutions have run out of them, this does not mean that the opportunity to get the help you need lost as soon as possible.
You can find out exactly how many quotas remain and which clinics have them at your local health department.
If quotas have expired, the patient must still go through the procedure for obtaining them. If the answer is positive, they are put on a waiting list.
Applicants will receive the long-awaited quota as soon as the state allocates a new portion of coupons.
— What may be charged for during a free operation under a quota?
- If medical institution where the operation will take place is in another city, the patient must pay for travel independently. Although these expenses can be covered by a compulsory health insurance policy.
To receive a free travel voucher, you need to contact the Foundation with a package of documents.
In addition, the quota is not always completely free. For some nuances of treatment, the patient will have to pay out of his own pocket.