High-tech treatment: those mysterious “quotas.” How to get a quota for a free operation - tips on getting quotas for different groups of the population List of diseases eligible for the quota
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 of diseases for the treatment of which 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.
If you have a 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
Volume 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 there are situations 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 installed accurate diagnosis, the doctor will make an extract from the medical history and prepare a referral for issuing a quota.
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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 required type 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 necessary help the list is not included, 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 
Mandatory policy health insurance does not cover all types of treatment and the state allocates additional funds, the size of which is limited. Read about how to get a quota for surgery in Moscow in 2019 and what high-tech medical care (HTMC) is in this article.
High-tech medical care - what is it?
VMP is medical care, which, due to the complexity of the disease, can only be provided in a specialized medical institution where there are appropriate specialists and equipment.
High-tech medical care includes:
- oncology
- cardiovascular surgery
- Maxillofacial Surgery
- otorhinolaryngology
- rheumatology
- ophthalmology
- pediatrics
- thoracic surgery
- traumatology and orthopedics
- organ and tissue transplantation
- urology
- endocrinology
- abdominal surgery
- combustiology
- obstetrics and gynecology
- gastroenterology
- dermatovenerology
- hematology
- neurology
- neurosurgery
The list of diseases eligible for the quota is approved annually by order of the Ministry of Health Russian Federation.
What is a quota for surgery and what does it have to do with VMP
In official documents, there is no such thing as a “quota”. A synonym for “receiving a quota” can be considered a referral to receive high-tech medical care at the expense of the federal budget.
In 2018, VMP will be provided to citizens of the Russian Federation mainly at the expense of compulsory health insurance (CHI). In practice, this may mean that the majority will be treated at their place of residence, and the decision to send the patient to another region, for example to Moscow, will be made only as a last resort.
How to get a quota for treatment in Moscow
For nonresidents, this procedure may be somewhat more complicated due to the need to coordinate high-tech medical care in another region. IN general view The scheme consists of three stages - passing three medical commissions:
- at the place of residence
- in the regional health department
- in the medical institution where treatment will be carried out
You can start designing with your own selection medical institution, and from collecting documents and submitting necessary tests at the clinic at your place of residence.
If you decide to select a medical institution on your own, you will be better informed about the timing and more confident in the quality of treatment.
A voucher for the provision of VMP must be issued by the regional health department.
Documents for obtaining a quota for treatment
In general, the following documents will be sufficient:
- extracts from the medical institution, expert opinions with the results of tests and studies
- original and photocopy of the compulsory medical insurance policy
- certificate of compulsory pension insurance and its photocopy
- original and photocopy of passport
- for the child, birth certificate and its copy
Where can a Moscow resident get a quota?
To obtain a coupon for the provision of VMP, you can contact the Moscow Department of Health, at the address: Moscow, 2nd Shchemilovsky Lane, building 4 “A”, building 4
Some time later, after submitting the documents, an employee of the health department will inform you of the coupon number and the clinic for treatment, if you have not chosen one in advance.
The coupon is electronic document and its status can be monitored on the website: talon.rosminzdrav.ru
In what time frame can I receive a quota for treatment?
Unfortunately, there are no clear regulations here; it all depends on the specific case. A response regarding the provision of VMP must be given within 10 days. After this, the waiting period for treatment can last from several days to several months.
Is treatment free under quota?
In theory, yes, treatment should be completely free. Even travel to the place of treatment and accommodation can be paid for, not to mention medications. Unfortunately, not everything in life goes as smoothly as we would like, so it is better to be prepared for unexpected expenses in advance.
Even taking into account that compulsory medical insurance already exists in our country, in practice not every surgery may be covered by insurance. If it so happens that the financial situation of the family does not allow, but the illness requires urgent treatment, you can try to get a quota for the operation regardless of the person’s region of residence.
Quota for surgery - what is it?
One of the types of state cash transfers, which is approved by the Ministry of Health and Social Development of the Russian Federation, compensates for the costs of treatment, which involves surgical intervention, is the quota. The current legislation of our country contains a list of diseases for the treatment of which surgery is necessary, the costs of which can be compensated by quotas. Every year the Government increases the number of quotas, and also expands the list of diseases for which they can be obtained. But getting a quota is not so easy. After all, to obtain it, you need to collect a rather impressive package of documents, as well as go through many authorities.
For what diseases can a quota be issued?
In 2015-2016, you can receive a state quota for the treatment of diseases such as:
- Operation of varying complexity on an open heart.
- Organ transplantation.
- Operation on hip joint, including prosthetics.
- Carrying out IVF.
- Treatment in the field of neurosurgery.
- Surgery on the spine.
- Treatment of endocrinological diseases, as well as pathologies that are inherited.
- Eye surgery, or serious expensive treatment in the field of ophthalmology.
Today, in 2015, the list of diseases for the treatment of which, following the registration procedure, you can obtain a quota, contains more than 140 items. Wherein surgical intervention, as well as other methods of therapy provided during the treatment of the disease, can be carried out not only in Moscow, but also in the best clinics our country. If the quota is received, the money is transferred by the state to the account of the hospital where the operation will be performed. But even here there are limitations - money is transferred only to the account of the institution that has all the necessary modern equipment and other equipment to carry out the maximum quality treatment specific disease.
How to apply for a quota
There is an opinion that it is much easier for Moscow residents to obtain a quota for treatment in the capital than for non-resident citizens of our country. In fact, this is one of the misconceptions. After all, the quota is issued exclusively for high-tech treatment of diseases specified by law, which can only be carried out in Moscow, the Moscow region, as well as in some clinics in St. Petersburg. Therefore, quotas are issued to nonresident citizens on the same conditions as to Moscow residents. You can receive a quota for treatment in the current, as well as in the future, 2016, provided that you provide the following documents to the clinic:
- Detailed extract from the medical history.
- Passport confirming the identity of a citizen of the Russian Federation. If a quota for treatment is issued for a child, then in this case the package of necessary documents is supplemented with a copy of the passport of the parents of the sick child, as well as the child’s birth certificate (the original can be used, but a copy can also be used).
- A copy of the compulsory medical insurance policy, as well as a copy of the compulsory medical insurance policy.
- Written application for a quota for conducting high-tech surgical treatment. If a package of documents is submitted without an application, or it was drawn up incorrectly, then the application for a quota will not be considered.
After everything Required documents collected, the patient will need to go to the clinic at his place of residence (if nonresidents want to get a quota for treatment in Moscow, they will have to go to their place of residence) to receive a referral for additional research. A meeting of a special medical commission is held, which decides whether a high-tech operation is needed, for which a quota is needed. The same medical commission issues a referral to a hospital in the capital, or a clinic in the Moscow region.
If the patient does not have time to wait for the commission’s decision, or there is a quota for this moment is not paid (this can also happen), then in this case you can carry out paid operation and after completing treatment, contact the department to apply for a quota. In this case, the patient must submit all documents along with receipts for payment for treatment, on the basis of which the money spent on the surgical intervention and the post-operative period will be returned.
Patients often choose their own hospital for treatment. In this case, to get a quota you will need to take a slightly different route. The patient applies to the institution of his choice with a statement of desire to undergo treatment there. A medical commission meets there and makes a decision to grant the patient’s request or not. If hospital doctors agree to treat a particular patient, their decision is recorded in writing and confirmed by the seal of the institution.
The commission’s decision, along with the package of documents described above, is sent to the country’s health department. You can get a quota this way much faster than in the first case.
Press services of the Mayor and the Moscow Government. Denis Grishkin
The Moscow government is increasing the amount of subsidies for the provision of high-tech medical care..
High-tech medical care (HTMC) is provided in the treatment of complex diseases. In such cases, cellular and information technologies, robotic technology and genetic engineering methods are used.
The number of Muscovites who receive such assistance is growing. This year, 99.8 thousand patients received it, and next year, according to forecasts, there will be 115 thousand people. This is also facilitated by the growth of funding for high-tech medical care: Moscow is doubling the city budget for the provision of high-tech assistance - from 2.5 billion to five billion rubles, due to which the number of operations performed with the help of modern equipment will be about 1.5 thousand types.
What medical profiles provide VMP?
High-tech assistance can be obtained in a number of profiles, including:
– abdominal surgery (treatment of organs abdominal cavity);
- obstetrics and gynecology;
— gastroenterology;
- hematology;
— dermatovenerology;
— combustiology (treatment of severe burn injuries);
— neurosurgery;
— oncology;
— otorhinolaryngology;
— ophthalmology;
- pediatrics;
— rheumatology;
— cardiovascular surgery;
- thoracic surgery (organ surgery chest);
— traumatology and orthopedics;
— transplantation of organs and tissues;
— urology;
- Maxillofacial Surgery;
— endocrinology;
— neonatology;
— pediatric surgery during the neonatal period.
The list of types of HFMP is published on the portal pravo.gov.ru.
Documents for obtaining VMP
Get high-tech assistance All Russian citizens can use it for free. Main condition - medical indications. They are determined by the attending physician of the medical organization where the patient is being diagnosed and treated. If there are such indications, the doctor issues a referral for hospitalization to provide high-tech medical care. There are requirements for the referral: it must be printed or legibly written by hand and certified by the personal signature and seal of the attending physician, the personal signature of the manager medical organization(for example, the head physician of a clinic) or an authorized person, as well as the seal of this medical institution.
In the referral, the doctor must indicate:
— Full name of the patient, date of birth, address of registration at the place of residence (stay);
— number of the compulsory health insurance policy (CHI) and the name of the medical insurance organization (if any);
— number of the insurance certificate of compulsory pension insurance (if available);
— diagnosis code of the underlying disease according to ICD-104;
— profile, name of the type of high-tech medical care needed by the patient;
— name of the medical organization to which the patient is sent;
- Full name and position of the attending physician, contact telephone number and email address(if available).
The referral for hospitalization must be accompanied by an extract from medical documents, certified by the personal signatures of the doctor and the chief physician (authorized person) of the clinic or hospital. It must indicate the diagnosis of the disease (condition), its ICD-10 code, information about the patient’s health status, the results of laboratory, instrumental and other types of studies that confirm this diagnosis. Also on the list of necessities are copies of a passport or other identification document (for children under 14 years of age - a copy of the birth certificate), SNILS (if available), compulsory medical insurance policy. To hospitalize a minor patient, you must provide a copy of his passport legal representative. The patient must consent to the processing of his personal data.
What to do after receiving documents
If the necessary assistance is included in compulsory medical insurance, the doctor’s referral and other papers must be sent to the medical institution where the patient will be treated. You can do this yourself or through your clinic or hospital. In the latter case, the documents must reach the addressee within three working days.
After this, the clinic or hospital will issue a coupon for the provision of high-tech medical care. Within seven working days, a special commission must decide whether the patient has indications for hospitalization.
Waiting times for emergency medical care depend on the availability of beds in the hospital where the patient is referred and on the queue on the waiting list.
If medical care is not provided for by compulsory medical insurance, then the documents are sent to the department for high-tech medical care of the Moscow Department of Health at the address: 2nd Shchemilovsky Lane, building 4a, building 4. In this case, the Department will issue a coupon for the provision of high-tech medical care. The patient selection committee will make a decision within 10 working days. Then you need to act in the same way as in the case of providing assistance under compulsory medical insurance.
How to get high-tech medical care in Moscow, described in detail in the section on the portal website.
