Is it possible to get rhinoplasty under the compulsory medical insurance policy? Inclusion of plastic surgery in the compulsory medical insurance policy: myth or reality of the future? Three stories of people who had expensive procedures under a regular policy

Compulsory health insurance is a component of the system of insurance services provided at the state level. It is needed to ensure equal opportunities in terms of providing qualified medical care to patients of different social categories. The compulsory medical insurance policy includes a wide range of services, including expensive surgical operations. Read on to learn about which areas of intervention are included in compulsory insurance, how to get them for free, and when a refusal is usually granted and the operation is not performed.

What is a compulsory medical insurance policy - definition

Compulsory medical insurance is compulsory health insurance, the most important component. Thanks to this policy, all citizens of the Russian Federation receive equal access to medicines and medical care (this is made possible by attracting). The procedure for provision and list of services is specified in No. 326-FZ dated November 29. 2010 “On compulsory health insurance in the Russian Federation.”

Free assistance is provided throughout the country in the amount specified in the basic program, and at the place of residence - in the amounts specified in the territorial rules.

The basic program is developed and approved by the Government of the Russian Federation, the territorial program is developed by official representative offices of the subjects (regions). Medical care within the scope of the policy is provided by those organizations that are part of the register of the Territorial Compulsory Medical Insurance Fund.

Read what is included in the free policy maintenance.

What does the basic package include?

The program of state guarantees clearly defines the list of preferential services that should be provided free of charge to citizens of the Russian Federation. They are paid for from budgets of different levels (city, regional, federal) and from the compulsory medical insurance fund.

Treatment and under what conditions it is provided

Under the policy, you have the right to receive treatment in the following areas free of charge:

Read where you can get a medical insurance policy.

In accordance with the provisions of the current state program, citizens of the Russian Federation can receive treatment for most diseases free of charge.

List of preferential ambulance and outpatient services

Emergency medical and outpatient care services are included in. This also includes carrying out diagnostic and therapeutic measures in a day hospital, in a clinic or at home.

Drug provision during treatment in the outpatient department is not included in the compulsory medical insurance program.

What services are included in the program within the state insurance system

Within the framework of the state insurance system, inpatient care is provided free of charge for:

1. Childbirth, abortion, pregnancy pathologies.
2. Injuries requiring intensive care, poisoning, exacerbations of chronic diseases, the need for acute treatment of pathologies, isolation for epidemiological reasons.
3. Planned hospitalization as part of therapy and rehabilitation programs, including when constant medical supervision is needed.

The list of additional paid inpatient services is specified in the order of the Health Committee.

The following services can be provided on a paid basis (voluntary or voluntary) during your stay in a medical institution:

• stay in a room with an increased level of comfort, other individual services;
• examination, treatment for concomitant diseases in the absence of exacerbations;
• observation, examination, treatment at home (except for those cases when the patient does not have the physical opportunity to visit a medical facility on his own);
• anonymous services (except for free AIDS diagnosis);
• assistance to persons who are not entitled to receive free assistance under the territorial state program;
• medical care using alternative (but necessarily approved at the state level) technologies and treatment methods;
• consultation on the personal initiative of citizens.

Read also about how to decorate for a newborn.

They do not provide free preventive vaccinations at the request of citizens, they do not provide homeopathic treatment, dental prosthetics, and some.

Cosmetology services and sexological therapy are provided only for a fee.

What free operations are performed under the policy and who pays for them - a list of the main areas in surgery

A number of surgical operations within the compulsory medical insurance policy are performed free of charge. The main areas in which they operate:

1. Gynecology and obstetrics.
2. Abdominal surgery.
3. Treatment of severe burn injuries.
4. Transplantation.
5. Traumatology, orthopedics.
6. And others - surgery of the chest organs, blood vessels, heart, rheumatology, ophthalmology, hematology, etc.

Read about MRI for free with your policy.

Thus, under the compulsory medical insurance policy, most surgical operations are performed free of charge. Rehabilitation activities are also in most cases provided free of charge (you will find a list of exceptions below).

If you are forced to pay for an operation that should be performed free of charge, call the MHIF hotline.

How to obtain a voucher for surgical intervention - sign up for a planned operation

Free operations are carried out using a coupon. To receive it and begin the operation, you need to collect a complete package of documents:

1. Extract from the protocol of the doctors' commission.
2. Extract and medical record justifying the need for treatment.
3. Passport, copy, application from a citizen who wants to use the service.
4. Compulsory medical insurance policy and copy.
5. Certificate of disability (for those persons who have it).
6. with a copy (if available).

How to get a referral for hospitalization at a clinic and begin surgery

A referral for planned or emergency hospitalization can be obtained from the attending physician - he will also draw up the necessary documents. It is sent to the Ministry of Health or a specific medical institution within three days; if the commission approves the request, the patient will receive a coupon.

Can a patient choose a clinic? No, but he has the right to express his wishes - if possible, they will be taken into account.

Please note that the list of free operations is updated annually and depends on the region. At the moment, you can apply and sign up for a compulsory medical insurance policy for free:

1. Endocrine surgical interventions are surgical treatment of the parathyroid glands, adrenal glands, and thyroid glands.
2. Cardiovascular, cardiac operations – on peripheral arteries, including vertebral and carotid arteries.
3. Urological treatment – ​​endoscopic interventions for prostate adenoma, urolithiasis, reconstruction of the pelvic floor organs in case of prolapse, urinary incontinence.
4. Neurosurgical interventions – on the spine.
5. General surgical operations – laparoscopy for abdominal hernias, cholelithiasis, inguinal, umbilical hernioplasty, etc.
6. Oncological treatment – ​​combined techniques are used.
7. Assisted reproductive surgeries – in vitro fertilization.
8. Gynecological interventions - plastic surgery for vaginal prolapse, removal of fibroids or fibroids while preserving the uterus, hysterectomy, laparoscopy, surgery on the uterine appendages, plastic surgery of the genital organs of the third category.
9. Coloproctology – removal of hemorrhoids, excision of the epithelial coccygeal tract, perianal tissue with fistula.
10. Otorhinolaryngological operations – septoplasty, polypotomy, tonsillectomy, endoscopic maxillary sinusotomy.
11. Laser vision correction is not cosmetic surgery for the treatment of myopia, cataracts, and astigmatism.

In these cases, the intervention will be free for the owner of the compulsory medical insurance policy; he pays for the medicines himself. If a Russian-made lens (for cataracts) offered to a patient as part of the insurance policy does not suit him, he has the right to order an imported one, but at his own expense.

In what cases can they refuse to operate?

A free surgical operation, even if it is included in the list of mandatory services, may be refused. Main reasons:

1. The patient can be cured without intervention.
2. Indications for therapy using high-tech methods.
3. The limit on benefits in the Ministry of Health for the year has been exhausted.

If you received a refusal due to the exhausted limit of benefits, find out which medical institutions have budget places. If there are none at all, issue a coupon and quota.

Read about how to restore a policy if lost.

When there are no free places, and the operation is urgently needed, it is better to do it on a paid basis, and then apply for compensation.

You may also be denied free rehabilitation. It is issued for severe anemia, postoperative complications, patient disability, sexually transmitted diseases, hypertension, drug addiction, alcoholism, severe mental disorders, and oncology.

If you think that you were wrongfully denied rehabilitation at the expense of budget funds, call the Compulsory Medical Insurance Fund - and a specialist will help clarify the situation.

Video

conclusions

Under the compulsory medical insurance policy, you can receive a large list of medical services free of charge. Please note that some inpatient treatment services require an additional fee, and surgery may be denied if the budget space limit is reached, or the patient can be treated without surgery. For any controversial issues, you can call the MHIF hotline.

As part of compulsory medical insurance, surgical treatment is carried out only upon referral from the clinic (form 057/у‑04) ...see sample Without a referral, the cost of services is according to the current price list. Some inpatient treatment services require additional payment. The number of quotas is limited.

1. Contact the hospitalization commission “NIMC Medica-Mente”. The presence of indications for hospitalization in a hospital is determined by the commission based on the provided package of documents:

• from patients with cardiovascular pathology - extract from the outpatient card, CT scan with contrast, angiography, ultrasound, etc.
• from patients with traumatology and orthopedic pathology - an extract from an outpatient card, CT, MRI, X-ray, ultrasound, etc.

2. Contact the city clinic at your place of residence with an application addressed to the chief physician of the clinic ( download sample application) and receive a referral using form 057/у-04 for hospitalization, for inpatient treatment and an extract from the outpatient card in form 027/у.

* According to No. 323-FZ, any person with Russian citizenship and a Russian-style insurance policy can seek medical help at any institution.

Normative base:

• Federal Law of November 21, 2011 N 323-FZ (as amended on December 28, 2013) “On the fundamentals of protecting the health of citizens in the Russian Federation” (Article 21. Choice of a doctor and medical organization).
• Order of the Ministry of Health of Russia dated December 21, 2012 N 1342n "On approval of the Procedure for a citizen to choose a medical organization (except for cases of emergency medical care) outside the territory of the constituent entity of the Russian Federation in which the citizen lives, when providing him with medical care within the framework of the program of state guarantees of free provision medical assistance."
• Order of the Moscow Department of Health of November 2, 2009 N 1400 (as amended on August 7, 2013) “On the organization of the provision and recording of inpatient medical care to nonresidents, as well as foreign citizens, in medical organizations of the Moscow Department of Health.
• Order of the Moscow Department of Health dated 11.10.2012 N 1090 "On amendments to the order of the Department of Health of the city of Moscow dated 02.11.2009 N 1400" (together with the "Instructions on the procedure for organizing the provision of inpatient medical care to nonresident and foreign citizens in medical organizations of the Department of Health city ​​of Moscow").

3. Before hospitalization, you need to undergo an examination in accordance with the necessary preoperative examination program issued to you (the examination is carried out in your local clinic or any other medical institution on an outpatient basis).

4. Hospitalization is carried out strictly at the appointed time in the presence of all the necessary tests, examination results, and correctly completed directions!

Today, the initiative to include plastic surgery in the compulsory health insurance system is being actively discussed. How realistic this is and what exactly should be added to compulsory health insurance was discussed by experts at a press conference at the Rossiya Segodnya International Medical Center.

The essence of the problem

“Our current task is to include the specialization “plastic surgery” in the list of compulsory medical insurance services,” says Sergei Vasiliev, head of the department of plastic surgery and cosmetology at South Ural State Medical University. - At the moment, the relevant medical services are provided within the framework of the “high-tech medical care” column, which provides for immediate or delayed reconstructive surgery. That is, plastic surgeons can participate in the aesthetic restoration of a patient’s appearance, for example after oncology, but as invited specialists. On paper, such plastic surgery would be part of the overall treatment of a cancer patient, and it would be free for the patient. Our goal is to begin to provide this range of services under the heading of plastic surgery.

Why is this important? The fact is that plastic surgery has very broad capabilities that are not fully used due to the fact that the specialty itself is still not included in the structure of compulsory medical insurance. Very often, reconstructive surgeries are performed by the same oncologists who do not have the necessary training and certification as a plastic surgeon. This procedure needs to be changed to improve the quality of medical care provided.”

In addition to reconstructive plastic surgery, the possibility of including some non-invasive procedures related to improving people’s quality of life and maintaining health, as well as issues of cellular technologies, is being considered in compulsory medical insurance. And if just a few years ago such an idea seemed far from reality, today there are active discussions of practical issues in the offices of the Ministry of Health. A nomenclature of medical services has already been developed, a common terminology has been created for the specialty “plastic surgery”, negotiations are underway with representatives of medical specialties on positions that need to be performed exclusively by plastic surgeons. Among these areas are congenital and acquired defects of appearance, burns and scar tissue changes. It is possible that the list will expand in the future.

Say a word about the surgeon

Participants in the initiative believe that a plastic surgeon should be permanently on staff at public medical centers and be available to the public. It is obvious that reconstructive medicine is a complex and labor-intensive area that requires not only the immediate efforts of specialists (the operation itself), but also a set of accompanying measures, such as initial examination and diagnosis, preoperative preparation of the patient, hospital stay, rehabilitation procedures - all these stages too must enter the compulsory medical insurance system.

“Special requirements are also imposed on the training of plastic surgeons,” noted Natalya Manturova, chief freelance specialist plastic surgeon of the Russian Ministry of Health, head of the expert council of the “Beauty Medicine” project. - To work as a plastic surgeon in a public medical institution, you need to have both a general surgical specialty and additional education in the field of plastic surgery, obtain a certificate in aesthetics, and be proficient in reconstructive and vascular surgery. As you can see, the requirements for specialists are very high, and not everyone can support them.” In the near future, it will be necessary to change and improve the training system for future plastic surgeons and develop quality standards in aesthetic medicine.

Children's question

Children, like adults, need reconstructive medicine. Many congenital facial deformities are much more amenable to correction at a very young age and, moreover, do not have time to negatively affect the child’s sense of self. However, in the structure of compulsory medical insurance there is no specialty “pediatric plastic surgeon”; there is simply a pediatric surgeon. Therefore, everything related to the treatment of congenital defects of appearance and severe injuries in children is addressed to the specialized specialist to whom the little patient was admitted. For example, in the case of a cleft jaw, this will be a maxillofacial surgeon, who, of course, will restore the functionality of the jaw, but the child will be left with an aesthetic defect in the upper lip, a scar on the skin, and it is unclear who should deal with this next. Unfortunately, such operations are often performed by doctors of related specialties who are not trained in plastic surgery, so the quality of treatment often leaves much to be desired. As in the case of adult patients, this issue requires clarification and refinement. To solve this problem, last summer a meeting was held with surgeons from the Russian Children's Clinical Hospital and a proposal was made to include the training of future pediatric plastic surgeons in the residency program, that is, to make plastic specialization part of the general education program. It is planned that within a year surgeons will learn the basics of reconstructive and plastic techniques specifically for children. In the future, such specialists will be able to provide competent assistance as plastic surgeons.

At whose expense is plastic surgery performed?

Of course, concerns remain - will the Ministry of Health accept the necessary changes at the legislative level? After all, the official inclusion of plastic surgery services in the list of free medical care will inevitably entail additional costs. However, the panellists are optimistic. “The problem can be solved without a noticeable increase in the burden on the state budget,” Sergei Vasiliev is convinced. - We are talking more about the reorganization of medical flows rather than the introduction of something fundamentally new. Already today, many reconstructive operations are paid for by the compulsory medical insurance fund, but payment goes within the framework of other specialties, and not plastic surgery. We are looking for ways to leverage existing resources and connect the patient directly with a plastic surgeon to improve the quality of care.”

As soon as the nomenclature of medical services for plastic surgery is signed and approved, we can expect the inclusion of this specialty in the compulsory medical insurance system. At the end of the press conference, the participants emphasized that they hope for a positive outcome in the foreseeable future.

On a note!

The ratio of aesthetic and reconstructive interventions is about 70 to 30 in favor of the former. Aesthetic surgeries are often cheaper and require less effort and time. A reconstructive surgeon must have a wider range of professional skills, have in-depth knowledge of anatomy, and be able to work with facial nerves and blood vessels. This is a special area in which there are not many qualified specialists.

Andrey Vygovsky, surgeon of the highest category, plastic surgeon at the Institute of Plastic Surgery and Cosmetology

A plastic surgeon as a nomenclature unit in the compulsory medical insurance system is very correct. Take, for example, cancer surgery. It is logical that it is carried out by an oncologist surgeon, and his main task is to solve a problem that is precisely within his competence - oncology. Of course, after the operation he will put stitches, but reconstruction or tissue restoration is not within his competence. And here it would be good to involve a plastic surgeon. The ideal development of events is when both a medical problem and an aesthetic one are solved in one operation. Yes, today you can get such services as part of high-tech medical care, but, alas, the number of quotas is limited. But if this service is included in compulsory medical insurance, then anyone who needs plastic surgery for medical reasons can have it. And the inclusion of aesthetic surgery in compulsory health insurance to improve appearance not for medical reasons, but only at the request of the patient, is not worth waiting for yet. Although in some countries you can, for example, change the shape of your nose through insurance.

Perhaps we will gradually come to this. After all, no one denies that improvement (rejuvenation) of appearance significantly affects a person’s quality of life, and therefore his health.