home Diseases List of diseases that are covered by the quota. The procedure for obtaining a preferential place in the clinic. How to get a quota for an operation

List of diseases that are covered by the quota. The procedure for obtaining a preferential place in the clinic. How to get a quota for an operation

Situations arise when money is urgently needed for an operation; a person’s life may depend on it. And often there are not enough funds. And it so happens that the necessary assistance is provided only in the capital. It is for such cases that a quota for surgery in Moscow is needed. We will describe how to obtain it below.

Quota concept

It is a monetary transfer used to cover the costs of an operation if the patient needs it. A list of diseases has been compiled, approved by the Ministry of Health and Social Development of Russia, for which surgery can be paid for using a quota. Taking into account the fact that the number of allocated quotas is increased annually, it can be quite difficult to obtain it. First of all, we are talking about paperwork that cannot be avoided. This also applies to trips to various authorities.

What treatment can be obtained under a quota?

What can you do with a quota:

Manipulations performed on the heart;

Transplantation of various organs;

Neurosurgical operations;

Joint replacement;

Therapy of diseases transmitted by inheritance;

Therapy of leukemia;

Treatment of complex forms of pathologies of the endocrine system;

For example, a quota for eye surgery in Moscow can be issued to a patient who does not have the financial ability to pay for it himself.

Currently, this list has been expanded and contains 22 profiles and 137 types of high-tech medical care provided. In addition, every year the Ministry of Health and Social Development of the Russian Federation approves a list medical centers in Moscow, where you can get necessary help according to quota. It also contains the number of indicators allocated to each institution, such as the quota for surgery in Moscow.

How to obtain and what documents are needed to obtain a quota

To obtain a quota, you will need to be patient and time to collect the necessary papers.

Below is what documents are required for an operation quota:

Identity documents;

Medical policy;

Results of examinations that have been completed recently;

Disease history.

How to get a quota in 2015

If previously high-tech medical care was provided only under a quota, then since 2015 it is provided under the compulsory medical insurance policy. In practice, this means that free operations will be provided only where the citizen lives. Only in rare exceptions can the opportunity for free treatment be obtained in Moscow, for example, a quota for

We get a quota

Specialists from the Ministry of Health and Social Development claim that the opportunity for free surgery has become available to citizens of the Russian Federation thanks to the “Health” project. It must be remembered that paid medicine does not accept patients according to quotas.

To get a referral for a free operation, you can go in two ways:

1. Registration of a quota “from below”.

Come to the health department of the region of residence, having with you a passport, social insurance policy, pension policy, extract from medical card the clinic in which the study was conducted. You also need copies of basic documents.

Get your own curator, who can be appointed from among department employees.

The request for a quota is considered and then, if the decision is positive, the patient is informed of the coupon number and the name of the clinic where he will be treated.

2. Registration of a quota “from above”.

The patient himself, based on his criteria, determines the medical institution where he would like to receive help under the quota. We must not forget that paid medicine does not participate in this program and will not be able to perform the operation under the quota. This institution must consult with necessary specialists, from your personal card and go through a committee that meets specifically to decide whether to approve your quota or not. If the answer is positive, the received document will indicate that this particular institution can operate under the quota. There will also be a signature of the head physician and a seal. Next, with the received documents, you go to the Moscow Department of Health and provide them with all the documentation specified in paragraph 1.

In general, the second option is much faster and can take on average from 1 to 3 weeks. In addition, it will give you the opportunity to choose medical institution.

Passing the commission

In order to receive free help, the patient will have to undergo several medical commissions:

Go to the clinic according to your registration, where the doctor will carry out everything necessary research. After the resolution issued by the first commission, he will issue a direction. You must then go to the Health Department of your region with this referral signed by the chief physician of the clinic and an extract from the medical record with the conclusions that the patient needs a quota for surgery in Moscow.

How to get it: you need to visit another commission at the Ministry, it will determine whether the patient has indications for VMP. If the answer is positive, the patient is given a document according to which he will be provided free assistance. It will outline detailed information about the disease, all the results and results of examinations.

The third commission will need to go where the referral was issued. A commission convened at this medical institution determines the correctness of the referral to this particular clinic and the presence of any contraindications for the operation. The result is that a quota is issued for the operation in Moscow.

How to get it faster? During the agonizing wait, patients ask this question. Since, in general, making a final decision takes a long time, although the decision itself to register the right to a free one can be made in one day.

Possible problems

Unfortunately, quotas for treatment at state expense are running out. If you need it, you can contact the Moscow Department of Health and request information on the availability of quotas in all

If there are still no quotas left, you can stand in line to receive them. If the situation is acute and the operation must be performed as soon as possible short time, for example, a quota for eye surgery is extremely important to you; you can have it done for money, but then return these funds through the Ministry of Health, presenting all the necessary documents.

In addition to the fact that quotas may end, there are often cases when there are no places in a certain clinic. For example, a patient needs a joint replacement, waiting is still acceptable, but if we are talking about tumor removal and there is simply no time, standing in line is unacceptable. Unfortunately, the assistance system is designed in such a way that the waiting time for quota surgery is not specified anywhere. In this case, you can try to contact another clinic or make a fuss by writing in the media.

Often in clinics where patients are referred under a quota, there are additional payments. For example, a patient who needs a transplant bone marrow, must pay for the search for a donor in foreign registries. Money for this is not included in any budget. In other words, the operation under the quota is at the expense of the state, all additional steps are paid by the patient.

Unfortunately, it is impossible to fight this. Primarily due to the fact that the patient does not have the strength to fight additionally, except with the disease. It’s also scary to spoil relationships with the doctors who will operate. Here we can only advise you to write letters and complaints to various authorities with requests to deal with additional payments. Perhaps the colossal flow of correspondence will help officials look at the problem differently and change it.

Conclusion

The number of allocated quotas for the implementation of high-tech medical activities is determined at the beginning of the year, and often they are all “selected” long before its end. Thus, sometimes, in order to quickly get the help you need, it is better to seek help from paid clinics. And only then try to return the funds by queuing for registration

According to the Department of Health, all large quantity patients receive special quotas for operations. But every day in the media we can see that many people still need treatment. What to do if you or your loved ones need money? Let's try to understand what a quota from the state is and what are the chances of receiving it.

Features of quotas

Quotas are cash transfers that are intended for operations if a person is sick and needs surgical treatment. There is a certain list of diseases that are covered by the quota. It was approved by order of the Ministry of Health and Social Development of the Russian Federation. But, despite the fact that the number of quotas has increased over the years, getting a quota is quite difficult. In particular, you will have to spend time and effort on paperwork - it will not be possible to avoid paperwork. The same can be said about going through the authorities. However, we hope that before you receive a quota for the operation, you will read this article, and the advice contained in it will definitely be useful to you, simplifying the procedure for resolving the issue.

Stages of obtaining a quota

First, you need to contact the clinic to which you are assigned at your place of residence. There, the doctor must conduct an examination, and based on the results obtained, he will decide whether it is advisable to send your documents for review by representatives of the healthcare authority of the constituent entity of the Russian Federation. Please note that the list of documents must include papers with information about the patient’s condition and the treatment performed. The following documents must also be attached to the extract:

· written appeal;

· results of clinical diagnostic tests;

· copy of passport or birth certificate (copy of parent’s passport, if a quota is received for a child);

· a copy of the compulsory medical insurance policy;

· a copy of the pension insurance policy;

· a copy of the insurance number of the individual personal account.

You can also receive a free travel voucher to the place of treatment, which is also very useful in conditions of limited finances. To do this, you will need to prepare the following documents:

· pension insurance certificate;

· copies of the first page of the passport and the registration page;

· compulsory medical insurance policy;

· a document that confirms the status of a beneficiary;

direction from medical institution, certified by the signature of the city’s chief specialist in the profile of the disease.

So, returning to the procedure for obtaining a quota, we note that the commission of the health authority must review and study your documents, and then send them to the chief specialist on the disease indicated in the papers. The latter will give a conclusion regarding the need surgical intervention.

Next, a commission meeting takes place, at which the conclusions of the attending physician and the chief specialist are reviewed. As for the commission, it decides which institution to send you to for medical care.

When the decision is made, medical documents are transferred to a specialized medical institution, where indications for surgery are established, and then a date for hospitalization is set. All you have to do is come with the documents and examination results within the specified time frame.

When is a patient sent for treatment abroad? This applies to cases in which Russia does not have the technology to carry out treatment. But the feasibility of obtaining a quota for an operation abroad is difficult to prove, and you will have to do this by communicating with not one, but several commissions.

That's all the advice. You can use them to get a quota.

Modern high-tech medicine is not available to a wide range of people due to its high cost. For this reason, the state annually allocates funds through which assistance is provided free of charge to a limited number of patients. Today we will talk about how to get a quota for surgery and what medical services are provided by the state program.

What is high-tech medicine?

High-tech medical care (hereinafter referred to as HTMC) is diagnostic and treatment services provided by highly qualified personnel using the latest equipment and latest achievements Sciences. Not all medical institutions have the right to provide VMP, but only those that have received a special license for this particular type of medical care. The Ministry of Health of the Russian Federation controls the number of these institutions, as well as the types of diseases for which VMP is used, annually approving the corresponding lists.

The basis of high medical care consists of medical services of a high degree of complexity:

open heart surgery;
internal organ transplantation;
neurosurgery;
eye surgeries;
treatment genetic diseases etc.

Another distinctive feature VMP is high price procedures based on remuneration for highly qualified doctors, the purchase of expensive equipment and rare medications. To make this segment accessible to ordinary citizens, the state has provided the opportunity to receive free medical care subject to certain conditions.

Who is entitled to free VMP services?

The state guarantee program for the provision of high medical care was first launched in 1994. Since then, it has been revised several times, and the latest version can be found in. The document reflects the main directions of providing high-tech medical care for 2017, 2018 and 2019.

The right to free medical care is enshrined in the Constitution of the Russian Federation; any citizen of Russia has it if there are appropriate indications for this. Art. 19 states that medical institutions are obliged to provide citizens with free volume medical services within the framework of the State Guarantees Program, which, among other things, provides for high-tech medical care.

A certain amount of funds is annually allocated from the federal budget to carry out free operations and provide other services within the framework of VMP. The amount of funding for the treatment of one patient is called a quota. It covers the entire treatment process, including payment for hospital stay, medications and consumables.

The number of quotas is limited, as are the types of free medical care provided. The latter are divided into 2 groups.

Basic list of VMP. These services can be used by any citizen of the Russian Federation who has a compulsory medical insurance policy. Assistance is provided free of charge both in the region of residence and in any other subject of the Russian Federation.
List of VMP not included in the basic compulsory medical insurance program. These services are financed from the budgets of the constituent entities of the Russian Federation, and therefore you can only receive them in your region of residence.

Let's take a closer look at what services are included in each of these lists.

Basic VMP program

VMP within the framework of the basic compulsory medical insurance program includes the following types medical services.

A more detailed basic composition of the VMP can be found in the first section of the Appendix to Resolution No. 1403.

VMP through regional funding

VMP, which is not included in the basic compulsory medical insurance program, includes the following types of treatment.

Surgical intervention for diseases of the gastrointestinal tract, liver, biliary tract, prolapse of organs due to pelvic prolapse, etc.
Treatment of newborns. Operations to eliminate congenital malformations, hydrops fetalis.
Therapeutic procedures and operations for gynecological problems (endometriosis, cysts, uterine fibroids, delayed sexual development).
Combined treatment of blood diseases.
Treatment of burns affecting more than 30% of the body surface.
Neurosurgery.
Surgery and therapy oncological diseases.
Elimination chronic otitis and hearing loss.
Complex treatment of diseases of the cornea of the eye, restoration of vision.
Hormonal therapy for premature sexual development in adolescents.
Surgery coronary disease heart disease, congenital defects, damage to the valve apparatus.
Reconstructive operations on chest for tuberculosis and congenital anomalies.
Surgical restoration of the spine after injuries, with hernia and scoliosis of 3 and 4 degrees.
Transplantation of organs and tissues.
Multicomponent treatment bronchial asthma, multiple sclerosis, severe forms of diabetes mellitus, congenital immunodeficiency and many other diseases.

WITH full list operations and other medical services financed by the regions can be found in the second section of the Appendix to Resolution No. 1403.

How to get a quota for treatment?

The procedure for referring patients to high-tech treatment fixed . The regional health department is responsible for issuing quotas for receiving high medical care. There you must provide a referral from the clinic where the initial examination was carried out. The referral must be accompanied by an extract from the medical history and the results of examinations and tests. All documents are certified by the signature of the chief physician.

Review of the submitted package of documents is carried out by a special commission under the Department of Health. It must include a specialist from the medical field corresponding to the patient’s diagnosis. The commission meeting usually takes place without the presence of the patient, but in a controversial situation he may be invited to participate. If a positive decision is made, the experts of the VMP department select a suitable medical institution for the patient.

The patient has the right to independently choose the place of treatment. In this case, the procedure changes somewhat, and you must first contact the organization of interest. If there are medical services suitable for the disease and appropriate quotas have been allocated, the patient will be given a conclusion according to which he is indicated for treatment in this particular institution. And with this conclusion you must then contact the Department of Health.

It is not necessary to visit the clinic in person to receive an opinion. If she is located in another region, you can contact her remotely by sending copies of documents by email or by fax. It is also possible reverse situation, when the patient independently goes to another region, confirms his diagnosis in the clinic, and a copy medical report sends for consideration to the regional commission in electronic form.

How long should I wait for treatment?

If the conclusion of the medical institution was received in advance, then all that remains is to issue a VMP coupon at the regional health authority, which usually takes 1-2 days. If there are free places in the clinic, hospitalization is possible the very next day after receiving the coupon.

When choosing a place of treatment by experts from the Department of Health, the patient will have to undergo another commission - this time directly at the institution to which he was sent. Clinic specialists can confirm or deny the presence of indications for high-tech treatment. When reviewing documents remotely, the decision must be made within 10 days, and when a patient visits the facility in person - within 3 days.

If a positive decision is made, a date for hospitalization is set, about which the authority that issued the coupon is informed. He, in turn, sends a notification to the patient. In addition, you can track the process of obtaining a quota for an operation on the Internet, since the VMP coupon has an electronic form and information about it is regularly updated. This can be done on a special one.

From the moment of diagnosis to receiving medical care, it can take several days or several months. It all depends on the availability of space in the clinic and how urgently the treatment is needed. The only way to reduce the time it takes to obtain a quota for medical treatment is to independently search for a suitable medical institution and obtain a preliminary conclusion from it.

The quota for the operation implies that high-tech medical care will be provided with the help of funds allocated from the federal budget. Everyone has the right to take advantage of a certain number of quotas for different types issued by the Ministry of Health. It's about about the list of services that are not available but are expensive.

The fact is that such operations (on the heart, blood vessels, aorta, its main branches, organ transplantation and a number of others) are very resource-intensive, which is why the state provides financial support in order to perform a certain number of such surgical interventions. But you need to keep in mind that quotas for operations do not include the treatment of varicose veins lower limbs, as he believes a large number of patients.

Every year, the Ministry of Health puts forward a plan that determines the volume of assistance based on the number of patients and the distribution of quotas by region. This document is compiled in accordance with applications received from regional health organizations from all over the country. As a rule, compiling it is very difficult process. The fact is that in addition to patients who are included in the so-called Waiting List, there are emergency situations when the provision of assistance occurs unscheduled, in accordance with an existing referral for urgent hospitalization.

Obtaining a quota for an operation includes a number of clearly defined stages, a list of documents and strict requirements, the compliance with which will determine the speed of its receipt. Let's look at this in more detail.

The operation quota will not be issued to all those who simply want to receive it. On initial stage there must be a referral issued by the attending physician, which must indicate strict indications for receiving free high-tech assistance. This is the primary link. Next, you will need a conclusion from a regional specialist and, finally, the patient must undergo a commission at the regional Ministry of Health. Without these three steps, a quota for the operation is not allocated.

Scroll necessary documents next:

pension insurance certificate;
passport;
insurance policy;
pensioner's certificate;
certificate of disability.

The following should be kept in mind. There is a certain time period, which includes consultations and paperwork. It lasts at least twelve weeks, from diagnosis to referral. Situations often arise when it is necessary to undergo further examination. Then this period will increase to fourteen weeks. Therefore, you will need to wait and complete all stages of obtaining a state quota.

This subsidy may be denied at one level or another. In the same case, if the patient believes that this violates his rights and current legislation, then he can appeal the inaction or actions of officials.

A written appeal must be drawn up and sent to the relevant authority or addressed to the official.
Within thirty days, this appeal will be reviewed and the result communicated.
It is possible that this period may be extended. In this case, the citizen who sent the appeal must be notified accordingly.

There are more than a hundred operating centers in Russia, which, in accordance with the permission of the Ministry of Health, have the right to provide high-tech medical care when a quota for an operation is issued.