home Adviсe High-tech treatment: those mysterious “quotas.” How to obtain and apply for a quota for surgery (treatment, IVF, VMP)? Types and who are entitled to them

High-tech treatment: those mysterious “quotas.” How to obtain and apply for a quota for surgery (treatment, IVF, VMP)? Types and who are entitled to them

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:

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 registration either by independently selecting a medical institution, or by 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 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.

Modern medicine is extremely expensive, especially surgical interventions, dental procedures and treatment of serious and fatal diseases. Despite the existing medical insurance system in Russia, you often have to pay for treatment yourself, since the policy does not even cover part of the costs. In this regard, residents of the country have the right to count on a quota for operations, which require modern equipment, which is not available in regional hospitals. The number of quotas and the scope of their application are reviewed by the Ministry of Health of the Russian Federation annually. Procedures for providing free treatment the completion of examinations and medical procedures at the patient’s place of permanent residence, and only sometimes it is possible to get the opportunity to get an operation in the capital. Let's figure out how to get a quota for surgery in Moscow for nonresidents in 2019.

Types of quotas for treatment and operations

The law guarantees any citizen of the country to receive a quota if the need for treatment or surgical intervention arises. Social status, financial situation and age are not important. Distinguish the following types quotas:

to carry out an operation (organizing the necessary surgical intervention for citizens in need of material support at the expense of the federal budget);
for the treatment of disease ( free provision all necessary for the treatment of the patient medicines);
for IVF or in vitro fertilization(free procedure artificial insemination);
to high-tech medical care or VMP (provided to patients whose candidacy was approved by the commission of the Ministry of Health).

In what cases can you get a quota?

Everyone cannot get a quota, otherwise the queues would be so long that the patients who need help most would not wait for surgery. Therefore, the Russian Ministry of Health has developed a closed list of diseases, if identified, you can receive a quota for treatment. To the main types of diseases and surgical interventions relate:

complex surgical operations, requiring high professionalism of the doctor, extensive experience of the specialist, high-tech equipment (including operations on the eyes, spine);
serious illnesses inherited, leukemia (bleeding);
neurosurgical operations to detect a brain tumor;
installation of a prosthesis hip joint(for dysplasia) or another type of prosthesis (endoprosthetics only);
transplantation internal organs(priority is heart, liver, kidney transplantation);
nursing firstborns during the first days of life;
operations carried out on open heart(including repeated ones).

In total, the list includes 140 diseases and types of operations, the identification of which is subject to a quota for treatment in Moscow.

Each medical institution in the capital receives a certain number of quotas and undertakes to organize treatment or surgery only if medical center there is an appropriate specialist with experience, as well as all the required equipment. The clinic must meet the requirements and standards.

How to get medical care in Moscow for nonresidents

Residents of many Russian cities believe that it would be fair to receive medical care in the capital as soon as the need arises, since, unlike small cities, Moscow has a huge number of clinics that have equipment that has no analogues in any other locality. That is, the capital has the opportunity to provide medical care to all Russians, however, the number of quotas is still limited.

At the legislative level, it is determined that the quota is allocated exclusively at the place of registration, since their number for each city is limited. And since in major cities There are waiting lists for operations; quotas for out-of-towners would force patients to wait for treatment for years.

To obtain a quota in Moscow, you must receive a referral from the Ministry of Health or the regional health authority, and you must also provide all documentary evidence of the diagnosis.

You can get a quota for an operation in Moscow only if there is no suitable specialist or equipment in the patient’s city of residence. Otherwise, it will be impossible to get a referral to the capital.

Conditions for obtaining a quota for surgery in Moscow

There is a certain procedure for registering a quota for an operation, it is as follows:

The patient must receive a referral for surgery signed by the head physician of the clinic at the place of registration. You will also need an extract from the medical history, which will be studied by a commission authorized to refer patients for surgery.
The commission, if the application is approved, issues a coupon for hospitalization in a regional clinic located in the region of registration of the applicant. There, the papers will be examined by a second commission for no more than 10 days, after which they will be sent to a clinic specializing in this disease, located in any city in the country. That is, first the patient is examined in a local hospital, then in a regional one, and only then in a specialized one.
Specialized clinic will independently decide through the third commission whether it is possible to carry out the operation. If the decision is made in favor of the patient, he will receive a notification indicating the timing of his appearance.

The procedure for obtaining a quota for an operation in Moscow, the necessary documents

In order for you to be allocated a quota to conduct medical procedures or operation, you must proceed as follows:

Go to the attending physician at the clinic at your place of registration, ask him to write you a individual plan examinations.
Take the examination, even if it is paid (no one will compensate for its cost, even if the quota is not received in the end).
Collect all the required documents (the list will be discussed below), send the papers to the local medical commission.
Wait for the commission’s decision (you won’t have to wait more than 3 days).
If the commission approves your candidacy, you will have to wait about 10 more days while the papers are reviewed by the regional commission.
If the second commission confirms the need to allocate a quota, your documents will be sent to a specialized clinic, where you will undergo treatment or wait for surgery.

Document	Where to get it
	–
Photocopy of Russian passport (for adult patients)	Ministry of Internal Affairs of the Russian Federation
Child's birth certificate (for children under 14 years old)	Civil registry offices
Photocopy medical policy	Insurance Company
Certificate of compulsory pension insurance (SNILS)	Pension Fund
Photocopy of insurance account	FSS
Extract from the medical history (signed by the chief physician of the local clinic)	At the place of observation of the course of the disease
Original certificates with the results of examinations and analyzes	Medical laboratory
If you plan to receive a free travel voucher to the clinic, please also prepare:
Original referral for surgery or treatment under the allocated quota	Medical commission
A document indicating the existence of rights to such a benefit (conclusion medical and social examination for disabled people, pension certificate for pensioners, veteran’s certificate and so on)	USZN and others government agencies, depending on the type of certificate

A quota for IVF can be obtained by following the following instructions:

Contact your local gynecologist or antenatal clinic.
Complete the prescribed medical examination (payment for procedures and tests is at the patient’s expense).
Collect everything Required documents(the list will be presented below), send the papers for consideration by the medical commission.
Wait first for the decision of the regional commission, then the regional one (in total no more than 2 weeks).
If the decision is positive, you will receive a quota for IVF in a specialized clinic.

You will need to prepare the following documents:

statement about the need for IVF under a quota;
photocopy of Russian passport;
social security card;
original extract from the medical history (signed by the chief physician);
original certificates of medical examination and laboratory tests.

Operation quota

A quota for surgery can be obtained by a person who needs help in treating a disease established by government agencies.

Registration of quotas for operations is carried out in accordance with the norms of legal acts of the Ministry of Health and Social Development of Russia. Persons who have applied for a quota for surgery have the opportunity to receive treatment at public expense.

VMP quota

VMP is high-tech medical care. Only a special medical commission can refer a patient for treatment by providing VMP.

As stated in Part 4 of Art. 34 of the Law “On the Fundamentals of Health Protection...” dated November 21, 2011 No. 323-FZ, VMP refers to specialized medical care, which is provided in accordance with the list of VMP established by the Government of the Russian Federation.

Treatment quota. Types of diseases

Varieties of VMP are enshrined in the regulations of the Government of the Russian Federation “On the program of state guarantees...” dated November 28, 2014 No. 1273, “On the program of state guarantees...” dated December 19, 2016 No. 1403. Regulatory acts includes among the types of high-tech medical care:

microsurgical, reconstructive plastic surgery on the pancreas, bile ducts and liver;
reconstructive plastic surgery on the perineum, as well as the small and large intestine;
surgical intervention in the area of the stomach and esophagus;
surgical treatment of adrenal tumors;
operations using robotics;
laser and surgical treatment gynecological disorders of a certain group;
complex treatment of patients with extensive burns;
microsurgical interventions performed using an operating microscope;
complex cases of implantation and transplantation;
therapeutic treatment of vascular complications of diabetes mellitus.

Quota for IVF

In vitro fertilization, or IVF, is an expensive procedure to help women diagnosed with infertility have a baby.

IVF includes methods of stimulating ovulation, culturing and transferring the embryo into the uterine cavity.

To find out how to get a quota for IVF, you need to refer to the procedure approved by order of the Ministry of Health of the Russian Federation dated December 29, 2014 No. 930n.

How to apply for a quota for an operation

How to obtain a quota for an operation is also described in detail in the above-mentioned order of the Ministry of Health.

To find out how to get a quota for treatment, you need to contact your attending physician.

Extract from the patient's medical records

The doctor prepares an extract from the medical card for a patient in need of VMP.

Such an extract must contain information:

about the patient's diagnosis;
the patient's health status;
measures taken to diagnose the disorder;
treatment.

Papers with the results of laboratory, instrumental and other studies should be attached to the extract.

Medical commission medical organization

After preparing the extract and examination results, the documents are submitted for consideration by the medical commission of the medical organization. A medical commission is created from specialists from the medical institution where the citizen was observed and treated .

Don't know your rights?

Actions of the medical commission

Within 3 days from the moment the documents are received, members of the commission review them. They can decide:

Send the papers to the Commission of the executive authority of the constituent entity of the Russian Federation in the field of healthcare for the selection of patients for the provision of medical care (hereinafter referred to as the Commission of the constituent entity of the Russian Federation). The commission of a constituent entity of the Russian Federation is formed by the executive bodies of the constituent entity and includes at least 5 specialists. The chairman of the commission is the head of the executive body of the subject in the field of healthcare.
Refuse to send documents to the Commission of a constituent entity of the Russian Federation. In this case, the commission sends the patient an extract from the protocol, which describes the reasons for the refusal.

Documents sent to the Commission of a constituent entity of the Russian Federation

The decision of the medical commission is formalized in the form of a protocol. If a decision is made to send the patient’s documents to the Commission of a constituent entity of the Russian Federation, then they are transmitted in the following set:

Extract from the protocol of the decision of the medical commission.

Patient's statement. If necessary, the application can be submitted by the patient's legal representative or his authorized representative. The application must contain information about:

In addition, the patient’s application must be accompanied by:

consent to the processing of a citizen’s personal data;
copies of the patient’s passport, birth certificate of a sick child under 14 years of age, compulsory medical insurance policy, extracts from medical documentation and test results;
power of attorney from the patient's representative.

If the medical commission refuses to send documents to the patient, he can independently or through his representative send all the listed papers to the Commission of the constituent entity of the Russian Federation for consideration.

Decision of the Commission of a constituent entity of the Russian Federation

The commission of a constituent entity of the Russian Federation accepts papers and makes a decision on them within 10 days.

It may make one of the following decisions:

About availability medical indications to refer the patient to medical institution to provide VMP.
Lack of medical indications for the provision of high-tech medical care.

Contents of the protocol of the Commission of a constituent entity of the Russian Federation

The decision of the bodies of the Commission of the constituent entity of the Russian Federation is drawn up in the form of a protocol, which describes the following information:

grounds for the creation of the Commission of a constituent entity of the Russian Federation;
composition of the commission;
passport details of the patient whose documentation was reviewed;
conclusion of the Commission of a constituent entity of the Russian Federation, describing:
- information about the availability of indications for referring a citizen for treatment;
- diagnosis and diagnosis code;
- information about the absence of medical indications for the provision of VMP;
- data on the grounds for additional examination sick;
- reasons for referring a patient to medical organization for the purpose of providing specialized medical care.

If a patient has indications for treatment under a quota, then the Commission of a constituent entity of the Russian Federation issues a voucher for him to provide VMP. Also, members of the commission agree with the medical organization providing medical treatment on the date of treatment of the patient and refer the patient to the institution.

The commission of a constituent entity of the Russian Federation sends the following documents to the medical institution that will provide medical treatment:

voucher for the provision of medical treatment;
a copy of an extract from medical records;
results of studies of the citizen’s health status.

Commission of a medical organization providing VMP

Before admitting a patient, the medical institution providing medical treatment convenes a commission of the medical organization.

The decision of the commission of a medical organization on the existence of grounds for hospitalization will be the basis for treating the patient.

The commission consists of at least 3 people. She makes a decision on the presence or absence of grounds for hospitalization of the patient within 10 days from the date of issuing a coupon for VMP. The protocol with the final decision of the commission of the medical organization providing VMT is stored in this organization.

After drawing up the protocol, the patient can receive medical care. In addition, the medical institution will give him recommendations for further treatment.

Thus, the procedure for obtaining a quota for surgery and treatment is very complex and lengthy. To receive the necessary medical care, the patient will need to wait for the decisions of 3 medical commissions.