Operation quota: how to get according to the new rules

Not all diseases are easy to treat. There are such ailments that you have to spend a lot of strength and money. Often, patients do not have such an opportunity, and free medicine with the quotation of special services comes to help them. How to get such a quota - in this material from InvaWorld.

Content

  1. What does the quota mean and who give it?
  2. What laws are adjusted quotas
  3. How to get a quota for treatment
  4. Is it possible to speed up the process?

What does the quota mean and who give it?

So, some types of treatment are possible only with the use of special tools and in the presence of highly professional narrow specialists. Such institutions can be counted on the fingers, and they are developing largely due to state support. In exchange for such support, doctors make free operations. But they may not accept all patients, so that the authorities provided for the conditions under which patients may apply for such assistance and a certain order in its receipt.

If you just say, the quota is a direction for special treatment over free health insurance.

Operation quota: how to get according to the new rules
Photo: PBS.TWIMG.com.

What laws are adjusted quotas

The chief legislative act regulating the issue of granting quotas - Federal Law No. 323. In 34, the article describes the entire order of quotation. From December 6, 2019 comes into force New procedure for providing high-tech medical care , approved by Order No. 824n of October 2, 2019. If you want to get acquainted with it, here it is:

Order of the Ministry of Health 824n of 02.10.2019 on the procedure for the provision of high-tech medical care

Not any disease is subject to specialized treatment. The Ministry of Health has prepared a list of almost one and a half hundreds of diseases that may fall under quota treatment. Among them - internal organ transfers, joint prosthetics, neurosurgical problems, eco and heavy hereditary diseases and much more, the list is very large.

How to get a quota for treatment

To get a referral to specialized medical care, you need to go a difficult path. Starting with a district doctor. It is necessary to get a referral to an additional examination. The conclusion of the doctor will consider the commission on quotation in the local medical institution and within three days will decide on the further direction or not direction of the patient for quotation.

The second stage is considered in the Health Department of the Region, the Republic or the region. Here will consider the package of documents. The composition of which includes documents. Certification of the patient's personality, his medical and pension policy, an extract from the history of the disease and the protocol of the first commission. This consideration highlights a maximum of 10 days.

The regional commission decides, in which a specialized clinic to send such a patient and sends documents there, with parallel informing about the adopted decision of the applicant.

Usually the clinic is selected, which is geographically located closer to the place of residence of the patient. But in some cases they can give direction to Moscow institutions.

In turn, the clinic, having received the patient's documents, considers them and decides whether it takes specifically for this case, and also assigns a deadline for treatment. It takes another 7 days.

It turns out that receiving a quota takes 20 days, and you need to keep in mind that on any of these stages you may well receive a refusal. Require a motivated failure to continue the fight for the quota if necessary.

Is it possible to speed up the process?

20 days can sometimes cost life, this is a fact. Sometimes treatment is required immediately and in most cases doctors go to the patient. But keep in mind that this is 20 days put on the consideration of the application, the waiting period appointed by the clinic will also be added.

Is it possible to somehow speed up the process? There are a pair of options for decisive people. The first is just to force people responsible for the decision, make it as quickly as possible. Help regular calls, letters and complaints. An affordable but effective method.

The second option is to start "from the tail", that is, directly contact the clinic, where you can help with the full required package of documents and directly write an application for quotation. With a good scenario, the clinic itself will welt all the formalities associated with your treatment.

Did you have to get a quota for treatment? Share your experience in the comments!

The disease often approaches imperceptibly, and it is not possible to prepare for the fight against it. In modern reality, to get out of this war by the winner, you need to mobilize all available resources, and the crucial role can be played by financial resources, since the most effective treatment based on the latest scientific developments is very expensive, and it is possible to get it far from any clinic.

What is a quota for treatment?

Not every citizen is informed that this case provides certain state aid to which he can expect, and it turns out in the form of a allocated medical quota.

Cuttle for treatment

The treatment quota is a cash allocated from the state budget to provide its health care services using high technologies. For the rational formation and distribution of quotas, a state system of high-tech medical care (VMP) was created, within which diagnostics are diagnosed and more than 100 clinics of regional and federal levels are being treated. Each year, more than 50 billion rubles are allocated to the work of these health care facilities from federal and regional budgets. This amount is on average divided by 350-450 thousand. Quotas - about such a number of Russians will be able to use VMP for free during the year.

More than 137 names of VMM types in 22 directions are distinguished. These include:

  • complex surgical interventions;
  • Operations on the open heart;
  • organ transplantation;
  • treatment of leukemia;
  • removal of brain tumors;
  • assistance in complex forms of endocrine pathologies;
  • treatment of genetic and systemic diseases;
  • application of reproductive technologies, including ECO;
  • Cleaning newborn children with the use of modern methods, etc.

How to get a quota for treatment?

There is a strictly established procedure for issuing a referral for the provision of VPM, which is full of bureaucratic obstacles. In order for the outcome of the case to be prosperous, you need to be prepared for possible difficulties. Obtaining a quota for an operation or treatment - a procedure for a long time and complex, requiring registration of a large number of documents and the passage of a number of additional surveys. All this is necessary so that state bodies authorized to solve these issues were able to estimate the feasibility of using VMM in a particular case.

Quality quota

Step one

In each region, the treatment quota is drawn up according to its regulations, which in minor aspects may have the difference from the general one. Therefore, it is better to start with the consultation of a specialist, contacting the Ministry of Health of the Subject of the Russian Federation. There you can learn about the presence of quotas for obtaining a WMD on the existing diagnosis and clarify the procedure for submitting an application.

Step two

The main package with documents is usually collected in the municipal clinic at the place of observation of the patient with the participation of the attending physician, which gives a direction, makes an extract from the history of the disease with an indication of the analyzes and surveys (according to the results of which the recommendation on the hospitalization of a citizen in a specialized clinic is made to provide a VMM). Copies of the passport, the policy of OMS and the evidence of the OPS are applied.

Important procedure

A formed package with documents is assigned by the signature of the Chief Doctor and is sent to the Commission under the Ministry or another health authority in the region. The decision on a specific case is given 10 days, during which the documents provided are considered, as a rule, without the applicant's participation.

The final stage

When issuing a positive decision, the documents are sent to the profile medical institution that has a license for the provision of VMM. There, the next commission is considered, who is also allocated for the decision of the decision, during which it should answer the date of the patient's hospitalization. Usually the period after which inpatient treatment should be launched is limited to 3 weeks.

Bureaucratic traps

By wondering how to get the quota for treatment, do not forget to take into account the following points.

Eye Acquisition Quota

First, the right to choose a specialized clinic for the provision of VMM remains for the health authority in the region, citizen's preferences are not taken into account.

Secondly, the quota for the treatment is in reality often drawn up longer than spelled out in the rules. It is determined by the fact that the time intended for consideration by the commission's commission is not withstanding, and the medical institution due to the download is not always capable of accepting a patient. Unfortunately, the nature of the disease may be such that urgent surgical interference is required, for which the patient has no funds, so the operation quota is needed immediately. In this case, it is necessary for all possible ways to forcing the work of officials.

How to speed up the procedure for making a medical quota?

There are two possible variants of accelerating the claimed process. According to the first of them, the citizen produces the steps provided for by us and described by us above, but at each stage it is actively interested in the course of consideration of the application, makes calls to officials, writes applications with a request to reduce decision making time, attributes visits to the reception hours. Perhaps one of the officials will want to send documents faster to further consideration in order to no longer be an object of massive attack. But, of course, no guarantees are that these events will raise at least some action and time will decrease.

how to get a quota for treatmentAccording to the second option, a citizen ignores all the stages with the consideration of the application by the Commissions. He independently collects documents for an operation quota, for example, is looking for all the necessary information on specialized clinics licensed to provide VPM and specializing in the necessary surgical intervention and refers to the selected institution. There is a chance that the clinic will meet the patient towards and agree to hospitalize it, providing the required treatment in the account of the quota available at the subject of the Russian Federation.

Causes of refusal

First, the Commission may not find grounds for the use of VMM in a specific case. Secondly, the presence of severe concomitant diagnoses and the particular nature of the underlying disease often serve as the causes of failure. Thirdly, at the level of the regions, there may be placed in the design of the quota. For example, in Moscow and St. Petersburg, the Eco operation quota is issued for women aged 22 to 38 years, in other regions these frameworks may be different.

In case of adoption by the Commission of a negative decision, it is necessary to obtain a refusal of writing with the reason. In the event of your disagreement, you can contact him to the Ministry of Health and Social Development of the Russian Federation to appeal.

Treatment abroad

If domestic medicine is not able to carry out full-fledged diagnostics or adequate therapy of the existing disease, then you are entitled to ask for allocating quotas for treatment abroad. Only in connection with this, the list of required documents will expand, will also increase by one number of commissions that must be passed.

If you get a refusal to leave the quota abroad, you will be required to offer an alternative to the provision of WMP in Russia.

Problem of additional payments

Oncology treatment quota

Very frequent occurs when the patient has to cover a lot of expenses for its treatment, although it is officially stated that it is carried out at the expense of the state. You should usually pay for the preparatory procedures before the operation, analyzes, surveys.

For example, on average, the cost of the course of the therapy of one cancer is 200-250 thousand rubles, and the quota for the treatment of oncology - 109 thousand rubles. Often, human has no such means to cover what they refuse to pay from the budget. Of course, charitable foundations are taken greatly involved in financing the costs of such patients, but it turns out that these are no obligations of the state, and it must be dealt with. The constant flow of written complaints and the attraction of the media is effective when solving such problems.

Queues: how to avoid them?

It is no secret that those who want to receive VMM are much more than the opportunity from the state to provide this assistance. Therefore, in the health management body, you can hear information that there is no quota for treatment for this diagnosis, since the amount of funding from the budget provided for this year has been exhausted, or receive from the clinic that there is no place for seats for the near future and hospitalization is postponed . But in any case, the hands should not be omitted. This or that way out is real.

Documents for an operation quota

First, you collect documents by the same scheme and enter your name in the registry of the quota expectation, or queue to hospitalization. If the disease quickly progresses, try through the local health authorities to raise an additional quota, contact the media, attracting the public. Then there will be a small chance that there will be funds, or it turns out that suddenly someone from the patients refused treatment, and the place in the medical institution was released.

If all your actions ignored, health problems will have to decide at their own expense, especially if there are no promises that there will be a quota soon.

For an eye operation, for example, on the replacement of the lens, you can try to collect funds yourself. The cost of such an intervention, in contrast to most others, does not exceed 70 thousand rubles. The amount is also rather big, but in the launched state of the cataract threatens 100% blindness, and risk, losing the precious time in the queues, is not worth it. Moreover, retaining all confirming documents, a citizen has the right to apply for compensation for the provision of WMP at the expense of the Ministry of Health and Social Development of the Russian Federation. In order for the refund to be approved, it is necessary to prove that you are registered as waiting assistance, while the course of the disease has gained a threatening nature and demanded immediate surgical interference, and the operation quota was not available for reasons from you.

Anonymously fail

Hepatitis C treatment quota

There are diagnoses that people try not to advertise due to the negative relationship of society and related restrictions in everyday life. Such diseases include hepatitis C, the treatment of which is very expensive (about 750 thousand rubles). The state allocates funds to combat this ailment, but in order to use them, the patient must be registered officially. On the one hand, there is a possibility of obtaining therapy on a budget basis, on the other - the risk of disseminating information on the presence of the disease appears.

Hepatitis C treatment is issued by citizens who are registered in profile medical institutions, most often in AIDS centers that operate in many cities. Only by decision of the Special Commission of this institution of the patient contributes to the register of waiting, as the quotas are not enough for everyone. Therefore, it is anonymously treated only at your own expense.

Overview

High-tech medical care (WPM): how to get it?

Since 2005, the concept has been introduced in our country - high-tech medical (VMP). This is a special type of medical services that imply the use of the latest achievements of medical science, for example, the use of genetic engineering, cellular technologies or robotic equipment for the diagnosis and treatment of complex diseases. The most in demand is such assistance in diseases of the heart and vessels, in traumatology and orthopedics, with eye diseases, as well as for the treatment of malfunctions in newborns. In total, about 1,500 types of expensive medical care fall under the definition of VMM. However, every citizen of the Russian Federation has the right to receive it for free. The only condition for this is the availability of indications.

To the types of VMM, for example, belong:

  • Transplanting kidney, heart, pancreas, small intestines, liver.
  • Implantation of expensive auditory devices (cochlear implantation).
  • Surgical operations in the tumors of internal organs.
  • Operations during angina and infarction (coronary angiography, balloon angioplasty, stenting vessels, etc.), including in an emergency, without waiting in the queue.
  • Some types of expensive chemotherapy in patients with blood tumors.
  • Complex treatment of heavy psoriasis forms.
  • Treatment of extensive burns (more than 30% of the body surface).

The full list of VMM types can be found in the Decree of the Government of the Russian Federation of December 19, 2016 No. 1403 "On the program of state guarantees of free provision of medical care for 2018 and for the planning period 2018 and 2019."

VMPs are provided both in large multidisciplinary hospitals with relevant specialists and equipment and in narrow-profile hospitals, which are exclusively provided by the provision of high-tech services (cardiac surgery centers, extracorporeal fertilization centers, etc.). Initially, the program included only federal medical clinics who received funding from the federal budget. Now a list of medical institutions that provide VMM are significantly expanded: most of them have regional status, in addition, private clinics received the right to render WMP.

Changed and payment order. The most popular types of VMP were allocated to a separate list. This, for example: stenting coronary arteries, installation of an artificial rhythm driver, hip joint, the use of genetic engineering drugs with rheumatoid arthritis, comprehensive surgical treatment of glaucoma, eco. Medical services from this list are now paid directly from regional compulsory health insurance funds.

Clinics that have a VMP in the framework of the CDM basic program are in many cities of our country, which increases the transport accessibility of this type of assistance for regions, and also accelerates and simplifies the treatment procedure for treatment. It is believed that now medical care from this group can only be obtained in the region where you received your OMS policy. However, this is not true. The law is prescribed by the mechanisms of financing in cases where VMP in the framework of the Basic FMA program turns out to be outside the region.

More complex and less common types of VPM are not included in the basic compulsory health insurance program. These are unique operations owned by a limited number of highly specialized doctors, or treatment with the help of a particularly complex and expensive equipment that are inappropriate to equip regional hospitals. The VMP from this group is now paid from the OMS Federal Fund and is accessible, as a rule, only in federal healing establishments, the main part of which is concentrated in Moscow, St. Petersburg and other major cities.

The financing mechanism, as well as belonging to the CHA program, is important, mainly for the heads and staff of the medical institution operating in the VMM system. If earlier the clinic received money on the WMD at the beginning of the year and could buy pre-expensive consumables and drugs, according to the statement issued (quota number), now "Money follows the patient", that is, the calculation with the clinic is already due to the fact of the rendered treatment.

For patients, these organizational subtleties are not significant, since problems with equal probability arise on the way to obtain a VMM, regardless of the form of the calculation of the clinic with the state. Nobody canceled the State party, and each clinic included in the VMP system receives a certain amount of quotas for the year. Take more patients than quotas allocated, the clinic cannot, since no one will pay for exceeding the plan. Consequently, of those who want to receive the VMM still retains the queue. Therefore, it is important to know how to act if you need high-tech medical care, which you can count on and how to overcome possible difficulties, without falling into a despondency.

How to get high-tech medical care (VMP)?

The first stage of obtaining a quota for VMM is the design of documents that confirm the need for treatment. Usually do it in the clinic at the place of residence, that is, where you are watching about the main disease. The required set of documents includes:

  • an extract from the history of the disease, where all information about the state of your health, results of analyzes and treatment data are contained;
  • Conclusion of the medical commission clinics that you need one or another type of VMM;
  • Direction to hospitalization;
  • Your consent to the processing of personal data;
  • For adults - a copy of the passport, for children under 14 years old - a copy of the birth certificate;
  • A copy of the CHA policy;
  • A copy of the insurance certificate of compulsory pension insurance.

If you are laid by a VMP, which is included in the basic program of the OMS, then these documents are transmitted directly to the clinic where you plan to be treated. There you are passing the commission that takes the final decision on hospitalization and, if there are no contraindications, the date of the beginning of treatment is appointed.

If the view of the VMP is not included in the base system of the OMS, then first the collected documents are necessary in submitting the territorial health authority to the department of the WMD. This duty by law is assigned to your clinic. However, it is possible to submit documents on your own, in person or through MFC and public services. The deadline for submission of documents is 3 days from the date of receipt of the direction to hospitalization.

The second stage is the consideration of your question in the VMM department. This assigned a period of no more than 10 working days. In the case of a positive solution, an electronic coupon for the provision of VMM is formed, and you report its number. Coupon for the provision of VMM serves as a basis for solving the issue of hospitalization in the clinic, in accordance with the presence of quotas. Next, the whole history of its appeal can be tracked on The site of the Ministry of Health .

The third stage is the consideration of your application in the clinic. There is a final decision on the need for the possibility of carrying out the necessary type of treatment. 7 working days are assigned to it. If the clinic is ready to assist, you are placed on a waiting list. The queue may come tomorrow, and sometimes the expectation in it is stretched for several years. This time interval does not regulate the law. It all depends on the capabilities of the clinic, the amount of money allocated on the VSM State and the number of people in need of treatment. The fastest turn in the directions: "Oncology", "cardiovascular surgery" and "neurosurgery", the slowest - to replace the joints towards the "orthopedics".

The quota for WMM can be obtained an unlimited number of times, however, the procedure for execution of documents every time you have to begin again. For example, people with oncological diseases receive quotas for each course of chemotherapy. Repeated along the path of the design of the WPM, people in need of prosthetics of several joints. Couples that dream of the birth of a baby have the right to multiple ECO attempts in the framework of the WMD.

How to cut the wait in the queue on VMM?

There is a completely official and honest way to accelerate hospitalization on VMM. To do this, you can also contact the clinic immediately. You independently collect the results of surveys, fresh analyzes and medical conclusions about the disease, write to the reception to a specialist of the selected medical institution and come to consult. Reception on VMP issues is usually carried out in special departments, centers or advisory clinics at the hospital. More information is usually published on the clinic website. Without a direction from the attending physician, such a consultation in a federal or private hospital is usually paid. In addition, additional examinations may be required by a clinic specialist for which they will also have to pay. However, this path of receiving a quota usually turns out to be shorter and more efficient.

Another way to slip without turn is to seek help in charity funds, "raise noise", attract the media, complain to the regional and supervisory health authorities. Sometimes it works and suddenly there is a free quota. But it is planted on this path, you need to be ready to enter into a deal with conscience. Well, if you achieve quota to win the victory over the bureaucracy. Bad, if attracting extraneous forces, you are inappropriate to take the quota for the one who needs it more and patiently defended its turn.

Can they refuse to provide VMM?

Legally defined two reasons for refusal in high-tech medical care: the first is the lack of indications, the second - the presence of contraindications to treatment. Failure must be reasonable and decorated in writing. If you or your attending physician do not agree with the decision of the Commission, you have the right to appeal it in the Ministry of Health.

In the event that in Russian clinics it is impossible to treat, for example, there are no necessary drugs or equipment, then the patient is directed abroad. VMM can be obtained free of charge in foreign clinics.

What will have to pay?

The view that having received a coupon on the VMM, you get rid of the need to pay, alas, erroneously. Where are unforeseen expenses? Most often this happens in case you have to be treated in the federal clinic not at the place of residence or in a private medical institution.

First, in this case, the OMS program does not cover an additional survey on the basis of this clinic. And it may be necessary. Secondly, the Hospital Chamber, Nutrition and other services in the clinic, directly not part of the VMM, can also be paid. Finally, individual stages of treatment and rehabilitation, as well as consumables, can also be outside government financing. For example, according to the VMM program, it is possible to offer the installation of a domestic implant, and more qualitative, imported, if desired, can be purchased at your own expense. Some preliminary manipulations with radiation therapy are paid, the search for the bone marrow donor, etc.

If you are offered to pay any services, drugs or consumables, carefully delve into the details. To avoid fraud, before making a decision, you can consult on this issue in the OMS department or call the Ministry of Health. With regard to payment for travel to the place of treatment and back, only beneficiaries can get free tickets (disabled people, participants of the Second World War). Payment of travel in this case is due to the funds of the Social Insurance Fund.

Is it possible to choose where to be treated?

From the medical institution that provides a lot of highlights. Therefore, patient preferences are always taken into account by the Guide Commission. However, other factors are influenced by the question of choosing a clinic: a region of accommodation and transport accessibility, the presence of free quotas, and most importantly, medical grounds. The view of the Commission of Doctors on where the help of the disease is most qualitative and will be able to provide a priority.

In cases where in the region where you live, there is no clinic that has a HDM of a specific profile (for example, engaged in the transplantation of organs), or the necessary institutions are there, but they did not have a sufficient number of quotas for a specific procedure, you may be sent to a hospital to another city , including Moscow or St. Petersburg.

Treatment of certain diseases is so complicated and expensive that citizens are not able to pay him independently and organize. But every citizen of the Russian Federation has guarantees from the state recorded in the main law. They are ensured by the quotation of specialized services of doctors.

Just need to know how to get a quota for treatment in 2021. This is a difficult process governing by law.

What is the quota and to whom it is

It is necessary to proceed from the fact that certain types of treatment (operational intervention) are provided only by those health facilities that are provided:

  • specialized equipment;
  • Highly professional personnel.

This means that such clinics receive additional funding for development. It is allocated from the state budget so that the doctors can save citizens in particularly difficult situations. There are not so many hospitals.

If this is understanding, it will not be easy to delve into how to get a quota for the operation. All state authorities are engaged in all the questions of quotation. Each stage is laid in the regulatory framework. The deviation from the implementation of the law in this case is unacceptable.

Thus, the quota is the allocation of state support to people in need of special treatment, within the framework of the general general health insurance (OMS).

Ministry of Health RF Determines the lists:

  • medical institutions dealing with the treatment of ailments;
  • Diseases for which quotas are provided.

The legislative framework

A number of government documents fully describes the process of allocating and using quotas. These include:

  • Resolutions guaranteeing free medical assistance to citizens of the country;
  • Federal Law No. 323. Its Article 34 Just describes the process of registration of quotas, the conditions for the implementation of this state guarantee;
  • Order of the Ministry of Health RF specifying the quotation process.
Medical financing issues are in the department of the specified ministry. Only this state authority has the right to decide how many quotas will be provided to citizens in the current year, in which health care facilities can be implemented. The relevant rulings are published regularly.
Download for viewing and printing

Federal Law of 08.12.2010 N 343-FZ

Diseases to be quoted

The state does not issue money to get rid of a citizen from any ailment. For quota, good reasons are needed.

The Ministry of Health publishes a document containing a list of diseases that are subject to treatment for the state account. The list is extensive, it contains up to 140 ailments.

Here is some of them:

  1. Heart diseases, to get rid of the operational intervention (including re-).
  2. Transplantation of internal organs.
  3. The prosthetics of the joints, if the endoprosthetics is necessary.
  4. Neurosurgical intervention.
  5. Extracorporal fertilization (ECO).
  6. Treatment of hereditary diseases in severe form, including leukemia.
  7. Surgical intervention, requiring specialized equipment, that is, high-tech medical care (WMP):
    • in front of;
    • on the spine and so on.
Ministry of Health RF Determines the number of quotas for each institution that has an appropriate license. This means that the appropriate clinic can take on the treatment at the expense of the budget only a certain number of patients.

The procedure for obtaining a preferential place in the clinic

The path to the medical insurance capable of cured, not easy. The patient will have to wait for a positive solution from the three commissions. Such an order of receiving a quota established the Ministry of Health RF .

There is a workaround. We describe it a little later. To start any appeal for the quota follows from the attending physician.

To obtain a preferential treatment, you need to confirm the diagnosis. To do this, you may need paid tests and surveys. Their patient will have to make their own savings.

First Commission - at the Patient Observation Place

The initiation of initiation of the quota is as follows:

  1. Contact your doctor and describe the intention.
  2. Get directions from him if you need to pass an additional examination. The refusal will lead to the deficiency of the quota.
  3. The doctor makes up a certificate in which the data is indicated:
    • about the diagnosis;
    • about treatment;
    • about diagnostic measures;
    • On the general condition of the patient.
  4. A certificate is considering a commission dealing with quota issues created in this medical institution.
  5. This body is assigned three days to make a decision.
The doctor is responsible for the "candidate" for the quota. He cannot recommend a citizen committee who can do without VMP. .

The decision of the first commission

If the patient needs specialized services, the hospital commission decides on the direction of documents to the next authority - the Department of Health of the Regional Level. At this stage, a package of documents is formed, which includes:

  1. An extract from the minutes of the meeting with the substantiation of a positive decision;
  2. A photocopy of the passport (or birth certificates, if we are talking about the child under 14);
  3. The application in which you need to reflect:
    • Full name ;
    • registration address;
    • Passport details;
    • citizenship;
    • contact information;
  4. A copy of the policy Oh. FROM;
  5. Pension insurance policy;
  6. Insurance account data (in some cases);
  7. Data on surveys and analyzes (originals);
  8. Extract from the medical record with a detailed diagnosis (prepares a doctor).
It is necessary to give the consent of a medical organization for processing personal data. For this he is written another statement.

The second stage of decision

The Regional Level Commission includes five specialists. Its activity is managing the head of the relevant department. Deciding this body is given to ten days.

In case of a positive decision, this commission:

  • determines the medical institution in which treatment will be carried out;
  • sends a package of documents there;
  • Informs the applicant.
It is customary to choose a clinic located near the residence of the patient. However, not all hospitals have licenses for specialized operations. Consequently, a citizen may well give a referral to another region or in the capital institution.

The work of this body is logoied. The paper reflects such data:

  • grounds for creating a subject RF ;
  • specific composition of meeting persons;
  • Information about the patient, whose application is considered;
  • Conclusion in which are deciphered:
    • full indications data for the provision of quota;
    • diagnosis, including its code;
    • grounds for directions to the clinic;
    • the need for additional examination;
    • grounds for refusal VMP. .

To the medical institution where the patient will be rendered VMP. , are sent:

  • Coupon for rendering VMP. ;
  • copy of the protocol;
  • Medical information about human health.

Third stage - final

In a medical institution chosen for treatment, there is also a quota commission. After receiving documents, she holds his own meeting, in which at least three people should take part.

This organ:

  1. Exploring the information provided for the possibility of a treatment for a patient
  2. Deciding on his provision.
  3. Determines specific deadlines.
  4. On this work, he is given ten days.
Coupon, in case of use, is stored in this clinic. It is the basis for budget financing of treatment.

Thus, the decision on the inclusion of a person in the quota program takes at least 23 days (still take into account the time to send documentation).

The hospital provides recommendations for the further treatment of the patient.

Features of services by quota

For public funds, only such medical services are provided that cannot be obtained at the local hospital.

Theses are as follows:

  • surgical intervention;
  • VMP. ;
  • ECO ;
  • treatment.
Each of the types of assistance requires specialized equipment that appropriate training of specialists. That is, ordinary diseases are not subject to quotation.

Operation

This type of support is provided to people whose diagnosis corresponds to the List of the Ministry of Health. They are sent to the clinic capable of carrying out the necessary manipulation. All treatment is available for free.

Some citizens are paid and travel to the place of assistance.

VMP.

This type of service implies use to get rid of high-tech diseases. This is an expensive procedure. All the necessary spending takes on the budget.

However, to provide VMP. Required medical grounds.

Treatment

This type of state support implies the acquisition of expensive drugs, which the patient itself is not able to pay. Its procedure is determined by Federal Law No. 323 (Article 34). Specifies the implementation of the provisions of this Regulatory Act into the practice of the Government RF With its regulations.

ECO

Women who are diagnosed with infertility are directed to such an operation. Extracorporal fertilization is a highly cost and long-term procedure.

Many women are not able to feel the joy of maternity without such an operation. But give way to ECO Only patients who have passed the difficult prior period of surveys and treatment.

Not all kinds of help in restoring the health and preservation of citizen's life are described. RF . There are many ailments, almost all of them fall under one of the described areas of medical technologies. But there are exceptions.

How to reduce support time

Often there is no way to wait. Help is needed urgently.

Accelerate the decision-making process in three commissions is not easy.

Experts recommend two ways:

In the first case, it is possible to provide "pressure" on people responsible for the selection of quotas:

  • call them to learn about the progress of the issue;
  • go to the reception to managers;
  • write letters and so on.
The effectiveness of this method is doubtful. Only experienced specialists take part in the work of the commissions. These people themselves understand that the delay is unacceptable.

The second option is to use directly into the clinic providing the necessary services. For this you need:

  • Collect a package of documents (described above);
  • Bring to the hospital and write a statement on site.

Documents from the local hospital, where the patient is put in the initial diagnosis, must be certified:

Unfortunately, without compliance with the clinic formalities, working in quotas, help will not be able to give. This medical institution still has to be reported for the use of budget funds.

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How to get a quota for online treatment

My niece has a weak heart, so you are watching a cardiologist from three years old. When she was eleven, the doctor said that it was time to operate.

Svetlana Fateeva

helped the nephew getting a quota for surgery

This is a normal practice: the operation is always risk, so doctors are trying to do without it until the latter. The niece was getting worse, and there was nothing more to wait. Cardiologist reassured us: the operation is planned and not very complicated. The problem is different: it does not cover polis OMS , and cost is almost 300 thousand rubles.

We were lucky that the quota gives such treatment. Now the niece chases on a large in the courtyard, and for the operation we did not pay a penny.

What kind of quota

Quota is money for the operation from the state. All citizens RF Have the right to get a quota.

The quotas are not issued by money: instead, the Ministry of Health at the beginning of each year distributes them along clinics. Therefore, get a quota - it means to get a direction for an operation to the clinic, which will treat you by quota funds. In Russia, 139 clinics who have the right to treat quota.

You can only get a quota for high-tech medical care, VMP. that does not cover the policy of compulsory health insurance. For example, there are no quotas for the removal of appendix - this will be done for free by policy OMS . And if we are talking about the operation on the heart, then first will have to get the quota.

The list of procedures and operations on which quotas are updated every year. In 2018 it looks like this:

  1. Operations on the open heart.
  2. Organ transplantation.
  3. Endoprosthetics of the joints.
  4. Extracorporeal fertilization.
  5. Neurosurgical interventions.
  6. Treatment of hereditary diseases, leukemia, severe forms of endocrine pathology.
  7. Surgical intervention of high complexity.
  8. Cutting newborns with the use of modern methods.

Quotas allocate on scheduled operations. It is not very clear how everything works if the patient needs to be rescued VMP. not included in OMS . On the one hand, medical lawyers on the forums clarify that the system is simple: no quota - no operation. On the other hand, under the law, the clinic is required to provide emergency medical assistance for free.

The surveyed doctors could not comment on the situation. If you are saved with VMP. And you didn't pay anything for it, tell me how you succeeded without getting a quota.

On its website, the Ministry of Health describes how the process of obtaining a quota looks like. For this you need to go through three commissions: in the heading of the medical institution, in the Ministry of Health and the clinic where the operation will be held.

Step 1

Commission in the guide of medical institution

The commission is collected in a hospital or clinic. Doctors learn the results of surveys and, if there is indications, give direction to VMP. .

Before the commission, you need to go through all examinations, pass the tests and obtain the conclusion of the attending physician. Sometimes there is enough polyclinic for this: come to the precinct therapist, make everything he says, get a diagnosis. But usually in the clinic do not make complex surveys, so the doctor sends to the profile clinic. For example, with cardiovascular pathology, coronorography is needed. With the direction of P. OMS In the clinic it will be free. With the results of surveys in the clinic they will diagnose.

After that, your doctor transfers the documents of the medical commission and decide there, is there any readings for VMP. . If there is - you get a direction on VMP. With the signature of the head doctor and extract from the medical card. With them, you can already apply for the quota.

Step 2.

Commission in the Ministry of Health

Officials are looking at the recommendations of the medical commission and decide, the quota is laid or not. If it is, it is issued.

The quota application must be submitted to the appropriate body of the health care system. Depending on the region, this can be the branches of the Ministry of Health, the Committees, the Department of Health.

To the application, attach documents:

  1. A copy of the passport or the birth certificate of the child.
  2. Copy OMS и SNILS .
  3. Consent to the processing of personal data.
  4. An extract from the medical card - it makes the guide medical unit.
  5. The results of studies confirming the disease - they are obtained on the basis of the diagnosis in the clinic or hospital.
  6. Direction by VMP. signed by the head physician of the guide medical institution.

The application for the quota is applied independently or with the help of a guide medical institution. You can submit it through state services MFC or receiving Ministry of Health.

If the application from your face gives a medical insurance, it loads your documents into the information system of the Ministry of Health, so you do not need to receive them.

The Commission of the Ministry of Health checks the documents and decides whether there is an indication for VMP. . If yes - draw up the quota. This process takes up to 10 days, but sometimes it can be accelerated. If the medical commission decides that with the usual procedure you will not wait until the operation, it will put this note in the direction and your application will be considered faster.

Another 10 days will go to the selection of the clinic, where you will operate by quota. After that, the Ministry of Health sends your documents to this clinic.

The clinic and the date of hospitalization can be tracked in the information system of the Ministry of Health at the quota number:

Step 3.

Commission in the clinic

When you get your documents and quotas for treatment from the Ministry of Health, there will be another medical commission. She decides whether you have contraindications for VMP. , And if they are not, assigns the date of hospitalization and makes a challenge. You are usually not called for this: there is enough surveys and diagnosis results. An extract from the protocol with the Commission's decision and the call refer to the Ministry of Health through the information system.

His quota on VMP. Together with the date of hospitalization and the challenge to the operation, you already receive from the Ministry of Health - the way that indicated in the application when submitting documents.

On this instruction ends - further hospitalization, additional analyzes, operation and rehabilitation. The doctors of the clinic in which the quota was issued, orient how to make a sick-based hospital when discharge and will give recommendations for further treatment.

Quota get difficult

In the instructions of the Ministry of Health, everything looks smooth, but in fact there are many nuances. Because of them we made a bunch of extra actions, and the quota as a result received the day before the operation. This is well illustrated by the fact that doctors and officials look at the process in different ways, and the patient suffers.

Payment and treatment are two parallel and independent process. Doctors are engaged in treating, and with payment the patient is dealing. Quota is just a type of payment. While no quotas, the doctor will not be able to operate you.

Officials understand that for a person the treatment and receipt of quotas is a single interaction with a health care system, which in ordinary life does not concern. Therefore, they are trying to build a consistent scheme, but as long as she is raw and the patient is stumbling all the time on what is missing for some kind of reference.

It happens that the doctors go towards patients and coordinate their work with officials or even take over the receipt of quotas. When perfect operation, the system should be. But while it is rather an exception.

Helps the experience of people who received a quota, but he is all different. Depending on the disease, the interpretation of the rules by the regional authorities and the experience of doctors, it can be months of running or a simple visit to a specialist in the clinic, which will issue an application in the information system and inform you when the Ministry of Health confirms it.

There is no guarantee that the experience of my relatives will save you from the bureaucracy, but it will help save time and nerves.

Operation code

They do not write about it in the instructions, but before serving the quota, it is not enough to receive a diagnosis and conclusion of a doctor. We need an operation code - the quota will not be given without it. We did not know that, and the doctors of the clinic missed sights. Because of this, we made an excess circle and lost a week.

In the clinic Bakulev, the niece was diagnosed and told that you need to get an extract from the medapation in the clinic and collect documents for the quota. We did everything, and the clinic filed our application to the Ministry of Health. She had to make documents into the information system for registration, but did not work: did not have enough code VMP. .

The fact is that the state states not to correct the interpreservation partition, but to the method that will solve this problem. The method is recorded in the system as a numerical code, for example 14.00.37.005. This is the code VMP. . While it is not, the state does not know how much treatment is, therefore it cannot give the quota.

We phoned with the clinic to determine the code VMP. . We were explained that when a doctor knows how to operate, there is no problem: the code is indicated in the direction. But in our case there were two methods of treatment and the surgeon was going to choose the optimal on a pre-consultation. Falstart came out with the application.

We were offered such a plan: I will wait for a challenge to hospitalization from Bakulev, to call to come with documents for quotas and hospitalization, immediately take advice to determine the method of surgical treatment and get a direction on VMP. . After that, all documents will be on hand to submit an application to the Ministry of Health. And the day will remain before the operation to get the quota.

Call for operation: date, time and list of analyzes for hospitalization are indicated.With the analysis, too, not everything is simple, a little later about them
Direction on VMM. Specified Code of VMM - Now you can get the quota
Direction on VMM. Specified Code of VMM - Now you can get the quota

How faster to apply for the Ministry of Health

We did not know that when personalized the application in the Ministry of Health, the documents will be considered on the same day. In Bakulev, they explained that this is possible: all documents on the quota are ready for us, and you do not need to select the clinic, because it is already known where we will operate.

We went to the Moscow Reception Ministry of Health in Monica And there were a few hours of live queue. The design itself took 5 minutes: checking documents, filling out an application with a specialist - and the quota from us.

So the quota looks like - this is a tear-off coupon from the commission of the Commission of the Ministry of HealthSo the quota looks like - this is a tear-off coupon from the commission of the Commission of the Ministry of Health

How to operate in a specific clinic

According to the instructions, the clinic picks up the Ministry of Health, but, as it turned out, it is possible to operate in a particular clinic. To do this, it is necessary for it to enter the list of institutions that provide you VMP. By quota.

If you are already watching the profile clinic, where you diagnosed, then the scenario will be similar to our.

The doctor in Bakuleva told what documents need to be applied to the application, so that the quota was given to them. In essence, you take part of the work of the officials of the Ministry of Health for the selection of the clinic. The clinic in this case is the guide and host institution - two commissions are held in one place. According to the first one you get the direction on VMP. . According to the results of the second - an extract from the protocol with the decision of the Commission, which checked that there are no contraindications for hospitalization. There is also a date of operation and it is indicated that the clinic is ready to take you by quota. With this document, the quota will be given to the clinic you need.

If you have not been observed in the clinic, but you want to operate on the quota there, then simply write to the primary reception in the advisory department. You will need surveys - Specify the full list of documents while recording on reception or on the clinic website. On them the doctor will make a conclusion and give it to the commission for the selection on VMP. which will issue a direction, a challenge to hospitalization and an extract from the protocol with the decision of the Commission.

Now about how to get to the reception in the clinic.

With a paid reception, everything is simple: come to the clinic from the street, write down to the consultation, pay.

If you do not want to pay, you will have to go to the clinic and get a referral of a consultation in the clinic in form 057 / y-04. It is used to see OMS Send a patient to another medical institution for surveys, clarifying diagnosis, consultations and hospitalization. Without this form, not to sign up for free reception, even with a call from the clinic.

With a diagnosis of Bakulev, we came to the cardiologist to our clinic and received a direction in form 57 / y-04. With him, we went on call to the Bakuleev clinic to clarify the method of treatment and hospitalization.

After consultation with the direction and discharge from the protocol, the clinic commission we went to the Ministry of Health and received the quota in Bakulev. The next day there was an operation.

The form 57 / U-04 from the polyclinic where you are attached is a direction to the clinic for free consultation, surveys or hospitalization on OMS. This is not the same as the direction on the VMM
The form 57 / U-04 from the polyclinic where you are attached is a direction to the clinic for free consultation, surveys or hospitalization on OMS. This is not the same as the direction on the VMM

Help and analyzes for hospitalization

Formally, hospitalization is not related to receiving a quota, but in fact we had to do everything at the same time.

To find in the clinic, you need help and analyzes. For each diagnosis, its list that is specified in the call to hospitalization. Analyzes can be made free by policy. OMS Directions will write down the therapist in the clinic.

Deliver tests will not work in advance, because the help has a valid. For example, the conclusions of specialists, analyzes on AIDS и Rh. -Factor There are a month, a clinical analysis of blood and urine - 10 days, certificate from the epidemiologist about the absence of contact with infection - 3 days.

Doctors understand that some dates are too strict, so they try to meet towards. For example, we took a certificate from the epidemiologist on Friday on June 9, on the day before the holidays. Hospitalization was June 13, immediately after the holidays, and the certificate was already released. In the clinic, this was understood with understanding and took an overdue certificate.

But it is better once again not to risk. If during hospitalization it turns out that a period of validity of some kind of reference passed, you will not be able to arrange in the hospital.

For hospitalization, you can use the results of the analyzes that you have passed before, for example, to obtain a quota. Therefore, just in case, keep the originals of all analyzes and survey results. If their term does not expire before hospitalization, they will be useful.

Who pays for what

If everything happened, the state will pay for consultation, surveys, analyzes, patient stay in hospital, nutrition, operation and rehabilitation, if you pass it throughout the year. If you feel about preferential category, then pass the clinic and back.

But for some services will have to pay. For example, if you operate the child, the food and accommodation of parents in the clinic for them is paid. In Bakuleva overnight in the rest room cost 400 РOvernight, and we fed in a cafe on the territory of the hospital.

In addition, there are special procedures that the law does not regulate. For example, radiation therapy can be passed free, and the markup for it will be paid. The search and activation of the donor in foreign registers is also paid. In theory, money for this can be returned, but you will need a good lawyer who will cost more the procedures themselves.

If the patient is a child

Hospitalization with parent. In order for the child to be hospitalized, accompanied by a parent, will need a parent's passport, SNILS , Polis OMS For registration of the hospital sheet and analyzes to find in the hospital - their list is in the challenge to hospitalization.

If the other day 18. If you have submitted documents for a quota at age 17, and by the time the operation you turned 18, then the quota is invalid. In this case, it is easier to wait for 18 years, to get a direction from an adult clinic or guide institution and then submit documents to the Ministry of Health.

If not enough quotas

Quotas are distributed at the beginning of each calendar year, and their amount is limited. If they end, as a rule, you have to wait for the following. Therefore, at the beginning of the year, the quota get it easier. The presence of quotas can be found in the office of the Ministry of Health in its region or in the quotation department of the clinic where you plan to make an operation.

But something else can do something.

Submit documents for the quota - You will be in the queue and report as soon as the state is allocated new. Sometimes patients refuse quotas: for example, when you need an urgent surgery and there is no time to wait for design. This quota can give you.

Find out in the Ministry of Health of Quotas in other regions. It happens that in neighboring regions conduct the same operations and there can still be quotas. You can ask for treatment there, but the Commissions will have to go back.

Apply for an additional quota In the regional Ministry of Health This option is suitable only if the operation is not urgent, because the application will consider three months or longer.

If the quota could not be obtained, and the time does not tolerate, save all documents, references and checks - you can get a tax deduction for treatment. Judicial practice shows that it is almost no chance of returning the full amount through the Ministry of Health, and 13% of deduction is better than nothing.

If there are no places in the clinic

It happens on the contrary: the quota in the arms, and there are no places in the clinic. The timing of the expectation of assistance by law is not regulated: you can wait for a month, and a couple of years - how lucky. The action plan is the same as when quota deficiency: Stand in the queue and parallel to look for a clinic that makes the operation you need and take you by quota.

You can search for the clinic on the portal of the Ministry of Health or by telephone hotline 8 800 200-03-89. If another clinic is found, the application for the quota again will have to be rented.

Treatment abroad

If they cannot help in Russia, the state will allocate funds for treatment abroad. For this, there will have to go through several commissions, the composition of which determines the Ministry of Health. The decision takes up to 3 months.

Searches for the clinic abroad, the Ministry of Health will begin after the two requests federal clinics will give conclusion about the presence of testimony for treatment abroad. The list of diseases whose treatment is impossible in our country does not exist.

With a positive decision, the Commission sends documents to the affiliate clinic abroad, concludes a treaty with it and lists the patient for housing, passage and daily. Upon return, the patient reports to expenses.

That in the end

If the doctor said that an operation for 300 thousand is needed, check if the state will not pay for it.

In order for the state to pay for treatment, you need to get the quota: in fact, it is a passage to operation. For this, there will have to go through three commissions: two medical and one commission of officials. The system is still working impaired, so do not expect everything to go smoothly.

But in some places, it is possible to raise straw:

  1. After the first medical commission, the quota application is sent to the Ministry of Health - check that the operation code in the direction of this commission is. Quoted exactly. It looks like this: 14.00.37.005.
  2. If the application for the quota is submitted personally, through the receiving Ministry of Health, you will have to defend a few hours of a live queue, but the documents will be considered in place and immediately allocate the quota. Even up to 10 days will leave the clinic selection, if you do not decide this question in advance yourself.
  3. So that you are operated on in a specific clinic, you need to go through three circles of hell. First, ask the doctor in the clinic to give a referral to consult this clinic. Then go through all surveys and pass all the tests that the clinic will ask. Finally, the doctor of the clinic will diagnose, make a conclusion and transfer your documents to the clinic quota commission. If you are shown VMP. and there are no contraindications, you will get a direction on VMP. and an extract from the protocol with the decision to treat you by quota. All this attach to the application for the quota, which will be submitted to the Ministry of Health. Only then will you cover the quest "Getting a quota in one day."
  4. And in terms, still follow the period for your analyzes not to be up to hospitalization. If such a risk is there, go to the clinic to the therapist, ask for directions and renovate.

I understand that all this is like juggling, when you need to hold a tray on the head with a glass of water and not splash. If you have to get a quota, feel free to ask questions from doctors, familiar and friends in social networks until it becomes clear. For example, if a friend said that he was not given the documents in the clinic, try to figure out why it happened and how it could touch you. Perhaps in your area your application scheme. It also happens.

Try to get together with the Spirit and take it to getting a quota as a working task. This will help not switch to emotions, concentrate and avoid errors.

And if you have already received a quota, share your experience with those who have yet to. They will appreciate.

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