Quota per operation check queue. How to get a quota for free surgery - tips for getting quotas for different populations

So, in special cases, any citizen of the Russian Federation has the right to count on free high-tech medical care (HMP). The procedure in which it is provided at the expense of the budget is prescribed in. It is this document that gives the right to expect that the operation will be carried out for money from the state budget. However, the resolution itself does not contain the definition of the term "quota". Nevertheless, it is interpreted as follows: the state allocates money for a certain type of treatment to its sick citizen.

FOR WHAT TREATMENTS CAN YOU GET A QUOTA

If specialized medical care does not help or cannot be provided, then the patient may receive a THC. The list of types of high-tech medical care is approved by the order of the Ministry of Health and Social Development of Russia. The main ones are: organ transplantation, joint replacement, in vitro fertilization, open heart surgery, neurosurgical interventions, surgical interventions of a high degree of complexity, treatment of hereditary diseases, severe forms of endocrine pathology.

WHERE AND HOW TO GET A QUOTA

1. Diagnostics

It all starts with a diagnosis in the medical organization where the patient is being examined or treated. This may be a local clinic. The attending physician of this polyclinic draws up a package of documents for issuing a coupon for the provision of VMP.

2. Review of documents

- if the patient is sent to provide HTMC at the expense of the federal budget, then the documents are delivered to the health management authority of a particular subject of the Russian Federation. The list of types of VMPs not included in the basic CHI program can be viewed.

- if a patient is sent to provide HTMC at the expense of compulsory medical insurance, the documents are immediately delivered to a medical institution, which will provide high-tech medical care. The list of types of VMPs included in the basic CHI program can be viewed.

3. Decision making and tracking

If the commission makes a positive decision, then a coupon for the provision of VMP is issued for the patient. Now it is electronic, which allows you to track all the stages of obtaining a VMP by the patient, as well as copies of extracts on the Internet.

4. Notice of Decision

As soon as the commission decides on the date of hospitalization, it informs the health authority of the territory where the patient lives. Notify the decision and himself, usually through the institution that sent him for further treatment. The patient is given a voucher for receiving VMP with the signature of an official. An important detail: if the treatment will be provided at the expense of the federal budget and the patient belongs to the preferential category, he has the right to free travel to the clinic and back. The Social Security Fund will pay for this.

REQUIRED DOCUMENTS

The package of documents for issuing a coupon for VMP includes:
1. Referral to hospitalization for the provision of VMP,
2. A copy of the first page of the passport and registration,
3. A copy of the compulsory health insurance policy,
4. A copy of the certificate of compulsory pension insurance,
5. Detailed extract from medical records,
6. Consent of the patient to the processing of personal data.

HOW TO GO FOR TREATMENT ABROAD FOR FREE

Yes, this option is also possible, although only a few can achieve it. It is difficult to find statistics on these cases on the website of the Ministry of Health and Social Development and in the public domain. However, in 2009, the Kommersant newspaper published data from the Ministry of Health and Social Development, according to which 11 people, seven of them children, were sent for treatment outside Russia. They were treated in Israel, Germany and Italy.

Patients who cannot receive the necessary medical care in Russia can be sent abroad free of charge. The Ministry of Health cooperates with well-known clinics in various countries: Germany, France, Italy and others. However, it is worth remembering that this issue takes more time than normal quota decisions. Although officially the deadline for completing all formalities is no more than 92 working days from the date of receipt of the application and the provision of the necessary papers. The thing is that the Ministry of Health will start looking for a clinic abroad only after two or more federal medical institutions give an opinion on the availability of indications for treatment outside of Russia at its request. In addition, the list of diseases, the treatment of which is impossible in our country, does not exist. If the Ministry of Health nevertheless makes a positive decision, then an agreement on the upcoming treatment is concluded between it and the foreign clinic. Funds for housing rental, travel to and from the place of treatment, and per diem are transferred to the patient's account. Two weeks after returning from abroad, the patient is required to report on expenses, and return unused funds to the ministry.

“We are constantly approached on the issue of quotas. Of course, the most common problem is the long queue - people need to urgently perform operations, but they are forced to stay on the waiting list. Each problem has to be solved on an individual basis, since there are many nuances: this is the patient's diagnosis itself, and the place of his registration, and the history of his requests to the departments.

However, as far as I remember, none of the patients who applied to us went abroad for treatment free of charge at the expense of the budget. That is, theoretically, of course, it is possible, but in practice it is necessary to comply with a huge number of conditions and criteria. In addition, not everyone has the strength and time to fight.”

POSSIBLE DIFFICULTIES

1. Quotas are over

This can really happen. And the point here is not that the clinic is not happy to accept the patient. Funds for the provision of high-tech assistance are allocated at the beginning of the year, by the end of it they may no longer be enough. You can find out how many quotas are left in the regional health department or in the quota department of the clinic that provides these types of care. However, there is a way out in this case.

First, you can try to get additional quotas through the local health authority by sending official letters there. If they refuse in the region, send an official complaint in writing or electronically to the Ministry of Health and Social Development. In any case, the request must be answered. Perhaps the problem will be solved if one of the planned patients, for example, refused treatment, and the clinic did not put things in order in the documentation. But this is certainly rare. And, of course, we must be prepared for the fact that all this will take several months.

Secondly, if time does not endure, it is worth making a fuss through social networks, the media.

Thirdly, you can try to take a referral to another clinic. The doctors themselves note that neurosurgical operations can be performed at the Federal Center for Neurosurgery in Tyumen, and not only at the Research Institute. N.N. Burdenko (quotas in the latter are constantly not enough).

2. There are quotas, but there is no place in the clinic

There are far more patients in Russia who need a certain type of treatment than there are opportunities to carry out this treatment. Therefore, even if there are quotas, there may not be places in the federal clinic. The queues are mainly for those who need arthroplasty and cancer patients. And we have no time limits for waiting for help, which is deadly for those who count every minute. The way out here is about the same as in the absence of quotas: either make a fuss or look for another clinic. In this case, you are looking for a specialized medical institution in the city, which provides medical care appropriate to your diagnosis.

An important point is that the clinic must have a license to provide HTMC and accept patients according to a quota. A complete list of such institutions is spelled out in Decree of the Government of the Russian Federation No. 1273 dated November 28, 2014. In the hospital, you are given an initial consultation with specialists and get acquainted with the extracts. After that, the so-called "quota committee" makes a decision. As a rule, it indicates that this particular institution is ready to accept you for hospitalization on a free quota. You receive a doctor's opinion and prepare a package of documents.

As in the first case, you can send your documents in several ways:
- if the patient is sent to provide HTMC at the expense of the federal budget, then the documents are delivered to the health management authority of a particular subject of the Russian Federation.
- if a patient is sent to provide HTMC at the expense of compulsory medical insurance, the documents are immediately delivered to a medical institution, which will provide high-tech medical care. Within 10 days, a Coupon for the provision of VMP is issued for the patient. After that, the patient is invited to hospitalization on a first-come, first-served basis.

3. There are quotas and places, but you need to pay extra

Often there are cases when free treatment under the quota turns out to be partially paid. Payment for the search and activation of a bone marrow donor in foreign registries, a separate cost of special marking before radiation therapy - the patient is obliged to pay for such nuances. And it is almost impossible to fight this, because there is no specific list of procedures for which you need to pay for free treatment under the quota. Most often, such costs are drawn up in accordance with a huge number of orders and resolutions. There is often neither time nor energy to challenge them. The only way to try to save the financial situation is to turn to charitable foundations.

David Melik-Guseinov, Director of the Research Institute of Health Organization and Medical Management of the Moscow Health Department:

“In order to understand why quotas remain in one city, while in another they have already ended, you need to understand the very procedure for distributing the budget. Once a year, the federal Ministry of Health receives a certain budget for quotas and distributes it by type of operation. Then officials look at how many operations of each type can be carried out with a given budget. There is, say, three percent for transplantation, these three percent are already divided by the number of operations that can be paid for. The cost of operations is determined by the center that conducts them. It includes the doctor's salary, consumables, medicines, and so on. Further, these quotas are evenly distributed among the constituent entities of the Russian Federation.

But in Moscow there are more applicants for the quota, and the migration flow is large. Therefore, in the capital, quotas are used in greater quantities, especially for some very specific high-tech types. Because of this, benefits in Moscow end earlier than, for example, in Kaluga.

But there are also regional quotas, and we should not forget about them either. Each subject of the Russian Federation is developing its own regional high-tech medical care. Until now, this has been beneficial for the regions, since they declared their capabilities at the federal level, and the federation included these capabilities in the overall structure of the distribution of finances that they received from the federal budget. In practice, it looked like this: the Ministry of Health said that high-tech oncological operations are being carried out in the Oryol region, so we are sending you some money from federal institutions. And you already pay extra from your budget, buy the necessary equipment and so on. In practice, it turned out that regional centers began to earn on quotas. That is, they took conditionally mild patients, and the severe ones were either sent to federal centers or saved. Of course, the federal centers are in a very difficult financial situation: there are a lot of expenses, but not much money. Therefore, the authorities made a new decision - all VMPs were immersed in the compulsory medical insurance system, and budget funding was stopped. Therefore, from 2017, all such treatment will be paid from the MHI funds, and the system itself will become the main manager of this money.”

The treatment of some diseases is so complicated and costly that citizens are not able to pay for and organize it themselves. But every citizen of the Russian Federation has guarantees from the state, written in the basic law. They are provided with quotas for specialized medical services.

You just need to know how to get a quota for treatment in 2019. This is a complex process regulated by law.

What is a quota and who is entitled to it

Do you need on the subject? and our lawyers will contact you shortly.

Diseases subject to quotas

The state does not issue money to rid a citizen of any ailment. A valid reason is required to obtain a quota.

The Ministry of Health issues a document containing a list of diseases that are subject to treatment at public expense. The list is extensive, it contains up to 140 ailments.

Here is some of them:

1. Heart diseases, for getting rid of which surgery is indicated (including repeated).
2. Transplantation of internal organs.
3. Joint prosthetics, if arthroplasty is necessary.
4. Neurosurgical intervention.
5. In vitro fertilization (IVF).
6. Treatment of hereditary diseases in severe form, including leukemia.
7. Surgical intervention requiring specialized equipment, i.e. high-tech medical care (HTMC):
   • before the eyes;
   • on the spine and so on.

The procedure for obtaining a preferential place in the clinic

The path to a medical facility that can cure is not easy. The patient will have to wait for a positive decision from three commissions. This procedure for obtaining a quota was established by the Ministry of Health of the Russian Federation.

There is a workaround. We will describe it a little later. Any application for a quota should begin with the attending physician.

To receive preferential treatment, you need to confirm the diagnosis. This may require paid tests and examinations. Their patient will have to do with their own savings.

The first commission - at the place of observation of the patient

The sequence for initiating a quota is as follows:

1. Contact the treating doctor and describe the intention.
2. Get a referral from him if you need to undergo an additional examination. Failure to do so will result in non-receipt of a quota.
3. The doctor draws up a certificate, which indicates the data:
   • about the diagnosis
   • about treatment;
   • on diagnostic measures;
   • about the general condition of the patient.
4. The certificate is considered by the commission dealing with quota issues, established in this medical institution.
5. This body has three days to make a decision.

The decision of the first commission

If the patient needs specialized services, then the hospital commission decides to send the documents to the next body - the regional health department. At this stage, a package of documents is formed, which includes:

1. An extract from the minutes of the meeting with the rationale for the positive decision;
2. A photocopy of the passport (or birth certificate if we are talking about a child under 14 years old);
3. Application to show:
   • registration address;
   • passport data;
   • citizenship;
   • contact information;
4. A copy of the OM C policy;
5. Pension insurance policy;
6. Insurance account details (in some cases);
7. Data on examinations and analyzes (originals);
8. An extract from a medical card with a detailed diagnosis (prepared by a doctor).

The second stage of decision making

The commission of the regional level includes five specialists. Its activities are supervised by the head of the relevant department. This body has ten days to decide.

In the event of a positive decision, this commission:

• determines the medical institution in which the treatment will be carried out;
• sends a package of documents there;
• informs the applicant.

The work of this body is recorded. The paper reflects the following data:

• the basis for the creation of a commission of a constituent entity of the Russian Federation;
• the specific composition of the sitting persons;
• information about the patient whose application is being considered;
• conclusion, which reads:
  • complete data on indications for granting a quota;
  • diagnosis, including its code;
  • grounds for referral to the clinic;
  • the need for additional testing;
  • grounds for refusal upon receipt of the VMP.

The following shall be sent to the medical institution where the patient will receive HTMC:

• coupon for the provision of VMP;
• a copy of the protocol;
• medical information about human health.

The third stage is the final

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

This body:

1. Examines the information provided for the possibility of carrying out the necessary treatment for the patient
2. Makes a decision to provide it.
3. Sets specific deadlines.
4. He has ten days to complete this task.

Thus, the decision to include a person in the quota program takes at least 23 days (the time for sending the documentation should also be taken into account).

Features of quota services

Public funds provide only those medical services that are not available at the local hospital.

Their types are:

• surgical intervention;
• treatment.

Operation

This type of support is provided to people whose diagnosis matches the list of the Ministry of Health. They are sent to a clinic capable of performing the necessary manipulation. All treatment is provided free of charge.

Some citizens are also paid for travel to the place of assistance.

VMP

This type of service involves the use of high technology to get rid of the disease. This is an expensive procedure. All necessary expenses are covered by the budget.

However, there are necessary compelling medical grounds to provide VMP.

Treatment

This type of state support involves the purchase of expensive drugs, which the patient himself is not able to pay for. Its procedure is determined by Federal Law No. 323 (Article 34). The Government of the Russian Federation specifies the implementation of the provisions of this regulatory act into practice by its resolutions.

ECO

Women who are diagnosed with infertility are referred for such an operation. In vitro fertilization is a costly and time-consuming procedure.

Many women are not able to feel the joy of motherhood without such an operation. But they give a referral for IVF only to patients who have passed a difficult preliminary period of examinations and treatment.

Not all types of assistance in restoring health and saving the life of a citizen of the Russian Federation are described. There are many ailments, almost all of them fall under one of the described areas of medical technology. But there are exceptions.

How to reduce the time to receive support

Often times people don't have time to wait. Help is needed urgently.

Speeding up the decision-making process of the three commissions is not easy.

In the first case, you can put "pressure" on the people responsible for allocating quotas:

• call them to find out about the progress of the issue;
• go to the reception to the leaders;
• write letters and so on.

The second option is to go directly to the clinic that provides the services you need. For this you need:

• collect a package of documents (described above);
• bring to the hospital and write a statement on the spot.

Documents from the local hospital where the patient was initially diagnosed must be certified by:

• treating doctor;

• chief physician;

• organization seal.

Unfortunately, without compliance with the formalities, the quota clinic will not be able to provide assistance. This medical institution has yet to account for the use of budgetary funds.

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How to get a quota for treatment online

March 2, 2017, 12:15 Mar 3, 2019 13:49

Treatment of diseases using new and unique methods, expensive drugs and modern equipment is part of the high-tech care in 2018. This is a modern therapy that minimizes the risk to human health and life. High-tech medical care differs from conventional medical care in its methodology and approach to treatment. It is provided at the expense of money under the CHI policy, but for some operations or medicines a quota is set.

What is VMP in medicine

This is a special medical care, for the provision of which unique scientific technologies are used, the latest achievements in the field of medicine, science and technology. Surgical interventions and procedures are performed exclusively by highly qualified doctors. The difference from the classic is a larger list of services provided. They are necessary in the treatment of severe ailments and their complications, such as:

• leukemia, oncological and urological pathologies;
• problems of the reproductive system;
• thyroid disease;
• problems with the liver, kidneys;
• neurosurgical diseases, etc.

VMP uses genetic engineering methods and technologies at the cellular level, modern equipment and materials. In recent years, non-invasive and minimally invasive surgical procedures have become common. They are characterized by minimal blood loss, a decrease in the number of complications. In addition, the patient does not have to stay in the hospital for too long, the recovery process is significantly reduced. After such operations, a person quickly returns to everyday life. Other examples of high-tech medical care:

• angiograph used in vascular surgery;
• gamma knife, which irradiates with a focused beam of radiation and removes benign and malignant tumors;
• replacement of joint components with implants;
• cryosurgery, radiosurgery;
• linear accelerator for 3D conformal radiation therapy, radiation therapy with image control or modulated dose rate;
• histoscanning of the prostate gland, which detects cancer at an early stage;
• cryotherapy for prostate cancer;
• magnetic resonance topometry;
• laparoscopy through small incisions;
• apparatus "Da Vinci" for prostatectomy;
• hospital-replacing technologies, such as shock wave technology for crushing kidney stones, which was previously carried out only in a hospital setting;
• aorto-coronary bypass;
• radionuclide therapy with iodine;
• stenting of the vessels of the heart;
• positron emission tomography combined with computed tomography.

Who can use

High-tech medical care in 2018 is available to every citizen of the Russian Federation. The condition is the presence of clear indications. They are reflected by a special document - a referral from the attending physician. When applying for a quota, you have to go through a more complicated procedure. A package of necessary documents is submitted to the commission, which, after 10 days, issues a decision on approval of treatment, refusal or the need for additional laboratory and instrumental examinations:

• radiological;
• endoscopic;
• ultrasonic.

Sources of financing

Until 2014, the only source of funding for the VMP was the federal budget. Then the VMP was divided into two main parts:

• financed at the expense of the Federal Compulsory Medical Insurance Fund (FOMS), i.e. included in the state compulsory medical insurance program;
• funded entirely from the federal budget.

This separation helped increase the availability of treatment and reduce the waiting time for hospitalization. By 2018, all high-tech assistance began to be financed only from the budget of the MHIF. The principle of financial security is as follows:

• VMP, which is part of the basic CHI program, is financed by transferring funds to territorial funds as part of subventions;
• VMP, which is not part of the state program, is funded directly by federal government agencies as part of the implementation of the state task for the provision of treatment.

For certain types of treatment, funds are allocated from the regional budget of the territorial units of the Russian Federation. There is also co-financing of the expenses of the constituent entities of the Russian Federation arising from the provision of MTCT from the MHIF. Fully determined by the Ministry of Health of the Russian Federation:

1. list of clinics;
2. the number of people who can receive high-tech medical care in 2018;
3. base rate calculation.

The list includes only institutions with the latest equipment and specialists of the highest category. Taking into account whether the therapy necessary for a person is included in the basic program, a medical institution is determined:

1. Therapy, which includes the state compulsory medical insurance program, can be obtained in organizations that work under the terms of this type of insurance.
2. VMP, not included in the basic system, is provided by private centers and state institutions of the Ministry of Health.

By 2018, the number of hospitals providing high-tech care in Moscow reached 45, and taking into account compulsory medical insurance - 48. All surgical departments of the capital's clinics have laparoscopic equipment. VMP is also provided to children. In the Center for Reproductive Health of Children and Adolescents of the Morozov Children's City Clinical Hospital, small patients can receive consultations:

• uroandrologist;
• endocrinologist;
• gynecologist.

Directions of high-tech medical care in 2018

The list of types of high-tech assistance, which is financed by subventions to the budgets of territorial funds or by regional budgets, can be found in the official document. This is 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 to Citizens for 2017 and for the Planning Period of 2018 and 2019".

According to the new procedural order, the list of HTHC referrals must be established annually by the Ministry of Health before December 20. Information is presented in the form of a table that reflects:

• assistance type code;
• name of the type of the VMP group;
• disease codes according to ICD-10;
• patient model, i.e. possible diseases in humans;
• type of treatment;
• treatment method.

Each area includes a large list of possible diseases that require high-tech medical care in 2018 and beyond. Among the many types of treatment, there is also surgical, but options for radiation, conservative, therapeutic and combination therapy are also offered. The general list of VMP directions includes such as:

• abdominal surgery (treatment of the abdominal organs);
• obstetrics and gynecology;
• hematology;
• combustiology (treatment of severe burn injuries);
• neurosurgery;
• pediatrics;
• oncology;
• otolaryngology;
• ophthalmology;
• pediatric surgery in the neonatal period;
• cardiovascular surgery;
• thoracic surgery (surgery of the chest organs);
• in vitro fertilization (IVF);
• traumatology and orthopedics;
• transplantation;
• urology;
• endocrinology;
• gastroenterology;
• dermatovenereology;
• rheumatology;
• Maxillofacial Surgery;

Features of the provision of assistance by medical institutions

High-tech medical care in 2018 will be provided under the compulsory medical insurance policy or at the expense of the federal budget. The difference is visible even at the stage of preparation of documents. It consists in the number of instances that will have to go through before the start of treatment. Depending on whether the diagnosis made to a person is included in the state program, the institution where you need to contact is determined. Prepared documents for 3 days are transferred to the following authorities:

• a medical institution providing high medical care, if the service is provided under compulsory medical insurance;
• regional profile structure, when assistance is financed from the federal budget.

VMP is included in the basic CHI program

If the disease is treated without going beyond the CHI program, then only a referral from the attending physician is required. The specialist prescribes it after checking for contraindications to the VMP. Next, they act like this:

1. The referral is given to provide the head of a medical institution that provides high-tech assistance. This may be a regional clinic or a metropolitan medical center where the patient undergoes a commission.
2. Within 7 days, the institution makes a decision that confirms the need for the procedure indicated by the doctor or refusal due to an unconfirmed diagnosis.
3. This information must be communicated to the patient no later than 5 days from the date of acceptance.

High-tech assistance that is not included in the CHI policy

When a patient requires therapy that is not provided for by the basic CHI program, the procedure for obtaining high-tech care is more complicated. The whole process includes several stages:

1. the doctor refers the patient to the health department;
2. this regional body convenes a panel to select patients for high-tech care in 2018 or any other;
3. in 10 days, if she agrees with the diagnosis, she makes a positive decision, which is recorded in the protocol;
4. the document is sent to the employees of the treatment center, which has a license, the necessary technological equipment and a quota for the treatment of oncology or another disease from the list;
5. only after that the patient appears before the staff of the "receiving" organization;
6. In case of refusal, the patient is also given a notification.

What is a treatment quota

If a patient needs high-tech medical care in 2018, which is not part of the basic CHI program, then he needs to allocate a quota for treatment. This is the name of the funds allocated from the federal budget to a particular medical institution for specific types of therapy. Today, the list of clinics that are eligible for HTMC has been significantly expanded with regional centers. This increased the total number of quotas and the chances of timely hospitalization, but made it more difficult to get into federal clinics.

The quota for surgery or treatment is given for certain diseases, and not for all. Their list reflects the document published by the Ministry of Health. The list is very large, contains up to 140 items from the directions that were listed above. Each stage of obtaining a quota is regulated by the regulatory framework. The process of their allocation is determined by a number of government documents, such as:

• decrees giving a guarantee to citizens of the country for free treatment;
• orders of the Ministry of Health of the Russian Federation, which describe in more detail the quota process;
• Federal Law No. 323, art. 34, which describes the process of issuing quotas and their implementation.

How to get a quota for surgery in 2018

Only the Ministry of Health deals with the issues of which institution and how much will receive quotas for the treatment of certain diseases, including in 2018. The procedure for obtaining them is not so simple. The whole process includes three main stages, each requires passing a specialized commission. You need to start with the attending physician at the place of observation and inform him of your intentions.

In order to apply for a quota for surgery or treatment in the provision of high-tech medical care in 2018, the following preliminary steps are required:

• obtaining a referral from a doctor, passing, if necessary, additional manipulations, examinations;
• issuance by a doctor of a certificate indicating the diagnosis, method of treatment, diagnostic measures, general condition of the patient;
• consideration of the certificate by the commission of this medical institution, which is engaged in quoting;
• receive a decision within 3 days.

If the commission confirmed the need for VMP, then the next step is the transfer of papers. The logistics are complicated: the patient's documents are sent to the regional health authority. The list of required papers includes:

• an extract from the minutes of the commission meeting with a positive decision;
• photocopy of passport or birth certificate;
• an application indicating the full name, address of registration, passport data, citizenship and contact information;
• a photocopy of the compulsory medical insurance policy and pension insurance;
• data on the insurance account, examinations, analyses;
• an extract from the medical card with a description of the diagnosis (detailed).

Submitted documents are considered by the regional level commission of 5 specialists. The Department of Health of the relevant subject of the Russian Federation makes a decision within 10 days. If it is positive, then the commission:

• indicates the clinic where high-tech care will be provided in 2018;
• sends documents to the patient;
• inform the patient of his decision.

For most patients, choose a clinic that is closer to the patient's place of residence. The main thing is that the institution has a license to provide high-tech medical care in 2018. Send to the clinic:

• coupon for the provision of VMP;
• a copy of the protocol;
• information about a person's condition.

The selected medical institution that received the package of documents has another quota commission. After holding their own meeting of 3 or more specialists, a final decision is made on the provision and timing of treatment. It takes another 10 days. When using money for the treatment of a patient, the voucher for the VMP is kept by the employees of this clinic as a document that is the basis for funding from the budget. The entire process of obtaining a quota can take approximately 23 days.

Where to go

The step-by-step instructions for obtaining a quota in the classical way are described above, but this procedure takes a very long time. In addition, there is a risk of a negative decision, and this is lost time, which is very valuable in some diseases. There is another option for obtaining a quota - applying directly to the clinic of your choice, which has a license for high-tech treatment. For this you need:

• sign the package of documents listed above at the local clinic where the diagnosis was made, at the main medical staff - the attending physician and the head physician;
• go to the selected medical institution with signed documents;
• write an application for a quota;
• with a positive decision with a coupon, visit the health department again.

This method of obtaining a quota is considered more efficient. The reason is that the patient has the opportunity to get acquainted with the medical institution. In addition, the processing of the request at the clinic will take less time compared to contacting the health department. This method of obtaining a quota for high-tech therapy is used by a large number of patients.

How to check the coupon for VMP

All quotas are distributed among several medical institutions. If in one clinic they have already ended, then you can find another. To find out the number of remaining quotas, it is worth visiting the local health department. For patients there is a special electronic resource. On it, you can check the coupon number online, according to which high-tech medical care will be provided in 2018. To do this, you need:

• go to the website http://talon.rosminzdrav.ru/;
• in the window that opens, enter your ticket number and click "Find";
• study information about the progress of the queue.

After entering the voucher rate and pressing the "Find" button, a new page will open, where the green box will contain information about the date the quota was created, its profile, medical institution and the status of the service (provided or not). The site has other sections. They include reference and regulatory information, news, surveys and search for a medical organization by type of HCW, which can be applied for a quota.

What documents are needed to obtain a quota

After contacting a doctor and confirming the diagnosis, the patient will need to collect a certain package of documents. To submit paperwork, employees of the regional department of health need:

• statement of the patient in need of treatment;
• written consent to the processing of personal data;
• minutes of the commission meeting from the local clinic where the initial diagnosis was made;
• an extract from the medical record indicating the examinations and diagnosis passed;
• passport and its copy;
• compulsory medical insurance policy, its photocopy;
• insurance certificate;
• if available, a certificate of disability.

Referral for hospitalization

To apply for a quota, a package of documents is required, without which a medical institution or the health department cannot make a positive decision. The most important is the direction for hospitalization, which must be correctly drawn up. To do this, you need to check the presence in the document of such information as:

• full name of the patient, year of birth, place of residence;
• number of compulsory medical insurance policy;
• patient diagnosis code according to ICD-10;
• number of insurance pension certificate;
• the name of the type of treatment that is shown to the patient;
• the name of the clinic where the patient is referred for treatment;
• full name, contact phone number, email address of the attending physician who performed the therapy.

Refusal to provide high-tech medical care

If at one of the stages the commission decided to refuse to provide the patient with high-tech care in 2018, then he is given the minutes of the meeting indicating the reason and an extract from the medical documentation. Reasons for a negative decision are:

1. The ability to cure the patient with traditional methods, the lack of indications for high-tech therapy. Solution: go to another clinic or other doctor for a more accurate diagnosis.
2. The definition that high-tech medical care in 2018 is not able to cope with the patient's disease. In this case, the patient is recommended to undergo additional examinations.
3. Quota limit exhausted. If in the current year the budget funds for VMP have been exhausted at a certain clinic, then it is worth trying to contact the staff of another medical institution. When treatment is required urgently, it is worth doing it on your own, and then returning the finances through the health department.

Many patients have to deal with rejection, so you should be prepared to go through a number of difficulties. The attending physician must be convinced of the need to obtain a quota. If the refusal was given by the regional department of health, it is worth going further by filing a complaint with the Ministry of Health and Social Development by sending a letter in writing or electronically. Patients are encouraged to involve the media in their problem. Then there is hope that the free quota will show up.

In what cases may paid services be required

If at the stage of confirming the diagnosis, the patient is prescribed additional studies, then not all of them are included in the CHI program. In this case, the patient has to go through them at his own expense. Additional costs are associated with travel to the place of treatment. They can also occur during the treatment phase. This is for example:

1. Marking of tumor irradiation sites. It is performed at the expense of the patient. Radiation therapy itself is free.
2. Finding donors for bone marrow transplantation.

Rehabilitation is also the responsibility of the patient. There are also restrictions on the provision of the most high-tech medical care in 2018. For example, when replacing the lens of the eye, the federal budget pays only for the installation of a domestically produced implant. If the patient decides to use an imported manufacturer, then the operation will have to be paid for on his own.

Video

In chapter Doctors, Clinics, Insurance to the question How to find out your turn for a quota? Eye surgery given by the author Miss the best answer is There is a website where you can enter your quota number and check its status. . I used it when I myself was operated on according to the quota... .if I find it I will leave a link... .found))))))) link. You can find out your electronic coupon number where you applied for the quota... BE HEALTHY!

Where can I find the quota number?

coupon No. 30.0000.05701.153 - find out the queue for eye surgery according to the quota

And how to find out your coupon, we have an operation on the spine?

I'm Marina Demenko wanted to know her turn in the quota for epilepsy surgery coupon No. 18000007017160

How to get a quota for surgery and treatment in 2018?

In this article, you will learn where and how to get a quota for an operation in 2018 and what is included in it. Other issues related to quotas will also be considered.

The treatment of some diseases can be so complicated and costly that a person cannot organize and pay for it himself. However, any citizen of the Russian Federation receives a guarantee from the state, which is written in the basic law. It is provided by quotas for special medical services.

You just need to know how the quota for treatment is obtained in 2018. This is a complex process that regulates legislation.

What are quotas and who is entitled to them?

It must be assumed that a certain type of treatment (surgical intervention) can only be provided by a healthcare institution that is provided with:

1) professional staff;

2) special equipment.

Such clinics are provided with additional funding for development. Money is allocated from the state budget so that doctors can save people's lives in very difficult situations. There aren't many hospitals yet.

If you understand this, then it will become clear to you how to get quotas for the operation. Quota issues are dealt with exclusively by state bodies. Each stage is in the regulatory framework. In this case, there can be no deviations from the implementation of the law.

It turns out that the quota is the allocation of state support to citizens who need special treatment, within the framework of Compulsory Medical Insurance (CHI).

The queue for a quota for surgery and treatment

Where can I see the queue for a quota for an operation? How to find out the queue for a quota for treatment? Further in the article you will learn everything in stages.

But before you queue up for free quotas for surgery, please note that only people with disabilities receive them. That is, if you do not have any group, then go through a medical social examination.

If the patient has a disability, he must find out from the medical institution where he is being treated, what documents are needed for a quota for a free operation.

How long you need to wait for a quota - this already depends on the limit of quota treatment in a particular medical institution (the state distributes a specific number of quotas at the beginning of the year). Now you are informed how long to wait for the quota for the operation and to whom it is given.

How to apply for a quota for an operation in Moscow?

As already mentioned, this year the VMP is provided to citizens of the Russian Federation mainly at the expense of the money of the Compulsory Medical Insurance (CHI). In practice, this means that most people will be treated at their place of residence. And the patient will be sent to other regions, for example, to Moscow, only in extreme cases. Read more about the quota scheme.

Laws regarding quotas

Some government documents fully describe the stages of allocation and use of quotas. These include:

1) orders of the Ministry of Health of the Russian Federation, which specify the quota process;

2) regulations that guarantee free medical care to citizens of our country;

3) Federal Law No. 323. Its article 34 describes the process of issuing quotas, as well as the conditions for the implementation of these state guarantees.

The issue of financing medical care is in the department of this ministry. Only this state body has the right to decide how many quotas there will be in the current year, and in which healthcare institution they can be used. Such resolutions are issued by him on a regular basis.

Diseases subject to quotas

Of course, the state does not allocate funds to rid citizens of all their ailments. To get a quota, you need a good reason.

The Ministry of Health issued a document containing a list of diseases that can be treated with public money. The list of diseases for treatment under the quota in 2018 contains up to 140 names of diseases.

Below are just a few of the list:

1. Heart disease, for the treatment of which surgical intervention is provided (including repeated).

3. Joint prosthetics, if necessary, then arthroplasty.

4. Neurosurgical intervention.

5. IVF (in vitro fertilization).

6. Treatment of hereditary diseases in severe form, including leukemia.

7. List of quota operations consists of those surgical interventions that require specialized equipment (high-tech medical care - HMP):

The Ministry of Health determines the number of quotas for each institution that has the appropriate license. This means that a certain clinic can take only a certain number of patients for treatment at the expense of the state budget.

How do I get a preferential place in the clinic?

Unfortunately, the path to a medical institution that provides free medical care is not easy. The patient must wait until he receives a positive response from the three commissions. Such stages of obtaining quotas are approved by the Ministry of Health of the Russian Federation.

There are also workarounds. We'll talk about them a little later. Any application for a quota must always begin with the treating doctor.

In order to secure preferential treatment, the diagnosis must first be confirmed. To do this, you may need to take paid tests and undergo examinations. The patient will have to pay for this with their own money.

How to pass the first commission (at the place of observation of a person)?

The steps to initiate a quota are as follows:

• contact your doctor and describe your intention;
• take a referral from him if you need to undergo an additional examination. If you refuse this, then you will not receive a quota;
• the doctor must draw up a certificate, which must contain information regarding:

4) the general condition of the patient;

• the certificate should be considered by a commission created in a particular medical institution that deals with quota issues;
• the body must make a decision within three days.

The attending physician is responsible for the "candidate" for the quota. He does not have the right to recommend to the commission that person who can do without VMP.

If the patient needs specialized services, then the hospital commission decides on the issue of documentation for the next body - the Department of Health at the regional level. At this stage, lists of documents are formed, consisting of:

1) extracts from the minutes of the meeting with an explanation of the positive decision;

2) photocopies of the passport (or birth certificate if the patient is a child under 14 years old);

3) application, which must contain full name, registration address, passport details, citizenship, contact information;

4) copies of the MHI policy (Compulsory medical insurance);

5) pension insurance policy;

6) data on the insurance account (in some cases);

7) information about the examinations passed and the analyzes passed (originals);

an extract from the medical card, where a detailed diagnosis is written (this is prepared by the doctor).

You must agree to the processing of personal data by a medical organization. To do this, you need to write an additional application.

What happens in the second stage of decision making?

The commission of the regional level consists of five specialists. Its activities are supervised by the head of a particular department. The authority must make a decision within ten days.

If the decision is positive, then the commission:

1) determine the medical institution where the treatment will be carried out;

2) send documentation there.

3) inform the applicant.

It is customary to choose a clinic that is located near the patient's place of residence. But not all hospitals are licensed to conduct special operations. It turns out that a citizen can be given a referral to another region or even to a metropolitan institution.

How this body works is recorded. The following information is reflected in the papers:

• the reason for the creation of the commission of the subject of the Russian Federation;
• the composition of the persons present;
• information about the patient whose application was considered;
• conclusion, which reads:

1) all data on indications for further provision of a quota;

2) diagnosis, as well as its code;

3) reason for referral to the clinic;

4) Is there a need for additional testing?

5) reasons for refusal upon receipt of VMP.

In a medical institution where a person will receive a VMP, they are sent:

1) coupon for the provision of VMP;

3) medical information about the patient's health status.

What characterizes the third, final stage?

In the medical institution where treatment is carried out, there is also a quota commission. After receiving the documents, it holds its own meeting, where at least three people must participate.

1) is engaged in the study of the information provided for the possibility of providing the necessary treatment to the patient;

2) decides whether the patient needs this treatment or not;

3) sets specific deadlines;

4) He has ten days to do all this.

The coupon, if used, is kept at the clinic. It is the basis for budget financing of treatment.

It turns out that in total the decision to include a person in the quota program takes at least 23 days. Also take into account the time for sending documents.

The state only pays for medical services that cannot be obtained at a local hospital. Namely: VMP, IVF, surgery and treatment.

Each type of assistance requires special equipment and appropriate training. Ordinary diseases are not quota.

Such support is provided to those patients whose diagnosis corresponds to the list of the Ministry of Health. They are sent to the clinic, where the necessary manipulations are carried out. All treatment is provided to the patient free of charge.

By the way, some citizens can get free transport to the place of assistance.

For this type of state support, expensive drugs are purchased, for which the patient himself cannot pay. The procedure for such state support is determined by Federal Law No. 323 (Article 34). The Government of the Russian Federation is concretizing the implementation of the provisions of this regulatory act into practice. Learn more about the procedure for obtaining a quota for rehabilitation and treatment.

Women who have been diagnosed with infertility are referred for this operation. In vitro fertilization is a long and expensive procedure. Unfortunately, without this operation, many women cannot become mothers. However, a referral for IVF is issued only to those patients who have undergone a difficult preliminary period of treatment and various examinations.

And this is not all the types of assistance related to the restoration of health and the preservation of the lives of citizens of the Russian Federation. There are many diseases, almost each falls under one of the mentioned areas of medical technology. Although there are exceptions.

How can I speed up the support process?

Often a person cannot afford to wait a long time for medical attention.

Experts advise the following:

1. you need to call the people responsible for allocating quotas to find out how your issue is being resolved;
2. it will be useful to go to an appointment with the leaders;
3. write letters and so on.

I must say that the effect of this may be insignificant. Only experienced specialists participate in the commissions. They themselves are aware that delays in such matters are unacceptable. But it's still worth a try.

The second way is as follows: you need to contact the clinic directly. For this:

1) collect documentation (we have already mentioned this above);

2) bring her to the hospital and write a statement on the spot.

Documentation from the local hospital where the patient was initially diagnosed is certified by:

Unfortunately, quota-based clinics cannot help without formalities. Such medical institutions will still need to account for the budget funds used.

Reimbursement of funds for a quota operation

If the patient needs urgent surgical intervention, and the quotas are over, the patient can pay the costs himself. Later, he submits documentation to the Department of Health. And the money will be returned to him. Now you know how to return money for a quota operation.

If the patient is denied a quota for surgery

Quite common and very unpleasant cases from which patients are upset and angry. And this can be explained, because a person has invested a lot of effort and patience in order to obtain the necessary documentation. And in the end, it is often a fiasco. Refusal of the quota for the operation must be explained to the patient.

And this is not always associated with an insufficiently critical state of health, although this is exactly what many people think about. Among the reasons for refusing a quota for an operation are the lack of quotas in a given period of time, the complete conviction that the use of VMPs is ineffective, or the inability of a particular clinic to perform complex operations.

Please note that a patient who was denied a quota due to lack of it has the right to take a queue for the next year. However, each case is considered on an individual basis, and much depends on the type of disease.

How to speed up the queue for high-tech medical care

Vladimir Zholobov, First Deputy Chairman of the Health Committee, answers questions from readers

I need hip replacement surgery. I was told that this can be done on a quota. I spent a lot of time on obtaining a quota, but I was told that it would take more than two years to wait for the operation at the Vreden Research Institute of Traumatology. But I need an operation urgently! I can hardly walk! I have no money to pay for the operation.

- You can follow the progress of your queue yourself. You have a queue number. It is given upon direct registration of a quota at the Medical Information and Analytical Center (Shkapina St., 30, telephone 576-22-22). The progress of the queue can be found on the website of the Ministry of Health of the Russian Federation for the provision of high-tech medical care.

Now about how to speed up the queue. There are two ways. The first is to agree that the operation is performed not at the Research Institute of Traumatology, but at another medical institution in the city. Contact the mentioned information and analytical center on Shkapina, and I'm sure you will be offered other options. No long wait! Believe me, all doctors performing high-tech operations have the required certificates. Operations are carried out with high quality.

If you fundamentally want to be operated on at the Research Institute of Traumatology, then there is another way. The institute itself must make a decision to speed up the operation for health reasons. This conclusion can be given by the medical commission of the institute after a thorough study of the situation. (The above rule also applies to any other medical institution where there is a quota queue.)

I must say right away: decisions to speed up the operation are very responsible and they are not given just like that. For reference: compliance with the queue for high-tech assistance is monitored very strictly, including by the prosecutor's office. And it will be sure to check why the patient with the queue number “1019raquo; operated on by the second.

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Otosclerosis involving the foramen ovale, obliterating surgical treatment reconstruction of the anatomical structures and sound-conducting apparatus of the middle ear using microsurgical techniques, autologous tissues and allogeneic grafts, including metal ones, with exposure of the facial nerve, reinnervation and the use of a facial nerve monitoring system 105185 reconstructive surgery for congenital anomalies development and acquired atresia due to chronic purulent otitis media with the use of microsurgical techniques, radiation techniques, autotissues and allogeneic grafts, including metal reconstructive hearing-improving operations after radical surgery on the middle ear in chronic purulent otitis media hearing-improving operations using a partially implantable bone conduction device H74 .1, H74.2, H74.3, H90 adhesive disease of the middle ear.

Talon rosminzdrav.ru - a portal for patients who received a coupon for VMP

Vladimir Zholobov, First Deputy Chairman of the Health Committee, answers questions from readers. I need a hip replacement surgery. I was told that this can be done on a quota. I spent a lot of time on obtaining a quota, but I was told that it would take more than two years to wait for the operation at the Vreden Research Institute of Traumatology. But I need an operation urgently! I can hardly walk! I have no money to pay for the operation.
-

Attention

You can follow the progress of your queue yourself. You have a queue number. It is given upon direct registration of a quota at the Medical Information and Analytical Center (Shkapina St., 30, telephone 576-22-22). The progress of the queue can be found on the website of the Ministry of Health of the Russian Federation for the provision of high-tech medical care.

How to speed up the queue for high-tech medical care

This body: 1) is engaged in the study of the submitted information for the possibility of providing the necessary treatment to the patient; 2) decides whether the patient needs this treatment or not; 3) determine specific terms; 4) he has ten days for all this. The coupon, if used, is kept at the clinic. It is the basis for budget financing of treatment. It turns out that in total the decision to include a person in the quota program takes at least 23 days.
Also take into account the time for sending documents. The hospital makes recommendations regarding the further treatment of the person. Quota services The government only pays for medical services that are not available at the local hospital. Namely: VMP, IVF, surgery and treatment.
Each type of assistance requires special equipment and appropriate training. Ordinary diseases are not quota.

Rosminzdrav.ru coupon: portal for patients who received a voucher for VMP

If you refuse this, then you will not receive a quota;

• the doctor must draw up a certificate, which must contain information regarding:

1) diagnosis; 2) treatment; 3) diagnostic measures; 4) the general condition of the patient;

• the certificate should be considered by a commission created in a particular medical institution that deals with quota issues;
• the body must make a decision within three days.

The attending physician is responsible for the "candidate" for the quota. He does not have the right to recommend to the commission that person who can do without VMP. What will the first commission decide? If the patient needs specialized services, then the hospital commission decides on the issue of documentation for the next body - the Department of Health at the regional level.

How do I find out what number I am in the queue for receiving the VMP?

The date of hospitalization in the order of the existing queue to the patient by his contact phone is reported by a representative of the medical institution in which the patient will be treated. 7. The presence of a Voucher for the provision of HTMC is the basis for the consideration by the commission of the medical organization providing HTTC of the issue of hospitalization of the patient in accordance with the waiting list and the availability of quotas. 8. The commission of the medical organization providing HTMC makes a decision on the presence (or absence) of medical indications for hospitalization of the patient, taking into account the types of HTMC provided by the medical organization, included in the list of types of HTMC, within a period not exceeding seven working days from the date of issuance of the Coupon for rendering VMP (with the exception of cases of emergency, incl.
emergency medical care). 9.

High-tech medical care

With any decision, the person receives a written notification of a positive result or refusal of assistance. Notification of the status of the UMP is sent to the postal address or e-mail, depending on the type of notification chosen by the patient. Check the status of the VMP coupon by number If the authorized, territorial commission, for any reason, refused to provide the VMP to a person, he can re-apply to the appropriate commission of the Ministry of Health of the Russian Federation.

An appeal to the Ministry of Health of the Russian Federation is possible only in 3 cases:

• If the patient does not live in the territory of the Russian Federation.
• The person is not registered at the place of residence in the Russian Federation.
• The medical institution does not issue a referral to the VMP.

In the presence of at least one of the above factors, the relevant body of the Ministry of Health will consider the application for VMP in the order of priority.

Diseases that qualify for a quota

Status "Blocked" - what does it mean and what to do If, when checking the status of a coupon on the patient portal, information appeared about its blocking, this does not indicate a refusal to conduct a VMP. For clarification, you must contact the coupon issuing authority, or directly to the medical institution where the patient is in line for hospitalization. The coupon number changes annually, so you need to clarify the new number and track the status according to new data.

Status “Documents are under consideration” There are review standards, basically the answer can be received 30 days after receipt of the coupon. During this time, specialists contact clinics and medical institutions and agree on the possibility of hospitalizing the patient, within the framework of the quota allocated by the state.
Annovic period of 2019 and 2020 Exposure: Appendix to the program of state guarantees for free medical care to citizens for 2018 and for the planning period of 2019 and 2020, a list of types of high -tech medical care, which also contains treatment methods and sources of financial support for high -tech medical care Section I List of types of high-tech medical care included in the basic program of compulsory medical insurance, the financial support of which is carried out at the expense of a subvention from the budget of the Federal Compulsory Medical Insurance Fund to the budgets of the territorial compulsory medical insurance funds Otorhinolaryngology VMP group N<1 Наименование вида ВМП <1 Коды по МКБ-10 <2 Модель пациента Вид лечения Метод лечения Норматив финансовых затрат на единицу объема медицинской помощи <3, рублей 23.