Quotas for high-tech medical care (HMP). Quota for treatment: what is it and how to get it? Operation quota: queue and receipt How to obtain and what documents are required to obtain a quota

The disease often approaches imperceptibly, and it is not possible to prepare for the fight against it. In modern reality, in order to emerge victorious from this war, it is necessary to mobilize all available resources, and it is financial resources that can play a decisive role here, since the most effective treatment based on the latest scientific developments is very expensive, and you can not get it anywhere. clinic.

What is a treatment quota?

Not every citizen is informed that in such a case certain state assistance is provided, which he can count on, and it is provided in the form of an allocated medical quota.

The treatment quota represents the funds allocated from the state budget for the provision of high-tech healthcare services to its citizens. For the rational formation and distribution of quotas, a state system of high-tech medical care (HMP) was created, within which they carry out diagnostics and provide treatment in more than 100 clinics at the regional and federal levels. Each year, more than 50 billion rubles are allocated from the federal and regional budgets for the operation of these healthcare institutions. This amount is divided on average into 350-450 thousand quotas - approximately the same number of Russians will be able to use the VMP for free during the year.

• complex surgical interventions;
• open heart surgery;
• organ transplant;
• treatment of leukemia;
• removal of brain tumors;
• help with complex forms of endocrine pathologies;
• treatment of genetic and systemic diseases;
• application of reproductive technologies, including IVF;
• nursing newborns using modern methods, etc.

How to get a quota for treatment?

There is a strictly established procedure for issuing a referral for the provision of high medical care, which is full of bureaucratic obstacles. In order for the outcome of the case to be successful, one must be prepared for possible difficulties. Obtaining a quota for an operation or treatment is a long and complicated procedure, requiring a large number of documents and a number of additional examinations. All this is necessary in order for the state bodies authorized to resolve these issues to be able to assess the feasibility of applying the VMP in a particular case.

Step one

In each region, the quota for treatment is drawn up according to its own regulations, which in minor aspects may differ from the general one. Therefore, it is better to start with a consultation with a specialist by contacting the Ministry of Health of a constituent entity of the Russian Federation. There you can find out about the availability of quotas for receiving VMP according to the existing diagnosis and clarify the application procedure.

step two

The main package with documents is usually collected at the municipal polyclinic at the place of observation of the patient with the participation of the attending physician, who gives a referral, makes an extract from the medical history indicating the tests and examinations performed (as a result of which a recommendation is made to hospitalize the citizen in a specialized clinic for VMP). Copies of the passport, compulsory medical insurance policy and OPS certificate are also attached.

Important Procedure

The generated package with documents is certified by the signature of the chief physician and sent for consideration by the commission under the Ministry or other health management authority in the region. 10 days are given to make a decision on a specific case, during which the submitted documents are considered, as a rule, without the participation of the applicant.

The final stage

When a positive decision is made, the documents are sent to a specialized medical institution that has a license to provide high-tech medical care. There they are considered by the next commission, which also has 10 days to make a decision, during which it must give an answer on the date of the patient's hospitalization. Usually, the period after which inpatient treatment should be started is limited to 3 weeks.

bureaucratic traps

When wondering how to get a quota for treatment, do not forget to consider the following points.

Firstly, the right to choose a specialized clinic for the provision of HTMC remains with the health authorities in the region, the preferences of the citizen are not taken into account.

Secondly, the quota for treatment in reality is often issued longer than prescribed in the rules. This is due to the fact that the time allotted for consideration by commissions of applications is not maintained, and the medical institution, due to workload, is not always able to accept the patient on time. Unfortunately, the nature of the disease may be such that an urgent surgical intervention is required, for which the patient does not have the funds, so a quota for the operation is needed immediately. In this case, it is necessary to speed up the work of officials by all possible means.

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

There are two possible options for accelerating the claimed process. According to the first of them, the citizen takes the steps prescribed by the procedure and described by us above, but at each stage he is actively interested in the progress of the consideration of the application, makes calls to officials, writes applications with a request to reduce the time for making a decision, makes visits during office hours. Perhaps one of the officials will want to quickly send documents for further consideration, so as not to be the object of a massive attack. But, of course, there are no guarantees that these measures will have at least some effect and the time will be reduced.

According to the second option, the citizen ignores all stages with the consideration of the application by the commissions. He independently collects documents for a quota for an operation, for example, searches for all the necessary information about specialized clinics that are licensed to provide HTMC and specialize in the necessary surgical intervention, and applies to the selected institution. There is a possibility that the clinic will meet the patient halfway and agree to hospitalize him, providing the required treatment at the expense of the quota available to the subject of the Russian Federation.

Reasons for rejection

First, the commission may not find grounds for applying the MLA in a particular case. Secondly, the presence of severe concomitant diagnoses and the special nature of the course of the underlying disease often serve as reasons for refusal. Thirdly, at the regional level, their own requirements may be presented when applying for a quota. For example, in Moscow and St. Petersburg, a quota for an IVF operation is issued to women aged 22 to 38, in other regions this framework may be different.

If the commission makes a negative decision, it is necessary to receive a refusal in writing, indicating the reason. If you disagree, you can contact the Ministry of Health and Social Development of the Russian Federation for an appeal.

Treatment abroad

If domestic medicine is not able to carry out a full diagnosis or adequate therapy for an existing disease, then you have the right to ask for a quota for treatment abroad. Only in connection with this, the list of required documents will expand, and the number of commissions that must be passed will also increase by one.

In the event of a refusal to travel abroad under a quota, you will be required to offer an alternative in providing VMP in Russia.

The problem of additional payments

A very common situation is when a patient has to cover a considerable part of the costs of his treatment, although it is officially stated that it is carried out at the expense of the state. You usually need to pay for preparatory procedures before the operation, tests, examinations.

For example, on average, the cost of a course of therapy for one cancer patient is 200-250 thousand rubles, and the quota for oncology treatment is 109 thousand rubles. Often a person does not have such funds to cover what they refuse to pay for from the budget. Of course, charitable foundations take a large part in financing the costs of such patients, but in fact it turns out that these are unfulfilled obligations of the state, and this must be combated. A constant stream of written complaints and the involvement of the media are effective in dealing with such problems.

Queues: how to avoid them?

It's no secret that there are much more people who want to get a VMP than there are opportunities for the state to provide this assistance. Therefore, in the health management authority of the region, 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 you can receive an answer from the clinic that there are no places for the near future and hospitalization is postponed . But in any case, you should not give up. It's possible to find one way or another.

First, you collect documents according to the same scheme and enter your name in the quota waiting list or stand in line for hospitalization. If the disease progresses rapidly, try to solicit an additional quota through the local health authorities, contact the media, involving the public. Then there will be a small chance that funds will be found, or it will turn out that suddenly one of the patients refused treatment, and a place in the medical institution became free.

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

For eye surgery, for example, to replace the lens, you can try to raise funds yourself. The cost of such an intervention, unlike most others, does not exceed 70 thousand rubles. The amount is also rather big, but in a neglected state, a cataract threatens with 100% blindness, and it’s not worth risking losing precious time in queues. Moreover, having retained all supporting documents, a citizen has the right to apply for compensation for the costs of providing high medical care at the expense of the Ministry of Health and Social Development of the Russian Federation. In order for the return to be approved, you must prove that you were registered as waiting for care, the course of the disease became threatening and required immediate surgery, and the quota for the operation was not available for reasons beyond your control.

It won't work anonymously.

There are diagnoses that people try not to advertise because of the negative attitude of society and the restrictions associated with it in everyday life. Such diseases include hepatitis C, the treatment of which is very expensive (about 750 thousand rubles). The state allocates funds to fight this disease, but in order to use them, the patient must register officially. On the one hand, there is a possibility of receiving therapy on a budgetary basis, on the other hand, there is a risk of dissemination of information about the presence of the disease.

The quota for the treatment of hepatitis C is issued to citizens registered in specialized medical institutions, most often in AIDS Centers, which operate in many cities. Only by decision of a special commission of this institution, the patient is entered into the waiting list, since there are not enough quotas for everyone. Therefore, you can only be treated anonymously at your own expense.

What is high-tech medical care?

High-tech medical care (HMC) is a treatment that uses new or unique methods, modern equipment, expensive drugs. Its provision requires highly qualified medical personnel.

It would be difficult to list all types of VMP, they are usually grouped according to directions. These can be surgical operations on the organs of the abdominal cavity and chest, neurosurgery, oncology, treatment of severe burns, cardiovascular, gynecological, gastroenterological, otolaryngological and eye diseases, organ and tissue transplantation, etc.

Since 2014, VMP began to be transferred to the system of compulsory health insurance. In theory, this should make treatment more accessible to patients. However, in practice, not everything is so simple.

“There are many processes going on at the same time. Along with the transfer of the VMP to the system of compulsory medical insurance, there is an optimization, a reduction in beds, the president of the League of Patient Defenders told Miloserdiyu.ru Alexander Saversky. “If earlier the VMP was a completely independent branch of financing, now, when part of it was loaded into the CHI, and part was left outside, uncertainty arose.”

64 vs 30

To date, the list of types of VMPs included in the basic CHI program consists of 30 groups, not included - of 64.

These lists are contained, for example, in the government decree of November 28, 2014 No. 1273

The Moscow City Compulsory Medical Insurance Fund does not recommend that patients independently figure out which list includes the treatment they need. “It uses complex medical terminology,” the department explained, adding that the same operations for different diagnoses can be funded under different schemes.

For example, such types of treatment as microsurgical operations on the pancreas, coronary myocardial revascularization, joint replacement, etc. are found in both lists. And the treatment of vascular complications of diabetes is divided into therapeutic (it is included in the basic CHI program) and combined (not included). That is, it's all about the nuances: the use of specific techniques that take into account the condition of the patient. Moreover, each type of VMP has its own code according to the international classification.

For medical institutions, the difference in the provision of HCW from the first and second lists lies in the methods of financing. According to Alexander Saversky, the principle “money follows the patient” does not work in cases where the clinic provides HTMC from the basic CHI program. “Therefore, medical institutions have no reverence for HTMC, and the attitude towards patients is appropriate,” he added.

How to get VMP?

For patients, the two lists of types of UMP differ in the number of instances that must be overcome before treatment begins. If the disease can be dealt with without going beyond the CHI, the attending physician immediately gives a referral to a medical institution licensed to provide the desired type of VMP. In this institution, whether it is a metropolitan medical center or a regional clinic, the patient goes through a commission that makes the final decision on hospitalization.

If you need treatment that is not covered by the basic CHI program, the doctor will first refer you to the territorial health department. There will be convened a commission for the selection of patients for the VMP. An extract from her protocol will be sent to the clinic that has not only a license, but also quotas from the budget for the necessary type of treatment. And only after that you will be able to appear before the commission in the "host" organization.

What are quotas? These are funds allocated to certain medical institutions from the federal budget for the provision of specific types of HTMC.

Recently, the list of clinics eligible to provide high-tech care has expanded significantly. This was mainly due to regional medical centers. On the one hand, this increased the total number of quotas and increased the chances of timely hospitalization. On the other hand, getting into the federal centers has become more difficult.

Alexander Saversky, President of the All-Russian public organization "League of Patient Defenders". Photo from the site nastroenie.tv

“Regions have a tendency not to release patients in order to keep the money,” said Alexander Saversky. According to him, federal medical institutions may even be underloaded. “The leapfrog is terrible,” he added.

A patient who wants to be sure to be in the best metropolitan medical center can directly apply there. In many such institutions there are quota departments. They help to prepare the necessary documents and pass the commission.

For example, in the quota department of the Scientific Center for Cardiovascular Surgery. Bakuleva was told that a resident of any region of Russia can apply to them, providing only an extract on their state of health. If the commission of the center considers that his disease corresponds to the profile of the institution, then he will send a call to the place of residence of the future patient. After that, it will be possible to ask the attending physician for a referral, which is still indispensable during hospitalization. However, there can be difficulties with quotas: they have to wait for months. According to the department, nine thousand quotas were allocated to the center for 2015, while employees do not give forecasts for 2016 yet.

Can they refuse?

A patient may be denied HTMC if, in the opinion of the attending physician or the "receiving" clinic, he does not require it for health reasons. In this case, lawyers recommend applying to the territorial body of Roszdravnadzor or the Compulsory Medical Insurance Fund.

Another reason for refusal may be the lack of an MHI policy. Then you just need to do its design.

But most often, the provision of a certain type of assistance is delayed due to a lack of quotas. In such a situation, lawyers advise you to quickly prepare all the documents and get an electronic coupon in order to wait for the allocation of quotas, taking one of the first places in the queue.

If the patient does not want to waste precious time, he can pay for the treatment himself, and then apply to government agencies for compensation.

Or contact the fund.

For example, in 2014 alone, the Podari Zhizn Foundation spent 42.8 million rubles on the treatment and diagnostic examination of children. During the same period, the Children's Hearts Foundation paid for cardiac surgery in the amount of 31.8 million rubles. The Zhivoy Adult Assistance Fund last year helped ten patients undergo expensive rehabilitation, spending more than 2 million rubles on it. In December 2015, Rusfond allocated more than 84 million rubles to help sick children aged from three months to seventeen years.

Even treatment under the basic compulsory medical insurance program or quotas for high-tech medical care requires certain expenses. The patient may need procedures, tests and examinations that are not funded by the state. The clinic may not have the necessary medicines or supplies, and then you have to buy them yourself. If a child is sick, his parents will have to pay for their accommodation in the city where the clinic is located. Finally, travel to the place of treatment can sometimes be quite expensive. In this case, the help of charitable organizations may be the only salvation.

The provision of medical care in Russia is organized under a compulsory or voluntary medical insurance policy. Any policy indicates a list of medical procedures that are carried out in accordance with it.

For all types of medical care beyond this list, it is necessary to receive additional funding, in other words, a quota for treatment is needed. These are expensive surgeries and high-tech examinations that, due to technical capabilities, cannot be carried out in your city, district, or region.

Some people think that a quota is needed for any complex operation, but this is not so. Many labor-intensive operations and medical manipulations are included in the CHI registry. For example, the doctor will perform the reimplantation of the subclavian artery in the carotid artery or the removal of the stomach free of charge, although this will require considerable skill (unfortunately, the skill and efforts of doctors are not additionally paid). According to the quota, only high-tech operations are carried out:

• for the implementation of which large expenditures are necessary;
• complex and expensive equipment is required.

That is, everything is logical: operations are expensive, they need additional money, this money is allocated by a special order at the beginning of the year. Such high-tech operations can be provided by a limited number of clinics in the country. Today there are more than 150 of them and they are located not only in Moscow and St. Petersburg, but in many large cities.

Which diseases require a quota for treatment, and which ones are treated under the CHI or VHI policy (voluntary insurance)? First of all, in order to count on providing you with such assistance, you must be included in the federal program, that is, you must have a disability group (). A complete list of diseases treated according to the quota is available from the doctor. The list is very large, it can be found in the appendix to the annual order of the Ministry of Health and Social Development (Appendix No. 4).

What to do if you need quota treatment?

First of all, it is necessary to clearly understand that clinics of different levels receive permission to perform such operations. If you do not have a group, you need to go through a special commission, () which determines your disability. There are Moscow clinics, there are regional ones. This situation can be compared to the distribution of grades among students in a class. "Passing" points are considered from "3" to "5", but the difference between an excellent student and a "three student" is felt significant. The level of medical care in different centers may differ, but it is not necessary to focus on the best and most famous clinic. When choosing, it is necessary to take into account various circumstances:

For example, a trip to a Moscow clinic will cost a lot: travel, housing for a relative or accompanying person.

• Experience shows that much more money is spent on treatment in Moscow, and all the payments that have to be made are completely legal. Money in Moscow or St. Petersburg and on the periphery is different, so it may be difficult to pay for such treatment, even taking into account the quota.
• The presence of a quota does not yet guarantee the availability of free space in the selected clinic. In many famous clinics, there are queues for surgery. To stand in line for an operation or to have it done at a nearby hospital is up to everyone to decide for themselves. It is necessary to take into account, first of all, the urgency of the surgical intervention. If we are talking about joint replacement or IVF, you can wait, and for cancer patients, every day of delay can irreparably change the situation for the worse. Therefore, it is worth striving for treatment in the capital or not, it is necessary to decide on an individual basis.
• The operation is performed by a doctor. He is a real person with strengths and weaknesses. In large clinics, the number of highly qualified professionals is greater, but there are also more trainees. If there is a desire to have a certain doctor perform the operation, it is better to agree with him personally. Better to even financially interest him.

How to get a quota

There are two ways to do this. It all starts with diagnostics. Suppose, at the appointment with the local therapist, the doctor suspected a disease. He directs to an appointment with a specialist, and he with his conclusion on hospitalization. The assumption is confirmed: the patient needs expensive treatment according to the quota.

Method 1

You must contact your local health department with the following documents:

• passport,
• compulsory medical insurance policy,
• conclusion from the hospital
• results of analyzes and conclusions of specialists.

It is better to make a photocopy of all documents. It is necessary to provide the maximum amount of data for feedback: address, zip code, phone number. All documents are submitted to the department, a request for a quota is submitted. At the department, the documents are considered by a commission that determines the justification for such a step. If this is proven, the patient is issued a coupon for a quota, and his documents are sent to the clinic where the operation is supposed to be performed. There they are considered by the "quota committee" and a decision is made. When the quota is allocated, the patient's supervisor from the department contacts the patient. The quota usually already indicates the clinic where the treatment will be carried out.

Method 2

If the patient wants to choose a clinic himself, then he goes there with all the documents. A "quota" committee gathers in the clinic, the patient's papers are reviewed and, possibly, the patient himself is examined. After that, a decision is made, which indicates that this clinic is ready to accept this patient for treatment. After such a conclusion, the process of obtaining a quota is simplified and takes only a few days. You need to submit the same documents: policy, passport, doctors' conclusions.

Can quotas not be enough?

The Ministry of Health and Social Development annually allocates a large number of quotas, but still they may not be enough. If it turns out that there are no quotas, it is worth finding out the situation in a neighboring clinic. For example, in a well-known federal clinic, quotas run out much faster than in a city hospital. And this is quite understandable. It is possible that there are still places in the city clinic and there is an opportunity to operate. If there are no quotas at all, and the situation is urgent, it is worth applying for an additional quota. But usually all these are lengthy procedures, decisions are not made instantly. Therefore, in some cases it is rational to make the operation for a fee, and then try to return the money through the Ministry of Health.

Funding for the treatment of diseases that are classified as deadly diseases is carried out by the state. This service is called quota for cancer treatment. It is provided to certain segments of the population on legal grounds. But you should be aware that financial support from the state is not very large, and also requires some waiting for registration.

Leading clinics abroad

Cancer treatment quota - what is it?

The funds allocated by the state are minimal. This factor is the most controversial, it causes a lot of conflicts when seeking help from a medical institution. Not many patients can afford expensive treatment, which forces them to apply for a special quota.

High-tech medical care is provided using complex and unique technologies. For the implementation of surgical interventions are taken by qualified specialists.

People who urgently need organ transplantation and patients suffering from oncological diseases can receive help. Many types of diseases are not eliminated on the territory of the CIS countries, which forces patients to go abroad for help.

Services included in the federal list are provided through direct funding. This happens with the use of regional quotas, by calculating the necessary service, taking into account its provision in a certain territory of the country. A fixed number of "shares" are allocated annually, which are often not enough.

Quotas for oncological operations

The list of types of high-tech assistance includes:

1. open-type cardiac surgery;
2. organ transplantation;
3. joint prosthetics;
4. in vitro fertilization;
5. neurosurgical profile of operations;
6. elimination of oncology;
7. surgical interventions of high complexity.

These are common types of interventions, which are complemented by 137 services to date. In total, there are about 22 profiles in the list. The list is reviewed annually and supplemented with new services. Medical intervention of various types of complexity is carried out by trained personnel using the latest equipment.

The number of "shares" has a strict limit. Moreover, they are distributed among all medical institutions. Information about their number is in the Department of Health. Each medical institution has a special department that has the necessary information.

Often there are situations when the “shares” end, and a person cannot receive help this year. In this case, it is necessary to apply for information not to the clinic at the place of residence, but to other medical institutions. Perhaps there are still quotas left, if not, it is not recommended to despair.

A person must register and receive a coupon, according to which he will be issued a “share” after an indefinite period. As soon as the quotas appear again, the patient will be able to use it on a first-come, first-served basis. If treatment is required on an urgent basis, it is carried out for a fee. The funds spent will be returned by the Department of Health upon submission of certain documents.

Leading specialists of clinics abroad

How to get a quota for cancer treatment?

After the diagnosis is made, the patient must take a referral from the doctor. Oncology treatment in many CIS countries is free. The presence of a quota is necessary if a complex operation is to be performed using high-tech equipment. Getting a "share" is an opportunity to go through all stages of treatment for free without financial costs on the part of a cancer patient.

The decision to provide this type of care is made by the attending physician after examining the patient. To receive assistance, a specialist must draw up an extract from the medical history, back it up with the results of examinations, a diagnosis, and information about the treatment course. Additionally, the current state of the patient is described. You can get all the data from the district therapist. For an initial examination, it is recommended to contact an oncologist. In this case, you will need a passport, a policy and the results of a previous examination (if any). A detailed extract from the outpatient card is a mandatory document.

After receiving all the certificates, it is necessary to prepare the documentation. Mandatory documents include:

1. the patient's application for assistance;
2. a photocopy of the passport;
3. birth certificate (for children);
4. photocopy of pension insurance (for pensioners);
5. card extract.

If for some reason the information is not enough, the patient is sent for additional examination. Some specialized cancer centers may be able to assist in obtaining a quota. If there are no free "shares", a coupon is issued to a person. It is important to monitor his status all the time. The decision on the possibility of obtaining free medical care is made by a special body within 10 days. In some cases, help is not immediately available. The patient is placed on a waiting list for hospitalization. Each coupon has its own number, in order of priority, each person receives medical care.

Quota for cancer treatment- this is a necessary "service", without which it is difficult to independently eliminate severe tumor diseases and not only.