Constitution Russian Federation guarantees free medical care to all citizens under the compulsory policy health insurance(OMS). Kinds free help provided under the compulsory medical insurance policy:

• primary health care(outpatient clinic);
• emergency,
• specialized medical care(if a diagnosis is established, treatment of a specific disease is carried out)
• high-tech medical care(treatment of diseases using high-tech, complex, costly treatment methods).

The presence of a compulsory medical insurance policy confirms that the patient’s treatment in public and some private clinics will be paid for from the compulsory health insurance fund, which is formed from mandatory contributions citizens.

Briefly about the compulsory medical insurance system

Payment for treatment in compulsory medical insurance system occurs at specially formed rates for each disease, but does not depend on the method of treatment of this disease. Tariffs are the same for all medical institutions. IN compulsory medical insurance tariff it is prescribed how many and what procedures, tests and studies the clinic can and should perform in the treatment of a particular disease.

Tariffs are the same for all clinics, which means that the patient can choose a more high-tech and well-equipped clinic, regardless of the cost of treatment. Will carry out mutual settlements with the clinic Insurance Company.

Some expensive procedures within the compulsory medical insurance system can only be performed if strictly necessary, which the clinic must prove, otherwise they simply will not be paid for compulsory medical insurance fund. Therefore, treatment of patients in the compulsory medical insurance system, unfortunately, has its limitations.

Medical institutions are forced to work according to the rules established by the Compulsory Medical Insurance Fund for each disease. It is important to say that the provision of high-tech medical care (HTMC) to patients, the so-called “quota” treatment, is also paid for from the compulsory medical insurance fund and, accordingly, is carried out according to the algorithms prescribed above.

But the tariffs of the VMP system are higher and are intended specifically for providing complex, high-tech treatment, which allows the clinic staff to use all their powers modern methods treatments, advanced technologies and high-quality consumables.

Not all hospitals in Russia have the right to provide high-tech medical care. Every year, the Ministry of Health of the Russian Federation creates a list of clinics that can treat patients with VMP. Selected clinics receive a so-called assignment from the Ministry of Health, which determines the number of patients that the hospital can treat under VMP.

In medical centers of federal significance, only high-tech and specialized medical care is provided under the compulsory medical insurance policy. The Clinic of Coloproctology and Minimally Invasive Surgery is part of the First Moscow State Medical University named after. Sechenov, accordingly, the same requirements apply to her.

How to get medical care under the compulsory medical insurance policy?

Option 1. By referral from the clinic

The compulsory medical insurance policy itself is required. If it is not there, and you are a citizen of the Russian Federation, you need to contact an insurance company that works with the territorial compulsory medical insurance fund, write an application and receive it immediately temporary policy, and after about a month, a permanent compulsory medical insurance policy. After receiving the compulsory medical insurance policy, you need to be assigned to a clinic, which you can choose yourself. After this, you can qualify for high-tech medical care under the compulsory medical insurance policy.

Referral from the clinic to which the patient is attached (at his place of residence or at his choice). Such a referral to a city hospital or federal center is issued to a patient if the clinic doctors cannot independently diagnose the patient or provide treatment. A referral from the clinic allows the federal medical institution, which is the First Moscow State Medical University named after. Sechenov and our Clinic, provide the patient with primary, specialized and high-tech care.

At the clinic you can receive both a referral for a free consultation in our Clinic and a referral for free treatment.

Option 2. Referred by doctors from our Clinic.

In some cases, doctors at the Clinic of Coloproctology and Minimally Invasive Surgery can also issue referrals for treatment. The number of referrals is limited and applies to certain types of diseases or complications.

You can find out about the possibility of free treatment under the compulsory medical insurance policy during a face-to-face consultation with a doctor. In this case, you will bypass the stage of agreeing and receiving a referral at the clinic. Please note that referrals for compulsory medical insurance treatment, which are issued directly at our Clinic, have a limited number.

To make a referral under the compulsory medical insurance policy through a doctor at the KKMH Clinic, you will need:

1. compulsory medical insurance policy
2. independent visit to the clinic only for treatment (not carrying out a set of diagnostic measures) with an already established diagnosis

A compulsory health insurance policy provides access to free healthcare services. But does everyone know what opportunities the compulsory medical insurance policy provides, what is included in free service, what types of examinations and operations can be performed?

Legislative acts regulating the compulsory medical insurance system

Free healthcare services are provided as part of compulsory health insurance. The compulsory medical insurance system guarantees citizens equal rights to receive medical services. It is regulated by a number of legal acts:

• Law No. 326-FZ “On Compulsory Health Insurance in the Russian Federation”;
• Government Decree No. 1403 “On the program state guarantees free provision of medical care to citizens for 2017 and for the planning period of 2018 and 2019,” which contains the basic compulsory medical insurance program. This document, in particular, explains what is included in compulsory medical insurance in 2017;
• a number of other acts allowing citizens to receive a minimum guaranteed volume of services.

Who is entitled to free health care?

Both Russians (for an indefinite period) and persons without Russian citizenship (with a limited validity period) can receive a compulsory medical insurance policy. The presence of this document means that the patient is under the protection of the insurance company with which he has entered into an agreement.

Medical care is provided by the health care organization (both public and private institutions participate in the compulsory medical insurance system) to which the patient is attached. At the same time, he has the right to change the clinic and attending physician once a year and an unlimited number of times when moving to another place of residence. Once a year, you are allowed to change your insurer; this must be done no later than November 1.

List of services under the compulsory medical insurance policy

What types of medical care are available under the policy, are high-tech diagnostic methods included in it, is MRI included in the list of free services under compulsory medical insurance?
The legislation provides for the following forms of medical care:

• emergency (ambulance);
• outpatient, including examinations (in basic list included MRI, ultrasound and endoscopic methods (gastroscopy, colonoscopy, etc.);
• stationary:

- in cases of exacerbation of diseases;
— referral for treatment and operations (available services include chemotherapy, removal of prostate adenoma, treatment of gynecological diseases, etc.);
— medical services for pregnant women, as well as childbirth, recovery after it, abortions;
- when intensive care is required (in case of poisoning, severe injuries);

• high-tech;
• palliative.

The last point regarding serious illnesses was added in 2017. In total, the basic list includes about 20 cases for which free medical care is available.

Is it allowed to carry out therapeutic massage, remove papillomas, warts - are such procedures provided by the compulsory medical insurance policy, which is included in the program? Having indications for the procedure will allow you to take a massage course free of charge. As for skin defects, the operation will be performed free of charge if the growth is bleeding or damaged, that is, there is a danger to the life and health of the patient.

Within the compulsory medical insurance system there are basic and territorial programs: the first is applied throughout the country, the rest - within a specific subject of the Russian Federation. The list of services under regional programs is wider. Some of them provide free tests for chlamydia and spermogram, some allergy tests (such types of examinations, for example, are carried out under the compulsory medical insurance policy in Moscow, the Moscow region and St. Petersburg).

From time to time, the media report on public initiatives to add or remove this or that service from the list. Thus, proposals to exclude abortion from the compulsory medical insurance system and include the work of a nutritionist in it were previously discussed, but they were not reflected in legislative acts they didn't find it.

Dental services under compulsory medical insurance policy

Is free dentistry available under the compulsory medical insurance policy? This question interests many, since dentists’ services, as we know, are not cheap. So, what opportunities does dentistry provide under the compulsory medical insurance policy, and what is included in the free service?
A visitor to a clinic participating in the compulsory medical insurance system can count on:

• for reception, examination and consultation;
• for the prevention and treatment of inflammation of the oral cavity;
• for dental fillings;
• for surgical intervention (tooth extraction, opening of an abscess, etc.);
• for an x-ray examination.

Please remember that dental services are also subject to restrictions. For example, filling will not require payment if cement material is used during the treatment. But they won’t install a light seal for free.

Certain services are possible with a referral, for example, the surgeon will perform trimming of the tongue frenulum upon presentation of a certificate from the orthodontist.

How to find out if a service is included in the compulsory medical insurance program?

Information on services provided free of charge is contained in regulatory documents adopted in a particular subject. A detailed list is also provided by healthcare institutions and insurance companies operating in the compulsory medical insurance system.
There is no list of compulsory medical insurance services on the official healthcare website in 2018, but from the Ministry of Health resource you can go to the Compulsory Medical Insurance website, where all the regulations relating to the compulsory health insurance system are posted.

Preparation for surgical intervention in private clinic differs from the usual speed and price. If a patient plans to exercise his right to free medical care, he will have to prepare for a long wait. The pause before hospitalization for a planned operation can last up to six months, but despite the duration of the procedure, it is quite possible to carry it out in a general manner. However, it should be taken into account that federal budget does not always cover all expenses. For example, the search for a donor is carried out by the patient at his own expense. Can I count on free operations under the compulsory medical insurance policy? Which categories of citizens are entitled to free surgeries? How to get a referral for surgery? We will try to answer these and other questions in this article.

What operations are free?

The list of free operations under compulsory medical insurance is reviewed and supplemented annually as part of regional health care programs. Further, this information from above goes down to those medical institutions who provide this type of service. This list is open and must be posted on information boards in clinics and hospitals. Under the compulsory medical insurance policy, any citizen of the Russian Federation (employed, unemployed, child, newborn) can receive a free operation in the event of:

• Gynecological diseases (fibroids, infertility, cyst);
• Surgical (hernia, cholecystitis);
• Urological (cyst, adenoma, urolithiasis);
• Diagnosis of prostate cancer (prostate biopsy);
• Chest surgery (oncological diseases, mediastinum and lung pathology).
• Varicose veins;
• Foot reconstruction.

It should be noted that this is only a short list of all possible medical services under the policy. Every year the list is replenished not only with diseases, but also with clinics that provide free treatment using high-tech equipment. To become fully familiar with the list, you should seek help from your attending physician or the head of the department at the hospital. This information is also available to the compulsory medical insurance company, whose manager can answer all questions on the hotline.

How to get a referral?

In order to get a free operation, you first need to make sure that it is included in the list of services provided under compulsory medical insurance. And then the procedure is quite simple, although getting directions to preferential operation and will take some time. So, the insured person will have to go through several stages:

1. Make an appointment with your doctor, receive an initial consultation and a referral for examination.
2. Submission of necessary tests.
3. Appearing for a follow-up appointment with the doctor with test results, receiving a referral to a commission at a medical institution.
4. Passing the selection committee on time.
5. Appearing for the third appointment with the attending physician at the hospital, receiving a referral for hospitalization.
6. Testing before admission to the hospital.
7. Registration to hospital.

In the hope of free treatment, you will have to wait in long queues. The waiting period for a decision on hospitalization can last up to six months. After 6 months of deferment, the patient has the right to write a complaint to the Compulsory Medical Insurance Fund. If a citizen wishes to undergo surgery in a particular hospital, he should voice his wishes at the first consultation with the attending physician. The therapist can take into account the patient’s request when issuing a referral if the specified institution has the opportunity to perform a free operation under the compulsory medical insurance policy. The final decision on the placement of the patient is made by the specialist, so the patient’s wishes may not coincide with the actual destination for the operation.

Recovery after surgery

After a free operation, the patient is also entitled to additional free rehabilitation under the compulsory medical insurance policy. How to get it? To do this, you need to go to your doctor, get a referral for additional examination and laboratory tests, and after receiving the results, apply for a trip to a sanatorium-resort institution for recovery, of course, if the results of the study allow it. In this case, rehabilitation measures may be denied due to complications after treatment of sexually transmitted diseases, cancer, psychiatric diseases, incapacity, drug addiction or alcoholism.

Free medical care is provided through state insurance. The role of the insurer is government bodies all levels: from federal to territorial. Insurer - federal, municipal, village budget. Insured persons are Russian citizens of all ages, working and non-working.

Compulsory health insurance

Emergency medical care can be obtained throughout the Russian Federation.

Planned – at the place of registration of the compulsory medical insurance policy. To receive free medical services, you must have an insurance policy. medical policy Compulsory medical insurance.

Conclusion of an agreement for compulsory insurance, unlike, occurs automatically upon receipt of insurance. Compulsory medical insurance policies are issued at enterprises and organizations or in Territorial funds(MHIF). At registration of compulsory medical insurance, and , required: passport with registration confirmation, work book.

The register of free medical services that a citizen can receive is approved for each territory annually. The clinic has a register of such services, which anyone can view. He will tell you about Article 326 of the Federal Law and compulsory health insurance in the Russian Federation.

On the video - what is included in the compulsory medical insurance policy:

State program for the provision of medical care for 2017-2019. includes:

• primary;
• specialized;
• ambulance;
• palliative (pain relief for incurable diseases) care.

Types of priority assistance and specialists:

• health care (nurses);
• pre-medical (paramedics, obstetricians);
• medical (therapists, pediatricians, family doctors).

Primary care is provided in a clinic, in a day hospital and at home.

The clinic doctor is obliged to:

• admit the patient;
• order an examination;
• to diagnose;
• determine treatment;
• control the course of the disease.

Medications for therapy are not included in the list of mandatory medical services and are purchased by the patient at his own expense.
Specialized medical care can be obtained at a day hospital from specialist doctors. In this case, high-tech methods and tools are used (genetic engineering, robotic systems).

Day hospital means receiving medical care in the form of intramuscular and intravenous injections, physiotherapy, massage, additional instrumental examination, minimally invasive surgical intervention (removal of warts, papillomas, etc.), which does not require hospitalization and health monitoring. Find out about Rosno's health insurance policy.

Citizens can receive all types of emergency care:

• urgent;
• emergency;
• specialized emergency;
• specialized emergency.

Urgent ambulance– when a sharp deterioration in health does not threaten the patient’s life. Emergency is assistance for conditions that are life-threatening to the patient.

Hospitalization, included in compulsory medical insurance, is prescribed for acute conditions, such as:

• heart attack;
• stroke;
• food intoxication;
• infectious disease (measles, dysentery, etc.);
• severe traumatic injuries.

Palliative services are provided in hospital and outpatient settings. What is the maximum duration sick leave read .

In the Program for 2017-2019. provided:

• provision of free medications for citizens suffering from serious, chronic, incurable diseases);
• preventive examination of persons working in catering, educational institutions, in hazardous and hazardous industries;
• monitoring the health of orphans, adopted children and under guardianship;
• antenatal examination of women;
• examination of newborns for hereditary diseases and hearing.

What is provided

The list of types of high-tech assistance is approved in the Appendix to the Program for 2017-2019.

The main areas of free high-tech assistance:

1. Surgery. Microsurgical operations (pancreas, liver, intestines).
2. Obstetrics and gynecology. Nursing premature babies (genetically engineered drugs, molecular diagnostic methods). Operations for implantation of internal organs.
3. Gastroenterology. Therapeutic treatment of stomach and intestinal ulcers.
4. Hematology. Therapy of hemolytic anemia, hemorrhagic diseases.
5. Surgery of newborns. Defects of the lungs, bronchi, esophagus.
6. Dermatovenerology. Severe forms of psoriasis, atopic dermatitis.
7. Neurosurgery. Oncological operations.
8. Neonatology. Birth injuries, sepsis, respiratory disorders, nursing newborns weighing up to 1.5 kg. Therapy and surgery using additional research methods: MRI, vascular Dopplerography, immunological and molecular genetic. Cryo-, laser coagulation of the retina. (Newborns are treated and examined at the expense of the mother's insurance).
9. Oncology. Surgical operations on the stomach, esophagus, rectum, nose, trachea, ear, liver using endoscopic and radiological means.
10. Otorhinolaryngology. Surgical treatment of otitis using reconstructive plastic intervention.
11. Ophthalmology. Surgical treatment of glaucoma, cataracts, retinal detachment, lens replacement. Implantation of an intraocular lens. Correction of strabismus, ptosis of the upper eyelid.
12. Pediatrics. Treatment of hereditary diseases (Gaucher, Wilson), renal, heart failure using MRI, ultrasound, Dopplerography, MCT, ventriculography, coronary angiography, genetic studies.
13. Rheumatology. Therapy of severe inflammatory processes.
14. Cardiovascular surgery. Implantation of artificial valves and pacemakers.
15. Thoracic surgery. Operations to remove a lung or part of it.
16. Traumatology and orthopedics. Restoration of intervertebral discs, plastic surgery of the bones of the chest, pelvis, upper and lower extremities.
17. Urology. Plastic surgery on the intestines and bladder. Removal of tumors on the prostate gland, kidney, bladder.
18. Maxillofacial Surgery. Correction of congenital defects of the lip and hard palate.
19. Endocrinology. Treatment of complicated diabetes mellitus.

In addition to the basic list of high-tech medical care, there is a second registry, in which the list of assistance has been expanded (for example, removal of a limb, eyes) and new sections have been added (treatment of all types of burns, organ transplantation). What disability group is assigned for oncology will be told.

Dental care

Dental care included in the compulsory medical insurance system:

• initial examination;

• dental filling;
• removal of teeth, including fragments;
• treatment of gums and teeth (caries, periodontal disease, gingivitis, abscess);
• adjustment of dislocations and subluxations of the jaw;
• treatment of salivary glands;
• removal of tartar and deposits;
• anesthesia;
• X-ray, orthopantography;
• physiotherapy.

In the video - what is included in the compulsory medical insurance policy: dentistry:

In this case, medicines are used according to the approved register.

Children have their teeth straightened and silvered. Find out where and how to get a medical insurance policy.

• pensioners;
• disabled people of WWII, childhood, groups 1 and 2;
• Chernobyl victims;
• persons who have received the highest state awards of the USSR;
• Leningrad siege survivors.

All other types of dental care, drugs and materials not included in preferential list, are paid.

For each territory in local level Within the framework of the state program, its own health protection measures are being developed. Settlements in remote, hard-to-reach areas they can receive free medical care with the help of air ambulances, telecommunications, and mobile outpatient clinics.