Constitution Russian Federation guarantees to all citizens free medical care under the policy of compulsory health insurance(OMS). Types of free assistance provided by compulsory medical insurance policy:

• primary health care(ambulatory polyclinic);
• emergency,
• specialized medical care(if the diagnosis is established, the specific disease is treated)
• high-tech medical care(treatment of diseases using high-tech, complex, costly methods of treatment).

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

Briefly about the CHI system

Payment for treatment in the 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. The compulsory medical insurance tariff specifies how many and what procedures, tests and studies the clinic can and must 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. Mutual settlements with the clinic will be carried out by the insurance company.

Some costly procedures under the MHI system can only be performed if strictly necessary, which the clinic must prove, otherwise they simply will not be paid for by the MHI fund. Therefore, the treatment of patients in the CHI system, unfortunately, has its limitations.

Medical institutions are forced to work according to the rules established by the CHI fund for each disease. It is important to say that providing patients with high-tech medical care(VMP), the so-called “quota” treatment, is also paid from the CHI 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 the provision of complex, high-tech treatment, which allows the clinic staff to use all the power of modern treatment methods, 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 compiles a list of clinics that can treat patients according to the VMP. Selected clinics receive a so-called task from the Ministry of Health, which determines the number of patients that the hospital can treat according to the HTMC.

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. Sechenov, respectively, the same requirements apply to her.

How to get medical assistance under the MHI policy?

Option 1. Referral from the clinic

You need the CHI policy itself. If it is not there, and you are a citizen of the Russian Federation, you need to contact the insurance company that works with the territorial CHI fund, write an application and receive it immediately temporary policy, and about a month later, a permanent compulsory medical insurance policy. After receiving the compulsory medical insurance policy, you need to attach to a polyclinic, which you can choose yourself. After that, you can apply for high-tech medical care under the CHI policy.

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

In the polyclinic, you can get both a referral for a free consultation at our Clinic, and a referral for free treatment.

Option 2. As directed by the doctors of our Clinic.

Doctors of the Clinic of Coloproctology and Minimally Invasive Surgery can also issue referrals for treatment in some cases. 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 CHI policy during an in-person consultation with a doctor. In this case, you will bypass the stage of approval and receiving a referral at the clinic. Please note that referrals for CHI treatment, which are issued directly at our Clinic, have a limited number.

To issue a referral under the CHI policy through the doctor of the KKMC Clinic, you will need:

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

According to the current legislation, patients have the right to equal access and receive medical care at the expense of compulsory medical insurance. Although usually, when talking about compulsory medical insurance, we mean state clinics, it is also possible to get expensive procedures for compulsory medical insurance in private clinics. Inclusion of private clinics in CHI system became real thanks to changes in the Federal Law on health insurance in 2010 - they got the opportunity to receive reimbursement for patient care from the fund.

What services are available in private clinics operating in the CHI system

The task of private clinics that receive patients under the CHI system is to help state budgetary health care. Thanks to the work of private clinics, the problem of the availability of narrow specialists is solved, or patients are given the opportunity to undergo technologically complex procedures, which state clinics are not always able to provide. The referral for such assistance is issued by the local doctor (therapist) of the territorial polyclinic. For getting free service in a private clinic (paid for by the MHI fund), patients need to present a referral from their physician and an insurance policy.

In order for the clinic to be able to obtain permits for work on compulsory medical insurance, it is necessary to send an application-notification to the regional fund, which is necessary for entering it into the register.

IMPORTANT!
You need to send an application before September 1, preceding the beginning of the year of conducting future work in compulsory medical insurance. At the same time, the regional fund cannot refuse medical institutions and not include them in the register of medical institutions.

After a private clinic is included in the list of commercial medical organizations cooperating with the compulsory medical insurance system, it can provide medical services to all citizens who have concluded compulsory medical insurance agreements to the extent determined by the territorial compulsory medical insurance program.

IMPORTANT!
If your private clinic cooperates with the CHI system, it is obliged to inform patients about the full list of types of medical care provided free of charge. This list should be as accessible as possible - be in a conspicuous place at the clinic's registry, be in a prominent place on the clinic's website. If this principle is violated, the clinic can be complained to Roszdravnadzor, since the lack of such information is an administrative offense.

What checks are waiting for clinics working with CHI

If private clinics are going to cooperate with MHIs, then they should be prepared for fairly strict quality control of the medical services provided by these clinics. The following points are controlled:

• registries are checked to pay for the services provided by the clinic;
• economic and medical examination is carried out;
• the quality of medical care provided by the clinic among patients who have applied for help is checked. Up to 8% of the total number of patients who received assistance can be tested.

If the clinic finds violations of the law, penalties are possible.

On the financing of private clinics operating under compulsory medical insurance

Private clinics operating under CHI, receive funds from the federal fund of the health insurance company to cover the state order for compulsory medical insurance (the number of those patients who received medical care under the program). Insurance company within established by the program tariffs from compulsory medical insurance funds reimburses:

• salaries of medical staff of the clinic;
• medicines and materials spent by the clinic, including dressings and consumables;
• hospital utility bills;
• funds spent on medical equipment.

What documents should a patient submit to a private clinic to provide him with medical care under compulsory medical insurance?

Ekaterina Tyulkina, director of the medical service of the clinic of OJSC "Medicina", MD

About company. Clinic JSC "Medicina" - a medical center that provides patients with comprehensive high-tech medical care.

The possibility of private clinics to participate in the program of state guarantees in the Russian Federation, in particular, in programs in within the CHI, appeared with the release of Federal Law No. 326 dated November 29, 2010 “On compulsory health insurance in RF". The procedure for filing a medical organization, including a private one, with an application or notification for participation in the program is presented in detail on the websites of the territorial funds for compulsory medical insurance (FOMS). In particular, for private clinics located in Moscow - on the website of the Moscow City Compulsory Medical Insurance Fund.

A private medical organization, like a public one, has the right to choose the services from the list of types of medical care in which it wants to participate.

Our clinic has been participating in the program of cooperation with the CHI for several years now. Although here it would be more correct to speak not about expensive services, but about the provision of high-tech medical care.

For example, now we provide high-tech medical care in the following areas within the framework of compulsory health insurance:

• Positron emission computed tomography (PET/CT). Such studies are carried out seven days a week, practically in two shifts, from 9.00 to 20.00. The results will be handed over to the patients who underwent the study within two hours after the study;
• Single-photon emission computed tomography (SPECT) is a nuclear medicine procedure that allows diagnosing the functional state of various organs and their pathology by obtaining three-dimensional images, studies in the clinic are carried out 7 days a week;
• Enhanced external counterpulsation (EECP) - for patients with certain indications. The programs are very interesting, they are carried out by specially trained cardiologists;
• In vitro fertilization (IVF) programs.

Surgical care is provided in the following areas:

• diseases of the bladder - transurethral resection of the bladder for tumors of the bladder;
• kidney resection - nephrectomy for kidney neoplasms;
• surgical treatment of complicated cataract;
• surgical treatment of melanoma. The clinic employs unique specialists who have specialized in these types of surgical treatment in foreign clinics, in particular in Israel;
• surgical treatment of the thyroid gland - resection of the thyroid gland for tumors of the thyroid gland;
• laparoscopic cholecystectomy, hernia repair and plastic surgery;
• radiofrequency ablation of varicose veins.

Operations are carried out in the multidisciplinary hospital of the clinic, which has 4 smart operating rooms, an intensive care unit and a paid department. These are such fast tracks - quick additional examination (if necessary), surgical treatment and discharge of the patient. In the postoperative period, we offer patients the possibility of rehabilitation, recovery, but already according to individual programs.

All of the above medical care programs apply to all residents of the Russian Federation, i.e., there may be a referral from any region of Russia.

Another type of high-tech care that we provide to patients is radiation therapy. So far, it is only for Moscow cancer patients and is included by the Moscow government in the program of high-tech medical care provided, which is offered in addition to the basic program under the list of compulsory medical insurance services.

The procedure for referral to receive medical assistance under compulsory medical insurance in a private clinic is determined by the documents of the Ministry of Health of the Russian Federation and the Moscow Department of Health.

For example, Muscovites, in order to undergo a PET / CT examination, will need to have the following list of original documents on hand:

• document proving the identity of the patient;
• a valid CHI policy issued to the patient;
• SNILS.

In addition to the documents sent to undergo this procedure, the patient must have with him the following originals of the results of his analyzes:

• referral for PET/CT with FDG according to the form of Order No. 477 of July 13, 2018 and the list of nosologies specified in the appendix to Order No. 477 of July 13, 2018;
• the result of a blood test for endogenous creatinine (the date of the analysis should be no later than 21 days at the time of the study);
• in addition to the originals, the patient will need the following list of copies of test results and extracts that will help create and evaluate a complete picture of the patient's disease and the treatment he received:

1. extracts from the place of the last treatment in the hospital (if the patient was on inpatient treatment);
2. data from analyzes of histology studies (if available);
3. data from CT and MRI studies conducted by the patient earlier;
4. data from PET / CT studies made earlier. You must also provide a study disk (if available).

And to take part in the IVF program, you need:

• the direction of the attending obstetrician (gynecologist) in the form No 57;
• passport, SNILS, compulsory medical insurance policy (originals and copies of these documents);
• an extract from the patient's medical record, issued by an obstetrician (gynecologist) working at his place of residence. Then you will need an extract from the medical documentation, which must be issued by the attending physician. It should contain: information about the diagnosis of the disease, data on the patient's state of health, information about the methods of diagnosis and treatment used. It should also contain recommendations on whether it is necessary and possible in this case to carry out the IVF procedure.

CHI policy holders can count on the free provision of services in public dentistry clinics. Any citizen of Russia, regardless of his age and type of employment, can apply for a compulsory medical insurance policy.

What is free medical insurance

There are no free dentists, their work costs money. Dental manipulations are paid either by the patient himself or by the insurance company. If a person is treated under insurance, all the medical services financed from the regional CHI fund.

Which polyclinics receive patients under the MHI program

Free dental treatment under the regular CHI policy is available in public clinics and hospital departments of maxillofacial surgery. To find a medical facility where you can treat your teeth for free, just find the nearest budget clinic.

The policy applies to all Russian regions, wherever its owner is registered. If the document was received in one subject of the Russian Federation, and its owner plans to live in another, then when moving, he must be registered at the local branch of the insurance company that issued the policy. If this company does not have its own representative office in a certain city, then one should proceed from the recommendations of the dental clinic where treatment is planned. In her registry, they may be advised to contact organizations with which the medical institution is actively cooperating.

That is, registration in another region does not affect the ability to remove and treat teeth for free, but without medical policy even if there is permanent registration, free treatment will be denied. The exception is emergency dental care in the event of a flux and symptoms that threaten a person's life. In such emergency situations, even a patient without a compulsory health insurance policy will be sent to a hospital for urgent surgery.

The procedure for attaching to the state clinic and the list of required documents

To start dental treatment in a certain dental clinic, you need to attach yourself to it. To do this, you must provide the following documents to the registry office:

• medical policy with a mark of the regional division of the insurance company;
• passport or birth certificate (if a child is attached);
• SNILS;
• statement.

If the dentist's office is located in the building of a regular clinic, it does not need to be additionally attached to it. If the dental clinic is a separate institution, then attachment to it is necessary.

Immediately after registration at the clinic, the patient will acquire the right to treatment or extraction of teeth in the framework of emergency care without an appointment. Further appointments will take place by appointment, it is necessary for the competent optimization of the dentist's working time.

There are three ways to make an appointment with a dentist under the MHI policy:

• by phone;
• through the Internet;
• using a special electronic recording machine in the foyer of the clinic (available in clinics in Moscow and other large cities).

When generating a coupon, you will need to indicate what service the patient needs - removal or treatment of teeth.

Free treatment at a private dental clinic

The compulsory medical insurance program involves mainly budgetary medical institutions, private clinics rarely provide such services. A list of commercial clinics where you can get qualified free dental care under the CHI policy can be found on the website of the insurance organization. Then you need:

1. Call the indicated clinics to find out the relevance of the information and the list of services that are really provided free of charge.
2. Come to the state dental clinic to which the policy is attached, and ask at its registry office for a referral to a private clinic where the patient is going to treat his teeth.
3. Contact a commercial institution, sign up for an examination and undergo treatment.

With free treatment in private dental clinics, some of the services will still have to be paid, so it is better to clarify in advance which dental treatment services under compulsory medical insurance are included in the preferential package of a particular commercial clinic in order to avoid presenting a bill after just one or two preventive examinations.

List of free dental services under the CHI policy in 2020

To find out what services from the field of dentistry are included in the CHI policy, you need to read the memo of the insurance company or find the same information on the company's website. According to the standard, the list of dental services under CHI for adults and children includes:

• initial appointment (in a clinic or at home, if we are talking about bedridden patients): examination, consultation, training in proper brushing of teeth;
• treatment of gingivitis, caries, pulpitis, periodontitis, abscess;
• extraction of teeth: milk, permanent or wisdom teeth;
• removal of tartar;
• removal of foreign bodies from the dental canals;
• reduction of the jaw (dislocations and subluxations);
• local operations on soft tissues;
• physiotherapy treatment;
• radiography;
• children's dental services included in compulsory health insurance: orthodontics with removable products, remineralization and silvering of teeth.

The expediency of carrying out a particular procedure is determined by the attending physicians, sometimes consultation of related specialists or additional paid procedures are required. In any region of the Russian Federation, free dental services under the CHI policy are provided only for medical reasons.

Consumables and medicines for CHI

As part of the treatment under the compulsory health insurance policy, the following materials and medicines are used:

• filling cements: silicate, phosphate cements, glass ionomers;
• polishing pastes;
• arsenic;
• cleaning brushes;
• consumables: dressings, sutures, burs, bandages, cotton wool, x-ray film;
• domestic anesthetics and antiseptics: Novocaine, Lidocaine, Trimecaine.

The doctor can offer the patient other drugs for anesthesia, a modern filling paste that "fills" almost instantly, and other better materials for an additional fee, but the patient has the right to refuse them. In this case, materials and medicines provided for by the state guarantees by OMS. The patient has the right to know what kind of medicines he will be administered, regardless of whether the treatment is free or paid.

A seal installed in a state clinic is guaranteed for 1 year.

Prosthetics

Prosthetics are not included in the state health insurance program, such services are provided for money. But There are a number of preferential categories of citizens who can install dentures for free. These include:

• WWII veterans;
• combatants (Afghanistan, Chechnya);
• Chernobyl liquidators.

Installation of light seals

Photopolymer light seals are practically not placed under the compulsory medical insurance policy, due to their high cost and insufficient financing of insurance funds. In a state clinic, you can get such a seal only for medical reasons. Dentists usually place them on the front teeth or in case of cervical caries.

In a private clinic participating in the CHI program, you can install a light filling by paying only the cost of the material - the treatment itself will be free. Cash spending in this case will be from 500 rubles. When paying for treatment, it is necessary to keep the payment documentation in order to receive it later. tax deduction and for this amount (relevant for working citizens).

Free Wisdom Tooth Removal

Wisdom teeth are removed free of charge if you have a compulsory health insurance policy, but during this operation, stronger anesthesia may be required, for which you will have to pay extra. Conventional anesthetics may not be effective enough to anesthetize the problem area.

The cost of paid dental services (filling, treatment, removal) is quite high and beyond the reach of most working and unemployed Russians. But teeth can be cured for free by issuing a CHI policy. We must remember our rights and focus on legislative acts, and not on the local orders of the head physician of any clinic.

More than 1.7 thousand non-governmental medical organizations in Russia in 2014 will receive patients under compulsory medical insurance policies (CHI). On what free help you can count on a private clinic and where to complain if a citizen was denied admission under the policy, in an interview with RIA Novosti correspondent Lyudmila Beskorovaynaya, said the head of the department of the compulsory medical insurance organization Federal Fund compulsory health insurance Svetlana Kravchuk.

— Svetlana Georgievna, what percentage of private clinics are currently involved in providing assistance under the CHI policy?

— There is a significant change in the number of non-governmental medical organizations participating in the system of compulsory health insurance. In 2010, only 618 organizations of non-state ownership worked in the MHI system throughout the country. For 2014, more than 1.7 thousand companies have already applied. If in 2010 their share was about 7.6% in the structure of medical organizations, then in 2014 it grows to 19%. These organizations are located in almost all regions of Russia, of course, there are more of them in Moscow and St. Petersburg.

— That is, it can be assumed that more and more private medical centers will be included in the CHI system?

- In the conditions of today's financing, I think so. In addition, the CHI system has fairly clear, understandable, transparent requirements for medical organizations, and interaction between medical organizations and medical insurance companies has been built. The procedure for including private medical organizations in the CHI system is carried out on the basis of a notification. If a clinic, regardless of its form of ownership, is licensed to practice medicine, it has the right to file a notice with territorial fund and he cannot refuse her participation in the CHI system.

— Are private clinics that receive compulsory medical insurance under the policy of compulsory medical insurance in demand among the population?

“I don’t think the population has any distrust. All these organizations provide medical care on the basis of a license, they have the right to this activity. In addition, since they work in the MHI system, the same requirements apply to them as to state-owned organizations. These are checks, and quality control and timing of medical care. Patients in this case have all the rights that insured persons have when receiving medical care in state organizations under the territorial programs of compulsory medical insurance. They can also contact their insurance company for clarification and protection in case of violation of their rights.

It should be borne in mind that private medical organizations, entering the MHI system, as a rule, provide outpatient, that is, outpatient medical care: they conduct diagnostic tests, consultations, and offer dental services.

The growth in the number of non-governmental medical organizations and their share in the payment for medical care provided allows us to conclude that they are quite attractive to the population.

— Can you attach yourself to these medical institutions under the policy in the same way as you can to your city clinic?

- If in medical organization there is a district service and it is ready to attach the population, the insured have the right to choose this organization to receive primary health care. But, as I already said, they mainly conduct diagnostic tests and provide advisory medical care, they see “narrow” specialists: ophthalmologists, neurologists, allergists, dentists and others.

policies CHI of the old samples will be valid in 2014Compulsory health insurance policies are being replaced in Russia. The CHI policy of a new sample was put into circulation in May 2011. It can be either paper or plastic. In addition, it can be a part of a universal electronic card.

Regardless of which insurance company issued a policy to a person, he can apply to any non-governmental medical organization participating in the territorial CHI program and receive assistance.

Even if a person is a resident of one region and has arrived in another, he can apply with an acute form of the disease to a private clinic operating under the territorial CHI program with his own policy. But if he came on vacation, for example, from Volgograd to Moscow, and decided to receive planned specialized care in a hospital, this can only be done with a referral from a doctor of the medical organization that he chose to attach.

Medical assistance to insured persons should be provided by a medical organization free of charge, it will be paid for by an insurance medical organization or a territorial compulsory medical insurance fund.

- Where can a person complain if he was denied assistance in a private clinic under the compulsory medical insurance policy, but this organization is included in the state guarantees program?

- First of all, to the administration of this medical organization in order to immediately understand the situation. If the administration does not respond or the person does not want to go there, he can contact the insurance company in which he is insured. There is always a phone number of this company on the back of the policy.

Healthcare may not be able to endure budget maneuver, experts sayProject federal budget for 2014-2016, encouraged by the government of the Russian Federation in mid-September, caused a negative response in the medical and patient communities. The reduction in health care costs, provided for by the country's main financial document, was the topic of a round table held at RIA Novosti.

All information about the medical organizations included in the territorial program should be posted on the website of the executive authorities of the region.

In any case, if a person comes to a medical organization, he must clarify whether it works in the CHI system. If in doubt, you can call in advance and check with the insurance medical company, the territorial fund for compulsory medical insurance, the health authority of the region.

There is a second point. When you are offered in any medical organization, even a city clinic, to provide medical care for a fee, call the insurance company and ask if it is free. And if this polyclinic is included in the territorial CHI program, you will definitely get help for free.

- How should private clinics included in the CHI program inform the population about the services they provide free of charge?

- All medical organizations working in the MHI should have stands with information about medical care, which is provided free of charge under the territorial program (types, conditions, terms). This information should not be located somewhere in a dark corner, far from the reception desk and the cashier window for paid services. It should be placed in a conspicuous place so that a person understands that he receives such and such assistance for free.

The choice of RIA Novosti: the most anticipated events of 2014 in the social sphereIn Russia, in 2014, the national vaccination calendar will be updated, programs of state co-financing of pensions and payments will be extended. maternity capital, and they promise to make the unified state exam more transparent.

Also, medical organizations should place this information on their websites. But not all medical organizations have their own websites. In this case, the health authorities are obliged to place all information about all participants in compulsory medical insurance on their websites. It is mandatory that this information is posted on its Internet resources by the territorial CHI fund, and Insurance companies. It is their duty to inform citizens about the provision of medical care, about the procedures, rules, and conditions for obtaining it.

For the first time this year, each territorial CHI program should include additional information on the timing of the provision of planned medical care.

- Recently, blogs have reported that private medical organizations in Moscow, which are included in the CHI program for 2014, are refusing to provide free medical care. Some of them say that they did not have time to issue documents, so they will start working on policies only from February ...

- A medical organization included in the register for the next year, by the end of the previous year, concludes an agreement on participation in the CHI system with insurance companies.

Each subject has a commission that determines the volume of medical care for each medical organization before the year in which the CHI program is implemented. Accordingly, by the end of last year, all clinics received the planned volumes of medical care, and if they entered the compulsory medical insurance system, then they have no right to refuse to provide free medical care to the insured person under the territorial program in the event of insured event.