Is it true that, thanks to the new Rules, some types of medical care that were previously free will become “over the counter”?
This is bad. The new Rules do not change the basic rules by which the compulsory health insurance system operates. The main document remains unchanged – the State Guarantee Program, which details all types of free medical care. This program is approved annually by the government and operates throughout the country.
“The new rules do not change the regulatory framework for free medical care under the State Guarantee Program. Assistance for Russians, as before, in the compulsory health insurance system is free,” explained Mikhail Pushkov, advisor to the director general of the health insurance organization Capital MS.
At the same time, for many years, medical organizations operating in the compulsory health insurance system have had the right to provide paid services. “The new Regulation clearly establishes the procedure for its provision, specifies the actions of medical personnel and the requirements for the terms of the contract,” the expert explained.
Do I have to pay for emergency care for sudden acute illnesses if it is not a life-threatening condition?
No, it is not necessary. In accordance with the State Guarantee Program, emergency care is provided free of charge. This very concept – emergency care – implies that patients receive it in case of sudden acute illnesses, exacerbation of chronic ailments, when there are no obvious signs of threat to the patient’s life.
Infographic “RG” / Anton Perepletchikov / Irina Nevinnaya
“Patients still have every right to seek emergency medical care, for example, in case of fever, blood pressure fluctuations, acute toothache, bruises, injuries, etc.,” explained Alexey Starchenko, member of the Public Council for the Protection of Patients. ‘ Rights according to Roszdravnadzor.
Do I have to pay for hospitalization if there is no doctor’s referral?
If I need. This procedure existed before: referrals for hospitalization and investigation were given by a doctor. The new Rules recorded these rules on paper.
The key concept is the presence of medical indications. Simply put, the doctor, after examining the patient, determines what examinations are necessary to confirm the diagnosis and chooses treatment tactics.
“A patient can undergo tests, undergo instrumental diagnostics or go to a specialist in a clinic with a referral from a therapist. If there is no such referral and the patient himself takes the initiative, all kinds of diagnostic and treatment procedures are performed “It is paid with the patient’s personal funds,” highlights Mikhail Pushkov.
In practice, there are cases when, while in a hospital, a person “at the same time” wants to be additionally examined, and this is not related to the underlying disease. For example, a patient is being treated in the cardiology department, but wants to perform an ultrasound of the abdominal organs. It is more advisable for the patient to be examined in a hospital “just in case”, since he knows that he has chronic pancreatitis. But that additional “complementary” research will be carried out only for money.
However, if the same patient goes to a gastroenterologist in his clinic and prescribes the same ultrasound, it will be free of charge.
“In the above example, the offer of a medical organization to undergo an ultrasound scan on a paid basis is completely justified. But if in a cardiac hospital the patient develops symptoms of acute pancreatitis, this is already a medical indication for an ultrasound scan. and prescribe treatment, and possibly even transfer the patient to a specialized gastroenterology department, all free of charge,” explains Mikhail Pushkov.
Should I pay a patient for prescribing medicines that are not included in the list of vital and essential medicines (VED)?
The new Rules define the cases in which this is possible. Medicines prescribed by a doctor for treatment in a hospital are free of charge for the patient. Clinical recommendations for the treatment of any disease also contain a list of medications. When choosing or replacing a drug, the doctor always focuses on medical indications. For example, if an allergy or adverse reaction to a medication occurs, it will be replaced.
“If a patient has indications for the use of a drug that is not included in the list of Vital and Essential Drugs, it is prescribed by a medical advisory commission. In addition, the new drug is also provided free of charge,” says Alexey Starchenko. .
“Purchase of medicines that are not included in the list of vital and essential medicines can be offered at your own expense if the patient insists on a specific brand (that is, wants to be treated with a branded medicine),” says Pushkov.
The same standards apply to medical devices and medical nutrition. By appointment, free of charge, at your own request, for money.
Should I pay for individual medical observation if there is no medical indication for it?
This is a paid service for the patient. If during treatment in a hospital the patient (or her family) wants to play it safe and set up an individual medical observation post so that a nurse is nearby at all times, this is possible, but only for a fee. It is about providing greater comfort to the patient. The situation is similar with accommodation in a single room.
“At the same time, if a patient requires 24-hour monitoring, that is, if there are medical indications, the service of an individual medical post should be free,” emphasizes Alexey Starchenko.
Should the patient pay if they want to remain anonymous during treatment?
Yes, in this case medical care will be paid.
The explanation is simple: if the patient remains “unnamed”, this excludes the possibility of payment for care provided in accordance with the rules in force in the compulsory health insurance system.
What to do if the right to receive free medical care is violated?
Practice shows that, unfortunately, medical organizations can interpret the provisions of documents in “their favor” and it is difficult for the patient to understand all the nuances. And it is problematic to prove that he is right in a dispute with medical workers. But there is a way out: contact his insurance representative.
“Every insured person who needs legal protection should simply know the telephone number of his insurance company, whose compulsory medical insurance policy is in his hands. Consultations with specialists of medical insurance organizations working in the compulsory medical insurance system are always free and competent,” advises Mikhail Pushkov.
