High-tech medical care for compulsory medical insurance

Main article: Compulsory medical insurance

What is high-tech medical care

High-tech medical care (HMP) is medical care using new complex or unique treatments, as well as resource-intensive treatments with scientifically proven effectiveness. Within the framework of the WMP, treatment methods using cellular technologies, robotic technology, information technology and genetic engineering methods can be used.

Who can get high-tech medical care

All citizens of the Russian Federation have the right to receive free high-tech medical care. Foreign nationals or stateless persons who are insured persons in the compulsory medical insurance system are also entitled to receive high-tech assistance included in the basic compulsory medical insurance program. The main condition for its receipt is the presence of medical indications and the absence of contraindications.

For 2020, in each individual case, the indications for receiving planned medical care (VMP) are determined individually, based on the main factors:

• the severity and stage of the underlying disease that caused WMP;
• initial patient condition (age, comorbidities and associated risk of complications);
• prognosis for patient life and health and others.

Where can I get WMP

Medical organization licensed for this activity.

In 2019, VMP in the field of compulsory medical insurance is provided by 1,114 medical organizations, including 152 medical organizations, subordinate federal authorities, 836 medical organizations, subordinate state authorities of the constituent entities of the Russian Federation, and 126 medical organizations of non-state ownership.

How many people receive VMP under compulsory medical insurance

The number of people who received VMP has increased since 2014 - from 228 thousand people to 1 million 133 thousand people in 2018.

List of high-tech medical care according to compulsory medical insurance

2020:536 methods

In 2020, patients of the compulsory medical insurance system had access to 18 new methods of high-tech care: in oncological diseases, for example, stereotactic radiation and proton therapy. They also included modern conformal radiation therapy. This is a radiotherapeutic treatment in which a model of the human body is built in a 3D projection. This method determines the optimal location for the patient of the points of effect on the tumor so that healthy tissues are minimally affected. In total, 536 types of high-tech medical care are available under the compulsory medical insurance policy.

At the expense of OMS funds, such types of VMP as comprehensive treatment for habitual pregnancy failure, treatment of patients with extensive burns, microsurgical interventions in neurosurgery, intravascular thrombolysis, nursing of newborns, video endoscopic intra-cavity surgeries, remote radiation therapy of malignancies, individual reconstructive operations in the coronoscopic cavity, endoscopic surgery and other traumatic surgery.

2019:518 methods

By 2018, 508 VMP methods entered the compulsory medical insurance system. In 2019, more than 10 VMP methods were additionally introduced, which are carried out within the framework of compulsory medical insurance.

High-tech medical care (HMP) can be provided in a number of profiles. This is:

• abdominal surgery (treatment of abdominal organs),
• obstetrics and gynaecology,
• gastroenterology,
• hematology,
• dermatovenerology,
• neurology,
• combustiology (treatment of severe burn lesions),
• neurosurgery,
• oncology,
• otorhinolaryngology,
• ophthalmology,
• pediatrics,
• rheumatology,
• cardiovascular surgery,
• thoracic surgery (surgery of bodies of a thorax),
• traumatology and orthopedics,
• transplantation of organs and tissues,
• urology,
• maxillofacial surgery,
• endocrinology;
• neonatology, pediatric surgery during newborn.

Among these methods are: cardioverter-defibrillator implants, reconstructive-plastic, microsurgical, expanded-combined surgical interventions in malignancies, the use of genetically engineered biological drugs in the treatment of rheumatoid arthritis, complex surgical treatment of glaucoma and others.

The provision of WMP within the framework of the basic MHI program in 2019 is carried out according to additional types of WMP included in the basic MHI program since 2019:

• endoprosthesis of limb joints with pronounced deformities, dysplasia, ankylosis, improperly fused and unswollen fractures of the joint area, post-traumatic dislocations and subversions, osteoporosis and systemic diseases, including using computer navigation;
• coronary myocardial revascularization using angioplasty in combination with stenting in coronary heart disease with stenosis of 1-3 coronary arteries.

Also, according to the profile "Maxillofacial surgery," the following treatments have been added:

• surgical elimination of jaw abnormalities by osteotomy and movement of articular discs and dentate complexes;
• removal of neoplasm with simultaneous elimination of defect using transplantation and implantation materials, including transplants on vascular pedicle and maxillofacial prostheses;
• elimination of defects and deformations using transplantation and implantation materials.

A complete list of VMP services is presented in Decree of the Government of the Russian Federation dated December 10, 2018 No. 1506 "On the Program of State Guarantees for Free Medical Care for Citizens for 2019 and for the Planning Period 2020 and 2021" on the website of the Government of Russia and the Federal Compulsory Medical Insurance Fund.

How to get high-tech help on compulsory medical insurance. Instruction

What to do if you need planned high-tech medical care:

1. Undergo an outpatient medical examination, during which the disease is diagnosed and the need for VMP is identified.

2. Get the direction of the district doctor of the polyclinic (or the direction from the regional health management body on the proposal of the polyclinic) based on the results of the decision of the medical commission.

3. Collect the necessary package of documents (extract from medical documentation, copy of passport/birth certificate, compulsory medical insurance and SNILS policy, examination results and other documents from the list issued by the sending organization - the clinic).

4. The sending organization (polyclinic, less often - a regional healthcare management body) within three working days or the patient himself (if desired) sends a referral and a package of documents to the medical organization that will provide VMP (this can be done on the website https://talon.rosminzdrav.ru/search_vmp/ - regardless of the way the VMP is financed).

5. The medical organization that will provide VMP conducts another medical commission (on the selection of patients for VMP), confirms the feasibility of hospitalization and issues a ticket for the provision of VMP for the patient. In some cases, according to clinical indications, the medical commission can determine the list of additional examinations before sending to the VMP, which the patient must undergo in the clinic at the place of attachment.

6. The medical commission of the medical organization that will provide the patient with VMP makes a decision on the presence (or absence) of medical indications or the presence of medical contraindications for hospitalization of the patient, taking into account the types of VMP provided by the medical organization within a period not exceeding 7 working days from the date of registration for the patient Talon for the provision of VMP.

7. You can check the status of the ticket on a special website: http://talon.rosminzdrav.ru/

8. Arrive at the medical organization within the time limit specified by it with the required package of documents (see item 3).

The patient in the compulsory medical insurance system has the right to contact the insurance representative if there are any questions about receiving medical care.

The insurance representative shall: · Clarify the procedure for obtaining WMP, indicate where it is necessary to contact the insured taking into account the peculiarities of the implementation of the state guarantees program in certain territories; · help the insured to determine the choice of a medical organization for the provision of VMP, taking into account indicators of the quality of medical care, territorial remoteness and other factors; · When making a complaint about the availability and quality of medical care: organize control and expert measures to assess the quality of the provided VMP (including in order to assess the achievement of the target treatment result - the second opinion). The material of this assessment, the medical organization takes into account when deciding on further treatment tactics, the need for repeated hospitalizations; · If the fact of unreasonable refusal of the insured person to issue a referral to the VMP or if the timing of its receipt is violated, contact the medical organization and help restore the right of the insured person to receive the VMP in a timely manner.

If the insured patient is denied VMP and wants to appeal the decision of the medical commission, then he needs to seek advice from the insurance medical organization, which issued a compulsory medical insurance policy. The insurance representative will advise the insured on this issue and will help to understand the current situation (with the participation of experts of the quality of medical care) and help to obtain a WMP if the refusal to provide it was unreasonable.

See also

• Free OMS cancer treatment
• How to choose or change a clinic for compulsory medical insurance
• Compulsory medical insurance policy on vacation in Russia