Free treatment covered by compulsory health insurance
At the expense of the CHI (compulsory health insurance), the clinic provides assistance within the framework of a 24-hour and day hospital (surgical treatment). Due to the fact that the provision of high-tech medical care at the expense of OMS (that is, free of charge for the patient) is carried out in accordance with the approved task plan and allocated limited amounts,then the patient will need to stand in a waiting line (you can learn about waiting times from the specialists of HospitalizationDepartment.
The Clinic DOES NOT PROVIDE outpatient care (admission by a doctor in the clinic) under the CHI.
Free medical care in our clinic for inpatient treatment is provided at the expense of the compulsory health insurance funds and at the expense of the federal budget for the provision of high-tech medical care in accordance with the approved target plan and the allocated amounts.
Compulsoryhealth insurance in the Russian Federation is regulated by Federal Law No. 326 dated November 29, 2010 OnCompulsory Health Insurance in the Russian Federation.
The order of provision, standards, volumes, types of free medical care, the conditions for its administering, criteria for quality and availability, other important issues are reflected in the Program of state guarantees of free medical care to citizens for 2018 and for the planned period of 2019 and 2020, approved by the Decree of the Government of the Russian Federation dated December 8, 2017 No. 1492, at the level of Nizhny Novgorod region – in the Program of state guarantees of free medical care to the population of Nizhny Novgorod region for 2018 and the planned period of 2019 and 2020, approved by the decree of the Government of Nizhny Novgorod region dated 22/12/ 2018 N. 930.
Our clinic within the framework of the Territorial program of state guarantees provides specialized, including high-tech, medical care.
In accordance with clause 4 of the Statute on the Commission for the Selection of Patients for Planned Hospitalization, approved by order for Center No. 7 dated 09/01/2017:
4.1. The referral of patients to our clinic (center) for the provision of specialized medical care is carried out by the attending physician of the Center or other medical organization, where the patient is diagnosed and treated under the provision of primary specialized medical care or specialized medical care (hereinafter – the attending physician).
4.2. When referring a patient to a Center for the provision of specialized medical care, the attending physician determines the availability of one or several medical indications for the provision of specialized medical care.
4.3. Medical indications for the provision of specialized medical care are:
- a) atypical course of the disease and (or) non-availability of effect of the treatment;
- b) the need to apply treatment methods that are not performed in medical organizations subordinated to the executive authorities of the constituent entities of the Russian Federation in the field of health care;
- c) high risk of surgical treatment in connection with the complicated course of the underlying disease or the availability of comorbid diseases;
- d) the need to perform repeated surgical interferences in cases provided for in subclauses a, b, c of this paragraph;
- e) the need for additional examination in diagnostically difficult cases and (or) complex preoperative preparation in patients with complicated forms of the disease and (or) comorbid diseases for subsequent surgical treatment;
- f) the need for re-hospitalization according to the recommendation of the center.
4.4. Ifmedical indications are detected in the patient for provision of specialized medical care in the center, the attending physician draws up a referral for hospitalization (form 057/y) for the provision of specialized medical care, an extract from the medical documentation (form 057/y) and other necessary documents.
4.5. If necessary, the center requests an extract from the patient’s medical records and other information contained in the patient’s medical records to decide on the possibility and timing of the patient’s hospitalization.
4.6. The basis for hospitalization of the patient in the center for the provision of specialized medical care is the decision of the commission on the selection of patients for planned hospitalization.
4.7. The basis for consideration by the Commission of the centerconcerning the question of availability (non-availability) of medical indications for hospitalization of a patient in order to provide specialized medical care are the documents referred to in 4.4. of this Regulation.
4.8. The Commission of the centermakes a decision about availability (non-availability) of medical indications for hospitalization of the patient in order to provide specializedmedical care within a period not exceeding seven working days from the date of receipt of the documents.
4.9. The decision of the Commission of the center is made out by the protocol containing the following data:
- a) the basis for the creation of a medical Commission of the center (details of a regulatory act);
- b) date of decision of the Commission of the center;
- c) personnel of theCommission of the center;
- d) passport data of the patient (surname, first name, patronymic (if any), date of birth, information about the place of residence);
- e) diagnosis of the disease (condition) and diagnosis code according to ICD-10;
- f) the opinion of the medical Commission of the center containing one of the following decisions:
on availability of medical indications for hospitalization of the patient in the center for the provision of specialized medical care with an indication of the diagnosis, the diagnosis code according to ICD-10, the planned date of hospitalization of the patient;
onnon-availabilityof medical indications for hospitalization of the patient in the center for the provision of specialized medical care with recommendations for further medical supervision and (or) treatment of the patient according to the profile of their disease;
on availability of medical indications for hospitalization of the patient in the center for the provision of specialized medical care with an indication of the diagnosis, the diagnosis code according to ICD-10, code of the type of high-tech medical care in accordance with the list of types of high-tech medical care approved in accordance with the legislation of the Russian Federation.
4.10. Record of the decision of the Commission of the center is drawn up on paper in one copy and is stored in the center.
4.11. Hospitalization of patients under CHI is carried out in accordance with the agreement with CHI territorial fund under the selected profiles and the established plan-task for the current year.
Benefit-entitled citizens have the right to the priorityfree medical care under the program of state guarantees of free medical care to the population.
The Hospitalization Department maintains a waiting list for specialized, including high-tech, medical care, provided in a planned manner, and informs citizens about the waiting time for the provision of specialized medical caretaking into account the requirements of the legislation of the Russian Federation in the field of personal data.
For planned hospitalization covered byCHIit is necessary:
- To draw a certificate in the 027/y form at the Medical and Preventive Treatment Facility at the place of residence (Extract from the medical card of the outpatient or inpatient), or another referral for planned hospitalization.
- Scan this certificate and scan or photograph existing X-ray images (including CT and / or MRI) and send them to the Hospitalization Department’s email address firstname.lastname@example.org for remote consultation by specialists of the center,or visit Consultation and Rehabilitation Department for the internal consultation with the center’s specialists.
Consultations at the Center are carried out only on a fee basis, because our “Adult Orthopedics Clinic” is not included in the list of organizations that provide outpatient care to citizens as part of the territorial compulsory health insurance program.
If there are indications for inpatient treatment at the center, you will be notified of the date of hospitalization and a list of mandatory laboratory tests, instrumental examinations, and documents necessary for planned hospitalization.
On the appointed date, you have to visit the admissions office of our hospital for hospitalization (18/1, Verkhne-Volzhskaia Embankment).
You should have:
- referral for planned hospitalization (form 027/у);
- passport of a citizen of the Russian Federation;
- insurance certificate of state pension insurance (SNILS);
- CHI health insurance policy;
- results of analyzes, examinations, expert opinions in accordance with the list.
Further information can be found on the hospitalization page.