REMINDER for citizens about the guarantees of free medical care
In accordance with Article 41 of the Constitution of the Russian Federation, every citizen has the right to health care and free medical care provided in a guaranteed volume without charging a fee in accordance with the Program of State Guarantees of Free Provision of Medical Care to Citizens (hereinafter referred to as the Program), annually approved by the Government of the Russian Federation.
The main state sources of funding for the Program are funds from the compulsory health insurance system and budget funds.
On the basis of the Program, the constituent entities of the Russian Federation annually approve territorial programs of state guarantees for free provision of medical care (hereinafter referred to as territorial programs).
1. What types of medical care are provided to you for free
Within the framework of the Program, free of charge are provided:
1. Primary health care, including:
- primary pre-medical care, which is provided by feldshers, obstetricians and other medical workers with secondary medical education on an outpatient basis, in a day hospital;
- primary medical care, which is provided by general practitioners, district therapists, pediatricians, district pediatricians and general practitioners (family doctors);
primary specialized medical care, which is provided by specialist doctors.
2. Specialized medical care, which is provided in inpatient conditions and in a day hospital by specialist doctors, and includes the prevention, diagnosis and treatment of diseases and conditions, including during pregnancy, childbirth and the postpartum period, requiring the use of special methods and complex medical technologies.
3. High-tech medical care with the use of new complex and (or) unique methods of treatment, as well as resource-intensive methods of treatment with scientifically proven effectiveness, including cell technologies, robotic technology.
The list of types of high-tech medical care, including, among other things, methods of treatment and sources of financial support, you can find in the appendix to the Program.
4. Emergency medical care, which is provided by state and municipal medical organizations for diseases, accidents, injuries, poisoning and other conditions requiring urgent medical intervention. Medical evacuation is carried out if necessary.
To get rid of pain and alleviate other severe manifestations of the disease, in order to improve the quality of life of terminally ill patients, citizens are provided with palliative medical care on an outpatient and inpatient basis.
The above types of medical care include free of charge:
- medical rehabilitation;
- in vitro fertilization (IVF);
- various types of dialysis;
- chemotherapy for malignant diseases;
- preventive measures, including:
- preventive medical examinations, including children, working and non-working citizens studying in educational institutions on a full-time basis, in connection with physical education and sports;
- medical examination, including those staying in inpatient institutions for orphans and children in difficult life situations, as well as orphans and children left without parental care, including those adopted (adopted), taken under guardianship (guardianship) in the reception room or a foster family. Citizens undergo medical examination free of charge in a medical organization in which they receive primary health care. Most of the events within the framework of clinical examination are carried out 1 time in 3 years, with the exception of mammography for women aged 51 to 69 years and fecal occult blood tests for citizens from 49 to 73 years, which are carried out 1 time in 2 years;
dispensary observation of citizens suffering from socially significant diseases and diseases that pose a danger to others, as well as people suffering from chronic diseases, functional disorders, and other conditions.
In addition, the Program guarantees the following:
- prenatal (prenatal) diagnosis of developmental disorders of the child in pregnant women;
- neonatal screening for 5 hereditary and congenital diseases in newborns;
audiological screening in newborns and children of the first year of life.
Citizens are provided with medicines in accordance with the Program.
2. What are the time limits for waiting for you to receive medical attention?
Medical care is provided to citizens in three forms - planned, urgent and emergency.
The emergency form provides for the provision of medical care in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient's life.
At the same time, emergency medical assistance is provided by a medical organization and a medical worker to a citizen without delay and free of charge. Refusal to provide it is not allowed.
The emergency form provides for the provision of medical care in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient's life.
The planned form provides for the provision of medical care during preventive measures, for diseases and conditions that are not accompanied by a threat to the patient's life, do not require emergency and urgent medical care, and a delay in the provision of which for a certain time will not entail a deterioration of the patient's condition, a threat to his life and health ...
Depending on these forms, the Government of the Russian Federation sets maximum waiting times for medical assistance.
So, the waiting time for the provision of primary health care in an emergency should not exceed 2 hours from the moment the patient contacts a medical organization.
The waiting times for the provision of medical care in a planned form for:
- reception by district general practitioners, general practitioners (family doctors), district pediatricians should not exceed 24 hours from the moment the patient contacts a medical organization;
- consultations of specialist doctors should not exceed 14 calendar days from the date of the patient's appeal to a medical organization;
carrying out diagnostic instrumental (X-ray examinations, including mammography, functional diagnostics, ultrasound examinations) and laboratory examinations in the provision of primary health care should not exceed 14 calendar days from the date of appointment;
- performing computed tomography (including single-photon emission computed tomography), magnetic resonance imaging and angiography in the provision of primary health care should not exceed 30 calendar days, and for patients with cancer - 14 calendar days from the date of appointment;
specialized (with the exception of high-tech) medical care should not exceed 30 calendar days from the date the attending physician issued a referral for hospitalization, and for patients with cancer - 14 calendar days from the date of the diagnosis of the disease.
The time of arrival to the patient of the ambulance teams in the provision of emergency medical care in an emergency form should not exceed 20 minutes from the moment of its call. At the same time, in territorial programs, the travel time of ambulance teams can be reasonably adjusted taking into account transport accessibility, population density, as well as climatic and geographical features of the regions.
3. What you shouldn't pay for
In accordance with the legislation of the Russian Federation in the field of public health, when providing medical care within the framework of the Program and territorial programs, the following are not payable at the expense of citizens' personal funds:
- provision of medical services;
appointment and use in stationary conditions, in a day hospital, in the provision of medical care in an emergency and urgent form of drugs for medical indications:
a) included in the list of vital and essential medicines;
b) not included in the list of vital and essential medicines, in cases of their replacement due to individual intolerance, for health reasons;
- appointment and use of medical devices, blood components, medical nutrition, including specialized medical nutrition products for medical reasons;
- accommodation in small wards (boxes) of patients for medical and (or) epidemiological indications;
- for children under the age of four, the creation of conditions for stay in stationary conditions, including the provision of a bed and food, when one of the parents, another family member or other legal representative is in a medical organization, and for a child over the specified age - in the presence of medical indications ;
transport services accompanied by a medical worker of a patient who is being treated in an inpatient setting, if it is necessary to conduct diagnostic tests for him in the absence of the possibility of their being carried out by a medical organization providing medical care.
4. About paid medical services
In accordance with the legislation of the Russian Federation, citizens have the right to receive paid medical services provided at their request in the provision of medical care, and paid non-medical services (household, service, transport and other services) provided additionally in the provision of medical care.
At the same time, paid medical services can be provided in full scope of medical care, or at your request in the form of individual consultations or medical interventions.
Medical organizations participating in the implementation of the Program and territorial programs have the right to provide you with paid medical services:
- on other terms than stipulated by the Program, territorial programs and (or) targeted programs. You should familiarize yourself with the important for a citizen section of the Program and the territorial program - "The procedure and conditions for the provision of free medical care to citizens."
- when providing medical services anonymously, with the exception of cases provided for by the legislation of the Russian Federation;
- citizens of foreign states, stateless persons, with the exception of persons insured under compulsory health insurance, and citizens of the Russian Federation who do not reside permanently on its territory and who are not insured under compulsory health insurance, unless otherwise provided by international treaties of the Russian Federation;
when self-applying for medical services, with the exception of:
a) an independent appeal of a citizen to a medical organization chosen by him no more than once a year (with the exception of changing his place of residence or place of stay);
b) providing medical assistance in an emergency and urgent form when a citizen independently applies to a medical organization;
c) referrals for the provision of medical services by a local general practitioner, a district pediatrician, a general practitioner (family doctor), a specialist doctor, a paramedic, as well as the provision of primary specialized health care, specialized medical care in the direction of the attending physician;
d) other cases provided for by legislation in the field of health protection.
Refusal of a patient from the offered paid medical services cannot be the reason for a decrease in the types and volume of medical care provided to such a patient without charging a fee within the framework of the Program and territorial programs.
5. Where to go on emerging issues and in case of violation of your rights to free medical care
For free provision of medical care and in case of violation of citizens' rights to provide it, resolution of conflict situations, including refusals to provide medical care, collection of funds for its provision, you should contact:
- the administration of a medical organization - to the head of the department, the head of a medical organization;
- to the office of an insurance medical organization, including an insurance representative, in person or by phone, the number of which is indicated in the insurance policy;
the territorial body of health care management and the territorial body of Roszdravnadzor, the territorial fund of compulsory medical insurance;
- public councils (organizations) for the protection of patients' rights under the state authority of the constituent entity of the Russian Federation in the field of health protection and under the territorial body of Roszdravnadzor;
- professional non-profit medical and patient organizations;
federal authorities and organizations, including the Ministry of Health of the Russian Federation, the Federal Fund for Mandatory Medical Insurance, Roszdravnadzor, etc.
6. What you need to know about insurance representatives of health insurance companies
An insurance representative is an employee of an insurance medical organization who has undergone special training, represents your interests and provides your individual support in the provision of medical care as provided for by law.
- provides you with reference and advisory information, including on the right to choose (replace) and the procedure for choosing (replacing) an insurance medical organization, a medical organization and a doctor, as well as on the procedure for obtaining a compulsory health insurance policy;
- informs you about the need to undergo medical examination and asks about the results of its passage;
- advises you on the provision of medical care;
- informs about the conditions for the provision of medical care and the availability of free places for hospitalization in a planned manner;
- helps you to find a medical organization, including one that provides specialized medical care;
- controls the passage of your medical examination;
organizes the consideration of complaints of insured citizens about the quality and availability of medical care.
In addition, you can contact the office of an insurance medical organization to an insurance representative when:
- refusal to make an appointment with a specialist in the presence of a referral from the attending physician;
- violation of the deadlines for waiting for medical care in planned, urgent and emergency forms;
- refusal to provide free drugs, medical devices, medical nutrition - everything that is provided for by the Program;
- situations when you have been asked to pay for those medical services that your attending physician prescribed for medical reasons. If you have already paid for medical services, be sure to keep the cashier's receipt, sales receipts and contact the medical insurance organization, where they will help you establish the legality of the collection of funds, and in case of illegality, arrange for their reimbursement;
in other cases when you believe that your rights are being violated.