The main character, on whose shoulders the rational routing of patients, is a district general practitioner or therapist
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The more difficult the economic situation, the more in demand free medical care under the CHI policy becomes, experts say. The flow of patients in commercial clinics is now thinning, while in the “districts”, on the contrary, it is growing. How is the system of “distribution” to doctors of different profiles arranged today? How long to wait for an appointment, examinations and tests? We discussed the most frequent questions with experts on compulsory health insurance of the All-Russian Union of Insurers (VSS).
ABOUT THE RIGHT CHOICE OF A DOCTOR
It happens that the patient knows exactly who he needs: if a tooth hurts, he must run to the dentist. And it happens that you don’t really understand: it grabs here and there. Whom should I contact if, for example, my joints hurt or I have a cough? Not everyone knows.
“Therefore, the main character, on whose shoulders the rational routing of patients, is a local general practitioner or therapist (for children – a pediatrician), – says an expert on compulsory medical insurance, vice president of the All-Russian Union of Insurers Dmitry Kuznetsov. – Such a doctor collects and evaluates complaints, anamnesis, conducts an examination and some types of physical examinations: measuring pressure, pulse, etc. And decides: to which narrow specialist to refer the patient.
– But besides, you can sign up directly with a dentist under the CHI policy. And, for example, to the allergist – only through the local therapist. Are there lists of doctors to whom we can go immediately and to whom in the direction of the district police officer?
– At the federal level, this issue is not regulated. That is, there are no uniform rules for the whole country. Regional authorities regulate routing within the framework of the legislation in their territory. In Moscow, for example, today the issue is resolved as follows:
* directly the patient has the right to contact a dentist-therapist or a dental surgeon, an ophthalmologist, an ENT specialist, a urologist, an obstetrician-gynecologist, a surgeon;
* to get to doctors of any other profiles under the CHI policy, you need a referral from a general practitioner / therapist / pediatrician.
In different regions of our country, the lists may differ, but, as a rule, insignificantly, Dmitry Kuznetsov explains. For up-to-date information about the rules in your area, you can call the call center of the health insurance organization that issued your CHI policy.
DO I NEED TO MAKE A REFERENCE
– Dmitry Yuryevich, it turns out that an appointment with such popular doctors as a neurologist, endocrinologist, cardiologist, allergist-immunologist, gastroenterologist requires a referral from a therapist. Do you need to get a special certificate, go to the registry office for stamps?
– If the specialist doctors to whom the therapist refers you work in the same clinic as he himself, then no additional registrations are needed. It is enough to record the therapist in your medical record (including electronic). If you need a doctor’s appointment at another medical organization (polyclinic, hospital), and not the one to which you are attached, then you will need a referral in the form No. 057 / y-04. It must be certified by the seal of the medical institution and the signature of the official. And it is imperative that the purpose of the referral is indicated – for example, for making a diagnosis or choosing a treatment strategy.
– And how to get to a psychiatrist? After all, there are no such specialists in district clinics. And now, due to the wave of anxiety disorders and depression, psychiatric help is especially in demand.
– To make an appointment with a psychiatrist, the patient can apply to the registry of the nearest psycho-neurological dispensary with a passport. A referral from a physician is not required for this. Keep in mind: the provision of psychiatric care in most subjects of the Russian Federation is paid for at the expense of regional budgets. And only in a minimal part – it is financed within the framework of compulsory medical insurance. You need to be prepared for the fact that assistance in this profile may be included in the list of paid medical services.
STAY IN TOUCH
In what terms should you be admitted, examined, provided with medical assistance
As experts of the ARIA explain, today the legislation defines the deadlines for the provision of medical care of one kind or another. Namely:
– outpatient care in an emergency form – the wait should not exceed 2 hours from the moment the patient contacts the medical facility. We are talking about sudden acute diseases and conditions, exacerbation of chronic diseases without obvious signs of a threat to life;
– reception of a local therapist or pediatrician, general practitioner – no later than 24 hours from the moment the patient applied;
– receptions of medical specialists (cardiologist, neurologist, endocrinologist, etc.) – no later than 14 working days.
– instrumental (X-ray, mammography, ultrasound, etc.) and laboratory tests (blood, urine, etc.) – no later than 14 working days from the date of appointment of the studies;
– computed tomography, magnetic resonance imaging, angiography – no later than 14 working days from the date of appointment of studies.
Important: for patients with suspected oncological diseases, special terms are established:
– waiting for an appointment with an oncologist – no more than 3 working days;
– diagnostic instrumental and laboratory studies – no more than 7 working days from the date of appointment of the studies.
BY THE WAY
Not only through the registry
Now patients have several ways to make an appointment with a doctor:
– in the polyclinic itself: through the registry or infomats;
– through the State Services portal/mos.ru;
– through mobile applications of regional health authorities (EMIAS.INFO, State Services, My Moscow).
THIS WILL BE USEFUL
Where to get help if you have questions or problems
“Waiting too long for examinations and appointments with narrowly specialized doctors is one of the most common problems that CHI patients face when contacting a polyclinic,” says the Vice President of the ARIA Dmitry Kuznetsov. – More than 40% of patients report such disorders.
If you are faced with a similar situation, the All-Russian Union of Insurers recommends contacting your insurance company that issued the CHI policy, bypassing other authorities and institutions – in person or by phone, which is indicated in your insurance policy. As part of their competence to protect the rights of the insured in the field of compulsory medical insurance, insurers, as a rule, solve most of these problems as soon as possible.