Terms Of Provision Of Oncological Medical Care - 2019. Control Over Its Quality And Availability

2023 Author: Abraham Higgins | [email protected]. Last modified: 2023-11-27 23:16

Terms of provision of oncological medical care - 2019. Control over its quality and availability

The All-Russian Union of Insurers continues to acquaint citizens with new rights and opportunities for patients. What does the CHI system offer to patients today? When are patients' rights most often violated? How do health insurance and patient organizations protect patients' rights? Why should patients be aware of their rights and be able to exercise them?

Photo: tomsk.gov.ru /

The All-Russian Union of Insurers (ARIA) continues to acquaint citizens with the new rights and opportunities of patients. What does the CHI system offer to patients today? Who are insurance representatives and how do they work? How is the prophylactic medical examination of the population and what is dispensary observation? When are patients' rights most often violated? How do health insurance and patient organizations protect patients' rights? Why should patients be aware of their rights and be able to exercise them?

In previous materials from the conference held by ARIA for journalists, Mednovosti talked about the "Clinical examination 2019", about the Top-100 free medical services for which they may unlawfully demand payment in medical institutions operating in the compulsory medical insurance system, about the most common violations of patients' rights. And also about how the insurance representative of the CHI system can be useful for chronic patients. Today we will talk about the deadlines for the provision of cancer care and its quality control.

Deadlines

The timing of the provision of oncological care is determined by the Decree of the Government of the Russian Federation of December 10, 2018 N 1506 "On the Program of state guarantees of free provision of medical care to citizens for 2019 and for the planning period of 2020 and 2021".

Within 5 working days from the date of diagnosis or suspicion

a general practitioner, pediatrician or general practitioner must write a referral and arrange for the patient to be seen by an oncologist

Within 1 business day from the date of reception

the oncologist must ensure that a biopsy is taken. If this is not possible, immediately refer the patient to another medical organization

Within 15 working days from the date of receipt of the biopsy material

an expert opinion must be given

Within 15 calendar days from the date of establishment of the preliminary diagnosis

the patient should be hospitalized in a specialized medical organization to confirm the diagnosis

Or within 10 calendar days if the diagnosis is confirmed

the patient should be hospitalized in a specialized medical organization

Documents required for the initial examination by a general practitioner, pediatrician or general practitioner:

compulsory medical insurance policy

• identity document: passport; birth certificate and passport of one of the parents or legal representative - for children under 14 years old

All oncological care in the amount stipulated by the Program of state guarantees of free medical care to citizens is provided free of charge. If you have any questions related to the provision of oncological care, you must contact the administration of the medical organization or the insurance representative of the medical insurance organization that issued you the compulsory medical insurance policy.

Accompaniment of patients with cancer by insurance representatives

Since January 2019, level III insurance representatives have been monitoring the quality of medical care provided to patients with malignant neoplasms. The new functionality of representatives of medical insurance organizations (CMO) was introduced as part of the implementation of the federal project "Fight against cancer", the national project "Health".

The new functions of medical insurance organizations include monitoring the availability and quality of medical care, as well as the selection of such cases for conducting examinations of the quality of medical care, medical and economic examinations. Among these features:

Monitoring the timeliness of medical care from the moment of suspicion and diagnosis of a malignant neoplasm to the moment of providing specialized, including high-tech, medical care, as well as during dispensary observation, and in cases of exacerbation of cancer;

• Monitoring the compliance of the stage of oncological disease with the method of treatment chosen by the medical organization;
• Monitoring the degree of achievement of the planned result during chemotherapy;
• Informational support of insured persons with oncological diseases.

Insurance medical organizations form a personalized "History of patient requests for medical help" in case of suspicion of a malignant neoplasm or with an established oncological disease. In an automated mode, a selection of insured events is carried out to control the volumes, terms, quality and conditions of the provided medical care under compulsory health insurance. Based on its results, an insurance representative of the III level will organize and / or conduct a medical and economic examination or examination of the quality of medical care.