How Can An Insurance Representative Of The CHI System Be Useful To Chronic Patients?

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How Can An Insurance Representative Of The CHI System Be Useful To Chronic Patients?
How Can An Insurance Representative Of The CHI System Be Useful To Chronic Patients?

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How can an insurance representative of the CHI system be useful to chronic patients?

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?

How can an insurance representative of the CHI system be useful to chronic patients?
How can an insurance representative of the CHI system be useful to chronic patients?

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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 spoke about the project "Clinical examination 2019", about the Top-100 free medical services, for which they may unlawfully demand payment by medical institutions operating in the compulsory medical insurance system, as well as about the most common violations of patients' rights. Today we will talk about how insurance representatives (SP) can help chronic patients.

Dispensary observation is a planned examination of persons suffering from chronic diseases, functional disorders and other conditions, carried out at a certain frequency. The purpose of dispensary observation is the timely detection and prevention of complications, exacerbations of diseases, other conditions, their prevention and medical rehabilitation of these persons.

Who is subject to dispensary observation

In accordance with the Order of the Ministry of Health of the Russian Federation of March 29, 2019 No. 173n "On approval of the procedure for conducting dispensary observation of adults", these are:

persons suffering from certain chronic diseases;

  • persons with a high risk of developing the above diseases;
  • persons who are in the recovery period after suffering acute diseases, including injuries and poisoning.
  • How SP should work with chronic patients

    An insurance representative advises on the provision of free medical care for compulsory health insurance;

    • helps to restore the violated right to receive affordable and high-quality medical care;
    • provides information support in the provision of medical care to patients with chronic diseases.
    • Chronic Patient Routing

      SP analyzes the results of clinical examinations and identifies those who are subject to further dispensary observation and further treatment. The joint venture reminds the insured about the need to undergo medical examination and dispensary observation by sending SMS messages, messages in messengers, e-mails, and also making phone calls. If the insured does not undergo the necessary examinations, the joint venture reminds him of this again.

      Consulting

      If the patient has additional questions, the JV can call the health insurance organization's hotline.

      When contacting, the SP will inform the patient:

      about the possibility of receiving medical care under the territorial compulsory medical insurance program for the profile of a chronic disease;

      • the importance of adhering to the terms of the prescribed examination and treatment;
      • the importance of fulfilling the dispensary observation program;
      • about possible health consequences in case of refusal of treatment.
      • Expertise

        The joint venture of the 3rd level organizes and conducts an examination aimed at identifying violations in the provision of medical care. This is necessary to protect the rights and interests of the insured person, as well as to further manage the availability and quality of medical care.

        Interview

        The joint venture is conducting a survey on satisfaction with the preventive measures taken. This is necessary to protect the rights and interests of the insured person, as well as to manage the quality of services provided by medical organizations.

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