Порядок и правила получения социальной помощи по программе квоты на лечение онкологии в 2021 году
Правительством Российской Федерации осуществляется социальная поддержка населения в сфере медицинского обслуживания. Льготы распространяются на покупку лекарственных препаратов, посещение специалистов больницы без очереди, а также прохождение лечения со скидкой или полностью бесплатно. Среди общего ассортимента привилегий – квота на лечение онкологии.
Законодательное регулирование вопроса
Содержание
Все виды предоставляемой медицинской помощи можно условно разделить на несколько групп:
- поддержка льготных категорий населения (к ним относятся: малообеспеченная семья, многодетные, инвалиды, пенсионеры);
- привилегии для детей;
- преференции всему населению при реализации дорогостоящего медицинского обслуживания;
- социальная помощь при необходимости использования высокотехнических медицинских препаратов и аппаратуры.
В зависимости от того, кто инициирует помощь, а также, какое ее целевое использование, будет зависеть объем оформляемых преференций.
Таблица № 1 «Правовое регулирование вопроса»
Это общефедеральные привилегии, которые компенсируются государственным бюджетом, поэтому власти регионов не имеют полномочий на формирование локальных особенностей получения поддержки. Поддержка предоставляется в порядке очередности, единой для всей территории Российской Федерации.
Что такое квота и кому она положена
Квота – это ограниченное количество мест чего-либо. В данном случае – это численность пациентов, которые могут претендовать на безвозмездное оказание медицинской помощи со стороны государства. Процедура квотирования предусматривает такие понятия и условия:
- льготные места распределяются отдельно по каждой группе заболеваний;
- установлено граничное число мест, которые могут быть предоставлены пациентам за один календарный год;
- отсутствует распределение по регионам, то есть очередь – общефедеральная;
- может быть установлена максимальная стоимость услуг, чтобы была произведена полная или частичная компенсация за лечение из бюджета;
- фиксируется список медицинских учреждений, которые в рамках своей лицензии могут осуществлять разные виды медицинской помощи.
В последние года наблюдается рост численности онкологических заболеваний. И, учитывая дорогую стоимость лекарств и процедур, было принято решение добавить рак в список недугов, частично компенсируемых из госбюджета.
Важно! Претендовать на получение преференций могут все граждане, у которых выявлено злокачественные опухолевые образования. Не учитывается стадия, тяжесть и срок заболевания.
С чего начать
Что характерно для этого вида привилегий, квоты распределяются между разными больницами. Если по окончанию календарного года, претендент не смог получить помощь, предстоит узнать, остались ли свободные места в других клиниках. Сделать это можно на официальном сайте Департамента здравоохранения.
Но начинать процедуру нужно не с этого. Претенденту придется пройти следующий алгоритм действий:
- обращение к лечащему врачу, который должен подготовить выписку из медицинских записей больного, подтверждающих наличие заболевания, его тяжесть и список проведенных исследований и процедур с результатами;
- первичный осмотр у онколога – это факультативная стадия (если выписка врача содержит полную информацию, то можно избежать повторного осмотра).
Необходимые документы
Следующий шаг – это сбор обязательных документов. Справка врача – одна из основных бумаг, но также обязательно подготовить оригиналы и копии таких документов:
- собственноручное заявление (законодателем не утверждена единая форма документа, но установлен список вопросов, которые обязательно должны отображаться в документе);
- личный паспорт;
- страховой полис;
- подтверждение льготного статуса, например, удостоверение многодетной семьи, инвалида детства, пенсионное;
- заявление, позволяющее обработку персональных сведений лица.
Если же предоставление помощи оформляется в пользу несовершеннолетнего лица, то заявление от его имени пишет один из родителей или опекун. Также дополнительно нужно подготовить свидетельство о рождении ребенка и копии гражданских паспортов родителей.
Образец талона на оказание высокотехнологичной медицинской помощи
Образец заявления о направлении на высокотехнологичное лечение.
Куда обращаться
Дальнейшие действия зависят от содержания полиса обязательного медицинского страхования. Так, если ОМС включает список услуг, получить которые пациент желает в рамках бесплатного квотирования, то допускается обращение напрямую в медицинское учреждение. Самостоятельно передавать бумаги не придется. Это может сделать лечащий врач или доктор-онколог, осуществляющий присмотр за больным.
Граничный срок передачи бумаг в клинику – трое суток. По истечении этого времени в базе медицинского учреждения формируется комиссия, которая принимает решение касательно целесообразности оказания помощи претенденту. При удовлетворительном решении гражданин получает талон с присвоенным порядковым номером в очереди.
Второй вариант – это обращение в локальное отделение здравоохранения региона, что сделать можно только по месту прописки. Такой шаг обязателен, если ОМС не покрывает затрат ВМП. Срок принятия решения по заявлению здесь несколько больше и может достигать десяти суток. По истечению которых также выдается талон участника очереди.
Что делать, если не дают направление
Алгоритм действий будет зависеть от того, кем было отказано в предоставлении льгот. Если лечащий врач не принял заявление, то гражданин может самостоятельно ознакомиться со списком поликлиник с лицензией на конкретные услуги и подать документы туда напрямую. При себе нужно иметь тот же пакет бумаг, что и при передаче через лечащего доктора.
Второй вариант – когда региональный отдел ВМП выдает официальное уведомление об отказе в предоставлении преференций. Это может быть связано с разными причинами. Если у пациента есть возможность исправить обстоятельства отказа, то после исправления неточностей, он вправе снова инициировать выплаты. Если же таковых нет, то допускается обращение в Министерство Здравоохранения России.
Срок получения квоты
Как уже отмечалось выше, предоставление сервисов ВМП онокобольным происходит в порядке очереди и не нужно рассчитывать на то, что преференции будут предоставлены сразу же после подачи заявления. После принятия документов от претендента у органов власти есть одна неделя, чтобы внести сведения о гражданине в общую базу и предоставить ему талон с номером. С этого момента срок реализации программы не ограничен.
Срочность оказания помощи зависит от того, есть ли свободные места для помещения в больницу пациента. Бывают случаи, что по истечению календарного года льготнику так и не была предоставлена квота на операцию.
Если же подошла очередь лица на получение преференций, то в течение одной недели он должен быть госпитализирован в больницу для получения медицинской помощи. Затягивание этого срока не допускается.
Перед началом инициации привилегий нужно понимать, что квотирование не гарантирует, что все препараты и услуги будут оказываться полностью бесплатно. Постановлением Правительства зафиксирован список сервисов с безвозмездным доступом, установлены скидки на отдельные процедуры, а также предусмотрена та поддержка, которая оплачивается гражданином самостоятельно.
Согласно статистическим сведениям, более 73% онкобольных ежегодно получают помощь в порядке предоставления квоты на лечение. Это большая цифра, учитывая, что помощь оказывается по всей территории России. И, даже, если в 2021 году пациент не успеет пройти льготное лечение, он сможет претендовать на выплаты в следующем календарном году.
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