With the declaration – an algorithm, without it – another. But help will be given to everyone
The second stage of medical reform, as planned, started on April 1, despite all the warnings related to the emergency. As of April 2, 1,640 specialized medical facilities have signed agreements with the NHA for the provision of medical services under the medical guarantees program, or more than 90% of the total, wrote Ukrinform. The majority of Ukrainians – 74.2% chose their family doctor by signing a declaration with him, while most of them have already visited their family doctor during this year and 79.9% were satisfied with the visit. Just before that, the SOCIS Center for Social Research and Marketing conducted a survey of citizens, finding that the number of opponents of medical reform had decreased considerably in Ukraine, from 45.7% in April 2019 to 33.3 % in March 2020.
Therefore, let us remember how it works now: in more detail about all the changes that await patients with the start of the second stage of medical reform and how the secondary link of Ukrainian medicine – medical institutions and specialists – is put implemented in this reform. Of course, the epidemic and quarantine in the country add to this issue of large-scale problems. But life does not end there and the need to be in good health only becomes more urgent.
The most pressing questions for all of us – with answers from experts from the NSZU.
Referral from family doctor is a basic requirement for free help
Recall that the medical guarantee program is a list and a volume of medical services and medicines which are guaranteed to the population and paid for from the state budget on the basis of uniform national tariffs. Consequently, from April 1, patients will be able to receive free ambulatory, hospitalized, emergency, palliative and rehabilitative medical care.
To receive free secondary or tertiary care, the patient must be referred by a family doctor or a specialist. The referral will be made in electronic form – and the doctor from any clinic that has signed an agreement with the NSZU will be able to see it in the database.
CAUTION: The patient must have an identity card with him.
It is this change that is most criticized by patients – they say, before it is possible to come immediately to a specialist, and now it is necessary to spend time in two stages – to a therapist and to a specialist .
The National Health Service explains that leadership is necessary to track and pay for state services to the patient. Therefore, again, it says the need to sign a declaration to those who have not yet done so. “When a patient concludes a statement, it appears in the system and we see it. And it is for his service that a certain doctor must transfer funds. We also see in the system what type of manipulation, operation, or consultation the doctor sent to the patient, ”said Tatyana Boyko, director of the NSZU Communications Department.
It will also help protect patients from their own diagnoses. The family doctor is specifically called and trained to determine the causes of the patient’s state of health.
How to act for a patient who has a declaration with a family doctor?
Algorithm for the patientwho needs the help of a specialist – a gastroenterologist, a cardiologist and others simple. Oksana Movchan, the head of the NSZU, said this at a press conference: “You are going to see your family doctor and, as recommended, the problem is either resolved immediately at the primary level or gives instructions to a level of specialized care. “
Andrei Vilensky, director of the contract work department at the INDH, adds: “THE CHOICE OF INSTITUTION AND THE DOCTOR WILL NOT DEPEND ON REGISTRATION.” When the patient receives a referral from the primary care doctor, he can choose a hospital where he can implement this referral. “
The same goes for referral by a specialist restricted to laboratory, functional and instrumental examinations (radiography, ultrasound, analyzes) or surgery – the patient will choose himself where he wishes to receive the service, and the NSZU will transfer funds for that. For example, a gastroenterologist will only prescribe a referral for an ultrasound or planned stomach operation, and the patient will choose the institution where to do it.
THROUGH THE PHYSICIAN’S DIRECTION, PATIENTS CAN OBTAIN Virtually ALL TYPES OF MEDICAL CARE, EXCEPT NOT CRITICALLY IMPORTANT – massage, physiotherapy, plastic surgery, elective dentistry (will only be paid in an emergency). The bottom line is that the institution is included in the secondary education reform, which can be checked on the NSZU website. Thus, the National Health Service hopes to solve the problem of paying for doctors’ services “out of their pocket”, because the patient will go to the appointment or the examination at the doctor in the same institution in which he trusts . According to the medical reform law, the ideal would be for the state to pay for almost all of the patient’s medical services, but as Ukrinform wrote earlier, this question remains open.
Cancer prevention services are also available for free
It is important that, in ambulatory care, PRIORITY SERVICES ACT – those that aim to treat conditions and diseases that affect the length and quality of life of people in Ukraine – for the most part costly examinations. A family doctor will also direct these examinations. And for the provision of these services, the NHA should pay the institutions at a higher rate, which will contribute to the modernization of material and technical equipment and improve the quality of medical care. We are talking about early cancer diagnosis because Ukraine ranks second in Europe in terms of the spread of cancer. These are hysteroscopy (endoscopic gynecological examination), esophagogastroduodenoscopy (examination of the mucous membrane of the esophagus, stomach and duodenum with an endoscope), colonoscopy, cystoscopy, bronchoscopy, mammography. According to WHO recommendations, such procedures should be performed for patients who are at an increased risk of developing neoplasms, and these are mainly people aged 40 to 50 years.
Hospital care: what to count on?
Routine hospital care for patients referred by a specialist should also be free. It is a surgical assistance, which includes surgical operations for adults and children in medical specialties: gynecology, combustiology (treatment of burns), neurosurgery, oncogynecology, oncology, oncotolaryngology, oncology, orthopedics and traumatology, oto-rhino -laryngology, ophthalmology, proctology, vascular transplantology surgery, urology, heart and large vessel surgery, maxillofacial surgery; medical care for patients with surgical (somatic) diseases in stationary conditions in the following areas: obstetrics and gynecology, allergology, gastroenterology, hematology, gynecology, pediatric dermatology, endocrinology, immunology, infectious diseases, cardiology, narcology, neurology , nephrology, pediatrics, pneumology, rheumatology, therapy, toxicology.
The only question is whether patients will have to buy additional drugs separately, as has often happened? In the NHA, it was previously explained that, although the prices for medical services do not include the cost of drugs and consumables, they are centralized by other state budget programs. Therefore, ideally, patients will receive free medical care and most related supplies and medications.
But for the moment, this question also remains open, because the prices of drugs have risen sharply, and the hospital budget was formed before that.
What to do without a reference?
If the patient wants to make an appointment with a narrow specialist himself, without a directive, he will have to pay for it out of his own pocket. However, with what rates will be in this case, hospitals are still being determined (hospitals do these calculations on the ground, not at the NSSU), as Ukrinform wrote about this in early March. Likewise, if a person expresses the desire to be treated in a hospital without the recommendation of a family or a treating physician, you will have to pay for this hospitalization.
IF THE PATIENT IS IN AN EMERGENCY CONDITION, THEN THEY CAN CALL MEDICAL EMERGENCY ASSISTANCE INDEPENDENTLY – WITH A DECLARATION OR NOT. “If the patient needs emergency medical care, he will receive the medical care that the hospital needs. This assistance will be free and the NSZU will pay for such a case, ”explains Andrei Vilensky.
Andrey Vilensky and the NSZU Contract Works Department
It is also important that RECEPTION OF SOME SPECIALISTS BE OFFERED WITHOUT DIRECTION – to the obstetrician-gynecologist, psychiatrist, narcologist, dentist, as well as the doctor with whom the patient is under medical supervision. But for this you need to have an identity card.
How will aid be organized during the coronavirus pandemic?
NSZU underlines: THE QUARANTINE IS NOT A REASON FOR NOT PASSING THE REVISIONS. At the same time, due to quarantine, only patients who need emergency and emergency care are hospitalized in hospitals. SCHEDULED HOSPITALIZATION POSTPONED UNTIL THE END OF THE QUARANTINE. Patients whose hospitalization is planned should consult their doctor by telephone to clarify their treatment regimen at home during this period.
All close specialist consultations are also coordinated by telephone and, depending on the patient’s condition, are postponed for a certain time to limit the flow of patients.
How to treat people with coronavirus
In this case, a separate action algorithm is defined:
- Stay at home.
- Call your doctor.
- Describe your doctor’s symptoms, your travel history. Separately, you must say whether you have been in contact with people who may be infected (for example, when returning from countries where the virus has spread).
- Follow your doctor’s instructions.
- In an emergency – a temperature above 38 ° C that does not get lost and shortness of breath – win 103.
REMEMBER: MOST RESPIRATORY ILLNESSES HAVE SIMILAR SYMPTOMS
Reasons for suspicion of COVID-19:
- difficult breathing;
- in the past 14 days, you were in the country where COVID-19 was registered;
- contact with a person infected with a coronavirus.
If you have symptoms of COVID-19, DO NOT:
- immediately consult your doctor or the nearest hospital.
- make your own decision and have tests for COVID-19. First, the decision as to whether tests are needed is made by your family doctor or therapist. Second, in laboratories and hospitals, the risk of actually getting the virus increases if an infected person is nearby.
- get a coronavirus test for someone with common SARS.
The first thing to do is to call the doctor with whom the report is made. IF YOU DO NOT HAVE A CONCLUDED DECLARATION, CALL THE CORONAVIRUS SUPPORT LINE IN YOUR REGION OR THE MINISTRY OF HOT HEALTH 0-800-505-201 OR THE PUBLIC HEALTH CENTER 42 You can also call 42 54 +5 by the number 1545. Another action algorithm will be given to you by your doctor or the contact center operator that you called.
Also, write down and place to find the fastest phone numbers:
- the registration number of the primary care center where you selected your doctor;
- the mobile number of your family doctor or therapist;
- in each region, there is a 24-hour hotline for coronavirus infections. Find and record this number. BE CAREFUL THAT YOUR PARENTS, GRANDS, GRANDGIRLS AND OTHER ELDERLY PERSONS ALSO HAVE THESE TELEPHONES Numbers for which they can ask for advice and help.
To treat patients with COVID-19, the NSZU prepares a separate set of medical services. As a result, institutions will be able to receive funding from the NHA for the care of patients infected with coronavirus. The first wave hospitals, which are designated for the hospitalization of patients with COVID-109, will mainly conclude this contract. In the near future, the NHA will approve the rates for which medical care will be paid for these patients, and the facility will be informed by a separate message of the date on which it will be possible to request this medical care package.
Julia Gorban, Kiev
According to the materials: ukrinform.ru