ОМС. Сроки оказания медицинской помощи

Медицинская помощь по системе ОМС. Куда жаловаться? 05.04.2018

ОМС Что надо знать пациенту?

- Что делать, если оказание помощи задерживается?

Медицинская помощь, оказываемая по системе ОМС, в обязательном порядке должна отвечать требованиям Федерального закона №323-ФЗ "Об основах охраны здоровья граждан в Российской Федерации", клиническим протоколам и медицинским стандартам, обязательным к применению в РФ, которые являются публичными, открытыми для общего ознакомления.

Каждый медицинским стандарт привязан к диагнозу и содержит сроки выполнения тех или иных лечебно-диагностических процедур. При явном завышении этих сроков, тем более если это привело к вреду здоровью, можно говорить о медицинских нарушениях.

 - Куда и на кого конкретно жаловаться?

Обжаловать нарушение сроков оказания медицинской помощи можно в страховую компанию, работающую по ОМС. Полисы страхования имеются (должны быть) у каждого гражданина.

 - Чего требовать?

Направляете в страховую компанию заявление с просьбой провести проверку качества и своевременности оказания Вам медицинской помощи в медицинской организации, работающей по системе ОМС. После получения от Вас указанного заявления страховщик проводит проверку медицинского учреждения по определенному алгоритму, куда обязательно включается такой параметр качества медицинской помощи как своевременность.

- Как заранее добиться соблюдения сроков?

Заранее добиться соблюдения сроков оказания медицинской помощи можно, во-первых, обратившись в страховую компанию с соответствующим вопросом в порядке консультации, во-вторых, в определенных ситуациях, требующих неотлагательного вмешательства можно привлечь специалиста (медицинского адвоката), практикующего по медицинским спорам.

- Советы 

Обращаясь за медицинской помощью, старайтесь держать с медиком определенную психологическую дистанцию, не панибратствуйте с врачом. Официальные отношения с медиком, оказывающим вам медицинскую помощь по системе ОМС часто несколько дисциплинирует медика, заставляет выполнять его хотя бы необходимый минимум действий, предписанных медицинскими стандартами и клиническими протоколами. Если перед Вами в лице медика - откровенный хам и вымогатель, - не идите у него на поводу, не отвечайте на провокации и в ответ не хамите и не оскорбляйте его, спокойно уйдите и постарайтесь попасть на прием к иному специалисту. Опять же, многое зависит от степени нуждаемости в медицинской помощи, неотложности ситуации.


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