Insured persons can benefit from services of prevention, detection, confirmation and monitoring of serious diseases, settled by the social health insurance system, announces the National Health Insurance House. However, in order to benefit from preventive services, an insured person must follow several steps.
Oncological patients, directed to the specialist doctor. Source: archive
The protocol in case of a hidden disease
Schedule and attend a preventive consultation with the family doctor. Prevention consultations for insured persons are granted by age group, being settled by the health insurance company as follows:
- upon discharge from the maternity ward and at 1,2,4,6,9,12,15,18,24,36 months for children aged between 0 and 3 years;
- once a year, for people aged between 4 and 18;
- two consultations per year for people aged 18 to 39;
- up to 3 consultations per year for people over 40 who are not in the family doctor’s records with other chronic conditions;
- up to 2 consultations per year for people over 40 who are in the family doctor’s records with chronic conditions.
The family doctor will assess the risk that the patient has a hidden disease without symptoms. Depending on the assessment, he can decide to send the patient for free preventive medical tests and will give him a referral ticket (dedicated form, marked with PREV 1….7).
The family doctor will also interpret the results of the tests, during a new prevention consultation, and on this basis will decide whether the patient should be sent to a specialist doctor on an outpatient basis or to the hospital, for the diagnosis or confirmation of a serious illness and for establishing the appropriate treatment . The family doctor will also advise the patient in order to reduce the health risk factors in his life (smoking, alcohol consumption, unhealthy diet, stress, etc.).
The protocol in case of detection of a chronic disease
The family doctor can send the patient to carry out medical tests to detect certain diseases and if, during a consultation for therapeutic purposes, he suspects that in addition to the condition for which the patient came to the consultation, there could also be such a hidden disease .
If the patient has been diagnosed with a chronic disease, he benefits from free periodic monthly consultations with the family doctor for monitoring the evolution of the disease, continuity of therapy, screening for complications, education regarding care and self-care, etc. If the family doctor, following the assessment of the risk of developing other conditions, finds that the respective patients have certain symptoms or test results outside the normal values, they can also provide active monitoring consultations (case management) for chronic diseases with a major impact ( high cardiovascular risk – hypertension, dyslipidemia and type 2 diabetes; bronchial asthma, chronic obstructive pulmonary disease – COPD and chronic kidney disease).
At the same time, in the case of exacerbation of chronic conditions or the presence of any symptoms whose provenance must be clarified, patients present themselves to the family doctor who, following the evaluation, determines the therapeutic conduct. For any acute/subacute condition/exacerbation of a chronic disease, the health insurance company bills family doctors for two more consultations for each episode of illness, in addition to the previously mentioned periodic consultations. Following consultations, the family doctor can issue referral tickets (including for paraclinical medical investigations) or other documents.
The protocol in case of detection of an oncological disease
If at any consultation the family doctor suspects that the patient has a form of cancer (oncological disease), in order to confirm or refute the suspicion, he will be able to refer him, as the case may be:
- to carry out free medical tests, x-rays, ultrasounds, the results of which will then be integrated by the family doctor;
- to be consulted on an outpatient basis by a specialist doctor;
- to be hospitalized in a day or continuous hospitalization regime.
Referral tickets for suspected oncological cases will be marked with the initials SO. On the basis of the referral ticket, the specialist doctor in the outpatient clinic will be able to give the insured patient consultations for the detection of oncological conditions (a maximum of 3 consultations per insured person is settled, in an interval of a maximum of 60 calendar days from the date of the first consultation, presentation to a the second and third consultations are done directly, without another referral ticket). Also, the specialist doctor will be able to perform diagnostic procedures and medical services for diagnostic purposes – case. If necessary, the specialist doctor will be able to issue referral tickets (marked SO) to the patient, for:
- another specialist doctor;
- laboratory analyses, x-rays, ultrasounds, high-performance investigations;
- day or continuous hospitalization.
On the basis of the referral ticket from the family doctor or from the outpatient specialist marked SO, in day hospitalization the following will be performed: the diagnosis of the oncological condition, the evaluation of the tumor extension, the evaluation of the clinical-biological status of the patient with the oncological condition. It is recommended that these services be performed within a maximum of 28 days from the opening of the first day hospitalization sheet. Also in the hospital, medical services can be performed for the purpose of case diagnosis for the early detection of cervical cancer and breast cancer.
After confirming the diagnosis of oncological disease, the insured patient will be able to be included in the National Oncology Program. Insured persons can also benefit from home care medical services, recovery treatments both in outpatients and sanatoriums, unassisted medical transport services, compensated medicines, medical devices, etc.
