The policyholder's guide. All about patients' rights

The National Health Insurance House has published the Policyholder's Guide, 2nd edition. The release of the document is the first step of a public information campaign about patients' rights and obligations, which will take place over the coming months

Many Romanian patients do not know their rights. Photo source: archive

Any patient in Romania, insured or uninsured, should know their rights and obligations, should know which services they can benefit from free of charge or compensated. The guide released the other day aims to do just that: to shed light on the wealth of information, many of which are misunderstood, others – totally unknown.

What medical services do the family doctor and the specialist provide

Who has ever wondered what a family doctor does besides release networks and referrals… here is some information: in the family doctor's office, the patient is consulted, receives a diagnosis and a treatment plan. We are basically talking about those diagnostic and therapeutic medical services which include: spirometry, blood pressure measurement, ankle-brachial pressure index, performing and interpreting the electrocardiogram, etc. Also here, patients are given vaccines, injections, intravenous infusions. In the family doctor's office, the patient also undergoes minor surgical interventions. Other services include: treating injuries, immobilizing sprains, collecting samples for the Babeș-Papanicolau test, etc. The family doctor offers consultations at home, but can also issue certain medical documents: certificates, notices, medical leaves, etc.

At the family doctor, patients benefit from three annual prevention packages. The 40+ annual prevention package is intended for healthy people and involves three consultations per year. The 40-60 annual prevention package is intended for chronic patients and involves two consultations per year. As well as the 60+ annual prevention package.

Also in the family doctor's office, the patient will also receive a set of laboratory tests for the prevention of anemia, rickets in children, tests for women planning a pregnancy, for sexually transmitted diseases, for the prevention of metabolic syndrome, etc.

The family doctor gives the patient a referral to a specialist, in case of need. Once in his book, the patient benefits from curative medical services for acute conditions, consultations for chronic diseases, consultations for the provision of family planning services, palliative care services, diagnostic and therapeutic services, etc.

And uninsured people have the right to free medical assistance provided by the specialist doctor.

They can benefit free of charge for medical emergencies, services for the surveillance and detection of diseases with endemic-epidemic potential, as well as consultations for monitoring the evolution of pregnancy and childbirth. Uninsured patients do not need a referral from their family doctor, but will bear the full costs of laboratory tests and imaging investigations, as well as the cost of treatment.

About laboratory tests and hospitalization

In order to benefit from free laboratory tests and imaging investigations, patients must be insured, have a referral from their family doctor or a specialist doctor under contract with CAS, go to a laboratory that has a contract with CAS . Insureds can benefit from hematological, serum, urine, immunological, microbiological analyses, examination of sampled tissues, Babeș-Papanicolau test. Radiology investigations, as well as ultrasounds, Doppler and high-performance investigations are also settled. The referral ticket for laboratory investigations is valid for 30 days.

Hospital services

Hospital services are provided for illnesses that require hospitalization and include: investigations, diagnosis, treatment, care, recovery, accommodation and meals. Inpatient medical services are granted, according to the schedule, on the basis of the referral ticket issued by the family doctor or the outpatient specialist. The referral ticket is not necessary in case of medical emergency, childbirth, chemotherapy, radiotherapy, diseases with endemic-epidemic potential that require isolation and treatment.

Uninsured persons benefit from hospital services until the emergency is resolved, in the case of medical-surgical emergencies in which the patient's life is endangered or have this potential, respectively until the case is completely resolved, for diseases with endemic-epidemic potential. What happens when an insured person, even though he is hospitalized, has to pay for the medicine out of his own money? The hospital is obliged to reimburse the patient the value of these expenses at the request of the insured. Public hospitals implement a methodology

on the basis of which it reimburses these expenses, which is made available to the Health Insurance Company and is brought to the attention of patients when they are admitted to the hospital.

How the pills are released

Compensated medicines can be prescribed by the family doctor and the specialist doctor under contract with a Health Insurance Company. The periods for which the drugs can be prescribed are a maximum of 7 days in acute conditions, up to 8-10 days in subacute conditions and up to 30-31 days for patients with chronic conditions. Medical prescriptions for chronic diseases, as well as those for vaccines, are valid for a maximum of 30 days from the date of issue, and for acute and subacute conditions, they are valid for a maximum of 48 hours.