One month after the announcement of the Minister of Health, Alexandru Rogobete, regarding the elimination of the referral ticket for chronic patients included in national programs, reality in hospitals and outpatients shows that the application of regulations remains a challenge.
Some doctors are still asking for FREEPIK photo referral ticket
The promise of a real debirocratization was enthusiastically received by family doctors. Dr. Daciana Toma, a family doctor and SNMF vice -president, explains that implementation is still a challenge.
In an interview for medical training, the doctor explains what direct access to specialists means and what bureaucratic obstacles continue to affect patients.
Removal of the referral ticket: What provides the law
In his announcement, the Minister Rogobete promised “the debirocratization and facilitating the access of patients to essential medical services”, stressing that chronic patients can go directly to the specialized doctor without referring to the family doctor.
“Debirocratization and facilitate the access of patients to essential medical services is a clear priority for us. We have committed to people that we will reduce the unnecessary barriers in the system and that we will build a simpler, faster and faster medical route. We come with a concrete step in this direction. Together with the president of the National House of Health Insurance, Mr. Horațiu Moldovan, we signed a common order that eliminates the obligation of the referral ticket for patients with chronic conditions that are enrolled in certain national health programs. It is a measure that will reduce waiting times, will simplify access to treatments and help patients get faster of the care they need“Alexandru Rogobete said.
The examples provided are the following:
Diabetes, nutrition and metabolic diseases – to the specialized doctors designated in the national program for prescribing specific treatments and materials.
Hemophilia and talasemia – to the hematologist designated for prescribing treatments within the national program.
Rare diseases – in specialists in various fields (allergology, cardiology, endocrinology, gastroenterology, neurology, oncology, pneumology and others) for prescribing the treatments dedicated to these rare pathologies.
Tuberculosis – to the pneumologist for patients enrolled in the National Tuberculosis Control Program.
HIV/AIDS – to the infectious doctor for patients enrolled in the National Program for the Prevention and Control of HIV/AIDS infection.
The health of the woman and the child – to specialized doctors in obstetrics-gynecology and medical genetics, for pre- and postnatal diagnosis, but also for the prevention of Rh isoimmunization syndrome, the minister emphasized that the measure will reduce waiting times, simplify access to treatments and support the continuity of care.
How things are in practice
However, Dr. Daciana Toma explains that the regulations exist, but are not always applied.
“I do not know if I tell him an initiative or if it is initiative by the fact that it is insisted on a procedure that should have already exist and be implemented altogether. It is something that was provided by Annex 13 to the framework contract, the fact that for certain pathologies there is direct address in the specialized ambulatory.”says the Vice President SNMF.
The specialist draws attention to the discrepancy between regulations and daily practice.
“In vain we have regulations if we do not apply them. If these regulations do not apply to the new upper structures (family doctors), if the doctors in the specialized ambulatory or the hospital do not accept that they need to receive the patient without a referral ticket, then the measure only remains on paper.”
There are situations where, although the patient has the legal right of direct access, the doctors continue to request the referral ticket, either annually or a few months, for fear of CNAS controls.
“There were situations in which I asked: But why do you ask for a ticket for referral? Because he is afraid of the CNAS controls. Our fear, of all those who work in the system, especially if we work with the house, it is so great that it is preferred to violate some regulations in force, only to cover us at a possible control.”said the doctor.
Dr. Daciana Toma: “Patients need to learn what their rights are
The correct implementation of the measure would bring concrete benefits: fewer roads, time earned, continuity in treatment and reduction of stress.
Dr. Toma, however, emphasizes that patients need to know their rights.
“After all, I believe that patients have to learn what their rights are and fight for these rights. For nothing, a family doctor, I tell him: you have the right to go without a referral ticket, if the patient comes and tells me:” My referral ticket did not give me. “, emphasizes the specialist.
Doctors, in turn, are caught between the desire to respect the law and fear of controls. Dr. Toma recommends that each specialist comply with the regulations and receive the patient without a referral ticket where the law allows it, and the patients are informed about their rights.
The measure of removing the referral ticket for chronic patients exists at the legislative level and should facilitate quick access to treatment, but without the consistent application of regulations, simplifying the medical route risks only a declarative intention.
“The problem is whether the doctors in the respective specialties will accept, apply or not,” concluded Daciana Toma.
