22 December 2021 14:18

Citizens will be able to apply to any state health facility for specialized outpatient care, without a referral

In order to increase the accessibility of medical services for the insured, protect the health of the population, ensure early detection of diseases and prevent complications, as well as to ensure citizen satisfaction, changes have been made to the "Rules of issuing referrals for provision of specialized medical services".

According to the amendment made by the relevant decision of the Board of the State Agency on Mandatory Health Insurance (Agency), insured citizens are now able to apply for specialized outpatient care (medical examination by a qualified doctor - cardiologist, urologist, ophthalmologist, endocrinologist, etc.) at any state medical facility supervised by the Administration of Regional Medical Divisions (TABIB) without a referral. These medical facilities include regional / city central hospitals, treatment & diagnostic centers, united city hospitals, united children's hospitals, city clinical hospitals, anti-tuberculosis health facilities, as well as the Clinical Medical Center, the Republican Clinical Hospital named after Academician M.A. Mirgasimov, the Scientific Surgery Center named after M.A. Topchubashov, the Scientific-Research Institute of Obstetrics and Gynecology, etc.

Insured citizens will be able to apply to any medical facility supervised by TABIB for specialized outpatient care in the area of residence, as well as in other cities (including Baku) and regions, without a referral, regardless of the area of residence or registration. For example, outpatient medical services will be provided to citizens living in the Sheki region, not only in the health facilities operating in the area of residence, but also in medical facilities in different cities and regions of the country. A citizen living in Baku can apply to medical facilities operating in different parts of the country for specialized outpatient care. If the required medical service is included in the Benefit Package, free use of medical services under mandatory health insurance will be provided for the citizen.

It should be noted that, in accordance with the Rules, until the provisions on co-financing enter into force under the Law on Health Insurance, a referral letter will be required only for inpatient medical services provided in public medical facilities. For this purpose, a citizen will need to obtain a referral from a family doctor (field doctor-therapist, field doctor-pediatrician) or a qualified doctor (treatment doctor).

A referral letter for the provision of in-patient medical care will be issued by the treating physician at his / her administrative territorial unit. If this is not possible, then at the regional medical division (detailed information on medical regional division is available here), or where this is not possible, at a state medical facility located outside the medical regional division. If there are several state medical facilities in all three destinations, then the patient's desire is considered and a referral is issued to the state medical facility of his / her choice.

If it is not possible to provide outpatient or inpatient medical services in state health facilities, the insured shall be referred to a private medical facility contracted by the Agency. Outpatient and inpatient medical services provided by a private medical facility will be paid from the mandatory health insurance  only if based on a referral issued by a treating physician [1].

Emergency medical care provided in private health facilities without a referral is paid by the mandatory health insurance only upon consent of the Agency. For this purpose, the private medical facility sends an electronic request to the Agency. The Agency agrees or refuses to pay for medical services from the mandatory health insurance scheme, taking into account whether the medical service is included in the Benefit Package, the possibility of providing medical services in state health facilities and the degree of urgency.

When a patient applies directly to private health facilities without a referral, he / she will use the medical services at his / her own expense.

Another important change made in the Rules is related to cases where the provision of specialized inpatient medical care to the insured in health facilities supervised by various government agencies (Ministry of Health, Ministry of Emergency Situations, Ministry of Internal Affairs, Ministry of Defense, etc.) is not possible. In such cases, the abovementioned medical facilities apply to the Agency with an official letter. The Agency agrees to pay for the medical services from the mandatory health insurance  or refuses to pay for the medical services, considering whether the service is included in the Benefit Package.

The insured means individuals whose health is insured under mandatory insurance and does not include active military servicemen, arrested persons, persons sentenced to a term of imprisonment or life imprisonment (except for precinct-type penitentiaries).

[1] A referral letter is a written instruction, issued by a medical facility to another medical facility for provision of medical services, if it is not possible to provide the required medical services to the patient at the medical facility issuing the referral.