Pregnancy and compulsory medical insurance policy: what is included for free? What should you know about pregnancy and childbirth under compulsory medical insurance? Infographics What is included in the pregnancy management procedure

Many people justify signing a birth contract with their own confidence and peace of mind. Some consider it a kind of guarantee that everything will go well, the child will be healthy, etc. In fact, much of what a contract for childbirth provides can be obtained under a regular compulsory medical insurance policy, that is, for free. What exactly and what myths should be debunked about paid childbirth, AiF.ru told pediatrician, organizer of the national award for children's goods "Parents' Choice" Tatyana Butskaya.

Better quality, more reliable

Many women, especially those who are going to the maternity hospital for the first time, naturally worry: how the process will go, how easy the birth will be, what can be asked from the doctors, what is better to refuse. Therefore, young mothers often enter into a contract, believing that this way they receive better medical services.

I would like to illustrate this myth with the answer of a doctor I know to the question about the difference between a “paid” and a “free” patient. He said, “Imagine that I am a pilot of a large airplane. And so we take off. I have business class and economy class on board. There is only one board. Can you imagine a situation where I would think more about the safety of business class than economy?”

So, firstly, the concepts of “paid” and “free” childbirth, in principle, do not exist. Any birth is paid for by the maternity hospital and the doctor, just from different budgets. If you give birth under compulsory medical insurance, this does not mean that the doctor will not receive money for your birth. This means that the funds will come to him not from you personally, but from the state.

In addition, as a doctor, I cannot even imagine a situation where I would prescribe the necessary tests or procedures to a “paid” patient, but not to a “free” one. This is my responsibility. Which, with this approach, can easily become criminal.

I also often hear stories about childbirth, where women complain that they were treated simply horribly “for free”: “they punctured the bladder, pressed on the stomach” and so on. Believe me, not a single procedure during childbirth can be performed for any other reason than the desire of the doctor to safely “get” a healthy child out of you. A woman during childbirth is in a slightly altered state of consciousness, and bodily sensations are also distorted, so she cannot always adequately perceive the necessary medical manipulations. “They pressed on my stomach,” the doctor checked how the uterus was contracting. “They pierced my bladder, but I didn’t want to,” the doctor will definitely write a justification for this in the birth report. Believe me, during the birth that you call “paid”, the doctor will puncture the bladder in the same way and check the contractions of the uterus when it is vital for you and the child inside.

We buy childbirth and a healthy child

Often, women, when concluding a contract, go into the mode: “Give birth for me.” That is, in this way they psychologically relieve themselves of responsibility for childbirth. Believe me, no one can give birth to a mother either paid or free: in any case, you will have to do the work yourself.

The same applies to caesarean section. It's not worth paying for a contracted birth if you simply don't want to give birth yourself. No doctor will perform an operation without indications for it. Even if you pay for it. For money, you can only choose the method of delivery: vertical birth, birth in the bathtub, lotus, home. And then only if the conditions of the maternity hospital allow it and there are no contraindications. But you can’t buy yourself an operation. Therefore, you shouldn’t even overpay to save yourself from the “torment”.

Also, you should not draw up a contract in the hope that this will guarantee you a healthy child. No doctor, no matter how experienced, can predict at the very beginning of labor how it will go. Unforeseen situations can happen even in a textbook process. The only advantage in this situation that a contract can provide is that the expectant mother can choose a doctor with whom she would be comfortable or who specializes in certain cases of pathologies, if any were diagnosed during pregnancy.

Paired births

Often, ladies enter into a contract with the maternity hospital in order to go to a joint birth with their husband. Our legislation is such that today a husband can attend a free birth under the compulsory medical insurance policy. True, there is a small condition: the husband is allowed in only if there is a free box. If there is not one, the birth together may fail.

When is it worth paying?

The cost of the contract is determined by the number of options and services that are included in it. Everything here is very individual. For example, for some it is important to stay in a VIP room, but for others it is enough just to have an individual room. Some contracts include monitoring of mother and baby after discharge from the hospital. Again, think about whether you need such an option, carefully review the range of services offered and evaluate their need for the proposed volume. Perhaps you do not want to vaccinate your child or carry out any other procedures included in the contract. Situations can be very different, and it is worth starting from your preferences and characteristics of the course of pregnancy. The same goes for choosing a doctor. The definition of “dear and experienced doctor” is very vague. Choose a doctor based on the specifics of your pregnancy. If you are 25, this is your first birth and the pregnancy is going smoothly, this is one story that any good doctor should be able to handle. If you are 45 and this is your first pregnancy after 15 IVF attempts, it is better to choose a more experienced doctor from a multidisciplinary clinic. A contract with such a doctor may be more expensive, but in a particular case it will be worth it.

The contract can also guarantee constant communication with the doctor, up to 24 hours a day. But, as practice shows, not such a large percentage of pregnant women and women in labor need such a connection. In addition, a contract will be required if you want relatives to come to you after giving birth: without a contract and payment, such a function will not be provided in maternity hospitals.

However, there are situations when a woman, by coincidence and after a free birth, finds herself alone in the ward: the child will be with her, and even her husband can be allowed in by agreement. But this is a matter of chance and is not guaranteed. If all these options are important for a young mother, then it is worth concluding a contract. If not, you can do without it. Let every birth take place in conditions necessary and sufficient for the mother to feel calm and comfortable!

And what to do if this is not given

Theoretically, all roads are open to a pregnant woman - even a private maternity hospital cannot but accept her if she appears on the doorstep already in labor. However, in practice, the rights of pregnant women are sometimes violated. Therefore, it doesn’t hurt every expectant mother to know what she is entitled to free of charge under the compulsory medical insurance policy. Alexey Bereznikov, an expert at the Interregional Union of Medical Insurers, head of the working group on organizing compulsory medical insurance of the All-Russian Union of Insurers, told MK about this.

– What services and examinations can a pregnant woman expect at a medical institution under the compulsory medical insurance policy?

– As part of the basic and territorial programs, all insured persons, including pregnant women, are entitled to free medical care under the compulsory medical insurance policy for diseases and conditions of all organs and systems (including dental ones). In addition, expectant mothers are provided with free medical services for pregnancy, childbirth, the postpartum period and abortion. Cases of treatment of sexually transmitted diseases caused by the human immunodeficiency virus, acquired immunodeficiency syndrome, tuberculosis, mental disorders and behavioral disorders are not covered by the compulsory medical insurance policy. But the state guarantees citizens free treatment of these diseases at the expense of budgetary funds.

You can get more detailed information by contacting your medical insurance organization (HMO) by calling the hotline or visiting the office. There you can also familiarize yourself with the list of medical organizations operating in the compulsory medical insurance system of a constituent entity of the Russian Federation, with their addresses and operating hours. In addition, this information is available on the official website of the health insurance company in which the citizen is insured and on the official website of the TFOMS of the given subject of the Russian Federation.

– Where to complain if a medical organization charges money unlawfully, or if the maximum waiting period for a doctor has expired, or if a woman is not at all satisfied with the services provided?

– In such situations, you can contact both the management of the medical institution and the insurance representative of your health insurance company by calling the “hotline”, as well as by calling the “hotline” of the Federal Compulsory Compulsory Medical Insurance Fund of the constituent entity of the Russian Federation. Information about phone numbers is posted on the official websites of SMO and TFOMS. If a citizen is located outside the insurance region, then regarding the protection of his rights and interests, he must contact the Territorial Compulsory Medical Insurance Fund of the region where he wants to receive medical care.

– For what services, examinations, tests can medical organizations most often try to illegally take money?

– Observation of pregnant women in antenatal clinics is carried out in accordance with the standards and procedures for the provision of medical care. In our country, this area is quite well controlled at all levels, so cases of poor quality monitoring of pregnant women, including unlawful collection of funds, are quite rare. In addition, adequate response measures are immediately taken against them. For example, there were situations when a pregnant woman was offered to pay for laboratory tests or diagnostic examinations. In this case, you need to call your health insurance company, insurance representatives will clarify with the medical organization the reasons for the current situation and, as a rule, the pregnant woman will receive an analysis or examination, if, of course, it is included in the list of those paid for from compulsory medical insurance funds. As a rule, the cause of such situations is the “human factor”, when the doctor is not sufficiently informed about the list of services of the territorial compulsory medical insurance program provided to the patient free of charge.

– What are the most common violations of the rights of a pregnant woman in the compulsory medical insurance system?

– It is quite difficult to single them out, since such specific reporting is not provided for in the compulsory medical insurance system and, accordingly, there are no statistics. But based on the experience of the service for protecting the rights of the insured, it can be said that if cases of treatment or complaints about violations of the rights of pregnant women are recorded, then they are approximately the same as for other patients. Sometimes the facts stated in the complaint are not confirmed or are confirmed, but it turns out that the patient (pregnant woman) interpreted them incorrectly, since, of course, not all patients are professionally versed in health issues and management of pregnant women.

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On the eve of International Mother's Day (celebrated on November 26), the Russian Ministry of Health published useful information about pregnancy and childbirth.

Every woman with citizenship of the Russian Federation is provided with free medical care during pregnancy, during and after childbirth. Assistance is provided to medical organizations within the framework of the state guarantee program for the provision of free medical care to citizens.

What is the deadline to register?

You should contact an antenatal clinic at 6-8 weeks of pregnancy. To register, you must present a passport and a compulsory health insurance policy.

Itrimester. 1-13 week

Appointment with an obstetrician:

General inspection
Assessment of the condition of the vagina and cervix
Measuring weight, height, blood pressure and pelvic size
Recommendations for nutrition and regimen
Flora smear (allows you to identify possible infections)
Issuing referrals for tests:

General urine analysis,
General blood analysis,
Coagulogram
Blood chemistry
Screening to determine the risk of chromosomal abnormalities in the fetus (Down syndrome)
Blood group and Rh factor analysis
Test for HIV, hepatitis B and C, syphilis
Blood test for TORCH infections

Issuing referrals to other specialists:

Therapist,
Endocrinologist,
Ophthalmologist,
Otolaryngologist,

IItrimester. 14-27 weeks

Appointment with an obstetrician:
Scheduled ultrasound
General blood analysis
General urine analysis
Registration of an Exchange card (22-23 weeks).

IIItrimester. 28-40 week

Appointment with an obstetrician:
Measuring the height of the uterine fundus and abdominal volume
Scheduled ultrasound
General blood analysis
General urine analysis
Cardiotocography (CTG) - study of the functioning of the cardiovascular system of the embryo and its motor activity
Registration of maternity leave (30th week).

From the 36th week until delivery, the doctor conducts a routine examination weekly.

I, II, IIItrimesters: general physical examination of the respiratory, circulatory, digestive, urinary system, mammary glands (examination, palpation, tapping, auscultation).

What is an exchange card?

The exchange card, which is drawn up in the second trimester, contains three parts:

Information about the pregnant woman (personal data, blood type, Rh factor, results of examinations, tests, screenings, ultrasound, etc.). It is filled out by the antenatal clinic doctor.
Information from the maternity hospital about the mother giving birth (information about how the birth and the period after it went, about the presence of any complications, etc.). Filled out by the doctor before the woman is discharged from the maternity hospital (give the coupon to the antenatal clinic doctor).
Information from the parental home about the newborn (height, weight, Apgar score, etc.). This part of the card must be clamped by the pediatrician at the first visit.

Who issues a birth certificate and when?

Medical care within the framework of the basic compulsory medical insurance program in Russia is provided free of charge. It includes childbirth, the postpartum period, and hospitalization in a gynecological hospital if necessary (before 22 weeks of pregnancy) or in the pregnancy pathology department of the maternity hospital (after 22 weeks).

In addition to the compulsory medical insurance policy, pregnancy management is additionally financed by the state - in the form of birth certificates, which are issued to women after 30 weeks of pregnancy (Order of the Ministry of Health and Social Development of the Russian Federation dated November 28, 2005 “701 (as amended on October 25, 2006) “On the birth certificate”). In case of multiple pregnancy, a certificate is issued to a woman after 28 weeks.

The birth certificate is used to pay for services provided to a woman in an antenatal clinic, maternity hospital, perinatal center, as well as services from a children's clinic for the follow-up of a child in the first year of life. You can get it at the antenatal clinic where you are registered.

Pregnancy is a time of special female vulnerability, when the expectant mother is worried about both her health and the health of the baby. Therefore, it is not surprising that many of us decide to follow the established stereotype: it is better to pay and even overpay for medical care, but save both the pregnancy and the nerves. This position, unfortunately, is supported by the frequent silence on the full list of services provided by the pregnancy management program under the compulsory medical insurance policy. And yet, before choosing a private clinic, it would be good to have a full understanding of what exactly and to what extent can be obtained for free, in accordance with the procedure and standards of medical care approved by the Ministry of Health.

The right of pregnant women to free medical care is given by the compulsory health insurance policy (CHI). Within the framework of this document, the patient has every right to choose for medical care and pregnancy monitoring any clinic operating under the compulsory health insurance system. This means that every expectant mother can be observed completely free of charge, not only at the district antenatal clinic at her place of registration, but also at any other public clinic in her city.

The compulsory medical insurance program includes both consultations with a doctor and the necessary list of examinations and diagnostic procedures. A medical insurance policy and a copy of it will be needed both when visiting the antenatal clinic and when entering the hospital. Unfortunately, without a compulsory medical insurance policy, an expectant mother can only receive emergency medical care free of charge.

The compulsory medical insurance pregnancy management program includes:

therapeutic and preventive procedures;
active home visits (patronage);
instrumental and laboratory examinations with the necessary clinical, laboratory and instrumental studies;
hospitalization (if necessary), including day hospitals;
early diagnosis of fetal malformations;
psychological and physical preparation for childbirth, the formation of motivation to give birth and raise a healthy child;
breastfeeding education;
examinations and consultations with other specialists;
referral, if necessary, to receive free medical care to other medical institutions.

Also in accordance with Art. 19 Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”, when seeking medical help and receiving it, the patient has the right, inter alia, to:

choice of a doctor, taking into account the doctor’s consent, and choice of a medical organization;
prevention, diagnosis, treatment, medical rehabilitation in medical organizations in conditions that meet sanitary and hygienic requirements;
receiving consultations from medical specialists;
relief of pain associated with a disease or medical intervention with available means and medications;
protection of information constituting medical confidentiality;
refusal of medical intervention;
admission of a lawyer, clergyman or legal representative to protect your rights; For pregnant women, this means, in particular, that you can come to any maternity hospital with your husband or girlfriend, if you have knowledge of your rights and a power of attorney beforehand.

Physiological course of pregnancy

Doctor visit

In a normal, that is, physiological, course of pregnancy without complications, according to the compulsory medical insurance program, a gynecologist invites you for an examination during the first half (up to the 20th week) once a month, during the second half of pregnancy - twice a month, and in the last month of pregnancy - weekly.

Also, during pregnancy, an examination by a general practitioner should be carried out twice: the first time - after the first examination by an obstetrician-gynecologist; the second - at 30 weeks of pregnancy.

When a pregnant woman first contacts the antenatal clinic, the obstetrician-gynecologist is obliged to issue referrals for a free examination by the following doctors: an ophthalmologist, an otolaryngologist, and a dentist.

Analyzes, laboratory tests, ultrasound

All studies for a pregnant woman, including ultrasound, laboratory tests, tests for intrauterine infections, genetics and hemostasis, should be carried out free of charge, under a compulsory health insurance policy.

If the antenatal clinic is not able to conduct the necessary research, then the doctor must give a referral to another antenatal clinic or hospital.

Also, according to the compulsory medical insurance program, two screening ultrasounds are required during pregnancy (as part of a screening test): at 11 - 13 weeks and 16 - 20 weeks. This test is also free: it is funded by the state program for improving the health of the nation, as it allows you to identify abnormalities in the development of the fetus.

Vitamins and medications

During pregnancy, the compulsory medical insurance program provides free vitamins and, if necessary, medications. In 2015, the list of such vitamin preparations included:

folic acid;
multivitamins;
multivitamins + minerals;
iron (III) hydroxide polymaltosate;
iron fumarate + folic acid;
iron (III) hydroxide polymaltosade + folic acid;
potassium iodide;
vitamin E;
calcium carbonate.

The list of free medicines for pregnant women is similar to the list of vital and essential medicines (VED), which is approved by the Government of the Russian Federation. It can be found on the websites of the Russian and regional Ministry of Health.

Treatment of pathologies during pregnancy

No one is immune from surprises, and it happens that a physiological, that is, normally proceeding, pregnancy suddenly turns into a pathological one. During pregnancy, problems arise quite often, and there are many reasons for this: poor ecology, various infectious diseases of women or men, hidden inflammatory processes and chronic diseases, poor nutrition and, of course, stress. Problems can be either serious, posing a danger to the child and requiring in-depth examination and treatment, or caused by an elementary deficiency of vitamins and minerals, immunodeficiency or disorders of the body's microflora.

In any case, the compulsory medical insurance program provides free treatment and assistance to maintain pregnancy, and therefore a number of additional studies and manipulations.

Examinations and laboratory tests

Thus, in case of a complicated pregnancy, the number of examinations, including by various medical specialists, is determined by the obstetrician-gynecologist, taking into account the state of health. According to his instructions, such examinations are carried out free of charge, as well as additional ultrasound and screening studies, Doppler sonography, etc.

In the case of a pathological pregnancy, many examinations, which are usually offered for a fee, are required to be provided to the woman free of charge, if this is necessary to identify any abnormalities in the health of the mother and child. If the housing complex does not have the necessary equipment, then, according to the law, the housing complex must find an institution that will perform this examination on their behalf using compulsory medical insurance funds. That is, any examination prescribed by a doctor as necessary during the normal course of pregnancy, as well as if any abnormalities are suspected, should be provided free of charge.

Negative Rh factor

In Rh-negative women, the father of the child is additionally examined for group and Rh affiliation, and if the father is Rh-positive, the pregnant woman's blood is tested monthly for Rh antibodies.

Emergency hospitalization and inpatient treatment

According to the testimony of the supervising doctor, the expectant mother may be prescribed treatment in a hospital. Planned treatment, as well as emergency hospitalization, should be provided free of charge under the compulsory medical insurance program. In the clinic, the expectant mother must undergo a full examination and be offered tactics for managing and maintaining the pregnancy, as well as a method of delivery. At the same time, the hospital providing the necessary treatment must work under the compulsory medical insurance system.

Typically, the maternity hospital conducts examinations and treatment of pregnant women with the following pathologies:

habitual miscarriage;
toxicosis of the first and second half of pregnancy;
placental insufficiency;
pregnancy with pathological features of the genital organs;
presence of a scar on the uterus;
uterine fibroids.

Assistance is provided using ultrasound examinations, CTG - computer monitoring of the condition of the fetus, examinations for genital tract infections and laboratory tests.

Inpatient treatment of other diseases, including chronic and infectious diseases that threaten pregnancy and the child, is carried out in specialized hospitals, with the direction of a doctor.

Just like a clinic, a hospital, an expectant mother has the right to choose at her own discretion if she is not satisfied with the institution to which the referral to the LCD was issued.

Sanatorium for pregnant women

In addition to inpatient treatment, every expectant mother has the right to free sanatorium-resort treatment, subject to indications and a referral from the attending physician.

You can count on a ticket in the following cases:

miscarriage;
infertility;
fibroids;
malformations of the uterus;
caesarean section or other stitches on the uterus;
primigravida under the age of 18 or over 28 years;
anemia;
hormonal imbalances;
a history of diseases that are at risk during pregnancy.

The total duration of such spa treatment can be 21 days.

IVF procedure

It is enough to have a compulsory medical insurance policy to get on the waiting list for the IVF procedure, since infertility is considered an insured event.

Conditions for free IVF:

availability of compulsory medical insurance policy;
medical indications for IVF;
age of the expectant mother (from 22 to 39 years);
no contraindications to IVF procedures;
normospermia in the father of the unborn child;
completing a course of infertility treatment prescribed by a doctor.

Under the new conditions, you can make an unlimited number of IVF attempts until a positive result is achieved.

The federal quota provides for expenses of up to 106,000 rubles, that is, unexpected expenses exceeding the preferential limit will have to be covered independently.

The cost of the benefit includes:

hormonal stimulation of follicle growth;
collecting the required number of cells;
artificial fertilization procedure.

According to the compulsory medical insurance program (or quota), there is also an IVF protocol, where, after rescheduling the procedure, support is mandatory, individual for each patient. Usually these are vitamins and progesterone - its dosage is prescribed by the doctor. If necessary, based on test results (blood, hormones), additional medications, hormonal and vitamin preparations are prescribed. After pregnancy is confirmed, the level of the hormone progesterone (and the patient’s individual indicators) is monitored and the dose is adjusted. After confirming the pregnancy and adjusting the support, the expectant mother is registered with the LCD, where she is observed as in a normal pregnancy, but taking into account the peculiarities. At the slightest problem, she is placed on continued pregnancy.

Nowadays, people often move, and sometimes they have to be observed during pregnancy and give birth in a place other than where they are registered. Is it possible to give birth for free in another city? How to change antenatal clinic? And what other opportunities does a compulsory health insurance policy provide for a pregnant woman? We answer the most popular questions.

If I have a compulsory medical insurance policy and live in Moscow, can I give birth for free in the city of St. Petersburg or in another city in Russia?

The compulsory health insurance policy is valid throughout the Russian Federation. If a person who has a compulsory medical insurance policy requires medical care in another constituent entity of our country, he is required to provide it within the framework of the so-called basic compulsory medical insurance program, which is uniform throughout the Russian Federation. Subjects of the Russian Federation have the right to expand the basic program for persons permanently registered on their territory. This expansion is called the territorial compulsory medical insurance program.

Medical care within the framework of the basic compulsory medical insurance program, which includes childbirth, the postpartum period, and, if necessary, hospitalization in a gynecological hospital (up to 22 weeks of pregnancy) or in the pregnancy pathology department of a maternity hospital (after 22 weeks), is provided throughout Russia for free. That is, if a woman goes to a maternity hospital outside the territory where she was issued a compulsory medical insurance policy, and she has medical indications for hospitalization (for example, pregnancy, childbirth, etc.), then the refusal to provide her with medical care is unlawful, as well as the requirement to pay any fees. or services.

Is it possible to choose an antenatal clinic under the compulsory medical insurance policy?

A pregnant woman has the right to choose any antenatal clinic, and not necessarily at her place of permanent registration, it is also possible in another city. To do this, you need to come to the head of the consultation where she would like to register for pregnancy, and write a statement about this addressed to the head. The manager signs this application, and with it the pregnant woman goes to the office of the insurance company where she is insured under compulsory medical insurance. The insurance company re-registers the expectant mother for a new antenatal clinic. The policy itself does not change, but a new antenatal clinic is included in the annex to the compulsory medical insurance policy.

The head of the consultation theoretically has the right to refuse to admit a woman to her consultation if all the consultation doctors have a workload that significantly exceeds their legal workload, that is, they have many more pregnant women on their register than they should have.

What services under the compulsory medical insurance policy can be obtained free of charge in commercial clinics?

If a commercial clinic operates only in cash or is part of the voluntary health insurance system, then under the compulsory medical insurance policy you will not be able to receive services there for free. However, every year the number of private clinics that operate in the compulsory medical insurance system increases. Therefore, before visiting a commercial clinic, check whether it has joined the compulsory medical insurance system, whether they do the examination you need under the compulsory medical insurance system, whether a specific doctor sees you, etc. If you receive a positive answer, you will receive medical services in this private clinic for free. As a rule, antenatal clinic doctors should be aware of similar opportunities in private clinics and, if necessary, refer patients there under the compulsory medical insurance policy.

Questions and answers

Comment on the article "Pregnancy and compulsory medical insurance policy: what is free?"

They asked me to pay for an additional examination under the compulsory medical insurance policy. I called my insurance company, which issued the compulsory medical insurance policy (ROSNO MS). I told them what and how, they promised to solve my problem. And they decided. Examined for free. So the policy really works and the insurance company is ready to defend its interests.

25.09.2015 17:50:46,

Total 3 messages .