New medical technologies: high-tech medical care and its availability

New medical technologies: high-tech medical care and its availability
Photo: Photo by the Mayor and Moscow Government Press Service. Denis Grishkin
Moscow residents have access to cutting-edge medical technologies. These include positron emission tomography (PET), robot-assisted surgery, stereotactic radiosurgery, histo-scanning, endovascular heart and blood vessel surgery and others. Where and how can high-tech medical care be received?

The average life expectancy in Moscow has reached 77, nearly three years older than in 2010 (74.1) and 5.4 years older than the average Russian indicator (71.4). In five years, the overall death rate at the economically active age has dropped by 22 percent, and the newborn infant death rate by 31 percent.

This trend is mostly due to the advanced high-tech medical equipment provided to Moscow hospitals and clinics. In six years, they have received 78 magnetic resonance imaging (MRI) and 136 X-ray computed tomography (CT) scanners, 158 video endoscopy systems, 28 X-ray diagnostic machines, as well as angiographs and robot-assisted surgery equipment – a total of over 500 high-tech medical equipment units.

 

In the past few years, there has been an increasing number of minimally invasive surgeries, causing the least possible blood loss and fewer complications, and requiring a shorter in-patient treatment time. Patients recover more quickly and are able to resume their normal life almost immediately. For example, up to 70 percent of oncological surgeries are carried out in this way in the Moscow Clinical Research Centre, which is one of the best indicators for surgical clinics in the world. In addition, an increasing number of surgeries are becoming robot-assisted each year. In 2016, the number of robot-assisted surgeries rose by 2.7 times compared to 2015. This is considered high-tech medical care.

What is high-tech medical care

High-tech medical care refers to that which is performed using new, complex or unique technologies.

This is provided in a number of areas, including:

— abdominal surgery (treating abdominal organs);

— midwifery and gynaecology;

— gastroenterology;

— hematology;

— dermatovenereology;

— burn injury medicine;

— neurosurgery;

— oncology;

—otorhinolaryngology (ENT);

— ophthalmology;

— pediatrics;

— rheumatology;

— cardiovascular surgery;

— thoracic surgery (Thoracic organs);

— traumatology and orthopaedics;

— organ and tissue transplantation;

— urology;

— oral and maxillofacial surgery;

— endocrinology;

— neonatology;

— newborn infant surgery.

In 2013, high-tech medical care covered 130 areas. Now the number is 1,500.

New health technologies: what is high-tech medical care and how can it be accessed? The Moscow Mayor’s official website

Where and how to access high-tech medical aid in Moscow

In 2011, high-tech medical aid was available in 15 Moscow hospitals, and today, it is available in 39 of them. These are hospitals funded by the city budget, and with the inclusion of mandatory health insurance funding, their number would rise to 45. In 2017, in-patient clinics providing high-tech medical aid will total 45 (48 including those funded by mandatory health insurance).

Laparoscopic equipment is available in all surgery departments of Moscow hospitals. The equipment allows for performing surgery via small key holes, with minimal invasion.  This technique is also applied in operations on the pancreas, prostate gland, liver, colon, rectum, uterus and other internal organs.

The Pletnev clinical hospital of Moscow provides high-tech medical aid in such areas as abdominal surgery, vascular surgery, urology, gynaecology and endocrinology. But its main specialisation is oncology: 40 percent of patients who need radiotherapy in Moscow received it in this hospital’s radiology department. The hospital has a modern linear accelerator that can be used for 3D conformal radiation therapy, IMRT (intensity-modulated radiotherapy) and IGRT (image-guided radiation therapy).

The accelerator also allows for supplying a scheduled dose with high (millimetre or even submillimetre) precision, without affecting healthy tissues.

 

Starting this year, Moscow residents have free access to positron emission tomography (PET) combined with computed tomography (CT), as this service is covered by the mandatory medical insurance policy. The Pletnev clinical hospital and city oncological hospital #62 (the out-patient clinic of which is on Staropetrovsky Proyezd, and the in-patient clinic in the village of Istra near Moscow) have two mobile PET/CT scanners. Another scanner operates in the Department of Radionuclide Diagnostics of the European Medical Centre, which has signed up to the mandatory medical insurance territorial programme.

The Botkin hospital performs robot-assisted surgeries using the Da Vinci surgical complex, which causes nearly zero blood loss and carries a minimal risk of complications. The Da Vinci equipment allows a surgeon to see a 3D image of internal organs. These surgeries are performed for patients with liver and pancreas disorders, and with oncological and urological issues.

Two unique modern Gamma Knife systems are used in the Sklifosovsky Research Institute of Emergency Medicine and the Burdenko Neurosurgery Institute. This equipment allows surgeons to non-invasively eliminate benign and malignant tumors and to treat small vessel brain diseases without using a needle or surgical instruments. The Sklifosovsky hospital also provides video-laparoscopic kidney or partial kidney removal. This is far more efficient than classical open surgery methods. The operation causes minimal damage to the tissue and rarely causes complications, which reduces the time a patient has to stay in hospital.

The Spasokukotsky clinical hospital performs histo-scanning of the prostate gland, allowing doctors to diagnose cancer at an early stage. The university clinic of the hospital has carried out a radical robot-assisted prostatectomy for the first time in Russia with the help of the Da Vinci apparatus. The clinic is the most experienced in Russia in cryosurgery for prostate cancer and abdominal laparoscopy.

Patients under 18 can receive high-tech medical care and consultations from an endocrinologist, gynaecologist and urologist and andrologist at the centre for children’s and teenagers’ health, which is open in the Morozov children’s city clinical hospital. The hospital provides 24/7 emergency clinical and lab, ultrasound and X-ray services, and also helps underage pregnant girls. The hospital also performs high-tech operations, such as bone marrow transplantation in special techno-integrated operating theatres.

Some Moscow outpatient clinics are already applying technologies replacing inpatient treatment, which means they do operations that were previously performed exclusively in hospitals. For example, doctors of the municipal outpatient clinic No. 180 can break up kidney stones using shock wave lithotripsy.

The list of federal medical centres that provide high-tech medical aid outside the mandatory medical insurance policy can be found on Moscow’s Healthcare Department’s website.

High-tech medical care recipients

All Russian citizens are eligible to receive free high-tech medical care as long as they have a relevant diagnosis by a doctor of the clinic where the patient is diagnosed and treated.

New healthcare technologies: what high-tech medical aid is and how to access it. The official website of the Moscow Mayor

Required documents

Once diagnosed, the patient is referred by his clinic doctor for inpatient treatment. The referral can be either typed or neatly handwritten, and has to be personally signed and stamped by the assigned doctor, the head of the medical clinic (organisation) or an authorised person with a stamp of the medical clinic.

The referral must include:

—patient’s surname, name and patronymic, DOB and address of registration at the place of residence (stay);

— mandatory medical insurance policy number (OMS) and the name of the medical insurance company (if any);

— number of the insurance certificate of the mandatory pension policy insurance (if any);

— diagnosis code of the main health disorder, according to the International Classification of Diseases (ICD)-104;

— medical area, type of high-tech medical care;

— name of the medical organisation where the patient is referred;

— surname, name, patronymic and post of the attending physician, contact phone number and email (if any);.

The required documents also include a copy of the patient's medical records personally signed by the doctor and the chief doctor (or authorised person) of the outpatient clinic or hospital. This document should include the name of the disease (condition), its code according to ICD-10, information about the patient’s health, and results of lab, instrumental and other tests confirming the diagnosis.

The document list also includes copies of the passport or any other ID (children under 14 should include their birth certificate), individual insurance account in the pension insurance system (SNILS, if any) and the mandatory health insurance policy certificate. Patients who are minors should provide a copy of the passport of their legal representative. The patient must give his/her consent for processing their personal data.

Documents are collected – what next?

It depends on whether the required high-tech medical care is included in the mandatory health insurance policy. If it is, then the patient should send all the documents to the medical organisation that will provide the high-tech medical care. The referring out-patient clinic or hospital should complete the referral within three days but the patient can post the papers him/herself to expedite the process.

A special commission will decide within seven days whether the patient is eligible for hospitalisation.

If high-tech medical care is not included into the mandatory health insurance policy, the documents are sent to the high-tech medical care department of Moscow’s  Healthcare Department at 4A 2nd Shchemilovsky Pereulok,  Bld 4. The department will issue permission for high-tech medical care. The commission on patient selection will decide on the matter within 10 working days. Further steps are the same as when the aid is included in the mandatory health insurance.

How many patients receive high-tech medical aid in Moscow?

The number of patients receiving high-tech medical care (covered by the budget or mandatory health insurance) has increased by 33 times in 2015 compared to 2011, from 2,998 to 101,189 people. This year, 115,000 patients will be eligible for this type of medical care.

Since 2011, provision of high-tech medical care has been growing in all areas, including cardiovascular surgery – by 15 times, traumatology and orthopaedics – by 5.2 times, neurosurgery and abdominal surgery – three-fold, in pediatrics by 2.7 times. In oncology, high-tech medical equipment is used 365 times more. In the nine months of this year, 8,957 people received high-tech medical care at budget medical organisations of the Healthcare Department.