How to get a quote for hip replacement surgery

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My aunt had problems with her hip joint all her life. She was treated at the clinic, but it did not give the desired result. Gradually the pain intensified and the question of a full examination arose. The results revealed a dislocated joint and severe wear. After reading information about the cost of the operation and materials, we came to the conclusion that it was worth trying to get a quota. The procedure turned out to be not as scary as it seemed at first. Today I will talk about how to get a quota for hip replacement surgery without spending your own savings on it.

• Price issue
• What is included in the quota
• The procedure for obtaining a quota for hip replacement surgery
• Conclusion

In what cases can a quota for joint surgery be issued (free endoprosthetics)

The following pathologies are indications for quotas:

• Diseases of the knee joint ligaments;
• Oncological diseases that impair the functioning of the patient’s musculoskeletal system;
• Pathologies resulting from systemic diseases and affecting connective tissue;
• Defects that manifested themselves in the postoperative period after a certain time after endoprosthetics;
• A complex of consequences of injuries (surgeries) and arthrosis, accompanied by deformation;
• von Willebrand's disease;
• Pathologies resulting from blood clotting disorders;
• Contraindications to treatment other than endoprosthetics;
• Infectious diseases affecting the location of the prosthesis;
• Problems with the functioning of the implant - wear, abrasion, loosening, etc.;
• Errors and inaccuracies associated with the installation of a prosthesis;
• Bone fracture in the immediate vicinity of the implant.

When knee and hip replacement surgery is not subject to quota

In some cases, endoprosthetics are not subject to quotas. First of all, we are talking about such contraindications to surgery as:

• Excessive bone fragility;
• Nerve ending defects;
• Underdevelopment of bone tissue;
• Rheumatoid arthritis;
• A number of diseases of the cardiovascular system;
• Osteoporosis;
• Infectious foci in the body;
• Purulent lesions;
• Acute pathologies of the extremities.

There are other points due to which a person in need of endoprosthetics is not subject to quotas. If they occur, then the patient has two options to help save money.

1. Seek treatment from a government medical institution. This way you won’t have to pay for the services of medical staff, although the purchase of most consumables (including a prosthesis) will fall on the patient’s shoulders.
2. Become a participant in a program called IPR - an individual rehabilitation plan. It will be discussed below.

How much does joint surgery (endoprosthetics) cost?

Treatment through endoprosthetics is a very expensive procedure and not always affordable for families with average incomes. Approximate prices (which, of course, can vary within fairly wide limits) are given in the table.

Types of hip implants

The manufactured hip replacements are of high quality. This applies to all manufacturers operating in Europe or the USA. Therefore, it is incorrect to talk about which prosthesis is better or worse.

The main difference between endoprostheses is the friction pair formed due to the materials from which the head and the artificial acetabulum (or liner) are made.

• Metal-polyethylene. The metal head is not resistant to wear, and the complex polymer of the liner inserted into the acetabulum reduces friction. This is an economical option, since the price in Moscow is low.
• Metal-metal. A frequent combination of materials, which is used less and less due to frequent complications due to metal friction products.
• Ceramics-ceramics. The most expensive option, as it is technically difficult to produce. Has minimal friction with rare complications after installation. Ceramics have a high price, since the price is approximately 2 times higher than analogues.

  Types of friction pairs.

• Ceramics-polyethylene. The “golden mean” of all types of artificial joint designs. The price is combined with low friction and high wear resistance. The head of the femur is made of ceramic, and the liner is made of a complex polymer. Feedback from patients with this type of construction installed is positive.

Pink - ceramics, white - polyethylene.

Compensation for the cost of joint surgery in the presence of an individual rehabilitation plan

There is a so-called IPR program - an individual rehabilitation plan. This is an excellent opportunity for people in need of urgent surgery to receive medical services on time, which will be reimbursed later. That is, the person pays for the operation and prosthesis himself, and the state reimburses him for the money spent after some time.

Who can get IPR if they have joint problems?

A person can become a participant in the IPR if:

• There is a disability due to a disease from the preferential list;
• Eligibility for the implant was not formalized until early 2015;
• There are features that are considered on a different individual basis.

Important!

Persons who confirmed their right to endoprosthetics before the beginning of 2015 are entitled to state support in a strictly defined amount - 160,000 rubles. All costs from above fall on the shoulders of the patient.

Individual rehabilitation plan and compensation for the cost of joint surgery

In order to exercise the right to IPR, you must first contact your doctor. The applicant will be given a certificate of a special form (No. 088/у-06), with which he will have to go through a number of specialists, and then come to the supervising specialist again to get a stamp.

The next step is contact with a medical and social expert. After providing this body with all the necessary documents, an appropriate decision is made within two weeks, and the patient becomes a participant in the program.

To receive compensation under the IPR, you should contact the territorial body of the Social Insurance Fund and provide certain documents according to the list. In particular, the package must contain documents confirming the purchase (and the validity of the purchase) of certain technical means used during treatment.

Cost of a hip prosthesis

Zimmer prostheses are the most popular, and the model range has all the necessary types of orthopedic implants. What are the best implants from the company? It depends on how the patient will use it. For normal everyday life at a slow pace, all design options are suitable. Price in Moscow.

• Classic bipolar implant. Equipped with a metal-polyethylene friction pair. Durability – up to lifelong with moderate use. The amount that the manufacturer asks for the product usually does not exceed 120 thousand rubles.
• Single-pole titanium prosthesis. The cheapest option. Only the head of the femur is prosthetic, and the acetabulum remains its own. It is impossible to select a friction pair; it always contains metal components. The starting price tag is from 75 thousand rubles.
• Ceramic. The most expensive type of construction. Has a minimal gradient of friction and wear. The price starts from 200 thousand rubles.

Black ceramics, which are more expensive and durable than regular pink or yellow ones.

To summarize, the question of how much a design from Zimmer costs depends directly on the model. The price in Moscow starts from 75 thousand rubles.

Quota for knee replacement: how to get a quota for surgery (step-by-step instructions)

To exercise your right to receive a quota, you will have to take a number of actions and go through the following stages.

1. Contact your doctor. The orthopedic traumatologist, who is registered with a person in need of surgery, issues a referral to a first-level commission based on the medical record data (records in it about tests, examinations and examinations of the patient).
2. Commission at the clinic. Each medical institution creates its own regulatory body, which is responsible for such issues. Within a maximum of 10 days, specialists generate a protocol that contains data on the diagnosis and condition of the patient, as well as recommendations for his treatment.
3. Formation of a package of documents. If the applicant has no contraindications, his application with the attached documents (the full list will be below) is sent to the regional health care institution.
4. Regional commission. The specialists at this level always include an orthopedic surgeon. The patient’s immediate appearance is not required (only in case of controversial issues). Any decision made is recorded. If the verdict is positive, then the completed package of papers, along with a copy of the protocol and a coupon, is sent to the hospital where the medical intervention will be performed. The decision is made on the 10th day maximum.
5. The application is reviewed by the medical institution selected to perform the surgical intervention.

Quota for hip replacement surgery in 2021

Until 2015, the state provided support for endoprosthetics to the majority of those who wanted it. However, by 2021 the situation was different. The state now helps only with regard to joint surgery (in public clinics and as part of the compulsory insurance program). The implant itself, the price of which is very high, is paid for by the patient himself.

But in some cases, endoprosthetics are financed from the budget in full. These include:

• Postoperative arthrosis leading to deformation;
• Anomalies in the form of articular dysplasia, which developed in parallel with arthrosis.

There are other situations, considered on an individual basis, that are subject to quotas.

The procedure for obtaining a quota for hip replacement surgery

To obtain a quota, the patient will have to take a number of actions in the following order:

• Obtaining a doctor’s opinion from the medical institution where the patient is registered;
• Formation of a package of documents;
• Submitting documents for consideration to a government agency;
• Consideration of the situation on an individual basis;
• Documentary confirmation of the patient's right to quota and provision of services.

Recovery after surgery

The recovery period of postoperative intervention lasts up to six months. At this time, it is necessary to carefully follow all the doctor’s instructions, in particular, gradually develop the limb, engage in a specially selected complex of physical therapy, conduct massage courses and physiotherapeutic procedures. This is necessary not only for the speedy and final strengthening of the endoprosthesis in the tissues, but also for restoring the mobility of the affected limb. You need to understand that some patients actually learn to walk again at this time. And to restore their skills, the help of loved ones and qualified specialists is extremely important for them.

Algorithm for obtaining a quota for joint surgery in 2021

Let's take a closer look at the algorithm for issuing quotas for endoprosthetics, which is in effect this year.

Conditions for inclusion in the program for obtaining a quota for joint surgery

State support is provided to citizens who, by submitting certain documents, prove the need to receive such assistance. In particular, such papers include:

• Compulsory medical insurance policy;
• Papers confirming an application for medical care for an illness covered by quotas;
• Extracts from the medical record and certificates that track the progress of the disease.

It is recommended to monitor the process of completing the document package by the medical institution in which the quota applicant is registered. Since the carelessness of the clinic staff, which could subsequently lead to a refusal of state support, is not excluded.

Algorithm for obtaining a quota for joint surgery

The feasibility of quotas for a specific patient is determined by the clinic where the patient is observed. This means that to receive state support you should go to the medical institution where the applicant is registered. Each state clinic has created a body whose competence includes issues related to the consideration of quotas. In particular, this commission will examine the following points:

• Results of the general survey;
• Conclusions of narrow specialists (orthopedists);
• Medical history;
• Examination results: tests, pictures, etc.

How to get a quota coupon for joint surgery

The next step is to contact the government agency. It is at this level that quota coupons are issued. In this case, you need to prepare a number of copies and originals of documents. Here is an approximate list of them.

Copies:

• Passport pages;
• Compulsory medical insurance policy;
• Pension certificate;
• Disability certificate;
• A conclusion that clearly confirms the need for endoprosthetics (it contains information about the state of health of the quota recipient, the diagnostic measures performed and their results).

Originals:

• Referral from the orthopedic doctor who is seeing the patient in the clinic;
• Protocol of the commission with a positive decision on the quota;
• Application for a quota from a patient.

All these copies and originals are sent to the health department. Moreover, his authorized representative can do this for the quota recipient.

Deadlines for assigning a quota for joint surgery

To roughly understand how long a patient will have to wait for state-funded medical care, you need to know the approximate timing of each stage of receiving a quota:

• An application submitted to a state-level body is considered within a maximum of 10 days;
• If the verdict is positive, the documents are sent to the medical institution where the operation will be performed;
• The commission dealing with quotas at this clinic determines the date of medical procedures and notifies the health department about this;
• The specialist of the state body informs the quota recipient about the decision made.

In practice, patients have to wait for hospitalization for quite a long time - from 3 months to a year or more.

Price of prosthetics in Russia and abroad

Surgery in such a country will cost an order of magnitude more than in St. Petersburg. The cost without rehabilitation can reach $25,000.

Treatment in centers in Germany is no less popular. Orthopedic departments are equipped with unique equipment and employ only leading specialists. The country's medicine is known for its state-run medical institutions, where the quality of surgery is not inferior to private clinics.

All clinics in Germany provide a guarantee for the prosthesis for 20 years or more, provided that it is used correctly and follows all the doctor’s recommendations.

The tariff will be calculated according to DRG (hospital inpatient pricing). The exact amount will include several prices - surgery, implant, hospital stay. In general, you will have to pay from 7,500 euros. The remuneration for the work of doctors will be calculated separately - from 2,500 euros. Further, mandatory examination starts from 900 euros and additional costs start from 500 euros. The minimum amount that will have to be paid is more than 11,000 euros. This does not include visiting a rehabilitation center - only primary recovery.

Recently, centers in the Czech Republic have become popular with the possibility of further rehabilitation at resorts without leaving the country. In the Czech Republic there is a huge selection of rehabilitation centers aimed at restoring patients after diseases of the musculoskeletal system.

Technical capabilities, qualifications of doctors, and quality of medical services are not inferior to Germany or Israel. In some aspects it even has advantages:

The Czech Republic is a leader in prosthetics; for more than 30 years it was the only country producing endoprostheses; Every year more than 10,000 operations are performed in the country, the success rate of which is 98%; The quality of surgery far outweighs the price. The cost of surgery will be at least 35% lower than in other countries; high level of qualifications of rehabilitation specialists

Czech doctors focus on the recovery period and directly tell the patient that a good operation does not guarantee a complete recovery.

Pricing in the Czech Republic is much more flexible compared to other European centers. There is no need to pay extra: the price of the operation includes the stay and the implantation structure.

The patient is provided with an initial rehabilitation course, which lasts on average two weeks, but classes will be carried out in full. Next, rehabilitators will provide a detailed scheme for further recovery at home.

The popularity of treatment in Europe is due to different standards of medicine, higher and more innovative. This is especially evident in orthopedic surgery. Thus, in Russia, minimally invasive intervention for joint replacement is not used, since there are no technical possibilities. But it is precisely this that eliminates the development of an infectious process and high blood loss.

Therefore, the question remains: get treatment at a high price and be confident in the outcome of prosthetics, or choose a less expensive treatment method that will not give any guarantee.