Institutions providing family doctor services must ensure free primary health care for their registered residents. This includes both the services of a family doctor's team and the tests required to diagnose and treat diseases, which are prescribed by a family doctor. Do you know what they are?
For residents insured by compulsory health insurance, in medical institutions where they are registered and which have an agreement with the territorial health insurance fund for family medicine services, tests prescribed by a family doctor within his/her competence and medical indications are paid for from the Compulsory Health Insurance Fund. Patients do not need to pay or pay extra for them, as these tests are included in the price of the family doctor's services. However, there are some things to note.
"A family doctor prescribes tests that are necessary only for diagnosing diseases, conditions, and health disorders within his or her competence, determining their course, adjusting treatment, and assessing effectiveness. In such cases, tests may be prescribed as many times as necessary. Other members of the family doctor's team may also prescribe certain tests according to established algorithms. For example, an obstetrician-gynecologist may prescribe mandatory laboratory tests for pregnant women, and extended and general practice nurses may prescribe laboratory tests within their competence," says Vaida Bernotienė, advisor to the Population Service Department of the Vilnius Territorial Health Insurance Fund.
If tests are needed that are beyond the scope of the family doctor's competence, the family doctor may issue a referral for a specialist consultation or, if the patient wishes to have the test performed immediately and without a referral, prescribe a paid test. Tests prescribed during a specialist consultation are an integral part of the specialist consultation. The costs of these tests are included in the price of the specialist consultation and are paid from the fund's funds. Therefore, if a specialist doctor, during a consultation, prescribes a test within his or her competence, the patient will not have to pay for the test.
Tests prescribed by a family doctor
According to the representative of the patients' bank, if indicated, the family doctor may prescribe general and biochemical blood tests (lipidogram, potassium, sodium, creatinine, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, creatine kinase, gamma glutamyltransferase, total protein, bilirubin, glucose, uric acid), general urine tests, albumin and creatinine ratio in urine, and if necessary, tests for inflammation indicators, such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), thyroid function (TSH), and glucose tolerance test.
A prostate-specific antigen test may be prescribed for patients after radical treatment for prostate cancer, as well as, if necessary, a coprogram, a gynecological smear from the vagina and cervix, an enterobiasis test, electrocardiography, spirometry, pulse oximetry, etc.
Also, if there are signs of upper respiratory tract diseases, the family doctor may prescribe tests for COVID-19 disease (coronavirus infection), influenza, and respiratory syncytial virus (RSV), if necessary.
In certain cases, tests are prescribed
"Anticoagulants such as Warfarin, Acenocoumarol", patients treated with these drugs need to monitor blood clotting indicators to avoid overdose of these drugs. Then the family doctor can prescribe as many tests of the blood clotting system as necessary. To control glycemia, in order to avoid complications, people with diabetes are prescribed up to 4 glycolyzed hemoglobin tests per year," says V. Bernotienė.
Before scheduled surgeries or procedures, a family doctor usually prescribes blood group, Rh factor, and blood clotting tests (prothrombin time, international normalized ratio (INR), activated partial thromboplastin time (APTT)) paid for by the fund.
If necessary, a syphilis (RPR) and specific (treponemal) test with T. pallidum antigen (TPHA) test, human immunodeficiency virus test, tuberculin test, tests for viral hepatitis B and C, ferritin test if iron deficiency anemia is suspected or diagnosed, and urine culture test if urinary tract infection is suspected or diagnosed are prescribed.
The fund also pays for appropriate tests needed by pregnant women.
Often, patients themselves wish to have ferritin, thyroid hormone or liver enzyme tests performed, which are within the competence of a family doctor. However, a family doctor can prescribe these and similar tests free of charge only if a pathology or illness is suspected or when general tests show a deviation from the norm. In cases where the patient wishes to have the tests performed themselves, they would have to pay for them themselves.
Preventive and prophylactic screening tests
V. Bernotienė reminds that for healthy patients of a certain age, the family doctor and his team provide services under disease prevention programs. Then, tests necessary for the prevention of cardiovascular diseases, paid for by the fund, are prescribed, such as a mammogram, a prostate-specific antigen test, a fecal occult blood test, and certain cervical smear tests depending on the woman's age.
Some tests prescribed by a family doctor may be performed free of charge at a set frequency for preventive examinations of children, students of general education schools, patients who are routinely undergoing preventive examinations for non-communicable diseases or who are subject to long-term monitoring after or during a serious illness.
