He alth insurance in Russia and its features. Development of he alth insurance in Russia

2024 Author: Howard Calhoun | [email protected]. Last modified: 2023-12-17 10:16

He alth insurance is a form of protection for the population, which consists in guaranteeing payment for medical care from the accumulated funds. It guarantees the citizen the provision of a certain amount of services free of charge in the event of a he alth disorder. Next, let's talk about what constitutes he alth insurance in Russia. We will try to consider its features in as much detail as possible.

Concepts

Compulsory he alth insurance (CMI) is implemented in accordance with the state program. It is universal for the citizens of the country. Voluntary he alth insurance in Russia allows you to receive additional services not covered by compulsory medical insurance. This may be a certain number of visits to specialists, inpatient treatment, etc. By participating in a voluntary program, a person independently chooses the types and volume of services, institutions in which he wants to be served. At the conclusion of the contract, the client pays a fee,which allows him to receive service for a certain period of time under the selected program without surcharge. Let's understand some terms.

The insured is the person who pays the contributions. It can be a person or an organization.

Insurer - a legal entity that provides he alth insurance.

Treatment-and-prophylactic establishments (MPU) - institutions that provide a range of medical services to people with various diseases. These include: therapeutic, surgical, psychiatric, neurological, pediatric medical facilities, maternity hospitals and rehabilitation centers.

Policy - a document confirming a person's participation in the program.

A medical insurance organization (CMO) is a legal entity with an authorized capital that is engaged exclusively in voluntary or compulsory medical insurance. Activities are carried out in two directions:

• accumulation of funds to help the population;
• examination after receiving services.

Development of he alth insurance in Russia

Stage 1 (1861-1903)An act was adopted that introduced the foundations of compulsory medical insurance in Russia. At state-owned factories, partnerships and auxiliary cash desks were established, through which temporary disability benefits were issued to members of the society, and deposits were accepted. In 1866, hospitals with a certain number of beds appeared at the factories. In general, the workers did not like such medical care.

2 stage (1903-1912)

Medicalinsurance in Russia experienced its first turning point in 1903, when a law was passed that made the employer liable for damage caused to the he alth of employees in accidents.3 stage (June 1912 - July 1917)

In 1912, the Law on compulsory medical insurance in case of accidents and illness was adopted. He alth insurance funds appeared on the territory of the Russian Federation. Employees at the expense of entrepreneurs were provided with assistance in four areas: initial, outpatient and bed treatment, obstetric care.

4 stage (July 1917 - October 1917)

Compulsory he alth insurance in Russia has been heavily reformed by the Provisional Government:

• requirements for sickness funds;
• the circle of insured people has expanded;
• He alth funds were merged without the consent of entrepreneurs.

5 stage (October 1917 - November 1921)The Declaration introduced full social he alth insurance in Russia, which extended to all wage workers, regardless of the reasons for disability. There was a merger of the People's Commissariat of He alth and insurance medicine. The medical business was transferred to the management of the People's Commissariat of He alth. Cash medicine has been abolished.

6 stage (November 1921 - 1929)

The New Economic Policy reintroduced social insurance in case of disability. Contribution rates were calculated according to the number of employees in the enterprise. Two funds were organized on the transferred funds. Onewas at the disposal of the social insurance authorities, the second - he alth care.

7 stage (1929–present)

The next 60 years formed the principles of financing the system. This is how the development of he alth insurance in Russia happened.

Modern system

He alth insurance in Russia currently exists in three forms. The state is fully funded from the budget. Insurance is formed by accumulating deductions from enterprises of all forms of ownership and contributions from individual entrepreneurs. The amount of funds that go into private medicine is calculated by the patient himself.

The state program does not provide quality medical care due to lack of funding. Private he althcare is expensive. Therefore, he alth insurance is considered the best option for receiving assistance. Ideally, all individuals should receive quality services. After all, the frequency of payments does not correspond to appeals to the he alth authorities. This is the principle of accumulation. And since the rate of contributions to the Russian Medical Insurance Fund is the same for all categories of citizens, the amounts of payments should be equal.

CMI

Compulsory he alth insurance in Russia is part of the state social program. Within its framework, all citizens are provided with equal opportunities to receive medicinal and medical assistance in a predetermined volume and conditions.

In the Russian Federation there are basic and territorial programs. They definewhat kind of assistance and in what institutions is provided to citizens living in one or another part of the region. The first is developed by the Ministry of He alth, the second is approved by the state authorities.

Scheme of work

Enterprises monthly transfer 3.6% of the FOP to compulsory medical insurance. Of these, 3.4% are paid to the territorial and 0.2% - to the federal Compulsory Medical Insurance Fund. For the non-working population, contributions are paid by the state. Both funds are independent institutions that accumulate funds, ensure the stability of the system and equalize financial resources. The accumulated money is used to pay for the established volume of medical services.

Insurance companies enter into agreements with he althcare facilities to provide assistance to holders of CHI policies, protect the interests of clients by controlling the timing, volume and quality of services provided. Program participants can be both citizens of the Russian Federation and non-residents. True, with regard to the latter, the list of services available to them is limited.

Territorial CHI program

This document defines the scope of providing free medical care to citizens. It includes:

• emergency;
• outpatient, polyclinic;
• inpatient care for acute illnesses and exacerbations of chronic diseases, injuries, pregnancy pathologies, abortions; planned hospitalization for treatment.

Exceptions:

• treatment of HIV, tuberculosis and other socially significant diseases;
• ambulance;
• preferentialdrug supply;
• expensive care, from open heart surgery to chemo and neonatal resuscitation.

Paid services

The he alth insurance system in Russia is built in such a way that even within the framework of the state program, a person will have to pay on the spot for some types of services. These services include:

• Citizen-initiated surveys.
• Anonymous diagnostic and preventive measures.
• Procedures performed at home.
• Prophylactic vaccinations at the request of citizens.
• Spa treatment.
• Cosmetology services.
• Dental prosthetics.
• Teaching Nursing Skills.
• Additional services.

CMI policy

This document can be issued by all citizens of Russia, including non-residents who temporarily reside in the country. The validity period of the policy coincides with the time of stay in the state. Citizens of the Russian Federation are issued a policy once for life.

Documentation should be handled by the employer or CMO. At the same time, the insured person has the right to choose the company in which he will be served. Non-working citizens receive a policy at the points of issue serving their area.

Change data

Features of he alth insurance in Russia are such that after changing the place of residence or passport data, the old policy must be handed over to the UK, and after registering in the newarea get a new one. When changing jobs, the document must be returned to the employer. The entrepreneur is obliged to notify the UK about this within 10 days.

In case of loss of the policy, you must notify the insurer as soon as possible. Employees of the company will exclude the document data from the CHI database and begin the procedure for registering a new policy. In this case, a fee of 0.1 minimum wage is charged for issuing a form.

Voluntary he alth insurance in Russia (VHI)

This service allows citizens to receive additional services in addition to compulsory medical insurance. The subjects of the program can be:

• individuals;
• organizations that represent the interests of citizens, or medical institutions;
• businesses.

A person can receive expensive, complex (in the field of dentistry, plastic surgery, ophthalmology, etc.) high-quality services, pass additional tests, etc. Medical insurance in Russia under this program is regulated by an agreement. According to this document, the company is obliged to pay for the services provided to citizens who are included in the corresponding list, to issue each insured person a policy with a service program and a list of institutions through which assistance will be provided within a certain period of time.

The contract also states that the insured person is obliged to pay contributions within a certain period, the validity period of the document, the conditions for its extension, the rules for receiving compensation, as well as the transfer of the right to the contributionafter the death of the insured.

According to the latest data, in 2015, 62% of Russian employers do not pay for VMI services to their employees. Most companies refused to participate in the program due to the difficult economic situation. The costs of employers who signed contracts before 2014-01-08 for 12 months remained unchanged. Only 14% of the 1,000 surveyed companies do. But there are exceptions. 2% of the surveyed employers have reduced the cost of VMI by optimizing the staffing. Units managed to conclude more profitable contracts. Some entrepreneurs have reduced costs by removing dentistry from insurance. Another 5% of surveyed companies saw their costs rise by 5% due to higher medical costs.

Problems of he alth insurance in Russia

At this stage of development, there are such difficulties in the functioning of the system:

1. Reduction of budget financing. The existing tariff of 3.6% does not cover medical care even for working citizens. The elderly, the disabled and children are in greatest need of medical care. Deductions for non-working citizens are transferred from the state budget. As a result, there is a reduction in funding, from which the ambulance suffers the most.
2. Funding of the non-working population comes from anti-tuberculosis, psychiatric and narcological services. There is a real threat of a gap between treatment and prevention.
3. There is no single insurance model.
4. Lack of reliable informationregarding receipts and spending of funds for he alth insurance in Russia.
5. Having outstanding contributions.

These are the serious problems of he alth insurance in Russia at the moment.

Conclusion

One of the forms of social protection of the country's population is he alth insurance. In Russia, its features are that services are provided in three areas. CHI is funded by the state, but within the framework of this program, a person does not receive all types of services. Private he althcare is not available to everyone. Therefore, Russians are offered to be served under a voluntary insurance program. By paying an additional contribution, a person can choose the intermediary insurance company, the scope of services, their types and institutions in which he will receive medical care.