He alth insurance - what is it? He alth Insurance Fund

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

Providing quality medical care is an important and integral part of the system of social protection of citizens. Wherever a citizen is, whatever his financial situation, he can receive decent medical care in the event of an unpredictable situation.

Development of the he alth insurance industry

The insurance market is an integral part of the economic system, and the development of market relations requires the formation of the domestic insurance market in compliance with international requirements and standards. Social protection of citizens cannot be partial or selective, therefore its permanent provision requires the authorities to fulfill all its components.

Voluntary he alth insurance is no exception. Because today, for every citizen, this is the only way to receive adequate medical care at a sufficient level. The development of the he alth insurance industry is currently hindered by a number of reasonswhere the main ones are a decrease in state funding for he alth care, an outdated material base, a shortage of medicines, indicators of the country's demographic development and the level of morbidity of citizens, and many others. Today, there are many controversies and problems in the field of he alth insurance that require further study.

Insurance justification

The level of financial support for he alth care in Russia is not entirely sufficient, which affects the life of citizens and the quality of treatment. The low salaries of doctors and the proclaimed constitutional guarantees of free he althcare assistance, unfortunately, do not encourage the provision of the required medical services. Therefore, today the medical industry is based on self-sufficiency, which is manifested in charitable contributions and unforeseen payments by laws. Thus, the share of public spending in the structure of total spending on medicine in Russia is only about 56%, while in the EU member countries it is about 76%. A significant part of funding in Russia (about 40%) comes from out-of-pocket expenses of the population, and the rest (about 4%) comes from voluntary he alth insurance and charitable assistance.

He alth insurance is a branch of personal insurance. It is carried out in 2 main forms: voluntary and mandatory. According to the rules, voluntary insurance has the following types: medical insurance (continuous he alth insurance), medical expenses insurance and insurancehe alth. The he alth insurance law is strictly regulated.

Given that increasing public funding of the he althcare industry is problematic due to the difficult economic situation in the state, it is necessary to find other ways to attract money to this industry. In the absence of a mandatory form, voluntary he alth insurance can solve a significant number of problems.

Insurance market analysis

He alth insurance is a social orientation, so the demand for this type of insurance among the population is growing every year. The level of payments under VHI agreements has increased, one of the factors of which is the annual growth in the number of settled insured events.

Analysis of the insurance market gives reason to assert that VHI is unprofitable for most insurance leaders. The specificity of insurance as a type of business activity is related to the fact that the more income from a certain type of insurance an insurance company has, the greater the likelihood of a corresponding increase in insurance payments, since insurance liabilities grow proportionally with income.

In 2013, there was an increase in net insurance payments for continuous he alth insurance by 34.2% compared to 2011. Net he alth insurance premiums for sickness also tend to increase, almost doubling. But in general terms, there is an excess of insurance premiums over payments, which is a positive moment in the activities of insurance companies.companies.

Among the reasons for the unprofitability of the industry is the increase in the number of clients seeking medical care due to the deterioration in the quality of he alth, the aging of the population, the exactingness of clients, the imperfection of underwriting services, the use of economically unreasonable tariffs, the poor organization of work on the settlement of losses, the low client orientation of public medical - preventive institutions, inflated costs of doing business, including commission fees of insurance intermediaries - sellers of VHI services.

Voluntary insurance

Today, a certain structure has been formed in Russia in the field of voluntary medical insurance. The structure of the domestic VHI market includes state insurance supervisory authorities, non-state insurance associations, insurance companies, insurance intermediaries, medical institutions, assistance services and consumers.

According to research results, a significant resistance to the development of voluntary he alth insurance is the lack of tax incentives, because companies, which account for 41% of insurance payments, pay them after tax from their net profit. This situation, associated with the lack of tax benefits, significantly slows down the process of deshadowing the medical services sector.

When attributing the costs of voluntary medical insurance to administrative and general production expenses, dual-purpose expenses,costs associated with the provision of services, as well as after resolving the problems associated with determining the numerical amount of such costs for the reporting tax period, it is possible to increase the quality of medical services, which will give a good impetus to the de-shadowing in the field of medical services and increase revenues to local and state budgets.

Insurance as an element of social protection of citizens

The practice of conducting he alth insurance allows us to conclude that there are no economic incentives for subjects: for insurers - improving their he alth; for a medical institution - the provision of the required medical services. Therefore, it is necessary to apply a mechanism to stimulate subjects by introducing a he alth insurance program. It will encourage policyholders to improve and increase the qualitative characteristics of their he alth, prevent its deterioration, and not create the necessary risk for their physical condition.

He alth insurance is an element of the system of social protection of citizens, which provides compensation for patients' expenses for medical care. In turn, voluntary he alth insurance is an addition to the mandatory one and guarantees payment for medical services. The debatable issues relate to the problems of increasing the burden on the wage fund, managing he alth insurance funds, duplicating insurance functions, etc.

Insurance in the CIS

He de alt with the problems of he alth insurance as an element of social protectiona wide range of both foreign and Russian scientists - economists and practitioners. Significant developments in this direction contributed to the development of the theoretical foundations of the social protection of citizens, in particular the development of the conceptual apparatus and the introduction of practical measures.

However, the issue of providing medical care to citizens of our state who went to the CIS countries, and citizens of any of the CIS countries who came to Russia for a certain period of time, remained unresolved. Difficult economic conditions, which are typical for a transformational economy, encourage the population to travel abroad quite often, in particular, to the CIS countries. Close economic, friendship and family ties are also a factor in travel.

At the same time, risk factors for human he alth always exist, regardless of whether the trip is carried out on a tourist package (when insurance is mandatory) or on your own. The need for medical care for citizens who do not have such a document as a he alth insurance policy leads to a purely financial problem. That is, how will medical care be paid for foreign citizens? In Russia, for example, there is compulsory he alth insurance, according to which medical care is provided free of charge only to Russian citizens. This situation exists in Belarus as well. Thus, a problem arises in the certain protection of Russian citizens in the CIS countries, which has not yet found its solution either in theory or in practice.

Insurance for people leaving forneighboring countries

Voluntary he alth insurance in the Russian Federation continues to develop, which indicates that citizens are aware of the need to protect their he alth. Every year, a significant number of citizens travel abroad for an appropriate period. The number of tourists traveling abroad is increasing every year.

During trips, there is a possibility that Russian citizens may find themselves in a difficult situation (illness, injury, etc.). To solve these problems, certain knowledge is needed, for example, where to get a he alth insurance policy, what will be the material costs. However, as a rule, people who go abroad to visit relatives or friends do not expect that they will fall ill and that they will be provided with the necessary funds for treatment (here there is a certain inertia of thinking when medical care in the USSR was free).

Sometimes medical assistance can be emergency (for tick bites, viral diseases, injuries, etc.). An analysis of the situation gives grounds to assert that the provision of medical care to Russian citizens in other states is carried out for an appropriate fee. In turn, foreigners in Russia had the opportunity to receive medical care free of charge. In order to ensure social protection of citizens in case of loss of he alth abroad, it is proposed to implement a pilot project (with appropriate legislative support): the introduction on a contractual basis of mandatorymedical insurance through the Medical Insurance Bureau between the CIS countries and Russia.

Abroad Travel Card

If you cross the border in your own vehicle, customs may check your he alth insurance policy. If you are traveling by plane, train or bus, then the insurance premium must be included in the ticket price. The proposed mandatory medical card for traveling abroad will make it possible to cover all the costs of treatment (inpatient, outpatient), purchase drugs, receive medical services, transport by ambulance, and in case of death, repatriate the body of the deceased to his homeland.

Compulsory medical card for traveling abroad will be valid for each country participating in this project. This he alth insurance policy can be issued for a period of 90 days. The card for traveling abroad must have a clearly approved uniform form, which will be agreed with all project participants. A he alth insurance contract cannot be a 100% guarantee of covering the costs of medical treatment of a traveler abroad. Insurance events do not include:

• treatment for mental illness;
• treatment of diseases, injuries resulting from illegal actions;
• injuries sustained while under the influence of drugs or alcohol;
• plastic surgery, except when necessary due to trauma;
• dental services, unlesshuman acute toothache;
• treatment of AIDS and STD related illnesses;
• treatment of relatives and close friends of the policyholder with whom he is visiting;
• suicide attempt injuries;
• performing an abortion, except when it threatens the woman's life;
• carrying out diagnostics at the request of the insured;
• treatment in sanatoriums and more.

Medical Insurance Bureau

Medical Insurance Bureau (MSB) is the only association of insurance organizations in the country. This organization may consist of a certain number of associate and full members who provide he alth insurance for travelers abroad. That is, membership is the main condition for the possibility of carrying out this type of insurance. Members of this bureau have the right to deduct premiums to the he alth insurance fund under he alth insurance contracts "Obligatory medical card for traveling abroad". The Bureau, in turn, will ensure timely and high-quality settlement of insured events under these contracts. All SME members will be able to make timely payments to the he alth insurance fund if it is necessary to treat a patient abroad, provide medical services, and repatriate a person to their homeland in case of death. The He alth Insurance Bureau will operate as a non-profit organization.

The proposed draft "Compulsory Traveler's He alth Card" provides for:

1) establishment of the National He alth Insurance Bureau, towhich includes all insurers providing compulsory he alth insurance for travelers abroad;

2) compulsory he alth insurance for persons crossing the border of their own state to visit the CIS countries for a certain period (up to 90 days);

3) the existence of an appropriate legislative framework on the medical insurance of citizens, which regulates the activities of insurers in this area.

Russian He alth Insurance Funds

The Mandatory Medical Insurance Fund was created to finance the costs of Russian citizens for he althcare services. Compulsory he alth insurance is an integral part of state social insurance.

Main goals of the fund:

• monitoring the rational use of funds;
• payment for targeted programs.

The income of the fund is the following contributions:

• he alth insurance from the state budget;
• enterprise contributions;
• use of temporarily free funds of the fund.

The main tasks of the federal CHI fund include:

• funding medicine;
• accumulation of financial resources;
• in the he alth sector - the implementation of federal programs.

The territorial system of compulsory medical insurance provides direct financing of medical institutions. The insurance contribution rate is 3.6% of the calculated wages. Insurance contributions to the compulsory he alth insurance fund are included in the prime cost. Payment to the medicalsocial and pension funds is called a unified social tax.

Key Factors

Based on the above, it is possible to determine the main factors that in the current conditions of the functioning of the insurance market affect he alth insurance:

• Economic instability in the state, which forces the population to spend financially only on the bare necessities.
• Imperfect legislation (for example, this is manifested in the absence of tax incentives).
• Increased sales and cost of medicines.
• Increasing the social responsibility of the insurance business (increasing the share of collective insurance of employees under VMI programs, which makes it impossible for employers to avoid reimbursement of medical expenses).
• Greater monopolization of the medical services market forces medical institutions to increase the cost and quantity of services provided.
• Low insurance culture of citizens.

Summing up, it can be noted that the prospects for the development of medical insurance, including voluntary types, are comforting. The share of VHI in the insurance services market tends to grow, insurers providing VHI services are becoming more competitive, the population's interest in this type of insurance is increasing, and the like.