Medical insurance in Russia and its features. Development of medical insurance in Russia

Medical insurance is a form of protection of the population, which consists in guaranteeing payment for doctors' help at the expense of accumulated funds. It guarantees the citizen the provision of a certain amount of services free of charge in case of health problems. Next, let's talk about what medical insurance is in Russia. We will try to consider its features in as much detail as possible.

Concepts

Mandatory medical insurance (OMS) is implemented in accordance with the state program. It is universal for the citizens of the country. Voluntary medical insurance in Russia allows you to receive additional services not provided for MHI. This can be a certain number of visits to specialists, inpatient treatment, etc. By participating in a voluntary program, a person independently chooses the types and scope of services, institutions in which he wants to be served. At the conclusion of the contract, the customer pays a contribution, which allows him to receive service for a certain period of time under the chosen program without additional payment. Let's look at some terms.

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

The insurer is a legal entity that provides medical insurance.

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

A policy is a document confirming the person's participation in the program.

Insurance medical organization (SMO) is a legal entity with authorized capital, which deals exclusively with voluntary or compulsory medical insurance. The activity is carried out in two directions:

• Accumulation of funds for rendering assistance to the population;
• Examination after receipt of services.

Development of medical insurance in Russia

1st stage (1861-1903)

An act was adopted that introduced the foundations of CHI in Russia. At state-owned enterprises, there were established partnerships and auxiliary cash offices, through which temporary disability benefits were granted to members of the company, and deposits were accepted. In 1866, factories had hospitals with a certain number of beds. In general, such a medical aid workers did not like.

Stage 2 (1903-1912)

Medical insurance in Russia survived the first critical stage in 1903, when the law was passed, according to which the employer was liable for damage caused to the health of employees in case of accidents.

Stage 3 (June 1912 - July 1917)

In 1912, the Law on Compulsory Medical Insurance was adopted in case of accidents and illness. On the territory of the Russian Federation there were health insurance companies. Employees at the expense of entrepreneurs were assisted in four areas: initial, outpatient and hospital treatment, obstetric.

Stage 4 (July 1917 - October 1917)

Mandatory medical insurance in Russia was heavily transformed by the Provisional Government:

• There were requirements for sickness funds;
• The circle of the insured has expanded;
• The sickness funds joined without the consent of the entrepreneurs.

Stage 5 (October 1917 - November 1921)

The declaration included full social health insurance in Russia, which was extended to all wage workers, regardless of the reasons for disability. There was a merger of the People's Commissar for Health and Insurance. The medical case was transferred to the People's Commissariat of Health. Cash medicine was abolished.

Stage 6 (November 1921 - 1929)

The new economic policy reintroduced social insurance in case of disability. The rates of contributions were calculated by the number of employed persons in the enterprise. Two funds were organized for these funds. One was at the disposal of social insurance authorities, the second - of public health.

7th stage (1929 - present)

In the next 60 years, the principles of financing the system were formed. Here's how the development of health insurance in Russia.

Modern system

Medical insurance in Russia at the moment exists in three forms. The state is fully financed from the budget. Insurance is formed by accumulation of deductions of enterprises of all forms of ownership and IP contributions. The amount of money that goes into private medicine is calculated by the patient himself.

The state program does not provide high-quality medical care because of a lack of funding. Private medicine is an expensive treat. Therefore, medical insurance is considered the best option for receiving care. Ideally, all persons should receive quality services. After all, the frequency of payments does not match the appeals to the health authorities. This is the principle of accumulation. And since the rate of deductions to the Medical Insurance Fund of Russia for all categories of citizens is set the same, then the amounts of payments should be equal.

OMS

Mandatory medical insurance in Russia is part of the state social program. Within its framework, all citizens are given equal opportunities to receive medicinal and medical assistance in a pre-agreed scope and conditions.

Basic and territorial programs operate in the Russian Federation. They determine what kind of assistance and in what institutions is provided to citizens living in this or that part of the region. The first is developed by the Ministry of Health, the second is approved by the state administration.

Scheme of work

Enterprises monthly list 3.6% of FOP in CHI. Of these, 3.4% are paid to the territorial and 0.2% to the federal MHIF. The state pays for the non-working population. Both funds are independent institutions that accumulate funds, ensure the stability of the system and equalize financial resources. The accumulated money goes to pay for the established volume of medical services.

Insurance companies conclude contracts with the health care facility to help the owners of MHI policies, protect the interests of customers, controlling the terms, volumes and quality of the services provided. Participants in the program can be both Russian citizens and non-residents. However, as for the latter, the list of services available to them is limited.

Territorial program of compulsory medical insurance

This document determines the amount of free medical care provided to citizens. It includes:

• Emergency;
• Out-patient, out-patient;
• Inpatient care Acute diseases and exacerbations of chronic diseases, traumas, pathologies of pregnancy, abortions; Planned hospitalization for treatment.

Exceptions:

• Treatment of HIV, tuberculosis and other socially significant diseases;
• First aid;
• Preferential medicines ;
• Expensive types of care: from open heart surgery to chemotherapy and intensive care of newborns.

Paid services

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

• Surveys are initiated by citizens.
• Anonymous diagnostic and preventive measures.
• Procedures performed at home.
• Preventive vaccinations at the request of citizens.
• Spa treatment.
• Cosmetology services.
• Dental prosthetics.
• Training in the skills of nursing.
• Additional services.

MHI policy

This document can be issued by all citizens of Russia, including non-residents who temporarily reside on the territory of the country. The term of the policy is the same as the period of stay in the state. Citizens of the Russian Federation receive a policy once for a lifetime.

The document must be handled by the employer or SMO. In this case, the insured person has the right to choose the company to be serviced. Non-working citizens receive a policy at the outlets serving their area.

Edit data

The peculiarities of health insurance in Russia are such that after changing the place of residence or passport data, the old policy must be transferred to the UK, and after registration in the new district, a new one should be obtained. When changing the place of work, 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 it is necessary to notify the insurer in the shortest possible time. Employees of the company will exclude these documents from the MHI base and begin the procedure for registering a new policy. At the same time, a fee of 0.1 MROT for issuance of the form is charged.

Voluntary medical insurance in Russia (LCA)

This service allows citizens to receive additional services in excess of CHI. Subjects of the program can be:

• Individuals;
• Organizations that represent the interests of citizens, or medical institutions;
• Enterprise.

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

The agreement also states that the insured person is obliged to pay contributions within a certain period, the terms of the document, the terms of its prolongation, the rules for obtaining compensation, as well as the transfer of the right to a deposit after the death of the insured are prescribed.

According to the latest data, in 2015 62% of Russian employers do not pay VMI services to their employees. Most companies refused to participate in the program because of the difficult economic situation. The costs of employers who concluded contracts before 12/12/2014 for 12 months, remained unchanged. There are only 14% of 1000 companies surveyed. But there are exceptions. 2% of the employers surveyed reduced the cost of VHI, optimizing the staffing level. Units managed to conclude more profitable contracts. Some entrepreneurs reduced the amount of costs by removing dentistry from insurance. Another 5% of the companies surveyed had a 5% increase in costs because of a rise in the cost of medical services.

Problems of health 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 provide coverage for medical care even for working citizens. The elderly, disabled and children need medical care most. Deductions for unemployed citizens are transferred from the state budget. As a result, there is a reduction in funding, from which the most affected first aid.
2. Financing of the unemployed population is at the expense of 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 information on income and expenditure on medical insurance in Russia.
5. Presence of arrears in payment of contributions.

Here such serious problems of medical insurance in Russia exist at the moment.

Conclusion

One of the forms of social protection of the country's population is medical insurance. In Russia, its features are that services are provided in three directions. The MHI is funded by the state, but within the framework of this program, a person does not receive all kinds of services. Private medicine is not available to everyone. Therefore, Russians are offered to be serviced within the framework of a voluntary insurance program. By paying an additional fee, a person can choose the insurance intermediary company, the volume of services, their types and institutions, in which he will receive medical assistance.