The provision of quality medical care is an important and integral component of the system of social protection of citizens. Wherever a citizen is, whatever his financial situation may be, he can receive decent medical care in the event of an unpredictable situation.
Health Insurance Industry Development
The insurance market is an integral element of the economic system, and the development of market relations requires the formation of a domestic insurance market in compliance with international requirements and standards. Social protection of citizens cannot be partial or selective, therefore, its constant provision requires the authorities to fulfill all its components.
Voluntary health insurance is no exception. Because today, for every citizen, this is the only way to get adequate medical care at an adequate level. The development of the medical insurance industry at the present time is holding back a number of reasons, where the main ones are a decrease in state financing of health care, an outdated material base, a shortage of medicines, indicators of the country's demographic development and the incidence rate of citizens, and many others. Today there are constantly many contradictions and problems in the field of health insurance, which require further study.
Insurance justification
The level of financial support for healthcare in Russia is not quite sufficient, which affects the life time of citizens and the quality of treatment. The low salaries of doctors and the declared constitutional guarantees of free care in the healthcare sector, 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 payments unforeseen by laws. Thus, the share of government spending in the structure of total spending on medicine in Russia is only about 56%, while in the EU member states it is about 76%. A significant part of financing in Russia (about 40%) falls on cash expenses of the population, and the rest (about 4%) - on voluntary medical insurance and charity assistance.
Health insurance is a personal insurance industry. It is carried out in 2 main forms: voluntary and mandatory. According to the rules, voluntary insurance has the following types: medical insurance ( continuous health insurance ), medical expenses insurance and health insurance. The health insurance law is strictly regulated.
Considering that increasing state financing of the healthcare sector is problematic due to the difficult economic situation in the state, it is necessary to find other ways to attract money to this sector. In the absence of a mandatory form, voluntary health insurance can solve a significant number of problems.
Insurance Market Analysis
Health insurance is a social orientation, therefore, among the population, the demand for this type of insurance is growing every year. The level of payments under VHI agreements has increased, one of the factors of which is the annual increase in the number of settled insured events.
Analysis of the insurance market gives reason to argue about the loss-making of VHI for most insurance leaders. The specifics of insurance as a type of entrepreneurial activity is related to the fact that the more insurance company has revenues for a certain type of insurance, the greater is the likelihood of a corresponding increase in insurance payments, since insurance liabilities grow proportionally with receipts.
In 2013, there was an increase in net insurance payments for continuous health insurance by 34.2% compared with 2011. Net health insurance benefits in case of illness also tend to increase - almost double. But in general terms, there is an excess of insurance premiums over payments, which is a positive moment in the activities of insurance companies.
Among the reasons for the unprofitability of the industry, there is an increase in the number of clients seeking medical help due to deterioration in the quality of health, aging of the population, demanding clients, imperfect underwriting services, the use of economically unreasonable tariffs, poor organization of work to manage losses, low customer orientation of state medical institutions, overstated business expenses, including commission fees of insurance intermediaries - sellers VHI services.
Voluntary insurance
To date, a certain structure has been formed in Russia in the field of voluntary health insurance. The structure of the domestic VHI market includes state bodies for the supervision of insurance activities, non-state insurance associations, insurance companies, insurance intermediaries, medical institutions, assistance services and consumers.
According to the research results, a significant opposition to the development of voluntary medical insurance is the absence of tax benefits, because companies, which account for 41% of insurance payments, pay them after tax at the expense of net profit. This situation, associated with the lack of tax benefits, significantly slows down the process of detailing the scope of medical services.
When classifying the costs of voluntary medical insurance as administrative and general production expenses, dual-purpose expenses, expenses related to 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 detailing in the field of medical services and increasing revenues to local and state budgets.
Insurance as an element of social protection of citizens
The practice of medical insurance allows us to conclude that there are no economic incentives for entities: for policyholders - improving their health; for a medical institution - the provision of the required medical services. Therefore, it is necessary to apply the mechanism of stimulation of subjects by introducing a health insurance program. It will encourage policyholders to improve and increase the quality characteristics of their health, to prevent its deterioration, and not to create the necessary risk for their physical condition.
Health insurance is an element of the social security system of citizens, which provides compensation for patients' expenses for medical care. In turn, voluntary health insurance is in addition to mandatory insurance and guarantees payment for medical services. Discussion questions concern the problems of increasing the load on the wage fund, managing health insurance funds, duplicating insurance functions, etc.
Insurance in the CIS
The problems of medical insurance as an element of social protection were dealt with by a wide circle of both foreign and Russian scientists - economists and practitioners. Significant developments in this direction contributed to the development of the theoretical foundations of social protection of citizens, in particular the development of the conceptual apparatus and the implementation of practical measures.
However, the issue of providing medical assistance to citizens of our state who went to the CIS countries and to citizens of any of the CIS countries who came to Russia for a certain period of time remained unresolved. The difficult economic conditions that are characteristic of a transformational economy prompt the population quite often to go abroad, in particular to the CIS countries. Close economic, friendly, and family ties are also a factor for travel.
At the same time, risk factors for human health always exist, regardless of whether a trip is made on a tourist permit (when insurance is compulsory) or on their own. The need for medical care for citizens who do not have such a document as a health insurance policy, runs into a purely financial problem. That is, how will medical care for foreign citizens be paid? In Russia, for example, compulsory medical insurance exists, according to which medical care is provided only to Russian citizens free of charge. This situation exists in Belarus. Thus, a problem arises in the specific protection of Russian citizens in the CIS countries, which has not yet been resolved either in theoretical positions or in practice.
Travel insurance for neighboring countries
Voluntary medical insurance in the Russian Federation continues to evolve, which indicates that citizens have recognized the need to protect health. Each year, a significant number of citizens travel abroad for the 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 health insurance policy, what will be the material costs. However, as a rule, people who go abroad to relatives or friends do not expect that they will fall ill and will be allocated the necessary funds for treatment (there is a certain inertia in thinking when medical care in the USSR was free).
Sometimes medical care can be emergency (for tick bites, viral diseases, injuries, etc.). An analysis of the situation gives reason to argue that the provision of medical assistance 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 for free. In order to ensure social protection of citizens in case of loss of health abroad, it is proposed to implement a pilot project (with appropriate legislative support): introduction of contractual health insurance through the Medical Insurance Bureau between the CIS countries and Russia.
Travel Card
If you cross the border in your own vehicle, the customs service can check your health insurance policy. If you are traveling by plane, train or bus, then the insurance fee must be included in the ticket price. The proposed compulsory medical card for a traveler abroad will make it possible to cover all the costs of treatment (inpatient, outpatient), purchase drugs, receive medical services, transport ambulances, and in case of death, repatriate the body of the deceased to his homeland.
Mandatory medical card traveling abroad will be valid for each country participating in this project. This health insurance policy can be issued for a period of 90 days. The card of a traveler abroad must have a clearly approved uniform form, which will be agreed with all participants in the project. A health insurance contract cannot be an absolute guarantee of covering the costs of treating a traveler abroad. Insured events do not include:
- treatment of mental illness;
- treatment of diseases, injuries resulting from illegal actions;
- injuries sustained in a state of drug or alcohol intoxication;
- plastic surgery, except when their need is due to trauma;
- dental services, except when a person has acute toothache;
- treatment of diseases related to AIDS and sexually transmitted diseases;
- treatment of relatives and close friends of the insured with whom he is visiting;
- injuries sustained while attempting suicide;
- the implementation of an abortion, except when it threatens the life of a woman;
- diagnostics at the request of the insured;
- sanatorium treatment and more.
Medical Insurance Bureau
The Medical Insurance Bureau (SME) is the only association of insurance companies in the country. This organization may consist of a certain number of associate and full members who provide medical insurance for travelers abroad. That is, membership is the main condition for the possibility of this type of insurance. Members of this bureau have the right to deduct bonuses under the health insurance contract “Mandatory medical card of a traveler abroad” to the health insurance fund. 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 health insurance fund if necessary to treat the patient abroad, provide medical services, and repatriate the person to his homeland in case of death. The health insurance bureau will act as a non-profit organization.
The proposed project “Mandatory medical card traveling abroad” provides:
1) the creation of the National Medical Insurance Bureau, which includes all insurers providing compulsory medical insurance for traveling abroad;
2) compulsory health insurance for people crossing the border of their own state to visit CIS countries for a certain period (up to 90 days);
3) the availability of the relevant legislative framework on medical insurance of citizens, which regulates the activities of insurers in this area.
Health Insurance Funds of the Russian Federation
The Mandatory Health Insurance Fund was created to finance the expenses of Russian citizens on health care services. Compulsory health insurance is an integral part of state social insurance.
The main goals of the fund:
- monitoring the rational expenditure of funds;
- payment for targeted programs.
The income of the fund is the following contributions:
- state health insurance;
- enterprise contributions;
- use of temporarily surplus funds of the fund.
The main tasks of the federal compulsory health insurance fund include:
- financing of medicine;
- accumulation of financial resources;
- in the health sector - the implementation of federal programs.
The territorial system of compulsory medical insurance provides direct financing for medical institutions. The insurance premium rate is 3.6% in relation to the calculated wage. Insurance contributions to the compulsory health insurance fund are included in the cost. Payment to the medical, social and pension funds is called a single social tax.
Key factors
Based on the foregoing, it is possible to determine the main factors that, in the current conditions of the functioning of the insurance market, affect health insurance:
- Economic instability in the state, which forces the population to carry out financial expenses only for the most necessary.
- 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 for employees under VHI programs, which makes it impossible for employers to avoid compensation for medical expenses).
- The big monopolization of the market for medical services 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 health insurance, including voluntary, are comforting. The share of VHI in the insurance market has a tendency to increase, insurers who provide VHI services are becoming more competitive, the interest of the population in this type of insurance and the like is increasing.