Health insurance is a form of public protection, which is to guarantee the payment of medical assistance from accumulated funds. It guarantees a 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.
The concepts
Compulsory medical insurance (MHI) 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 by the compulsory medical insurance. This may be a certain number of specialist visits, 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 services for the selected program for a certain period of time without surcharge. We will deal with some terms.
Policyholder - a person who pays contributions. It can be a person or an organization.
Insurer - a legal entity that provides health insurance.
Treatment and prevention institutions (MPIs) are 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 the participation of a person in the program.
Medical insurance organization (SMO) is a legal entity with authorized capital that deals exclusively with voluntary or compulsory medical insurance. The activities are carried out in two directions:
- accumulation of funds to assist the population;
- examination after receiving services.
The development of health insurance in Russia
Stage 1 (1861-1903)
An act was passed that introduced the basics of compulsory medical insurance in Russia. At state-owned factories, partnerships and subsidiary cash desks were established, through which temporary disability benefits were issued to members of the company, 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.
Stage 2 (1903-1912)
Health insurance in Russia went through the first turning point in 1903, when a law was passed under which the employer was held responsible for damage to the health of employees in 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 appeared health insurance funds. Employees at the expense of entrepreneurs were assisted in four directions: initial, outpatient and bed care, obstetric care.
Stage 4 (July 1917 - October 1917)
Compulsory health insurance in Russia was strongly transformed by the Provisional Government:
- there were requirements for sickness funds;
- the circle of insured has expanded;
- sickness funds were combined without the consent of entrepreneurs.
Stage 5 (October 1917 - November 1921)
The declaration provided full social health insurance in Russia, which extended to all wage workers, regardless of the reasons for their disability. There was a merger of the People's Commissariat of Health and Insurance Medicine. The medical case was transferred to the management of the People's Commissariat of Health. Cash register medicine has been abolished.
Stage 6 (November 1921 - 1929)
The new economic policy has again introduced social insurance in case of disability. Contribution rates were calculated by the number of employees in the enterprise. Two funds were organized for the transferred funds. One was at the disposal of the social insurance authorities, the second - health.
Stage 7 (1929 - present)
In the next 60 years, the principles of financing the system were formed. This is how the development of health insurance in Russia took place.
Modern system
Health insurance in Russia currently exists in three forms. The state is fully funded from the budget. Insurance is formed by the accumulation of deductions of enterprises of all forms of ownership and contributions of individual entrepreneurs. The amount of funds that go into private medicine is calculated by the patient himself.
The state program does not provide high-quality medical care due to a lack of funding. Private medicine is an expensive pleasure. Therefore, health insurance is considered the best option for getting help. Ideally, all individuals should receive quality services. After all, the frequency of payments does not correspond to appeals to health authorities. This is the principle of accumulation. And since the rate of deductions to the Russian Health Insurance Fund is the same for all categories of citizens, the volume of payments should be equal.
Compulsory medical insurance
Compulsory health insurance in Russia is part of the state social program. Within its framework, all citizens are given equal opportunities to receive medical and medical care in a predetermined amount and conditions.
In Russia, there are basic and territorial programs. They determine what kind of assistance and in what institutions is provided to citizens living in one or another part of the region. The first is being developed by the Ministry of Health, the second is approved by government.
Scheme of work
Every month, enterprises transfer 3.6% of the federal pension to the compulsory medical insurance. Of these, 3.4% are paid to the territorial and 0.2% to the federal MHIF. For the non-working population, the state pays the fees. Both funds are independent institutions that accumulate funds, ensure system stability and equalize financial resources. The accumulated money is used to pay for the established amount of medical services.
Insurance companies conclude agreements with health care providers to assist holders of compulsory medical insurance policies, protect the interests of clients by controlling the timing, volume and quality of services provided. The program participants can be both Russian citizens and non-residents. True, with regard to the latter, the list of services available to them is limited.
Territorial program of compulsory medical insurance
This document defines the amount of free medical care provided to citizens. It includes:
- emergency;
- outpatient, outpatient;
- inpatient care acute diseases and exacerbations of chronic diseases, injuries, pathologies of pregnancy, abortion; planned hospitalization for treatment.
Exceptions:
- treatment of HIV, tuberculosis and other socially significant diseases;
- ambulance;
- preferential drug provision;
- expensive types of care: from open heart surgery to chemotherapy and resuscitation of newborns.
Paid services
The medical insurance system in Russia is designed in such a way that even within the framework of the state program, for some types of services, a person will have to pay on the spot. These services include:
- Surveys initiated by citizens.
- Anonymous diagnostic and preventive measures.
- Procedures carried out at home.
- Preventive vaccinations at the request of citizens.
- Spa treatment.
- Cosmetology services.
- Dental prosthetics.
- Patient care training.
- Additional services.
MHI policy
This document can be issued by all citizens of Russia, including non-residents who temporarily reside in the country. The term of the policy coincides with the time spent in the state. Citizens of the Russian Federation issued a policy once for life.
The paperwork should be done by the employer or QS. In this case, 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 delivery serving their area.
Data change
The peculiarities of medical insurance in Russia are such that after changing your place of residence or passport data you need to return the old policy to the UK, and after registering in a new area, get a new one. When changing jobs, the document must be returned to the employer. The entrepreneur is obliged to notify the UK within 10 days.
In case of loss of the policy, it is necessary to notify the insurer as soon as possible. Employees of the company will exclude the document data from the MHI database and begin the procedure for registering a new policy. In this case, a fee of 0.1 minimum wage for issuing the form is charged.
Voluntary Health Insurance in Russia (VHI)
This service allows citizens to receive additional services beyond the compulsory medical insurance. The subjects of the program may be:
- individuals
- organizations that represent the interests of citizens, or medical facilities;
- enterprises.
A person can receive expensive, complex (in the field of dentistry, plastic surgery, ophthalmology, etc.) services of higher quality, undergo additional tests, etc. Medical insurance in Russia under this program is regulated by the contract. According to this document, the company is obliged to pay for the services rendered to citizens, which are included in the corresponding list, to give each policyholder a policy with a service program and a list of institutions through which assistance will be provided.
The contract also states that the insured person is obliged to pay contributions at a specified time, the validity period of the document, the conditions for its extension, the rules for receiving compensation, and the transfer of the right to payment after the death of the insured are prescribed.
According to the latest data, in 2015, 62% of Russian employers do not pay for VHI services to their employees. Most companies refused to participate in the program due to the difficult economic situation. The costs of employers who entered into contracts for 12 months before 01.08.2014 remained unchanged. There are only 14% of the 1000 companies surveyed. But there are exceptions. 2% of the surveyed employers reduced the cost of VHI by optimizing their staffing levels. The units managed to conclude more profitable contracts. Some entrepreneurs have reduced costs by removing dentistry from insurance. Another 5% of the companies surveyed increased costs by 5% due to the 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:
- Reduce budget funding. The existing 3.6% tariff does not provide coverage for medical care even for working citizens. Most of all, elderly people, people with disabilities and children need medical care. Deductions for unemployed citizens are transferred from the state budget. The result is a reduction in funding, from which the ambulance is most affected.
- Funding for the non-working population comes from the funds of the TB, psychiatric and narcological services. There is a real threat of a gap between treatment and prevention.
- There is no single insurance model.
- Lack of reliable information regarding the receipts and expenditures of funds for health insurance in Russia.
- The presence of arrears in the payment of contributions.
These are the serious problems of medical insurance in Russia 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. Compulsory medical insurance is funded by the state, but within the framework of this program, a person receives far from all types of services. Private medicine is not available to everyone. Therefore, Russians are offered to be served as part of a voluntary insurance program. Having paid an additional fee, a person can choose an intermediary insurance company, the amount of services, their types and institutions in which he will receive medical care.