PURPOSE of the Lesson: To get acquainted with the procedure for financing health care facilities in the conditions of the budgetary and insurance system of health care. To study the content of the financial plan of the health facility. Master the basics of knowledge on economic relations in health care, the methodology for calculating indicators of total economic damage due to morbidity, prevented economic damage, economic efficiency ratio, economic losses from idle beds, etc.

Methodology of the lesson: Students independently prepare for a practical lesson according to the recommended literature and do individual homework. The teacher within 10 minutes checks the correctness of the homework and points out the mistakes made, checks the degree of preparation using testing and oral questioning. Then students complete standard assignments in health economics.

TEST QUESTIONS:

1. What is the purpose of compulsory health insurance?

2. How is the financing of healthcare institutions in the conditions of budget-insurance medicine?

3. Name the subjects of compulsory medical insurance. What are their rights and obligations?

4. How are compulsory medical insurance funds formed to finance medical care?

5. How are CHI funds distributed?

6. Who are the insurers and what is their role in CHI?

7. Does the policyholder have the right to choose an insurance medical organization?

8. What contributed to the emergence in the second half of the 20th century of an independent science - health economics?

9. What is the purpose of health economics?

10. What are the main challenges facing health economics?

11. What is the role of health economics in the system of public health protection?

12. What types of efficiency of the existing healthcare system do you know?

13. How are health care performance indicators calculated?

TOPIC SUMMARY:

With the enactment in 1993 of the Law "On health insurance in Russian Federation"(1991) in Russia, the process of direct reform of the healthcare system began. It was focused primarily on improving the financing model. The goals of the reform were associated with increasing the efficiency of the use of available resources, improving the quality of medical care, strengthening preventive work, and eliminating the actual inequality of access to qualified medical care, depending on the place of residence and level of income of citizens. social insurance- compulsory medical insurance (CHI) and voluntary medical insurance (VHI).

Compulsory health insurance is a form of social protection for citizens in the transition of the country's economy to market relations and is designed to provide affordable and free medical care of a guaranteed volume and quality with the rational use of available health care resources. CHI funds are state-owned by the Russian Federation. Compulsory medical insurance for citizens of the Russian Federation is universal and provides the entire population with equal opportunities to receive medical and drug assistance in the amount provided for by compulsory medical insurance programs. These programs cover all major types of assistance. Voluntary health insurance provides additional medical and other services in excess of those provided for and is not universal.

The introduction of the compulsory health insurance system proceeded from the main goal - to obtain additional sources of financing for the healthcare system and improve the quality of medical care for patients. Currently, health care is financed not only from the funds state budget and local budgets, but also from the funds of the compulsory health insurance system and extrabudgetary funds (VHI funds, personal funds of citizens, bank loans, sponsors' funds, profit from valuable papers and etc.). The state legislates the sources of financing for health care and the percentage of the gross national product (GNP) that goes to providing medical care to the population. In our country, this indicator ranges from 3 to 4% of the expenditure part of the budget, which is clearly not enough. According to WHO recommendations, the share of GNP allocated for health needs should not be less than 5%, and many economically developed countries spend 10-12% of GNP for these purposes.

The Law "On Health Insurance in the Russian Federation" defines the participants (subjects) of compulsory health insurance. The subjects of compulsory medical insurance are: a citizen, an insurer (an individual or legal entity that concludes an insurance contract for citizens), an insurer (an individual or legal entity that conducts insurance and is in charge of spending the insurance fund), a medical institution. The basic rights and obligations of health insurance participants are also reflected in the Law. Thus, a citizen in the MHI system has the right to: choose an insurance medical organization, a medical institution and a doctor, receive guaranteed (free) assistance throughout the Russian Federation, including outside the permanent place of residence. Eligible to receive medical services corresponding in terms of volume and quality to the terms of the contract, regardless of the amount of the actually paid insurance premium, filing a claim against the insured, the medical insurance organization, the medical institution for material compensation for the damage caused through their fault.

The insured is the one who contributes funds for the provision of medical care. The insurers in the MHI for the working population are employers (enterprise, institution, organization where the insured citizen works), individuals engaged in individual activities, and freelancers. The insured for the non-working population (children, students, disabled people, pensioners, temporarily unemployed), as well as for those working at budgetary enterprises are the authorities state entities Russian Federation and local administration. The law provides for the right of the insured to choose an insurance medical organization. The insured should, first of all, check whether the insurance medical organization has a state license for the right to carry out insurance activities for compulsory medical insurance in the given territory, as well as indicators of its financial condition and solvency. If the policyholder is satisfied with the degree of reliability of the insurance medical organization chosen by him, then he has the right to make an independent decision on the conclusion of compulsory medical insurance contracts. The insured is required to pay insurance premiums on CHI in the manner prescribed by applicable law. In the event of failure to comply with this obligation, contributions may be collected by force. At the expense of the insurers' funds, the Federal and Territorial Funds of Compulsory Medical Insurance of Citizens are formed, where the insurers deduct 0.2% and 3.4% of the salary fund, respectively (3.6% in total). Unfortunately, the funds of compulsory medical insurance are sufficient only to pay for 30% of the current volume of medical care. In order to maintain free medical care for citizens in full, it is necessary to compensate for the missing funds from the state and local budgets.

Compulsory medical insurance funds and medical insurance companies can act as insurers. The main functions of the territorial CHI fund are: the accumulation of financial resources of compulsory medical insurance, the establishment of a per capita funding standard per 1 inhabitant of the region, the approval of territorial basic programs of compulsory medical insurance, the development of rules for compulsory medical insurance in the relevant territory, the provision of loans to insurers with a justified lack of financial resources. The Federal Compulsory Medical Insurance Fund ensures the unity of the compulsory health insurance system in Russia and subsidizes territorial funds when they lack funds due to objective reasons (the difficult state of the economy, a large number of sick and elderly people, etc.). The Federal CHI Fund also collects and analyzes information on the financial resources of the CHI system and conducts methodological work to improve its activities. It should be emphasized that CHI funds are non-profit financial and credit institutions.

Insurance companies are public non-profit organizations that are not subordinate to the health authorities. Insurance companies enter into contracts with state, private healthcare facilities, private practitioners for the provision of medical services to insured citizens and are financed from the funds of the territorial compulsory medical insurance fund. For this, 4% of the funds contained in the territorial fund are deducted. Insurance companies have two departments in their structure: 1 - department of financial and accounting activities (accumulation of funds to pay for the cost of medical care), 2 - department for the examination of the provision of medical services to insured citizens. This department employs highly qualified doctors who control the quality of medical care and take part in the selection of medical institutions for participation in compulsory medical insurance. The relationship between insurance medical organizations (insurer) and medical institutions is regulated by contracts for the provision of inpatient and outpatient care for compulsory health insurance.

Medical institutions operating in the MHI system are independent business entities and build their activities on the basis of contracts with insurance medical organizations. They provide therapeutic, diagnostic and preventive assistance to persons who have an insurance policy - a monetary document certifying the conclusion of an insurance contract and containing its conditions. The cost of medical care provided to insured citizens within the framework of the Basic Compulsory Medical Insurance Program (the minimum volume of free medical services) is paid for by insurance medical organizations. Mutual settlements can be carried out for one treated patient at the average rate or for specifically rendered medical services. In case of violation by the medical institution of the terms of the contract, the insurance organization has the right to partially or completely not reimburse the costs of providing medical services.

Under compulsory medical insurance, medical institutions have additional sources of funding: budgetary funds (funds from health authorities, if they participate in targeted and comprehensive programs); funds of insurance companies CHI and VHI; as well as funds for the provision of paid services to the population (medical and non-medical); direct contracts with industrial enterprises - a contract for a medical examination, charitable funds, etc. Each health facility operating in the CHI system must be licensed and accredited. License - a special permit to carry out a specific type of activity (type of medical care), subject to mandatory compliance with license requirements and conditions, issued by the licensing commission. Licensing must be carried out by all medical institutions, regardless of the form of ownership. State institutions are licensed every 5 years; private - once every 3 years. The purpose of licensing is to assess the possibility of providing various types of medical care and services. Accreditation - determination of the compliance of the activities of health facilities with established standards for the quality of medical care and services. A health care facility is assigned a certain category and a certificate is issued. Accreditation is carried out by special accreditation commissions operating under the guidance of governing bodies. The goal is to provide the consumer with the necessary volume and quality of medical care. In many regions there are unified accreditation and licensing commissions.

With the transition to the CHI system, not all health problems in Russia have been resolved. Over the past period, the vast majority of regions have not been able to provide funding for the minimum volume of free medical services guaranteed by the Law, as determined by the Basic CHI Program. Therefore, part of the medical services provided by this program began to be transferred to the sphere of paid medicine. The level and volume of medical care began to depend on the solvency of patients. Until now, insufficient financing of health care is combined with low efficiency in the use of resources and an imbalance in the structure of medical care. In this regard, the main task of strengthening the financial base of compulsory medical insurance is to develop new approaches to the formation of a program for providing citizens with free medical care, as well as to increase the efficiency of the use of allocated financial and material resources.

The introduction of insurance medicine and the development of market relations in the country led to the reorganization of the economic base of healthcare, reforming the economy of the industry. Health economics- a field of economic sciences and healthcare organization that studies the economic efficiency of measures to protect public health and develops methods for the rational use of healthcare resources. Health economics is relative new area economic knowledge, which emerged as an independent science in the second half of the 20th century. Reasons for singling out health economics as an independent science:

· In the 20th century, health care has become a resource-intensive sector of the country's economy, which accumulates a large amount of material, labor, financial, and information resources. The problem of their rational planning and effective use is ripe.

· The volume of offered medical services and the demand for them have increased, so there is a need to regulate supply and demand in healthcare.

· The importance of economic problems arising from the reproduction of the labor force is recognized. Investments in programs related to the promotion of public health have become economically justified.

The goal of health economics is to find the most rational and economical ways of using the material and financial resources allocated for the protection of public health, as well as to evaluate the effectiveness of health care.

The main tasks of the health care economy: analysis of the efficiency of the use of material, labor and financial resources; economic justification of plans, targeted programs, preventive measures; determination of expenses for various types of medical care; study and evaluation of the economic efficiency of medical care, various medical measures and forms of medical care.

Efficiency is the ratio of any results obtained to the cost of resources. The results can be expressed in the form of medical, social, economic and other indicators.

There are the following types of health care efficiency:

· Medical efficiency is assessed by the quality and degree of achievement of a positive result of a particular technique, technology of treatment, prevention, diagnosis or rehabilitation. It can be expressed by various indicators of the quality and efficiency of the activities of medical institutions (reduction of the average time for diagnosis, the average duration of the disease, the patient's stay in the hospital). An increase in the percentage of favorable outcomes of diseases, a decrease in the level of disability and mortality, the optimal use of the bed fund, medical equipment, labor and financial resources also speak of medical effectiveness.

· Social efficiency - assesses not only the number of lives saved, the number of increase in the economically active age by reducing morbidity, disability and mortality, but also the availability of health measures for all segments of the population. It is expressed in a decrease in negative indicators of the health of the population (morbidity, mortality) and an increase in positive ones (physical development, fertility, life expectancy, etc.).

· Economic efficiency - obtaining the maximum possible benefits from the limited resources available, that is, optimizing the costs of medical care, the economic justification of health measures, economic analysis of the use of funds in health care.

By the end of the 20th century, the problems of economic evaluation of the effectiveness of treatment have become one of the important problems of clinical medicine. The need for economic analysis of the effectiveness of medical interventions is determined by several reasons. First, the rapid growth in the cost of treating the most common diseases and the general rise in the cost of medical services. Secondly, the emergence of alternative methods of treating the same disease, the choice of which has to take into account not only their clinical effectiveness, but also the cost. And, finally, thirdly, the lag in the possibilities of financing high-tech and expensive methods of treatment, which exists in all countries. The rising cost of treating certain diseases is becoming a serious social and economic problem. Thus, improving the immediate results of medical and surgical treatment of the most common heart diseases increases the proportion of patients who live to a more advanced age and the stage of disease development at which the likelihood of developing chronic heart failure (CHF) is high. Progress in the treatment of heart disease is increasing the number of people suffering from CHF. This is a paradoxical situation, which some authors have called "the ironic failure of success." In the United States alone, annual direct costs associated with treating heart failure have doubled in 10 years. The existence of alternative approaches to the treatment of the most common diseases poses the problem of choosing the most effective one. However, high clinical efficacy may be accompanied by unacceptably high financial costs.

The economic evaluation of the effectiveness of a particular medical program or method of treatment as a whole is a comparison of the effectiveness of these interventions and the costs associated with them. Cost accounting involves the assessment of direct and indirect costs, expressed in terms of monetary units. Determination of direct costs is considered less difficult. Typically, these costs include the cost of equipment and drugs, the cost of transportation, food, payment of attendants, correction of side effects. It is more difficult to take into account indirect costs: losses associated with the termination of the patient's participation in social production due to illness, as well as a decrease in his personal income. Evaluation of the effectiveness of interventions is a more complex component of the economic evaluation of the effectiveness of interventions. In contrast to the assessment of costs, which always lead to a monetary equivalent, the effectiveness of interventions can be expressed both in monetary terms and in other units that are more acceptable in a given situation: life expectancy, the number of lives saved, a decrease in morbidity with temporary disability, and others. In accordance with the choice of evaluation criterion, there is a need for various forms of cost-effectiveness analysis.

The need to introduce health insurance in Russia during the transition to a market economy was largely predetermined by the search for new sources of healthcare financing.

Compared to the existing public health care system in Russia, financed from the budget, moreover, according to the residual principle, the health insurance system allows the use of additional sources of health care financing in order to create the most favorable conditions for the full realization of citizens' rights to receive qualified medical care.

In connection with the introduction of the principles of medical insurance in the country, the system of financing both the industry as a whole and individual medical institutions was practically revised.

The main sources of medical and preventive and health-improving and rehabilitation services are budgetary funds and insurance funds generated by contributions from individuals and legal entities. The state budget performs a protective function in relation to socially unprotected groups of the population (pensioners, the disabled, children) and workers in the field of education, culture, healthcare, and management. Contributions to the insurance funds of the working part of citizens are made through enterprises (institutions, organizations). These costs are included in the cost of the enterprise's products (works or services).

Thus, insurance funds play the role of an intermediary between the medical institution (HCI) and the population. However, the maximum effect of the functioning of insurance medicine can be achieved only when the consumer enjoys the freedom to choose both the medical facility and the doctor, and those intermediaries that guarantee the protection of his interests to the patient (insured). Otherwise, the monopoly of the intermediary generates corporate interests that are opposite to the interests of the end consumer.

In accordance with Article 10 of the Law of the Russian Federation "On Health Insurance", the sources of financial resources of the healthcare system are:

• funds of the republican budget (of the Russian Federation), the budgets of the republics within the Russian Federation and local budgets;
• funds of state and public organizations (associations), enterprises and other economic entities;
• personal funds of citizens;
• gratuitous and (or) charitable contributions and donations;
• income from securities;
• loans from banks and other creditors;
• other sources not prohibited by law.

From these sources are formed:

• financial resources of the state, municipal health care systems;
• financial resources state system compulsory health insurance.

Financial resources of the state system of compulsory medical insurance are intended for the implementation of the state policy in the field of compulsory medical insurance and are formed at the expense of deductions from insurers for compulsory medical insurance. In most foreign countries with a developed system of compulsory health insurance, there are three main sources of funding for compulsory health insurance:

• deductions from the budget;
• funds of entrepreneurs;
• personal funds of citizens.

In Russia, the financial resources of the compulsory health insurance system are formed from two sources:

• payments from the budget;
• contributions from enterprises, organizations and other legal entities to the compulsory health insurance fund.

Funds are transferred through banks to the mandatory health insurance funds from insurers who are required to register with these funds as payers of insurance premiums. The financial resources of the mandatory medical insurance funds are state-owned, are not included in the budgets of other funds, and are not subject to withdrawal for other purposes.

Voluntary health insurance is intended to finance medical care in excess of the social guaranteed volume determined by compulsory insurance programs. The financial resources of the voluntary medical insurance system are formed from the payments of insurers, which are enterprises in collective insurance, and citizens in individual insurance. Medical insurance companies at established rates pay for medical services provided by medical institutions within the framework of voluntary medical insurance programs. In accordance with the terms of the contract, part of the unspent funds may be returned to the insured (citizen).

The concentration of all financial resources in one hand - a territorial department (regional hospital) or a local government body - limits the freedom of choice as the main principle for implementing an effective mechanism for providing citizens with treatment and preventive services. Therefore, a necessary condition for the development of the insurance medicine system is the freedom to conclude an insurance contract between an interested group of persons (employees of an enterprise, individual citizens) and independent holders of insurance funds (independent medical insurance companies).

The formation and use of compulsory health insurance funds has its own peculiarities. Conceived as insurance funds, they do not always correspond to the principles of formation and use of insurance funds. In their activities, the features of the budget approach are obvious: mandatory and normative deductions, planned spending of funds, lack of savings, etc. In economic essence, these funds are not insurance, in form they belong to extra-budgetary funds. However, it should be noted that along with compulsory state insurance, non-state - voluntary ones are developing.

Health insurance rates

Tariffs for medical services in the system of compulsory health insurance are determined by an agreement between insurance medical organizations, government bodies at all levels, local administration and professional medical organizations. Tariffs should ensure the profitability of medical institutions and the modern level of medical care.

The insurance rate of contributions for compulsory health insurance for enterprises, organizations, institutions and other economic entities, regardless of the form of ownership, is set as a percentage in relation to the accrued wages for all reasons in accordance with the instructions on the procedure for collecting and accounting for insurance premiums (payments), approved by the Government RF November 11, 1993

Insurance premiums are set as payment rates for compulsory health insurance in amounts that ensure the implementation of health insurance programs and the activities of medical insurance organizations.

Tariffs for medical and other services under voluntary medical insurance are set by agreement between medical insurance organizations and the enterprise, organization, institution or person providing these services.

List of used literature

1. Law "On health insurance of citizens in the Russian Federation".

2. Borodin A.F. About health insurance//Finance.-1996.- No. 12.

3. Grishin V. Federal fund of obligatory medical insurance//Zdravookhraniye RF.-2000.- №4.

4. Starodubtsev V.I. Savelyeva E.N. Peculiarities of health insurance in modern Russia//Russian Medical Journal.-1996.-No. 1.

5. Federal fund of obligatory medical insurance//Analytical review.-2001

6. G.V. Suleimanova. Social security and social insurance - M.1998

7. Magazine "Expert". - 2001.- No. 9.

8. Magazine "Insurance business". -2001.- No. 4.

Compulsory health insurance is one of the most important elements of the system of health care and obtaining the necessary medical care in case of illness. In Russia, compulsory medical insurance is organized and implemented by the state, therefore, the state, through its legislative and executive bodies, determines the basic principles for organizing compulsory medical insurance, sets the contribution rates, the circle of insurers, and creates special state funds for accumulating contributions for compulsory health insurance.

The financial resources of the state compulsory medical insurance system are formed from the mandatory contributions of various categories of insurers. 

All business entities, regardless of the form of ownership of organizational and legal forms of activity  , are obliged to pay insurance premiums for the working population as part of the UST  . Insurance premium rates are set on a regressive scale depending on the category of taxpayer.

Insurance premiums are paid from all payments accrued for the benefit of employees in cash in kind, with the exception of payments made from net profit, compensation: payments, social payments and some others. The amounts of accrued contributions are paid to the accounts of the Federal Treasury on a monthly basis, no later than the 15th day of the following month. The insurers submit payment orders for the transfer of insurance premiums to the bank simultaneously with the submission of documents for the issuance of funds for wages. Bodies of the Federal Treasury are required to transfer the incoming amounts of contributions to the accounts of the relevant OM S funds within 24 hours. Insurers are responsible for the correct calculation and timely payment of insurance premiums. For violation of the procedure for paying insurance premiums, they are subject to various financial sanctions provided for by the Tax Code of the Russian Federation.

For the non-working population, insurance premiums for compulsory medical insurance are required to be paid by executive authorities, taking into account the volume of territorial compulsory medical insurance programs within the funds provided for in the relevant budgets for health care. The non-working population includes children, students, the disabled, pensioners, and the unemployed. Executive authorities are obliged to transfer funds to compulsory medical insurance of the non-working population on a monthly basis, no later than the 25th, in the amount of at least 1/3 of the quarterly amount of funds provided for these purposes.

The transfer of funds to the territorial CHI funds should be carried out according to the standard for the non-working population, which is established based on the cost of the territorial CHI program. However, at present, the obligations of local administrations to pay these insurance premiums are very uncertain, and there are no legislative or regulatory acts regulating these issues. If for policyholders of economic entities tariffs are established by the Tax Code, then for executive authorities normative documents according to the calculation of payments for compulsory health insurance, there is no non-working population. The contributions are calculated according to the residual principle, based on the standards independently established in each subject of the Russian Federation. The methodology for determining payments for the non-working population, proposed by the Federal Compulsory Medical Insurance Fund, when determining regional standards for insurance payments for the non-working population, recommends proceeding from the difference between the cost of the territorial compulsory medical insurance program and the amount of its financing from contributions from business entities and other income.

In accordance with the Law "On Health Insurance of Citizens of the Russian Federation", the financial resources of the CHI system are managed by compulsory health insurance funds and insurance medical organizations. 8 The financial and organizational mechanism of compulsory medical insurance is shown in fig. one

Rice. 1 Scheme of organization and financing of CHI

7) collection, processing of personalized records of information about insured persons and personalized records of information about medical care provided to insured persons, ensuring their safety and confidentiality, exchanging said information between subjects of compulsory medical insurance and participants in compulsory medical insurance in accordance with this Federal Law ;

7. The application of the insurance medical organization for the provision of targeted funds in excess of the established amount of funds to pay for medical care for this insurance medical organization from the normalized insurance reserve of the territorial fund is considered by the territorial fund simultaneously with the report of the insurance medical organization on the use of targeted funds.

Thus, a large burden is placed either on the budget of low-income citizens or on the state budget. The first does not correspond to the principle of social justice, while the second can be an unbearable burden for the state and municipal budgets. In addition, an increase in the burden on the state or municipal budget does not correspond to the task of the MHI in Russia - to find additional funds in addition to budgetary sources.

Next, consider the financial support of CHI. The budget revenues of the Federal Fund include: insurance premiums for this type of insurance; arrears on contributions, tax payments; accrued penalties and fines; federal budget funds transferred to the budget of the Federal Fund; income from the placement of temporarily free funds; other sources provided for by the legislation of the Russian Federation.

Compulsory health insurance

The Dutch model of organization of medical insurance became the basis for the Law “On Health Insurance of Citizens in the RFSR”, adopted by Russia. Its attractiveness consisted in the active role of the state in the formation of a socially oriented system aimed at reducing differences in the social status of those citizens who received medical services in the social insurance system (low-income segments of the population) and those who had to insure themselves (highly paid citizens) in voluntary insurance system.

Compulsory health insurance is a system of relations that ensures the protection of the material and social situation of the insured persons and guarantees the provision of medical care in the event of an insured event defined by the legislation of the Russian Federation.

insurance coverage- in property insurance, the absolute (value) expression of the amount for which certain objects or all the property of the insured are insured. The concept of S.o. it is also used to assess the total obligations of an insurance organization in aggregate ... ... Big Law Dictionary

". 5) insurance coverage for compulsory medical insurance (hereinafter - insurance coverage) - the fulfillment of obligations to provide the insured person with the necessary medical care in the event of an insured event and to pay for it to a medical organization; "

What is CHI (compulsory health insurance)

Insurance case- an event that has taken place (illness, injury, other state of health of the insured person, preventive measures), upon the occurrence of which the insured citizen is provided with insurance coverage in accordance with the territorial CHI program. Insured events include diseases, injuries, other health conditions requiring medical care, as well as preventive measures.

CHI is one of the types of state compulsory social insurance of citizens in the Russian Federation. To implement the CHI system, a set of legal, economic and organizational measures is applied. They are aimed at ensuring and guaranteeing the provision of free medical care to the insured person (in the event of an insured event) in the appropriate amount, quality and deadlines. This assistance will be provided at the expense of compulsory health insurance funds on the terms established by the territorial or basic program of compulsory medical insurance.

Insurance coverage for compulsory health insurance

Movement of funds in the system of compulsory health insurance shown in fig. 15.1. Employers' insurance premiums are credited to an account opened by the Federal Treasury. The Department of the Federal Treasury transfers funds by payment orders to the accounts of the Federal and Territorial Compulsory Medical Insurance Funds. The funds of the territorial funds of compulsory medical insurance are formed from revenues from the budgets of the constituent entities of the Russian Federation, as well as subsidies from the Federal Fund for Compulsory Medical Insurance. In the future, the funds of compulsory medical insurance come from the territorial funds to insurance medical organizations to pay for the actually provided medical care to the insured.

The largest share in the expenditures of the Federal Compulsory Medical Insurance Fund is occupied by subsidies to equalize the financial conditions for the activities of territorial compulsory medical insurance funds within the framework of the basic program of compulsory medical insurance, including the use of normalized insurance reserves. The Fund's expenses also include a transfer to the Social Insurance Fund of the Russian Federation.

Compulsory health insurance in Russia

Secondly, commercial companies take part in the organization of compulsory medical insurance - medical insurance organizations (HIOs), which, under the current Law of the Russian Federation "On medical insurance of citizens in the Russian Federation", are assigned the role of a direct insurer. In Art. 6 federal law“On the Fundamentals of Compulsory Social Insurance” states that only non-profit organizations can act as insurers in the state social insurance system. Therefore, the legislation establishes that the activities of HMOs in the MHI system should be non-commercial in nature, i.e. insurance organizations cannot profit from compulsory health insurance. All funds not used to pay for medical services are reserved.

Compulsory health insurance (CHI) is an integral part of compulsory social insurance. It should provide all citizens of the country with equal opportunities to receive medical and drug assistance provided at the expense of compulsory medical insurance in the amount and on conditions corresponding to compulsory medical insurance programs.

Characteristics of the Compulsory Medical Insurance Fund

2) accumulate and manage compulsory medical insurance funds, form and use reserves to ensure the financial stability of compulsory medical insurance in the manner established by the authorized federal executive body;

The law establishes the legal, economic and organizational foundations of health insurance for the population in the Russian Federation, defines the means of compulsory health insurance as one of the sources of financing for medical institutions and lays the foundations for the insurance model of health care financing in the country.

Compulsory health insurance

Health insurance is a form of social protection of the population's interests in health protection; the purpose of health insurance is to guarantee citizens, in the event of an insured event, receiving medical care at the expense of accumulated funds and to finance preventive measures.

Federal Law No. 326-FZ dated November 29, 2010 “On Compulsory Medical Insurance in the Russian Federation” defines the following concepts: compulsory medical insurance as a type of compulsory social insurance, the object and subject of compulsory medical insurance, insurance risk and insurance coverage, insurance premiums for compulsory medical insurance, the insured person, basic and territorial CHI programs.

INSURANCE CONSULTANT

Thus, participating in voluntary health insurance, a citizen personally takes part in the formation of the insurance program, that is, determines the types and scope of services that it implies, selects the medical institutions in which he would like to be served. When concluding a contract of voluntary medical insurance, the insured pays an insurance premium, which gives him the right to receive medical care under the selected program during the term of the policy without paying an additional fee.

Medical care within the framework of compulsory medical insurance is provided in accordance with the basic and territorial programs of compulsory medical insurance developed at the level of the Federation as a whole and in the subjects of the Federation. Approved by Decree of the Government of the Russian Federation of September 11, 1998, No. 1096, the Basic CHI Program for Russian citizens contains the basic guarantees provided to the insured within the CHI on a free basis.

27 Jul 2018 460