Compulsory health insurance is ... Insurance premiums for compulsory health insurance

Compulsory social, pension and medical insurance are elements of a state program aimed at supporting the population. It includes a set of organizational, legal and economic measures. Let's consider what federal mandatory medical insurance is.

Terminology

Compulsory medical insurance is a system of legal and organizational-economic measures aimed at providing guarantees of free assistance to citizens in the event of appropriate circumstances. Funding is provided at the expense of the MHIF in the framework of a territorial or a base state program. The basic normative act regulating compulsory medical insurance is Federal Law No. 326. It defines key concepts. In particular, the normative act defines the subject and object of MHI, the risk and security, the maintenance of the territorial and basic program, in accordance with which compulsory medical insurance is conducted. FZ No. 326 also formulates the duties and rights of persons entering into a contract, their responsibility.

Relevance of the problem

Until 2011, there was a definite model of CHI. However, as practice has shown, it was very inefficient. The main reason for this was the lack of proper conditions, within which the patient and his needs acted as the center of the system. Until 2011, the opportunity to choose an organization that provides compulsory health insurance in Moscow or other city, was a citizen, and his employer or executive body. In practice, this situation caused the actual removal of the population from participating in the definition of the CHI company. In addition, relations within the system were built on a specific principle. In particular, polyclinics and hospitals received funds from such organizations, not as compensation for the costs of treatment, but for providing patients with care. In fact, in this way, a certain budget was allocated to medical facilities. The Mandatory Medical Insurance Fund did not have a stimulating effect on hospitals and polyclinics. Accordingly, the latter were not interested in improving the quality of services.

Current situation

At present, compulsory health insurance is a program designed to finance the services provided, rather than the health facility as such. The normative act mentioned above contributes to a significant expansion of citizens' opportunities. So, a person can choose both an insurance company, a medical institution, and a doctor. In this case, the medical institution, which is included in the register and has concluded a contract for the provision of appropriate services under the program, has no right to refuse to help the citizen.

Key areas

One of the main aspects in the sphere in question is the procedure under which compulsory health insurance is financed. Law No. 326 regulates the following areas:

1. Rules for the formation of funds.
2. The amount of insurance premium for non-working citizens.
3. Terms, procedure, period of payment of amounts.
4. Responsibility for violations in the allocation of contributions.
5. Rules for setting tariffs for compensation for medical care in compulsory medical insurance.

During 2011-2012, insurance premiums for compulsory health insurance were increased by 2%. This made it possible to send an additional 460 billion rubles to the health sector.

Rates

The enrollment of insurance contributions to the compulsory medical insurance in the budget of the FFOMC CSC is a procedure that all employers must pass through. Their value depends on the taxation regime and the type of activity of the enterprise. In addition, the tariff is calculated taking into account the payer category. The organization can accrue contributions as a general rule or use reduced rates. Also, the category of the employee in whose favor payments are made is of importance.

In 2016, the tariff for IP with employees and organizations in the MHIF is 5.1%. Benefits are: disabled persons of any group (2.9%), public organizations (2.9%), institutions that provide free assistance (2.9%), organizations whose authorized capital is deposits (2.4%).

Fundamental principles

Regulating obligatory medical insurance Law № 326 fixes the following provisions:

1. The universal nature of CHI.
2. Providing state guarantees for the protection of persons against risks.
3. Autonomy of financing of the CHI system.

The principles for compulsory medical insurance are:

1. Provision at the expense of the MHIF of guarantees of free assistance to the subject in the event of appropriate circumstances.
2. Stability of the financial system. Sustainability is ensured on the basis of the equivalence of insurance support by MHI funds.
3. Mandatory payments of payments in the amounts established in regulatory enactments.
4. State guarantee of observance of interests of the insured citizens for fulfillment of obligations within the framework of the basic program of MHI regardless of the financial state of the insurer.
5. Formation of conditions for ensuring the quality and availability of medical care.
6. Parity of representation of participants and subjects of MHI in management bodies.

Specificity of the reforms

The change in the system of CHI acts as an integral part of large-scale transformations of the healthcare sphere in the Russian Federation. Experts believe that the adopted normative acts will contribute to the effective development of the entire system. At the same time, the health of the citizen should be at the center of attention of the responsible persons. It is up to him to decide to which specialist, in what institution to apply. The choice of a person should not be limited to clinics and hospitals in the region of residence or registration.

Subjects

This category includes:

1. Insured persons:

• Working under the civil-law and labor contracts, the subject of which is the performance of work or the provision of services, as well as licensing and copyright agreement;
• Self-employed citizens (IP, private practitioners).

2. The Insured:

• Persons performing payments and other remunerations to citizens (organizations, IP);
• Individual entrepreneurs.

3. Federal Fund, acting as an insurer. It is a non-profit organization formed to implement state policy in the sphere of local self-government.

The participants

In the system of CHI there are:

1. Territorial funds. They are represented as non-profit organizations formed by the regions for the implementation of government policy in the sphere of compulsory medical insurance in the territories of the subjects of the Russian Federation. These structures exercise certain powers of insurers in the implementation of territorial compulsory medical insurance programs.
2. Medical facilities. These include organizations listed in the MHI register and entitled to carry out activities in the field of health and compulsory medical insurance. They can be formed by individual entrepreneurs or be the organization of any legal form permitted by regulatory enactments.
3. Medical insurance companies. They carry out their activities in the field of MHI on the basis of a license granted by an authorized supervisory authority. Insurance medical organizations implement certain powers of insurers under Federal Law No. 326 and a contract for the financing of compulsory medical insurance, which it includes with the territorial fund.

Registry

As it was said above, it includes honey organizations. In the register there are:

1. The names.
2. The list of services that are provided within the framework of territorial programs of CHI.
3. Addresses.

The Territorial Fund maintains the register and places it on a mandatory basis on the official website. Additional publication of information is possible in other ways.

Software development

In accordance with the normative act No. 326, the basic and territorial directions of the MLA were formed. In Ch. 7 of this document lists the types of services that are included in each program. Since 2013, the basic direction includes emergency medical care, and since 2015 - high-tech. The programs are approved at the regional and federal levels. The basic direction extends to the entire country, and the territorial one operates within the subject. Regions have the right to add to the main program insurance cases and types of assistance not included in the MLA. At the same time, they finance their provision independently.

Compulsory health insurance: policy

Moscow was the first city in the country where these documents were introduced. During the implementation of the CHI program, they began to be provided to citizens in other settlements. Until 2011, the MHI policy was not uniform for all. Each company printed its own forms. They were to be replaced after expiry. If the citizen changed his place of work, he should have handed over his policy to the employer. A new document was issued to him by another employer. This procedure took some time, during which the resigned person could not get medical help. If the citizen became unemployed, he needed to obtain a policy in the organization that insured the unemployed persons by the results of the competition. At the present time, the document is issued to all citizens and has a uniform form for all regions. It looks like a plastic card. On the front side, the policy of compulsory health insurance of a new sample (where a 16-digit number) contains a chip. It records information about the company that issued the document. Information about the insured person is present on the back of the card. They include the name, date of birth. On the reverse side there is also a photograph and a sample of the signature.

Procedure for obtaining

Earlier, citizens were issued with regional MHI policies. In order to implement the state program, they were gradually replaced. The PMSC acts as a document confirming the citizen's right to receive free medical care throughout the Russian Federation in the amount provided for in the basic program. To receive it, a person personally or through his representative submits an application. This can be done directly in the insurance company itself or in the TFOMS. On the day of accepting the application, the citizen is issued a temporary certificate. It replaces the policy that will be issued. At the end, as a rule, 2 weeks a citizen receives an electronic document. A plastic policy is valid for an unlimited period of time. Document replacement is possible in the following cases:

1. Loss / damage / wear.
2. Shifts

If you change the place of residence / residence registration, the status of a citizen (working or unemployed), the PMS is not provided for.

Terms of payment for services rendered

Within the framework of the state compulsory medical insurance program, the norms concerning the period of compensation for the care provided to patients are rigidly regulated. At medical institutions now there is a guarantee of payment of the given services to the nonresident citizen. This, in turn, increases the interest of medical institutions in helping people. If the payment is delayed, the insurance organization from its own funds pays the institution penalties. Its amount is calculated at the refinancing rate of the Central Bank (1/300), which was in effect on the date of the delay. Calculation is carried out from unchecked amounts daily.

Compulsory health insurance in Moscow: rating of companies

The list of organizations working within the framework of the CHI program is compiled for certain indicators:

1. Number of delivery points for PMS.
2. Operating mode.
3. Availability of information on the rights of citizens.

As experts say, the level of financial reliability does not have a significant value in the rating. This is due to the fact that the termination of the activities of the organization especially on citizens will not be reflected. The only thing they will have to do is change the policy. The most popular organizations in the capital are:

1. "RESO-MED". This company has 37 offices in which the registration of PMS is carried out. Their schedule is different, some of them operate around the clock and on weekends. For 9 months. 2012 received more than 200 thousand appeals, of which 43 were justified complaints. The company provides information on the procedure for challenging inaction / actions of employees, the list of medical organizations of the compulsory health insurance system is qualitatively designed.
2. MSK "MEDSTRAKH". This company has 4 delivery points for PMS. The central office works round the clock. The company provides for the receipt of applications in electronic form, as well as paid delivery of documents. The organization deals exclusively with medical insurance.
3. Ingosstrakh-M. The organization has 4 points of delivery of PMS. The company provides citizens with services to protect their interests in court. The organization has contracts with more than 4.5 million customers.

Questions for discussion

In addition to a single MHI policy, it is proposed to introduce electronic instead of the usual paper medical records (case histories). This is due to the fact that when taking a non-resident citizen, the doctor needs to know about the patient's illnesses and conditions. Citizens, as a rule, do not bring a medical card with them. If there is an electronic medical history recorded in a single database, any specialist in any city could quickly get all the necessary information. However, in some European countries, the use of such electronic case histories in the global network is not allowed. This is due to the insecurity of personal data protection systems.

Conclusion

Obligatory medical insurance is an essential step of the state forward in the decision of a question on rendering to the population of the various help. The developed programs include all the necessary amount of services that a person can get for free. Providing the population with accessible assistance is carried out at the expense of a source of financing guaranteed by the state. The law regulating the scope of compulsory medical insurance was adopted relatively recently. However, during the validity of this normative act many people were able to receive emergency, emergency and planned assistance. They were provided with services that previously these people could not take advantage of. Act No. 326 applies to all citizens living in the territory of the country. The purpose of the normative act is primarily to strengthen the guarantees of the constitutional right of a citizen to free medical care. The implementation of its provisions contributes to a gradual increase in the financing of the health sector. This, in turn, assumes the balance of state guarantees for free medical care to citizens with the obligations of the state.

The implementation of the provisions of the normative act helps to strengthen the material and technical base of the healthcare system. As a result, the goal, which was originally set, will be achieved - the quality and availability of medical care to people will increase. In the law, the duties and rights of all participants and subjects, the rules in accordance with which compulsory medical insurance is carried out, are regulated in sufficient detail. Moscow was the first city where the established order began to operate. Today the developed scheme operates throughout the country. FZ No. 326 regulates the interrelationships of all parts of the system, involves the modernization of CHI and the subsequent development of the entire health care sector.