Health insurance is what? Health Insurance Fund

Providing high-quality medical care is an important and integral part of the system of social protection of citizens. Wherever a citizen is, no matter what his financial situation, he can get decent medical care in the event of an unpredictable situation.

Development of the health insurance industry

The insurance market is an integral part 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 can not be partial or selective, so its constant provision requires the authorities to perform all its components.

Voluntary health insurance is no exception. Because for today for each citizen this is the only way to get adequate medical care at an adequate level. The development of the health insurance industry, and at the current time, hinders a number of reasons, the main ones being the reduction of public health financing, the outdated material base, the shortage of medicines, the demographic development indicators of the country and the incidence of citizens, and many others. Today, there are many contradictions and problems in the field of health insurance, which require further study.

Justification of insurance

The level of financial health care 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 proclaimed constitutional guarantees for free health care, unfortunately, do not encourage the provision of the required medical services. Therefore, for today the medical industry is self-sufficient, which is manifested in charitable contributions and unpredictable payments. Thus, the share of public expenditure in the structure of total medical expenses in Russia is only about 56%, while in the EU member countries it is about 76%. A significant part of the financing in Russia (about 40%) falls on the cash expenditures of the population, and the rest (about 4%) - on voluntary medical insurance and charity.

Medical insurance is a branch of personal insurance. It is conducted in two basic forms: voluntary and compulsory. According to the rules, voluntary insurance has the following types: medical insurance ( permanent health insurance ), medical costs insurance and health insurance. The law on health insurance is strictly regulated.

Given that increasing public funding for the healthcare sector is problematic due to the difficult economic situation in the country, it is necessary to seek other ways to attract money to the industry. In the absence of a compulsory form, voluntary health insurance can solve a significant number of problems.

Insurance market analysis

Medical insurance is a social direction, therefore among the population the demand for this type of insurance grows every year. The level of payments under VHI contracts has increased, one of the factors of which is the annual growth in the number of regulated insured events.

Analysis of the insurance market gives reason to argue about the loss of VHI for most insurance leaders. Specificity of insurance as a type of entrepreneurial activity is related to the fact that the more receipts for a certain type of insurance the insurance company has, the greater is the likelihood of a corresponding increase in insurance payments, as the insurance liabilities proportionately increase with receipts.

The increase in 2013 of net insurance payments for continuous health insurance was registered by 34.2% compared to 2011. Net insurance payments for health insurance in case of illness also tend to increase - almost twice. 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 loss of the industry is the increase in the number of complaints from clients for medical assistance due to deterioration in the quality of health, aging of the population, the demands of clients, imperfection of underwriting services, the use of economically unjustified tariffs, unsatisfactory organization of work on settlement of losses, low client-orientation of state medical and preventive institutions, overstated Costs for conducting business, including commission fees of insurance intermediaries - sellers Services on LCA.

Voluntary insurance

For today in Russia the certain structure in sphere of voluntary medical insurance has generated. The structure of the domestic VHI market includes state insurance supervision bodies, private insurance associations, insurance companies, insurance intermediaries, medical institutions, assistance services and consumers.

According to the results of the research, a significant counteraction to the development of voluntary medical insurance is the absence of tax benefits, because companies, some of which pay 41% of insurance payments, pay them after taxation at the expense of net profit. Such a situation, connected with the absence of tax benefits, significantly hinders the process of detenization of the sphere of medical services.

When allocating the costs of voluntary medical insurance to administrative and general production expenses, double-purpose expenditures, costs associated with the provision of services, and after resolving the problems associated with determining the number of such costs for the reporting tax period, it is possible to increase the quality of medical services, which will give a good push De-privatization in the sphere of medical services and increase in revenues to local and national 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 subjects: for the insured - to improve their health; For the medical institution - the provision of the required medical services. Therefore, it is necessary to apply the incentive mechanism for subjects by introducing the health insurance program. It will stimulate policyholders to improve and increase the quality characteristics of their health, not to allow its deterioration, not to create the necessary risk for their physical condition.

Medical insurance is an element of the system of social protection of citizens, which provides compensation for patients' expenses for medical care. In turn, voluntary medical insurance is an addition to the mandatory and guarantees payment for medical services. The discussion questions concern the problems of increasing the burden on the payroll, the management of medical insurance funds, the duplication of insurance functions,

Insurance in the CIS

The problems of health insurance as an element of social protection were dealt with by a wide range of both foreign and Russian scientists - economists and practitioners. Significant developments in this direction contributed to the development of theoretical bases for the social protection of citizens, in particular, the development of the conceptual apparatus and the introduction of practical measures.

However, the issue of providing medical assistance to citizens of our state who went to the CIS countries and citizens of any of the CIS countries who arrived in Russia for a certain period remained unresolved. The difficult economic conditions that characterize the transformational economy prompt the population to travel abroad quite often, 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 compulsory insurance is obligatory) or independently. The need for medical care for citizens who do not have such a document as a health insurance policy pushes out a purely financial problem. In other words, how will medical aid be paid to foreign citizens? In Russia, for example, there is compulsory medical insurance, according to which only Russian citizens are provided with medical assistance free of charge. This situation exists in Belarus. Thus, there is a problem in the specific protection of Russian citizens in the CIS countries, which has not yet found its solution either in theoretical positions or in practice.

Insurance for those who leave for the near abroad

Voluntary health insurance in the Russian Federation continues to evolve, indicating that citizens are aware of the need to protect health. Every year a significant number of citizens leave for the relevant period abroad. The number of tourists traveling abroad is increasing every year.

During travel, it is likely that Russian citizens may find themselves in a difficult situation (illness, injuries, etc.). To solve these problems, some knowledge is needed, for example, where to get a health insurance policy, what material costs will be at the same time. However, as a rule, people who go abroad to relatives or friends do not expect that they will get sick and they will be provided with the necessary funds for treatment (here there is a certain inertia of thinking when medical assistance in the USSR was free).

Sometimes medical care can be emergency (with tick bites, viral diseases, injuries, etc.). Analysis of the situation gives grounds to argue that the provision of medical care to Russian citizens in other states is carried out for an appropriate fee. In turn, foreigners in Russia had the opportunity to receive medical assistance free of charge. In order to ensure the social protection of citizens in the event of loss of health abroad, it is proposed to implement a pilot project (with the appropriate legislative support): the introduction on a contractual basis of compulsory medical insurance through the Medical Insurance Bureau between the CIS countries and Russia.

Card traveling abroad

If you cross the border on your own vehicle, the customs can check your health insurance policy. If you are traveling by air, train or bus, then the cost of the ticket must include the insurance payment. The proposed compulsory medical card traveling abroad will provide an opportunity to cover all costs for treatment (inpatient, outpatient), purchase drugs, get medical services, transport ambulances, and in case of death - repatriate the body of the deceased to their homeland.

A compulsory medical card traveling abroad will be valid for each country participating in this project. This medical 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 of the project. The contract of medical insurance can not be a one hundred percent guarantee of covering the costs of treatment for a traveler abroad. The insurance cases do not include:

  • Treatment of mental illness;
  • Treatment of diseases, injuries resulting from unlawful acts;
  • Injuries received in the state of drug or alcohol intoxication;
  • Plastic surgery, except when they are necessitated by trauma;
  • Dental services, except in cases when a person has acute toothache;
  • Treatment of diseases associated with AIDS and sexually transmitted diseases;
  • Treatment of relatives and close friends of the insured, from whom he is staying;
  • Injuries resulting from attempted suicide;
  • Implementation of abortion, except in cases when it threatens the life of a woman;
  • Carrying out of diagnostics at will of the insurer;
  • Treatment in sanatoriums and other.

Medical Insurance Bureau

The Medical Insurance Bureau (SME) is the only association of insurance organizations in the country. This organization can consist of a certain number of associated and full members who carry out medical insurance for travelers abroad. That is, membership is the main condition for the possibility of carrying out this type of insurance. Members of this bureau have the right to count the premiums under medical insurance contracts "Mandatory medical card traveling abroad" to the medical insurance fund. The Office, in turn, will ensure timely and qualitative settlement of insurance cases under these agreements. All members of the SMEs will be able to make timely payments in the medical insurance fund if they need to treat a patient abroad, provide medical services, and repatriate a person to their homeland in the event of death. The Medical Insurance Bureau will act as a non-profit organization.

The proposed project "Mandatory medical card traveling abroad" provides:

1) the establishment of the National Medical Insurance Bureau, which includes all insurers who carry out compulsory medical insurance traveling abroad;

2) compulsory medical insurance of persons crossing the border of their own state to visit the CIS countries for a certain period (up to 90 days);

3) the existence of an appropriate legislative framework for the medical insurance of citizens, which regulates the activities of insurers in this field.

Funds of medical insurance of the Russian Federation

The Mandatory Medical Insurance Fund was established to finance the costs of Russian citizens for health care services. Compulsory medical insurance is a component of state social insurance.

The main objectives of the fund:

  • Monitoring the rational use of funds;
  • Payment of targeted programs.

The income of the fund is as follows:

  • Medical insurance from the state budget;
  • Contributions of enterprises;
  • Use of temporarily idle funds.

The main tasks of the federal MHIF 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 carries out direct financing of medical institutions. The insurance contribution rate is 3.6% in relation to the calculated pay. Insurance premiums to the compulsory medical insurance fund refer to the cost price. Payment in medical, social and pension funds is called a single social tax.

Key Factors

Based on the above, it is possible to identify 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 spend financial expenses only on the most necessary.
  • Imperfection of legislation (for example, this is manifested in the absence of tax incentives).
  • Increased sales and cost of medicines.
  • Increase of social responsibility of insurance business (increase in the share of collective insurance of employees under VHI programs, which makes it impossible to avoid employers compensating medical expenses).
  • The large monopolization of the medical services market forces medical institutions to increase the cost and the number of services provided.
  • Low insurance culture of citizens.

Summing up, it can be noted that the prospects for the development of medical insurance, including voluntary ones, are comforting. The share of VHI in the insurance services market tends to grow, insurers that provide VHI services are becoming more competitive, the population's interest in this type of insurance is increasing, and so on.

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