health insurance - a form of protection, which is to guarantee payment of medical aid at the expense of the accumulated funds.It guarantees citizens the provision of certain services free of charge volume in the case of health problems.Next, let's talk about what is health insurance in Russia.Its features will try to consider as detailed as possible.
concepts
Compulsory health insurance (MHI) is implemented in accordance with the state program.It is universal for citizens.Voluntary health insurance in Russia makes it possible to obtain additional services not covered by the MLA.It may be a certain number of visits to specialists, hospital care, and others. By participating in the voluntary program, a person chooses the types and amount of services, the institution in which he wants to be served.When signing the contract the customer pays a fee, which allows him for a certain period to receive service of the selected program at no additional cost.Let us examine some of the terms.
Insured - the person who pays the fee.This may be a person or organization.
insurer - a legal entity which carries out medical insurance.
Medical institutions (MPI) - institutions which provide a range of health services for people with various illnesses.These include: medical, surgical, psychiatric, neurological, pediatric medical facilities, maternity homes and rehabilitation centers.
policy - a document confirming the participation of the person in the program.
health insurance organizations (CMOs) - a legal entity with a registered capital, which is engaged in purely voluntary or compulsory health insurance.The activities carried out in two directions:
- accumulation of funds to help the population;
- examination after receiving services.
development of health insurance in Russia
Stage 1 (1861-1903 gg.)
Act was passed, introducing the basics of CHI in Russia.When state-owned factories were established partnerships and subsidiary offices, through which issued temporary disability benefits members of society, takes deposits.In 1866, when factories were hospitals with a certain number of beds.In general, such medical aid workers did not like.
Phase 2 (1903-1912 gg.)
Medical insurance in Russia survived the first critical stage in 1903, when the law was passed, according to which the employer was responsible for the damage caused to the health of employees in case of accidents.
Stage 3 (June 1912 - July 1917.)
In 1912 Act was passed MLA for accidents and illness.On the territory of the Russian Federation there were health insurance.Employees at the expense of entrepreneurs assisted in four areas: First, outpatient and hospital care, childbirth care.
Stage 4 (July 1917 - October 1917.)
Compulsory health insurance in Russia was greatly transformed the Provisional Government:
- appeared sickness funds requirements;
- the circle of insured;
- health insurance companies merged without the consent of the entrepreneurs.
5th stage (October 1917 - November 1921.)
Declaration was Vedeno full social health insurance in Russia, which applies to all salaried workers, regardless of the cause of disability.Merged narkomzdravovskoy and health insurance.Medicine was transferred to the control of the People's Commissariat of Health.Cash abolished medicine.
Stage 6 (November 1921 - 1929.)
new economic policy was reintroduced social insurance in case of disability.Contribution rates were calculated according to the number of persons employed in the enterprise.For listed funds were organized two funds.One was at the disposal of social insurance, the second - health.
Stage 7 (1929 - present)
In the next 60 years, formed the principles of financing of the system.Here is how is the development of health insurance in Russia.
modern system of health insurance in Russia at the moment exists in three forms.The State is fully financed from the budget.Insurance is formed by the accumulation of contributions from enterprises of all forms of ownership and SP contributions.The amount of funds that are received in private medicine, calculated by the patient.
state program does not provide quality medical care due to lack of funding.Private medicine is expensive -.Therefore, medical insurance is considered to be the best option for assistance.Ideally, all persons should receive high-quality services.After all, the frequency of payment does not correspond to the appeals of health authorities.This is the principle of accumulation.And since the rate of contributions to the health insurance fund Russia for all citizens is set the same, the volume of payments should be equal.
MHI Mandatory health insurance in Russia is part of government social programs.In the framework of all citizens an equal opportunity to receive the drug and medical assistance in a pre-specified amount and conditions.
in Russia are basic and territorial programs.They define what kind of assistance and public institutions to citizens living in some parts of the region.First developed by the Ministry of Health, the other approved by the state authorities.
Scheme of
Companies list every month 3.6% of the FOP in the MLA.Of these, 3.4% shall be paid to the territorial and 0.2% - to the Federal Fund of CHI.For non-working population pays contributions to state.Both funds are autonomous institutions that accumulate funds ensure the stability of the system and align financial resources.The accumulated money goes to pay for the set volume of medical services.
Insurance companies enter into contracts with health facilities for assistance policyholders CHI protect the interests of customers, controlling the timing, scope and quality of services provided.Participants can be as citizens of the Russian Federation and non-residents.However, with regard to the latter, a list of services available to them is limited.
territorial programs CBOs
This document defines the scope of providing citizens with free medical care.It includes:
- emergency;
- outpatient polyclinic;
- inpatient care at acute illness and exacerbation of chronic diseases, injuries, pathologies of pregnancy, abortion;planned hospitalization for treatment.
Exceptions:
- treatment of HIV, tuberculosis and other socially significant diseases;
- emergency medical service;
- beneficiary drug coverage;
- expensive types of help: from open-heart surgery and ending chemotherapy and neonatal resuscitation.
Paid services
health insurance system in Russia is built in such a way that even under the state program for certain services a person must be pay on the spot.These services include:
- surveys on the initiative of citizens.
- Anonymous diagnostic and preventive measures.
- the procedure at home.
- Vaccinations at the request of citizens.
- Spa treatment.
- Cosmetology services.
- Dentures.
- Training in nursing.
- Additional services.
MHI policy
This document may issue all Russian citizens, including non-residents, who are temporarily resident in the territory of the country.The term of the policy coincides with the time of stay in the country.Citizens of the Russian policy is issued once in a lifetime.
execution of documents should be engaged by the employer or SMO.At the same time the insured person has the right to choose the company itself, which will be served.Unemployed citizens receive policy at point of serving their area.
Changing Data
Features health insurance in Russia is such that after the change of residence or passport data of the old policy should be handed over to the UK, and after registration in the new district to get a new one.If you change jobs the document should be returned to the employer.The entrepreneur is obliged within 10 days to notify the SC.
In case of loss of the policy is necessary to notify the insurer as soon as possible.Employees of the company will eliminate document data from the database and begin the MLA procedure for registration of the new policy.This will be charged at a rate of 0.1 minimum wages for the issuance of the form.
Voluntary medical insurance in Russia (LCA)
This service allows citizens to receive additional services in excess of the MLA.The subjects of the program could be:
- individuals;
- organizations that represent the interests of citizens and medical institutions;
- enterprise.
person can get costly, complicated (in the field of dentistry, plastic surgery, ophthalmology, and so on. N.) Of high-quality services, to pass additional tests and so on. D. Health insurance in Russia as part of the program is governed by a contract.According to this document, the company is obliged to pay for the services rendered to citizens, are included in the appropriate list, give each insured in the policy of a fixed period of service with the program and the list of institutions through which assistance will be provided.
The agreement also stated that the insured person is obliged to pay the fees at a certain time, spelled out the terms of the document, the conditions for its extension, the right to compensation, as well as the transfer of the right to the payment after the death of the insured.
According to the latest data, in 2015 62% of Russian employers do not pay for services LCA to its employees.Most of the companies refused to participate in the program because of the difficult economic situation.The costs of employers who have entered into the contract until 01.08.2014 for 12 months, remained unchanged.There are 14% of the 1,000 companies surveyed.But there are exceptions.2% of employers surveyed have reduced the costs of the VHI, optimizing staff size.Units managed to sign more lucrative contract.Some employers have reduced the amount of the costs of removing the dental insurance.Another 5% of the companies surveyed costs increased by 5% due to the increased cost of health care.
Problems of health insurance in Russia
At this stage of development there are difficulties in the functioning of the system:
- budget cuts.The current rate of 3.6% does not provide coverage of medical care even working citizens.Most in need of medical care elderly, disabled and children.Contributions to non-working citizens are transferred from the state budget.The result is a reduction in funding, from which most affected the ambulance.
- Financing unemployed population comes at the expense of TB, mental health and substance abuse services.There is a real threat to the gap between treatment and prevention.
- No single model of insurance.
- lack of reliable information on revenues and expenditures for health insurance in Russia.
- presence of arrears.
These are serious problems of health insurance exist in Russia at the moment.
Conclusion
One form of social protection of the population - health insurance.In Russia, its features lie in the fact that services are provided in three directions.OMC financed by the state, but this program is not a person receives all kinds of services.Private medicine is not available to everyone.Therefore, the Russians offer serviced under a voluntary insurance program.By paying an additional fee, a person can choose his insurer-broker of services, their types, and institutions where he will receive medical treatment.
