According to the adopted legislation, almost every person registered and living in the territory Russian Federation, has the right assigned to him to apply to any medical institution to receive appropriate treatment if such a need arises. However, there is one important nuance - services of this kind, as well as the right to receive medicines on a gratuitous basis, that is, free of charge, are provided only if the citizen has such a document as a compulsory health insurance policy.
Who can receive free medical services?
Any citizen who owns the following has the right to use the services of medical institutions:
- Employed citizens. That is, the category of persons who regularly pay taxes to the state budget. That is, in essence, he pays for his treatment in advance.
- Unemployed citizens. IN in this case pay Money Treatment of these persons is also paid for from the federal budget.
- Children, teenagers, and who have not reached the age of eighteen and are not taxpayers.
If a person is officially employed, he has the right to register, as well as . If he is not employed, works unofficially, or has not reached the age of majority, you can apply for the specified document to any company that provides insurance services.
In the event that any citizen needs to contact a specialist who provides consultation outside the locality where the specified person lives individual, a referral from the attending physician is also required.
There is a certain list of medical services, the provision of which is free of charge. These include the following:
- Emergency assistance, that is, the departure of an ambulance when a patient is called. This service is provided free of charge not only to persons who have, but also to those who do not have this document. In the recent past, there were unreliable rumors that if a person does not have a compulsory health insurance policy, he will have to pay about one and a half to two thousand rubles to call an emergency room. This is wrong. This service is provided absolutely free of charge in any case.
- Ambulatory treatment in a medical institution that is part of the insurance system and includes a number of different manipulations: examination and diagnosis of the patient’s disease, performing the necessary procedures and prescribing adequate treatment. However, when a patient is under so-called outpatient, daytime or home treatment, all necessary medications must be purchased by him at his own expense, since there are no benefits in this case.
- Working with the public to raise awareness of sanitary and hygienic issues. That is, holding various lectures, seminars and so on.
- Diagnosis and treatment of the population using expensive innovative drugs and methods. For example, in some regions of the Russian Federation, in vitro fertilization is carried out free of charge.
- Diagnosis of the disease followed by hospitalization.
- in dental clinics and offices that have state status.
Free services for compulsory medical insurance policy
For example, while undergoing treatment in a state hospital, a citizen has the right to receive free services for the treatment of diseases of the following kind: support of pregnancy during its complicated course, as well as in the presence of pathologies of any kind, medical abortion, the presence of chronic diseases, or in case of exacerbation of the disease, poisoning , causing bodily harm and so on. In this case, the provision of medications necessary for adequate treatment is free of charge.
The diseases that, according to the list, are treated free of charge include the following:
- Diseases of an infectious nature, with the exception of those categories classified as sexually transmitted infections.
- Various diseases of the blood, vascular system, heart.
- Stomach diseases, as well as gastrointestinal tract generally.
- Any disease caused by a nervous disorder.
- Diseases of joints, bones, muscles and so on.
- All kinds of defects in vision, hearing, speech.
- Tumors of both benign and malignant nature.
- Diseases of tissues and skin.
- Diseases of the genitourinary area.
- Diseases of the respiratory system.
What to do if treatment is denied if you have a policy?
Currently, not every citizen is fully aware of the rights that are granted to him in accordance with this, which is often taken advantage of by unscrupulous workers in this field of activity, demanding a certain payment for the provision of the necessary assistance.
What to do if your rights are violated
Every citizen of the Russian Federation who has insurance has the right to seek help from any medical institution located on the territory of the state. The specified institution is obliged to admit him and carry out appropriate diagnosis, treatment, as well as other manipulations that are necessary.
However, it often happens that doctors, as well as hospital staff, refuse to admit the patient in such cases. This is not legal and violates human rights. It is important to produce.
To restore the violated right, a person who has been denied medical services must file a complaint with the medical service, whose employees will take appropriate measures. If such a case is detected, administrative penalties may be applied to medical service workers.
What can you expect with a compulsory medical insurance policy?
In order to know which services the compulsory health insurance policy gives you, you need to carefully read the list of services provided to the population free of charge. It should be remembered that, in essence, these services are not free at all due to the fact that wages Each employed citizen is deducted a certain amount every month, intended specifically for this purpose. Consequently, in this way, each individual pays in advance for his treatment in a state-type institution. .
In our other articles you can familiarize yourself with and
Over the weekend, I was at home with an impossible sore throat and a temperature of 39.6.
Taking another dose of paracetamol that day, I called an ambulance. I was told that it was a sore throat and that I should call the local police officer on Monday. The ambulance didn't arrive.
The insurance company protects my rights and actually guarantees free treatment. But if you don’t know the laws, then unscrupulous doctors will be able to deceive you, refuse treatment, and demand additional payment.
I recovered and decided to figure out what your compulsory health insurance guarantees you.
Get to know your compulsory medical insurance policy
Most likely, you already have a compulsory health insurance policy. Your parents made it for you immediately after birth. It is either in your passport or in the box with all your important documents.
If you don't have a policy, drop everything and go get one.
Without a policy, you will not get any free treatment. Fortunately, you can get or exchange a policy in any city without residence permit or registration. To do this, take your passport and SNILSi with you and go to an insurance company that is convenient for you, which issues these policies.
If you don’t have SNILS, first go to the insurance company with your passport, then wait 21 days and only then get the policy.
Citizens of the Russian Federation who permanently or temporarily reside in the territory of the Russian Federation can obtain the policy Foreign citizens, refugees and stateless persons. Citizens of the Russian Federation are issued a policy without limitation of validity period. According to the law, even if you have an old policy and it is expired, the insurance will still work. Only until you change your passport details: first name, last name, place of residence.
If you come to the clinic with an old expired policy and are denied treatment, this is illegal. You must be accepted. Clinics ask everyone to change their policies to new documents, but for now this is only a recommendation. Of course, it is better to heed this recommendation: when a law comes out that terminates the old-style policies, it will not take you by surprise.
Which insurance companies provide compulsory medical insurance policies?
Compulsory medical insurance is an insurance program, that is, everyone pays a little into a common pot, and then they pay from it to those who need it. The state collects the common pot from entrepreneurs and distributes it through an extensive system of funds, which, in turn, pay hospitals. And the insurance company is an intermediary manager who connects you, the hospital and the state.
Insurance companies make money from compulsory medical insurance in the same way as from other services. They are also responsible for the quality of services and discipline in the system. Your first point of contact is the insurance company.
Each region has its own registries of companies that issue compulsory medical insurance policies. Just Google it.
Insurance companies with compulsory medical insurance
Where can you get treatment with a compulsory medical insurance policy?
You have the right to treatment in any state clinic throughout Russia. The only difficulty is that different regions of the country work with different insurance companies.
To get to a clinic in another city or region, you need:
- Select a clinic. Any, not necessarily the one that is closer to home.
- Find out at the reception which insurance companies work with this clinic. If you have a choice, look at the company description on the CMO website. Everyone has the same insurance, but some have more offices, while others have 24-hour support.
- Come to the insurance office with your passport and SNILS and fill out an application for a replacement policy.
- Get a temporary certificate. It works like a policy for a month.
- Return to the clinic. Tell the receptionist the code phrase “I want to join your clinic.” Receive an application form, fill it out and return it to the registration office.
Now you can be treated for free at this clinic.
If your insurance company services the clinic to which you are going to attach, then you do not need to change your policy. But you need to inform the insurance company that you have moved and want to be treated in another place. Otherwise, the new clinic will not receive money for your treatment.
Why do you need to join a clinic?
You need to be attached to a clinic because our country has a per capita financing system. Money for your treatment is given only to the institution to which you are assigned. Therefore, you cannot be assigned to several clinics at once. You can also officially change clinics no more than once a year. Previously, this could only be done if you moved. In this case, the new clinic will ask you to write an application addressed to the chief physician.
You cannot attach to a research institute or hospital, only to a district clinic. And there your local therapist will write out referrals to specialized specialists: an eye surgeon, a cardiologist, a chiropractor. Without a referral from your attending physician or emergency specialist, specialized clinics can only admit you for a fee.
What is EMIAS
In Moscow, the data of all patients is entered into EMIAS, a unified medical information and analytical system. This simplifies the process of making an appointment with specialists: you can get a coupon to see a doctor, cancel or reschedule an appointment, get a prescription issued at in electronic format. EMIAS even has a mobile application.
Please note: if you have moved and decided to join a new clinic, you cannot simply do it through the system. You need to write an application addressed to the chief physician and wait until the bureaucratic apparatus approves it. This may take 7-10 business days. If you are registered on the Moscow government services portal, then you can submit an application. They promise to review it within 3 business days.
When I faced such a problem, I needed help urgently. And by law they are obliged to help me without any multi-day delays. But the clinic is afraid that if they treat me before the clumsy machine enters new data into EMIAS, then they will not receive money for me from the insurance company.
Right in front of the hospital administrator on duty, I called the insurance company, after which I received the necessary consultations at the hospital for free. I was also examined by a whole commission of department heads, and to this day everyone treats me very carefully.
What is included in compulsory medical insurance treatment?
The law on compulsory health insurance gives us all the right to treatment for free. And even if your policy has expired, you can still use it.
If you don’t have the insurance policy with you, you can still make an appointment with a doctor; they don’t have the right to refuse you.
Although for nurses this is additional concern, so most likely they will try to convince you that this is impossible. If this happens, just call your insurance company.
In any unclear situation, call your insurance company.
The minimum amount of assistance is described in the basic compulsory health insurance program. Each region decides independently whether to add anything else to this list. The exact list of insurance claims can be found in any clinic or found on the website of the Ministry of Health in your region.
In any case, you can apply the following rule: if something threatens your life and health, it is treated for free. If you are generally healthy, but want to feel even better, then most likely you can only do it for money. If the state can help you, but the level of this assistance seems too low to you, you will have to accept it or pay extra.
Examples of what can and cannot be done under the compulsory medical insurance policy
| It is forbidden | Can |
|---|---|
| Teeth whitening is an aesthetic procedure | Brushing your teeth because it prevents caries |
| Get imported Japanese adult diapers by choosing your own brand | Get diapers for an elderly person |
| Remove a couple of extra pounds. Your figure is not insured by the state | Remove boil |
| Wait for exercises from hatha yoga or a modern gym during physical therapy | Go to physical therapy |
| Contact a dermatologist if you are simply concerned about oily skin on your face. | See a dermatologist if you have a serious skin rash |
| Make a denture | Remove the tooth |
When something hurts, you can see a therapist for free, who will write a referral to a specialist. If indicated, the therapist must write out referrals to any doctors who work in public clinics.
Without a referral, you can make an appointment with a surgeon, gynecologist, dentist and dermatologist at the dermatovenerological dispensary. Or register your child with a child psychiatrist, surgeon, urologist-andrologist or dentist. Compulsory medical insurance does not guarantee free tests and examinations without a referral from the attending physician.
Once every three years you can undergo a free medical examination and find out whether everything is in order with your health. A medical examination is carried out for everyone every three years - that is, if this year you turn 21, 24, 27 years old, and so on.
The compulsory medical insurance program also includes free pain relief and rehabilitation after illnesses and injuries. But it won’t be possible to write down once or twice in which cases you are entitled to free insurance assistance, and in which cases you will have to pay on your own. There are a lot of nuances in this matter. If you have a rare disease or a complex situation, contact us.
What exactly is not included in the compulsory medical insurance program
The state will not pay for:
- any treatment without a doctor’s prescription;
- conducting surveys and examinations;
- treatment at home at will, and not for special indications;
- vaccinations outside government programs;
- sanatorium-resort treatment, if you are not a sick child or a pensioner;
- cosmetology services;
- homeopathy and traditional medicine
- dentures;
- superior rooms - with special meals, individual care, TV and other amenities;
- medicines and medical devices, if you are not in a hospital.
If the hospital asks for money for services that are not on this list, just in case, call your insurance company and find out if it is legal.
Privileges
People with disabilities, orphans, large families, participants in military operations and other citizens who are entitled social benefits, the state is ready to pay for more medical services. Each category has its own lists of benefits; you can find them at the social security department or find them on the Internet.
Sometimes you are legally entitled to free treatment, but doctors just shrug their shoulders. There may be a waiting list of up to several months for free rehabilitation, and your local hospital may simply not have painkillers. It's illegal, but it's a fact of life.
If you spend money on treatment because you tried it, but can’t get it for free, then you can get your money back through the courts.
Extortion
Doctors are people too, and nothing human is alien to them. Like any person, some doctors are more interested in getting a lot of money from you right now than getting a little less money from the insurance company much later. Therefore, a whole illegal practice of extorting money for treatment under compulsory medical insurance has grown in Russia.
This extortion is based on legal illiteracy. All a doctor needs to do is pretend to be smart and take a stern tone so that frightened patients will start throwing money at him. But the slightest sign that the doctor is dealing with a legally savvy patient, and the tone changes. Therefore, it is very useful to know what medical services are required to be provided to you free of charge.
Remember that treatment is free only for you. The hospital and doctor will receive money for this treatment from the health insurance fund. This money was paid into the fund by entrepreneurs, including your employer.
You do not have to pay out of pocket a second time for what the state guarantees to you. Moreover, the doctor will most likely receive payment from the fund, even if you are forced to pay.
You don't pay for the treatment, but the hospital will get paid for it...
If you know for sure that you should and can be treated for free, but the doctor offers to pay, call the insurance company. The insurance number is written on your policy, experts hotline they will help you.
If you cannot do this, ask your doctor to write a written refusal to provide free medical care. If the doctor behaves defiantly, you can turn on the recorder, this is legal. Even if this doesn’t help, call the department for protecting citizens’ rights in the compulsory medical insurance system.
Emergency assistance is always free
If something really bad happens - you lose consciousness, break your leg or feel acute pain - you should be helped in any public clinic, even if you don’t have any documents with you and you’ve never received a policy.
The hospital does not have the right to refuse care to newborns and children under one year of age, even if the child’s parents do not have an insurance policy or registration. They cannot refuse pregnant women either - they can go to any antenatal clinic and any maternity hospital, even without documents.
Money can be returned
If you needed treatment urgently and you decided not to understand the laws, but to pay money, then you can contact the insurance company for compensation. Collect receipts, make a copy of the contract for the provision of medical services, write a statement in free form and send it all to the insurance company.
An alternative option is to get your treatment money back in the form of a tax deduction. But you can return only 13% of the amount spent and no more than 15,600 rubles.
I understand your indignation
A minute of moralizing from the editor-in-chief.
In the comments to this article, all hell will break loose about how bad everything is with Russian medicine, how there are no medicines in hospitals, cleaners are waving dirty rags, and a surgeon is demanding a bribe for pain relief. You will forgive me for my directness, but we ourselves are to blame for this.
All participants in the healthcare system are just people: someone’s acquaintances, friends, brothers, matchmakers and godfathers. They have parents and children. They are all Russians and they work just like any of us.
- If a surgeon demands a bribe for pain relief, then it’s not the healthcare system, it’s this particular surgeon, his parents and teachers. This means that his father, somewhere in his childhood, set an example for him that a bribe is normal. How do you feel about bribes?
- If a hospital says that it doesn’t have money for medicine, it’s not Putin’s fault, but some officials who don’t know how to draw up budgets. Or the head physician who doesn’t know how to manage money. You have plenty of friends who do the same thing at their jobs.
- After all, when you receive your salary in an envelope, it is your employers who underpay into the health insurance fund. Where will the money for your medications come from if you have given permission not to pay for them?
It turns out to be mild schizophrenia: the same person supports mediocre salaries and complains about insufficient funding for hospitals.
Putin, Navalny, Medvedev, Tinkov or Trump will not solve our healthcare problems. We will solve this problem ourselves if we set an example for our children of a conscientious attitude towards work and the law. To skip classes at the institute was not a feat, but a shame. It was a shame to take tests for money. It was against our principles to give bribes. Knowing and standing up for your rights was a responsibility, not a superpower.
In short: no one will fly in and give us free medicine like in paid Israeli clinics. All the hell that we see in hospitals is not hospitals, it is ourselves. And me too.
Let's start with paying taxes and fees. I have everything, thank you. Sorry for the moralizing tone, but I'm just tired of this whining.
Remember
- If you don’t have a policy, drop everything and go get one.
- With a compulsory medical insurance policy, you should be treated for free in any state clinic throughout Russia.
- The treatment is free just for you. The hospital and doctor will receive money for this treatment from the health insurance fund.
- The policy works even if it has expired. If you come to the clinic with an old insurance policy and are denied treatment, this is illegal.
- In any unclear situation, call your medical insurance company. The number is on the policy. Put it in your phone right now.
- If your insurance doesn’t save you, call the Federal Compulsory Health Insurance Fund: +7 499 973-31-86.
- If you spent money on treatment that should be free by law, write a statement to the insurance company - you should get your money back.
- Emergency assistance is always free, even if you do not have documents.
Medical services provided to citizens free of charge under compulsory medical insurance actually cost a lot of money.
How much each patient costs the budget will become known thanks to the individual information system.
In accordance with the instructions of the President of the Russian Federation and on the basis of the FFOMS order No. 108 of July 28, 2014, from January 1, 2015, each patient will be able to find out how much budget money was spent on him.
Every year, funds are allocated to the budget for the so-called “free” treatment of citizens under the compulsory medical insurance policy.
Each year, the amount is indexed: in 2013, the state allocated about 9 thousand rubles for the treatment of one person, in 2014 - more than 10 thousand rubles, and in 2015 - more than 12 thousand rubles.
In federal subjects these amounts may increase at the expense of the regional budget. Thanks to the principle of health insurance, which can be stated as: “The rich will pay for the treatment of the poor, the healthy will pay for the sick”, – people can receive medical care for free.
It was decided to convey to citizens the real amount of treatment costs in the form of a certificate or statement: seeing a specialist, conducting diagnostic procedures, providing emergency assistance, outpatient treatment and round-the-clock observation in a hospital have their costs.
The document contains a list of services provided with an indication of their price. Information is provided free of charge to the patient. All he needs is desire receive a receipt or a waiver.
How much does it cost the state for medical care received by citizens free of charge under compulsory medical insurance?
In most cases, a person does not realize that what is provided free of charge as part of compulsory health insurance may be expensive. And at this time the state spends huge sums to help its citizens.
So, for example, the state spends:
- for nursing one child with extremely low body weight - about 200 thousand rubles;
- for bypass surgery of each coronary vessel - more than 100 thousand rubles;
- for the installation of one heart valve - about 200 thousand rubles;
- for a kidney transplant for each patient - 800 thousand rubles.
Not only is it expensive high-tech assistance.
Consultations with specialists at a public clinic cost more than people are used to thinking:
- examination by a gynecologist – almost 500 rubles;
- appointment with a therapist - about 300 rubles;
- consultation with an endocrinologist – more than 1 thousand rubles.
Why does the population need to know the cost of treatment?
The introduction of a new system of informing citizens about the cost of medical services has the following goals:
It is likely that after several years of successful operation of the information program, patients will be able to receive tax deduction based on the amounts indicated in the certificate.
Who and when can start using the information system?
By the beginning of the year, a new patient information program was tested in a number of regions of Russia. On September 1, 2014, the pilot project was launched in seven constituent entities of the federation: Bryansk, Moscow, Nizhny Novgorod, Novgorod, Tula regions, the Republic of Tatarstan and Krasnodar region.
Some constituent entities of the Russian Federation joined the project on their own initiative. Since the beginning of 2015 information about the cost of treatment should be available to all patients in any region of Russia.
Even before the introduction of a new information system in the Krasnodar Territory, on the initiative of local authorities patients received information about the cost of treatment. Since 2008, the procedure for issuing certificates is here in full automated.
Some regions that tested the pilot project did not stop at the proposed procedure and went further: in the Bryansk region, for example, they began to actively develop the use of electronic medical records. In his personal account, the patient can view the list and cost of procedures performed. An electronic certificate does not require paper and copying costs, and it cannot be lost.
Knowledge is power
The undoubted advantage of such information is transparency of spending for the treatment of each individual patient and the ability to independently monitor the quality of medical care provided.
If violations are detected, a citizen may complain to the health insurance company, which will always find a way to influence a clinic or hospital. 
To provide feedback and clarify the functioning of the program, a prerequisite is the presence of representatives of the insurance company in medical institutions so that people who do not own a computer can get the information they need.
Compulsory medical insurance is a state system that guarantees all citizens a minimum amount of medical care. It is financed by the federal compulsory health insurance funds (FFOMS). They receive employer contributions from the wages of all officially employed citizens. Funds for the treatment of unemployed persons come from the state budget, the source of which is citizens’ taxes. Medical insurance funds also pay bills for treatment under the compulsory medical insurance policy presented by medical institutions. Providing information to patients about the cost of services provided attracts them to control the expenditure of tax funds for medical purposes.
For what purpose was a program created to inform insured persons about the cost of services provided? When did the program come into effect and what law is it regulated by? Why does the insured person need to know about the cost of services provided? In what form does the information take place? We will answer these questions in this article.
Legislative basis for informing about the cost of treatment under compulsory medical insurance
The state program for informing citizens about the cost of “free” medical services was launched on July 25, 2014, on the instructions of the President of the Russian Federation - “Instruction No. Pr-1788”. And on July 28, 2014, FFOMS Order No. 108 “On the introduction of a system for informing insured persons about the cost of medical care” was published. Since September 2014 in seven regions of Russia medical institutions They began to issue certificates to patients stating what kind of medical care they received and what its cost was. At the outset, the public information experiment encountered difficulties and misunderstandings, including:
- Overload of medical personnel forced to calculate the volume and cost of services for each patient, issue certificates, explain their purpose, collect signatures on receipt or refusal;
- Misunderstanding and wary attitude of patients towards certificates. Some asked what to do with them; others accepted them on account to pay out of their own pockets; Still others were amazed at how cheap services under the compulsory health insurance policy are priced.
The first difficulties were overcome. In 2015, medical institutions in almost all regions of Russia entered into a system of mandatory informing patients about the cost of care provided to them under compulsory medical insurance policies.
Goals and objectives of the awareness program
The program, the development of which was an initiative of the President of the Russian Federation, helps solve several problems. Thus, the need for information was initially explained by psychological factors: knowing the cost of insurance medicine services, citizens will begin to be understanding about the expenditure of budget funds, take care of their health, etc. But such a measure primarily pursues a practical goal: establishing control over the expenditure of state budgetary funds for medical purposes. By receiving a certificate of assistance that was provided to him, the patient thereby finds out how much the insurance fund is transferring for his treatment, whether the volume and quality of services correspond to state guarantees. In addition, a certificate indicating the tariffs for free care allows citizens to clearly understand what the required minimum is provided by insurance medicine, and for which services they will have to pay out of their own pocket.
Receiving information about medical care through Personal Area On the government services website, a citizen can find services that were not provided to him, but are recorded in his book. According to experts, medical institutions are engaged in registrations in order to attract additional funds to finance their urgent needs. Therefore, such a database is also useful for state control authorities. The expenditure of FFOMS funds becomes transparent, easier to account for and regulate.
How much does it cost to treat a patient?
Money for compulsory health insurance funds comes from several sources. Enterprises allocate 5.1% of wage funds for these needs to provide medical care to their employees and their families. The state budget finances the treatment of unemployed citizens and some types of socially dangerous diseases (HIV, tuberculosis, etc.). Based on Law No. 286-FZ of July 3, 2016, signed by the President of the Russian Federation, from January 1, 2017, high-tech free service patients will not be paid state budget, and FFOMS. Individual regions contribute additional funds to territorial compulsory medical insurance funds to expand free treatment opportunities for its population.
The problems of distribution of funds in the compulsory medical insurance system are evidenced by the following figures - 1.7 trillion. rub. - this amount was managed by the FFOMS in 2017, which is 7.8% more than the funds in 2016. For each average owner of a compulsory medical insurance policy, the planned expenditure is 9.1 thousand rubles, while in Moscow it was about 24 thousand rubles in 2014. The cost of most medical services according to the price list of basic compulsory health insurance services is an order of magnitude lower than in paid clinics, which is not always economically justified. The table below shows data on tariffs for some types of medical care and services provided under compulsory medical insurance.
Table - Tariffs for payment for certain types of medical services under the compulsory health insurance program in 2017, rubles.
| Types of medical care |
Medical service |
Tariff (cost) |
|---|---|---|
| Primary in an outpatient clinic |
Appointment with a therapist |
327
|
| Oncologist appointment |
348
|
|
| Neurologist appointment |
333
|
|
| Gynecologist appointment |
406
|
|
| Specialized in hospital (including day care) |
Oncology procedures |
40 000 - 200 000
|
| Procedures for cardiac and pulmonary pathologies |
15 000 - 120 000
|
|
| Procedures for orthopedic pathologies |
55 000 - 250 000
|
|
| High tech |
Balloon angioplasty for pulmonary valve stenosis |
128 190
|
| Kidney transplant |
800 000
|
|
| Treatment of diabetes |
166 495
|
Based on data from the Tariff Agreement in the compulsory health insurance system of the Kaliningrad region for 2017 and the planning period of 2018 and 2019
Free treatment of serious diseases is difficult, since there are long queues, lack of quotas, and low level of service. Obtaining information about the cost of treatment will force patients to take their health more seriously and not neglect the opportunity for free medical examinations and preventive examinations under the compulsory medical insurance policy, so as not to trigger incipient diseases.
Ways to obtain information about the cost of treatment under compulsory medical insurance
The issuance of certificates on the volume of medical services provided is carried out by order of the Federal Compulsory Medical Insurance Fund dated October 19, 2015 No. 196 on the basis of the “Rules of Compulsory Medical Insurance” in new edition, approved by order No. 536n of the Ministry of Health of the Russian Federation dated August 6, 2015. This information is issued by the insurance company that issued the policy, by the medical organization that carried out medical treatment, or on the government services portal and on the websites of insurance companies, where the patient can create a personal account and receive all information electronically upon request.
The requested information on paper is provided only by written statement citizen (or his representatives with a legally certified power of attorney), upon presentation of a passport. Receipt is confirmed by a receipt from the patient. The content of such a certificate includes the patient’s personal data and a list of diagnostic and treatment procedures with an indication of their cost.
Conclusion
The program for informing the population about the cost of treatment under compulsory health insurance involves the population in controlling the expenditure of tax funds. It also determines the directions for optimizing health insurance: creating electronic medical records, introducing compulsory medical insurance plus policies, etc.
Few people think about the fact that medical and pension insurance premiums– this is almost the only opportunity to maintain your health today and ensure a decent old age in the future. Not long ago, the Russian Ministry of Labor revealed a sad fact: there are about 20 million Russians in the country who are of working age (18-60 years), but do not pay insurance premiums for themselves for various reasons.
This fact finally convinced industry experts and government officials that the time has come to legalize the labor market and create a personal insurance savings account for every resident of the country. Bank cards will be linked to it, and it will also provide the opportunity to track pension contributions, accumulate compulsory medical insurance contributions, pay for medical services, buy medicines, etc.
The most surprising thing in this matter is not even the number of defaulters, but the fact that over 25 years of introducing social insurance systems, it has been possible to count who needs to be insured and in what quantity.
Consider, for example, the healthcare system. Today we see a large number of defaulters, regions that are not always highly disciplined in paying payments for non-working citizens, as well as an unreasonably low rate of contributions that the employer pays to compulsory medical insurance (so far only 5.1%, when about 8-9% is needed).
All this does not allow us to create a full-fledged health insurance system in Russia, which has been successfully operating in many other countries for so many years. One of the real tools for solving the above problems is a system of personal social accounts, in particular medical ones, which can already be implemented today for every citizen of our country.
Let's consider an ideal model of social accounts. Insurance funds are generated from revenues from several sources: contributions from the state, employers, their own contributions as a percentage of wages, as well as voluntary revenues.
Only if there are funds in a personal account, a citizen (by analogy with OSAGO) has the right to receive this or that service or buy medicine, since only in this case his insurance company has the opportunity to transfer money for him medical organizations(with the possible exception of emergency medical care, oncology, organ and tissue transplantation, including bone marrow, i.e. particularly expensive manipulations and operations that must be financed from the budget).
This may seem cruel and inconsistent with the practice of civic solidarity. But if we are talking about millions of non-payers, this essentially means that they are outside the compulsory medical insurance system, but claim, with reference to the Constitution, for free medical care, for the provision of which they have not paid a penny to the state, funds or insurers.
You and I do this for them, limiting our opportunities to receive a wide range of medical services. Let me give you a current example. Recently, oncologists have said that they will soon have to offer their patients alternative treatment options, as they are forced to work at an economically unjustified rate.
We allocate a little more than 8 thousand rubles per capita per year in the compulsory medical insurance system, but it is known that just one course of chemotherapy can cost up to 1.5 million rubles. How can an insurance company, within the compulsory medical insurance, guarantee coverage of such expensive treatment?
That is, the very concept of “social insurance” turns out to be economically distorted. It turns out that our insurance in this situation is not financially secure. That is, we come to the conclusion that the constitution in terms of ensuring state guarantees will have to be revised with the amendment “within the limits of funds allocated by the state.”
And only when medical policies are provided with funds from individual savings accounts will people be interested in contributing money to their health and will be able to personally manage and independently control their finances.
We will finally find out what and how much it costs in our healthcare, and where are the “streams” of inefficiency through which the collected money flows. With a personal account system, everything will become clear, logical and transparent for everyone. And in order for there to be enough funds, the cost of the insurance period (calendar year) should not be at the level living wage, and amount to the same amount as the minimum insurance costs in the VHI system - at least 30 thousand rubles.
And one last thing. If the conditions in the state change, then its legislation must also change. Maybe then the compulsory medical insurance system will acquire its true purpose, people will have enough money for full and effective medical care, and the pension will be enough to go on a trip in old age, for example, to the resorts of the Caucasus or the Crimea, not to mention just to live longer.
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