Compulsory medical insurance of compulsory medical insurance

Compulsory health insurance (compulsory medical insurance) is a type of social insurance representing a system of measures aimed at ensuring guarantees of free provision of medical care to the insured person at the expense of compulsory medical insurance.

The main regulatory legal acts regulating the activities of medical organizations in the field of compulsory health insurance are: Federal Law of 29.11.2010 No. 326-FZ "On Compulsory medical Insurance in of the Russian Federation"; Order Ministry of Health and Social Development Russia No. 158n of 28.02.2011 "On Approval of the Rules of Compulsory Health Insurance"

• Since 2011, citizens have been issued compulsory medical insurance policies of a single model.
• Since 2011, citizens have received the right to independently choose an insurance medical organization (SMO) that defends and protects the rights of their insured.

The Compulsory Health Insurance Policy (Compulsory Medical Insurance) is valid throughout the Russian Federation, regardless of the region in which it was issued. Traveling to another region, a citizen of the Russian Federation retains the right to receive free medical care under the basic compulsory medical insurance program. The basic compulsory medical insurance program is valid throughout the Russian Federation. Territorial compulsory medical insurance programs operating in each specific region can expand and supplement the Basic. At the same time, everything that is included in the Basic Compulsory Medical Insurance Program is also included in the Territorial Programs.

Number of insured

In Russia, as of May 2019, 146.4 million people were insured under the compulsory medical insurance program.

Compulsory medical insurance policy on vacation in Russia

Main article: Compulsory medical insurance policy on vacation in Russia

Program funding

2.2 trillion rubles will be the budget of the basic compulsory medical insurance program in 2020 as of August 2020. This is due to an increase in the per capita standard of the basic compulsory medical insurance program to 12,699 rubles.

Program Management

Main article: Federal Compulsory Medical Insurance Fund (FFOMS, Federal Compulsory Health Insurance Fund)

Free compulsory medical insurance services, for which they should not require payment

Inoculations

In Russia, there is a national calendar of preventive vaccinations, within which vaccinations are carried out at a certain age for children and adults. Vaccinations included in the calendar for compulsory medical insurance insured are given free of charge.

Top 10 free services that can be charged

The top 10 free medical services for December 2018, for which they may illegally require payment in medical organizations operating in the compulsory medical insurance system. These services should be provided in the presence of indications for their conduct, identified by the attending physician.

1. Hospital supplies: medicines, needles, syringes, infusion therapy systems, etc.

2. Medical devices implanted in the human body (metal structures, etc.)

3. Consumables, outpatient - filling material in dentistry, X-ray film, disc for recording CT or MRI results (in most regions)

4. Performing hardware diagnostic techniques such as MRI and CT (outpatient and inpatient)

5. Medical care for dental diseases (except for dental prosthetics)

6. Medicinal products for the treatment of oncological diseases

7. Blood tests, wh. on hormones

8. Shortening study waiting times: ultrasound, radiography, gastroscopy

9. Restorative treatment (massage, exercise therapy, etc.) prescribed by the attending physician

10. Consultation of "narrow specialists" (oculist, neurologist, ENT, surgeon, oncologist, etc.)

The rating was compiled on the basis of requests from Russians to medical insurance organizations operating in the compulsory medical insurance system and which are part of the All-Russian Union of Insurers in 2018. This list may differ or have clarifications in various constituent entities of the Russian Federation in accordance with the Territorial Program of State Guarantees for the Provision of Medical Care to Citizens approved by the constituent entity of the Russian Federation.

In case of questions related to the provision of medical services in the compulsory medical insurance system, contact the administration of a medical institution or the insurance representative of the medical insurance company that issued you a compulsory medical insurance policy.

Cancer Care Standard

Main article: Cancer treatment

In 2019, the state allocated 198 billion rubles to expand the compulsory medical insurance program, from which it follows that citizens with an insurance policy can count on a significant expansion of the list of medical services in medical institutions. Thanks to the increase in funding, the state guarantee program for 2019 includes innovations that are aimed at developing an oncological profile. Now, according to the basic compulsory medical insurance program, there is a standard for the volume of medical services provided in this area in the conditions of both a day and a round-the-clock hospital. In addition, in connection with the increased funding of the compulsory medical insurance program, medical institutions began to use effective drugs, without replacing them with cheap analogues.

Also in 2019, the government ordered annual subventions to regional funds for the implementation of the compulsory medical insurance program in the amount of 2 trillion 68 billion rubles, which, in turn, is 10.6% higher than in 2018. In this regard, residents of the Moscow region and other regions are advised to pay attention to the possibility of obtaining medical services under the insurance policy in private Moscow clinics, which are believed to be equipped with more modern equipment and where modern methods of treating cancer are used.

Read more here.

MHI IVF

Main article: IVF (In vitro fertilization)

High-tech medical care for compulsory medical insurance

Main article: High-tech medical care for compulsory medical insurance

Implants

2023: Mishustin allowed to supply dentures of the dura mater under compulsory medical insurance

At the end of July 2023, Prime Minister Mikhail Mishustin signed an order that expanded the list of medical devices implanted under the compulsory medical insurance program. The list was replenished with only one of the three medical devices recommended by the Commission of the Ministry of Health for the inclusion in 2023 - a prosthesis of the dura mater based on a biopolymer composite.

The list of medical devices implanted into the human body in the provision of medical care within the framework of the program of state guarantees for the provision of free medical care to citizens, <…>after the position classified by code 323160, is supplemented with the following position: "323330 - Dura dura prosthesis, based on a biopolymer composite," the document says.

According to Roszdravnadzor, by the end of July 2023, about 10 names of specialized medical products produced by German, Chinese and American companies were registered in Russia. The description is suitable for the patch registered in 2020 for the restoration of the cerebral dura defect NeoDuraTM manufactured by the Chinese-German Medprin Biotech (Medprin Regenerative Medical Technologies) with production sites in Frankfurt am Main and Guanzhou.

The Commission of the Ministry of Health of the Russian Federation on the formation of lists of medical devices recommended that out of 17 applications, three medical devices be included in the list: a set for sclerotherapy of veins and a coronary venous and MRI-compatible withdrawal of an electrocardiostimulator, the applicant of which was Medtronic, and a prosthesis of the dura on the basis of a biopolymer composite, which was proposed by the authorized registrar - BiVi Company LLC. However, only the latter was included in the list.

By the end of July 2023, the list of medical devices implanted under the compulsory medical insurance program includes 376 items.

Order of the Government of the Russian Federation No. 1990- dated 25.07.2023

Psychological assistance

2023: For the first time, psychological assistance was included in the compulsory medical insurance

For the first time, psychological assistance was included in the compulsory medical insurance - from July 1, 2023, it became available to citizens Russia in clinics.

Special offices for medical and psychological counseling have been opened in state medical institutions. There will be medical psychologists.

In particular, the innovation involves consulting the patient and his loved ones on the issues of disease and adherence to treatment, participating in the provision of assistance to persons with mental disorders associated with stress, including PTSD. Also, the doctor sends persons with signs of mental disorders and behavioral disorders to medical organizations that provide assistance in profile, and patients with symptoms of diseases - to consult with specialists. In addition, the measure is aimed at conducting sanitary and educational work among the population on the prevention of mental disorders.

Ministry of Health Svetlana Shport, chief freelance psychiatrist, told To the businessman"" that the new order is aimed at integrating the psychiatric service into the common link. health care It allows you to organize work "according to the modular principle": organize offices or departments in the primary care, deploy somatopsychiatric departments in multidisciplinary hospitals, and, if necessary, open nosological offices (suicidological, geriatric).

According to TASS with reference to the draft government decree on October 28, 2023, it is proposed for the first time to introduce the possibilities of medical and psychological counseling in clinics in the draft program of state guarantees for the provision of free medical care (Compulsory Medical Insurance) for 2024 and for the planning period 2025 and 2026. It is proposed to increase expenses at the expense of budgets of all levels, as well as compulsory medical insurance funds for the provision of all types of medical care provided to citizens free of charge.^[1]

How to choose or change the clinic

Main article: How to choose or change a clinic for compulsory medical insurance

Insurance reps: If something went wrong

Main article: Insurance representatives

Insurance representatives are employees of medical insurance organizations operating in the compulsory health insurance system (compulsory medical insurance). The main tasks of insurance representatives are to increase the level of awareness of insured citizens about the possibilities of the compulsory medical insurance system, to ensure the protection of the rights and legitimate interests of citizens for affordable and high-quality medical care, information support of citizens at all stages of receiving medical care.

Digital compulsory medical insurance policy

Main article: Digital compulsory medical insurance policy

GIS CHI

Main article: GIS CHI

Health insurance fraud

Main article: Health insurance fraud

Chronicle

2024

Since 2018, ₽60 billion has been spent in the Russian Federation on the provision of medical care to migrants without policies. Leading regions

On October 15, 2024, it became known that from 2018 to 2024, the regions of Russia spent more than ₽60,7 billion from local budgets to provide medical care to migrants without health insurance policies. Such data were obtained by the deputy of the State Duma Mikhail Matveyev during the analysis of official responses to deputy requests.

According to APN, Moscow, which spent more than ₽42 billion, became the leader in spending on medical care for migrants. In second place is St. Petersburg with over ₽4 billion, followed by the Khanty-Mansiysk Autonomous Okrug (₽2,2 billion), the Kurgan Region (₽1,7 billion) and the Krasnodar Territory (more than ₽1 billion). Significant expenses were also recorded in the Novosibirsk and Rostov regions.

Since 2018, 60 billion rubles have been spent on medical care for migrants without policies in the Russian Federation

Matveev noted the annual increase in the volume of free medical care provided to migrants. The deputy stressed that this situation not only increases the burden on regional budgets, but also deprives Russian insurance companies of a significant market segment.

In parallel with the increase in the cost of medical care for migrants, there is an increase in the number of crimes committed by minor foreigners. The head of the Investigative Committee of Russia, Alexander Bastrykin, reported a 10 percent increase in such crimes in 2024. Of particular concern is the more than twofold increase in the number of particularly serious crimes committed by migrant adolescents: from 53 to 108 cases.

In this regard, the Chairman of the State Duma Vyacheslav Volodin proposed to revise the list of professions that allow you to obtain a residence permit in Russia in a simplified manner. He stressed the need for more active government participation in the formation of migration policy.

The State Duma also passed a law aimed at countering fictitious marriages with migrants. According to the new legislation, foreign citizens will be able to obtain a residence permit no earlier than three years after marriage or adoption of a child.^[2]

Hospitals were allowed to buy equipment worth up to 400 thousand rubles at the expense of compulsory medical insurance

In March 2024, Prime Minister Mikhail Mishustin signed a decree that expanded the parameters of the program of state guarantees of free medical care for citizens for 2024 and the planning period 2025 and 2026. One of the innovations is that hospitals are now allowed to purchase equipment, production and economic inventory worth up to 400 thousand rubles at the expense of compulsory health insurance (compulsory medical insurance). Previously, the limit was 100 thousand rubles.

Also, the tariff structure includes the costs of medical organizations for the maintenance and repair of such equipment and equipment.

Mikhail Mishustin signed a decree that expanded the parameters of the program of state guarantees for the provision of free medical care to citizens

In addition, medical organizations were allowed, subject to a number of conditions, to use compulsory medical insurance funds when these legal entities:

• complete participation in the implementation of the compulsory medical insurance program for the year;
• will fulfill all obligations under contracts for the payment and provision of medical care.

The government decree signed by Mishustin in March 2024 added coefficients to the wages of medical workers providing high-tech medical care (VMP). The innovation is due to the fact that part of the volume of high-tech medical care since 2024 is provided within the framework of the basic program of compulsory medical insurance, the press service of the Cabinet of Ministers explained. We are talking about 23 methods of VMP in six profiles: obstetrics and gynecology, ophthalmology, pediatrics, cardiovascular surgery, traumatology and orthopedics, urology.

Financing of the program of state guarantees of free medical care for citizens for 2024 increased by more than 400 billion rubles, which, as emphasized in the government, will improve the quality and availability of free medical care for citizens.

Government of the Russian Federation Resolution of March 23, 2024 No. 371

2023

How the digitalization of the compulsory medical insurance system is taking place in Russia

In November 2023, the chairman of the Federal Fund of OMSI Balanin spoke about how the system of compulsory medical education is being digitalized. According to him, the development of information technologies in this area is one of the important tasks of public administration and ensuring the national security of the Russian Federation.

As Balanin said in a conversation with Komsomolskaya Pravda, as part of the department's digital transformation, an information system for compulsory health insurance (GIS OMS) was launched, which contains a unified register of insured persons issued by policies, insurance history and attachment to medical organizations. GMP GIS is associated with other GIS.

Balanin also announced the launch of the Patient Digital Medical Profile system. It contains data on the provision of medical care to the patient, appointments in connection with the treatment and prevention of chronic diseases, as well as procedures. In fact, the project includes a digital compulsory medical insurance policy and an electronic medical history.

In addition, the head of the MHIF recalled the launch of an electronic compulsory medical insurance policy, which is convenient to show from a smartphone when visiting medical institutions or changing the insurance organization. The new method has already tested 50 million customers, including all newborn children in 2023, Balanin said in early November 2023.

In addition, the digitalization of the compulsory medical insurance system allows for the establishment of dispensary registration of people with chronic diseases. They are reminded of the necessary surveys and shown the optimal route of their passage. This allows you to reduce the risks of exacerbations and relapses and ultimately increase life expectancy, Balanin said.

The digital transformation of the compulsory medical insurance system includes electronic personalized accounting of medical care and the transition to unified directories and classifiers. They do not concern patients directly, but contribute to improving the quality and availability of medical care. ^[3]

Federal Compulsory Medical Insurance Fund spent 203.3 billion rubles on the treatment of patients with COVID-19

The Federal Compulsory Medical Insurance Fund for 2022 spent 203.3 billion rubles on the treatment of patients with COVID-19. The Accounts Chamber provides such data in its report on the progress of the budget execution of the MHIF. Read more here.

2022

Federal medical centers received 266 billion rubles from compulsory medical insurance. Funding rises

The volume of financial support for federal medical organizations (FMO) for the provision of specialized, including high-tech medical care within the framework of the basic compulsory medical insurance program in 2022 reached 156.2 billion rubles, which is 10.8% more than a year earlier. This is stated in the draft law on the execution of the budget of the Federal Fund for Compulsory Medical Insurance (MHIF) for 2022, which was published in March 2023.

According to the publication "Medical Bulletin" with reference to the corresponding document, in 2022 more than 2 million cases of medical care were distributed between the FMO. This is 10% higher than the planned indicators of 2021 in terms of the volume of medical care (1.88 million thousand cases). Among other things, 453 cases of VMP were taken into account using a number of unique methods of treatment used in cardiovascular surgery and organ transplantation in the amount of over 1.1 billion rubles.

Federal medical centers received 109.9 billion rubles from the MHIF budget in 2022 to provide high-tech medical care not included in the basic compulsory medical insurance program (VMP-II). Private medical centers for these purposes were transferred 2.6 billion rubles, the document says.

As a result, the FMO 141 provided assistance within the framework of VMP-II in the amount of 305.1 thousand cases, 14 private clinics - 2.1 thousand cases. In total, more than 1.2 million patients received high-tech medical care outside the compulsory medical insurance at the expense of the fund, which is 110.2 thousand (9.9%) more than in 2021. The main volumes of medical care were provided according to the profiles "Cardiovascular Surgery," "Oncology," "Traumatology and Orthopedics."

The total expenses of the MHIF amounted to 2.8 trillion rubles in 2022. Federal medical organizations receive the volume of medical care and funding directly from the MHIF from 2021 after the next reform of the MHI system.^[4]

The limit on the purchase of medical equipment at the expense of compulsory medical insurance has been increased 10 times

In March 2022, Prime Minister Mikhail Mishustin signed a decree that expanded the capabilities of medical organizations to purchase medical equipment for medical interventions, laboratory and instrumental research at the expense of the Compulsory Health Insurance Fund. Read more here.

Mishustin, after a request from Medtronic, expanded the list of implants available for compulsory medical insurance

In mid-January 2022, Prime Minister Mikhail Mishustin signed a decree of the Government of the Russian Federation, which expanded the list of implantable medical devices within the framework of the Campus Management compulsory medical insurance program. Read more here.

2021

The share of private clinics in compulsory medical insurance has hardly increased since 2017

By the end of 2021, there were 3692 private clinics participating in compulsory health insurance (compulsory medical insurance) programs in Russia. In 2020, there were 3484 of them, in 2019 - 3048, in 2017 - 3618. Such data on February 20, 2023 was cited by Svyatoslav Sorokin, Director of the Department for the Development of the Social Sphere and the Sector of Non-Profit Organizations of the Ministry of Economic Development, at a meeting of the Council for the Development of Social Innovations of Subjects in the Federation Council.

Thus, the number of non-governmental medical organizations in the compulsory medical insurance has increased slightly since 2017. At the same time, the total number of medical organizations of all forms of ownership participating in the implementation of the compulsory medical insurance program is decreasing. According to the official's presentation, their number decreased from 10,916 in 2017 to 9951 in 2021. The lowest indicator took place in 2020 (9638).

The Compulsory Health Insurance Fund emphasized that the regulatory framework in the field of health care established uniform requirements for the qualification of doctors in clinics of all forms of ownership. Procedures for the provision of medical care are also mandatory for everyone.

The participation of private clinics in the implementation of compulsory medical insurance programs creates the necessary competitive environment for state medical institutions. Non-state clinics help to ensure the implementation of the basic principles of protecting the health of citizens - improving the quality and availability of medical care, - said the chairman of the MHIF Natalya Stadchenko.

As the publication "Medical Bulletin" reminds, in 2021, Boris Titov, Commissioner for the Protection of the Rights of Entrepreneurs, in a report to the president, advocated a change in the principles of regulation in the field of compulsory medical insurance. It was about creating understandable and transparent criteria for the distribution of the volume of medical care. According to the business ombudsman, the current standards limit competition in the medical services market and deprive citizens of the opportunity to choose the place of treatment.^[5]

Medical organizations presented a record amount of fines

In April 2022, the Federal Compulsory Medical Insurance Fund (MHIF) published a report in which it reported a record amount of fines that were presented to medical organizations in the compulsory health insurance system. At the end of 2021, medical and preventive institutions lost 202 billion rubles due to defects in the provision of medical care, which is three times more than a year earlier (68.1 billion rubles).

The increase in the volume of financial sanctions against medical organizations was associated with the suspension of planned examinations of quality control of medical care due to the COVID-19 coronavirus pandemic. Control was carried out only in cases of cancer, heart attacks, strokes and appeals of insured citizens. The most fines were issued in the following areas:

• when carried out medical and social expertise (ITU) by 182.7 billion rubles, of which according to the profile "" oncology- by 20.6 billion rubles. In 2020, these amounts amounted to 54.6 billion and 12.7 billion rubles, respectively;
• for non-compliance with clinical recommendations by 6.4 billion rubles (in 2020 - by 4 billion rubles);
• for premature termination of treatment in the provision of medical care for 160.1 million rubles (in 2020 - 129.4 million rubles);
• for violation of continuity by 135.4 million rubles (in 2020 - 81.2 million rubles);
• for charging fees for medical care provided for by compulsory medical insurance programs - 20.7 million rubles (in 2020 - 17.7 million rubles);
• for unreasonable failure to comply with consultations/consultations of medical workers of national research medical centers - 61.8 million rubles (in 2020 - 8.6 million rubles).

Until April 2022, the MHIF did not disclose the indicators of the volume of fines imposed annually on medical organizations working in the MHI system.^[6]

Navzvan average salary of doctors working in the compulsory medical insurance system - Ministry of Health of Russia

The average salary of doctors working in the field of compulsory medical insurance in Russia at the end of 2021 amounted to 93.5 thousand rubles. For nurses, the corresponding earnings were measured at 46.1 thousand rubles. This is stated in the draft report on the execution of the budget of the Federal Compulsory Medical Insurance Fund (FFOMS). Read more here.

Accounts Chamber: Private clinics account for only 5% of compulsory medical insurance services

According to the Accounts Chamber, which were released in mid-March 2022, in 2021, private clinics accounted for only 5.1% of the allocated medical care in the Compulsory Health Insurance (Compulsory Medical Insurance) system. At the same time, the share of non-state medical institutions in the total number of medical organizations participating in compulsory medical insurance amounted to 35.9%.

Their [private clinics - approx. Zdrav.Expert] participation is represented in the overwhelming majority of cases by the provision of individual medical services at secured rates or symbolic amounts of medical care used for marketing purposes to attract patients, "the joint venture said in a report.

The control and supervisory body also noted that the total amount of subvention to finance the powers transferred to the regions in the field of compulsory medical insurance remains insufficient. The current method of subvention distribution does not fully take into account objective differences between subjects. In particular, the difference in the cost of some goods and services that occupy a significant share in the costs of medical organizations (for example, in the cost of purchasing drugs), differences in the cost of medical care within the framework of inter-territorial calculations are not taken into account.

In addition, as reported in the Accounts Chamber, most subjects do not sufficiently implement the powers to additionally finance the territorial compulsory medical insurance program at the expense of the regional budget, even if there are unpaid super-planned volumes of medical care. In 2018-2020, only 31 entities co-financed territorial programs.

The joint venture proposed to the government to instruct the Ministry of Health to amend the compulsory medical insurance rules in the mechanism for distributing the volume of medical care between medical organizations.^[7]

Compulsory medical insurance reform is stalling: insurance companies continue to work with patient complaints

On January 1, 2021, a law came into force that imposed the powers of the insurer in relation to federal medical institutions (FMU) to the Federal Compulsory Health Insurance Fund (FFOMS). Accordingly, quality control of medical care and protection of the rights of patients of medical organizations should have become the prerogative of the FFOMS. However, in accordance with the official website of the Unified Procurement Information System:

• throughout 2021, FMU patients were left without planned quality control of the medical care provided to them by the FFOMS;
• examination of the quality of medical care in the FMU will begin to be carried out only in 2022.

At the end of 2021, patients of regional medical institutions (and this is the vast majority of hospitals and clinics) are still protected by insurance companies that issued them compulsory medical insurance policies. According to the All-Russian Union of Insurers (ARIA), from January to October 2021, insurance companies conducted 24.1 million examinations and revealed 3.5 million violations. The vast majority are concerned with non-compliance with care standards and clinical guidelines.

Insurance companies, on the direct instructions of the FFOMS, still continue to work with complaints from FMU patients. However, the real capabilities of insurance companies to restore and protect the rights of FMU patients are limited (since there is no contract for the provision and payment of medical care between FMU and insurance companies). According to the SCS, in the structure of incoming complaints from FMU patients, the leading place is occupied by non-compliance with the requirements for the availability of medical care (unjustified refusal to issue referrals, violation of the deadlines for waiting for planned hospitalization, violation of the right to choose a place of treatment), collection of funds from insured persons. Ultimately, this leads to both violation of citizens' rights in the field of health protection and dissatisfaction with the quality of the care received.

Through State Services launched proactive information on digital compulsory medical insurance services

and Ministry of Digital Development of Russia Compulsory Health Insurance Fund (MHIF) on December 2, 2021 announced the launch on the Public Services Portal notification service within the framework of the project "." OMS Digital Services The service will provide proactive information support for each citizen in the process medical of obtaining compulsory medical insurance services, will minimize visits to medical institutions, and will also relieve unnecessary burden on the staff of medical organizations. More. here

The Accounts Chamber named 7 defects in the medical insurance system in Russia

In mid-November 2021, the Accounts Chamber (JV) published a report in which it pointed out the insufficient effectiveness of the compulsory health insurance system (compulsory medical insurance). The report was compiled based on the results of a study conducted in 2018-2020. The main problems of compulsory medical insurance are:

• failure of the participants of the compulsory medical insurance system to motivate actions to increase its effectiveness;
• instability of financial parameters of the activities of insurance organizations and medical institutions;
• poor focus on the planning and distribution of health care to address the challenges of improving the quality of health care and resource efficiency;
• weak rationale and over-individualization of health care rates;
• maintaining obstacles to the participation of private medical organizations in the compulsory medical insurance system;
• insufficient grounds for competition of insurance medical organizations;
• lack of monitoring of the effectiveness of various ways of informing insured persons about their rights and obligations.

Russia, according to the joint venture, surpassed most countries with compulsory medical insurance and all countries with budgetary funding in such parameters as the provision of outpatient care, the provision of the population with hospital beds and the duration of hospitalization. In terms of the number of doctors' appointments per capita, Russia is on a par with Germany and Lithuania. Russia differs from countries from the comparison group and in the structure of mortality: here in the first three places - diseases of the circulatory system, cancer and external causes (accidents, accidents, etc.). In other countries, the main causes of mortality are cancer, diseases of the circulatory system and respiratory organs, the report says.

The Ministry of Health and the Federal Compulsory Medical Insurance Fund (FFOMS) reported that based on the results of the analysis of the Accounts Chamber, methodological recommendations were prepared describing the coordination of the FFOMS "standards for ensuring that territorial funds fulfill their functions in order to develop a unified approach to the formation of these standards."^[8]

Mishustin approved the rules for the work of GIS in the field of compulsory medical insurance

Prime Minister Mikhail Mishustin approved the rules for the operation of the state information system of compulsory health insurance (GISOMS). The press service of the Cabinet of Ministers announced this on June 15, 2021. Read more here.

2020

Courts in Russia satisfy only a third of patients' claims for medical care under compulsory medical insurance

Courts in Russia satisfy only a third of patients' claims for medical care for compulsory health insurance (compulsory medical insurance). This was reported in early February 2022 in the Accounts Chamber (JV) based on the results of the study.

According to the statistics of the department, in 2019-2020, the courts accepted and satisfied 506 out of 1382 applications of patients who tried to defend their rights in the field of medical care for compulsory medical insurance. The plaintiffs and their representatives managed to sue 190 million rubles in two years. In pre-trial order, problems were solved much more often - 46.8 thousand citizens managed to agree with territorial funds (TFCMI) and insurance medical organizations (SMO), who were compensated for damage by 28.8 million rubles.

In 2019-2020 citizens insured under compulsory medical insurance accounted for about 97% of the considered claims related to the protection of patients' rights. We are talking about the requirements of people who were dissatisfied with the treatment, said Galina Izotova, deputy chairman of the Accounts Chamber.

Also recorded a small percentage of claims from insurance medical organizations that are not endowed with such powers. At the same time, the territorial compulsory medical insurance funds, just endowed with them, have not filed a single claim in two years. It is noted that the court satisfies claims from insurance more often than those filed by citizens.

According to the joint venture, in addition to legislative gaps, the low awareness of insured persons about their rights is due to shortcomings in the work of information systems of territorial compulsory medical insurance funds and numerous technical errors that allow medical organizations to work in these systems.

Information is often entered late or retroactively, which does not affect the accuracy of the information. In addition, not all medical organizations in the regions work in these information systems, added to the Accounts Chamber.^[9]

Revocation of the license for compulsory medical insurance at Spassky Gate-M

The Bank of Russia revoked the license for compulsory health insurance (compulsory medical insurance) at Spassky Gate-M. The corresponding order was signed by the regulator on December 10, 2020, and the next day the decision entered into force. Read more here.

Putin signed a law on the reform of the compulsory medical insurance system

In December 2020, the President Russia Vladimir Putin signed a law on the reform of the compulsory health insurance system (). Campus Management OMS The corresponding document was published on December 8 on the official portal of legal information.

According to the law, a line will appear as part of the basic compulsory medical insurance program, which determines the standards for the volume of provision and financing of medical care in federal institutions. In 2021, 119.4 billion rubles are provided for these purposes.

FFOMS will maintain a unified register of medical organizations operating in the field of compulsory medical insurance. Federal medical organizations have the right to send an application to the fund for the distribution of the provision of specialized medical care, including high-tech. After that, the fund includes the medical organization in a single register. The application for the next year must be sent by September 1 of this year. If we are talking about the distribution of assistance for 2021, then the application can be submitted until December 25, 2020 inclusive.

Earlier, auditors of the Accounts Chamber said that the bill on compulsory medical insurance reform threatens to worsen the situation with medicine in Russia. They warned that the document carries the risks of a departure from insurance principles in the compulsory medical insurance system and its financial stability. It can reduce the quality control of medical care and the level of protection of the rights of insured persons.

State Duma Speaker Vyacheslav Volodin said that the quality of medical care "should grow, because the volume of funding will be higher and there will be less delays."

Earlier, auditors of the Accounts Chamber said that the bill on compulsory medical insurance reform threatens to worsen the situation with medicine in Russia. They warned that the document carries the risks of a departure from insurance principles in the compulsory medical insurance system and its financial stability. It can reduce the quality control of medical care and the level of protection of the rights of insured persons.^[10]"

The costs of testing and treatment of COVID-19 exceeded the entire budget of the compulsory medical insurance

On December 7, 2020, it became known that the costs of testing and treating the COVID-19 coronavirus in Russia exceeded the entire budget of the compulsory health insurance program. Read more here.

The State Duma approved the reform of the compulsory medical insurance

At the end of November 2020, the State Duma approved in the third final reading a bill on the reform of the Compulsory Health Insurance (Compulsory Medical Insurance) system. The amendments are aimed at increasing the availability of medical care.

In accordance with the new law, a separate line will appear as part of the basic compulsory medical insurance program, which determines the standards for the volume of provision and financing of medical care in federal institutions. In 2021, 119.4 billion rubles are provided for these purposes.

The normative amount of funds provided by the territorial fund of the compulsory medical insurance insurance organization for conducting compulsory medical insurance will be reduced from 1-2% to 0.8-1.1%. It is assumed that this will allow by 2023 to free up to 6.8 billion rubles, which can be used to implement territorial compulsory medical insurance programs.

The Federal Compulsory Medical Insurance Fund without the participation of medical insurance organizations will carry out settlements for medical care, control of the volumes, terms, quality and conditions for the provision of this medical care by federal medical organizations. Also, the fund will present claims or claims against the person who caused harm to the health of the insured person.

Now the law provides that the fund will maintain a single register of medical organizations operating in the field of compulsory medical insurance, and registers of medical organizations that work in the field of compulsory medical insurance under territorial compulsory medical insurance programs.

Institutions subordinate to the Ministry of Health received the right to provide primary, ambulance and specialized assistance in accordance with the territorial program.

Federal executive bodies will deal with the distribution of assistance between federal medical institutions, taking into account their capacities.

The basic norms of the law will enter into force on January 1, 2021.^[11]

Start providing remote medical advice on compulsory medical insurance

On July 16, 2020, it became known that remote medical consultations for the first time in Russia began to be provided under the compulsory health insurance policy. Telemedicine service "Doctor nearby" has become available to the owners of the compulsory medical insurance policy in the Kaluga region - this is about 1 million people. Read more here.

2019

Allocation of an additional 198 billion rubles for the expansion of the compulsory medical insurance program

In 2019, the state allocated 198 billion rubles to expand the compulsory medical insurance program, from which it follows that citizens with an insurance policy can count on a significant expansion of the list of medical services in medical institutions.

Start of the project "Development of primary health care"

Since January 2019, the federal project "Development of primary health care" has been launched in the Russian Federation, which is designed for the period until 2024. According to this project, the state should create a system for managing the quality of medical care, as well as accompanying the patient throughout the treatment process, including protecting his rights.

2011: Private clinics authorized to provide compulsory medical insurance services

In 2011, the Federal Law on Health Insurance was amended, which made work within the framework of state guarantees possible for private clinics and medical centers. Despite this, even for 2019, a large number of residents of the Moscow region and Russian regions were poorly aware of this possibility and did not apply to non-state clinics for free medical care.

See also

• VHI (Voluntary Health Insurance)

Notes