INTRODUCTION
Conclusions on Chapter I
2.2 Results of the empirical study
2.3 Prospects for the development of the voluntary health insurance
Conclusions on Chapter II
CONCLUSION
BIBLIOGRAPHY
APPLICATION
INTRODUCTION
Voluntary health insurance is a form of health insurance in case of loss of health, which provides the possibility of full or partial reimbursement of medical expenses. The social and economic significance of voluntary medical insurance is to supplement the guarantees for medical care provided to the population free of charge through the system of budgetary financing of medical institutions and compulsory medical insurance.
Voluntary health insurance is becoming increasingly important in the development of private medicine. However, the penetration of this type of insurance into life is still not large enough.
In this regard, the object of research is the system of voluntary medical insurance.
The subject of the research is voluntary medical insurance programs.
The purpose of the study is to determine the features modern system voluntary health insurance.
To achieve this goal, it is necessary to perform a number of tasks:
To study the scientific literature on this issue;
To study the history of the formation of the voluntary medical insurance system in Russia;
Consider the features of voluntary medical insurance abroad;
Summarize the experience of insurance organizations working with voluntary medical insurance programs;
Develop a questionnaire and conduct empirical research on this issue;
Determine the prospects for the development of a system of voluntary medical insurance.
Hypothesis: the development of a system of voluntary medical insurance is possible under the following conditions:
1) insurance companies will carry out activities to inform the population about the essence of voluntary medical insurance and its benefits;
2) new insurance products will be created within the framework of voluntary medical insurance.
The methods by which this study will be carried out include the analysis of scientific literature, questioning, generalization of experience, and conversation.
The practical significance of the work lies in the fact that the results can be used in the activities of insurance companies operating under voluntary medical insurance programs.
Base of the study: the study was conducted on the streets of the city and at enterprises with various forms of ownership.
The structure of the work includes: introduction, two chapters, conclusions by chapters, conclusion, bibliography and appendix.
CHAPTER I. THEORETICAL FOUNDATIONS OF THE STUDY PROBLEM
1.1 The essence of voluntary health insurance
Insurance business is important economic institute, which existed in different economic formations, one of the developing types of business. Insurance is designed to satisfy the urgent and fundamental human need - the need for security. Increasing the role of insurance in modern economy, on the one hand, and the increasing differentiation of legal norms regulating the life of society and economic activity people, on the other hand, determined the formation of insurance law as a specific part of the legal system of the state and a complex branch of legislation (43).
The limited basic program of compulsory health insurance, the lack of motivation among medical workers, the inaccessibility of modern clinical and laboratory facilities in the face of deteriorating health care financing have led to an aggravation of problems associated with obtaining qualified medical care. In this regard, the only possible system for the provision of medical services at a qualitative level remains the system of voluntary medical insurance. The Constitution of the Russian Federation in Article 41 proclaims the right to health care and medical care, putting it on a par with such social rights as the right to pension and social security , the right to housing, the right to protection of motherhood and childhood. Economic guarantees themselves are a system in which the central place is occupied by state (budgetary) financing, compulsory health insurance (CHI) and voluntary health insurance (VMI). Voluntary health insurance occupies a worthy place among the economic guarantees of the right to health care and is one of the most effective among them. insured event- (in VMI) an insured person applying to a medical institution (doctor) for medical assistance. Voluntary medical insurance is carried out on the basis of voluntary medical insurance programs and provides citizens with additional medical and other services in excess of the established compulsory medical insurance programs (32, p. 54 ). Voluntary medical insurance is carried out on the basis of an agreement between the insured and the insurer. Voluntary medical insurance rules defining general terms and Conditions and the procedure for its implementation are established by the insurer independently in accordance with the provisions of the Law of the Russian Federation of November 27, 1992 No. 4015-1 "On Insurance". Specific conditions of insurance are determined at the conclusion of the insurance contract.
In accordance with the contract of voluntary medical insurance, the insurance company (or its representative - insurance agent) issues to each insured person an insurance policy of voluntary medical insurance, which indicates:
– the name of the insurance program of voluntary medical insurance chosen by the insured when concluding the VHI contract (for example, “outpatient medical care”, “inpatient medical care”, “comprehensive medical care”, “dental care”, etc.) – insurance program Voluntary health insurance contains a list of medical services that the insured person can receive if necessary. A detailed description of the insurance program of voluntary medical insurance with a list of medical services is contained in the so-called "VHI Rules", developed by each insurance company independently, agreed with the Federal Insurance Supervision Service of the Russian Federation and in without fail attached to the contract of voluntary medical insurance;
– a list of medical and service institutions to which, if necessary, the insured person can apply. The insurance company entered into financing agreements with all these medical institutions, providing for the admission by the medical institution of patients with voluntary medical insurance policies of this insurance company and the subsequent payment by the insurance company for the rendered medical services. Price lists with contractual prices for medical services. In practice, the insured person does not apply directly to a medical institution, but to a service company or to the doctors-organizers of the insurance company, and they already organize the provision of medical care: they agree on the time of admission of the patient, conduct diagnostic tests, deliver the patient to a medical institution, etc. .;
- Sum insured - the maximum total cost of medical services that this insured person can receive under this VHI insurance policy (44).
The subjects of voluntary medical insurance are: a citizen, an insured, an insurance medical organization, medical institution.
The insurers in case of voluntary medical insurance are individual citizens with legal capacity and/or enterprises representing the interests of citizens. If the court recognizes the insurant during the period of validity of the contract of voluntary medical insurance as incompetent in full or in part, his rights and obligations are transferred to the guardian or custodian acting in the interests of the insured.
Insurance medical organizations are legal entities that carry out voluntary medical insurance and have state permission(license) for the right to engage in voluntary health insurance (32, p. 71) .
Medical institutions in the VHI system are licensed medical institutions, medical research institutes, other institutions providing medical care, as well as individuals engaged in medical activities, both individually and collectively.
The object of voluntary medical insurance is the insured risk associated with the costs of providing medical care in the event of an insured event. An insured risk is a prospective event against which insurance is provided. An event considered as an insurance risk must have signs of probability and randomness of its occurrence (13, p. 17).
The insured has the right to:
– participation in all types of health insurance;
– free choice of insurance company;
– control over the fulfillment of the conditions of the medical insurance contract;
– repayment of a part of insurance premiums from an insurance medical organization under VHI in accordance with the terms of the contract.
The insured company, in addition to the rights listed above, has the right to:
- reduction of the amount of insurance premiums in case of a stable level of morbidity of the employees of the enterprise or its decrease within three years;
- attraction of funds from the profit (income) of the enterprise for voluntary medical insurance of its employees.
The insured is obliged:
- make insurance premiums in the manner prescribed by the contract of voluntary medical insurance;
- within its competence, take measures to eliminate adverse factors affecting the health of citizens;
- provide the insurance medical organization with information on the health indicators of the contingent subject to insurance.
Voluntary medical insurance funds are formed in insurance medical organizations at the expense of funds received from insurance premiums. They are intended for financing by the insurance organization of medical and other services provided under this species insurance.
Voluntary medical insurance is carried out at the expense of profits (income) of enterprises and personal funds of citizens by concluding an agreement. The amount of insurance premiums for VHI is established by agreement of the parties. The insurance premium is the payment for insurance, which the policyholder is obliged to pay to the insurer in accordance with the VHI agreement. Tariffs for medical and other services under VHI are established by agreement between the medical insurance organization and the enterprise, organization, institution or person providing these services. The insurance rate is the rate insurance premium per unit of the sum insured or the object of insurance. Tariffs should ensure the profitability of medical institutions and the modern level of medical care (16, p. 25).
Since January 1, 1993 legal entities, directing funds from profits for voluntary medical insurance of employees of the enterprise, members of their families, persons who have retired from this enterprise, are represented tax incentives in the amount of up to 10% of the amount directed from the profit for these purposes.
The main features of compulsory insurance in accordance with Chapter 48 of the Civil Code of the Russian Federation, Part 2 are:
– the insurance obligation arises from the law,
– the objects of insurance are personal and property insurance, civil liability insurance,
– the obligation to insure may be imposed on persons specified in the law in the event of an insured risk, that is, in the event of damage to life, health or property of other persons specified in the law, or violation of contracts with other persons.
Health insurance does not meet these criteria, except for the first one, which refers to CHI. First, the object of health insurance is to maintain the health of citizens by providing medical care at the expense of health insurance funds. Secondly, the conclusion of an insurance contract does not imply the presence of an insurance risk, but insurance payment not carried out upon the occurrence of an insured event. Moreover, the provision of medical care involves the implementation of preventive measures. All these features are typical for both compulsory and voluntary medical insurance, since the object of voluntary medical insurance is also to maintain the health of citizens, but by providing additional medical care (additional medical services) in excess of the established programs of compulsory medical insurance. In this case, the definition of the object of voluntary medical insurance given in Article 3 of the current law on health insurance is questionable, since, in our opinion, it is also unlawful to talk about an insured risk and an insured event for voluntary medical insurance, as well as for compulsory medical insurance ( 14, p. 83).
Now let's move on to the consideration of the features that are specific to voluntary health insurance, that is, its main differences from compulsory health insurance. The differences between compulsory and voluntary health insurance are as follows:
Firstly, the insurance obligation in case of compulsory health insurance follows from the law, and in case of voluntary health insurance it is based only on contractual relations, which, however, does not exclude the need for compulsory health insurance by concluding an insurance contract between the insured and the insurer.
Secondly, the main difference between compulsory and voluntary health insurance lies in the sphere of relations arising between their subjects in the provision of medical care at the expense of insurance funds. If compulsory health insurance is carried out in order to ensure the social interests of citizens, employers and the interests of the state, then voluntary health insurance is implemented only in order to ensure the social interests of citizens (individual or collective) and employers.
Thirdly, from the previous difference follows, in particular, the difference in who are the insurers in compulsory and voluntary health insurance: in compulsory health insurance, these are executive authorities and employers; in case of voluntary health insurance, citizens and employers.
Fourthly, relations on voluntary medical insurance, as well as on compulsory medical insurance, relate to social insurance, which pursues the goal of organizing and financing the provision of medical care to the insured contingent of a certain volume and quality, but under voluntary medical insurance programs (21, p. 40) .
However, voluntary health insurance, unlike compulsory health insurance, does not apply to state social insurance. First, due to the difference in the social interests they realize. Secondly, due to the difference in the forms of ownership and organizational and legal forms of insurance organizations that carry out social insurance. At the same time, it is understood that social insurance can be not only state, but also municipal, and given the differences in its internal organization, it can also be professional (according to professional and sectoral characteristics) and international.
However, classification social insurance on the basis of forms of ownership and differences in its internal organization (state, municipal, professional, international) does not coincide with the classification according to the forms of social insurance - compulsory and voluntary. Thus, compulsory health insurance and voluntary health insurance differ from each other according to the above types of classification (25, p. 89).
Fifth, as a result of the foregoing, pursuing common goals and having a common object of insurance - compulsory and voluntary health insurance differ significantly in insurance subjects - they have different not only insurers, but also insurers. Voluntary health insurance is not state organizations having any organizational and legal form, for compulsory health insurance - state organizations (41).
Sixth, compulsory and voluntary health insurance also differ in terms of sources of funds. The financial resources of the compulsory health insurance system are formed from budget payments and contributions from enterprises, bodies government controlled appropriate level. The amount of contributions for compulsory health insurance for enterprises, organizations and other economic entities is set as a percentage of the accrued wages. Voluntary medical insurance is carried out at the expense of the profit (income) of the enterprise and personal funds of citizens, the amount of insurance premiums is established by agreement of the parties.
Unlike voluntary health insurance, with compulsory health insurance, the term insurance period does not depend on the deadline for payment of insurance premiums, and the insurer is liable even in the absence of payment of insurance premiums.
The basic CHI program is determined by the Government of the Russian Federation and approved on its basis territorial program, representing the list of medical services provided to all citizens in the given territory. With voluntary medical insurance, the list of services and other conditions are determined by the contract between the insured and the insurer (35, p. 28).
In addition, tariffs for medical services under CHI are determined at the territorial level by an agreement between medical insurance organizations, government bodies of the appropriate level and professional medical organizations. Tariffs for medical services under VHI are established by agreement between the insurance medical organization and the medical institution, enterprise, organization or person providing these services.
The quality control system under compulsory medical insurance is determined by agreement of the parties, with the leading role of government authorities, and under VHI is established by agreement. In addition, many differences can be listed, for example, in the mechanisms legal regulation, but we have indicated the most basic ones.
If we talk about the combination of two types of health insurance, it should be noted that in Russian reality the process of combining compulsory and voluntary health insurance occurs largely spontaneously. The lack of medical care received in the public health sector forces patients to look for ways to obtain the missing medical services at the expense of personal income or employers' funds (15, p. 46). At the same time, citizens belonging to the category of socially unprotected - chronically ill and low-income citizens can use such opportunities to a much lesser extent. And they are the ones who need more medical care. With insufficient medical care for this category, the need for it increases. As a result, the disproportion between the volumes of necessary and available to these citizens increases. medical care.
1.2 The history of the formation of the voluntary medical insurance system in Russia
For the first time, voluntary health insurance was discussed in the 1990s, towards the end of Gorbachev's perestroika, when it finally became clear that the state was unable to fulfill its obligations to finance health care. An economic catastrophe was approaching, which increasingly affected the implementation of the state social functions. Under these conditions, it was decided to turn to the experience of other countries, where national systems health care had various sources funding complement each other. Health care organizers, economists and legislators alike understood the need for reforms in the industry, first of all, a revision of the concept financial support healthcare.
In other words, voluntary health insurance, as it is today, appeared only two decades ago. But this is only the end result of the evolution of health insurance, which has lasted for many decades. Let us consider the stages of development of medical insurance, which began in the first half of the 19th century (26, p. 40).
The prototype of what today is commonly called "employee insurance" first appeared in 1827 in St. Petersburg. At that time, the workers of individual enterprises expressed the initiative to create a mutual aid society. Its budget was formed regular contributions participants, while the owners of the factories remained on the sidelines. The worker received monetary compensation if an accident occurred to him, resulting in a temporary or permanent loss of ability to work. In the event of death, payments went to the family of the member of the society. This principle formed the basis of the first sickness funds, which appeared only in the second half of the 19th century (18, p. 55).
The beginning of the next stage in the development of health insurance is considered to be 1842, when an announcement was printed in major periodicals that obliged all citizens belonging to the 4th and 5th categories (diggers, janitors, lackeys, stove-makers, etc.) to pay 60 kopecks. In return, they received the right to be treated in city hospitals for one year. By the way, their employers had to make regular contributions for clerks, cooks, barmaids and gardeners.
As is often the case in Russia, this form of health insurance arose due to the unwillingness of a separate department to spend money on treating the poor. At that time, such a duty lay with the police ministry, which wanted to relinquish additional responsibility. However, this did not last long: it soon became clear that the symbolic 60 kopecks per person did not even partially cover the actual costs of treatment. Therefore, during the reign of Alexander II, tariffs were raised to 1 ruble. Another 1 ruble for each worker had to be paid by employers (45).
No less interesting is another fact: since 1870, absolutely all citizens had to pay a contribution, regardless of social status and prosperity. Including, these are nobles and merchants who have never been treated in city hospitals, but were observed by private doctors. Thus, compulsory health insurance appeared - at least required list medical services that absolutely everyone could use. If you do not consider the details, then these are the features that are inherent in health insurance to this day. By the way, the decree provided for the categories of citizens who enjoyed benefits - these are members of the imperial family, officials, the military, children under 15, as well as employees of diplomatic missions and trade missions.
The turning point in the practice of health insurance is considered to be 1861, when the first normative act came into force, establishing the standards of compulsory insurance for state-owned mining plants. He demanded the establishment of auxiliary cash desks at the factories. They were engaged in the issuance of benefits for temporary disability caused by accidents, as well as the payment of pensions and compensation to the families of workers in the event of the death of breadwinners. After some time, an addition appeared, instructing managers to found hospitals on enterprises.
Health insurance entered a new round of development after 9 years: in 1912 III State The Duma approved the law "On Insurance of Workers against Sickness and Accidents". In fact, this document became the successor to the law of 1903, but it was radically different from it in content. In addition to disability or death benefits, legislative act obliged entrepreneurs to pay for medical services provided to participants of auxiliary cash desks. Including - emergency medical care, outpatient treatment, hospital stay, as well as obstetric care. The most interesting thing is that in terms of the range of services, such employee insurance is in many ways reminiscent of the basic programs of modern voluntary medical insurance. With the adoption of the law, sickness funds appeared in many regions of the country, and in St. Petersburg, the number of people who applied for medical care during the year reached 8% of the total number of workers (27, p. 41).
But five years later, this stage of evolution ended: the events of 1917 radically changed the approach to health insurance. Moreover, the term “insurance” itself disappeared from the normative acts for a long time: it was replaced by the expression “social security”, which is much more in line with the worldview of that time. With the establishment of Soviet power, medical care became equally accessible to all segments of the population, and the cost of it was completely taken over by the state. But today we can also note the downside of this approach - the low quality of service, as well as insufficient funding for medical institutions, which was carried out according to the residual principle.
Voluntary medical insurance in Russia gained the right to exist only in 1991, with the entry into force of the Law "On Medical Insurance of Citizens in the RSFSR". But at the very beginning, voluntary medical insurance was extremely inefficient: the amount of payments for an insured event did not exceed the amount of the insurance premium, and funds not spent on treatment were returned minus the insurer's commission. This situation suited entrepreneurs who used voluntary health insurance to hide from tax authorities part of the wages of employees. In the future, more and more voluntary medical insurance programs appear on the market, providing for an amount of insurance coverage that exceeds the amount of the down payment.
A radical turning point occurred in 1995, when the requirements for companies providing insurance for employees under voluntary medical insurance programs became significantly tougher. In particular, federal Service The Russian Insurance Supervision Authority has completely banned the practice of returning unused funds in order to deprive businessmen of the opportunity to avoid the tax burden. From that moment on, voluntary health insurance entered the modern phase of development. Over time, more and more insurance companies began to appear on the market, offering their customers various programs of voluntary medical insurance. In addition, the range of services offered by voluntary health insurance has significantly expanded, and the popularity of such products among citizens and legal entities has grown.
Summing up, it is necessary to mention once again that in Russia voluntary medical insurance as an economic and legal category and type of insurance activity arose in 1991 with the adoption of the Law of the RSFSR "On Medical Insurance of Citizens in the RSFSR". statutory the insurance model was fundamentally different from the varieties of personal insurance that existed at that time. It was about a qualitatively new legal relationship for our legal system. The novelty was in the object of the insurance legal relationship arising under VHI. Its subject composition also looked in a new way. Personal insurance, including health insurance, common in Soviet period provided for in the event of an insured event (illness or other harm to health) payments directly to the insured. The purpose of such insurance is to mitigate the possible financial losses of the insured as a result of damage to health. In this case, the property interests of the insured person were the object of insurance. The most common was the "simple" structure of the insurance legal relationship, which included the insurer and the insured as subjects, and the insured usually personally coincided with the insured (29, p. 35).
The current law of the Russian Federation "On medical insurance of citizens in Russian Federation"As an object of voluntary medical insurance, it defines the risk associated with the costs of providing medical care in the event of an insured event. At the same time, the law states that voluntary medical insurance "provides citizens with additional medical services and other services in excess of those established by compulsory insurance programs."
The objects of voluntary medical insurance are two groups of insurance risks:
1) the occurrence of expenses for medical services for the restoration of health, rehabilitation, care;
2) loss of income due to the impossibility of carrying out labor activities both during the illness and after - in the event of disability.
The legislation of the Russian Federation limited the object of medical insurance only to reimbursement of expenses for medical care.
The insurers in case of voluntary medical insurance are individual citizens with legal capacity and/or enterprises representing the interests of citizens. Voluntary medical insurance provided for a qualitatively new type of insurance relationship that was previously unknown to domestic insurance practice. Its object should have been the property interests of third parties, and not the insured person himself. The concept of the object was revealed in the law as "expenses but the provision of medical care." The subject composition of the legal relationship became more complicated, except for the insurer, the insured and the insured person, a medical institution was introduced into it as a person directly providing medical care (46).
But it should be noted that voluntary health insurance in Russia has not yet reached the level of European countries, and this segment of insurance services retains a huge potential for further development.
1.3 The system of voluntary medical insurance abroad
The most developed VHI system is in the USA, where it entered its heyday in the distant 30s. In total, in the United States today, more than one and a half thousand companies are engaged in health insurance, and more than 160 million people are covered by the VHI system, that is, almost 70% of the entire population of the States. VHI provides up to a third of the funding for American health care, which is considered the most expensive in the world. More than three-quarters of VHI in America is group (corporate) insurance provided by firms for their employees (46).
In the US, health insurance is voluntary and almost entirely provided by employers. Health insurance is the most common type of workplace insurance, but employers are not required to provide it at all. Not all American employees receive such insurance. Yet in the most large companies health insurance is almost a prerequisite.
There are many types of health insurance. The most common is the so-called compensatory insurance, or "fee-for-service" insurance. With this form of insurance, the employer pays the insurance company an insurance premium for each employee provided with the appropriate policy. The insurance company then pays for the checks presented by the hospital or other health care provider or doctor. Thus, the services included in the insurance plan are paid for. Typically, the insurance company covers 80% of the costs of treatment, the rest must be paid by the insured himself (47).
There is an alternative - insurance of the so-called managed services. The number of Americans covered by this type of insurance is rapidly increasing. In this case, the insurance company enters into contracts with doctors, other medical professionals, as well as with institutions, including hospitals, for the provision of all services provided for by this type of insurance. Typically, medical institutions receive fixed amount, which is paid in advance for each insured person.
The differences between the two described types of insurance are very significant. Fee-for-service insurance pays for services that are actually provided to patients. With "managed services" insurance, medical institutions receive only a fixed amount per insured patient, regardless of the volume of services provided. Thus, in the first case, healthcare workers are interested in attracting clients and providing them with a variety of services, while in the second case, they are more likely to refuse to prescribe additional procedures to patients, at least are unlikely to appoint more than necessary (33, p. 49).
In America, insurance medicine with its voluntary health insurance guards the health of its clients, guaranteeing not only payment for the medical service provided, but also high-quality treatment with traditional medicines. No insurance company will cover the cost of treatment using hypnosis, acupuncture, homeopathic or herbal remedies. From the point of view of insurance medicine, such therapy is unconventional and the effect of its use is controversial.
Health insurance in the US has another feature. There is a certain credit of trust in medicines prescribed by a doctor. But if the result from their use is insufficient and the disease progresses slowly but steadily, the next only correct stage of treatment for the clients of the insurance company is not prescribing drugs, but surgical treatment. The United States ranks first in the number of coronary artery bypass grafting operations (23, p. 68).
One of the basic principles of health insurance is the high efficiency of medical care. With regard to treatment costs, the insurance company covers the costs associated with applying the only correct treatment with a high success rate. Of course, the cost of heart surgery is very high, but less than the cost of drugs that need to be taken for quite a long time. And the effect of conservative therapy is not always desirable. Therefore, insurance companies prefer to incur large expenses, but once.
Americans are serious about their health. On the one hand, insurance companies protect their clients from unprofessional medical care, on the other hand, Americans trust their doctors and do not buy medicines without a specialist's recommendation.
As for voluntary health insurance in European countries, here in most cases VHI is being intensively developed as an addition to public funding medicine, expanding the range of medical and preventive services and financial opportunities for healthcare. For example, in small Israel, which is famous for the highest level of medical care, more than 70 companies (including foreign ones) operate in the VHI system, despite the fact that four of the largest insurance companies control half of this market. The VHI system covers almost a fifth of Israelis who use services not included in the basic programs of mandatory insurance funds, including nursing and patronage care (mainly for the elderly). The State Commission for Health Analysis in Israel believes that the role of VHI will continue to grow steadily in the future. Similar trends are observed both in Russia as a whole and in our region, where a network of large insurance companies operates (17, p. 46).
In Germany, an alternative (and supplement) to compulsory health insurance is voluntary (private) health insurance, which applies to citizens who, by virtue of high income or professional activity are not subject to compulsory health insurance, as well as to those persons who have the means and desire to receive additional assistance alternative to compulsory health insurance. The existence of two different forms of health insurance in the country is a positive factor that stimulates competition in the medical services market, which creates conditions for a more efficient and dynamic development of the existing healthcare system in Germany, improvement of the services offered and innovative activity. The main factor that determines the difference between compulsory and private health insurance systems is income, the amount of which exceeds the limit of compulsory health insurance (today it is 40.034 euros per year), which is the reason for applying for the services of the private health insurance system. As a rule, entrepreneurs or representatives of free professions, as well as employees whose incomes exceed the limit established by law, become participants in this system. At the same time, voluntary (private) health insurance also means the possibility of obtaining additional medical care in excess of provided by the system compulsory insurance, which is relevant for all categories of the population. This is important if the insured in the MHI wants to receive a more expanded set of medical services. According to statistics, about 15% of the population are insured in the voluntary health insurance system, 80% in the CHI system, 3% of which simultaneously use additional services from VHI programs (41).
Unlike compulsory voluntary health insurance, it offers a larger volume of medical services. For example, within the framework of VMI, there is a free choice of a hospital, as well as improved conditions for staying in it, services of a personal doctor, reimbursement of up to 100% of the costs associated with inpatient treatment (in MHI, as a rule, part of the costs is reimbursed by the patient). Compared to CHI, in which the amount of contributions does not depend on the degree of probability of an insured event, contributions in the voluntary health insurance system are formed taking into account individual risk. Private insurance companies use a large number of different regional and professional tariffs for this. Since age characteristics have a significant impact on the amount of insurance premiums, the most favorable rates VHI's are for young people. It should be noted that in last years the volume of expenses of the German population in voluntary health insurance is constantly increasing by an average of 5%. A significant difference from the CHI system is that for each age group insured in VHI there is its own financing of their expenses. In the context of the general complication of the demographic situation in all European countries (an increase in the number of pensioners in relation to the working part of the population), such a system for the formation of insurance premiums does not depend on this trend, and in the future, VHI may be one of the ways to avoid accumulating financial difficulties in the compulsory health insurance system ( 14, p. 82).
As distinctive features Voluntary health insurance can also be called higher amounts of sickness benefits (they are insured separately), reimbursement of expenses for spa treatment, the possibility of receiving full medical care abroad (since no conclusion is required for the main additional agreement insurance), as well as exemption from payment of contributions in case of failure to seek medical care for 1 to 6 months (the CHI does not provide such a service). The advantage of voluntary health insurance is also that the insured can, within a wide framework, independently choose the amount of medical care and services he wants, as well as their combinations. The choice of one or another set of medical services depends on the insurance program (30, p. 43).
In contrast to the compulsory in the system of private health insurance, the conclusion of an insurance contract occurs exclusively on a voluntary basis, the content of which (the volume and quality of medical services) is negotiated by the parties. If CHI is based on the principle of solidarity, then the functioning of the private health insurance system is based on the principle of equivalent cost recovery, according to which the amount of contributions to the insurance fund corresponds to the volume of services provided, the insurance risk specified in the contract, and also depends on age, gender, health status and other conditions that determine the amount of insurance and the amount of contributions paid. Unlike compulsory medical insurance in the private insurance system, the insured, receiving medical care, is obliged to pay for it himself, after which, by presenting the paid invoice to the insurance company, he can receive appropriate compensation for the costs of treatment in accordance with the insurance contract. An exception exists for paying for inpatient treatment, the costs of which may be burdensome for the patient. If there is an agreement between the insurance company and the insured, these calculations can be paid without the participation of the latter.
Unlike compulsory health insurance, in the system of voluntary medical insurance, insurance institutions providing sickness insurance are not connected contractual relations with other participants in the healthcare system (doctors, doctors' unions, pharmacies, hospitals, etc.). The employer pays half of the insurance premiums, but only if they overall size does not exceed the amount of insurance in the framework of compulsory health insurance. Insurance in VHI for such categories of the population as the unemployed (if they were previously insured in VHI) and students differs from general order. The fact is that the partial financing of their participation takes on the corresponding government agency(33, p. 49).
Whereas in compulsory medical insurance there is the possibility of free insurance for all family members with a small total income, there is no such possibility in the voluntary medical insurance system, therefore, regardless of income level, all family members are forced to conclude separate health insurance contracts.
Insurance companies operating in the private health insurance market do not directly limit the amount of medical care provided. The insured person must himself ensure that the medical services he needs are covered by the scope of insurance under the contract, which means that he must independently decide which form of treatment or examination suits him best. In general, unlike CHI, voluntary health insurance offers a higher degree of patient independence and, at the same time, greater responsibility. As in compulsory health insurance, in the system of private health insurance, the state legislates the principles of its functioning and standards, and also exercises control over its activities.
Thus, the voluntary health insurance system in force in Germany, performing the same functions as CHI, is both an alternative and a significant addition to compulsory health insurance. Having a different organization and principles of work, each of the systems is at the same time aimed at solving one problem - providing affordable, highly qualified medical care to the entire population of the country, which could be a positive example of the implementation and existence of an effective health insurance system in the context of economic restructuring and social sphere Russia.
Conclusions on Chapter I
1. Insurance business is an important economic institution that existed in different economic formations, one of the developing types of business. Insurance is designed to satisfy the urgent and fundamental human need - the need for security.
2. Voluntary medical insurance is carried out on the basis of voluntary medical insurance programs and provides citizens with additional medical and other services in excess of the established compulsory medical insurance programs. Voluntary medical insurance is carried out on the basis of an agreement between the insured and the insurer. The subjects of VHI are: a citizen, an insurer, a medical insurance organization, a medical institution.
3. The object of voluntary medical insurance is the insured risk associated with the costs of providing medical care in the event of an insured event. An insured risk is a prospective event against which insurance is provided. An event considered as an insured risk must have signs of probability and randomness of its occurrence.
4. Voluntary medical insurance in Russia gained the right to exist only in 1991, with the entry into force of the Law "On Medical Insurance of Citizens in the RSFSR". The purpose of such insurance is to mitigate the possible financial losses of the insured as a result of damage to health. In this case, the property interests of the insured person were the object of insurance.
5. The current law of the Russian Federation "On the health insurance of citizens in the Russian Federation" defines the risk associated with the costs of providing medical care in the event of an insured event as an object of VHI. At the same time, voluntary medical insurance "provides citizens with additional medical services and other services in excess of those established by compulsory insurance programs."
6. The most developed VMI system is in the USA, where it entered its heyday in the distant 1930s. In total, in the United States today, more than one and a half thousand companies are engaged in health insurance. In the US, health insurance is voluntary and almost entirely provided by employers. Health insurance is the most common form of workplace insurance. One of the basic principles of health insurance is the high efficiency of medical care.
7. In most European countries, VHI is being actively developed as an addition to public funding of medicine, expanding the range of preventive and curative services and financial opportunities for healthcare. In Israel, more than 70 companies operate in the VHI system, the VHI system covers almost a fifth of Israelis who use services that are not included in the basic programs of compulsory insurance funds, including nursing and patronage care.
8. In Germany, voluntary (private) health insurance applies to citizens who, due to high incomes or professional activities, are not subject to compulsory health insurance, as well as to those persons who have the means and desire to receive additional assistance alternative to compulsory health insurance. A distinctive feature of the VHI is the high rates of sickness benefits, reimbursement of expenses for resort treatment, the possibility of receiving full medical care abroad, as well as exemption from paying fees in case of not seeking medical help for 1 to 6 months (the CHI does not provide for such a service) .
CHAPTER II. PRACTICAL ASPECTS OF THE STUDY PROBLEM
2.1 Summarizing the experience of insurance companies operating in the voluntary medical insurance market
health care payment medical insurance
It is believed that the very idea of insurance was invented by English merchants who suffered losses due to ships that had gone sailing and never returned. The merchants decided to distribute the damages equally in the event of loss or loss of ships. For this, deductions were made to the general fund - some part of the property participating in the expedition. Assistance was provided from this fund.
Today, in the conditions of modern market competition insurance is one of the most profitable occupations. The number of insurance companies and clients of these companies is growing.
At the same time, the leaders of the VHI market, the leading universal insurers of the federal level, which account for more than half of all premiums in this segment, are engaged in medical insurance mainly. So, only about a dozen companies provide medical protection to the personnel of most large industrial complexes in Russia, at the same time providing services to medium and small businesses, as well as private clients.
Among the companies operating in the VHI market, three groups can be conditionally distinguished, differing in the strategy of attracting customers (11, p. 89).
1. Insurance companies that are subsidiaries financial and industrial holdings. The main task of these insurers is to organize medical care for the parent structure and companies that can influence it. As a rule, these companies operate in regions in accordance with the geography of the business of the founders. Having accumulated experience in working with "related" client companies. They begin to actively offer their services to their partners and other enterprises operating in their respective regions. Often in such cases, insurance is carried out with full or partial consideration of the principles of repayment. Most of the leaders can be attributed to such companies: SOGAZ Group, ZHASO, insurance group Kapital, SCM, Soglasie. In addition, Energogarant, which traditionally insures regional energy companies and companies close to the electric power industry, has its own market segments.
2. Companies operating in the compulsory health insurance program (through specially created subsidiaries) and largely building their marketing policy on this. Fame to people, ability to coordinate financial flows through the channels of compulsory and voluntary insurance, as well as established relationships with many clinics and hospitals, allow these insurers to take a leading position in VHI. First of all, these companies include ROSNO and Spasskiye Vorota. However, they are not the only ones who combine the activities of VHI and MHI. Many regional insurers work on such principles.
3. Companies focused exclusively on the market clientele. They work only with those clients who have been attracted by various marketing programs. In any of the companies of this group, you can buy the entire range of insurance programs existing on the market: outpatient treatment with attachment to any of the leading medical institutions, inpatient treatment, "Ambulance", "Personal Doctor", etc. Such insurers include the leading Russian universal insurance companies Ingosstrakh, RESO-Garantia, Rosgosstrakh, UralSib, and Renaissance Insurance companies. VSK Insurance House and AlfaStrakhovanie are active in the mass VHI market.
Experts believe that the Russian market for corporate voluntary medical insurance is already close to saturation. Both in companies with foreign owners and large Russian enterprises VHI has become an integral part of the social package, a tool to motivate and increase staff loyalty, a method of managing the company's finances by reducing sick leave and tax minimization.
Russian market Voluntary health insurance went through a stage of extensive development, when the increase in contributions was ensured by attracting new enterprises, and the price of insurance was considered the main criterion for choosing an insurer. The next stage is the intensive development of the market, which involves competition by improving the quality of service, complicating and increasing the service component of insurance products, as well as further concentration of the market.
The growth rates of the voluntary medical insurance market lag behind the average market indicators. Among the main problems of the VMI sector, one can mention the outstripping price growth in the paid medical services market, which in turn affects the cost of VHI policies and hinders the expansion of this type of insurance. To a greater extent, the high cost of a VHI policy hinders the development of individual insurance.
Another factor hindering the development of corporate voluntary medical insurance is existing restriction by attributing to the cost of expenses for insurance of employees in the amount of no more than 3% of the wage fund, while the standard VHI program involves high costs. In addition, the employer, in addition to contributions to VHI, is forced to pay a single social tax, which includes deductions for compulsory medical insurance, which employees do not actually use.
Currently, some insurance companies involved in the implementation of CHI programs are trying to run VHI programs called "CHI with a plus". Patients receive services based on the CHI program, i.e. programs state guarantees approved by the subject of the Federation, but in more comfortable conditions. At the same time, the insurance company also pays for part of the medical services that are not included in the standard of treatment under the state guarantee program, as well as high-quality, often imported, medicines or medical products (for example, prostheses for joints, blood vessels, heart valves).
Of the classic types of VHI, insurance in case of any disease is popular. This is the cheapest type of insurance available to people with an average income. For all that, there is no tradition of insuring health and medical expenses among the population. For most citizens Russian VHI in the individual version is not available due to its high cost (12, p. 50).
The reasons explaining why it is unprofitable for insurance companies to carry out classical VHI today are as follows:
Inefficiency in the use of public consumption funds allocated for health care, and above all budgets various levels, the lack of personalized accounting for the allocation and expenditure of funds or the per capita principle of financing the program of state guarantees;
The high cost of the VMI policy in conditions when the insured through VMI is forced to pay again for the entire compulsory health insurance program at market prices, without taking into account his participation through taxes and mandatory health insurance contributions in the formation of public consumption funds directed to healthcare;
The limited capacity of most medical institutions to adequately encourage the work of doctors and medical personnel who have provided services to patients insured under VHI;
Lack of insurance traditions and culture among the population;
Absence state support VHI in the form of tax benefits, since tax code allows up to 20 thousand rubles per year spent on medical services and medicines to be used to reduce tax base on personal tax. There is no such exemption for funds allocated for the payment of insurance premiums.
As already mentioned, voluntary medical insurance (VHI) is designed to ensure that citizens receive additional medical and other services (services) in excess of those established by the MHI program. The list of these medical and other services is contained in VHI programs offered by insurance companies.
Consider the experience of one of the insurance companies offering VMI services to the population.
OAO IC "Sochi-garant" has been engaged in medical insurance in the territory of the Krasnodar Territory since 1992. During this time, the company has accumulated vast experience in interacting with medical institutions, which allows us to solve customer problems as quickly and efficiently as possible.
The activities of this company in the local insurance market honored with a number of awards. Thus, in 2006, the results of the company's work on the creation of a quality management system in VHI were awarded with a Certificate of Merit from the Governor of the Krasnodar Territory.
OAO Insurance Company Sochi-Garant has been actively operating in the insurance market of the Krasnodar Territory since the company was founded in 1992. Being a joint-stock company with the participation of the state capital of the Krasnodar Territory, acting in accordance with the license of the Federal Tax Service of the Russian Federation, the company offers the following insurance services: auto hull, insurance of property of individuals and legal entities (44).
Until 2007, the company carried out CHI for citizens in the territories of eight municipalities Azov-Black Sea coast of the Krasnodar Territory (the cities of Sochi, Tuapse, Gelendzhik, Novorossiysk, Anapa, Tuapse, Temryuk and Primorsko-Akhtarsky districts) with a total population of 1,195 thousand people.
In 2008, the company's shareholders decided to reorient the company towards voluntary types insurance and refuse compulsory medical insurance. In addition to the existing license for VHI, the company additionally received a license for other voluntary types of insurance: auto hull, property of legal entities and citizens, insurance entrepreneurial risks. In addition, for the convenience of customers, the company began to work under agency contracts for OSAGO, agricultural insurance, etc.
Many years of experience, flexible tariff policy, contractual relations with leading Russian reinsurers allow JSC "IC "Sochi-garant" to sell in the territory of the Krasnodar Territory, Rostov region and the Republic of Adygea insurance programs of high complexity with an individual approach to each client. The company's plans for 2010-2011 include the development of agency and partner sales channels.
Insurance reserves and own funds the company invests exclusively in the territory of the Krasnodar Territory, ensuring high safety, reliability and profitability of investments, while simultaneously contributing to the development of the Kuban economy. The Company actively supports measures to develop the regional financial market held by the Administration of the Krasnodar Territory, is one of the first members of the Association of Insurance Companies of the Krasnodar Territory, a member of the Chamber of Commerce and Industry of the Krasnodar Territory.
OAO IC "Sochi-garant" within the framework of VHI programs offers the following types of services (44):
– round-the-clock reference and information (dispatch) service;
– a complex of outpatient and polyclinic services, including:
visiting a doctor at a convenient time for the patient;
consultations of medical specialists at home;
The doctor's visit to the office, the organization of a comprehensive examination;
Carrying out a full medical examination, including the necessary laboratory and instrumental studies;
· preventive actions;
– urgent health care;
– organization of inpatient treatment in wards of increased comfort;
- the whole range of medical dental care;
– rehabilitation and rehabilitation treatment;
– organization of medical care outside the Krasnodar Territory.
The cost of the VHI insurance policy is determined by the set of medical services chosen by the client independently, as well as the list of medical institutions on the basis of which these services will be provided.
Today, voluntary medical insurance is one of the most popular types of insurance coverage in Russia. Evidence of this is the growth rate of the industry, which has been about 20% for several years now. In particular, according to the results of 2008, the total amount of premiums collected under VHI by Russian insurers reached 45.7 billion rubles. The total volume of payments in 2008 amounted to 35.3 billion rubles (42).
One of the main prerequisites for the active development of VHI is the deplorable state of state, formally free healthcare, which is financed through the system of compulsory medical insurance. According to most experts, existing system financing of health care has long proved its inconsistency, and the basic principles of compulsory medical insurance have not been earned. As before, citizens cannot choose an insurance company and a medical institution where they would like to receive medical care, there is a division of the insured on a territorial basis, and no one remembers the protection of their rights. Therefore, it is not surprising that people who want to receive quality medical care and have at least minimal opportunities for this prefer paid services. One of the most common options for obtaining paid medical care is direct payment for treatment upon the provision of services. However, voluntary health insurance is more profitable due to the risk component, which allows avoiding contingencies, and, just as importantly, due to the control of the quality of treatment and the volume of services provided by the insurance company (48). It should also be noted that the state has recently been paying serious attention to improving the healthcare system - the national project "Health" has been announced as one of the priority areas for the country's development in the near future. But the question arises to what extent its implementation will affect the market mechanism for financing the industry - voluntary medical insurance.
An experience developed countries proves that it is voluntary health insurance that is the most effective mechanism for financing medicine. Nevertheless, the development of VHI in our country, despite the great potential for its demand, runs into obstacles. The most important deterrent is the low income of a significant part of the population and the delay in the formation of the middle class, leading to a shortage of mass demand for commercial health insurance. A possible solution to this problem in the future could be state subsidies to poor citizens for the use of VHI programs. In this case, insurance companies could become a powerful tool for financing health care by building their own infrastructure or investing in existing medical facilities. Often the development of VMI is hindered by the medical institutions themselves. Low competition in the market leads to an increase in prices for medical care, while medical institutions capable of fully servicing such programs are constantly lacking. In many, even large, cities, there are only a few hospitals or clinics with which insurers could work. An important problem is the prevalence of "gray" medicine, which hinders the improvement of the culture of receiving paid medical services. Finally, it limits the scope of cooperation between insurance companies and medical institutions and the conflict of interest associated with the desire of physicians to inflate the cost and quantity of services provided. Insurers note that medical institutions sometimes raise prices several times a year, which is why insurance companies are forced to bear additional costs, since contracts with policyholders are concluded without taking into account price increases. At the same time, according to many insurers, the quality of treatment is not improving, and sometimes even, on the contrary, there is a clear regression. Moreover, there are so many people wishing to insure under VHI that a number of clinics refuse to work with insurance companies, preferring to make payments with patients directly, apparently considering control by insurers too burdensome. The most critical among the factors hindering the development of the voluntary medical insurance market is the factor of legitimacy, in other words, problems with tax legislation in this domain. According to the law, deductions for VHI, which can be attributed to the cost price, should not exceed 3% of the wage fund of the enterprise. At the same time, in the social packages of large foreign companies up to 40% of personnel costs are indirect cash payments including both health insurance and pension plan and life insurance.
2.2 Course and results of the empirical study
Solving the numerous problems that have accumulated in the healthcare sector over the years of reforms requires a balanced and socially responsible policy. One of the key areas of health policy is to improve the health insurance system, which requires strengthening financial base health insurance, including by attracting the necessary financial resources from the private sector. The emphasis in reforming the healthcare system on the development of medical insurance is considered by most experts to be quite justified, and important role is given to the development of a system of voluntary medical insurance.
The creation of a system (DMS) is caused not only by objective, but also by subjective reasons. In particular, in the state, on the basis of compulsory health insurance, only those measures to protect the health of citizens that are considered important for the whole society are financed. The remaining unsatisfied part of the needs of citizens in ensuring the necessary state of health is proposed to be implemented through the VMI system, based on market mechanism. At the same time, VHI is currently considered as one of the important sources of financial support for the existing healthcare model.
The question is natural: how well do people know about the possibilities of voluntary medical insurance, and how are they used? In this regard, we have set ourselves the goal of determining the degree of awareness of the population of the city of Magnitogorsk about the programs offered under VMI. A questionnaire survey was used to collect primary information on this issue. It was attended by 98 people, including 19 heads of enterprises of various forms of ownership. In the course of the study, a quota sample was used.
The survey showed that almost a third (31%) of individuals are not aware of the existence of a voluntary health insurance system. It should be noted that when evaluating the answer, we took into account not the fact of simple knowledge about the VMI system (“I heard something ...”), but the respondent’s ability to describe the purpose of this system and its functions.
Among individuals, high awareness of the VHI system (84% of respondents) was shown by representatives of two age groups: 35-45 and 45-55 years old. This indicator The explanation is simple: it is in these age groups that interest in health problems objectively increases, and accordingly, interest in information about the possibilities of solving them grows. Of course, the population over the age of 55 has a good indicator of awareness of the VHI system, which is primarily due to the increase in health problems.
It is quite natural that legal entities are more aware of the issues of voluntary medical insurance. Firstly, increased awareness is due to the fact that the population represented in this group, due to their socio-economic status, is characterized by increased activity and purposeful work with information flows. They have information about the VHI system for another important reason: the use of VHI programs in the hands of a manager is an effective factor contributing to the motivation of employees of an enterprise. In addition, having a higher level of income, legal entities have more opportunities to use VHI programs. Finally, legal entities are represented mainly by the two age groups mentioned above, which are characterized by a high level of awareness.
In view of the foregoing, it is a matter of some concern that 12% of business leaders do not know anything about the VHI system. Among them are the heads of small enterprises, represented by the first age group, who, as a rule, do not have a higher education. This group of managers should be the subject of increased attention on the part of insurance companies, since it represents a reserve for the growth of the customer market.
The survey showed that 36% of individuals used VHI programs in the following areas: inpatient treatment, outpatient care, observation by a personal doctor, etc. As a rule, respondents noted that they purchased VHI programs in case of health problems (79%). It is interesting to note that 42% of business leaders have never purchased VHI programs for their employees. At the same time, 44% of managers said that they do not yet see the need for this.
However, nearly half (52%) of those executives who did not purchase VHI programs for their employees said they wanted to do so soon. In order to use the growth reserves of the VHI market, insurance companies should first of all investigate the incentives for purchasing VHI products. As for the desire of individuals to purchase VHI programs, out of 46 people who had no experience in using such services before, 20 people (44%) showed it. The rest did not express such readiness.
The main advantage of the VHI system (compared to the CHI system), according to individuals, is better medical care (31%). In addition, consumers also indicate as advantages a more attentive attitude of the staff (22%), saving material costs (17%), the timeliness of the provision of medical services (13%) and the provision of legal protection (9%). It is noteworthy that not all respondents noted such advantages of the VMI system as a wide range of medical services (5%) and saving time and effort (3%).
The survey showed that business leaders most often purchase voluntary health insurance programs in order to increase the motivation of employees for highly productive work (54%), increase the prestige of the workplace, and also to optimize taxation (48%). In addition, managers noted the following benefits of using VMI programs: reduced loss of working time (38%), increased employee productivity (29%), improved company image (17%), and social and psychological climate (16%). This leads to the conclusion that managers clearly see the benefits of VMI and regard the results of employee insurance as a factor contributing to the improvement of the efficiency of enterprises. At the same time, the heads of enterprises in their mass noted the underdevelopment of the system of voluntary medical insurance.
As for the population, in the opinion of individuals, a major drawback of the voluntary health insurance system is the high cost of the services offered, which makes them inaccessible to the majority of respondents.
The distribution of individual voluntary health insurance policies among individuals primarily depends on the level of consumers' insurance culture. Along with an increase in the level of general penetration of insurance services, the share of the population with a VHI policy will also increase, and, consequently, the VHI market as a whole will grow. Therefore, insurance companies interested in the development of VHI sales today have something to think about.
2.3 Prospects for the development of voluntary medical insurance
Market development also requires positive initiatives from the legislature and supervisory authorities, qualified and tangible marketing efforts, including the development of effective mechanisms for the sale of VHI by insurance companies.
The survey showed that the low awareness of clients about all the benefits of VHI negatively affects the motivation to purchase VHI programs. Insurance companies need to use the principles of marketing to organize work among potential clients, including both individuals and business leaders, so that they understand for themselves all the benefits that VHI provides. In addition, it is necessary to study the features of the formation of needs for medical care in each specific region. A systematic and continuous analysis of the needs and demands of key consumer groups (individuals and organizations) is needed.
Our study showed that insurance companies have significant opportunities to attract customers.
So, along with the residents of nearby regions, the residents of the Chelyabinsk region also experienced the consequences of the Chernobyl disaster. A large number of residents of the region were employed in the work to eliminate the consequences of the accident. In this regard, most of them have changes in the thyroid gland and systemic osteoporosis. Therefore, this contingent can be offered separate VHI programs, which require the presence in the medical center, for example, of such equipment as a CT scanner.
From a marketing point of view, the buyer does not need the product as such, he needs a solution to the health problems that have arisen. These problems can be most effectively solved in complex medical centers, where there are doctors of all specialties and their own pharmacy with an arsenal of new modern pharmaceuticals, all types of examinations, analyzes, mandatory treatment can be carried out, psychological assistance and physiotherapy exercises are offered. It is on this basis that the problem of health as a whole must be solved.
To better serve selected groups, two types of marketing efforts can be proposed. For insurance companies operating in the VHI market, the following marketing efforts can be offered:
Undoubted damage to voluntary medical insurance is caused by inadequate pricing policy of medical institutions. Moreover, the population is often offered to pay for services already paid for from the CHI fund. This practice is not an exception; it is also typical for other regions of the country.
One of the manifestations of market orientation is the opening by private insurance companies of their own clinics. The development of relationships with consumers (patients) in them is the task of all members of the organization, and not just the sales department of insurance products. In order to improve the quality of medical care and increase the profits received by insurance companies, it is necessary to develop a network of their own medical centers with the latest material and technical base, capable of providing assistance on the principle of "attachment", including to insured individuals.
The approach to a product (service) as a solution to a problem affects all components of marketing and, especially, such a component as distribution: convenient, easy access to a solution - the introduction of an appointment by phone at a convenient time for the client, the work of medical representatives, the allocation of individual assigned doctors.
It should also be noted that various marketing studies show that, for objective reasons in the country, the current attempts to commercialize medicine lead to two inevitable results:
Firstly, to the accelerated formation of the medical-industrial complex of Russia with its own special goals, which in many respects do not coincide with the interests of the majority of the population;
Secondly, the slowdown in the development of socially effective medical technologies (cheap and effective systems of prevention and preventive therapy).
World and Soviet experience shows that the best way out of this situation is free medicine. Many states (Sweden, Great Britain and others) follow this path, or consider it more effective. For example, in France, during the election campaign, some candidates for the post of head of state promise to switch to free medicine. In our country, it is almost impossible to get away from the commercialization of the sphere of medical care for the population under the current conditions. Therefore, it is necessary to look for a way out that allows you to mitigate these negative consequences as much as possible.
In our opinion, one of these solutions may be a deeper division of powers between the systems of social and commercial health insurance, as well as targeted stimulation of the development of both medical insurance complexes in accordance with the specifics of the tasks they solve and the segments of the population they serve.
Summarizing the foregoing, let us single out the advantages that, in our opinion, determine the prospects for the development of the voluntary medical insurance system.
Firstly, voluntary health insurance is currently of great benefit to all subjects of the paid medical services market. For the first time, insured clients get the opportunity to receive exactly the medical care that they would like to receive, and which consists of:
Real care and assistance of a medical representative of the insurance company in choosing a medical institution that is optimal in terms of "price - quality" ratio;
Ensuring the timeliness and priority of assistance;
Service by a trusted doctor (the most competent specialist chosen by the insurance company in advance), who would be interested in doing everything necessary and possible for the client at the highest level;
The feeling of complete security of each insured person from the insurance company, who is not left alone for a minute with the arbitrariness that often exists in health care facilities (which is especially dangerous in obstetrics and pediatrics).
In addition, every head of an institution who purchases VHI programs for his employees receives a huge benefit, since the image of the enterprise and the prestige of jobs are significantly increased. The manager really has the opportunity to help an employee valuable to the team not only financially (for example, in carrying out a very expensive operation, even if this moment there is no profit at the enterprise), but also organizationally (after all, contracts with leading clinics, as a rule, have already been concluded, and it will take very little time to organize assistance). Moreover, VHI funds can pay for the necessary expensive medicines that are not included in the list provided for by the MHI. Benefit from participation in the VHI market and medical institutions that receive huge financial resources that go to the development of the material and technical base of the institution and additional incentives for employees.
Secondly, insurance companies concluding voluntary medical insurance contracts are beginning to take a direct part in the development of the material and technical base of healthcare, creating their own health facilities. Today, depending on the risk or deposit type insurance companies, the profits of insurance companies can fluctuate within a small range at fairly low figures, since the bulk of the funds end up in medical institutions. If the founders of insurance companies open their own medical institutions, then both the insurance companies themselves and the clients, for whom everything possible will be done at the modern level, and the local healthcare system as a whole will benefit from this.
Thirdly, with an increase in the number of insurance companies working with individuals, the protection of well-to-do people who are able to independently buy a VHI policy from the arbitrariness of business leaders who, for various reasons, do not want to take care of the health of their employees, increases. Unfortunately, there are heads of enterprises who seek to get rid of a sick employee under any pretext.
Fourthly, there are cases when people who for some reason do not have a compulsory medical insurance policy need medical care. These include, for example, migrants who did not have registration in the region at the time of the disease.
Fifth, a very important advantage of VHI is the availability of highly qualified expert doctors and lawyers in large insurance companies who are ready to really stand up for the interests of their insured.
Many years of experience of insurance companies in the field of voluntary medical insurance and the growing interest in this type of insurance on the part of the largest domestic enterprises allows us to speak of voluntary medical insurance as the most important and promising source of healthcare financing at this stage and in the future.
Conclusions on Chapter II
1. Today, in the conditions of modern market competition, insurance is one of the most profitable activities. The number of insurance companies and clients of these companies is growing. At the same time, the leaders of the VHI market, the leading universal insurers of the federal level, which account for more than half of all premiums in this segment, are engaged in medical insurance mainly.
2. The Russian market of voluntary medical insurance has passed the stage of extensive development, the next stage is the intensive development of the market, which involves competition by improving the quality of service, complicating and increasing the service component of insurance products, as well as further concentration of the market.
3. Among the main problems of the VMI sector, one can mention the outstripping price growth in the paid medical services market, which in turn affects the cost of VMI policies and hinders the expansion of this type of insurance. To a greater extent, the high cost of a VHI policy hinders the development of individual insurance.
4. To determine the degree of awareness of the population of the city of Magnitogorsk about the programs offered under the VHI, we conducted a study. It was attended by 98 people, including 19 heads of enterprises of various forms of ownership. The survey showed that almost a third (31%) of individuals are not aware of the existence of a voluntary health insurance system; legal entities are more knowledgeable about voluntary medical insurance.
5. The main advantage of the VMI system (compared to the CHI system), according to individuals, is better medical care. The survey showed that business leaders most often purchase VHI programs in order to increase the motivation of employees for highly productive work, increase the prestige of the workplace, and also to optimize taxation.
6. The survey showed that the low awareness of clients about all the benefits of VHI negatively affects the motivation to purchase VHI programs. Insurance companies need to use marketing principles to target potential customers, including both individuals and business leaders, so that they understand the benefits of VHI. In addition, it is necessary to study the features of the formation of needs for medical care in each specific region. A systematic and continuous analysis of the needs and demands of key consumer groups (individuals and organizations) is needed.
7. To better serve selected groups, two types of marketing efforts can be proposed. For insurance companies operating in the VHI market, the following marketing efforts can be offered:
Promotion of the distinctive qualities of the product - the creation of new insurance products - the program "Pediatrician", "Management of pregnancy and obstetrics", "Personal cardiologist", etc.
Introduction of individual voluntary health insurance policies for such a promising segment as migrants who do not have compulsory health insurance policies.
CONCLUSION
Voluntary medical insurance (VHI) has existed in Russia since 1991, and today it accounts for a tenth of all insurance premiums. It was in 1991 that the main legal document was adopted, which is still guided by all insurers - the Law of the Russian Federation of June 28, 1991 "On the medical insurance of citizens in the Russian Federation." He changed the system of financing health care, as a result of which there was a need for full or partial payment for medical services.
The social and economic significance of VHI is to complement the guarantees for medical care provided to the population free of charge through the system of budgetary financing of medical institutions and compulsory medical insurance (CHI). This concerns, first of all, expensive types of treatment and diagnostics, the use of modern medical technologies, the provision of comfortable conditions for treatment, the implementation of those types of treatment that are not included in the scope of "medical care for vital indications."
In addition, VHI differs from CHI in the following ways:
CHI - social, and VHI - commercial insurance.
CHI builds its work on the principle of insurance solidarity, that is, it equalizes the rights of all insured, regardless of their income level and capabilities. VHI is based on the principles of insurance equivalence, that is, under the VHI agreement, the insured receives those types of medical services and in the amounts for which the insurance premium was paid. At the same time, VHI provides policyholders with higher quality medical care that meets the individual requirements of the client.
Participation in VHI programs is not regulated by the state and depends on the needs and capabilities of the insured. For example, in CHI rules, programs, the amount and procedure for paying insurance premiums, standard forms contracts, a list of medical institutions, the cost of medical services are developed and approved by the authorities. In VHI, the rules and methodology for calculating insurance premiums are developed by the insurance organization and are only agreed upon by the supervisory authorities for insurance activities. The remaining conditions are regulated by agreements concluded by the subjects of the system.
At first glance, the conditions put forward by the insurance company are quite acceptable, and, nevertheless, there are often cases of citizens refusing insurance. This behavior of people is due to two reasons. The first is the open distrust of citizens in health insurance, the second is the fact that it does not matter how many times the client has applied for medical services, insurers have to pay regularly in any case.
The insurance company is fully responsible to its customers for the provision of medical services. This is one of the main arguments in favor of VHI over compulsory health insurance. Also, the quality of services provided under a voluntary medical insurance policy is incommensurably higher than with a mandatory one.
Almost every insurance company offers a wide range of insurance programs. Services can be selected individually. In addition, it should be taken into account that when applying for VHI, the client receives the right to provide medical services not in one, but in several clinics at once, the list of which is negotiated with the insurance company. In addition, the client can count on the advice of a specialist who will help in a number of medical issues.
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APPLICATION
Dear respondent!
We ask you to take part in our study, the purpose of which is to determine the degree of awareness of the population of the city of Magnitogorsk about the programs offered under VHI.
Below is a list of questions you are asked to answer. Choose the answer that reflects your opinion. If there is no option among the proposed options that matches your point of view, write your answer in the special line. The survey is anonymous and the answers will be used in summary form for scientific purposes.
Thanks in advance!
1. Have you ever used the services of insurance companies?
a) yes, I did;
b) no, did not use;
c) no, but I'm going to use it;
d) other ________________________________
2. Do you know about the existence of a system of voluntary medical insurance?
a) yes, I know;
b) no, I don't know (go to question 6);
c) find it difficult to answer.
3. In your opinion, voluntary health insurance is…
4. Have you ever used VHI programs?
a) yes, I did;
b) no, did not use (go to question number 6)
5. What VHI programs did you use?
a) outpatient care
b) treatment in a hospital;
c) observation by a personal doctor;
d) other ______________________________
6. In your opinion, are VHI programs in demand in our city?
a) yes, they are in demand;
b) no, not in demand;
c) find it difficult to answer;
7. In your opinion, is there a need for the existence of voluntary medical insurance?
c) find it difficult to answer;
8. Do you plan to use VMI programs in the near future?
a) yes, I plan to;
b) no, I don't plan to;
c) other _______________________________
9. In your opinion, is the VMI system sufficiently developed in our city?
a) yes, it is sufficiently developed;
b) no, underdeveloped;
c) find it difficult to answer;
10. What are the advantages of VHI compared to the compulsory health care system?
insurance? (multiple answers possible)
a) a wide range of medical services;
b) saving time and effort;
c) better medical care;
d) more attentive attitude of the staff;
e) saving material costs;
f) the timeliness of the provision of medical services;
g) provision of legal protection;
h) other __________________________________
11. For what purpose do employers (legal entities) use VHI programs to
your employees?
a) increasing the motivation of employees for highly productive work;
b) increasing the prestige of the workplace;
c) reducing the loss of working time;
d) improvement of the socio-psychological climate;
e) increase in labor productivity of employees;
f) improving the image of the company;
g) other _________________________________
12. What shortcomings, in your opinion, does the VHI system have?
Your gender: a) male; b) female.
Your age: a) 18-25 years old; b) 26-35 years old; c) 36-45 years old; d) 46-55 years old; e) 56 years and older.
Your socioeconomic status: a) an individual; b) a legal entity.
Thanks for participating!
Description
In 2014-2017, the natural volume of the voluntary medical insurance market in Russia decreased annually: from 96.8 million appointments in 2014 to 79.4 million appointments in 2017. In 2018, for the first time in 5 years, the indicator showed a positive trend and increased by 3 .9% compared to 2017, amounting to 82.6 million appointments.
Adapting to economic conditions, insurance companies began to offer their customers cost-effective VHI insurance options. Another factor in the development of the market was the introduction of a mechanism for co-financing medical services under VMI policies at the expense of employees. VHI co-financing implies the division of payment for the policy by the employer and the employee in certain shares. A number of insurance companies have segmented the market and developed VHI programs for each identified segment, taking into account age composition team, working conditions and the structure of morbidity.
According to BusinesStat forecasts, in 2019-2023 the number of VMI medical appointments in Russia will grow by 1.1-3.0% annually. In 2023, the indicator will reach 91.2 million appointments, which will exceed the value of 2018 by 10.5%. The growth factors for medical appointments under VHI policies will be: the development of insurance products related to telemedicine and digital technologies; promotion of VHI services for individuals through new distribution channels; increasing the personification of policies, etc.
Every year BusinesStat releases a series of reviews of the medical services market in Russia:
- Analysis of the medical services market in Russia
- Analysis of the medical services market in Russian cities
- Rating of medical service operators in Russia
- Separate ratings of medical service operators by big cities Russia
- Market analyzes by medical fields: dentistry, gynecology, pediatrics, hospital medicine, laboratory diagnostics
- Analysis of the voluntary medical insurance market in Russia
- Holding structure of private medicine in Russia
"Analysis of the VHI market in Russia in 2014-2018, forecast for 2019-2023" includes the most important data needed to understand the current market conditions and assess the prospects for market development. The review contains statistics of insurers, patients, VMI services, prices of services, natural and value market volumes, volumes and structure of insurance payments and premiums, ratings of insurance companies.
In the review, the information is detailed by regions of the country.
The review provides ratings for the 100 largest VHI insurers: SOGAZ, Absolut Insurance, AlfaStrakhovanie, Alliance Life, VSK, VTB Insurance, Renaissance Insurance, Ingosstrakh, Capital Policy, Liberty Insurance, Max, Medexpress, MetLife, Independent Insurance Group, RESO-Garantia, Rosgosstrakh, Sberbank Insurance, Consent, Chulpan, Energogarant, etc.
Separately, detailed profiles of five leading VHI insurers are given.
When preparing the review, official statistics and the company's own databases were used.
Information of relevant state bodies:
- federal Service state statistics RF (Rosstat)
- Federal tax service RF
- Ministry of Health of the Russian Federation
- central bank RF
- Ministry economic development RF
- All-Russian Center for the Study of Public Opinion
- Federal State Institution Central Research Institute of Health Organization and Informatization
BusinesStat info:
- Sample census of health facilities
- Audit of prices and sales volumes of medical services
- Survey of patients of medical services
Expand
ContentTHE STATE OF THE RUSSIAN ECONOMY
Basic parameters of the Russian economy
- Table 1. Nominal and real GDP, RF, 2014-2023 (trillion rubles)
Results of Russia's entry into the Customs Union
The results of Russia's accession to the WTO
Prospects for Russian business
FORMATION OF THE VMI SYSTEM
CURRENT STATE AND DEVELOPMENT PROSPECTS OF THE VHI MARKET
INSURANCE COMPANIES
Number of insurers
- Table 12. Rating of insurers by volume of VMI premiums, RF, 2018 (million rubles)
- Table 13. Rating of insurers in terms of VHI payments, RF, 2018 (RUB mln)
- Table 14. Rating of insurers by the number of concluded VHI agreements, RF, 2018 (thousands)
- Table 15. Rating of insurers by the number of active VHI agreements, RF, 2018 (thousands)
- Table 16. Rating by return on assets (ROA), RF, 2017 (%)
- Table 17. Rating by return on equity (ROE), RF, 2017 (%)
- Table 18. Rating by profitability of an insurance company, RF, 2017 (%)
- Table 19. Rating of insurers by payout ratio, RF, 2018 (%)
- Table 20. Rating of insurers by share of expenses for doing business, RF, 2017 (%)
- Table 21. Rating of insurers by coefficient of dependence on reinsurance, RF, 2017 (%)
PATIENTS AND VHI CONTRACTS
The patients
Treaties
NATURAL VOLUME OF THE VHI MARKET
COST VOLUME OF THE VHI MARKET
Insurance premiums and payments
AVERAGE PRICE OF VHI ADMINISTRATION
VHI POLICY PRICE
PROFILES OF VMI INSURERS
JSC "SOGAZ"
- Enterprise management
- Subsidiaries
SPAO "RESO-Garantiya"
- Company registration data
- Enterprise management
- The main shareholders of the enterprise
- Subsidiaries
- The balance sheet of the enterprise according to Form No. 1 2014-2015
- The balance sheet of the enterprise according to Form No. 1 2016-2018
- gg
- Profit and loss statement of the enterprise in the form No. 2 2016-2018
JSC "Alfastrakhovanie"
- Company registration data
- Enterprise management
- The main shareholders of the enterprise
- Subsidiaries
- The balance sheet of the enterprise according to Form No. 1 2014-2015
- The balance sheet of the enterprise according to Form No. 1 2016-2018
- Profit and loss statement of the enterprise in the form No. 2 2014-2015
- Profit and loss statement of the enterprise in the form No. 2 2016-2018
SPAO Ingosstrakh
- Company registration data
- Enterprise management
- The main shareholders of the enterprise
- Subsidiaries
- The balance sheet of the enterprise according to Form No. 1 2014-2015
- The balance sheet of the enterprise according to Form No. 1 2016-2018
- Profit and loss statement of the enterprise in the form No. 2 2014-2015
- Profit and loss statement of the enterprise in the form No. 2 2016-2018
LLC IC "VTB Insurance"
- Company registration data
- Enterprise management
- The main founders of the enterprise
- Subsidiaries
- The balance sheet of the enterprise according to Form No. 1 2014-2015
- The balance sheet of the enterprise according to Form No. 1 2016-2018
- Profit and loss statement of the enterprise in the form No. 2 2014-2015
- Profit and loss statement of the enterprise in the form No. 2 2016-2018
Expand
tablesTable 2. Real GDP and real GDP index, RF, 2014-2023 (trillion rubles, %)
Table 3. Investments in fixed capital from all sources of financing, RF, 2014-2023 (trillion rubles, %)
Table 4. Export and import, balance trade balance, RF, 2014-2023 (billion dollars)
Table 5. Average annual dollar/ruble exchange rate, RF, 2014-2023 (rubles per dollar, %)
Table 6. Consumer price index (inflation) and food price index, RF, 2014-2023 (% of the previous year)
Table 7. Population including migrants, RF, 2014-2023 (million people)
Table 8. Really disposable income of the population, RF, 2014-2023 (% of the previous year)
Table 9. Number of VHI insurers, RF, 2014-2018 (units; %)
Table 10. Forecast of the number of VHI insurers, RF, 2019-2023 (units; %)
Table 11. Number of VHI insurers, by regions of the Russian Federation, 2018 (units)
Table 22. Number of VHI patients and their proportion in the population, RF, 2014-2018 (million people; %)
Table 23. Forecast of the number of VHI patients and their share in the population, RF, 2019-2023 (million people; %)
Table 24. Average number of appointments per patient, RF, 2014-2018 (appointments)
Table 25. Forecast of the average number of appointments per patient, RF, 2019-2023 (appointments)
Table 26. Number of concluded and valid VHI agreements, RF, 2014-2018 (thousands)
Table 27. Number of concluded VHI agreements, by regions of the Russian Federation, 2018 (pcs)
Table 28. Natural volume of the VHI market, RF, 2014-2018 (million appointments; %)
Table 29. Forecast of natural volume of the VHI market, RF, 2019-2023 (million appointments; %)
Table 30. The value of the VHI market, RF, 2014-2018 (billion rubles; %)
Table 31. Forecast of the value of the VHI market, RF, 2019-2023 (billion rubles; %)
Table 32. Insurance premiums and VHI payments, RF, 2014-2018 (billion rubles; %)
Table 33. Forecast of insurance premiums and VHI payments, RF, 2019-2023 (billion rubles; %)
Table 34. Volume of VMI premiums, by regions of the Russian Federation, 2018 (million rubles)
Table 35. Volume of VHI payments, by regions of the Russian Federation, 2018 (million rubles)
Table 36. Insurance premiums and payments for VHI policies of citizens served in Russia and traveling abroad, RF, 2014-2018 (billion rubles)
Table 37. Forecast of insurance premiums and payments for VHI policies of citizens served in Russia and traveling abroad, RF, 2019-2023 (billion rubles)
Table 38. Insurance premiums and payments for VHI policies of legal entities and individuals, RF, 2014-2018 (billion rubles)
Table 39. Forecast of insurance premiums and payments for VHI policies of legal entities and individuals, RF, 2019-2023 (billion rubles)
Table 40. Average cost of taking VHI, RF, 2014-2018 (rubles per appointment; %)
Table 41. Forecast of the average price of taking VHI, RF, 2019-2023 (rubles per appointment; %)
Table 42. Average price of an annual VMI policy, RF, 2014-2018 (thousand rubles; %)
Table 43. Forecast of the average price of the annual VHI policy, RF, 2019-2023 (thousand rubles; %)
Market development also requires positive initiatives from the legislature and supervisory authorities, qualified and tangible marketing efforts, including the development of effective mechanisms for the sale of VHI by insurance companies.
The survey showed that the low awareness of clients about all the benefits of VHI negatively affects the motivation to purchase VHI programs. Insurance companies need to use marketing principles to target potential customers, including both individuals and business leaders, so that they understand the benefits of VHI. In addition, it is necessary to study the features of the formation of needs for medical care in each specific region. A systematic and continuous analysis of the needs and demands of key consumer groups (individuals and organizations) is needed.
Our study showed that insurance companies have significant opportunities to attract customers.
So, along with the residents of nearby regions, the residents of the Chelyabinsk region also experienced the consequences of the Chernobyl disaster. A large number of residents of the region were employed in the work to eliminate the consequences of the accident. In this regard, most of them have changes in the thyroid gland and systemic osteoporosis. Therefore, this contingent can be offered separate VHI programs, which require the presence in the medical center, for example, of such equipment as a CT scanner.
From a marketing point of view, the buyer does not need the product as such, he needs a solution to the health problems that have arisen. These problems can be most effectively solved in complex medical centers, where there are doctors of all specialties and their own pharmacy with an arsenal of new modern pharmaceuticals, all types of examinations, analyzes, mandatory treatment can be carried out, psychological assistance and physiotherapy exercises are offered. It is on this basis that the problem of health as a whole must be solved.
To better serve selected groups, two types of marketing efforts can be proposed. For insurance companies operating in the VHI market, the following marketing efforts can be offered:
Promotion of the distinctive qualities of the product - the creation of new insurance products - the program "Pediatrician", "Management of pregnancy and obstetrics", "Personal cardiologist", etc.
Introduction of individual voluntary health insurance policies for such a promising segment as migrants who do not have compulsory health insurance policies.
Undoubted damage to voluntary medical insurance is caused by inadequate pricing policy of medical institutions. Moreover, the population is often offered to pay for services already paid for from the CHI fund. This practice is not an exception; it is also typical for other regions of the country.
One of the manifestations of market orientation is the opening by private insurance companies of their own clinics. The development of relationships with consumers (patients) in them is the task of all members of the organization, and not just the sales department of insurance products. In order to improve the quality of medical care and increase the profits received by insurance companies, it is necessary to develop a network of their own medical centers with the latest material and technical base, capable of providing assistance on the principle of "attachment", including to insured individuals.
The approach to a product (service) as a solution to a problem affects all components of marketing and, especially, such a component as distribution: convenient, easy access to a solution - the introduction of an appointment by phone at a convenient time for the client, the work of medical representatives, the allocation individual assigned doctors.
It should also be noted that various marketing studies show that, for objective reasons in the country, the current attempts to commercialize medicine lead to two inevitable results:
Firstly, to the accelerated formation of the medical-industrial complex of Russia with its own special goals, which in many respects do not coincide with the interests of the majority of the population;
Secondly, the slowdown in the development of socially effective medical technologies (cheap and effective systems of prevention and preventive therapy).
World and Soviet experience shows that the best way out of this situation is free medicine. Many states (Sweden, Great Britain and others) follow this path, or consider it more effective. For example, in France, during the election campaign, some candidates for the post of head of state promise to switch to free medicine. In our country, it is almost impossible to get away from the commercialization of the sphere of medical care for the population under the current conditions. Therefore, it is necessary to look for a way out that allows you to mitigate these negative consequences as much as possible.
In our opinion, one of these solutions may be a deeper division of powers between the systems of social and commercial health insurance, as well as targeted stimulation of the development of both medical insurance complexes in accordance with the specifics of the tasks they solve and the segments of the population they serve.
Summarizing the foregoing, let us single out the advantages that, in our opinion, determine the prospects for the development of the voluntary medical insurance system.
Firstly, voluntary health insurance is currently of great benefit to all subjects of the paid medical services market. For the first time, insured clients get the opportunity to receive exactly the medical care that they would like to receive, and which consists of:
Real care and assistance of the medical representative of the insurance company in choosing a medical institution that is optimal in terms of "price - quality" ratio;
Ensuring the timeliness and priority of assistance;
Service by a trusted doctor (the most competent specialist chosen by the insurance company in advance), who would be interested in doing everything necessary and possible for the client at the highest level;
The feeling of complete security of each insured person from the insurance company, who is not left alone for a minute with the arbitrariness that often exists in health care facilities (which is especially dangerous in obstetrics and pediatrics).
In addition, every head of an institution who purchases VHI programs for his employees receives a huge benefit, since the image of the enterprise and the prestige of jobs are significantly increased. The manager really has the opportunity to help an employee valuable to the team not only financially (for example, in carrying out a very expensive operation, even if at the moment there is no profit at the enterprise), but also organizationally (after all, contracts with leading clinics, as a rule, already concluded, and it will take very little time to organize assistance). Moreover, VHI funds can pay for the necessary expensive medicines that are not included in the list provided for by the MHI. Benefit from participation in the VHI market and medical institutions that receive huge financial resources that go to the development of the material and technical base of the institution and additional incentives for employees.
Secondly, insurance companies concluding voluntary medical insurance contracts are beginning to take a direct part in the development of the material and technical base of healthcare, creating their own health facilities. Today, depending on the risky or deposit type of insurance, the profit of insurance companies can fluctuate within a small range at rather low figures, since the bulk of the funds end up in medical institutions. If the founders of insurance companies open their own medical institutions, then both the insurance companies themselves and the clients, for whom everything possible will be done at the modern level, and the local healthcare system as a whole will benefit from this.
Thirdly, with an increase in the number of insurance companies working with individuals, the protection of well-to-do people who are able to independently buy a VHI policy from the arbitrariness of business leaders who, for various reasons, do not want to take care of the health of their employees, increases. Unfortunately, there are heads of enterprises who seek to get rid of a sick employee under any pretext.
Fourthly, there are cases when people who for some reason do not have a compulsory medical insurance policy need medical care. These include, for example, migrants who did not have registration in the region at the time of the disease.
Fifth, a very important advantage of VHI is the availability of highly qualified expert doctors and lawyers in large insurance companies who are ready to really stand up for the interests of their insured.
Many years of experience of insurance companies in the field of voluntary medical insurance and the growing interest in this type of insurance on the part of the largest domestic enterprises allows us to speak of voluntary medical insurance as the most important and promising source of healthcare financing at this stage and in the future.
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INTRODUCTION
Conclusions on Chapter I
2.2 Results of the empirical study
2.3 Prospects for the development of the voluntary medical insurance system
Conclusions on Chapter II
CONCLUSION
BIBLIOGRAPHY
APPLICATION
INTRODUCTION
Voluntary health insurance is a form of health insurance in case of loss of health, which provides the possibility of full or partial reimbursement of medical expenses. The social and economic significance of voluntary medical insurance is to supplement the guarantees for medical care provided to the population free of charge through the system of budgetary financing of medical institutions and compulsory medical insurance.
Voluntary health insurance is becoming increasingly important in the development of private medicine. However, the penetration of this type of insurance into life is still not large enough.
In this regard, the object of research is the system of voluntary medical insurance.
The subject of the research is voluntary medical insurance programs.
The purpose of the study is to determine the features of the modern system of voluntary medical insurance.
To achieve this goal, it is necessary to perform a number of tasks:
To study the scientific literature on this issue;
To study the history of the formation of the voluntary medical insurance system in Russia;
Consider the features of voluntary medical insurance abroad;
Summarize the experience of insurance organizations working with voluntary medical insurance programs;
Develop a questionnaire and conduct an empirical study on this issue;
Determine the prospects for the development of a system of voluntary medical insurance.
Hypothesis: the development of a system of voluntary medical insurance is possible under the following conditions:
1) insurance companies will carry out activities to inform the population about the essence of voluntary medical insurance and its benefits;
2) new insurance products will be created within the framework of voluntary medical insurance.
The methods by which this study will be carried out include the analysis of scientific literature, questioning, generalization of experience, and conversation.
The practical significance of the work lies in the fact that the results can be used in the activities of insurance companies operating under voluntary medical insurance programs.
Base of the study: the study was conducted on the streets of the city and at enterprises with various forms of ownership.
The structure of the work includes: introduction, two chapters, conclusions by chapters, conclusion, bibliography and appendix.
CHAPTER I. THEORETICAL FOUNDATIONS OF THE STUDY PROBLEM
1.1 The essence of voluntary health insurance
The insurance business is an important economic institution that existed in various economic formations, one of the developing types of business. Insurance is designed to satisfy the essential and fundamental human need - the need for security. The increasing role of insurance in the modern economy, on the one hand, and the growing differentiation of legal norms for regulating the life of society and the economic activity of people, on the other, determined the formation of insurance law as a specific part of the legal system of the state and a complex branch of legislation (43).
The limited basic program of compulsory health insurance, the lack of motivation among medical workers, the inaccessibility of modern clinical and laboratory facilities in the face of deteriorating health care financing have led to an aggravation of problems associated with obtaining qualified medical care. In this regard, the only possible system for the provision of medical services at a qualitative level remains the system of voluntary medical insurance.
The Constitution of the Russian Federation in Article 41 proclaims the right to health care and medical care, putting it on a par with such social rights as the right to pension and social security, the right to housing, the right to protection of motherhood and childhood. Economic guarantees themselves are a system in which the central place is occupied by state (budgetary) financing, compulsory health insurance (CHI) and voluntary health insurance (VMI). Voluntary health insurance occupies a worthy place among the economic guarantees of the right to health care and is one of the most effective among them.
From an economic point of view, voluntary health insurance is a mechanism for compensating citizens for expenses and losses associated with the onset of an illness or accident, i.e. insured event - (in VMI) the insured person's appeal to a medical institution (doctor) for medical assistance.
Voluntary medical insurance is carried out on the basis of voluntary medical insurance programs and provides citizens with additional medical and other services in addition to the established compulsory medical insurance programs (32, p. 54).
Voluntary medical insurance is carried out on the basis of an agreement between the insured and the insurer. The rules of voluntary medical insurance, which determine the general conditions and procedure for its implementation, are established by the insurer independently in accordance with the provisions of the Law of the Russian Federation of November 27, 1992 No. 4015-1 "On Insurance". Specific conditions of insurance are determined at the conclusion of the insurance contract.
In accordance with the contract of voluntary medical insurance, the insurance company (or its representative - insurance agent) issues to each insured person an insurance policy of voluntary medical insurance, which indicates:
The name of the insurance program of voluntary medical insurance chosen by the insured when concluding the VHI contract (for example, "outpatient medical care", "inpatient medical care", "comprehensive medical care", "dental care", etc.) - insurance program of voluntary medical insurance contains a list of medical services that the insured person can receive if necessary. A detailed description of the insurance program of voluntary medical insurance with a list of medical services is contained in the so-called "VHI Rules", developed by each insurance company independently, agreed with the Federal Insurance Supervision Service of the Russian Federation and without fail attached to the contract of voluntary medical insurance;
A list of medical and service institutions to which, if necessary, the insured person can apply. The insurance company entered into financing agreements with all these medical institutions, providing for the admission by the medical institution of patients with voluntary medical insurance policies of this insurance company and the subsequent payment by the insurance company for the rendered medical services. Price lists with contractual prices for medical services are attached to the financing agreements. In practice, the insured person does not apply directly to a medical institution, but to a service company or to the doctors-organizers of the insurance company, and they already organize the provision of medical care: they agree on the time of admission of the patient, conduct diagnostic tests, deliver the patient to a medical institution, etc. .;
Sum insured - the maximum total cost of medical services that this insured person can receive under this VHI insurance policy (44).
The subjects of voluntary medical insurance are: a citizen, an insurer, an insurance medical organization, a medical institution.
The insurers in case of voluntary medical insurance are individual citizens with legal capacity and/or enterprises representing the interests of citizens. If the court recognizes the insurant during the period of validity of the contract of voluntary medical insurance as incompetent in full or in part, his rights and obligations are transferred to the guardian or custodian acting in the interests of the insured.
Insurance medical organizations are legal entities that carry out voluntary medical insurance and have a state permit (license) for the right to engage in voluntary medical insurance (32, p. 71) .
Medical institutions in the VHI system are licensed medical institutions, medical research institutes, other institutions providing medical care, as well as individuals engaged in medical activities, both individually and collectively.
The object of voluntary medical insurance is the insured risk associated with the costs of providing medical care in the event of an insured event. An insured risk is a prospective event against which insurance is provided. An event considered as an insurance risk must have signs of probability and randomness of its occurrence (13, p. 17).
The insured has the right to:
Participation in all types of health insurance;
Free choice of insurance organization;
Control over the fulfillment of the terms of the medical insurance contract;
Repayment of a part of insurance premiums from an insurance medical organization under VHI in accordance with the terms of the contract.
The insured company, in addition to the rights listed above, has the right to:
Reducing the amount of insurance premiums with a stable level of morbidity among employees of the enterprise or its decrease within three years;
Raising funds from the profit (income) of the enterprise for voluntary medical insurance of its employees.
The insured is obliged:
Make insurance premiums in the manner prescribed by the contract of voluntary medical insurance;
Within its competence, take measures to eliminate adverse factors affecting the health of citizens;
Provide the insurance medical organization with information on the health indicators of the contingent subject to insurance.
Voluntary medical insurance funds are formed in insurance medical organizations at the expense of funds received from insurance premiums. They are intended for financing by the insurance organization of medical and other services provided under this type of insurance.
Voluntary medical insurance is carried out at the expense of profits (income) of enterprises and personal funds of citizens by concluding an agreement. The amount of insurance premiums for VHI is established by agreement of the parties. The insurance premium is the payment for insurance, which the policyholder is obliged to pay to the insurer in accordance with the VHI agreement. Tariffs for medical and other services under VHI are established by agreement between the medical insurance organization and the enterprise, organization, institution or person providing these services. The insurance rate is the rate of the insurance premium per unit of the sum insured or the object of insurance. Tariffs should ensure the profitability of medical institutions and the modern level of medical care (16, p. 25).
From January 1, 1993, legal entities that direct funds from profit for voluntary medical insurance of employees of the enterprise, members of their families, persons who have retired from this enterprise, are provided with tax benefits in the amount of up to 10% of the amount allocated from profit for these purposes.
The main features of compulsory insurance in accordance with Chapter 48 of the Civil Code of the Russian Federation, Part 2 are:
The obligation to insure arises from the law,
The objects of insurance are personal and property insurance, civil liability insurance,
The obligation to insure may be assigned to persons specified in the law in the event of an insured risk, that is, in the event of damage to life, health or property of other persons specified in the law, or violation of contracts with other persons.
Health insurance does not meet these criteria, except for the first one, which refers to CHI. First, the object of health insurance is to maintain the health of citizens by providing medical care at the expense of health insurance funds. Secondly, the conclusion of an insurance contract does not imply the presence of an insured risk, and the insurance payment is not made upon the occurrence of an insured event. Moreover, the provision of medical care involves the implementation of preventive measures. All these features are typical for both compulsory and voluntary medical insurance, since the object of voluntary medical insurance is also to maintain the health of citizens, but by providing additional medical care (additional medical services) in excess of the established programs of compulsory medical insurance. In this case, the definition of the object of voluntary medical insurance given in Article 3 of the current law on health insurance is questionable, since, in our opinion, it is also unlawful to talk about an insured risk and an insured event for voluntary medical insurance, as well as for compulsory medical insurance ( 14, p. 83).
Now let's move on to the consideration of the features that are specific to voluntary health insurance, that is, its main differences from compulsory health insurance. The differences between compulsory and voluntary health insurance are as follows:
Firstly, the obligation of insurance in case of compulsory health insurance follows from the law, and in case of voluntary health insurance it is based only on contractual relations, which, however, does not exclude the need for compulsory health insurance by concluding an insurance contract between the insured and the insurer.
Secondly, the main difference between compulsory and voluntary health insurance lies in the sphere of relations arising between their subjects in the provision of medical care at the expense of insurance funds. If compulsory health insurance is carried out in order to ensure the social interests of citizens, employers and the interests of the state, then voluntary health insurance is implemented only in order to ensure the social interests of citizens (individual or collective) and employers.
Thirdly, from the previous difference follows, in particular, the difference in who are the insurers in compulsory and voluntary health insurance: in compulsory health insurance, these are executive authorities and employers; in case of voluntary health insurance, citizens and employers.
Fourthly, relations on voluntary medical insurance, as well as on compulsory medical insurance, relate to social insurance, which pursues the goal of organizing and financing the provision of medical care to the insured contingent of a certain volume and quality, but under voluntary medical insurance programs (21, p. 40) .
However, voluntary health insurance, unlike compulsory health insurance, does not apply to state social insurance. First, due to the difference in the social interests they realize. Secondly, due to the difference in the forms of ownership and organizational and legal forms of insurance organizations that carry out social insurance. At the same time, it is understood that social insurance can be not only state, but also municipal, and given the differences in its internal organization, it can also be professional (according to professional and sectoral characteristics) and international.
However, the classification of social insurance on the basis of forms of ownership and differences in its internal organization (state, municipal, professional, international) does not coincide with the classification according to the forms of social insurance - compulsory and voluntary. Thus, compulsory health insurance and voluntary health insurance differ from each other according to the above types of classification (25, p. 89).
Fifth, as a result of the foregoing, pursuing common goals and having a common object of insurance - compulsory and voluntary medical insurance differ significantly in insurance subjects - they have different not only insurers, but also insurers. For voluntary health insurance, these are non-governmental organizations that have any organizational and legal form, for compulsory health insurance, these are state organizations (41).
Sixth, compulsory and voluntary health insurance also differ in terms of sources of funds. The financial resources of the compulsory health insurance system are formed from budget payments and contributions from enterprises, government bodies of the appropriate level. The amount of contributions for compulsory health insurance for enterprises, organizations and other economic entities is set as a percentage of the accrued wages. Voluntary medical insurance is carried out at the expense of the profit (income) of the enterprise and personal funds of citizens, the amount of insurance premiums is established by agreement of the parties.
In contrast to voluntary health insurance, with compulsory health insurance, the term of the insurance period does not depend on the term for paying insurance premiums, and the insurer is liable even if insurance premiums are not paid.
The basic CHI program is determined by the Government of the Russian Federation and on its basis a territorial program is approved, representing a list of medical services provided to all citizens in a given territory. With voluntary medical insurance, the list of services and other conditions are determined by the contract between the insured and the insurer (35, p. 28).
In addition, tariffs for medical services under CHI are determined at the territorial level by an agreement between medical insurance organizations, government bodies of the appropriate level and professional medical organizations. Tariffs for medical services under VHI are established by agreement between the insurance medical organization and the medical institution, enterprise, organization or person providing these services.
The quality control system under compulsory medical insurance is determined by agreement of the parties, with the leading role of government authorities, and under VHI is established by agreement. In addition, many differences can be listed, for example, in terms of legal regulation mechanisms, but we have indicated the most basic ones.
If we talk about the combination of two types of health insurance, it should be noted that in Russian reality the process of combining compulsory and voluntary health insurance occurs largely spontaneously. The lack of medical care received in the public health sector forces patients to look for ways to obtain the missing medical services at the expense of personal income or employers' funds (15, p. 46). At the same time, citizens belonging to the category of socially unprotected - chronically ill and low-income citizens can use such opportunities to a much lesser extent. And they are the ones who need more medical care. With insufficient medical care for this category, the need for it increases. As a result, the disproportion between the volumes of medical care needed and available to these citizens is growing.
1.2 The history of the formation of the voluntary medical insurance system in Russia
For the first time, voluntary health insurance was discussed in the 1990s, towards the end of Gorbachev's perestroika, when it finally became clear that the state was unable to fulfill its obligations to finance health care. An economic catastrophe was approaching, which increasingly affected the implementation of social functions by the state. Under these conditions, it was decided to turn to the experience of other countries, where national health systems had various sources of funding that complemented each other. Organizers of health care, economists and legislators equally understood the need for reforms in the industry, first of all, a revision of the concept of financial support for health care.
In other words, voluntary health insurance - such as it is today - appeared only two decades ago. But this is only the end result of the evolution of health insurance, which has lasted for many decades. Let us consider the stages of development of medical insurance, which began in the first half of the 19th century (26, p. 40).
The prototype of what today is commonly called "employee insurance" first appeared in 1827 in St. Petersburg. At that time, the workers of individual enterprises expressed the initiative to create a mutual aid society. Its budget was formed by regular contributions from the participants, while the owners of the factories remained on the sidelines. The worker received monetary compensation if an accident occurred to him, resulting in a temporary or permanent loss of ability to work. In the event of death, payments went to the family of the member of the society. This principle formed the basis of the first sickness funds, which appeared only in the second half of the 19th century (18, p. 55).
The beginning of the next stage in the development of health insurance is considered to be 1842, when an announcement was printed in major periodicals that obliged all citizens belonging to the 4th and 5th categories (diggers, janitors, lackeys, stove-makers, etc.) to pay 60 kopecks. In return, they received the right to be treated in city hospitals for one year. By the way, their employers had to make regular contributions for clerks, cooks, barmaids and gardeners.
As is often the case in Russia, this form of health insurance arose due to the unwillingness of a separate department to spend money on treating the poor. At that time, such a duty lay with the police ministry, which wanted to relinquish additional responsibility. However, this did not last long: it soon became clear that the symbolic 60 kopecks per person did not even partially cover the actual costs of treatment. Therefore, during the reign of Alexander II, tariffs were raised to 1 ruble. Another 1 ruble for each worker had to be paid by employers (45).
No less interesting is another fact: since 1870, absolutely all citizens had to pay a contribution, regardless of social status and wealth. Including, these are nobles and merchants who have never been treated in city hospitals, but were observed by private doctors. Thus, compulsory health insurance appeared - the minimum necessary list of medical services that absolutely everyone could use. If you do not consider the details, then these are the features that are inherent in health insurance to this day. By the way, the decree provided for the categories of citizens who enjoyed benefits - these are members of the imperial family, officials, the military, children under 15, as well as employees of diplomatic missions and trade missions.
The turning point in the practice of health insurance is considered to be 1861, when the first normative act came into force, establishing the standards of compulsory insurance for state-owned mining plants. He demanded the establishment of auxiliary cash desks at the factories. They were engaged in the issuance of benefits for temporary disability caused by accidents, as well as the payment of pensions and compensation to the families of workers in the event of the death of breadwinners. After some time, an addition appeared, instructing managers to found hospitals on enterprises.
Health insurance entered a new round of development after 9 years: in 1912 III The State Duma approved the law "On Insurance of Workers in Case of Sickness and Accidents". In fact, this document became the successor to the law of 1903, but it was radically different from it in content. In addition to the payment of benefits for disability or death, the legislative act obliged entrepreneurs to pay for medical services provided to participants in auxiliary funds. Including - emergency medical care, outpatient treatment, hospital stay, as well as obstetric care. The most interesting thing is that in terms of the range of services, such employee insurance is in many ways reminiscent of the basic programs of modern voluntary medical insurance. With the adoption of the law, sickness funds appeared in many regions of the country, and in St. Petersburg, the number of people who applied for medical care during the year reached 8% of the total number of workers (27, p. 41).
But five years later, this stage of evolution ended: the events of 1917 radically changed the approach to health insurance. Moreover, the term “insurance” itself disappeared from the normative acts for a long time: it was replaced by the expression “social security”, which is much more in line with the worldview of that time. With the establishment of Soviet power, medical care became equally accessible to all segments of the population, and the cost of it was completely taken over by the state. But today we can also note the reverse side of this approach - the low quality of service, as well as insufficient funding for medical institutions, which was carried out according to the residual principle.
Voluntary medical insurance in Russia gained the right to exist only in 1991, with the entry into force of the Law "On Medical Insurance of Citizens in the RSFSR". But at the very beginning, voluntary medical insurance was extremely inefficient: the amount of payments for an insured event did not exceed the amount of the insurance premium, and funds not spent on treatment were returned minus the insurer's commission. This situation suited entrepreneurs who used voluntary medical insurance to hide part of the employees' salaries from the tax authorities. In the future, more and more voluntary medical insurance programs appear on the market, providing for an amount of insurance coverage that exceeds the amount of the down payment.
A radical turning point occurred in 1995, when the requirements for companies providing insurance for employees under voluntary medical insurance programs became significantly tougher. In particular, the Russian Federal Service for Supervision of Insurance Activities completely banned the practice of returning unused funds in order to deprive businessmen of the opportunity to avoid the tax burden. From that moment on, voluntary health insurance entered the modern phase of development. Over time, more and more insurance companies began to appear on the market, offering their customers various programs of voluntary medical insurance. In addition, the range of services offered by voluntary health insurance has significantly expanded, and the popularity of such products among citizens and legal entities has grown.
Summing up, it is necessary to mention once again that in Russia voluntary medical insurance as an economic and legal category and type of insurance activity arose in 1991 with the adoption of the Law of the RSFSR "On Medical Insurance of Citizens in the RSFSR". The insurance model provided for by law was fundamentally different from the varieties of personal insurance that existed at that time. It was about a qualitatively new legal relationship for our legal system. The novelty was in the object of the insurance legal relationship arising under VHI. Its subject composition also looked in a new way. Personal insurance, including health insurance, widespread in the Soviet period, provided for payments directly to the insured upon the occurrence of an insured event (illness or other harm to health). The purpose of such insurance is to mitigate the possible financial losses of the insured as a result of damage to health. In this case, the property interests of the insured person were the object of insurance. The most common was the "simple" structure of the insurance legal relationship, which included the insurer and the insured as subjects, and the insured usually personally coincided with the insured (29, p. 35).
The current law of the Russian Federation "On health insurance of citizens in the Russian Federation" as an object of voluntary medical insurance defines the risk associated with the cost of medical care in the event of an insured event. At the same time, the law states that voluntary medical insurance "provides citizens with additional medical services and other services in excess of those established by compulsory insurance programs."
The objects of voluntary medical insurance are two groups of insurance risks:
1) the occurrence of expenses for medical services for the restoration of health, rehabilitation, care;
2) loss of income due to the impossibility of carrying out labor activities both during the illness and after - in the event of disability.
The legislation of the Russian Federation limited the object of medical insurance only to reimbursement of expenses for medical care.
The insurers in case of voluntary medical insurance are individual citizens with legal capacity and/or enterprises representing the interests of citizens. Voluntary medical insurance provided for a qualitatively new type of insurance relationship that was previously unknown to domestic insurance practice. Its object should have been the property interests of third parties, and not the insured person himself. The concept of the object was revealed in the law as "expenses but the provision of medical care." The subject composition of the legal relationship became more complicated, except for the insurer, the insured and the insured person, a medical institution was introduced into it as a person directly providing medical care (46).
But it should be noted that voluntary health insurance in Russia has not yet reached the level of European countries, and this segment of insurance services retains a huge potential for further development.
1.3 The system of voluntary medical insurance abroad
The most developed VHI system is in the USA, where it entered its heyday in the distant 30s. In total, in the United States today, more than one and a half thousand companies are engaged in health insurance, and more than 160 million people are covered by the VHI system, that is, almost 70% of the entire population of the States. VHI provides up to a third of the funding for American health care, which is considered the most expensive in the world. More than three-quarters of VHI in America is group (corporate) insurance provided by firms for their employees (46).
In the US, health insurance is voluntary and almost entirely provided by employers. Health insurance is the most common form of workplace insurance, but employers are not required to provide it at all. Not all American employees receive such insurance. Yet in the largest companies, health insurance is almost an indispensable condition.
There are many types of health insurance. The most common is the so-called compensatory insurance, or "fee-for-service" insurance. With this form of insurance, the employer pays the insurance company an insurance premium for each employee provided with the appropriate policy. The insurance company then pays for the checks presented by the hospital or other health care provider or doctor. Thus, the services included in the insurance plan are paid for. Typically, the insurance company covers 80% of the costs of treatment, the rest must be paid by the insured himself (47).
There is an alternative - the insurance of the so-called managed services. The number of Americans covered by this type of insurance is rapidly increasing. In this case, the insurance company enters into contracts with doctors, other medical professionals, as well as with institutions, including hospitals, for the provision of all services provided for by this type of insurance. Typically, medical institutions receive a fixed amount, which is paid in advance for each insured.
The differences between the two described types of insurance are very significant. Fee-for-service insurance pays for services that are actually provided to patients. With "managed services" insurance, medical institutions receive only a fixed amount per insured patient, regardless of the volume of services provided. Thus, in the first case, health care workers are interested in attracting clients and providing them with a variety of services, while in the second they are more likely to refuse to prescribe additional procedures to patients, at least they are unlikely to prescribe them more than necessary (33, p. 49).
In America, insurance medicine with its voluntary health insurance guards the health of its clients, guaranteeing not only payment for the medical service provided, but also high-quality treatment with traditional medicines. No insurance company will cover the cost of treatment using hypnosis, acupuncture, homeopathic or herbal remedies. From the point of view of insurance medicine, such therapy is unconventional and the effect of its use is controversial.
Health insurance in the US has another feature. There is a certain credit of trust in medicines prescribed by a doctor. But if the result from their use is insufficient and the disease progresses slowly but steadily, the next only correct stage of treatment for the clients of the insurance company is not prescribing drugs, but surgical treatment. The United States ranks first in the number of coronary artery bypass grafting operations (23, p. 68).
One of the basic principles of health insurance is the high efficiency of medical care. With regard to treatment costs, the insurance company covers the costs associated with applying the only correct treatment with a high success rate. Of course, the cost of heart surgery is very high, but less than the cost of drugs that need to be taken for quite a long time. And the effect of conservative therapy is not always desirable. Therefore, insurance companies prefer to incur large expenses, but once.
Americans are serious about their health. On the one hand, insurance companies protect their clients from unprofessional medical care, on the other hand, Americans trust their doctors and do not buy medicines without a specialist's recommendation.
With regard to voluntary health insurance in European countries, in most cases, VMI is being intensively developed as an addition to state financing of medicine, expanding the range of treatment and preventive services and financial opportunities for healthcare. For example, in small Israel, which is famous for the highest level of medical care, more than 70 companies (including foreign ones) operate in the VHI system, despite the fact that four of the largest insurance companies control half of this market. The VHI system covers almost a fifth of Israelis who use services not included in the basic programs of mandatory insurance funds, including nursing and patronage care (mainly for the elderly). The State Commission for Health Analysis in Israel believes that the role of VHI will continue to grow steadily in the future. Similar trends are observed both in Russia as a whole and in our region, where a network of large insurance companies operates (17, p. 46).
In Germany, an alternative (and supplement) to compulsory health insurance is voluntary (private) health insurance, which applies to citizens who, due to high incomes or professional activities, are not subject to compulsory health insurance, as well as to those persons who have the means and desire to receive additional alternative assistance to compulsory health insurance. The existence of two different forms of health insurance in the country is a positive factor that stimulates competition in the medical services market, which creates conditions for a more efficient and dynamic development of the existing healthcare system in Germany, improvement of the services offered and innovative activity. The main factor that determines the difference between compulsory and private health insurance systems is income, the amount of which exceeds the limit of compulsory health insurance (today it is 40.034 euros per year), which is the reason for applying for the services of the private health insurance system. As a rule, entrepreneurs or representatives of free professions, as well as employees whose incomes exceed the limit established by law, become participants in this system. At the same time, voluntary (private) health insurance also means the possibility of obtaining additional medical care in excess of the mandatory insurance system, which is relevant for all categories of the population. This is important if the insured in the MHI wants to receive a more expanded set of medical services. According to statistics, about 15% of the population are insured in the voluntary medical insurance system, 80% in the CHI system, 3% of which simultaneously use additional services from VHI programs (41).
Unlike compulsory voluntary health insurance, it offers a larger volume of medical services. For example, within the framework of VMI, there is a free choice of a hospital, as well as improved conditions for staying in it, services of a personal doctor, reimbursement of up to 100% of the costs associated with inpatient treatment (in MHI, as a rule, part of the costs is reimbursed by the patient). Compared to CHI, in which the amount of contributions does not depend on the degree of probability of an insured event, contributions in the voluntary health insurance system are formed taking into account individual risk. Private insurance companies use a large number of different regional and professional tariffs for this. Since age characteristics have a significant impact on the amount of insurance premiums, the most favorable rates in VHI are for young people. It should be noted that in recent years the volume of expenses of the German population in voluntary health insurance has been constantly increasing by an average of 5%. A significant difference from the CHI system is that for each age group insured in VHI there is its own financing of their expenses. In the context of the general complication of the demographic situation in all European countries (an increase in the number of pensioners in relation to the working part of the population), such a system for the formation of insurance premiums does not depend on this trend, and in the future, VHI may be one of the ways to avoid accumulating financial difficulties in the compulsory health insurance system ( 14, p. 82).
The distinguishing features of voluntary health insurance include higher amounts of sickness benefits (they are insured separately), reimbursement of expenses for spa treatment, the possibility of receiving full medical care abroad (since it is not required to conclude an additional insurance contract to the main one), as well as exemption from the payment of contributions in case of failure to seek medical care for 1 to 6 months (the MHI does not provide for such a service). The advantage of voluntary health insurance is also that the insured can, within a wide framework, independently choose the amount of medical care and services he wants, as well as their combinations. The choice of one or another set of medical services depends on the insurance program (30, p. 43).
In contrast to the compulsory in the system of private health insurance, the conclusion of an insurance contract occurs exclusively on a voluntary basis, the content of which (the volume and quality of medical services) is negotiated by the parties. If CHI is based on the principle of solidarity, then the functioning of the private health insurance system is based on the principle of equivalent cost recovery, according to which the amount of contributions to the insurance fund corresponds to the volume of services provided, the insurance risk specified in the contract, and also depends on age, gender, health status and other conditions that determine the amount of insurance and the amount of contributions paid. Unlike compulsory medical insurance in the private insurance system, the insured, receiving medical care, is obliged to pay for it himself, after which, by presenting the paid invoice to the insurance company, he can receive appropriate compensation for the costs of treatment in accordance with the insurance contract. An exception exists for paying for inpatient treatment, the costs of which may be burdensome for the patient. If there is an agreement between the insurance company and the insured, these calculations can be paid without the participation of the latter.
In contrast to compulsory medical insurance, in the system of voluntary medical insurance, insurance institutions providing sickness insurance are not bound by contractual relations with other participants in the healthcare system (doctors, doctors' unions, pharmacies, hospitals, etc.). The employer pays half of the insurance premiums, but only if their total amount does not exceed the amount of insurance under compulsory health insurance. Insurance in VHI for such categories of the population as the unemployed (if they were previously insured in VHI) and students differs from the general order. The fact is that the corresponding state institution undertakes partial financing of their participation (33, p. 49).
Whereas in compulsory medical insurance there is the possibility of free insurance for all family members with a small total income, there is no such possibility in the voluntary medical insurance system, therefore, regardless of income level, all family members are forced to conclude separate health insurance contracts.
Insurance companies operating in the private health insurance market do not directly limit the amount of medical care provided. The insured person must himself ensure that the medical services he needs are covered by the scope of insurance under the contract, which means that he must independently decide which form of treatment or examination suits him best. In general, unlike CHI, voluntary health insurance offers a higher degree of patient independence and, at the same time, greater responsibility. As in compulsory health insurance, in the system of private health insurance, the state legislates the principles of its functioning and standards, and also exercises control over its activities.
Thus, the voluntary health insurance system in force in Germany, performing the same functions as CHI, is both an alternative and a significant addition to compulsory health insurance. Having a different organization and principles of work, each of the systems is at the same time aimed at solving one problem - providing affordable, highly qualified medical care to the entire population of the country, which could be a positive example of the implementation and existence of an effective health insurance system in the context of economic and social restructuring. spheres of Russia.
Conclusions on Chapter I
1. Insurance is an important economic institution that existed in various economic formations, one of the developing types of business. Insurance is designed to satisfy the essential and fundamental human need - the need for security.
2. Voluntary medical insurance is carried out on the basis of voluntary medical insurance programs and provides citizens with additional medical and other services in excess of the established compulsory medical insurance programs. Voluntary medical insurance is carried out on the basis of an agreement between the insured and the insurer. The subjects of VHI are: a citizen, an insurer, a medical insurance organization, a medical institution.
3. The object of voluntary medical insurance is the insured risk associated with the costs of providing medical care in the event of an insured event. An insured risk is a prospective event against which insurance is provided. An event considered as an insured risk must have signs of probability and randomness of its occurrence.
4. Voluntary medical insurance in Russia gained the right to exist only in 1991, with the entry into force of the Law "On Medical Insurance of Citizens in the RSFSR". The purpose of such insurance is to mitigate the possible financial losses of the insured as a result of damage to health. In this case, the property interests of the insured person were the object of insurance.
5. The current law of the Russian Federation "On the health insurance of citizens in the Russian Federation" defines the risk associated with the costs of providing medical care in the event of an insured event as an object of VHI. At the same time, voluntary medical insurance "provides citizens with additional medical services and other services in excess of those established by compulsory insurance programs."
6. The most developed VMI system is in the USA, where it entered its heyday in the distant 1930s. In total, in the United States today, more than one and a half thousand companies are engaged in health insurance. In the US, health insurance is voluntary and almost entirely provided by employers. Health insurance is the most common form of workplace insurance. One of the basic principles of health insurance is the high efficiency of medical care.
7. In most European countries, VHI is being actively developed as an addition to public funding of medicine, expanding the range of preventive and curative services and financial opportunities for healthcare. In Israel, more than 70 companies operate in the VHI system, the VHI system covers almost a fifth of Israelis who use services not included in the basic programs of compulsory insurance funds, including nursing and patronage care.
8. In Germany, voluntary (private) health insurance applies to citizens who, due to high incomes or professional activities, are not subject to compulsory health insurance, as well as to those persons who have the means and desire to receive additional assistance alternative to compulsory health insurance. A distinctive feature of the VHI is the high rates of sickness benefits, reimbursement of expenses for resort treatment, the possibility of receiving full medical care abroad, as well as exemption from paying fees in case of not seeking medical help for 1 to 6 months (the CHI does not provide for such a service) .
CHAPTER II. PRACTICAL ASPECTS OF THE STUDY PROBLEM
2.1 Summarizing the experience of insurance companies operating in the voluntary medical insurance market
health care payment medical insurance
It is believed that the very idea of insurance was invented by English merchants who suffered losses due to ships that had gone sailing and never returned. The merchants decided to distribute the damages equally in the event of loss or loss of ships. For this, deductions were made to the general fund - some part of the property participating in the expedition. Assistance was provided from this fund.
Today, in the conditions of modern market competition, insurance is one of the most profitable activities. The number of insurance companies and clients of these companies is growing.
At the same time, the leaders of the VHI market, the leading universal insurers of the federal level, which account for more than half of all premiums in this segment, are engaged in medical insurance mainly. So, only about a dozen companies provide medical protection to the personnel of most large industrial complexes in Russia, at the same time providing services to medium and small businesses, as well as private clients.
Among the companies operating in the VHI market, three groups can be conditionally distinguished, differing in the strategy of attracting customers (11, p. 89).
1. Insurance companies that are subsidiaries of financial and industrial holdings. The main task of these insurers is to organize medical care for the parent structure and companies that can influence it. As a rule, these companies operate in regions in accordance with the geography of the business of the founders. Having accumulated experience in working with "related" client companies. They begin to actively offer their services to their partners and other enterprises operating in their respective regions. Often in such cases, insurance is carried out with full or partial consideration of the principles of repayment. Most of the leaders can be attributed to such companies: SOGAZ Group, ZHASO, Kapital Insurance Group, SCM, Soglasie. In addition, Energogarant, which traditionally insures regional energy companies and companies close to the electric power industry, has its own market segments.
2. Companies operating in the compulsory health insurance program (through specially created subsidiaries) and largely building their marketing policy on this. The popularity of people, the ability to coordinate financial flows through the channels of compulsory and voluntary insurance, as well as established relationships with many clinics and hospitals allow these insurers to take a leading position in VHI. First of all, these companies include ROSNO and Spasskiye Vorota. However, they are not the only ones who combine the activities of VHI and MHI. Many regional insurers work on such principles.
3. Companies focused exclusively on the market clientele. They work only with those clients who have been attracted by various marketing programs. In any of the companies of this group, you can buy the entire range of insurance programs existing on the market: outpatient treatment with attachment to any of the leading medical institutions, inpatient treatment, "Ambulance", "Personal Doctor", etc. Such insurers include the leading Russian universal insurance companies Ingosstrakh, RESO-Garantia, Rosgosstrakh, UralSib, and Renaissance Insurance companies. VSK Insurance House and AlfaStrakhovanie are active in the mass VHI market.
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term paper, added 12/05/2010
Concept, types, subjects, legal framework voluntary medical insurance contracts in the Russian Federation. Features, principles, content, types and forms of civil liability under a voluntary medical insurance contract.
thesis, added 04/15/2013
Definition of the concept and essence of health insurance. Analysis of compulsory and voluntary medical insurance. Advantages of the new health insurance system. Features and development prospects various kinds medical insurance.
term paper, added 03/09/2011
Characteristics of voluntary medical insurance: subject; policyholder; insurance cover. Basic health insurance programs: outpatient care; hospital treatment. Voluntary medical insurance policy.
Voluntary health insurance (Market overview)
Compulsory health insurance services satisfy people less and less. And high-quality protection under voluntary medical insurance policies is becoming better and more affordable. Moreover, insurance companies are beginning to take a serious interest in individual citizens - individuals. We offer readers an overview of the possibilities of this market.
help yourself
Voluntary health insurance (VHI) is gradually becoming an incubator of civilized medicine in our country. Thanks to VHI, opportunities for advanced medical technologies and new services are opening up for the general population, and the level of service is increasing. Today, VHI and free CHI coexist like two parallel worlds. This is despite the fact that often the services for them are provided in the same medical institution. How to get into the "good" world of medical services? This is usually done through insurance at your facility. But gradually, insurance companies are beginning to be interested in individual customers. Today in St. Petersburg you can choose exactly the program that suits you the most. Insurance companies now want to insure individuals. And it's time for us, those individuals, to learn how to choose the very best.
The peculiarity of the situation is that violent advertising campaigns encourage manufacturers to do a lot of pleasant things for people - more than before. But the campaigns are running. What is happening now in the insurance market is not just a temporary campaign. Insurers are beginning to focus on a new category of customers. The best way win their sympathy - behave like a human being.
insurance companies demonstrate to people a willingness to delve into their problems informally. Here is a typical case: a client of an insurance company, insured under the Outpatient and Home Doctor programs, suffered a mild stroke. The hospital doctors sent him home, prescribing medications and monitoring by a neurologist. Due to health reasons, he could not go to the clinic, and according to VMI, his program did not provide for a home visit by a specialist. But the very next day, the company sent their doctor to his house, and the doctor observed the patient for a long time. In fact, the company did it at its own expense.
Of course, it is possible to assume advertising intent in the actions of insurers - the client will tell his friends about what happened. But this is the essence of civilized business. His law: to be noble is beneficial. And it is a sin for clients not to take advantage of excellent opportunities.
As for insurers, good deeds are contagious. If it is possible to combine humanity with profitability, any normal businessman will do so. In the field of VHI, this leads to the development of new programs and their "human" execution.
In the St. Petersburg market, such a trend is taking shape today. Of course, you can use its fruits "not for your money." To do this, you need to influence the management of your enterprises. There are many means: trade unions, collective agreement, public opinion.
DMS - THE MAGIC WAND OF MANAGERS
Numerous studies of consulting agencies and expert organizations show that VMI today can be one of the most effective elements in the field of personnel management. Only many managers of small and medium-sized enterprises do not yet know about it.
If the company does not have enough funds to increase salaries, its management is faced with the destruction of the motivational system. Good employees leave or start working carelessly. Losses from theft and fraud increase, labor productivity decreases. Punitive measures do not help, the threat to the economic security of the enterprise is growing. And what to do? The company has no money to increase salaries! A competent leader in such cases resorts to additional motivation.
An agency workshop gave the following example. There was a huge turnover at one service industry enterprise. The theft began. It was impossible to hire new good workers or keep old ones, since the salary was 3,500 rubles. The company's income made it possible to raise wages by 300-400 rubles a month, but the management did not believe that this amount would change anything in the attitude of employees to duties.
Then the expert, after an interview with the staff, offered to issue VHI insurance for the team, as well as pay 3,000 rubles in the form of bonuses ("the thirteenth salary") at the end of the year. For the enterprise, the conclusion of the VHI agreement meant the payment of an insurance premium of about 600 rubles per year for each employee. But the volume of medical services that an employee could receive was dozens of times higher than this amount.
The company's expenses for VHI and the bonus cost just the money that it could have spent on an inefficient salary increase. Interestingly, after that, the turnover decreased by half, theft almost stopped. A year later, out of increased profits, the company raised salaries by 2,000 rubles a month and got rid of difficulties with staff.
Why has VMI become the favorite of workers' sympathies today? Two interrelated reasons can be named: the formation in society of the concept of "values of health" and the steady deterioration of the latter among the majority of the population. The insurance coverage of VHI is in stark contrast to the powerless OMS machine. Faced with a caring attitude towards their health, a person will appreciate it much more than the presentation of a diploma or a random ticket to a boarding house. And positive reactions from high-quality VHI service are transferred to the one who provided it. To the "home company".
Prepared by Sergey Dovbnya.
Specialists - about DMS
Experts from insurance companies answer questions from Komsomolskaya Pravda about the problems and trends of VHI.
— Is there a growing interest of individual citizens in VHI insurance, and which groups of the population buy these policies the most?
Alexandra Bogdanova, Director of VHI, IC "ASK-Med":
— Over the past six months, the demand for VHI policies has grown significantly. Most of all, the topic of VHI is of interest to parents, because assistance to children under the compulsory medical insurance system is getting worse due to the lack of district doctors and the overload of free institutions. Insurance companies offer parents not only the infrastructure of quality treatment. Programs "family doctor" allow you to monitor the child constantly and prevent severe forms of disease. In addition, VHI is becoming popular with migrants, people from other regions and even countries. VHI for them (in the absence compulsory medical insurance policy and unformed documents for work) is the only way to receive permanent medical care.
— What VHI programs are most in demand by citizens?
Alexey Kuznetsov, director of IC "Capital-Polis":
- In our opinion, family programs VHI has the best prospects. Consumers already understand the benefits of treating the whole family with one doctor. Constant monitoring by a family doctor is especially effective in chronic diseases. Such a doctor not only helps patients recover, but also provides prevention, early diagnosis and the establishment of a healthy lifestyle. The experience of our company shows that one of the most promising areas for the development of VHI programs is the creation of Family Medicine Centers in different parts of the city. This saves the client time and money.
— What VHI programs, in your opinion, are the most promising?
Valery Ovsyannikov, General Director of IC "Virilis":
— From our point of view, VHI programs for children and adolescents are one of the most promising areas of insurance. Firstly, because children are still our future, and the health of children is the health of the nation (although, perhaps, it sounds hackneyed). Secondly, because by purchasing a VHI policy, parents acquire both peace of mind and confidence that the necessary medical care in the right amount and at the right time will be provided to their child. And, finally, today we are well aware that you have to pay for high-quality medical services and, often, pay a lot. The company's liability limit under all VMI agreements for pediatrics is many times higher than the amount that parents pay when concluding the agreement, and this is an extremely important circumstance.
— What VHI clients are most interesting for insurance companies?
Tatyana Voloshina, director of the medical insurance center of the Russkiy Mir insurance company:
— To date, insurance companies are most interested in collective agreements with businesses. As a rule, enterprises acquire comprehensive insurance programs that include outpatient and inpatient treatment, and an ambulance call. Due to the large number of insured, the company minimizes premiums, and the insurance company provides a wide range of services. And insured workers benefit the most from this.
- Why is a VHI policy better than applying for paid medicine on "your own behalf" for a specific disease?
Inna Vishnevskaya, head of the voluntary medical insurance department of IC "RESO-Garantia":
– Firstly, in the case of treatment “on their own behalf”, the patient will have to pay full cost treatment - in some cases, funds may not be enough. Secondly, medical institutions in such cases tend to inflate prices and impose additional services. The VHI policy protects the patient from unnecessary expenses and loss of time. Thirdly, the voluntary health insurance system is just a system. The specialist will direct you exactly where you need it. Choosing a clinic on their own, the patient runs the risk of being a victim of advertising or incompetent advice. And finally, the insurance company is the guarantor of the protection of the rights of the patient.
A mature business protects itself from employee illness
A new insurance project is able to solve a whole range of problems for an employee and an organization
When a person begins to take care of his health, this means that he has reached maturity and shows elementary responsibility towards himself and his loved ones. And when a leader takes care of the health and medical protection of his subordinates, it means that his business has reached maturity. The manager looks ahead and plans the attitude of the staff towards the company, the quality of their work, the safety of the business and the maximum effect from the funds spent on motivation. VMI today allows you to solve a whole range of problems of the employee and the organization.
General director Aleksey Nikolayevich Kuznetsov, IC Capital-Polis, noted on this occasion: “In recent years, organizations have been entering into more and more VHI agreements. Managers understand that today VHI has become the basis of a system of non-material incentive measures. it is included in the cost.
Indeed, if a person gets sick less, labor productivity increases and working time is saved. And if you still get sick, then the insurance company makes the chain of calls to various specialists optimal. Without queues, confusion and unreasonable bureaucracy.
VHI attracts highly qualified employees and stabilizes the situation in the team. Fear-protected employees feel valued to the organization. As a rule, this gives rise to a reciprocal feeling in them.
In addition, VHI is also a kind of inflationary insurance. The prices of medical institutions grow by an average of 20-30% per year. An insurance company negotiates with a medical institution to keep prices and discounts for its customers.
The company "Capital-Policy" has been specializing as a medical insurance company for 8 years. This made it possible to acquire a unique experience, which the company embodied in the insurance project "People's Policy". It will be carried out on the basis of the company's Family Medicine Center under the "Your Personal Doctor" insurance program. The project offers both individual and corporate insurance. The quality of insurance coverage really makes the project unique.
The heads of organizations can offer their employees a personal doctor for quite reasonable money, who will take care of their health and coordinate the actions of specialists. In addition to increasing the effectiveness of treatment and prevention of diseases, such a measure really raises the relationship between the employee and the employer to a new qualitative level. This can be especially interesting for small and medium businesses.
In small teams, the personal factor is especially important and can be easily corrected by means of proper management. "Personal Doctor" from the "People's Policy" project is the best suited for the recovery of small and medium-sized business organisms. Moreover, the prices for corporate insurance make the project undoubtedly affordable for many customers.
By offering the People's Policy project on the St. Petersburg market, the Capital-Policy company promotes a new quality of treatment, understanding and relations between all VMI participants.
Protecting mothers and children...
IC "Virilis" offers effective insurance coverage to the most beloved and most vulnerable people: pregnant women, mothers, babies and children.
Insurance company "Virilis" provides customers with a wide range of insurance services. However, there is an area where IC "Virilis" occupies a leading position in the insurance market - programs to protect mothers and children. Working in this area requires special care and attention. It is here that the company "Virilis" has raised the level of services to the height of real quality and has no competitors.
"Virilis" offers to insure against an accident, possible complications during childbirth or after childbirth for a mother or child. Of course, none of the parents wants to allow this even in their thoughts. But the manifestation of responsibility towards the unborn child cannot harm his birth. Rather, on the contrary.
With a policy price of 200 rubles, the liability of the insurance company is 10,000 or more. Every third woman giving birth in our city is insured in Virilis.
In addition, the company offers VHI policies for monitoring during pregnancy. These policies guarantee a woman an attentive, individual attitude and high-quality medical protection in any worthy institution of the city.
But even after the birth of a child, "Virilis" helps parents by offering special programs for children of the first year of life and children from one to seventeen years old. Especially for children of different age groups, a program has been developed that includes a set of measures to prevent diseases specific to the age of the insured child. These programs involve the arrival of doctors at home, including a speech therapist and an exercise therapy specialist. It is these VHI policies that happy parents can give their children.
RESO guarantees quality and care
Real help to people can only be provided with impeccable technology.
Insurance company "RESO-Garantiya" occupies a strong position among the leaders in the field of VHI. The company can offer a set of quality insurance programs to both organizations and individuals. The complex includes outpatient and children's programs, dental care, inpatient, sanatorium, rehabilitation treatment and others. Programs can be combined at very different levels of prices, volumes of assistance and choice of services.
Managers can create a package for their employees based on the capabilities and needs of the enterprise. When planning an insurance strategy, you should remember: discounts apply when renewing the VHI contract. After the first period of cooperation, the company already represents the health situation in the team and goes to reduce the fee for the contract. In addition, after a year of quality service under the VHI program, there are much fewer patients at the enterprise!
And the insured good programs VHI people will always remember how genuine medical care differs from ordinary ordeals in hospitals and clinics.
For 10 years of work, "RESO-Garantiya" was able to build up an impeccable technology for providing all types of medical care to its wards. The company relies on the work of its own structure of services - therapists, emergency medical services, family doctors. Naturally, their own doctors treat the matter with the appropriate level of responsibility and professionalism. These are people who do not work "on the stream". For them, a high level of service is indeed the norm. After all, VHI means an individual approach to each patient.
In addition, RESO-Garantia has established contacts with almost 500 medical institutions. Among them are leading medical centers with the most advanced technologies and technical equipment in medicine.
The company "RESO-Garantia" is respected by all partner medical institutions. A client with a VHI policy "RESO-Garantia" will always be provided with high-quality medical care, and additional requests will be fulfilled.
And for individual clients "RESO-Garantiya" can offer programs of emergency assistance, personal doctor, nurse patronage.
Clients of "RESO-Garantia" renew their VHI contracts and recommend us to their friends. This is the best advertisement for our work. After all, together with the policy "RESO-Garantia" gives its customers attention and care. And with the start of the work of its own medical center, the service of the insured will rise to a qualitatively new level.
As a result, having once met and started cooperation, we no longer part with our wards. Good friends are not lost, they are treasured!
"Russian world" everywhere at the highest level
Russkiy Mir Insurance Company offers all types of VHI programs in St. Petersburg and Leningrad region
For insurance companies a sign high level development of VHI is the presence of its own medical center or its own ambulance service.
Russkiy Mir is the only company in St. Petersburg that has both. Own medical center, medical ambulance service, round-the-clock dispatcher, own doctors - such an infrastructure allows you to make the treatment process continuous. The disease can be detected and treated from the moment a mild ailment appears. It is clear that this means a huge advantage for the client. The disease does not start, precious time is not wasted, costs are reduced. In addition, Russkiy Mir provides policyholders with any worthy medical facility in St. Petersburg to choose from for their programs. St. Petersburg hospitals, medical units, institutes cooperate with the Russkiy Mir company - everyone who is known as a manufacturer of quality medical services. This choice in the "Russian World" is really huge.
PROGRAMS FOR EVERYONE
In the same way, among the VHI programs of the Russkiy Mir, any client can find the one that suits him.
The Russkiy Mir company offers organizations and individuals a full range of medical protection. These are outpatient programs and programs for planned and emergency hospitalization, ambulance, children and families ... Convenient combinations of medical services for the client are offered at a standard or elite level. The conclusion of the VHI agreement is a creative process aimed at the benefit of the client.
Among the VHI programs there are programs that are especially convenient for organizations, such as "office doctor". Its meaning is in regular medical examinations, prevention and early diagnosis of diseases. Reception takes place right in the office, at a convenient time for the organization. This saves time and money for the employer and the insured. And in time, noticed and cured diseases no longer threaten losses in the future.
Citizens are traditionally attracted by the system of family doctors of the Russkiy Mir insurance company.
A family doctor is in charge of the health of the whole family: first of all, he helps health not to turn into "illness". If any disorders occur, then the help of a permanent specialist helps to cope with them as quickly as possible.
With this approach, the disease will not be able to cause serious damage to the health of family members. The family doctor is especially important for chronic patients. In combination with the supervision of a family doctor, nurse patronage, home procedures and other medical services that the client wants to include in the contract are possible.
Insurance policies Voluntary health insurance from the Russkiy Mir company makes high-quality medicine affordable for both Petersburgers and residents of the Leningrad Region. This is served by the system of branches of the company.
