Introduction
Chapter 1. Theoretical foundations of the organization of voluntary medical insurance and their impact on the healthcare system in Russia 10
1.1 Socio-economic importance of voluntary health insurance 10
1.2 Features of the functioning of the voluntary medical insurance market in the Russian Federation 19
1.3 General characteristics and distinctive features of compulsory and voluntary medical insurance 36
Chapter 2 Russian market voluntary medical insurance 55
2.1 Analysis and development dynamics of the voluntary medical insurance market 55
2.2 Features of the design of insurance products and its impact on the cost of the VHI policy 91
2.3. Marketing policy of insurers in the VHI market 109
Chapter 3. Prospects for development and proposals for modifying the model of voluntary medical insurance in the Russian Federation 116
3.1 The main directions for improving the voluntary medical insurance market and its place in the healthcare reform system 116
3.2. Proposals for modifying the existing model of voluntary medical insurance in Russia for present stage 125
Conclusion 155
References 168
Applications
Introduction to work
Relevance of the research topic. Currently, the Russian health insurance market is undergoing significant changes. Adopted on January 1, 2011, Federal Law No. 326 “On Compulsory Medical Insurance (CHI), has significantly changed the healthcare system in the country: the model for financing CHI has changed; Every citizen has the right to choose a medical institution and a doctor. At the same time, the development and the market of voluntary medical insurance (VHI) itself, in the context of the modernization of compulsory medical insurance, was not provided by the new law on compulsory medical insurance.
At the moment, there is a situation in the Russian Federation when state obligations to provide the population with free medical care of the required volume and quality are not fully supported by financial resources. There is an opportunity to receive a wider range of quality medical services, both directly in medical institutions and through the system of voluntary medical insurance.
In modern conditions, voluntary medical insurance serves as an addition to free forms of providing the population with medical services. However, the question of the rational ratio of CHI and VHI is not yet developed. The development of VHI provides significant opportunities for improving health care, being in essence a civilized form of development of the Russian health insurance system. Since the financing of medical services through VHI is much more profitable than their direct payment, this circumstance opens up broad prospects for the development of VHI.
The system of voluntary medical insurance in Russia has not yet been fully formed, which is due not only to internal factors of its development, but is also a direct consequence of macroeconomic processes. This is due, on the one hand, to the involvement of a large number of market entities interested in its intensive development in the VHI system, and, on the other hand, to the lack of a ready-made mechanism for overcoming a number of social, economic and legislative restrictions that prevent the system from moving to the next stage of development.
In this regard, a comprehensive analysis of the characteristics of the VHI segment in modern conditions in order to identify its trends and development prospects, as well as the development of methods for improving the activities of insurers in the VHI market, is an important area of modern science.
The degree of development of the problem
At present, the problems of development of the voluntary medical insurance sector attract the attention of many authors.
Scientific developments in the field of formation and development of the insurance market are presented in the works of scientists: V.D. Arkhangelsky, A.P. Arkhipov, Akhvlediani Yu.T., IT. Balabanov, M.I. Braginsky, V.B. Gomelli, A.A. Gvozdenko, A.I. Gizburg, V.V. Droshnev, E.F. Dyuzhikova, E.I. Ivashkin, I.A. Kuznitsova, L.A. Orlanyuk-Malitskaya, L.I. Reitman, Yu.A. Spletukhov, D.S. Tulenty, Yu.B. Fogelson, V.V. Shakhov, A.K. Shikhova, R.T. Yuldasheva and others.
The problems of the formation of the voluntary medical insurance market in Russia are reflected in the works of N.B. Grishchenko, E.T. Kagalovskoy, L.I. Korchevskaya, K.E. Turbina N.P. Sakhirova, G.V. Chernova, T.A. Fedorova, I.M. Sheiman and others.
An analysis of the available domestic literature sources shows that issues related to the prospects for the development of VMI in Russia are currently quite debatable, widely discussed both among health care organizers and among practitioners. However, there is still no single point of view on solving this problem. Issues related to the analysis of the VHI segment and the methodology for its implementation are poorly developed. There is no comprehensive approach to the study of the characteristics of the activities of insurers in the VMI segment.
Thus, the insufficient conceptual study of the problem under study and the need for its further understanding determined the relevance, purpose and objectives of the study.
Purpose and main objectives of the study. The purpose of the dissertation research is to substantiate proposals for modifying the existing VMI model that meets modern market development requirements in the country.
Realization of the goal required the solution of the following tasks:
systematize conceptual approaches to the concept of "voluntary medical insurance", analyze existing interpretations and clarify the author's interpretation of the concept of "voluntary medical insurance";
to study the distinctive features of compulsory and voluntary health insurance in the Russian health insurance system;
Analyze the dynamics of the VHI market over a 5-year period and systematize the main factors influencing the development of the VHI market in the Russian Federation at the present stage;
To study the existing model of VHI in insurance companies, in the Russian health insurance market and their marketing policy and determine the possibility of developing the VHI market;
Determine the main directions for reforming the development of the voluntary medical insurance market and develop a set of proposals for improving the organization and optimizing the functioning of the VMI system.
The object of the study is the VHI market of the Russian Federation.
The subject of the dissertation research is economic relations that arise in the process of interaction between subjects of the voluntary health insurance market.
The theoretical basis of the dissertation research was the work of domestic and foreign authors on voluntary medical insurance, as well as discussion materials, scientific and practical conferences, numerous theoretical works, journalistic materials and information from the official websites of the state authorities of the Russian Federation and the constituent entities of the Russian Federation on the Internet.
The methodological basis for considering the problems of the dissertation was general scientific methods, as well as methods of structural-functional and institutional analysis. In the course of the work, the following research methods were used: system analysis, graphical and economic-mathematical modeling, abstract-logical, comparative and economic-statistical methods. The combination of various scientific methods contributed to the formation of the author's position on a number of essential provisions related to the chosen topic.
The information base of the study was the laws of the Russian Federation, regulatory documents of the Federal Insurance Supervision Service and the Ministry of Finance of the Russian Federation, which determine the conditions for the implementation of insurance activities, statistical and analytical materials of the Federal State Statistics Service (Rosstat), the Federal Insurance Supervision Service (FSSN), the All-Russian Union insurers (ARC), rating agency "Expert RA". When writing the work, scientific publications in periodicals, materials and documents of individual insurance companies, thematic Internet resources, information and analytical materials, as well as expert opinions, estimates and calculations of researchers were used.
The scientific novelty of the dissertation research lies in the substantiation of theoretical provisions and the development of directions for modifying the existing VMI model to improve the organization and increase the optimization of its functioning. In the course of the study, the author obtained the following results, which have scientific novelty:
1. The definition of voluntary medical insurance is given as a system of economic relations, in the process of which the insured is provided with guarantees of full or partial compensation by the insurer of those expenses that arise in connection with the insured person applying to a medical institution for medical care provided in accordance with the program provided for by the VHI agreement ;
2. The features of the functioning of the CHI and VHI segments in the health insurance sector of the Russian Federation are revealed, which consist in a different combination of voluntary and compulsory medical insurance, as well as in ensuring a balance in the volume of state guarantees for the provision of free medical and voluntary medical insurance to the population;
3. The main trends in the development of the VHI segment over a 5-year period were determined and the financial indicators of the VHI market were identified; as well as positive and negative factors influencing the development of the VMI segment of the Russian Federation at the present stage; 4. Based on the study of the existing model in the most successful insurance companies, characterized by the ability to attract customers, high results financial activities and their position in the VHI segment, the features of the marketing policy of insurance companies in the Russian market of voluntary medical insurance are revealed. The possibility and necessity of developing the voluntary medical insurance market in the context of the modernization of compulsory medical insurance, which consist in the legislative consolidation of VHI, in increasing the efficiency of monitoring the volume of services provided and a real significant improvement in the quality of service for the insured, for which it is necessary to determine specific measures for the development of the VHI market and its place, has been proved. in the health care system of the country;
5. A set of measures has been developed to modify the existing VHI model, aimed at improving the organization of the VHI system in order to optimize the volume and structure of consumption of medical services provided under VHI programs.
The theoretical and practical significance of the results of the dissertation research lies in the fact that conceptual approaches to the development of voluntary health insurance in modern conditions have been developed and theoretically substantiated. The information obtained in the course of conducting a comprehensive multifaceted study served as the basis for the development of comprehensive measures for the development of voluntary medical insurance and proposals for optimizing the functioning of insurance companies operating in the voluntary medical insurance market, and also contributed to the further development of medical care provided under VHI programs. It is advisable to use the dissertation materials in the preparation of lecture courses on the disciplines “Insurance”, “Insurance of foreign economic activity; when developing and conducting seminars for students and conducting scientific research.
Testing and implementation of research results.
The results of the study, in particular, the marketing policy of insurance companies, as well as the set of measures proposed in the dissertation aimed at improving the organization of the VMI system, are successfully applied in the practical activities of LLC IC SOGLASIE.
The main provisions and results of the dissertation research were published in 6 scientific papers with a total author's volume of 6.7 pp, including 3 articles in publications recommended by the Higher Attestation Commission of the Ministry of Education and Science of the Russian Federation.
Structure and scope of the study. The structure of the work corresponds to the goal and objectives of the study and has the following form.
Socio-economic importance of voluntary health insurance
The offer on the insurance services market of an insurance product in the form of voluntary medical insurance was a response to the emergence of a corresponding demand from various categories of individuals and legal entities - market entities. In turn, the demand for a specific insurance service was generated by the following circumstances.
firstly, the adoption in June 1991 of the Law of the RSFSR "On the health insurance of citizens in the RSFSR", as a result of which the procedure for financing health care was changed;
secondly, the limited basic (territorial) program of compulsory medical insurance, which determines the volume and conditions for the provision of medical care to Russian citizens;
thirdly, the decline in the quality of free medical services provided within the framework of public health care and the emergence of paid medical care provided by self-supporting medical institutions (departments).1
As a result of these reasons, there is a need to receive medical services that are not provided within the framework of public health care. It became possible to realize such a need either by direct payment for the received medical care.
A feature of medical services is their almost absolute lack of alternatives. The purpose of voluntary medical insurance is to compensate insured citizens for the costs associated with the onset of insured event.
Voluntary health insurance is an addition to compulsory (social) health insurance. Within its framework, insurance is provided that provides for payment for services provided in excess of the compulsory medical insurance program. In the conditions of licensing insurance activities in Russia, the Federal Insurance Service of the Ministry of Finance of the Russian Federation defined the concept of VHI as “a set of types of insurance that provide for the insurer’s obligations to make insurance payments in the amount of partial or full compensation for the additional expenses of the insured caused by the insured person applying to medical institutions for medical services included in the program DMS".
As Fedorova T.A. substantiated, the emergence and development of VMI is associated with the presence of a number of prerequisites. Voluntary health insurance appears and successfully develops in conditions when there is a need for full or partial payment for medical services. If health care is fully funded by the state, then there is no need for additional health insurance.2
Recently, the popularity of voluntary medical insurance (VHI) has been growing in Russia. If a few years ago most people received medical care under the poles of compulsory health insurance, then recently
2 Fundamentals of insurance activities: Textbook / Pod. ed. T.A. Fedorov. - M .: BEK, 2008 an increasing number of Russian citizens, in addition, conclude an agreement on voluntary medical insurance (VHI).
When concluding a contract of voluntary medical insurance, a potential client of a medical institution is given the opportunity to reduce one-time (often rather high) costs of paying for medical care. In addition, the VHI agreement usually provides for the control of the insurer over the quality of medical services provided to the insured person, their compliance with the list guaranteed by the voluntary medical insurance program.
Analysis and development dynamics of the voluntary medical insurance market
Currently, 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 - 25% for several years now. The VHI market is growing at a fairly high rate, which, since 2000, has been steadily outpacing the average growth rates of the entire insurance market as a whole.
The author found that one of the main prerequisites for the active development of VHI is an obvious increase in effective demand, an increase in the social responsibility of business and an understanding that VHI can be used as part of a social package. The system of employee motivation through a social package is becoming more and more in demand among the country's employers. To this they are prompted by the situation of supply and demand in the personnel market.
After analyzing the current trend in the VHI market, we can state that voluntary health insurance is in demand mainly by corporate clients. They account for about 90% of contributions collected under VHI programs. There are several explanations. On the one hand, this is the growth of social responsibility of business, when employee insurance becomes an integral part of the compensation package in an increasing number of companies. In addition, firms have tax benefits when using VMI programs and a collective insurance contract is cheaper by 50-70%.16
Collected premiums for voluntary health insurance from individuals account for only 5-10%. This is explained by the fact that it is easier for individuals to contact a medical institution directly, bypassing the insurance company, because, unlike legal entities that receive tax benefits when purchasing VHI policies, private clients do not have such benefits.
In addition, it is easier for insurance companies themselves to work with corporate clients, because when insuring large groups, the risk is evenly distributed among the company's employees (the healthy pays for the sick principle works), that is, there is no need to conduct a medical examination and risk assessment for each insured. In addition, under VMI for individuals, there is an anti-selection (worsening selection) of risks, in which the policies are applied mainly by people who already know that in the near future they will have to use medical services. All this significantly increases the cost of VHI policies for individuals, and makes them less attractive compared to corporate insurance.
The main directions for improving the voluntary medical insurance market and its place in the healthcare reform system
Analysis of the development of the VHI market at the present stage and the adoption of a new law on compulsory health insurance (OMI) in Russia on January 1, 2011, which has greatly changed the healthcare system as a whole (a citizen now has the right to choose a doctor, clinic, and his policy is valid anywhere in the country ), showed that the segment of the voluntary medical insurance (VMI) market was outlawed. Based on the current situation, the development of the VHI market in the Russian Federation, accompanied by the adoption of a new law on compulsory medical insurance, which does not specify the place of VHI in the health care financing system, and the Strategy for the Development of the Insurance Industry in the Russian Federation for 2008-2012 does not indicate any specific measure to develop the market DMS. In addition, the Russian Health Care Development Concept until 2020 states that VHI “leads to a decrease in the availability and quality of medical care for the population served under the state guarantee program”49 This state of affairs makes insurers think about the prospects for the development of VHI and how to improve the efficiency of insurance companies.
At present, the Russian Constitution and legislation guarantee Russian citizens the receipt of almost all types of medical care: from consulting a general practitioner to inpatient treatment. No other country in the world has such a broad program of state guarantees. In many countries, the state guarantees the very minimum there - primary health care and measures to ensure health and well-being (the fight against infectious diseases, sanitary measures, etc.). In our country, the range of medical services is very wide, but in reality many types of medical care cannot be obtained or their quality will be extremely low. State obligations are not supported by real funding. Having analyzed the report on the implementation of the Program of State Guarantees for the Provision of Free Medical Care to the Citizens of the Russian Federation in 2009, it can be seen that the expenditures of state sources of financing for provision in 2009 amounted to 1,378.6 billion rubles and increased by 53.6%. The program of state guarantees was financed from the budgets of all levels (63.3%) and from the CHI system (36.7%). Funding sources were -Federal budget- 391.6 billion rubles, the consolidated budgets of the constituent entities of the Russian Federation amounted to 481.6 billion rubles (34.9% of all expenses) and the funds of the CHI system amounted to 505.4 billion rubles in 2009.50
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
APPENDIX
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 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 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. 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 protection 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 (VHI). 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 VHI) 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. 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 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 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 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 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 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 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, their family members, persons who 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 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 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 characteristic of 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 compulsory medical insurance programs. In this case, the definition of the object of voluntary medical insurance given in Article 3 of the current law on health insurance is doubtful, 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 aims to organize and finance 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 health 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 alike understood the need for reforms in the industry, first of all, a revision of the concept of financial provision of health care.
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 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 published 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.
Medical insurance entered a new round of development after 9 years: in 1912, the III 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 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 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 the 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. The objects of insurance were this case property interests of the insured person. 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 medical insurance in Russia has not yet reached the level 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 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 - 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 workers, 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, 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 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 addition) 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 sickness insurance in the country is a positive factor that stimulates competition in the medical services market, which creates conditions for more efficient and dynamic development the existing healthcare system in Germany, improvement of the offered services 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 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 VHI, 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 a 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, VMI 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 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 paying premiums in case of not seeking medical help 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 the 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 in the contract, the insurance risk, 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 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, at the same time, is 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 conditions of structural restructuring of the economy 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 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 contributions in case of not seeking medical help for 1 to 6 months (the MHI 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.
Experts believe that the Russian market for corporate voluntary medical insurance is already close to saturation. Both in companies with foreign owners and at large Russian enterprises, VHI has become an integral part of the social package, a tool for motivating and increasing staff loyalty, and a method of managing company finances by reducing sick leave and tax minimization.
The Russian market of voluntary medical insurance has passed the stage of extensive development, when the increase in premiums 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 the existing restriction on attributing to the cost of insurance costs for employees in the amount of no more than 3% of the wage fund, while the standard voluntary medical insurance program involves high costs. In addition, in addition to contributions to VHI, the employer 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. program of 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 the majority of Russian citizens, individual VHI 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 healthcare, and above all, budgets at various levels, the lack of personalized accounting for the allocation and expenditure of funds or the per capita principle of financing the state guarantee program;
The high cost of the VHI policy in conditions when the insured through VHI 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;
Lack of state support for VHI in the form of tax incentives, since the Tax Code allows up to 20,000 rubles spent on medical services and medicines to be used to reduce the tax base for 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 activity of this company in the local insurance market has been marked by 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. As a joint-stock company with the participation of the state capital of the Krasnodar Territory, acting in accordance with the license of the Federal Insurance 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 compulsory medical insurance for citizens in the territories of eight municipalities of the Azov-Chernomorsky coast of the Krasnodar Territory (the cities of Sochi, Tuapse, Gelendzhik, Novorossiysk, Anapa, Tuapsinsky, Temryuksky and Primorsko-Akhtarsky districts) with a total population of 1,195 thousand people.
In 2008, the company's shareholders decided to reorient the company to voluntary types of insurance and abandon compulsory medical insurance. In addition to the existing license for VHI, the company additionally received a license for other voluntary types of insurance: motor hull insurance, property of legal entities and citizens, insurance of business 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 OJSC IC Sochi-garant to implement insurance programs of high complexity in the Krasnodar Territory, Rostov Region and the Republic of Adygea, providing an individual approach to each client. The company plans to 2010-2011 - development of agency and partner sales channels.
The company invests insurance reserves and its own funds exclusively in 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 the activities for the development of the regional financial market, carried out 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 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;
- emergency medical 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, the existing health care financing system has long proved its inconsistency, and the basic principles of compulsory medical insurance have not yet come into operation. 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 that avoids unexpected costs, 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.
The experience of developed countries proves that voluntary health insurance 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 area. 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 related to indirect cash payments, including medical insurance, a 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 the financial base of 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 an important role is assigned 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 the 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 is explained simply: 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 VMI 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 the 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, executives noted the following benefits of using VHI 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 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:
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;
Second, slowing down the development of socially effective medical technologies (cheap and efficient systems 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 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 VMI policy increases from the arbitrariness of business leaders who, according to different reasons unwilling to take care of the health of their employees. 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 compulsory health insurance, rules, programs, the amount and procedure for paying insurance premiums, standard forms of contracts, a list of medical institutions, and 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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APPENDIX
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 VMI 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!
Introduction
Conclusion
Annex A
Annex B
Introduction
The process of formation of market relations in Russia has affected all spheres of economic and social activity, including healthcare, which affects the interests of every person and predetermines, to a certain extent, indicators of the health of the nation, the quality and standard of living of the population.
Insurance plays an ever-increasing role in the development of a market economy in Russia (the share of insurance in the GDP of the Russian Federation in 2011 was about 2.5%), while about half of the insurance market belongs to health insurance: its share in the total collection of insurance premiums is about 50%. %. Basically, this is compulsory health insurance, however, voluntary health insurance also contributes to the development of the market.
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 one of the most promising types of insurance. In modern socio-economic conditions, when free medicine is losing credibility, it is voluntary medical insurance that comes to the fore.
Voluntary health insurance is one of the most important mechanisms for attracting Money designed to reduce the gap in health care financing and provide the population with the opportunity to receive quality health care. However, the development of the Russian market of voluntary medical insurance is hampered by numerous problems.
In scientific research, there is still quite a bit of space devoted to the analysis of long-term voluntary health insurance, which is a private and most complex type of market insurance, although some of its provisions may find application in the system of compulsory health insurance.
In this regard, the study of the system of voluntary medical insurance in Russia is of particular relevance.
The object of study of the course work is the system of voluntary medical insurance.
The subject of the study is the market of voluntary medical insurance in the Russian Federation.
The purpose of the study is the current state of the voluntary medical insurance market of the Russian Federation and the direction of its development.
In connection with the goal in the course of the course work, it is necessary to solve a number of problems, namely:
study the theoretical foundations of the organization of voluntary medical insurance, including determining the socio-economic significance of voluntary medical insurance and revealing the specifics of concluding voluntary medical insurance contracts, as well as considering the possibility of using voluntary medical insurance as a tool for motivating enterprise personnel;
explore the current state of the system of voluntary medical insurance by studying the market for voluntary medical insurance in Russia and abroad;
consider the main programs of voluntary medical insurance;
determine the main directions of development of the voluntary medical insurance system in Russia;
reveal key issues development of the Russian market of voluntary medical insurance.
The information basis of the study was the data of the Federal Service for Financial Markets of the Russian Federation, the Expert RA rating agency, as well as monographs and articles by domestic and foreign experts on insurance theory, regulatory legal acts of the Russian Federation and materials from periodicals.
medical insurance russia voluntary
1. Theoretical foundations of the organization of voluntary medical insurance
1.1 Voluntary health insurance: content, classification of types
Voluntary health insurance is a set of types of insurance that provide for the obligations of the insurer for insurance payments in the amount of partial or full compensation for the additional expenses of the insured person, caused by his application to a medical institution for medical services included in a specific health insurance program.
Voluntary health insurance provides citizens with additional medical services in excess of those established by compulsory health insurance programs. However, the differences between voluntary health insurance and compulsory health insurance are as follows:
) voluntary health insurance, in contrast to compulsory health insurance, is not a branch of social, but commercial insurance;
) voluntary medical insurance, as a rule, is an addition to the system of compulsory medical insurance, providing citizens with the opportunity to receive medical services in excess of those established in compulsory medical insurance programs or guaranteed within the framework of state budgetary medicine;
) participation in voluntary medical insurance programs is not regulated by the state and depends on the needs and capabilities of the insured. Individuals and legal entities that conclude medical insurance contracts for their employees can act as insurers. The collective form of voluntary health insurance is very widespread.
) voluntary health insurance is based on the principles of equivalence and closed distribution of damage between the participants of this insurance fund, while compulsory health insurance uses the principle of collective solidarity. Under a voluntary medical insurance contract, the insured person receives certain types of medical services and in the amounts for which the insurance premium was paid. Voluntary health insurance provides policyholders with higher quality medical care that meets the individual requirements of the client.
A more detailed comparative description of the two forms of health insurance is presented in Appendix A.
The trend towards an increase in the population's costs of financing medical services in the form of their direct payment and voluntary medical insurance is also typical for Russia, where the reform of the healthcare system towards the introduction of insurance principles of financing began in 1992. In dynamics, the population's costs for medical services tend to grow rapidly .
It is known that the financing of medical services through voluntary medical insurance is much more profitable than their direct payment, and this circumstance opens up broad prospects for the development of voluntary medical insurance.
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.
The subject of voluntary medical insurance is the health of the insured person, which is at risk of damage as a result of adverse events or diseases of the insured person, causing the need to apply to medical institutions for medical care.
The object of voluntary medical insurance is the property interests of the insured person related to additional costs to receive medical assistance in connection with contacting medical institutions.
According to global standards, health insurance covers two groups of risks arising from a disease:
the cost of medical services for the restoration of health, rehabilitation and care;
loss of labor income caused by the inability to carry out professional activities, both during the illness and after it with the onset of disability.
The need for voluntary health insurance depends on the extent to which the risk of disease is covered by compulsory health insurance.
The narrower the range of guarantees for compulsory health insurance, the higher the demand for voluntary health insurance, and vice versa. In addition, the demand for voluntary health insurance is determined in many cases by the desire to receive better and more specialized medical care and a high level of service in a medical institution (private room, nurse, treatment by leading specialists and some other services).
The whole variety of types of voluntary health insurance services can be classified according to various criteria.
So, according to the economic consequences for a person, two types of voluntary medical insurance are distinguished:
insurance of costs associated with treatment, restoration of health;
insurance for loss of income caused by the onset of the disease.
The set of guarantees for voluntary medical insurance is different in individual insurance companies, depending on what programs of voluntary medical insurance they work under. Therefore, it is customary to single out the main types of health insurance and additional types (options). The former include insurance for the costs of outpatient and inpatient medical care. These guarantees compensate for the cost of treatment necessary for health reasons.
Additional insurance includes types of insurance that cover the cost of related services or specialized medical care.
Depending on the amount of insurance coverage, there are:
full medical expenses insurance;
partial insurance of medical expenses;
insurance costs for only one risk.
Comprehensive health insurance provides a guarantee to cover the costs of both outpatient and inpatient treatment.
Partial insurance covers the cost of either outpatient treatment or inpatient or specialized treatment at the option of the insured.
Depending on whether there is an imposition of two forms of health insurance - compulsory and voluntary, for the same insurance risk, we can distinguish:
additional voluntary medical insurance;
independent voluntary medical insurance.
Supplementary voluntary health insurance provides coverage for expensive surgeries, for attracting leading specialist doctors, choosing a hospital and a doctor, providing comfortable conditions for treatment, care, and some others.
Independent voluntary health insurance offers medical policies:
citizens who are not covered by compulsory health insurance;
for treatment in private clinics and private practitioners;
certain groups of the population with special treatment (children, women and some others);
to provide medical insurance when traveling abroad.
Thus, the form of voluntary medical insurance provides citizens with the opportunity to expand the range of medical services provided by the compulsory medical insurance program and the opportunity to receive better medical care. Also, participation in voluntary medical insurance programs depends entirely on the needs and capabilities of the insured.
1.2 The use of voluntary medical insurance as an effective tool for motivating employees of an enterprise
Today, the portfolio of the insurer in the field of voluntary medical insurance mainly contains contracts with legal entities. This is primarily due to the fact that the voluntary medical insurance policy at large enterprises has long been an integral part of the social package of employees and is used by employers as one of the methods of additional motivation. Insurance market experts note that it is easy to sell a voluntary medical insurance policy compared to other types of collective insurance, since this is the first product from which employers begin to form a social package.
According to statistics, today almost 90% of all contributions for voluntary health insurance are paid by employers under corporate insurance contracts, that is, the main client of the insurer for voluntary health insurance are legal entities. Medical insurance is a form of additional workers' compensation.
The international practice of staff motivation confirms the fact that the absence of voluntary medical insurance reduces the competitiveness of the employer in the labor market, especially for skilled workers.
According to a survey conducted by the Research Center of the Superjob.ru recruiting portal in 2013 among 1,000 representatives of domestic enterprises and organizations, 66% of companies with more than 5,000 employees either already provide their employees with a package of voluntary medical insurance services.
According to surveys, the most popular services within corporate voluntary health insurance programs are usually:
service in polyclinics (96.8% of respondents);
ambulance services (85.5%);
calling a doctor at home (83.2%);
dental services (81.8%);
emergency hospitalization (75.9%).
Also quite popular for corporate insurance are vaccination of employees, planned hospitalization and medical examination.
Within the framework of standard insurance programs of voluntary medical insurance, each company pays for a different amount of medical services.
The mechanism of relationships between subjects of voluntary medical insurance that arise when employers insure their employees can be represented as shown in Figure 1.
Figure 1 - Scheme of relationships between subjects of voluntary medical insurance in collective insurance
When determining the legal status of an employer in the system of voluntary medical insurance, it was established that insurers in voluntary medical insurance are individual citizens with civil capacity, and/or enterprises representing the interests of citizens. Therefore, according to Figure 1, the employer acts as an insured.
Insurance organizations are legal entities that provide health insurance and have a license to engage in health insurance, that is, it is an insurer.
Medical institutions in the health insurance system are licensed medical and preventive institutions, scientific research and medical institutes, other institutions providing medical care, as well as persons engaged in medical activities, both individually and collectively.
The employee in this scheme of relationships is the object of insurance, which is directed by the employer's concern for his health, which is one of the manifestations of the social responsibility of management in relation to its workforce. Upon the occurrence of an insured event, the employee applies to a medical institution (specified in the voluntary medical insurance contract), while from the point of view of the medical institution, the "employee" in the framework of the presented scheme is a patient who is targeted by the activities of this institution, which is financed at the expense of the insurer in within the framework of the agreement on voluntary medical insurance.
In world practice, the use of voluntary medical insurance as an effective tool for motivating the personnel of an enterprise involves:
A differentiated approach in the formation of a voluntary medical insurance program, that is, the scope of services and services depends on the role of the employee in the company and on his contribution to the overall result.
The following are used as the main criteria for differentiating the voluntary medical insurance program:
employee position. Higher positions, as a rule, involve a greater volume of services and services, which stimulates employees to career growth;
the work experience of the employee in the company and his qualifications. This allows you to secure the most valuable employees in the organization;
the nature of the work performed, taking into account professional characteristics and risks. This makes it possible to ensure the targeted nature of the provision of services, to carry out early detection of occupational diseases.
Thus, a differentiated approach allows you to increase the efficiency and loyalty of the staff.
Creation of comfortable conditions for managers and highly qualified specialists. In order to increase the efficiency and loyalty of managers and highly qualified specialists, the insurance programs formed for them provide for medical services in the best clinics in Russia (and, if necessary, in leading foreign clinics).
Thus, a properly selected insurance program allows you to provide medical services with high quality and service with minimal loss of working time.
Formation of insurance programs for honored workers. Providing voluntary medical insurance to pensioners, honored workers has a positive impact on the psychological climate in the team.
This increases the loyalty of the staff, shows that the employer cares about the employees even after their retirement.
Development of co-financing of voluntary medical insurance. Practice shows that the development of co-financing of voluntary medical insurance programs by the employee and the employer increases the rationality of the demand for medical services.
In addition to reducing the employer's costs for voluntary health insurance, co-financing has a positive impact on the employee's attitude to their health.
In other words, co-financing makes it possible to increase the responsibility of employees when choosing voluntary medical insurance programs.
In conclusion, it is worth emphasizing once again that collective voluntary health insurance is beneficial both to the organization itself and to its employees. So for the organization as a whole, the advantages of corporate programs of voluntary medical insurance are that:
a company that cares about the health of its employees develops a positive image, which also works to attract valuable personnel;
expenses for voluntary medical insurance can be charged to the cost (and, accordingly, reduce the taxable base for income tax) in an amount not exceeding 6% of the wage fund;
contributions to voluntary health insurance are not subject to taxes (on profits, on personal income), which allows employers to significantly save on staff motivation compared to other types of compensation, salary increases;
The voluntary medical insurance policy ensures the reduction of morbidity, the general improvement of employees, which leads to a reduction in loss of working time and an increase in labor productivity.
In turn, the employee of the organization:
receives high-quality and timely medical care;
receives guarantees for the protection of their interests in disputable situations with a medical institution, the possibility of obtaining compensation in case of poor quality medical services;
can get the necessary advice from the insurer, which allows you to get targeted and qualified assistance. In addition, even if the requested service is outside the scope of the voluntary health insurance contract, the insurer will help find a solution that is suitable in terms of quality and price.
1.3 Specifics of concluding a voluntary medical insurance contract
The contract of voluntary medical insurance is one of the most difficult to apply in practice. First of all, this is due to the lack of a satisfactory legislative framework.
On January 1, 2011, the Law of the Russian Federation dated June 28, 1991 "On the health insurance of citizens in the Russian Federation" became invalid. Wherein the federal law dated November 29, 2010 "On Compulsory Medical Insurance in the Russian Federation" does not apply to voluntary medical insurance. Civil law relations in the field of voluntary medical insurance are regulated only by the Civil Code of the Russian Federation and the Federal Law of the Russian Federation of November 27, 1992 "On the organization of insurance business in the Russian Federation" (last amended on December 28, 2013), which contain only general provisions on insurance contracts.
A voluntary medical insurance contract is an agreement between the insured and the medical insurance organization, according to which the insurer undertakes to organize and finance the provision of medical care to insured persons under agreed medical insurance programs, and the insurant undertakes to pay insurance premiums in a timely manner.
Medical insurance (both voluntary and compulsory) is different in that it can function only on the basis of two contracts - the actual contract on voluntary or compulsory health insurance, as well as a contract for the provision of preventive care (medical services). A contract for the provision of medical and preventive care is an agreement between the insurer and medical institutions, according to which the medical institution undertakes to provide the insured persons with medical care of a certain amount and quality, as well as within a specific time frame within the framework of health insurance programs, and the insurer undertakes to finance these services.
Contracts for the provision of medical and preventive care (both in individual and collective health insurance) refer to contracts in favor of a third party. Such a conclusion can be drawn as a result of the analysis of Article 430 of the Civil Code of the Russian Federation. Firstly, the debtor (medical institution) is obliged to fulfill the obligation to the third party specified in the contract, that is, the insured citizen. Secondly, insured citizens have the right to demand from the debtor the performance of the obligation in their favor. The rights of insured persons are regulated by Article 1064 and Article 1068 of the Civil Code of the Russian Federation, as well as the Federal Law of the Russian Federation dated November 21, 2011 "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation".
Voluntary medical insurance contracts are divided into two types: collective and individual. These contracts differ in subject composition. In individual contracts, there are three subjects - the insurer, the policyholder and the medical institution. In this case, the insured is the person in whose favor the contract is concluded in order to receive medical care. Individual contracts of voluntary medical insurance do not apply to contracts in favor of a third party, since they are concluded in favor of the insured. In collective agreements, insurers are organizations acting in the interests of employees, insurers - insurance medical organizations, insured - citizens working in organizations under an employment contract. Such contracts, by their legal nature, relate to contracts in favor of a third party.
According to clause 2 of Article 942 of the Civil Code of the Russian Federation, when concluding a personal insurance contract, an agreement must be reached between the insured and the insurer on the insured person, on the nature of the event for which insurance is carried out in the life of the insured person (insured event), on the amount of the insurance amount about the duration of the contract.
In most cases, a voluntary medical insurance contract is concluded from the moment the text of the contract is signed. However, the contract may provide otherwise.
This means that there are two options:
the contract may provide for a condition according to which it is considered concluded from the moment the text of the contract is signed. In practice, this option is the most common;
The contract may enter into force from the moment of payment of the first insurance premium.
In practice, the term of a voluntary medical insurance contract and the term of insurance often do not coincide. In this case, the norm of clause 2 of article 957 of the Civil Code of the Russian Federation applies. According to this article, insurance stipulated by an insurance contract shall apply to insured events that occurred after the entry into force of the insurance contract, unless the contract provides for a different period for the commencement of the insurance. This means that, firstly, the parties to the contract of voluntary medical insurance may provide that payment is subject to, including medical care, which was provided before the conclusion of this transaction. Secondly, the contract may also provide for the reverse situation, namely, payment only for those medical services that will be provided from a later moment than the moment the contract was concluded.
In practice, such a measure as the suspension of a voluntary medical insurance contract is often used. Suspension of the contract is a kind of sanction on the part of the insurer in case of delay in payment of the insurance premium by the insured. The insurer has the right to suspend the contract of voluntary medical insurance unilaterally by notifying the insured about it. During the suspension of the contract, the medical institution provides the insured with medical services only at their expense. In other words, suspension means a break in the term of insurance and is a period of time when the relevant events are not recognized as insured events.
In the field of voluntary medical insurance, the issue of the sum insured is highly controversial. We are talking about the sum insured for each insured person under a collective health insurance contract and for the insured under an individual health insurance contract. Some lawyers believe that subparagraph 3 of paragraph 2 of Article 942 of the Civil Code of the Russian Federation should apply, in which the amount of the sum insured is indicated as an essential condition of any personal insurance contract. Indication of the amount of the sum insured not only does not contradict the law, but is expressly provided for by it. Other experts, on the contrary, believe that in voluntary medical insurance contracts, the indication of the sum insured is not mandatory.
Since until January 2011 the Law of the Russian Federation "On Health Insurance of Citizens in the Russian Federation" was applied, the sum insured was not one of the essential terms of medical insurance contracts and could not be agreed upon in the contract. Currently, clause 2 of Article 942 of the Civil Code of the Russian Federation is applied, in which the sum insured is listed as an essential condition of a personal insurance contract. Thus, in contracts concluded after January 2011 (from the moment the Law of the Russian Federation "On Medical Insurance of Citizens in the Russian Federation" became invalid), the sum insured must be indicated.
At the same time, in practice, voluntary medical insurance contracts in most cases indicate the sum insured for one insured person. This is due to the convenience of calculations. Since the expected volume of services for each insured person may change during the term of the contract, it is advisable to give the policyholder the right to change the amount of the sum insured by signing an additional agreement with the insurer. In the contract, it is necessary to provide for the obligation of the insured, in case of receiving medical services in an amount exceeding the sum insured, to pay an additional insurance premium in the amount and terms specified in the supplementary agreement.
In accordance with paragraph 1 of Article 450 of the Civil Code of the Russian Federation, amendment and termination of the contract are possible by agreement of the parties, unless otherwise provided by the Civil Code of the Russian Federation, other laws or the contract.
The amounts of insurance premiums for voluntary medical insurance are established by agreement of the parties. The repayment of a part of insurance premiums from an insurance medical organization in case of voluntary medical insurance is carried out in accordance with the terms of the contract.
A lot of controversy arises about the insured event in health insurance. An insured event in health insurance is when the insured person seeks medical care at the medical institution specified in the contract and receives assistance within the framework of an agreed program of voluntary medical insurance. In accordance with Article 9 of the Federal Law of the Russian Federation "On the organization of insurance business in the Russian Federation", an insured event is an event that has occurred, provided for by an insurance contract or law, upon the occurrence of which the insurer is obliged to make an insurance payment to the insured, the insured person, the beneficiary or other third parties . An event considered as an insured risk must have signs of probability and randomness of its occurrence.
Thus, voluntary health insurance provides citizens with the opportunity to receive a number of medical services in excess of those established by compulsory health insurance programs of higher quality.
In addition, the use of voluntary medical insurance by employers is an effective tool for motivating and encouraging staff, helping to reduce staff turnover and attract highly qualified specialists. Therefore, medical insurance is one of the forms of additional compensation to employees along with vacation pay.
The specificity of the conclusion of health insurance contracts is that their purpose is to provide medical care under the relevant health insurance programs. Medical assistance can be both random and planned. The main thing is that this medical service should be included in the voluntary medical insurance program.
2. Analysis of the current state and practice of voluntary medical insurance
2.1 Analysis of the Russian market of voluntary medical insurance
Today, medical insurance is one of the most popular types of insurance in the Russian Federation. The level of its development is characterized by the following data. In 2012, the total volume of medical insurance in our country amounted to 699 billion rubles (excluding insurance for those traveling abroad). Of these, 604 billion rubles (that is, 86%) fell on compulsory medical insurance (OMI), 95 billion rubles (that is, 14%) - on voluntary medical insurance (VHI), as shown in Figure 2. For 2012 compared to 2011, the compulsory health insurance market increased by 24.3%, the voluntary health insurance market by 13.3%.
Figure 2 - Structure of the Russian health insurance market in 2012
The growth of the compulsory health insurance market was associated with an increase in the rate of insurance premiums for compulsory health insurance for the working population from 3.1% to 5.1%, as well as with an increase in premiums for the non-working population.
The growth of the voluntary health insurance market is mainly due to inflation. In 2012, the likelihood of new incentives for the growth of the voluntary health insurance market was extremely small. The client base of the voluntary medical insurance market has already been formed, and the appearance of new large clients is quite rare. According to the Expert RA rating agency, the volume of the voluntary medical insurance market in 2012 reached 107 billion rubles, and in 2014 this figure will approach 140 billion rubles (provided there are no macroeconomic "shocks" and significant legislative changes).
The dynamics of insurance premiums for voluntary health insurance is shown in Figure 3.
Figure 3 - Dynamics of insurance premiums for voluntary medical insurance
Voluntary medical insurance is in demand mainly by corporate clients. They account for about 95% of contributions collected under voluntary health insurance programs.
This can be explained, on the one hand, by the growth of social responsibility of business, when insurance of employees becomes an integral part of the compensation package, and, on the other hand, by the desire of insurance companies to work with corporate clients, since when insuring collectives, risks are evenly distributed among all employees. It was in the field of corporate insurance that one of the few steps was taken to stimulate the voluntary medical insurance market - an increase in the rate of attributing premiums for voluntary medical insurance to the cost price from 3% to 6% of the wage fund. In 2012, this measure was most demanded by small and medium-sized businesses.
Low demand from private clients is due to low incomes of the population and the high cost of a voluntary medical insurance policy. The volume of the retail voluntary medical insurance market for 2012 is 5% (Fig. 4).
Figure 4 - Structure of the voluntary medical insurance market in 2012
The profitability of retail voluntary health insurance is low, which leads to higher prices for private clients than for corporate ones.
The high unprofitability of retail voluntary health insurance is due to the fact that a private client seeks to make the most of the insurance - to visit the clinic as many times as possible in order to recoup its cost. In addition, there is a worsening selection, since insurance is purchased mainly by people who already have a certain type of disease.
During the crisis, there was a redistribution of clients from the corporate sector of voluntary medical insurance to the retail one. Employees of companies who have lost their social packages began to purchase voluntary medical insurance policies themselves. With the recovery from the crisis and the return of corporate clients to voluntary health insurance, retail demand declined.
Since the demand of individual customers is small, the supply of insurers is appropriate.
For individuals, there are also tax benefits - these are tax deductions for medical care and contributions for voluntary medical insurance in the amount of 120 thousand rubles. However, few people know about this, there are difficulties with making a deduction, and you can get it only after purchasing a voluntary health insurance policy.
The concentration of the voluntary health insurance market is increasing every year. If at the end of 2011 the top 20 insurers in the segment of voluntary medical insurance accounted for 74% of premiums, at the end of 2012 this figure increased to 77.6%.
In 2011, 390 insurance companies were engaged in voluntary health insurance, at the end of 2012 - 354. The reduction in the number of companies is not due to the refusal to provide insurance to universal insurers, but to the revocation of licenses from small companies with a weak reputation and engaged in "pseudo-insurance". The growth in concentration occurred due to the redistribution of contributions in favor of larger and more reliable companies.
As part of the modernization of the compulsory health insurance system, the state seeks to minimize the volume of the voluntary health insurance market, which may adversely affect the entire health care system.
Building an efficient market for voluntary health insurance has positive externalities for the healthcare system and society as a whole:
growth of social stability;
reduction of information asymmetry in the market of medical services;
the possibility of reducing the shadow financing of the health care system;
growth of investments in the construction of medical centers.
As well as in the entire insurance industry, two or three leaders can be identified in the voluntary medical insurance market, whose share in total premiums is significantly higher compared to other insurers (Appendix B).
The largest player in this market is the SOGAZ Group of Companies.
JSC ROSNO, JSC ZHASO, OSAO Ingosstrakh, OSAO Reso-Garantia follow with a significant margin from the leader, the data on contributions of which are presented in Table 1.
Table 1 - Leading companies in terms of insurance premiums in voluntary medical insurance in 2012
RankCompaniesContributions, billion rubles1OJSC SOGAZ15.92OJSC ROSNO6.93OJSC ZhASO6.14OJSC Ingosstrakh5.35OJSC RESO-Garantiya4.9
The practice of conducting voluntary health insurance in Russia shows that there are a number of difficulties and problems that hinder the further effective development of voluntary health insurance.
A brief review of the state of the voluntary medical insurance market showed that the Russian market of corporate voluntary medical insurance has passed the stage of extensive development, when the increase in premiums was ensured by attracting new enterprises and the main criterion for choosing an insurer was the price of insurance. 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.
2.2 Foreign experience of voluntary medical insurance
The most developed system of voluntary health insurance in the United States, 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, that is, almost 70% of the entire population of the country, are covered by the voluntary health insurance system. Voluntary health insurance 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 the volume of voluntary health insurance in America is group (corporate) insurance, which is carried out by firms in relation to their employees.
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 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 cost of treatment, the rest must be paid by the insured himself.
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, 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 they are unlikely to prescribe them more than necessary.
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 grafts.
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 it 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 voluntary health insurance system, despite the fact that four of the largest insurance companies control half of this market.
The voluntary health insurance 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 (mainly for the elderly). The State Commission for Health Analysis in Israel believes that the role of voluntary health insurance will continue to grow steadily.
In Germany, an alternative (and addition) 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 the income, the amount of which exceeds the mandatory health insurance threshold (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 compulsory health insurance system wants to receive a more extended set of medical services.
According to statistics, about 15% of the population are insured in the voluntary health insurance system, 80% - in the compulsory health insurance system, 3% of which simultaneously use additional services from voluntary health insurance programs.
Unlike compulsory voluntary health insurance, it offers a larger volume of medical services. For example, within the framework of voluntary health insurance, 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 compulsory health insurance, as a rule, part of the costs is reimbursed by the patient).
Compared to compulsory health insurance, 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 voluntary health insurance 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 system of compulsory health insurance is that for each age group of those insured in voluntary health insurance there is its own financing of their expenses. In the context of a 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 one.
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 payment of contributions in case of not applying for medical care for 1 to 6 months.
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.
German 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 Germany, both in compulsory health insurance and 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 systems of voluntary health insurance operating in Germany and the USA, performing the same functions as the system of compulsory health insurance, are both an alternative and a significant addition to compulsory health insurance. Having a different organization and principles of work, each of the systems at the same time is aimed at solving one problem - providing affordable, highly qualified medical care to the entire population of countries, which could be a positive example of the implementation and existence of an effective health insurance system in the conditions of structural restructuring of the economy and social sphere Russia.
2.3 Analysis of voluntary health insurance programs
Voluntary health insurance products include three main types of coverage - an outpatient clinic (service in a polyclinic), a hospital (treatment in a hospital, as well as hospitalization services, necessary surgeries and others), and spa services. A few years ago, when analyzing voluntary health insurance products, experts limited themselves to this classic set, since special medical services were not as popular as they are today. Individual companies supplemented the minimum set with special products, for example, insurance for medical services in connection with pregnancy and childbirth, the treatment of chronic diseases in specialized medical institutions. However, such actions were not of a systematic nature, since the products were expensive, and their quality did not match the price.
The first two types are classic insurance services that have been in stable demand for many years and are guaranteed to bring profit to insurers in the future.
With sanatorium and resort services, the situation is more complicated - the tax legislation removes it from the scope of tax benefits (payment for sanatorium and resort vouchers can be accepted as payment for medical expenses only if a contract for medical care has been concluded with sanatorium and resort institutions and these institutions have a license for medical activities).
Voluntary health insurance in most cases is a set of medical services (package), focused on a certain category of insured people. Packages may differ in terms of the set of services, the volume of services provided, the territory of the policy, the age of the insured persons, and so on.
Table 2 - Main types of voluntary medical insurance programs
PackageTypical contentEstimated costBasicHealth insurance for an adult aged 18-60. Usually includes a house call, outpatient treatment, hospitalization, emergency medical care, dental care (with a number of exceptions) 30-40 thousand rubles per person per year up to 18 years old. Includes outpatient care, laboratory diagnostic tests, treatment procedures, emergency medical care, dental care (with a few exceptions), hospitalization, house calls. 50-60 thousand rubles Pregnancy and childbirth The program provides for a comprehensive examination and monitoring of women at any stage of pregnancy by a personal obstetrician-gynecologist. 36-162 thousand rubles Dentistry Includes only dental care. Usually in a larger volume than in the basic package. 2-25 thousand rubles Traveling abroad Travel insurance. Medical care when traveling abroad in case of illness and injury. From 1 euro per person per day Special insurance for athletes, drivers, extreme sportsmen. individually
A large number of emerging medical insurance programs in the field of maternal and child health should also be included among specialized products - policies for women and children of different ages, differing in the volume of medical services provided and cost.
New products for Russia also include products for insurance against critical illnesses recently offered by large companies (such life-threatening diseases as heart attack, stroke, cancer, AIDS, and others). According to the Russian classification, they are at the intersection of voluntary medical insurance and accident and illness insurance. Their advantage lies in the fact that by paying a small contribution today, the insured is guaranteed to protect himself from possible expenses in the event of such a disease, the amount of which significantly exceeds the savings of the average Russian. Naturally, the insurance is not valid if the disease was already known at the time of the conclusion of the contract.
In the West, consumer preferences are given to this particular group of policies; in terms of popularity, it outstrips even traditional outpatient care policies. This is quite understandable, given that the likelihood of an insured event, on the one hand, is tangible enough for the insured to be afraid of it and positively perceive insurance as a way of protecting against it, and on the other hand, not so great that increased rates make insurance too expensive and repel client. In turn, the costs that such a policy saves the patient from are very significant.
Thus, in this type of insurance, the essence of risk insurance- temporal and spatial distribution of damage from random events, extraordinary for an individual, but normal for an insurance company that has combined contributions from a large number of clients. In addition, Western insurers often introduce a cumulative component into health insurance - you can capitalize contributions for a number of years. However, it should not be forgotten that, unlike the Russian market abroad, the main share of receipts and payments from voluntary medical insurance falls on individual contracts of individuals, and not on collective insurance contracts for employees of enterprises. Insurance products for the treatment of deadly diseases are designed primarily for individual insurers, which complicates their promotion on the Russian market.
According to the results of the survey, outpatient care, hospitalization, ambulance, house calls and dentistry are still the most popular in voluntary health insurance programs.
In 2011-2012 eleven% Russian companies reduced the budgets of voluntary medical insurance programs for employees at the expense of certain categories of personnel, 24% reduced the cost of voluntary medical insurance policies for all employees, 65% of employers did not revise the budget for voluntary medical insurance.
Pricing in the market of voluntary medical insurance has a number of features. First of all, attention should be paid to the fact that a high price is not always a real indicator of the usefulness and quality of a medical service. The increase in the cost of the policy is also influenced by such factors as the reputation and prestige of the clinic, the number of patients (the so-called economies of scale effect - the more patients, the cheaper the service for each, and, on the contrary, a purely individual approach leads to an increase in prices), the organization of the production process in a medical institution (large volumes of space and capacity, irrational workload of personnel lead to an increase in the cost of the policy), the availability of equipment and the timing of its purchase, the number and qualifications of personnel, and so on.
Extended coverage is also not always a positive thing, since not all services included in the program are really necessary for the client, and you have to pay for them anyway. So the rule "you can't buy health" confirms its validity - the speed and guarantee of a patient's cure is not directly dependent on how much he paid for his medical policy. In connection with the need to provide narrower, and therefore cheaper coverage that meets the needs of a particular client, the sector of special health insurance services began to actively develop.
Thus, the development of the segment of voluntary medical insurance in Russia today is going in a positive way. This situation is related to the development of post-crisis trends - most insurance companies have increased their insurance budgets after overcoming the crisis. The recovery of demand for voluntary medical insurance programs is also evidenced by official data: in 2011, the volume of the Russian voluntary medical insurance market grew by 13.3%, amounting to 95 billion rubles. The concentration of the voluntary health insurance market is also increasing every year.
The study of world achievements in the field of medical insurance, as well as problems arising in the creation and functioning of the insurance medicine system, allows using the experience of developed countries in the Russian insurance market and avoiding the repetition of mistakes when modernizing the domestic insurance model.
3. Prospects for the development of voluntary medical insurance
3.1 Main problems of development of voluntary medical insurance in Russia
Based on the practical experience of conducting voluntary medical insurance by Russian insurance companies, a number of difficulties and problems that face an insurer engaged in voluntary medical insurance can be identified.
Firstly, this is the imperfection of the legislative framework, namely:
the absence of a special federal law on voluntary medical insurance;
discrepancy between existing legislative documents.
Secondly, the low insurance culture of the population: citizens acquire voluntary medical insurance policies not to protect themselves from unforeseen costs in the event of an insured event, but to "treat" at the expense of the insurance company. This forces most insurance companies to limit or completely exclude insured individuals from their insurance portfolio for voluntary medical insurance.
Thirdly, complex civil law relations in the system "Treatment and preventive institution - medical insurance organization". This is perhaps the main problem that all insurers who provide voluntary health insurance face.
The main criterion for an insurance company when choosing a medical institution to serve those insured under voluntary health insurance is the final result of the activities of a medical institution - the onset of objective changes in the state of human health, allowing him to continue to perform his functions in society. Another important factor is the satisfaction of the patient with the quality of medical services provided in the institution.
Currently, in the Russian Federation there is no unified methodology for assessing the activities of medical institutions, both by insurers and in general in the healthcare system.
Many of the approaches used in this case are often subjective, the different orientation of the evaluation and analytical indicators reduces the information content and objectivity of the estimates obtained, their comparability, and, therefore, makes it difficult to realistically evaluate the activities of medical institutions.
The introduction into practice of a single indicator, the so-called rating of a medical institution, would allow standardizing the evaluation criteria, which would undoubtedly have a positive impact on the formation of an accessible and transparent market for medical services, where the insured, as the end consumer of medical services, would have the opportunity to choose based on objective data, and the medical institution - to form its image.
The fundamental document regulating the relationship between a medical institution and an insurance company is a contract for the provision of medical services. Therefore, when concluding such an agreement, special attention is paid to coordinating the disputed points in such a way as to optimally balance the interests of the contracting parties.
An integral part of the contract for the provision of medical services is the Voluntary Medical Insurance Program, the approval of which sometimes takes longer than the approval of the contract itself. In fact, the Voluntary Medical Insurance Program is an order from an insurance medical organization to a medical institution. Unfortunately, quite often a medical institution seeks to maximize the scope of medical services provided to a particular patient, based primarily on the available diagnostic and treatment capabilities, but not with the goal of providing economical and adequate medical care to the patient's state of health.
Even more acutely, the lack of standards in the formation of the names of paid medical services affects the formation of relationships between a medical institution and an insurance company. Each medical institution creates its own list of paid medical services, based on rules and approaches that are clear to him alone. As a result, there is a lot of information, but it is almost impossible to track the overall picture and trends.
Unfortunately, in many medical institutions, the development of a list of medical services (the formation of a price list) is entrusted to employees with an economic education, who approach this task accordingly. As a result, the price list sometimes includes, under the guise of medical services, something that is not actually a medical service. This applies to an impressive list of medicines, instruments, consumables, services and more.
This situation is negative for everyone: for medical institutions, for insurance companies, and ultimately for patients.
The next problem in the relationship between a medical institution and an insurance company is the control of the volume and quality of medical services provided. The lack of unified medical and economic standards for the provision of medical care and a unified approach (system) in naming paid medical services significantly reduces the possibilities of medical and economic expertise as a control tool.
The existing few state medical and economic standards for the provision of medical care were developed, firstly, many years ago, and secondly, in relation to individual nosological forms, and also in the conditions of a low-budget system of compulsory medical insurance. They are more focused on saving public funds, do not take into account the use of new and effective technologies for diagnosis and treatment.
Existing terminology used in current normative documents Russian Federation, defines the quality of medical care from the perspective of a consumer of medical services by four characteristics: accessibility, safety, optimality, patient satisfaction.
At the same time, accessibility is understood as a guaranteed necessary minimum of medical services. The safety of medical care is the ratio of two interrelated elements of the service: benefit and harm. With safe medical intervention, the harm should not be greater than the benefit. Optimality - the choice of medical technologies, taking into account the characteristics of the health status of a particular patient, his diagnosis, individual characteristics (age, gender, concomitant diseases), the current level of achievements medical science and technology and optimal cost. And finally, patient satisfaction is the correspondence of the quality of the received medical care to the needs, including the expected ones, of the patient.
The main legally defined tasks of the insurance company to control the volume and quality of medical care are:
realization of the rights of the insured to receive medical care of adequate quality under the Voluntary Medical Insurance Programs;
control of the validity, effectiveness (to achieve a result according to the determined outcome and economic feasibility) of the medical services prescribed to the insured persons.
And the choice of a potential policyholder in favor of a particular company ultimately depends on how effectively the insurance company copes with solving these problems.
3.2 Prospects for the development of voluntary medical insurance in Russia
According to the Health Development Strategy until 2020, the operation of the voluntary medical insurance market leads to "a decrease in the availability and quality of medical care for the population served under the state guarantees program." Based on this, the state does not support its development. However, a recent study showed that in conditions of insufficient financing of the health care system, such a position will lead to an increase in shadow payments and a decrease in the efficiency of the entire health insurance system.
The development of the voluntary health insurance market is currently taking place without explicit participation from the state:
in the development strategy of the insurance industry in the Russian Federation for 2010-2014. no specific measures for the development of the voluntary medical insurance market have been prescribed;
the reform of the compulsory health insurance system does not specify the place of voluntary health insurance in the health care financing system;
the concept for the development of health care in the Russian Federation until 2020 states that voluntary health insurance "leads to a decrease in the availability and quality of medical care for the population served under the program of state guarantees";
The instructions of the President of the Russian Federation to develop a set of measures to stimulate voluntary demand for personal insurance and draw up standard contracts for the main types of personal insurance have not been fully implemented so far.
An exception is the increase in the deduction rate for the cost of expenses for voluntary medical insurance of employees from 3 to 6% of the amount of labor costs (from 01.01.2009). However, this measure is more likely to support business than to develop a system of voluntary medical insurance.
Paying attention to the changes that have taken place in Russian legislation and the Russian healthcare system, several directions for the development of voluntary medical insurance can be identified.
First, the most discussed direction today is the promotion of contracts for voluntary health insurance in conjunction with compulsory health insurance ("VMI + CHI"). Such a product involves the provision of a volume of medical services agreed in advance between the insurer and the client within the framework of the compulsory medical insurance system, the rest of the services - in the voluntary medical insurance system. Here it is necessary to clearly understand that clients expect from voluntary health insurance not so much wide medical coverage as qualified medical staff and a high level of service provided. However, it is unlikely that clients will be willing to accept a significant increase in the share of services provided under the compulsory health insurance system in order to reduce the cost of health insurance. Indeed, in this case, the client will feel the contrast between district and private (or departmental) medical institutions. Without losing the status of the voluntary medical insurance system as a medical service with a high level of service, within the framework of the VHI+OMS product, it is possible to "redirect" to the compulsory medical insurance system only a small set of medical services, the provision of which will be convenient for clients of nearby medical institutions.
There is another alternative to "VHI+OMS" agreements, where voluntary health insurance really acts as an extension to the system of compulsory health insurance: through voluntary health insurance, only medical services that are inaccessible within the state health care system are provided. The latter includes treatment with the use of high-tech equipment, organ transplantation, treatment of serious diseases, and so on. In this case, the cost of voluntary medical insurance policies will be low, which will allow clients to significantly reduce staff costs.
In general, the insurance product "VHI + MHI" has both positive and negative sides. The disadvantages include the obvious decrease in the value of voluntary medical insurance for staff: the overwhelming majority of medical services will be received by clients in the system of compulsory medical insurance. Nevertheless, despite the significant difference from the traditional broad medical coverage, the presence of such a voluntary medical insurance policy will help increase staff loyalty. In addition, the VHI+OMS product will contribute to the development of the state healthcare system.
Another direction in the development of the voluntary medical insurance market is the development of joint insurance products, when the risk is distributed between the medical institution and the insurer.
For example, a medical institution undertakes to cover the costs of patients with inpatient care for up to 7 days, and everything over is covered by the insurer. To date, such a practice of interaction almost does not exist. This approach allows insurers to solve the problem of imposing unnecessary services on the insured, since the medical institution will not be interested in "promoting" patients. For a medical institution, such a scheme is also beneficial: it allows you to get additional profit, subject to a balanced regulation of the health of patients.
Joint products open up new horizons not only for corporate clients, but also for the retail market. At the moment, only a few insurers offer individuals boxed products with an "as a matter of fact" calculation, where the insurer bears all the risk. Most insurance companies, however, are ready to sell to individuals only programs with a pay-as-you-go basis, when the risk is borne only by a medical institution. Accordingly, firstly, many more medical institutions will be ready to work with a joint scheme of interaction than in the case of "attachment", and, secondly, when sharing risks between a medical institution and an insurer, it is possible to develop integrated programs rather than truncated insurance programs.
The third direction is to develop a new scheme of interaction between participants in the voluntary medical insurance market, which is applicable to corporate clients. In the current practice, the insurance program can include both one medical institution and a fixed set of them (network). In both cases, the insured may apply for medical assistance under a voluntary medical insurance policy only in a medical institution from the "permitted" list. Appeals to other medical institutions are not covered by the insurance company. Under the new model of interaction, the insured are allowed to apply to a medical institution outside the "allowed" list, while part of the costs is covered by the insurer. Thus, the insured have a choice: to apply to a medical institution from the "permitted" list free of charge, or to other medical institutions with the condition of partial payment for services.
The main feature of the new interaction scheme is one insurance program for the entire client team, which is compensated by the ability to apply to a medical institution outside the "permitted" list. The following advantages can be distinguished:
) for corporate clients:
reduction in the cost of a contract for voluntary medical insurance;
no restrictions in the choice of a medical institution;
) for insurers:
reduction of information asymmetry;
referral of the insured to profitable providers;
) for a medical institution:
increased competition;
increase in client flow.
Another solution to the identified problems can be long-term voluntary health insurance, which is a private and most complex type of market insurance. When using it and forming a tariff policy, it is necessary to take into account the territorial differentiation of the population, the heterogeneity of living conditions in the federal districts of the country, as well as in individual regions within the district.
Leading domestic insurance companies have an extensive branch network covering many regions of Russia. Therefore, the task of determining the optimal net tariff for long-term voluntary medical insurance is especially relevant.
The advantages of long-term voluntary health insurance are that:
the conclusion of long-term medical insurance contracts will allow Russian insurers to significantly increase the amount of insurance coverage, including the risk of serious diseases requiring long-term and expensive treatment. This will become possible, since over a long period of time the insurance company will be able to create significant insurance reserves, the funds from which, without prejudice to the financial condition of the company, can subsequently be directed to the treatment of the insured;
the introduction of long-term medical insurance into the personal insurance system will help solve the problem of the lack of a mass product for individuals, which is the central problem of the Russian voluntary medical insurance market;
when concluding long-term medical insurance contracts, it will be possible to include in insurance coverage such a socially important risk as medical care for patients;
long-term voluntary medical insurance will make it possible to form insurance reserves taking into account the average individual risk during the life of the insured in terms of its expected duration and taking into account the formation of an accumulative reserve. Then the system of long-term voluntary medical insurance will operate on a cumulative basis throughout the life of the insured;
long-term voluntary health insurance will ensure a reduction in the amount of insurance premiums, which will make them more accessible to a wide range of the population.
Thus, characterizing the current state of the Russian insurance market, we can note the following. The system of voluntary medical insurance in Russia has not yet been fully formed, which is due not only to internal factors of its development, but also to macroeconomic processes. Significant shortcomings and problems in the organization of medical insurance that need to be eliminated have been identified.
Conclusion
Voluntary health insurance has existed in Russia since 1991, and today it accounts for a tenth of all insurance premiums.
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. 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, voluntary health insurance differs significantly from compulsory health insurance in several ways:
compulsory health insurance - non-commercial, and voluntary health insurance - commercial insurance;
Compulsory health insurance builds its work on the principle of insurance solidarity, that is, it equalizes the rights of all insured people, regardless of their income level and capabilities. Voluntary medical insurance is based on the principles of insurance equivalence, that is, under a voluntary medical insurance contract, the insured person receives those types of medical services and in the amounts for which the insurance premium was paid. At the same time, voluntary health insurance provides policyholders with higher quality medical care that meets the individual requirements of the client;
participation in voluntary medical insurance programs is not regulated by the state and depends on the needs and capabilities of the insured. In voluntary medical insurance, 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.
Voluntary medical insurance is in demand mainly by corporate clients. They account for about 95% of contributions collected under voluntary health insurance programs. At many Russian enterprises, voluntary medical insurance has become an integral part of the social package, which has its advantages both for employees and for the enterprise as a whole.
Its most important advantage is that it reduces the costs of the enterprise, which arise due to the disability of employees and lost time. Also, a company that takes measures to protect the health of its employees has a positive reputation. And to create a good reputation in modern conditions is an important matter, since in the market, in addition to ordinary competitors, there are many companies that would like to get qualified personnel. It is also necessary to mention the tax benefits that the company receives when insuring its employees.
Among the many advantages of corporate voluntary medical insurance, as the main one for employees, one can note the guarantee of the provision of highly qualified medical care and an individual approach to the problems and complaints of the patient. Also, for clients of insurers under voluntary medical insurance programs, it is beneficial that they can choose a package of additional services, as well as receive background information and services not only in the best clinics of the capital, but if necessary, in other regions of the country.
As for the current state, in 2012 the volume of the Russian market of voluntary medical insurance grew by 13.3%, amounting to 95 billion rubles. The growth of the voluntary health insurance market is mainly due to inflation. The concentration of the voluntary health insurance market is also increasing every year. If at the end of 2010 the top 20 insurers in the segment of voluntary medical insurance accounted for 74% of premiums, at the end of 2011 this figure increased to 77.6%.
The practice of conducting voluntary medical insurance in Russia shows that there are a number of difficulties and problems that hinder the further effective development of voluntary medical insurance, namely:
imperfection of the legislative base;
low incomes of a significant part of the population, leading to a shortage of mass demand for commercial health insurance;
low insurance culture of the population;
medical institutions sometimes raise prices several times a year, which forces insurance companies to take on additional costs.
Possible ways to solve the identified problems can be:
development of programs that take into account the joint functioning of voluntary and compulsory health insurance systems;
rational distribution of risks between the medical institution and the insurer;
development of long-term voluntary medical insurance.
List of sources used
1. Civil Code of the Russian Federation, Part One: Federal Law of the Russian Federation of November 30, 1994 No. 51 - FZ [Electronic resource]. - Access mode: #"justify">. Civil Code of the Russian Federation, part two: federal law of the Russian Federation of January 26, 1996 No. 14 - FZ [Electronic resource]. - Access mode: #"justify">. Civil Code of the Russian Federation, part three: federal law of the Russian Federation of November 26, 2001 No. 146 - FZ [Electronic resource]. - Access mode: #"justify">. On compulsory health insurance in the Russian Federation: Federal Law of the Russian Federation dated November 29, 2010 No. 326 - FZ // Rossiyskaya Gazeta. Federal release. - 2010. - No. 5353.
On the organization of insurance business in the Russian Federation: Federal Law of the Russian Federation of November 27, 1992 No. 4015-1 - FZ [Electronic resource]. - Access mode: #"justify">. On the basics of protecting the health of citizens in the Russian Federation: Federal Law of the Russian Federation of November 21, 2011 No. 323 - FZ // Rossiyskaya Gazeta. Federal release. - 2011. - No. 5639.
Kuznetsova, O.V. Voluntary insurance: a practical guide / O.V. Kuznetsova. - M.: URAIT. - 2012. - 75s.
Insurance: textbook [Text] / ed. T.A. Fedorova. - 2nd ed., revised. and additional - M.: The Economist. - 2011. - 875s.
Options for the development of the VHI market in Russia // Modern insurance technologies. - 2011. - No. 3. - P.42-47.
Govorov, A.M. Voluntary medical insurance in the Russian Federation: development experience and prospects for the provision of quality medical services / A.M. Govorov, I.S. Cherepanova // Bulletin of Roszdravnadzor. - 2013. - No. 1. - P.50-53.
Dedikov, S.V. Contract of voluntary medical insurance / S.V. Dedikov // Civilist. Scientific and practical journal. - 2010. - No. 4. - P.32-45.
Zhukova, M.V. On the development of the VHI system within the framework of the socio-economic model of health care / M.V. Zhukov // Izvestiya TulGU. Economic and legal sciences. - Tula: TulGU. - 2010. - 381 p.
Ilinykh, Yu.M. The current state of voluntary medical insurance in Russia / Yu.M. Ilinykh // Bulletin of the Altai Academy of Economics and Law. - 2011. - No. 2. - P.52-54.
Lavrova, Yu. Compulsory health insurance - the experience of Germany / Yu. Lavrova // Finance. - 2013. - No. 8. - P.82-85.
Ovchinnikova, Yu.S. Contract of voluntary medical insurance: main features and problems of application / Yu.S. Ovchinnikova // Law and Economics. - 2011. - No. 8. - P.25-30.
Pletneva, S. VHI market in Russia: from expectations to realities / S. Pletneva // Personnel Management. - 2012. - No. 7. - P.78-83.
Povaliy, A.S. Trends in the development of the world market of insurance services / A.S. Povaliy // Russian Foreign Economic Bulletin. - 2011. - No. 1. - P.64-70.
Rodionov, A.S. Topical issues of long-term voluntary medical insurance / A. S. Rodionov // Finance, money circulation and credit. - 2010. - No. 9 (70). - P.220-223.
Suglobov, A.E. Accounting for expenses for voluntary medical insurance and life insurance / A.E. Suglobov // Consultant accountant. - 2012. - No. 2. - P.41-46.
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Table A.1. Comparative characteristics of health insurance forms
Comparison criteriaCompulsory health insuranceVoluntary health insuranceType of activityNon-commercial Commercial Insurance industryPersonal insuranceScale (by population coverage) General or massIndividual or group No. 326 - Federal Law "On Compulsory Medical Insurance in the Russian Federation" The most general provisions contain: the Civil Code of the Russian Federation; Federal Law of the Russian Federation of November 27, 1992 No. No. 4015-1 - Federal Law "On the organization of insurance business in the Russian Federation" Insurance rules Determined by the state Determined by insurance organizations insurance contractUsing income from insurance activitiesOnly for the main activity of health insuranceFor any commercial and non-commercial activities
Annex B
Table B.1. List of insurance companies leading in terms of insurance premiums in the voluntary medical insurance sector in 2012
No. Name of the insurance companyInsurance premiums, billion rubles Increase against 2011, %Insurance payments, billion rubles Increase against 2011, %Payment ratio,%1SOGAZ15.921%15.315%96%2ROSNO6.938%4.731%69%3ZHASO6 ,15%5.36%86%4INGOSSTRAKH5.3-4%4.9-16%93%5RESO-GUARANTEE4.948%3.10%64%6ALFASTRAKHOVA-NIE3.926%2.624%68%7ROSGOSSTRAKH3.5150%2.257 %65%8 MILITARY INSURANCE COMPANY2.567%1.660%64%9 RENAISSANCE INSURANCE GROUP2.433%1.4-12%60%10MAX2.054%1.567%73%11CONSENT1.8-0.8166%47%12CAPITAL INSURANCE1.76 %1.5-12%90%13SURGUTNEFTEGAZ1.536%1.440%96%14URALSIB1.50%1.3-7%86%15TRANSNEFT1.427%1.043%67%16PROGRESS-GARANT1.025%0.814%81%17ENERGOGARANT1.0 -23%0.6-14%66%18YUGORIA0.9-25%0.80%92%19MEDEXPRESS0.8-0.50%63%20INNOGARANT0.7-0.620%91%
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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
APPENDIX
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 protection 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 (VHI). 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, their family members, persons who 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 characteristic of 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 compulsory medical insurance programs. In this case, the definition of the object of voluntary medical insurance given in Article 3 of the current law on health insurance is doubtful, 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 aims to organize and finance 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. This means 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 health insurance differ significantly in insurance subjects - they have not only different 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 published 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.
Medical insurance entered a new round of development after 9 years: in 1912, the III 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 the 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, healthcare professionals 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 slowly but steadily progresses, 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 addition) 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 VHI, 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 a 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, VMI 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 the 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 in the contract, the insurance risk, 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 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 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 contributions in case of not seeking medical help for 1 to 6 months (the MHI 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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Concept, types, subjects, legal bases of the contract of voluntary medical insurance 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 prospects for the development of various types of 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.
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.