According to the Law of the Russian Federation "On medical insurance of citizens of the Russian Federation" /2/, "voluntary medical insurance is carried out on the basis of programs of voluntary health insurance and provides citizens with additional medical and other services in excess of those established by compulsory medical insurance programs.” In fact, this provision of the law is not respected: many HMOs offer VHI programs that cover the medical services provided for by the basic MHI program.
State statistics show high rates of growth in the contributions of individuals and legal entities to voluntary medical insurance and the volume of paid medical services provided to the population. But VHI has not yet become the main form of private health financing. Paid medical services developed at a faster pace than VHI /15/.
Let us present a comparative analysis of insurance premiums and insurance payments for voluntary and compulsory types of medical insurance according to the FSIS.
Table 2.7 Analysis of insurance premiums and insurance payments by types of medical insurance for 2005-2006, million rubles
It follows from the table that CHI is developing at a faster pace than VHI. So, if the growth rate of insurance premiums under the voluntary form of health insurance was 119.5%, then under its mandatory form, this figure was 141.0%. Similarly, for insurance payments: the growth rate was 107.9% and 140.3%, respectively, with voluntary and compulsory medical insurance.
It should be noted that in the "classic" risky form, VHI is carried out only by some Russian insurers when insuring certain individuals and legal entities. At the same time, the tariffs for this type of insurance are quite high. This is due to the fact that due to the insignificant distribution of VHI, there is a large amount of unprofitability of the sum insured. Namely, this statistical indicator is used as the basis for calculating tariffs for voluntary types of insurance. As a result, insurers who risk insurance need to have sufficient insurance reserves to cover their obligations, are forced to sell insurance services at a high price, ensuring the accumulation of the necessary reserves. Few Russian insurers and insurers can afford to work in such conditions.
Until now, the main part of the VHI programs has been the options for providing "one-off" medical services - the so-called "monopolies" or "deposit insurance schemes". In these cases, the role of the insurer is reduced to organizing the provision of medical care within an amount slightly less than that which he paid. At the same time, funds from citizens and their employers initially go to the insurance organization, allowing the medical institution to transfer responsibility for accounting for these funds, formalizing contractual relations with patients, etc. to it.
Given that the patient or his employer, when acquiring a monopolist, pays for the necessary services immediately before receiving them, we can state the absence of signs insurance risk in this scheme. When concluding a contract, the size of the “insurance payment” is known in advance - the price of the service. Also, the main advantage of the VMI system is missing - the possibility of planning individual costs for medical care. From a theoretical point of view, funds received by a medical institution when operating under a monopoly scheme cannot be considered VMI funds. However, this form of service provision is the main one in the actual activities of medical insurance organizations, carried out under the name VHI.
Insurance under VMI programs is carried out by both individuals and their employers. Today, about 1.5% of Russian enterprises and organizations and 80% of foreign companies whose representative offices operate on the territory of the Russian Federation pay contributions for the VHI of employees. According to OJSC ROSNO, Russian enterprises provide 55% of the volume of collected insurance premiums for VHI, foreign - 35%
Considering the features of the combination of CHI and VHI in our country, it is also necessary to pay attention to the following circumstance. Persons insured under VHI programs usually hardly use the services paid for by compulsory medical insurance. Contributions paid for such persons to the MHI system become lost money for these persons.
Thus, a comparative analysis of VHI and compulsory medical insurance showed an unsatisfactory state and weak development of VHI in the Russian Federation, as well as the absence of a combination of VHI and compulsory medical insurance, which is well developed in foreign countries. The combination of VHI and CHI allows both forms of health insurance to complement each other and makes them more effective for both insurers and insured persons.
Market development also requires positive initiatives from the legislature and supervisory authorities, qualified and tangible marketing efforts, including the development of effective mechanisms for selling 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 how individuals and business leaders so that they understand for themselves all the benefits that VHI provides. In addition, it is necessary to study the features of the formation of needs for medical care in each specific region. A systematic and continuous analysis of the needs and demands of key consumer groups (individuals and organizations) is needed.
Our study showed that insurance companies have significant opportunities to attract customers.
So, along with the residents of nearby regions, the residents of the Chelyabinsk region also experienced the consequences of the Chernobyl disaster. A large number of residents of the area 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, who was chosen in advance by the insurance company), who would be interested in highest level everything necessary and possible has been done;
The feeling of complete security of each insured by 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 materially (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 risk or deposit type insurance companies, the profits of insurance companies can fluctuate within a small range at fairly low figures, since the bulk of the funds end up in medical institutions. If the founders of insurance companies open their own medical institutions, then both the insurance companies themselves and the clients will benefit from this, for whom everything possible will be done in these institutions on modern level and the overall health care system.
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, 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 compulsory medical insurance policy. These include, for example, migrants who did not have registration in the region at the time of the illness.
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.
Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.
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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 study 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 ones will be created insurance products 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. Increasing the role of insurance in modern economy, on the one hand, and the increasing differentiation of legal norms regulating the life of society and economic activity people, on the other hand, determined the formation 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. For this reason, the only possible system 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 (VMI). Voluntary health insurance occupies a worthy place among the economic guarantees of the right to health care and is one of the most effective among them.
From an economic point of view, voluntary health insurance is a mechanism for compensating citizens for expenses and losses associated with the onset of an illness or accident, i.e. insured event- (in VHI) 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. Voluntary medical insurance rules defining general terms and Conditions and the procedure for its implementation are established by the insurer independently in accordance with the provisions of the Law of the Russian Federation of November 27, 1992 No. 4015-1 "On Insurance". Specific conditions of insurance are determined at the conclusion of the insurance contract.
In accordance with the contract of voluntary medical insurance, the insurance company (or its representative - insurance agent) issues to each insured person an insurance policy of voluntary medical insurance, which indicates:
The name of the insurance program of voluntary medical insurance chosen by the insured when concluding the VHI contract (for example, "outpatient medical care", "inpatient medical care", "comprehensive medical care", "dental care", etc.) - insurance program Voluntary health insurance contains a list of medical services that the insured person can receive if necessary. A detailed description of the insurance program of voluntary medical insurance with a list of medical services is contained in the so-called "VHI Rules", developed by each insurance company independently, agreed with the Federal Service insurance supervision RF and in without fail attached to the contract of voluntary medical insurance;
A list of medical and service institutions to which, if necessary, the insured person can apply. The insurance company concluded financing agreements with all the indicated medical institutions, providing for the admission of patients with voluntary medical insurance policies of this insurance company to the medical institution and 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 voluntary medical insurance contract 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 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 in case of 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 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 directing funds from profits for voluntary medical insurance of employees of the enterprise, members of their families, persons who retired from this enterprise are presented tax incentives in the amount of up to 10% of the amount directed from the profit for these purposes.
Main Features 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, insurance civil liability,
The obligation to insure may be imposed on persons specified in the law in the event of an insured risk, that is, in the event of damage to life, health or property of other persons specified in the law, or violation of contracts with other persons.
Health insurance does not meet these criteria, except for the first one, which refers to CHI. First, the object of health insurance is to maintain the health of citizens by providing medical care at the expense of health insurance funds. Secondly, the conclusion of an insurance contract does not imply the presence of an insurance risk, but insurance payment not carried out upon the occurrence of an insured event. Moreover, the provision of medical care involves the implementation of preventive measures. All these features are 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 programs of compulsory medical insurance. In this case, the given in Article 3 is questionable. current law about medical insurance, the definition of the object of voluntary medical insurance, since, in our opinion, it is also unlawful to talk about an insured risk and an insured event for voluntary medical insurance, as well as for compulsory medical insurance (14, p. 83).
Now let's move on to the consideration of the features that are specific to voluntary health insurance, that is, its main differences from compulsory health insurance. The differences between compulsory and voluntary health insurance are as follows:
Firstly, the obligation of insurance in case of compulsory health insurance follows from the law, and in case of voluntary health insurance it is based only on contractual relations, which, however, does not exclude the need for compulsory health insurance by concluding an insurance contract between the insured and the insurer.
Secondly, the main difference between compulsory and voluntary health insurance lies in the sphere of relations arising between their subjects in the provision of medical care at the expense of insurance funds. If compulsory health insurance is carried out in order to ensure the social interests of citizens, employers and the interests of the state, then voluntary health insurance is implemented only in order to ensure the social interests of citizens (individual or collective) and employers.
Thirdly, from the previous difference follows, in particular, the difference in who are the insurers in compulsory and voluntary health insurance: in compulsory health insurance - these are executive authorities and employers, in case of voluntary health insurance - citizens and employers.
Fourthly, relations on voluntary medical insurance, as well as on compulsory medical insurance, relate to social insurance, which pursues the goal of organizing and financing the provision of medical care to the insured contingent of a certain volume and quality, but under voluntary medical insurance programs (21, p. 40) .
However, voluntary health insurance, unlike compulsory health insurance, does not apply to state social insurance. First, due to the difference in the social interests they realize. Secondly, due to the difference in the forms of ownership and organizational and legal forms of insurance organizations that carry out social insurance. This means that social insurance can be not only state, but also municipal, and given the differences in its internal organization- also professional (according to the professional-industry basis) 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. Voluntary health insurance is not state organizations having any organizational and legal form, for compulsory health insurance - state organizations (41).
Sixth, compulsory and voluntary health insurance also differ in terms of sources of funds. The financial resources of the compulsory health insurance system are formed from budget payments and contributions from enterprises, bodies government controlled appropriate level. The amount of contributions for compulsory health insurance for enterprises, organizations and other economic entities is set as a percentage of the accrued wages. Voluntary medical insurance is carried out at the expense of the profit (income) of the enterprise and personal funds of citizens, the amount of insurance premiums is established by agreement of the parties.
Unlike voluntary health insurance, in case of 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 for CHI is determined by agreement of the parties, with the leading role government agencies management, and with 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 the state social functions. Under these conditions, it was decided to turn to the experience of other countries, where national systems health care had different 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 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 advertisement 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 obstetrics. 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 ineffective: 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, federal Service The Russian Insurance Supervision Authority has completely banned the practice of returning unused funds in order to deprive businessmen of the opportunity to avoid the tax burden. From that moment on, voluntary health insurance entered the modern phase of development. Over time, more and more insurance companies began to appear on the market, offering their customers various programs of voluntary medical insurance. In addition, the range of services offered by voluntary health insurance has significantly expanded, and the popularity of such products among citizens and legal entities has grown.
Summing up, it is necessary to mention once again that in Russia voluntary medical insurance as an economic and legal category and type of insurance activity arose in 1991 with the adoption of the Law of the RSFSR "On Medical Insurance of Citizens in the RSFSR". The insurance model provided for by law was fundamentally different from the varieties that existed at that time. personal insurance. 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, which was 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 object of insurance was property interests 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 medical insurance of citizens in Russian Federation"As an object of voluntary medical insurance, it defines the risk associated with the costs of providing medical care in the event of an insured event. At the same time, the law states that voluntary medical insurance "provides citizens with additional medical services and other services in excess of those established by compulsory insurance programs."
The objects of voluntary medical insurance are two groups of insurance risks:
1) the occurrence of expenses for medical services for the restoration of health, rehabilitation, care;
2) loss of income due to the impossibility of carrying out labor activities both during the illness and after - in the event of disability.
The legislation of the Russian Federation limited the object of medical insurance only to reimbursement of expenses for medical care.
The insurers in case of voluntary medical insurance are individual citizens with legal capacity and/or enterprises representing the interests of citizens. Voluntary medical insurance provided for a qualitatively new type of insurance relationship that was previously unknown to domestic insurance practice. Its object should have been the property interests of third parties, and not the insured person himself. The concept of the object was revealed in the law as "expenses but the provision of medical care." The subject composition of the legal relationship became more complicated, except for the insurer, the insured and the insured person, a medical institution was introduced into it as a person directly providing medical care (46).
But it should be noted that voluntary 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 VHI system is most developed 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 is slowly but steadily progressing, 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 method of treatment with a high success rate. Of course, the cost of heart surgery is very high, but less than the cost of drugs that need to be taken for quite a long time. And the effect of conservative therapy is not always desirable. Therefore, insurance companies prefer to incur large expenses, but once.
Americans are serious about their health. On the one hand, insurance companies protect their clients from unprofessional medical care, on the other hand, Americans trust their doctors and do not buy medicines without a specialist's recommendation.
As for voluntary health insurance in European countries, here in most cases VHI is being intensively developed as an addition to public funding medicine, expanding the range of medical and preventive services and financial opportunities for healthcare. For example, in small Israel, famous for the highest level of medical care, more than 70 companies (including foreign ones) operate in the VHI system, despite the fact that four of the largest insurance companies control half of this market. The VHI system covers almost a fifth of Israelis who use services not included in the basic programs of mandatory insurance funds, including nursing and patronage care (mainly for the elderly). The State Commission for Health Analysis in Israel believes that the role of VHI will continue to grow steadily in the future. Similar trends are observed both in Russia as a whole and in our region, where a network of large insurance companies operates (17, p. 46).
In Germany, an alternative (and supplement) to compulsory health insurance is voluntary (private) health insurance, which applies to citizens who, due to high incomes or professional activities, are not subject to compulsory health insurance, as well as to those persons who have the means and desire to receive additional alternative assistance to compulsory health insurance. The existence of two different forms of sickness 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 limit of compulsory health insurance (today it is 40.034 euros per year), which is the reason for applying for the services of the private health insurance system. As a rule, entrepreneurs or representatives of free professions, as well as employees whose incomes exceed the limit established by law, become participants in this system. At the same time, voluntary (private) health insurance also means the possibility of obtaining additional medical care in excess of the mandatory insurance system, which is relevant for all categories of the population. This is important if the insured in the MHI wants to receive a more expanded set of medical services. According to statistics, about 15% of the population are insured in the voluntary medical insurance system, 80% in the CHI system, 3% of which simultaneously use additional services from VHI programs (41).
Unlike compulsory voluntary health insurance, it offers a larger volume of medical services. For example, within the framework of VMI, there is a free choice of a hospital, as well as improved conditions for staying in it, services of a personal doctor, reimbursement of up to 100% of the costs associated with inpatient treatment (in MHI, as a rule, part of the costs is reimbursed by the patient). Compared to CHI, in which the amount of contributions does not depend on the degree of probability of an insured event, contributions in the voluntary health insurance system are formed taking into account individual risk. Private insurance companies use a large number of different regional and professional tariffs for this. Since age characteristics have a significant impact on the amount of insurance premiums, the most favorable rates VHI's 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. Under conditions of general complication 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 forming 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 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 mandatory in the private health insurance system, the conclusion 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 health 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 general order. The fact is that the partial financing of their participation takes on the corresponding government agency(33, p. 49).
If there is an opportunity in the OMS free insurance all family members with a small total income, then there is no such possibility in the VMI system, therefore, regardless of the level of income, 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 operating in Germany, performing the same functions as the MHI, 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 also 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 addition to the established compulsory medical insurance programs. Voluntary medical insurance is carried out on the basis of an agreement between the insured and the insurer. The subjects of VHI are: a citizen, an insurer, a medical insurance organization, a medical institution.
3. The object of voluntary medical insurance is the insured risk associated with the costs of providing medical care in the event of an insured event. An insured risk is a prospective event against which insurance is provided. An event considered as an insured risk must have signs of probability and randomness of its occurrence.
4. Voluntary medical insurance in Russia gained the right to exist only in 1991, with the entry into force of the Law "On Medical Insurance of Citizens in the RSFSR". The purpose of such insurance is to mitigate the possible financial losses of the insured as a result of damage to health. In this case, the property interests of the insured person were the object of insurance.
5. The current law of the Russian Federation "On the health insurance of citizens in the Russian Federation" defines the risk associated with the costs of providing medical care in the event of an insured event as an object of VHI. At the same time, voluntary medical insurance "provides citizens with additional medical services and other services in excess of those established by compulsory insurance programs."
6. The most developed VMI system is in the USA, where it entered its heyday in the distant 1930s. In total, in the United States today, more than one and a half thousand companies are engaged in health insurance. In the US, health insurance is voluntary and almost entirely provided by employers. Health insurance is the most common form of workplace insurance. One of the basic principles of health insurance is the high efficiency of medical care.
7. In most European countries, VHI is being actively developed as an addition to public funding of medicine, expanding the range of preventive and curative services and financial opportunities for healthcare. In Israel, more than 70 companies operate in the VHI system, the VHI system covers almost a fifth of Israelis who use services not included in the basic programs of compulsory insurance funds, including nursing and patronage care.
8. In Germany, voluntary (private) health insurance applies to citizens who, due to high incomes or professional activities, are not subject to compulsory health insurance, as well as to those persons who have the means and desire to receive additional assistance alternative to compulsory health insurance. A distinctive feature of 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 VMI 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. Thus, only about a dozen companies provide medical protection to the personnel of most large industrial complexes 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 conventionally 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. Fame to people, ability to coordinate financial flows through the channels of compulsory and voluntary insurance, as well as established relationships with many clinics and hospitals, allow these insurers to take a leading position in VHI. First of all, these companies include ROSNO and Spasskiye Vorota. However, they are not the only ones who combine the activities of VHI and MHI. Many regional insurers work on such principles.
3. Companies focused exclusively on the market clientele. They work only with those clients who have been attracted by various marketing programs. In any of the companies of this group, you can buy the entire range of insurance programs existing on the market: outpatient treatment with attachment to any of the leading medical institutions, inpatient treatment, "Ambulance", "Personal Doctor", etc. Such insurers include the leading Russian universal insurance companies Ingosstrakh, RESO-Garantia, Rosgosstrakh, UralSib, and Renaissance Insurance companies. VSK Insurance House and AlfaStrakhovanie are active in the mass VMI market.
Normative regulation of health insurance. Characteristics of the market of medical insurance services in the Russian Federation, prospects for their development. Systems of compulsory and voluntary medical insurance, goals and scheme of interaction between subjects.
thesis, added 09/29/2015
The use of voluntary medical insurance as an effective tool for motivating employees of an enterprise. The specifics of concluding a contract for voluntary medical insurance. Problems of development of voluntary medical insurance in Russia.
term paper, added 09/17/2014
Stages of historical development of voluntary medical insurance. Legislative framework and features of voluntary medical insurance in comparison with compulsory insurance. Prospects for the development of voluntary medical insurance in Russia.
term paper, added 07/05/2010
Forms of medical insurance of citizens in the Russian Federation, their purpose and directions of reform. Members of compulsory and voluntary health insurance. Specifics of medical insurance of citizens traveling abroad.
test, added 01/18/2013
Identification of features and general characteristics health insurance system of the Russian Federation. Compulsory and voluntary insurance as models of medical insurance in the Russian Federation. Analysis of the distinctive features of voluntary medical insurance.
term paper, added 06/26/2011
Organizational and legal aspects of the organization of CHI and VHI. The main problems existing in the practice of their implementation within the healthcare system. Features of interaction, economic principles compulsory and voluntary health insurance.
term paper, added 08/12/2015
The need for transition to insurance medicine and the importance of compulsory health insurance. Principles of organization and features of compulsory and voluntary medical insurance in Russia, dynamics of funding sources and spending.
term paper, added 12/05/2010
Concept, types, subjects, legal framework voluntary medical insurance contracts in the Russian Federation. Features, principles, content, types and forms of civil liability under a voluntary medical insurance contract.
thesis, added 04/15/2013
Definition of the concept and essence of health insurance. Analysis of compulsory and voluntary medical insurance. Advantages of the new health insurance system. Features and prospects for the development of various types of health 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.
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 study is voluntary medical insurance programs.
The aim 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 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 care and medical care, putting it on a par with such social rights as the right to pension and social security , the right to housing, the right to protection of motherhood and childhood. Economic guarantees themselves are a system in which the central place is occupied by state (budgetary) financing, compulsory health insurance (CHI) and voluntary health insurance (VMI). Voluntary health insurance occupies a worthy place among the economic guarantees of the right to health care and is one of the most effective among them. insured event - (in 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 organization (or its representative - insurance agent) issues to each insured person a voluntary medical insurance policy, 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 concluded financing agreements with all the indicated medical institutions, providing for the admission of patients with voluntary medical insurance policies of this insurance company to the medical institution and 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 voluntary medical insurance contract 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, members of their families, persons who have retired from this enterprise, are provided with tax benefits in the amount of up to 10% of the amount allocated from profit for these purposes.
The main features of compulsory insurance in accordance with Chapter 48 of the Civil Code of the Russian Federation, Part 2 are:
– the 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 programs of compulsory medical insurance. In this case, the definition of the object of voluntary medical insurance given in Article 3 of the current law on health insurance is 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 to insure in case of compulsory health insurance follows from the law, and in case of voluntary health insurance it is based only on contractual relations, which, however, does not exclude the need for compulsory health insurance by concluding an insurance contract between the insured and the insurer.
Secondly, the main difference between compulsory and voluntary health insurance lies in the sphere of relations arising between their subjects in the provision of medical care at the expense of insurance funds. If compulsory health insurance is carried out in order to ensure the social interests of citizens, employers and the interests of the state, then voluntary health insurance is implemented only in order to ensure the social interests of citizens (individual or collective) and employers.
Thirdly, from the previous difference follows, in particular, the difference in who are the insurers in compulsory and voluntary health insurance: in compulsory health insurance, these are executive authorities and employers; in case of voluntary health insurance, citizens and employers.
Fourthly, relations on voluntary medical insurance, as well as on compulsory medical insurance, relate to social insurance, which pursues the goal of organizing and financing the provision of medical care to the insured contingent of a certain volume and quality, but under voluntary medical insurance programs (21, p. 40) .
However, voluntary health insurance, unlike compulsory health insurance, does not apply to state social insurance. First, due to the difference in the social interests they realize. Secondly, due to the difference in the forms of ownership and organizational and legal forms of insurance organizations that carry out social insurance. At the same time, it is understood that social insurance can be not only state, but also municipal, and given the differences in its internal organization, it can also be professional (according to professional and sectoral characteristics) and international.
However, the classification of social insurance on the basis of forms of ownership and differences in its internal organization (state, municipal, professional, international) does not coincide with the classification according to the forms of social insurance - compulsory and voluntary. Thus, compulsory health insurance and voluntary health insurance differ from each other according to the above types of classification (25, p. 89).
Fifth, as a result of the foregoing, pursuing common goals and having a common object of insurance - compulsory and voluntary 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.
Unlike voluntary health insurance, in case of 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 medical insurance, it should be noted that in Russian reality the process of combining compulsory and voluntary medical 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. Healthcare organizers, 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 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 advertisement 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 ineffective: the amount of payments for an insured event did not exceed the amount of the insurance premium, and funds not spent on treatment were returned minus the insurer's commission. This situation suited entrepreneurs who used voluntary medical insurance to hide part of the employees' salaries from the tax authorities. In the future, more and more voluntary medical insurance programs appear on the market, providing for an amount of insurance coverage that exceeds the amount of the down payment.
A radical turning point occurred in 1995, when the requirements for companies providing insurance for employees under voluntary medical insurance programs became significantly tougher. In particular, the Russian Federal Service for Supervision of Insurance Activities completely banned the practice of returning unused funds in order to deprive businessmen of the opportunity to avoid the tax burden. From that moment on, voluntary health insurance entered the modern phase of development. Over time, more and more insurance companies began to appear on the market, offering their customers various programs of voluntary medical insurance. In addition, the range of services offered by voluntary health insurance has significantly expanded, and the popularity of such products among citizens and legal entities has grown.
Summing up, it is necessary to mention once again that in Russia voluntary medical insurance as an economic and legal category and type of insurance activity arose in 1991 with the adoption of the Law of the RSFSR "On Medical Insurance of Citizens in the RSFSR". The insurance model provided for by law was fundamentally different from the varieties of personal insurance that existed at that time. It was about a qualitatively new legal relationship for our legal system. The novelty was in the object of the insurance legal relationship arising under VHI. Its subject composition also looked in a new way. Personal insurance, including health insurance, which was 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" defines the risk associated with the costs of providing medical care in the event of an insured event as an object of voluntary medical insurance. 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 VHI system is most developed 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 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 (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 method of 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, 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, famous for the highest level of medical care, more than 70 companies (including foreign ones) operate in the VHI system, despite the fact that four of the largest insurance companies control half of this market. The VHI system covers almost a fifth of Israelis who use services not included in the basic programs of mandatory insurance funds, including nursing and patronage care (mainly for the elderly). The State Commission for Health Analysis in Israel believes that the role of VHI will continue to grow steadily in the future. Similar trends are observed both in Russia as a whole and in our region, where a network of large insurance companies operates (17, p. 46).
In Germany, an alternative (and supplement) to compulsory health insurance is voluntary (private) health insurance, which applies to citizens who, due to high incomes or professional activities, are not subject to compulsory health insurance, as well as to those persons who have the means and desire to receive additional alternative assistance to compulsory health insurance. The existence of two different forms of sickness 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 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 VMI, there is a free choice of a hospital, as well as improved conditions for staying in it, services of a personal doctor, reimbursement of up to 100% of the costs associated with inpatient treatment (in MHI, as a rule, part of the costs is reimbursed by the patient). Compared to CHI, in which the amount of contributions does not depend on the degree of probability of an insured event, contributions in the voluntary health insurance system are formed taking into account individual risk. Private insurance companies use a large number of different regional and professional tariffs for this. Since age characteristics have a significant impact on the amount of insurance premiums, the most favorable rates in VHI are for young people. It should be noted that in recent years the volume of expenses of the German population in voluntary health insurance has been constantly increasing by an average of 5%. A significant difference from the CHI system is that for each age group insured in VHI there is its own financing of their expenses. In the context of 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 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 health 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 operating in Germany, performing the same functions as the MHI, 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 context 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 addition to 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 conventionally 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 VMI market.
Experts believe that the Russian market for corporate voluntary medical insurance is already close to saturation. Both in companies with foreign owners and large Russian enterprises VHI has become an integral part of the social package, a tool to motivate and increase staff loyalty, a method of managing the company's finances by reducing sick leave and tax minimization.
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 limitation 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, the employer, in addition to contributions to VHI, is forced to pay a single social tax, which includes deductions for compulsory medical insurance, which employees do not actually use.
Currently, some insurance companies involved in the implementation of CHI programs are trying to run VHI programs called "CHI with a plus". Patients receive services based on the CHI program, i.e. 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).
From classic types VHI is popular insurance in case of any disease. 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 health care, 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;
Absence state support VHI in the form of tax benefits, since tax code allows up to 20,000 rubles per year spent on medical services and medicines to be used to reduce the taxable base for tax on individuals. 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 working in the insurance market of the Krasnodar Territory since the company was founded in 1992. Being a joint-stock company with the participation of the state capital of the Krasnodar Territory, acting in accordance with the license of the Federal 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 CHI for citizens in the territories of eight municipalities Azov-Black Sea coast of the Krasnodar Territory (the cities of Sochi, Tuapse, Gelendzhik, Novorossiysk, Anapa, Tuapse, Temryuk and Primorsko-Akhtarsky districts) with a total population of 1,195 thousand people.
In 2008, the company's shareholders decided to reorient the company 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.
Years of experience, flexible tariff policy, contractual relations with leading Russian reinsurers allow OAO IC Sochi-Garant to sell on the territory of the Krasnodar Territory, Rostov region and the Republic of Adygea insurance programs of high complexity with an individual approach to each client. The company's plans for 2010-2011 include the development of agency and partner sales channels.
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 measures to develop the regional financial market held by the Administration of the Krasnodar Territory, is one of the first members of the Association of Insurance Companies of the Krasnodar Territory, a member of the Chamber of Commerce and Industry of the Krasnodar Territory.
OAO IC "Sochi-garant" within the framework of VHI programs offers the following types of services (44):
– round-the-clock reference and information (dispatch) service;
– a complex of outpatient and polyclinic services, including:
visiting a doctor at a convenient time for the patient;
consultations of medical specialists at home;
The doctor's visit to the office, the organization of a comprehensive examination;
Carrying out a full medical examination, including the necessary laboratory and instrumental studies;
- 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.
Price insurance policy VHI is determined by the set of medical services chosen by the client independently, as well as by 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, which avoids unexpected costs, and, equally important, due to the control of the quality of treatment and the volume of services provided by the insurance company (48). It should also be noted that the state has recently been paying serious attention to improving the healthcare system - the national project "Health" has been announced as one of the priority areas for the country's development in the near future. But the question arises to what extent its implementation will affect the market mechanism for financing the industry - voluntary medical insurance.
An experience developed countries proves that it is voluntary health insurance that is the most effective mechanism for financing medicine. Nevertheless, the development of VHI in our country, despite the great potential for its demand, runs into obstacles. The most important deterrent is the low income of a significant part of the population and the delay in the formation of the middle class, leading to a shortage of mass demand for commercial health insurance. Possible option The 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. important problem the prevalence of "gray" medicine remains, 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 VMI that a number of clinics refuse to work with insurance companies, preferring to make payments with patients directly, apparently considering control by insurers too burdensome. The most critical among the factors hindering the development of the voluntary medical insurance market is the factor of legitimacy, in other words, problems with tax legislation in this domain. According to the law, deductions for VHI, which can be attributed to the cost price, should not exceed 3% of the wage fund of the enterprise. At the same time, in the social packages of large foreign companies, up to 40% of personnel costs are 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 VHI system, based on market mechanism. At the same time, VHI is currently considered as one of the important sources of financial support for the existing healthcare model.
The question is natural: how well do people know about the possibilities of voluntary medical insurance, and how are they used? In this regard, we have set ourselves the goal of determining the degree of awareness of the population of the city of Magnitogorsk about the programs offered under VMI. A questionnaire survey was used to collect primary information on this issue. It was attended by 98 people, including 19 heads of enterprises of various forms of ownership. In the course of the study, a quota sample was used.
The survey showed that almost a third (31%) of individuals are not aware of the existence of a voluntary health insurance system. It should be noted that when evaluating the answer, we took into account not the fact of simple knowledge about the VMI system (“I heard something ...”), but the respondent’s ability to describe the purpose of this system and its functions.
Among individuals, high awareness of the VHI system (84% of respondents) was shown by representatives of two age groups: 35-45 and 45-55 years old. This indicator 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 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%), savings 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 VMI programs: reduced loss of working time (38%), increased employee productivity (29%), improved company image (17%), and social and psychological climate (16%). This leads to the conclusion that managers clearly see the benefits of VMI and regard the results of employee insurance as a factor contributing to the improvement of the efficiency of enterprises. At the same time, the heads of enterprises in their mass noted the underdevelopment of the system of voluntary medical insurance.
As for the population, according to 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 VMI policy will also increase, and, consequently, the VMI 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 selling 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 clients, 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;
Secondly, the slowdown in the development of socially effective medical technologies (cheap and effective systems of prevention and preventive therapy).
World and Soviet experience shows that the best way out of this situation is free medicine. Many states (Sweden, Great Britain and others) follow this path, or consider it more effective. For example, in France, during the election campaign, some candidates for the post of head of state promise to switch to free medicine. In our country, it is almost impossible to get away from the commercialization of the sphere of medical care for the population under the current conditions. Therefore, it is necessary to look for a way out that allows you to mitigate these negative consequences as much as possible.
In our opinion, one of these solutions may be a deeper division of powers between the systems of social and commercial health insurance, as well as targeted stimulation of the development of both medical insurance complexes in accordance with the specifics of the tasks they solve and the segments of the population they serve.
Summarizing the foregoing, let us single out the advantages that, in our opinion, determine the prospects for the development of the voluntary medical insurance system.
Firstly, voluntary health insurance is currently of great benefit to all subjects of the paid medical services market. For the first time, insured clients get the opportunity to receive exactly the medical care that they would like to receive, and which consists of:
Real care and assistance of a medical representative of the insurance company in choosing a medical institution that is optimal in terms of "price - quality" ratio;
Ensuring the timeliness and priority of assistance;
Service by a trusted doctor (the most competent specialist chosen by the insurance company in advance), who would be interested in doing everything necessary and possible for the client at the highest level;
The feeling of complete security of each insured by 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 materially (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 illness.
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 VMI 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 clients, 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 it was paid insurance premium. At the same time, VHI provides policyholders with higher quality medical care that meets the individual requirements of the client.
Participation in VHI programs is not regulated by the state and depends on the needs and capabilities of the insured. For example, in CHI rules, programs, the amount and procedure for paying insurance premiums, standard forms contracts, a list of medical institutions, the cost of medical services are developed and approved by the authorities. In VHI, the rules and methodology for calculating insurance premiums are developed by the insurance organization and are only agreed upon by the supervisory authorities for insurance activities. The remaining conditions are regulated by agreements concluded by the subjects of the system.
At first glance, the conditions put forward by the insurance company are quite acceptable, and, nevertheless, there are often cases of citizens refusing insurance. This behavior of people is due to two reasons. The first is the open distrust of citizens in health insurance, the second is the fact that it does not matter how many times the client has applied for medical services, insurers have to pay regularly in any case.
The insurance company is fully responsible to its customers for the provision of medical services. This is one of the main arguments in favor of VHI before mandatory medical 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 must 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.
Thank you for participating!
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 amount 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 (CHI), 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 medical 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 rating agency"Expert RA", 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 employee insurance 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 to stimulate the voluntary medical insurance market was taken - 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 private client seeks to maximize the use of 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 exit from the crisis and the return corporate clients for 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 incentives - this is 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, then 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
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.
Short 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.
