Articles with tag: «compulsory health insurance»
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2016 № 4 The quality of medical care as a tool of resource-saving in obstetric institutions in conditions of compulsory health insurance
Annotation. In this article we represented data of quality of medical care in Maternity hospitals operating in the conditions of compulsory health insurance system. Identification of medical care defects during medical and economic expertise shall be sanctioned and fine by health insurance organizations. Analysis of that sanctions allow you reduce internal economical costs and keep economical resources of the obstetric hospital.
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2019 № 4 The review of judicial practice on the payment of over-planned volumes of medical care in the system of compulsory health insurance
Despite rather rigid legislative norms concerning payment of the medical care rendered over the volumes allocated by the Commission on development of the territorial program of CHI, and also the developed practice of rela- tionship between the medical organizations – on the one hand and the insurance medical organizations, territorial funds of CHI – on the other hand, judicial practice often demonstrates other approaches. Although the current legislation does not imply payment of over-planned volumes of medical care, the courts often take the side of medical organizations. Thus, the current judicial practice illustrates the existence of problems in this area. This article is devoted to the review of judicial practice in the matter of payment for over-planned volumes of medical care in the system of compulsory health insurance.
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2018 № 4 The sources of financial provision of rendering emergency medical care
Free provision of emergency medical care is provided by the legislation. This requires a clear definition of the source of cost recovery for medical organizations that provide this assistance, In a particular situation, how¬ever, there are often situations where law enforcement officials refuse to pay for emergency assistance provided to their employees, referring to the above-mentioned legislative requirement. Many problems in the provision of emergency arises in the system of compulsory health insurance. Payment for emergency medical care rendered in excess of the approved amounts remains an unresolved problem. The problem of compensation for emergency assistance to uninsured citizens is not settled either. These problems are especially urgent for private medical organizations
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2022 № 1 Financing of the compulsory health insurance system in 2022
The most important factor affecting the amount and methods of financial support of the compulsory medical insurance system, as in the last two years, continues to be the spread of coronavirus infection COVID‑19.
In the proposed paper discusses not only the indicators of the budget of the Federal compulsory medical insurance Fund, but the dynamics of indicators, including, in comparison with the rate of inflation, and other factors.
New directions of the use of compulsory medical insurance funds are identified, the reasons for their appearance are considered. -
2018 № 1 Prospects of health financing in 2018
New 2018 in terms of funding health care will differ from the previous - it is expected a sharp increase in funding from all types of sources. However, this is due not only to increased revenues and the restructuring expenses. It becomes more rational - "saving" (for example, reducing expenditures on more costly inpatient care in the Federal budget). In the system of obligatory medical insurance is the refusal of a number of "non-core" expenditure. All of this should have a positive impact on the development of health care
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2016 № 9 Prospects of implementation «May» Decrees of the President in the field of health
2017 is key year in the implementation of the «May» Decrees of the President. Despite the difficult financial conditions, there are many ways to achieve the specified orders, the levels of remuneration. Planned real measures for financial support of these activities. However, more important is not how to provide the intended level of pay, and how to achieve the goals of the Decrees, which are not be reduced to a simple wage increase.
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2017 № 7 The issues of creation and functioning of centralized laboratories in the system of compulsory medical insurance
Centralization of laboratory diagnostics is a time commitment associated with the benefits it provides. However, the appeal to this topic is also connected with the new factors that are considered in the article. The difference in the regional features of the organization of health care, the availability of various sources of financial support for medical organizations, etc., suggest a distinction between specific models of centralization, the system of financial relationships, etc. In addition, the centralization of the laboratory service, having undoubted merits, also carries certain risks and threats that must be taken into account. This article addresses these and other issues related to the practical aspects of the centralization of the laboratory service.
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2023 № 1 Review of the work of the state dental service of the Tver region in 2021
Taking care of the health of the population of the Tver region is an important direction of social regional policy. The main task of the dental service of the Tver region is to preserve and strengthen the health of the citizens of the Tver region, to increase the role of preventive care of dental diseases, to form a model of organization of the dental industry that ensures the availability and quality of dental care, to increase the efficiency of dental services, the volume, types and quality of which should correspond to the level of morbidity and the needs of the population, advanced achievements of medical science. The aim of the research is the analysis of the statistical data of the stomatological service of the state public health institutions of the Tver region.
Materials and methods. Analysis of the statistical data reflecting demographic indexes, statistics of the stomatological service structure, staffing, distribution of dentists among the institutions of the Tver region, quality of dental care, the main indexes of the stomatological service of the Tver region, indexes of treatment and preventive work.
Results. The present study is devoted to the analysis of the activity of state medical institutions of health care of the Tver region that provide dental care to the population of the Tver region. The indices of the provision of dentists in this region (not taking into account orthopedists and orthodontists) makes 3,82 posts for 10 thousand population (426,25 rates in total). Indicators of provision of the region’s population with dentists are 4,3 positions per adult population of the region. The deficit specialties have been revealed: pediatric dentists, orthodontists, in the regional institutions there is a shortage of orthopedists. The share of occupied staff positions in the specialty of pediatric dentistry was 49%, which reflects the need for training in this area. The difficulties in the organization of preventive examinations of the
children’s population were revealed, and the low percentage of the examined persons.
Conclusions. The municipal, district and regional medical institutions of health care rendering dental treatment to the population are functioning on the territory of the city of Tver and the Tver region in general. The statistical analysis has revealed a number of difficulties that require further action on the part of the medical community and public organizations. It is necessary to develop comprehensive measures to solve the shortage of pediatric dentists at the level of the Ministry of Health and educational institutions. The difficulties of preventive examinations among the population of different groups are highlighted. It is important to strengthen the preventive profile in order to reduce the cases of complicated caries, tooth extraction. Development of hygienic direction will increase awareness of the population
about the peculiarities of dental and oral hygiene, methods of prevention and treatment of dental diseases. -
2023 № 2 Analysis of drug supply for patients with malignant neoplasms at the inpatient stage of treatment.
Drug provision of patients with malignant neoplasms in a hospital and day hospital in the constituent entities and Federal districts of the Russian Federation has not been studied enough. Meanwhile, hundreds of billions of rubles are annually spent on the purchase of drugs for these patients. The aim of the study is to analyze the drug supply of patients with malignant neoplasms at the inpatient stage of treatment. We analyzed the purchase of medicines at the expense of compulsory medical insurance in the subjects and federal districts of the Russian Federation according to the website zakupki.gov.ru. To compare federal districts and constituent entities with each other, we compared the amounts spent on the purchase of medicines at the expense of compulsory medical insurance, in terms of 1 patient with a newly diagnosed cancer in each federal district and constituent entity, respectively. We found significant differences
in the drug treatment of patients with MN not only between the Federal Districts, but also within the Federal District. Moreover, the difference in drug provision of patients with specific drugs in the subjects reaches multiple values. Oral drugs are also used differently, with a mixed trend in the Federal Districts of their use over the past two years. Drug provision of patients with malignant neoplasms in the constituent entities of the Russian Federation at the inpatient stage of treatment varies significantly, patients have different access to drugs with oral administration. -
2013 № 6 Regarding experience of organizing issue of obligatory health insurance policies in multifunctional centers of public services of Saint-Petersburg (The Regional medical insurance fund of Saint-Petersburg, Saint-Petersburg, Russia)
In this article we discussed the experience of organization of issue policies of compulsory health insurance in the multifunctional centers of public services of Saint-Petersburg. Considered are the main organizational activities carried out to ensure the possibility of obtaining the policies of compulsory health insurance in multifunctional centers.
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2014 № 1 The problem targeted use of funds CHI (Ltd. CDC «The Dobryi Doctor», Altayskiy State Medical University; ANO «Medicine and Law» NP «Medstandart», Barnaul, Russia; Federal Research Institute for Health Care Organization and Information of the Ministry of Health and Social Development of Russian Federation, Moscow, Russia)
Annotation. Transition to a single channel funding, a variety of legal forms of medical organizations involved in the delivery of medical care within the compulsory health insurance, expanding the powers of state ( municipal) institutions, etc. raise the question of the need to reform the rights of medical organizations independent of funds. The article examines the legality of preserving the concept of «improper use of funds» in the current conditions and appropriate sanctions.
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2013 № 6 Models of the optimal distribution of the planned volume of financial means in the sphere of compulsory health insurance of Saint-Petersburg (The territorial compulsory health insurance fund of Saint-Petersburg, Saint-Petersburg, Russia)
The article deals with the mathematic modeling of distribution of the planned volume of financial means in the compulsory health insurance and the results of modeling.
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2021 № 5 FROM MULTI – TO THE MONOPAYER IN THE RUSSIAN SYSTEM OF OBLIGATORY MEDICAL INSURANCE
Since January 1, 2021 amendments to the law “About Obligatory Medical Insurance in the Russian Federation” according to which medical insurance companies are excluded from the system of financing of medical care in federal clinics came into force. The logic of these changes provides creation in each territorial subject of the Russian Federation of a system of “the uniform payer” not only for federal, but also for other medical organizations that can regard as the beginning of centralization and restoration of integrity of a health care system that demands carrying out the analysis and forecasting of consequences of these innovations.
Research objective – the analysis and the forecast of consequences of the changes in the legislation on obligatory medical insurance providing creation of “the uniform payer” of the medical care provided in federal clinics.
Materials and methods. Content analysis methods, information and analytical materials of the Russian and foreign news agencies, expert estimates are used.
R e s u l t s . The federal law of December 8, 2020 № 430-FZ “About introduction of amendments to the Federal law “About Obligatory Medical Insurance in the Russian Federation” provides creation of two parallel systems of financial security of activity of the federal medical organizations – the first for directly from the compulsory health insurance Federal fund, the second – through the compulsory health insurances territorial funds and medical insurance companies. The law provided development of an order of distribution of volumes of the medical care provided at the expense of means of obligatory medical insurance in the federal medical organizations, taking into account capacities of such organizations and volumes of the provided medical care at the expense of other sources of financing. It can lead to division of the federal medical organizations into groups taking into account their dependence on treasury which force is inversely proportional to a share of paid services in revenue breakdown of these organizations.
Conclusions. Application in the system of obligatory medical insurance of the principles of “the uniform payer” of medical care is economic due to reduction of administrative expenses and elimination aspiration of commercial insurers to receiving profit. This decision also corresponds to global trends and will promote ensuring intrasystem efficiency in the industry, to development of network of the medical organizations as the “uniform organism” providing need of citizens for medical care. Division of the federal medical organizations into groups taking into account their dependence on treasury can have ambiguous consequences, including lead to strengthening of commercialization of federal clinics, many of which have legal status of autonomous budgetary institutions that causes need of creation of a system of protection of the population against catastrophic payments for medical care. -
2017 № 6 Metamorphosis standardization of medical care
The article discusses a bill regulating the development and use of clinical guidelines in public health practice. The authors believe that the bill makes clinical recommendations to the regulatory option binding standards of сare. This approach only superficially converts the ways of ensuring the quality of medical care. From the point of view of the authors of the health care system fell into the organizational trap of technological regulation of the actions of the physicians, while the traditional values of the medical profession is gradually devalued. The authors propose to reconfigure relationships in the industry, not only by importing foreign countries, but in accordance with the usual Russian professional medical community’s leadership in the field of cultural, spiritual and intellectual development
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2016 № 10 Аnalysis of the application of standards of care
The article addresses the problem of application of standards in the provision of medical care, and also when exercising control and expert activities. Set out grounds for revision of the paradigm of quality assessment of medical aid in system of obligatory medical insurance based on the comparison of the standardized and the actual performance of medical-diagnostic process.
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2015 № 4 High-tech medical care in the system of compulsory health insurance
Health care reform had an impact on the such expensive type of medical services as a high-tech medical care. Since in 2015, as planned new federal legislation, went into the system of compulsory health insurance. Answer to the question, what is the purpose of the transfer of high-tech health care insurance rails, whether all the volume of this type of medical care today is subordinate stringent requirements of the compulsory health insurance, and what kind of the medical organization involved in providing this type of care, to what extent and for the what funds are reimbursed which health organizations can get the volume of the entire high-tech medical care, dedicated to this material.
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2016 № 9 Рayment of primary health care on per capita financing
Examines conditions and problems of translation of health care organizations on a per capita principle of financing. The material is based on the experience of the constituent entities of the Russian Federation, a long-time practicing activities in terms of per capita funding. Recommendations for minimization of financial risks of healthcare organizations.