Articles with tag: «compulsory medical insurance»
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2023 № 3 Issues of payments for medicines in the provision of specialized medical care for compulsory medical insurance
In the article, on the basis of regulatory legal acts, the issues of the legality of the use of co-financing mechanisms (co-payments) in the system of compulsory medical insurance are considered.
The situations and conditions in which co-payments are legitimate are analyzed.
It is concluded that it is necessary not to combat this phenomenon, but to regulate cases of co-payments on the part of insured citizens. -
2018 № 8 The application of leasing in state (municipal) health care institutions
Difficult economic conditions lead to the fact that the expenditures of budgets of all levels for the purchase of equipment are highly reduced. State (municipal) institutions are forced to look for other sources and channels for financing equipment purchases. In this respect, leasing at the expense of compulsory medical insurance is an interesting, but incomprehensible tool. Especially, given the variety of its forms. Moreover, the use of leasing in the system of compulsory medical insurance encounters a number of serious limitations. Meanwhile, the competent conclusion of leasing contracts, in fact, in a number of cases makes it possible to solve problems of obtaining equipment worth more than 100,000 rubles at the expense of compulsory medical insurance.
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2021 № 4 NEW SYSTEM OF CONTRACTS WITHIN THE FRAMEWORK OF COMPULSORY HEALTH INSURANCE
The system of compulsory health insurance is regulated by a large number of regulatory legal acts. Nevertheless, many issues related to the relationship between the participants of the MHI system, and above all – financial, are determined by the content of the contracts concluded between them. This article analyzes the new system of contracts that has developed in the system of compulsory medical insurance in connection with the adoption of Federal Law No. 430-FZ of December 8, 2020 “On Amendments to the Federal Law “On Compulsory Medical Insurance in the Russian Federation”, as well as other related regulatory legal acts. There have been changes not only in the content of the contracts, but also in the composition of their participants. In addition, there is a new, previously absent type of contract. The purpose of the work is to analyze changes in contracts in the MHI system and their possible consequences.
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2021 № 5 New system of control measures in relation to medical organizations within the framework of compulsory health insurance
One of the most serious innovations in the system of compulsory health insurance is the change in the procedure for conducting control measures. In accordance with the new version of Federal Law No. 326-FZ (in accordance with the provisions of the Federal Law of December 8, 2020 № 430-FZ On Amendments to the Federal Law "On Compulsory Medical Insurance in the Russian Federation"), the procedure for monitoring the volume, timing, quality and conditions of providing medical care for compulsory medical insurance to insured persons, as well as its financial support, is now established not by the Federal Fund for Compulsory Medical Insurance, but by the Ministry of Health of the Russian Federation. At the same time, both the participants of the CMI system who have the authority to conduct control measures, and the procedure for conducting control, are changing.
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2021 № 10 ACCOUNTS PAYABLE OF MEDICAL ORGANIZATIONS OPERATING IN THE COMPULSORY HEALTH INSURANCE SYSTEM
Among the indicators used to assess the financial condition of medical organizations, one of the most important is accounts payable, which characterizes the risks to their normal activities.
In this article, this problem is considered in relation to the system of compulsory medical insurance from the point of view of factors that do not depend on the medical organizations themselves. -
2019 № 6 New rules of obligatory medical insurance: major changes
The rules of obligatory health insurance regulate legal relations of subjects and participants of compulsory health insurance. New rules of obligatory health insurance developed by the Ministry of health of Russia in accordance with the recommendations of the Ministry of justice. The essence of these recommendations was not to make regular changes to the existing rules of obligatory health insurance, but to approve new rules of obligatory health insurance. To a large extent, these changes are associated with the Informatization of health care, with the advent of legislative regulation of the use of telemedicine technologies. Most of the changes affect the order of calculation of the value of sanctions applied to the medical organisations in the mandatory medical insurance system. In turn, these changes reflect the desire to reduce the financial burden on state (municipal) institutions and make it easier for them to achieve the level of wages provided for by the "may" presidential Decrees of 2012.
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2019 № 5 The procedure for co-financing of salary for newly hired employees in primary care
In his Decree No. 204 of May 7, 2018 “On the national goals and strategic objectives of the development of the Russian Federation for the period up to 2024”, the President set the task to ensure the achievement of a number of goals and targets in the health sector. These include the elimination of personnel shortages in medical organizations that provide primary health care.
To help solve this problem, a mechanism has been developed to co-Finance the salary costs of state (municipal) institutions, which provide an increase in the staffing of employees.
Corresponding changes were made to Federal Law of November 29, 2010 № 326-ФЗ “On Compulsory Medical Insurance in the Russian Federation” (Part 6.6. Of Article 26).
This article is devoted to the order of formation, the conditions of provision to medical organizations of the state health system and the municipal health care system, providing primary health care in accordance with the territorial programs of compulsory health insurance, the funds of the normalized insurance stock of the territorial Fund of compulsory medical insurance provided for co-financing of expenses of the medical organizations for compensation of doctors and average medical personnel. -
2015 № 8 Regulatory control of state-private (municipal-private) partne
The article examines a legislation, related to the state-private partnership and municipal-private partnerships, specifics of its application in the state system. There is also analysis done of a possible impact of the new legislation on investment activity in circumstances of current economic crisis. There are demonstrated legislation opportunities and limitations for realizing state-private partnership projects with participation of state (municipal) institutions in health care.
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2020 № 3 The problems of paying for medical care provided to residents of other subjects of the Russian Federation within the framework of compulsory medical insurance
The legislation guarantees citizens the right to receive medical care under a compulsory health insurance policy (CHI) throughout the Russian Federation. But in some cases, in accordance with current legislation, a referral is required to receive medical care. This also applies to situations where a citizen receives medical care outside of the subject of the Russian Federation where the citizen is insured. The system of such referrals to medical organizations located in another region is more or less regulated only when they are sent to Federal medical organizations. The situation is further compounded by the fact that the Supreme court contrary to law, making decisions, actually leveling a direction. At the same time, payment for medical care provided outside the region in which the MHI policy is issued depends on the payment of this assistance from the Territorial Fund of this region. This leads to numerous delays in payment and, as a result, reduces the interest of medical organizations in providing medical care to "nonresidents". Patients suffer as a result. All this raises the question of the need to improve the current mechanism for conducting inter-territorial settlements in the MHI system.
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2019 № 1 Financing health care in 2019: new priorities and channels for the movement of funds
Analysis of the future financing of health care shows that in 2019–2021, despite the difficult financial situation, the volume of financial support for the industry will continue to grow. Thus, the size of health care spending from the Federal budget is growing not only in absolute terms, but also occupies all a large share in the structure of Federal budget expenditures. The increase in expenses in the system of compulsory health insurance (CHI) in absolute terms is still quite large. Among the priorities of 2019 are the increase in funding for cancer care, as well as high-tech medical care, which directly follows from the provisions of the Decree of the President of the Russian Federation May 7, 2018 № 204 "The national goals and strategic objectives of the Russian Federation for the period up to 2024" (presidential Decree № 204). The distribution of funds to the compulsory medical insurance system is based on these priorities, and based on the results of implementation of decrees of the President 2012 for leveling a series of problems, such as unreasonable reductions in personnel. All this should have a positive impact on the further development of health care.
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2023 № 6 Overview of the state of dental care to the children’s population of the Tver region for the period 2016–2020 years.
Taking care of the health of the population of the Tver region is an important area of social regional policy. The main task of the dental service of the Tver region is to preserve and strengthen the health of citizens of the Tver region, increase the role of prevention of dental diseases, form a model of the organization of the dental industry, ensuring the availability and quality of dental care, improving the efficiency of dental services, the volumes, types and quality of which should correspond to the level of morbidity and the needs of the population, advanced achievements of medical science.
P u r p o s e . To review statistical data on the provision of dental care to children in public institutions of the Tver region.
M a t e r i a l s a n d m e t h o d s . The review, analysis, collection and comparison of aggregated data for 2016–2020 in Tver and the Tver region were carried out: statistical data on demography, analysis of dental service performance indicators, analysis of indicators of accessibility of dental care to the children’s population by questioning parents/legal representatives of children’s patients, analysis of personnel potential and questioning of dentists in the profile “Pediatric dentistry”.
R e s u l t s . This article is devoted to an overview of the activities of public health institutions of the Tver region providing dental care to the children’s population within the framework of compulsory medical insurance. The results of the study indicate that the prevalence of dental caries among children of the Tver region is consistently high. Further preventive programs and additional research are needed to improve the dental health of children. -
2023 № 6 WAYS TO IMPROVE INTERNAL CONTROL OF THE QUALITY AND SAFETY OF MEDICAL ACTIVITIES: HOW TO USE THE RESULTS OF CONTROL IN THE SPHERE OF COMPULSORY HEALTH INSURANCE
R e l e v a n c e . Currently, the issues of ensuring the quality and safety of medical activities are one of the priority areas in healthcare management. The legislation of the Russian Federation has determined the organization and conduct of internal quality control and safety of medical activities as a licensing requirement. Identified inconsistencies/violations in the provision of medical care are one of the elements of risk management and should be used to improve the efficiency of medical organizations.
T h e p u r p o s e of the study is to develop management practices to improve the quality and safety of medical activities using the results of external audits in the field of compulsory health insurance.
M a t e r i a l s a n d m e t h o d s . The analysis of modern requirements of normative legal acts of quality control and safety of medical activity has been carried out, the main tools used in conducting external audits in the system of compulsory medical insurance have been systematized.
R e s u l t s . The modern architecture of quality control and safety of medical activities includes 5 levels of control. The tools for monitoring the quality of medical care for identifying violations, applying financial sanctions to a medical organization are described. In order to improve the quality and safety of medical activities, the development of corrective measures and various management practices is recommended.
C o n c l u s i o n s . The results of external audits are an important element of the modern model of quality management and safety of medical activities, which should be integrated into the work of a medical organization of any profile for use in a system of continuous quality improvement -
2018 № 9 Influence of activity of the medical organization, providing medical assistance to children, on the economy of the region
The analysis of 46 7122 entries in the medical information system of the organization for 2016 characterizing the treatment of children for the purpose of medical care, 9533 cases when the sheet can not work (SNW) was issued. The costs of territorial funds of compulsory medical insurance (CMI) and social insurance fund, an internal regional product for the treatment of a child, are estimated. It is established that the budget of the region loses 8,9 times more than the amount of CMI funds that was spent for the treatment of the child, if issued by the SNW. This requires active prophylactic measures for children.
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2022 № 7 Topical issues of organization and financial support of high-tech medical care
The article provides a historical overview of changes in approaches to the financial provision of high-tech assistance, analyzes the causes of these changes, shows the system that has developed at the moment.
Comments are given on the most relevant changes concerning the financial provision of high-tech medical care. -
2018 № 3 Topical issues of arbitration practice in the CHI system (the experience of Saint-Petersburg)
The current legislation in the system of compulsory health insurance has opened wide opportunities for participation in this system of medical organizations of any organizational and legal form. However, this has led to an increase in the number of economic disputes in the compulsory health insurance system. In particular, the number of lawsuits is increasing on new grounds: the amount of medical care; payment for medical care provided in excess of these volumes. The defendants in the claims are not only the insurance medical organizations and territorial funds of the MLA, but also the Commission, which develop territorial programs of compulsory medical insurance and are not legal entities. Court practice in many cases violates the logic of legislation on compulsory health insurance. This article is devoted to the consideration of these problems for recommendations to improve the legislation
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2023 № 6 Payment methods for primary health care, specialized (including high-tech) medical care in the compulsory health insurance system: the logic of the most urgent changes in the tariff policy of 2023.
The article discusses new methodological approaches to the methods of paying for medical care in the compulsory medical insurance system for 2023, including those approved by recently issued regulatory legal acts, as well as joint recommendations of the Ministry of Health of Russia and the Federal Compulsory Medical Insurance Fund (FOMS).
The article analyzes the main reasons for changes in the tariff policy and their expected consequences in terms of increasing the motivation of medical organizations.
It is noted that there is a need to revise the remuneration systems of employees of medical organizations (primarily state and municipal) in order to more closely link incentive payments with performance indicators used in determining the amount of payment for medical care, which is intended to become an important motivation tool for improving the availability and quality of primary health care and, as a consequence, reducing the need for specialized medical care.
An overview of innovations in the payment of high-tech medical care is given. -
2019 № 5 Providing income activities as a conscious necessary for functioning of the state (municipal) medical providers
Realization of the rights of citizens to health care and medical care free of charge, enshrined in the Constitution of the Russian Federation, carried out by state and municipal health care institutions «… at the expense of the relevant budget, insurance premiums and other income». Analysis of the dynamics of the volume of financial sources for 2014–2017 showed a significant increase in revenues of medical organizations, which are state budgetary institutions, funds from income-gener- ating activities.
The article describes the main financial sources that a medical organization – a state (municipal) institution may have for providing medical care, as well as for implementing the Program of state guarantees of free medical care to citizens. The rationale for the insufficiency of public funds to ensure the necessary level of wages for medical workers is given on the example of comparing tariffs of the compulsory health insurance system and prices (tariffs) of private medical organizations in the city of Moscow.
The regulatory and legislative conditions for obtaining funds from various financial sources by a public institution are con- sidered, the relevance of developing measures to attract additional financial sources, which include revenues from providing paid medical services to the population, including through voluntary medical insurance, is justified. -
2022 № 3 he program of state guarantees of free medical care to citizens for 2022: logic and basic provisions in the fight against coronavirus infection
Changes in the Program of state guarantees of free medical care to citizens for 2022 and for the planned period of 2023 and 2024 compared to previous years are closely related to the current stage of the fight against the spread of COVID‑19 coronavirus infection. At the same time, given that the logic of the changes being made is not always obvious, it is necessary to start both from the current state of healthcare and from an analysis of how innovations will affect the development of the industry in the coming period.