Articles with tag: «payment for medical care»

    Manager of heath care consults
  • 2020 № 8 Changes in the procedure for financial support of medical organizations in the system of compulsory medical insurance at the present stage of the spread of coronavirus infection

    In the context of the spread of coronavirus infection, the main problem of medical organizations is not an obvious increase in the cost of providing medical care associated with ensuring the sanitary and epidemiological regime (personal protective equipment, disinfection, etc.), but a decrease in income due to a drop in the volume of planned medical care, suspension of preventive measures, downtime (during the period of re-profiling, etc.).
    The state quickly responded to this situation by making changes to the relevant legislation and adopting a number of special regulatory legal acts. However, the implementation of these rather varied measures tied to a number of factors, such as the presence or absence of restrictive measures on the territory of the Russian Federation; participation or non-participation in the care of patients with coronavirus infection; periods within which the one or the other order advances, etc.
    All this causes difficulties in understanding what financial security mechanism is applied to this particular situation, what should be the actions of medical organizations.
    This article is devoted to the analysis of ways of financial support of medical organizations in the system of compulsory medical insurance at various stages of the fight against coronavirus infection.

    Authors: Kadyrov F. N. [95] Obukhova O. V. [18] Chililov A. M. [7]

    Tags: advance payment1 financial support1 mandatory medical insurance10 medical insurance organizations4 medical organizations15 payment for medical care4 volumes of medical care2

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  • Manager of healthcare consults
  • 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.

    Authors: Yu. V. Kuftova [4] F.  N.  Kadyrov [9]

    Tags: compulsory health insurance13 health care organizations1 health  insurance  organizations3 judicial practice1 payment for medical care4 the commission on the development of the territorial chi program1 the  volume  of  medical  care2

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  • Manager of health care consults
  • 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.

    Authors: F.  N.  Kadyrov [9] O.  V.  Obukhova [3] Yu. V. Endovitskaya [6]

    Tags: compulsory medical insurance9 federal  compulsory  medical  insurance  fund1 insurance medical organizations3 inter- territorial  settlements1 medical organizations15 payment for medical care4 standardized  insurance  stock.1 territorial  compulsory  medical   insurance  funds1

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  • Management in health care
  • 2013 № 6 The problems of payment for medical care provided to the citizens of the Republic of Belarus, temporarily residing in the Russian Federation (The Regional medical insurance fund of Saint-Petersburg, Saint-Petersburg, Russia)

    Delivery and payment of medical assistance to the citizens of the Republic of Belarus in the framework of the Agreement between the Russian Federation and the Republic of Belarus «On equal rights of citizens» is important for Russia. The paper examines existing at the moment the problem and suggests ways to address them in accordance with applicable law and the authority of government.

    Authors: Gordeev E. A. [2] Timofeeva I. M. [1]

    Tags: citizens of the republic of belarus1 payment for medical care4

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