Articles with tag: «compulsory medical insurance»
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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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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. -
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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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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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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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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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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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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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.