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.
2019 № 3 Рayment for medical care provided in excess of the volumes of granting of medical aid in system of obligatory medical insurance
Сurrently, health organizations are extremely important are the issues associated with excess of volumes of granting of medical aid in system of obligatory medical insurance. This is the so-called problem of "super-planned patients". The current legislation does not provide for payment of super-planned volumes of medical care.. But the incidence rate is difficult to predict with a high level of accuracy. Within the framework of the current regulatory framework, all financial risks in this situation are assigned to the medical organization, which does not correspond to the logic of insurance. However, there are some options to mitigate this problem. This is illustrated by the court practice in this area.
сompulsory medical insurance, volumes of medical care, insurance medical organizations, medical organizations, sanctions, the Commission on development of the territorial judicial practice.
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.
2014 № 3 Outcome of reforming the system of mandatory medical insurance in 2010–2013 years. Analysis of drawbacks of existing system of mandatory medical insurance (Ministry of health care of Novosibirsk region, Novosibirsk, Russia)
Annotation. The article examines the system of mandatory medical insurance operating on the territory of Russian Federation, there has been conducted a complex analysis of main problems and drawbacks of the system. There are formulated the main directions of reforming Mandatory Insurance System.