Today, medical insurance is one of the most popular types of insurance in the Russian Federation. The level of its development is characterized by the following data. In 2012, the total volume of medical insurance in our country amounted to 699 billion rubles (excluding insurance for those traveling abroad). Of these, 604 billion rubles (that is, 86%) fell on compulsory medical insurance (OMI), 95 billion rubles (that is, 14%) - on voluntary medical insurance (VHI), as shown in Figure 2. For 2012 compared to 2011, the compulsory health insurance market increased by 24.3%, the voluntary health insurance market by 13.3%.

Figure 2 - Structure of the Russian health insurance market in 2012

The growth of the compulsory health insurance market was associated with an increase in the rate of insurance premiums for compulsory health insurance for the working population from 3.1% to 5.1%, as well as with an increase in premiums for the non-working population.

The growth of the voluntary health insurance market is mainly due to inflation. In 2012, the likelihood of new incentives for the growth of the voluntary health insurance market was extremely small. The client base of the voluntary medical insurance market has already been formed, and the appearance of new large clients is quite rare. According to the Expert RA rating agency, the volume of the voluntary medical insurance market in 2012 reached 107 billion rubles, and in 2014 this figure will approach 140 billion rubles (provided there are no macroeconomic "shocks" and significant legislative changes).

The dynamics of insurance premiums for voluntary health insurance is shown in Figure 3.

Figure 3 - Dynamics of insurance premiums for voluntary medical insurance

Voluntary medical insurance is in demand mainly by corporate clients. They account for about 95% of contributions collected under voluntary health insurance programs.

This can be explained, on the one hand, by the growth of social responsibility of business, when insurance of employees becomes an integral part of the compensation package, and, on the other hand, by the desire of insurance companies to work with corporate clients, since when insuring collectives, risks are evenly distributed among all employees. It was in the field of corporate insurance that one of the few steps was taken to stimulate the voluntary medical insurance market - an increase in the rate of attributing premiums for voluntary medical insurance to the cost price from 3% to 6% of the wage fund. In 2012, this measure was most demanded by small and medium-sized businesses.

Low demand from private clients is due to low incomes of the population and the high cost of a voluntary medical insurance policy. The volume of the retail voluntary medical insurance market for 2012 is 5% (Fig. 4).

Figure 4 - Structure of the voluntary medical insurance market in 2012

The profitability of retail voluntary health insurance is low, which leads to higher prices for private clients than for corporate ones.

The high unprofitability of retail voluntary health insurance is due to the fact that a private client seeks to make the most of the insurance - to visit the clinic as many times as possible in order to recoup its cost. In addition, there is a worsening selection, since insurance is purchased mainly by people who already have a certain type of disease.

During the crisis, there was a redistribution of clients from the corporate sector of voluntary medical insurance to the retail one. Employees of companies who have lost their social packages began to purchase voluntary medical insurance policies themselves. With the recovery from the crisis and the return of corporate clients to voluntary health insurance, retail demand declined.

Since the demand of individual customers is small, the supply of insurers is appropriate.

For individuals, there are also tax benefits - these are tax deductions for medical care and contributions for voluntary medical insurance in the amount of 120 thousand rubles. However, few people know about this, there are difficulties with making a deduction, and you can get it only after purchasing a voluntary health insurance policy.

The concentration of the voluntary health insurance market is increasing every year. If at the end of 2011 the 20 largest insurers in the segment of voluntary medical insurance accounted for 74% of premiums, then at the end of 2012 this figure increased to 77.6%.

In 2011, 390 insurance companies were engaged in voluntary health insurance, at the end of 2012 - 354. The reduction in the number of companies is not due to the refusal to provide insurance to universal insurers, but to the revocation of licenses from small companies with a weak reputation and engaged in "pseudo-insurance". The growth in concentration occurred due to the redistribution of contributions in favor of larger and more reliable companies.

As part of the modernization of the compulsory health insurance system, the state seeks to minimize the volume of the voluntary health insurance market, which may adversely affect the entire health care system.

Building an efficient market for voluntary health insurance has positive externalities for the healthcare system and society as a whole:

growth of social stability;

reduction of information asymmetry in the market of medical services;

the possibility of reducing the shadow financing of the health care system;

growth of investments in the construction of medical centers.

As well as in the entire insurance industry, two or three leaders can be identified in the voluntary medical insurance market, whose share in total premiums is significantly higher compared to other insurers (Appendix B).

The largest player in this market is the SOGAZ Group of Companies.

JSC ROSNO, JSC ZhASO, OSAO Ingosstrakh, OSAO Reso-Garantiya follow with a significant margin from the leader, the data on contributions of which are presented in Table 1.

Table 1 - Leading companies in terms of insurance premiums in voluntary medical insurance in 2012

The practice of conducting voluntary health insurance in Russia shows that there are a number of difficulties and problems that hinder the further effective development of voluntary health insurance.

A brief review of the state of the voluntary medical insurance market showed that the Russian market of corporate voluntary medical insurance has passed the stage of extensive development, when the increase in premiums was ensured by attracting new enterprises and the main criterion for choosing an insurer was the price of insurance. The next stage is the intensive development of the market, which involves competition by improving the quality of service, complicating and increasing the service component of insurance products, as well as further concentration of the market.

Voluntary health insurance (Market overview)

Compulsory health insurance services satisfy people less and less. And high-quality protection under voluntary medical insurance policies is becoming better and more affordable. Moreover, insurance companies are beginning to take a serious interest in individual citizens - individuals. We offer readers an overview of the possibilities of this market.

help yourself

Voluntary health insurance (VHI) is gradually becoming an incubator of civilized medicine in our country. Thanks to VHI, opportunities for advanced medical technologies and new services are opening up for the general population, and the level of service is increasing. Today, VHI and free CHI coexist like two parallel worlds. This is despite the fact that often the services for them are provided in the same medical institution. How to get into the "good" world of medical services? This is usually done through insurance at your facility. But gradually, insurance companies are beginning to be interested in individual customers. Today in St. Petersburg you can choose exactly the program that suits you the most. Insurance companies now want to insure individuals. And it's time for us, those individuals, to learn how to choose the very best.

The peculiarity of the situation is that violent advertising campaigns encourage manufacturers to do a lot of pleasant things for people - more than before. But the campaigns are running. What is happening now in the insurance market is not just a temporary campaign. Insurers are beginning to focus on a new category of customers. The best way to win their sympathy is to behave like a human being.
Insurance companies show people their willingness to delve into their problems informally. Here is a typical case: a client of an insurance company, insured under the Outpatient and Home Doctor programs, suffered a mild stroke. The hospital doctors sent him home, prescribing medications and monitoring by a neurologist. Due to health reasons, he could not go to the clinic, and according to VMI, his program did not provide for a home visit by a specialist. But the very next day, the company sent their doctor to his house, and the doctor observed the patient for a long time. In fact, the company did it at its own expense.
Of course, it is possible to assume advertising intent in the actions of insurers - the client will tell his friends about what happened. But this is the essence of civilized business. His law: to be noble is profitable. And it is a sin for clients not to take advantage of excellent opportunities.
As for insurers, good deeds are contagious. If it is possible to combine humanity with profitability, any normal businessman will do so. In the field of VHI, this leads to the development of new programs and their "human" execution.
In the St. Petersburg market, such a trend is taking shape today. Of course, you can use its fruits "not for your money." To do this, you need to influence the management of your enterprises. There are many means: trade unions, collective agreement, public opinion.

DMS - THE MAGIC WAND OF MANAGERS

Numerous studies of consulting agencies and expert organizations show that VMI today can be one of the most effective elements in the field of personnel management. Only many managers of small and medium-sized enterprises do not yet know about it.
If the company does not have enough funds to increase salaries, its management is faced with the destruction of the motivational system. Good employees leave or start working carelessly. Losses from theft and fraud increase, labor productivity decreases. Punitive measures do not help, the threat to the economic security of the enterprise is growing. And what to do? The company has no money to increase salaries! A competent leader in such cases resorts to additional motivation.
An agency workshop gave the following example. There was a huge turnover at one service industry enterprise. The theft began. It was impossible to hire new good workers or keep old ones, since the salary was 3,500 rubles. The company's income made it possible to raise wages by 300-400 rubles a month, but the management did not believe that this amount would change anything in the attitude of employees to duties.
Then the expert, after an interview with the staff, offered to issue VHI insurance for the team, as well as pay 3,000 rubles in the form of bonuses ("the thirteenth salary") at the end of the year. For the enterprise, the conclusion of the VHI agreement meant the payment of an insurance premium of about 600 rubles per year for each employee. But the volume of medical services that an employee could receive was dozens of times higher than this amount.
The company's expenses for VHI and the bonus cost just the money that it could have spent on an inefficient salary increase. Interestingly, after that, the turnover decreased by half, theft almost stopped. A year later, out of increased profits, the company raised salaries by 2,000 rubles a month and got rid of difficulties with staff.
Why has VMI become the favorite of workers' sympathies today? Two interrelated reasons can be named: the formation in society of the concept of "values ​​of health" and the steady deterioration of the latter among the majority of the population. The insurance coverage of VHI is in stark contrast to the powerless OMS machine. Faced with a caring attitude towards their health, a person will appreciate it much more than the presentation of a diploma or a random ticket to a boarding house. And positive reactions from high-quality VHI service are transferred to the one who provided it. To the "home company".

Prepared by Sergey Dovbnya.

Specialists - about DMS

Experts from insurance companies answer questions from Komsomolskaya Pravda about the problems and trends of VHI.

— Is the interest of individual citizens in VHI insurance growing, and which groups of the population are buying these policies the most?

Alexandra Bogdanova, Director of VHI, IC "ASK-Med":

- Over the past six months, the demand for VHI policies has grown significantly. Most of all, the topic of VHI is of interest to parents, because assistance to children under the compulsory medical insurance system is getting worse due to the lack of district doctors and the overload of free institutions. Insurance companies offer parents not only the infrastructure of quality treatment. Programs "family doctor" allow you to monitor the child constantly and prevent severe forms of disease. In addition, VHI is becoming popular with migrants, people from other regions and even countries. Voluntary medical insurance for them (in the absence of a compulsory medical insurance policy and unformed documents for work) is the only way to receive permanent medical care.

— What VHI programs are most in demand by citizens?

Alexey Kuznetsov, director of IC "Capital-Polis":

— In our opinion, VHI family programs have the best prospects. Consumers already understand the benefits of treating the whole family with one doctor. Constant monitoring by a family doctor is especially effective in chronic diseases. Such a doctor not only helps patients recover, but also provides prevention, early diagnosis and the establishment of a healthy lifestyle. The experience of our company shows that one of the most promising areas for the development of VHI programs is the creation of Family Medicine Centers in different parts of the city. This saves the client time and money.

— What VHI programs, in your opinion, are the most promising?

Valery Ovsyannikov, General Director of IC "Virilis":

— From our point of view, VHI programs for children and adolescents are one of the most promising areas of insurance. Firstly, because children are still our future, and the health of children is the health of the nation (although, perhaps, it sounds hackneyed). Secondly, because by purchasing a VHI policy, parents acquire both peace of mind and confidence that the necessary medical care in the right amount and at the right time will be provided to their child. And, finally, today we are well aware that you have to pay for high-quality medical services and, often, pay a lot. The company's liability limit under all VMI agreements for pediatrics is many times higher than the amount that parents pay when concluding the agreement, and this is an extremely important circumstance.

— What VHI clients are most interesting for insurance companies?

Tatyana Voloshina, director of the medical insurance center of the Russkiy Mir insurance company:
— To date, insurance companies are most interested in collective agreements with enterprises. As a rule, enterprises acquire comprehensive insurance programs that include outpatient and inpatient treatment, and an ambulance call. Due to the large number of insured, the company minimizes premiums, and the insurance company provides a wide range of services. And insured workers benefit the most from this.

- Why is a VHI policy better than applying for paid medicine on "your own behalf" for a specific disease?

Inna Vishnevskaya, head of the voluntary medical insurance department of IC "RESO-Garantia":

- Firstly, in the case of treatment "on their own behalf", the patient will have to pay the full cost of treatment - in some cases, the funds may not be enough. Secondly, medical institutions in such cases tend to inflate prices and impose additional services. The VHI policy protects the patient from unnecessary expenses and loss of time. Thirdly, the voluntary health insurance system is just a system. The specialist will direct you exactly where you need it. Choosing a clinic on their own, the patient runs the risk of being a victim of advertising or incompetent advice. And finally, the insurance company is the guarantor of the protection of the rights of the patient.

A mature business protects itself from employee illness

A new insurance project is able to solve a whole range of problems for an employee and an organization

When a person begins to take care of his health, this means that he has reached maturity and shows elementary responsibility towards himself and his loved ones. And when a leader takes care of the health and medical protection of his subordinates, it means that his business has reached maturity. The manager looks ahead and plans the attitude of the staff towards the company, the quality of their work, the safety of the business and the maximum effect from the funds spent on motivation. VMI today allows you to solve a whole range of problems of the employee and the organization.
Aleksey Nikolayevich Kuznetsov, General Director of IC Capital-Policy, commented on this: “In recent years, organizations have been concluding more and more VHI agreements. Managers understand that today VHI has become the basis of a system of non-material incentives. VHI is even more beneficial for the employer because costs are included in the cost.
Indeed, if a person gets sick less, labor productivity increases and working time is saved. And if you still get sick, then the insurance company makes the chain of calls to various specialists optimal. Without queues, confusion and unreasonable bureaucracy.
VHI attracts highly qualified employees and stabilizes the situation in the team. Fear-protected employees feel valued to the organization. As a rule, this gives rise to a reciprocal feeling in them.
In addition, VHI is also a kind of inflationary insurance. The prices of medical institutions grow by an average of 20-30% per year. An insurance company negotiates with a medical institution to keep prices and discounts for its customers.
The company "Capital-Policy" has been specializing as a medical insurance company for 8 years. This made it possible to acquire a unique experience, which the company embodied in the insurance project "People's Policy". It will be carried out on the basis of the company's Family Medicine Center under the "Your Personal Doctor" insurance program. The project offers both individual and corporate insurance. The quality of insurance coverage really makes the project unique.
The heads of organizations can offer their employees a personal doctor for quite reasonable money, who will take care of their health and coordinate the actions of specialists. In addition to increasing the effectiveness of treatment and prevention of diseases, such a measure really raises the relationship between the employee and the employer to a new qualitative level. This can be especially interesting for small and medium businesses.
In small teams, the personal factor is especially important and can be easily corrected by means of proper management. "Personal Doctor" from the "People's Policy" project is the best suited for the recovery of small and medium-sized business organisms. Moreover, the prices for corporate insurance make the project undoubtedly affordable for many customers.
By offering the People's Policy project on the St. Petersburg market, the Capital-Policy company promotes a new quality of treatment, understanding and relations between all participants in VHI.

Protecting mothers and children...

IC "Virilis" offers effective insurance coverage to the most beloved and most vulnerable people: pregnant women, mothers, babies and children.
Insurance company "Virilis" provides customers with a wide range of insurance services. However, there is an area where IC "Virilis" occupies a leading position in the insurance market - programs to protect mothers and children. Working in this area requires special care and attention. It is here that the company "Virilis" has raised the level of services to the height of real quality and has no competitors.
"Virilis" offers to insure against an accident, possible complications during childbirth or after childbirth for a mother or child. Of course, none of the parents wants to allow this even in their thoughts. But the manifestation of responsibility towards the unborn child cannot harm his birth. Rather, on the contrary.
With a policy price of 200 rubles, the liability of the insurance company is 10,000 or more. Every third woman giving birth in our city is insured in Virilis.
In addition, the company offers VHI policies for monitoring during pregnancy. These policies guarantee a woman an attentive, individual attitude and high-quality medical protection in any worthy institution of the city.
But even after the birth of a child, "Virilis" helps parents by offering special programs for children of the first year of life and children from one to seventeen years old. Especially for children of different age groups, a program has been developed that includes a set of measures to prevent diseases specific to the age of the insured child. These programs involve the arrival of doctors at home, including a speech therapist and an exercise therapy specialist. It is these VHI policies that happy parents can give their children.

RESO guarantees quality and care

Real help to people can only be provided with impeccable technology.

Insurance company "RESO-Garantiya" occupies a strong position among the leaders in the field of VHI. The company can offer a set of quality insurance programs to both organizations and individuals. The complex includes outpatient and children's programs, dental care, inpatient, spa, rehabilitation treatment and others. Programs can be combined at very different levels of prices, volumes of assistance and choice of services.
Managers can create a package for their employees based on the capabilities and needs of the enterprise. When planning an insurance strategy, you should remember: discounts apply when renewing the VHI contract. After the first period of cooperation, the company already represents the health situation in the team and goes to reduce the fee for the contract. In addition, after a year of quality service under the VHI program, there are much fewer patients at the enterprise!
And people insured under good VHI programs will always remember how genuine medical care differs from ordinary ordeals in hospitals and clinics.
For 10 years of work, "RESO-Garantiya" was able to build up an impeccable technology for providing all types of medical care to its wards. The company relies on the work of its own structure of services - therapists, emergency medical services, family doctors. Naturally, their own doctors treat the matter with the appropriate level of responsibility and professionalism. These are people who do not work "on the stream". For them, a high level of service is indeed the norm. After all, VHI means an individual approach to each patient.
In addition, RESO-Garantia has established contacts with almost 500 medical institutions. Among them are leading medical centers with the most advanced technologies and technical equipment in medicine.
The company "RESO-Garantia" is respected by all partner medical institutions. A client with a VHI policy "RESO-Garantia" will always be provided with high-quality medical care, and additional requests will be fulfilled.
And for individual clients "RESO-Garantiya" can offer programs of emergency assistance, personal doctor, nurse patronage.
Clients of "RESO-Garantia" renew their VHI contracts and recommend us to their friends. This is the best advertisement for our work. After all, together with the policy "RESO-Garantia" gives its customers attention and care. And with the start of the work of its own medical center, the service of the insured will rise to a qualitatively new level.
As a result, having once met and started cooperation, we no longer part with our wards. Good friends are not lost, they are treasured!
"Russian world" everywhere at the highest level
Russkiy Mir Insurance Company offers all types of VHI programs in St. Petersburg and the Leningrad Region
For insurance companies, a sign of a high level of VHI development is the presence of their own medical center or their own ambulance service.
Russkiy Mir is the only company in St. Petersburg that has both. Own medical center, medical ambulance service, round-the-clock dispatcher, own doctors - such an infrastructure allows you to make the treatment process continuous. The disease can be detected and treated from the moment a mild ailment appears. It is clear that this means a huge advantage for the client. The disease does not start, precious time is not wasted, costs are reduced. In addition, Russkiy Mir provides policyholders with any worthy medical facility in St. Petersburg to choose from for their programs. St. Petersburg hospitals, medical units, institutes cooperate with the Russkiy Mir company - everyone who is known as a manufacturer of quality medical services. This choice in the "Russian World" is really huge.

PROGRAMS FOR EVERYONE

In the same way, among the VHI programs of the Russkiy Mir, any client can find the one that suits him.
The Russkiy Mir company offers organizations and individuals a full range of medical protection. These are outpatient programs and programs for planned and emergency hospitalization, ambulance, children and families ... Convenient combinations of medical services for the client are offered at a standard or elite level. The conclusion of the VHI agreement is a creative process aimed at the benefit of the client.
Among the VHI programs there are programs that are especially convenient for organizations, such as "office doctor". Its meaning is in regular medical examinations, prevention and early diagnosis of diseases. Reception takes place right in the office, at a convenient time for the organization. This saves time and money for the employer and the insured. And in time, noticed and cured diseases no longer threaten losses in the future.
Citizens are traditionally attracted by the system of family doctors of the Russkiy Mir insurance company.
A family doctor is in charge of the health of the whole family: first of all, he helps health not to turn into "illness". If any disorders occur, then the help of a permanent specialist helps to cope with them as quickly as possible.
With this approach, the disease will not be able to cause serious damage to the health of family members. The family doctor is especially important for chronic patients. In combination with the supervision of a family doctor, nurse patronage, home procedures and other medical services that the client wants to include in the contract are possible.
Voluntary health insurance policies from the Russkiy Mir company make high-quality medicine affordable for both Petersburgers and residents of the Leningrad Region. This is served by the system of branches of the company.

According to the Law of the Russian Federation "On Health Insurance of Citizens of the Russian Federation" /2/, "voluntary medical insurance is carried out on the basis of voluntary medical insurance programs and provides citizens with additional medical and other services in excess of those established by compulsory medical insurance programs." In fact, this provision of the law is not respected: many HMOs offer VHI programs that cover the medical services provided for by the basic MHI program.

State statistics show high rates of growth in the contributions of individuals and legal entities to voluntary medical insurance and the volume of paid medical services provided to the population. But VHI has not yet become the main form of private health financing. Paid medical services developed at a faster pace than VHI /15/.

Let us present a comparative analysis of insurance premiums and insurance payments for voluntary and compulsory types of medical insurance according to the FSIS.

Table 2.7 Analysis of insurance premiums and insurance payments by types of medical insurance for 2005-2006, million rubles

It follows from the table that CHI is developing at a faster pace than VHI. So, if the growth rate of insurance premiums under the voluntary form of health insurance was 119.5%, then under its mandatory form, this figure was 141.0%. Similarly, for insurance payments: the growth rate was 107.9% and 140.3%, respectively, with voluntary and compulsory medical insurance.

It should be noted that in the "classic" risky form, VHI is carried out only by some Russian insurers when insuring certain individuals and legal entities. At the same time, the tariffs for this type of insurance are quite high. This is due to the fact that due to the insignificant distribution of VHI, there is a large amount of unprofitability of the sum insured. Namely, this statistical indicator is used as the basis for calculating tariffs for voluntary types of insurance. As a result, insurers who need to have sufficient insurance reserves to cover their obligations in risk insurance are forced to sell insurance services at a high price that ensures the accumulation of the necessary reserves. Few Russian insurers and insurers can afford to work in such conditions.

Until now, the main part of the VHI programs has been the options for providing "one-off" medical services - the so-called "monopolies" or "deposit insurance schemes". In these cases, the role of the insurer is reduced to organizing the provision of medical care to the patient within the amount slightly less than that which he paid. At the same time, funds from citizens and their employers initially go to the insurance organization, allowing the medical institution to transfer responsibility for accounting for these funds, formalizing contractual relations with patients, etc. to it.

Taking into account that the patient or his employer, when acquiring a monopolis, pays for the necessary services immediately before receiving them, we can state that there are no signs of insurance risk in this scheme. When concluding a contract, the size of the “insurance payment” is known in advance - the price of the service. Also, the main advantage of the VMI system is missing - the possibility of planning individual costs for medical care. From a theoretical point of view, funds received by a medical institution when operating under a monopoly scheme cannot be considered VMI funds. However, this form of service provision is the main one in the actual activities of medical insurance organizations, carried out under the name VHI.

Insurance under VMI programs is carried out by both individuals and their employers. Today, about 1.5% of Russian enterprises and organizations and 80% of foreign companies whose representative offices operate on the territory of the Russian Federation pay contributions for the VHI of employees. According to OJSC ROSNO, Russian enterprises provide 55% of the volume of collected insurance premiums for VHI, foreign - 35%

Considering the features of the combination of CHI and VHI in our country, it is also necessary to pay attention to the following circumstance. Persons insured under VHI programs usually hardly use the services paid for by compulsory medical insurance. Contributions paid for such persons to the MHI system become lost money for these persons.

Thus, a comparative analysis of VHI and CHI showed the unsatisfactory state and weak development of VHI in the Russian Federation, as well as the absence of a combination of VHI and CHI, which is well developed in foreign countries. The combination of VHI and CHI allows both forms of health insurance to complement each other and makes them more effective for both insurers and insured persons.

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INTRODUCTION

Conclusions on Chapter I

2.2 Results of the empirical study

2.3 Prospects for the development of the voluntary medical insurance system

Conclusions on Chapter II

CONCLUSION

BIBLIOGRAPHY

APPLICATION

INTRODUCTION

Voluntary health insurance is a form of health insurance in case of loss of health, which provides the possibility of full or partial reimbursement of medical expenses. The social and economic significance of voluntary medical insurance is to supplement the guarantees for medical care provided to the population free of charge through the system of budgetary financing of medical institutions and compulsory medical insurance.

Voluntary health insurance is becoming increasingly important in the development of private medicine. However, the penetration of this type of insurance into life is still not large enough.

In this regard, the object of research is the system of voluntary medical insurance.

The subject of the research is voluntary medical insurance programs.

The purpose of the study is to determine the features of the modern system of voluntary medical insurance.

To achieve this goal, it is necessary to perform a number of tasks:

To study the scientific literature on this issue;

To study the history of the formation of the voluntary medical insurance system in Russia;

Consider the features of voluntary medical insurance abroad;

Summarize the experience of insurance organizations working with voluntary medical insurance programs;

Develop a questionnaire and conduct an empirical study on this issue;

Determine the prospects for the development of a system of voluntary medical insurance.

Hypothesis: the development of a system of voluntary medical insurance is possible under the following conditions:

1) insurance companies will carry out activities to inform the population about the essence of voluntary medical insurance and its benefits;

2) new insurance products will be created within the framework of voluntary medical insurance.

The methods by which this study will be carried out include the analysis of scientific literature, questioning, generalization of experience, and conversation.

The practical significance of the work lies in the fact that the results can be used in the activities of insurance companies operating under voluntary medical insurance programs.

Base of the study: the study was conducted on the streets of the city and at enterprises with various forms of ownership.

The structure of the work includes: introduction, two chapters, conclusions by chapters, conclusion, bibliography and appendix.

CHAPTER I. THEORETICAL FOUNDATIONS OF THE STUDY PROBLEM

1.1 The essence of voluntary health insurance

The insurance business is an important economic institution that existed in various economic formations, one of the developing types of business. Insurance is designed to satisfy the essential and fundamental human need - the need for security. The increasing role of insurance in the modern economy, on the one hand, and the growing differentiation of legal norms for regulating the life of society and the economic activity of people, on the other, determined the formation of insurance law as a specific part of the legal system of the state and a complex branch of legislation (43).

The limited basic program of compulsory health insurance, the lack of motivation among medical workers, the inaccessibility of modern clinical and laboratory facilities in the face of deteriorating health care financing have led to an aggravation of problems associated with obtaining qualified medical care. In this regard, the only possible system for the provision of medical services at a qualitative level remains the system of voluntary medical insurance.

The Constitution of the Russian Federation in Article 41 proclaims the right to health care and medical care, putting it on a par with such social rights as the right to pension and social security, the right to housing, the right to protection of motherhood and childhood. Economic guarantees themselves are a system in which the central place is occupied by state (budgetary) financing, compulsory health insurance (CHI) and voluntary health insurance (VHI). Voluntary health insurance occupies a worthy place among the economic guarantees of the right to health care and is one of the most effective among them.

From an economic point of view, voluntary health insurance is a mechanism for compensating citizens for expenses and losses associated with the onset of an illness or accident, i.e. insured event - (in VMI) the insured person's appeal to a medical institution (doctor) for medical assistance.

Voluntary medical insurance is carried out on the basis of voluntary medical insurance programs and provides citizens with additional medical and other services in addition to the established compulsory medical insurance programs (32, p. 54).

Voluntary medical insurance is carried out on the basis of an agreement between the insured and the insurer. The rules of voluntary medical insurance, which determine the general conditions and procedure for its implementation, are established by the insurer independently in accordance with the provisions of the Law of the Russian Federation of November 27, 1992 No. 4015-1 "On Insurance". Specific conditions of insurance are determined at the conclusion of the insurance contract.

In accordance with the contract of voluntary medical insurance, the insurance company (or its representative - insurance agent) issues to each insured person an insurance policy of voluntary medical insurance, which indicates:

The name of the insurance program of voluntary medical insurance chosen by the insured when concluding the VHI contract (for example, "outpatient medical care", "inpatient medical care", "comprehensive medical care", "dental care", etc.) - insurance program of voluntary medical insurance contains a list of medical services that the insured person can receive if necessary. A detailed description of the insurance program of voluntary medical insurance with a list of medical services is contained in the so-called "VHI Rules", developed by each insurance company independently, agreed with the Federal Insurance Supervision Service of the Russian Federation and without fail attached to the contract of voluntary medical insurance;

A list of medical and service institutions to which, if necessary, the insured person can apply. The insurance company entered into financing agreements with all these medical institutions, providing for the admission by the medical institution of patients with voluntary medical insurance policies of this insurance company and the subsequent payment by the insurance company for the rendered medical services. Price lists with contractual prices for medical services are attached to the financing agreements. In practice, the insured person does not apply directly to a medical institution, but to a service company or to the doctors-organizers of the insurance company, and they already organize the provision of medical care: they agree on the time of admission of the patient, conduct diagnostic tests, deliver the patient to a medical institution, etc. .;

Sum insured - the maximum total cost of medical services that this insured person can receive under this VHI insurance policy (44).

The subjects of voluntary medical insurance are: a citizen, an insurer, an insurance medical organization, a medical institution.

The insurers in case of voluntary medical insurance are individual citizens with legal capacity and/or enterprises representing the interests of citizens. If the court recognizes the insurant during the period of validity of the contract of voluntary medical insurance as incompetent in full or in part, his rights and obligations are transferred to the guardian or custodian acting in the interests of the insured.

Insurance medical organizations are legal entities that carry out voluntary medical insurance and have a state permit (license) for the right to engage in voluntary medical insurance (32, p. 71) .

Medical institutions in the VHI system are licensed medical institutions, medical research institutes, other institutions providing medical care, as well as individuals engaged in medical activities, both individually and collectively.

The object of voluntary medical insurance is the insured risk associated with the costs of providing medical care in the event of an insured event. An insured risk is a prospective event against which insurance is provided. An event considered as an insurance risk must have signs of probability and randomness of its occurrence (13, p. 17).

The insured has the right to:

Participation in all types of health insurance;

Free choice of insurance organization;

Control over the fulfillment of the terms of the medical insurance contract;

Repayment of a part of insurance premiums from an insurance medical organization under VHI in accordance with the terms of the contract.

The insured company, in addition to the rights listed above, has the right to:

Reducing the amount of insurance premiums with a stable level of morbidity among employees of the enterprise or its decrease within three years;

Raising funds from the profit (income) of the enterprise for voluntary medical insurance of its employees.

The insured is obliged:

Make insurance premiums in the manner prescribed by the contract of voluntary medical insurance;

Within its competence, take measures to eliminate adverse factors affecting the health of citizens;

Provide the insurance medical organization with information on the health indicators of the contingent subject to insurance.

Voluntary medical insurance funds are formed in insurance medical organizations at the expense of funds received from insurance premiums. They are intended for financing by the insurance organization of medical and other services provided under this type of insurance.

Voluntary medical insurance is carried out at the expense of profits (income) of enterprises and personal funds of citizens by concluding an agreement. The amount of insurance premiums for VHI is established by agreement of the parties. The insurance premium is the payment for insurance, which the policyholder is obliged to pay to the insurer in accordance with the VHI agreement. Tariffs for medical and other services under VHI are established by agreement between the medical insurance organization and the enterprise, organization, institution or person providing these services. The insurance rate is the rate of the insurance premium per unit of the sum insured or the object of insurance. Tariffs should ensure the profitability of medical institutions and the modern level of medical care (16, p. 25).

From January 1, 1993, legal entities that direct funds from profit for voluntary medical insurance of employees of the enterprise, members of their families, persons who have retired from this enterprise, are provided with tax benefits in the amount of up to 10% of the amount allocated from profit for these purposes.

The main features of compulsory insurance in accordance with Chapter 48 of the Civil Code of the Russian Federation, Part 2 are:

The obligation to insure arises from the law,

The objects of insurance are personal and property insurance, civil liability insurance,

The obligation to insure may be assigned to persons specified in the law in the event of an insured risk, that is, in the event of damage to life, health or property of other persons specified in the law, or violation of contracts with other persons.

Health insurance does not meet these criteria, except for the first one, which refers to CHI. First, the object of health insurance is to maintain the health of citizens by providing medical care at the expense of health insurance funds. Secondly, the conclusion of an insurance contract does not imply the presence of an insured risk, and the insurance payment is not made upon the occurrence of an insured event. Moreover, the provision of medical care involves the implementation of preventive measures. All these features are typical for both compulsory and voluntary medical insurance, since the object of voluntary medical insurance is also to maintain the health of citizens, but by providing additional medical care (additional medical services) in excess of the established programs of compulsory medical insurance. In this case, the definition of the object of voluntary medical insurance given in Article 3 of the current law on health insurance is questionable, since, in our opinion, it is also unlawful to talk about an insured risk and an insured event for voluntary medical insurance, as well as for compulsory medical insurance ( 14, p. 83).

Now let's move on to the consideration of the features that are specific to voluntary health insurance, that is, its main differences from compulsory health insurance. The differences between compulsory and voluntary health insurance are as follows:

Firstly, the obligation of insurance in case of compulsory health insurance follows from the law, and in case of voluntary health insurance it is based only on contractual relations, which, however, does not exclude the need for compulsory health insurance by concluding an insurance contract between the insured and the insurer.

Secondly, the main difference between compulsory and voluntary health insurance lies in the sphere of relations arising between their subjects in the provision of medical care at the expense of insurance funds. If compulsory health insurance is carried out in order to ensure the social interests of citizens, employers and the interests of the state, then voluntary health insurance is implemented only in order to ensure the social interests of citizens (individual or collective) and employers.

Thirdly, from the previous difference follows, in particular, the difference in who are the insurers in compulsory and voluntary health insurance: in compulsory health insurance, these are executive authorities and employers; in case of voluntary health insurance, citizens and employers.

Fourthly, relations on voluntary medical insurance, as well as on compulsory medical insurance, relate to social insurance, which pursues the goal of organizing and financing the provision of medical care to the insured contingent of a certain volume and quality, but under voluntary medical insurance programs (21, p. 40) .

However, voluntary health insurance, unlike compulsory health insurance, does not apply to state social insurance. First, due to the difference in the social interests they realize. Secondly, due to the difference in the forms of ownership and organizational and legal forms of insurance organizations that carry out social insurance. At the same time, it is understood that social insurance can be not only state, but also municipal, and given the differences in its internal organization, it can also be professional (according to professional and sectoral characteristics) and international.

However, the classification of social insurance on the basis of forms of ownership and differences in its internal organization (state, municipal, professional, international) does not coincide with the classification according to the forms of social insurance - compulsory and voluntary. Thus, compulsory health insurance and voluntary health insurance differ from each other according to the above types of classification (25, p. 89).

Fifth, as a result of the foregoing, pursuing common goals and having a common object of insurance - compulsory and voluntary medical insurance differ significantly in insurance subjects - they have different not only insurers, but also insurers. For voluntary health insurance, these are non-governmental organizations that have any organizational and legal form, for compulsory health insurance, these are state organizations (41).

Sixth, compulsory and voluntary health insurance also differ in terms of sources of funds. The financial resources of the compulsory health insurance system are formed from budget payments and contributions from enterprises, government bodies of the appropriate level. The amount of contributions for compulsory health insurance for enterprises, organizations and other economic entities is set as a percentage of the accrued wages. Voluntary medical insurance is carried out at the expense of the profit (income) of the enterprise and personal funds of citizens, the amount of insurance premiums is established by agreement of the parties.

In contrast to voluntary health insurance, with compulsory health insurance, the term of the insurance period does not depend on the term for paying insurance premiums, and the insurer is liable even if insurance premiums are not paid.

The basic CHI program is determined by the Government of the Russian Federation and on its basis a territorial program is approved, representing a list of medical services provided to all citizens in a given territory. With voluntary medical insurance, the list of services and other conditions are determined by the contract between the insured and the insurer (35, p. 28).

In addition, tariffs for medical services under CHI are determined at the territorial level by an agreement between medical insurance organizations, government bodies of the appropriate level and professional medical organizations. Tariffs for medical services under VHI are established by agreement between the insurance medical organization and the medical institution, enterprise, organization or person providing these services.

The quality control system under compulsory medical insurance is determined by agreement of the parties, with the leading role of government authorities, and under VHI is established by agreement. In addition, many differences can be listed, for example, in terms of legal regulation mechanisms, but we have indicated the most basic ones.

If we talk about the combination of two types of health insurance, it should be noted that in Russian reality the process of combining compulsory and voluntary health insurance occurs largely spontaneously. The lack of medical care received in the public health sector forces patients to look for ways to obtain the missing medical services at the expense of personal income or employers' funds (15, p. 46). At the same time, citizens belonging to the category of socially unprotected - chronically ill and low-income citizens can use such opportunities to a much lesser extent. And they are the ones who need more medical care. With insufficient medical care for this category, the need for it increases. As a result, the disproportion between the volumes of medical care needed and available to these citizens is growing.

1.2 The history of the formation of the voluntary medical insurance system in Russia

For the first time, voluntary health insurance was discussed in the 1990s, towards the end of Gorbachev's perestroika, when it finally became clear that the state was unable to fulfill its obligations to finance health care. An economic catastrophe was approaching, which increasingly affected the implementation of social functions by the state. Under these conditions, it was decided to turn to the experience of other countries, where national health systems had various sources of funding that complemented each other. Organizers of health care, economists and legislators equally understood the need for reforms in the industry, first of all, a revision of the concept of financial support for health care.

In other words, voluntary health insurance - such as it is today - appeared only two decades ago. But this is only the end result of the evolution of health insurance, which has lasted for many decades. Let us consider the stages of development of medical insurance, which began in the first half of the 19th century (26, p. 40).

The prototype of what today is commonly called "employee insurance" first appeared in 1827 in St. Petersburg. At that time, the workers of individual enterprises expressed the initiative to create a mutual aid society. Its budget was formed by regular contributions from the participants, while the owners of the factories remained on the sidelines. The worker received monetary compensation if an accident occurred to him, resulting in a temporary or permanent loss of ability to work. In the event of death, payments went to the family of the member of the society. This principle formed the basis of the first sickness funds, which appeared only in the second half of the 19th century (18, p. 55).

The beginning of the next stage in the development of health insurance is considered to be 1842, when an announcement was printed in major periodicals that obliged all citizens belonging to the 4th and 5th categories (diggers, janitors, lackeys, stove-makers, etc.) to pay 60 kopecks. In return, they received the right to be treated in city hospitals for one year. By the way, their employers had to make regular contributions for clerks, cooks, barmaids and gardeners.

As is often the case in Russia, this form of health insurance arose due to the unwillingness of a separate department to spend money on treating the poor. At that time, such a duty lay with the police ministry, which wanted to relinquish additional responsibility. However, this did not last long: it soon became clear that the symbolic 60 kopecks per person did not even partially cover the actual costs of treatment. Therefore, during the reign of Alexander II, tariffs were raised to 1 ruble. Another 1 ruble for each worker had to be paid by employers (45).

No less interesting is another fact: since 1870, absolutely all citizens had to pay a contribution, regardless of social status and wealth. Including, these are nobles and merchants who have never been treated in city hospitals, but were observed by private doctors. Thus, compulsory health insurance appeared - the minimum necessary list of medical services that absolutely everyone could use. If you do not consider the details, then these are the features that are inherent in health insurance to this day. By the way, the decree provided for the categories of citizens who enjoyed benefits - these are members of the imperial family, officials, the military, children under 15, as well as employees of diplomatic missions and trade missions.

The turning point in the practice of health insurance is considered to be 1861, when the first normative act came into force, establishing the standards of compulsory insurance for state-owned mining plants. He demanded the establishment of auxiliary cash desks at the factories. They were engaged in the issuance of benefits for temporary disability caused by accidents, as well as the payment of pensions and compensation to the families of workers in the event of the death of breadwinners. After some time, an addition appeared, instructing managers to found hospitals on enterprises.

Medical insurance entered a new round of development after 9 years: in 1912, the III State Duma approved the law "On Insurance of Workers in Case of Sickness and Accidents." In fact, this document became the successor to the law of 1903, but it was radically different from it in content. In addition to the payment of benefits for disability or death, the legislative act obliged entrepreneurs to pay for medical services provided to participants in auxiliary funds. Including - emergency medical care, outpatient treatment, hospital stay, as well as obstetric care. The most interesting thing is that in terms of the range of services, such employee insurance is in many ways reminiscent of the basic programs of modern voluntary medical insurance. With the adoption of the law, sickness funds appeared in many regions of the country, and in St. Petersburg, the number of people who applied for medical care during the year reached 8% of the total number of workers (27, p. 41).

But five years later, this stage of evolution ended: the events of 1917 radically changed the approach to health insurance. Moreover, the term “insurance” itself disappeared from the normative acts for a long time: it was replaced by the expression “social security”, which is much more in line with the worldview of that time. With the establishment of Soviet power, medical care became equally accessible to all segments of the population, and the cost of it was completely taken over by the state. But today we can also note the reverse side of this approach - the low quality of service, as well as insufficient funding for medical institutions, which was carried out according to the residual principle.

Voluntary medical insurance in Russia gained the right to exist only in 1991, with the entry into force of the Law "On Medical Insurance of Citizens in the RSFSR". But at the very beginning, voluntary medical insurance was extremely inefficient: the amount of payments for an insured event did not exceed the amount of the insurance premium, and funds not spent on treatment were returned minus the insurer's commission. This situation suited entrepreneurs who used voluntary medical insurance to hide part of the employees' salaries from the tax authorities. In the future, more and more voluntary medical insurance programs appear on the market, providing for an amount of insurance coverage that exceeds the amount of the down payment.

A radical turning point occurred in 1995, when the requirements for companies providing insurance for employees under voluntary medical insurance programs became significantly tougher. In particular, the Russian Federal Service for Supervision of Insurance Activities completely banned the practice of returning unused funds in order to deprive businessmen of the opportunity to avoid the tax burden. From that moment on, voluntary health insurance entered the modern phase of development. Over time, more and more insurance companies began to appear on the market, offering their customers various programs of voluntary medical insurance. In addition, the range of services offered by voluntary health insurance has significantly expanded, and the popularity of such products among citizens and legal entities has grown.

Summing up, it is necessary to mention once again that in Russia voluntary medical insurance as an economic and legal category and type of insurance activity arose in 1991 with the adoption of the Law of the RSFSR "On Medical Insurance of Citizens in the RSFSR". The insurance model provided for by law was fundamentally different from the varieties of personal insurance that existed at that time. It was about a qualitatively new legal relationship for our legal system. The novelty was in the object of the insurance legal relationship arising under VHI. Its subject composition also looked in a new way. Personal insurance, including health insurance, widespread in the Soviet period, provided for payments directly to the insured upon the occurrence of an insured event (illness or other harm to health). The purpose of such insurance is to mitigate the possible financial losses of the insured as a result of damage to health. In this case, the property interests of the insured person were the object of insurance. The most common was the "simple" structure of the insurance legal relationship, which included the insurer and the insured as subjects, and the insured usually personally coincided with the insured (29, p. 35).

The current law of the Russian Federation "On health insurance of citizens in the Russian Federation" as an object of voluntary medical insurance defines the risk associated with the cost of medical care in the event of an insured event. At the same time, the law states that voluntary medical insurance "provides citizens with additional medical services and other services in excess of those established by compulsory insurance programs."

The objects of voluntary medical insurance are two groups of insurance risks:

1) the occurrence of expenses for medical services for the restoration of health, rehabilitation, care;

2) loss of income due to the impossibility of carrying out labor activities both during the illness and after - in the event of disability.

The legislation of the Russian Federation limited the object of medical insurance only to reimbursement of expenses for medical care.

The insurers in case of voluntary medical insurance are individual citizens with legal capacity and/or enterprises representing the interests of citizens. Voluntary medical insurance provided for a qualitatively new type of insurance relationship that was previously unknown to domestic insurance practice. Its object should have been the property interests of third parties, and not the insured person himself. The concept of the object was revealed in the law as "expenses but the provision of medical care." The subject composition of the legal relationship became more complicated, except for the insurer, the insured and the insured person, a medical institution was introduced into it as a person directly providing medical care (46).

But it should be noted that voluntary health insurance in Russia has not yet reached the level of European countries, and this segment of insurance services retains a huge potential for further development.

1.3 The system of voluntary medical insurance abroad

The most developed VHI system is in the USA, where it entered its heyday in the distant 30s. In total, in the United States today, more than one and a half thousand companies are engaged in health insurance, and more than 160 million people are covered by the VHI system, that is, almost 70% of the entire population of the States. VHI provides up to a third of the funding for American health care, which is considered the most expensive in the world. More than three-quarters of VHI in America is group (corporate) insurance provided by firms for their employees (46).

In the US, health insurance is voluntary and almost entirely provided by employers. Health insurance is the most common form of workplace insurance, but employers are not required to provide it at all. Not all American employees receive such insurance. Yet in the largest companies, health insurance is almost an indispensable condition.

There are many types of health insurance. The most common is the so-called compensatory insurance, or "fee-for-service" insurance. With this form of insurance, the employer pays the insurance company an insurance premium for each employee provided with the appropriate policy. The insurance company then pays for the checks presented by the hospital or other health care provider or doctor. Thus, the services included in the insurance plan are paid for. Typically, the insurance company covers 80% of the costs of treatment, the rest must be paid by the insured himself (47).

There is an alternative - the insurance of the so-called managed services. The number of Americans covered by this type of insurance is rapidly increasing. In this case, the insurance company enters into contracts with doctors, other medical professionals, as well as with institutions, including hospitals, for the provision of all services provided for by this type of insurance. Typically, medical institutions receive a fixed amount, which is paid in advance for each insured.

The differences between the two described types of insurance are very significant. Fee-for-service insurance pays for services that are actually provided to patients. With "managed services" insurance, medical institutions receive only a fixed amount per insured patient, regardless of the volume of services provided. Thus, in the first case, health care workers are interested in attracting clients and providing them with a variety of services, while in the second they are more likely to refuse to prescribe additional procedures to patients, at least they are unlikely to prescribe them more than necessary (33, p. 49).

In America, insurance medicine with its voluntary health insurance guards the health of its clients, guaranteeing not only payment for the medical service provided, but also high-quality treatment with traditional medicines. No insurance company will cover the cost of treatment using hypnosis, acupuncture, homeopathic or herbal remedies. From the point of view of insurance medicine, such therapy is unconventional and the effect of its use is controversial.

Health insurance in the US has another feature. There is a certain credit of trust in medicines prescribed by a doctor. But if the result from their use is insufficient and the disease progresses slowly but steadily, the next only correct stage of treatment for the clients of the insurance company is not prescribing drugs, but surgical treatment. The United States ranks first in the number of coronary artery bypass grafting operations (23, p. 68).

One of the basic principles of health insurance is the high efficiency of medical care. With regard to treatment costs, the insurance company covers the costs associated with applying the only correct treatment with a high success rate. Of course, the cost of heart surgery is very high, but less than the cost of drugs that need to be taken for quite a long time. And the effect of conservative therapy is not always desirable. Therefore, insurance companies prefer to incur large expenses, but once.

Americans are serious about their health. On the one hand, insurance companies protect their clients from unprofessional medical care, on the other hand, Americans trust their doctors and do not buy medicines without a specialist's recommendation.

With regard to voluntary health insurance in European countries, in most cases, VMI is being intensively developed as an addition to state financing of medicine, expanding the range of treatment and preventive services and financial opportunities for healthcare. For example, in small Israel, which is famous for the highest level of medical care, more than 70 companies (including foreign ones) operate in the VHI system, despite the fact that four of the largest insurance companies control half of this market. The VHI system covers almost a fifth of Israelis who use services not included in the basic programs of mandatory insurance funds, including nursing and patronage care (mainly for the elderly). The State Commission for Health Analysis in Israel believes that the role of VHI will continue to grow steadily in the future. Similar trends are observed both in Russia as a whole and in our region, where a network of large insurance companies operates (17, p. 46).

In Germany, an alternative (and supplement) to compulsory health insurance is voluntary (private) health insurance, which applies to citizens who, due to high incomes or professional activities, are not subject to compulsory health insurance, as well as to those persons who have the means and desire to receive additional alternative assistance to compulsory health insurance. The existence of two different forms of health insurance in the country is a positive factor that stimulates competition in the medical services market, which creates conditions for a more efficient and dynamic development of the existing healthcare system in Germany, improvement of the services offered and innovative activity. The main factor that determines the difference between compulsory and private health insurance systems is income, the amount of which exceeds the limit of compulsory health insurance (today it is 40.034 euros per year), which is the reason for applying for the services of the private health insurance system. As a rule, entrepreneurs or representatives of free professions, as well as employees whose incomes exceed the limit established by law, become participants in this system. At the same time, voluntary (private) health insurance also means the possibility of obtaining additional medical care in excess of the mandatory insurance system, which is relevant for all categories of the population. This is important if the insured in the MHI wants to receive a more expanded set of medical services. According to statistics, about 15% of the population are insured in the voluntary medical insurance system, 80% in the CHI system, 3% of which simultaneously use additional services from VHI programs (41).

Unlike compulsory voluntary health insurance, it offers a larger volume of medical services. For example, within the framework of VMI, there is a free choice of a hospital, as well as improved conditions for staying in it, services of a personal doctor, reimbursement of up to 100% of the costs associated with inpatient treatment (in MHI, as a rule, part of the costs is reimbursed by the patient). Compared to CHI, in which the amount of contributions does not depend on the degree of probability of an insured event, contributions in the voluntary health insurance system are formed taking into account individual risk. Private insurance companies use a large number of different regional and professional tariffs for this. Since age characteristics have a significant impact on the amount of insurance premiums, the most favorable rates in VHI are for young people. It should be noted that in recent years the volume of expenses of the German population in voluntary health insurance has been constantly increasing by an average of 5%. A significant difference from the CHI system is that for each age group insured in VHI there is its own financing of their expenses. In the context of the general complication of the demographic situation in all European countries (an increase in the number of pensioners in relation to the working part of the population), such a system for the formation of insurance premiums does not depend on this trend, and in the future, VHI may be one of the ways to avoid accumulating financial difficulties in the compulsory health insurance system ( 14, p. 82).

The distinguishing features of voluntary health insurance include higher amounts of sickness benefits (they are insured separately), reimbursement of expenses for spa treatment, the possibility of receiving full medical care abroad (since it is not required to conclude an additional insurance contract to the main one), as well as exemption from the payment of contributions in case of failure to seek medical care for 1 to 6 months (the MHI does not provide for such a service). The advantage of voluntary health insurance is also that the insured can, within a wide framework, independently choose the amount of medical care and services he wants, as well as their combinations. The choice of one or another set of medical services depends on the insurance program (30, p. 43).

In contrast to the compulsory in the system of private health insurance, the conclusion of an insurance contract occurs exclusively on a voluntary basis, the content of which (the volume and quality of medical services) is negotiated by the parties. If CHI is based on the principle of solidarity, then the functioning of the private health insurance system is based on the principle of equivalent cost recovery, according to which the amount of contributions to the insurance fund corresponds to the volume of services provided, the insurance risk specified in the contract, and also depends on age, gender, health status and other conditions that determine the amount of insurance and the amount of contributions paid. Unlike compulsory medical insurance in the private insurance system, the insured, receiving medical care, is obliged to pay for it himself, after which, by presenting the paid invoice to the insurance company, he can receive appropriate compensation for the costs of treatment in accordance with the insurance contract. An exception exists for paying for inpatient treatment, the costs of which may be burdensome for the patient. If there is an agreement between the insurance company and the insured, these calculations can be paid without the participation of the latter.

In contrast to compulsory medical insurance, in the system of voluntary medical insurance, insurance institutions providing sickness insurance are not bound by contractual relations with other participants in the healthcare system (doctors, doctors' unions, pharmacies, hospitals, etc.). The employer pays half of the insurance premiums, but only if their total amount does not exceed the amount of insurance under compulsory health insurance. Insurance in VHI for such categories of the population as the unemployed (if they were previously insured in VHI) and students differs from the general order. The fact is that the corresponding state institution undertakes partial financing of their participation (33, p. 49).

Whereas in compulsory medical insurance there is the possibility of free insurance for all family members with a small total income, there is no such possibility in the voluntary medical insurance system, therefore, regardless of income level, all family members are forced to conclude separate health insurance contracts.

Insurance companies operating in the private health insurance market do not directly limit the amount of medical care provided. The insured person must himself ensure that the medical services he needs are covered by the scope of insurance under the contract, which means that he must independently decide which form of treatment or examination suits him best. In general, unlike CHI, voluntary health insurance offers a higher degree of patient independence and, at the same time, greater responsibility. As in compulsory health insurance, in the system of private health insurance, the state legislates the principles of its functioning and standards, and also exercises control over its activities.

Thus, the voluntary health insurance system in force in Germany, performing the same functions as CHI, is both an alternative and a significant addition to compulsory health insurance. Having a different organization and principles of work, each of the systems is at the same time aimed at solving one problem - providing affordable, highly qualified medical care to the entire population of the country, which could be a positive example of the implementation and existence of an effective health insurance system in the context of economic and social restructuring. spheres of Russia.

Conclusions on Chapter I

1. Insurance is an important economic institution that existed in various economic formations, one of the developing types of business. Insurance is designed to satisfy the essential and fundamental human need - the need for security.

2. Voluntary medical insurance is carried out on the basis of voluntary medical insurance programs and provides citizens with additional medical and other services in excess of the established compulsory medical insurance programs. Voluntary medical insurance is carried out on the basis of an agreement between the insured and the insurer. The subjects of VHI are: a citizen, an insurer, a medical insurance organization, a medical institution.

3. The object of voluntary medical insurance is the insured risk associated with the costs of providing medical care in the event of an insured event. An insured risk is a prospective event against which insurance is provided. An event considered as an insured risk must have signs of probability and randomness of its occurrence.

4. Voluntary medical insurance in Russia gained the right to exist only in 1991, with the entry into force of the Law "On Medical Insurance of Citizens in the RSFSR". The purpose of such insurance is to mitigate the possible financial losses of the insured as a result of damage to health. In this case, the property interests of the insured person were the object of insurance.

5. The current law of the Russian Federation "On the health insurance of citizens in the Russian Federation" defines the risk associated with the costs of providing medical care in the event of an insured event as an object of VHI. At the same time, voluntary medical insurance "provides citizens with additional medical services and other services in excess of those established by compulsory insurance programs."

6. The most developed VMI system is in the USA, where it entered its heyday in the distant 1930s. In total, in the United States today, more than one and a half thousand companies are engaged in health insurance. In the US, health insurance is voluntary and almost entirely provided by employers. Health insurance is the most common form of workplace insurance. One of the basic principles of health insurance is the high efficiency of medical care.

7. In most European countries, VHI is being actively developed as an addition to public funding of medicine, expanding the range of preventive and curative services and financial opportunities for healthcare. In Israel, more than 70 companies operate in the VHI system, the VHI system covers almost a fifth of Israelis who use services not included in the basic programs of compulsory insurance funds, including nursing and patronage care.

8. In Germany, voluntary (private) health insurance applies to citizens who, due to high incomes or professional activities, are not subject to compulsory health insurance, as well as to those persons who have the means and desire to receive additional assistance alternative to compulsory health insurance. A distinctive feature of the VHI is the high rates of sickness benefits, reimbursement of expenses for resort treatment, the possibility of receiving full medical care abroad, as well as exemption from paying fees in case of not seeking medical help for 1 to 6 months (the CHI does not provide for such a service) .

CHAPTER II. PRACTICAL ASPECTS OF THE STUDY PROBLEM

2.1 Summarizing the experience of insurance companies operating in the voluntary medical insurance market

health care payment medical insurance

It is believed that the very idea of ​​insurance was invented by English merchants who suffered losses due to ships that had gone sailing and never returned. The merchants decided to distribute the damages equally in the event of loss or loss of ships. For this, deductions were made to the general fund - some part of the property participating in the expedition. Assistance was provided from this fund.

Today, in the conditions of modern market competition, insurance is one of the most profitable activities. The number of insurance companies and clients of these companies is growing.

At the same time, the leaders of the VHI market, the leading universal insurers of the federal level, which account for more than half of all premiums in this segment, are engaged in medical insurance mainly. So, only about a dozen companies provide medical protection to the personnel of most large industrial complexes in Russia, at the same time providing services to medium and small businesses, as well as private clients.

Among the companies operating in the VHI market, three groups can be conditionally distinguished, differing in the strategy of attracting customers (11, p. 89).

1. Insurance companies that are subsidiaries of financial and industrial holdings. The main task of these insurers is to organize medical care for the parent structure and companies that can influence it. As a rule, these companies operate in regions in accordance with the geography of the business of the founders. Having accumulated experience in working with "related" client companies. They begin to actively offer their services to their partners and other enterprises operating in their respective regions. Often in such cases, insurance is carried out with full or partial consideration of the principles of repayment. Most of the leaders can be attributed to such companies: SOGAZ Group, ZHASO, Kapital Insurance Group, SCM, Soglasie. In addition, Energogarant, which traditionally insures regional energy companies and companies close to the electric power industry, has its own market segments.

2. Companies operating in the compulsory health insurance program (through specially created subsidiaries) and largely building their marketing policy on this. The popularity of people, the ability to coordinate financial flows through the channels of compulsory and voluntary insurance, as well as established relationships with many clinics and hospitals allow these insurers to take a leading position in VHI. First of all, these companies include ROSNO and Spasskiye Vorota. However, they are not the only ones who combine the activities of VHI and MHI. Many regional insurers work on such principles.

3. Companies focused exclusively on the market clientele. They work only with those clients who have been attracted by various marketing programs. In any of the companies of this group, you can buy the entire range of insurance programs existing on the market: outpatient treatment with attachment to any of the leading medical institutions, inpatient treatment, "Ambulance", "Personal Doctor", etc. Such insurers include the leading Russian universal insurance companies Ingosstrakh, RESO-Garantia, Rosgosstrakh, UralSib, and Renaissance Insurance companies. VSK Insurance House and AlfaStrakhovanie are active in the mass VHI market.

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Characteristics of voluntary medical insurance: subject; policyholder; insurance cover. Basic health insurance programs: outpatient care; hospital treatment. Voluntary medical insurance policy.

Many insurance policy holders are wondering if they can take VHI tests. Most often they are issued in the direction of a doctor - if necessary. However, many biochemical studies are included in the general list of mandatory procedures, so the patient does not pay extra money for them.

The examination is carried out only in the clinic with which you have concluded an agreement. In this case, laboratory tests do not require payment and are carried out by specialists on the basis of a valid insurance contract.

Voluntary insurance analyzes

DMS analyzes in clinics selected under the policy are performed using ultra-precise equipment. The best specialists work in the laboratories, who promptly prepare the results of the examination. The patient does not spend much time waiting in line, because the work of the medical center is optimized for the frequency of visits and the number of clients.

There is no need to make an appointment with a doctor, you can seek medical help in any emergency. A blood test reveals a wide range of diseases at the earliest stages of development:

• endocrine;
• immunological;
• diseases of the reproductive system;
• oncological;
• bacterial;
• infectious;
• viral.

In order to have an examination, you must get a referral from your doctor. Both urgent and scheduled medical examinations are taken. At any time, you can consult a doctor to decide on a further treatment plan and diagnostic procedures. Specialists are always ready to help in order to provide you with a guarantee of a quick recovery.