Central Bank of the Russian Federation calculated: General cash collections Russian insurance companies on voluntary health insurance (DMS) in 2017 increased compared with the level of 2016 by 1.59% - from 137.8 billion to 140.0 billion rubles.
Recall: since 2010, the volume of federal fees and payments on DMS changed like this:
DMS. Volumes of fees / payments and their ratio. Russia (2010-2017)
| Year | Fees | Payments | The ratio of payments and fees (pay ratio),% | ||
| Fees (billion rubles) | Payments (billion rubles) |
Change for the last year (%) | |||
| 2017 | 140,0 | +1,59% | 105,8 | +5,14% | 75,58% |
| 2016 | 137,8 | +6,87% | 100,6 | +1,00% | 73,02% |
| 2015 | 128,9 | +3,94% | 99,6 | +4,64% | 77,27% |
| 2014 | 124,1 | +7,92% | 95,2 | +5,87% | 76,74% |
| 2013 | 114,9 | +5,81% | 89,9 | +10,29% | 78,23% |
| 2012 | 108,7 | +11,80% | 81,5 | +11,01% | 75,06% |
| 2011 | 97,2 | +13,32% | 73,4 | +11,84% | 75,59% |
| 2010 | 85,8 | — | 65,7 | — | 76,59% |
today».
Thus, in 2017, the All-Russian Growth of DMS fees was minimal over the past 7 years - even worse than in the first "fully sanctions" 2015.
The federal experts will tell about the fundamental reasons for such a slowdown. We will begin to descend to your regional level.
The most insured regions
The top 5 Russian regions in the absolute sizes of DMS fees and payments in 2017 looks like this:
DMS. Fees, payments and their dynamics. Regions of the Russian Federation. Top-5. (2017 year)
| A place | Region | The change For the post Year (%) |
A place | Region | The change For the post Year (%) |
||
| 1 | Moscow | 92,7 (66,19% ) | -1,9% | 1 | Moscow | 72,5 (68,56%) | +4,9% |
| 2 | St. Petersburg | 11,9 (8,48% ) | +8,0% | 2 | St. Petersburg | 7,8 (7,40%) | +7,1% |
| 3 | Khanty-Mansiysky JSC - Ugra | 3,8 (2,75% ) | +115,6% | 3 | Khanty-Mansiysky JSC - Ugra | 3,2 (3,02%) | +99,8% |
| 4 | Republic of Tatarstan | 2,8 (2,02% ) | +16,2% | 4 | Republic of Tatarstan | 1,9 (1,84%) | +3,3% |
| 5 | Sverdlovsk region | 2,0 (1,43% ) | -1,5% | 5 | Yamalo-Nenets Autonomous District | 1,6 (1,48%) | — |
| — | — | — | 6 | Sverdlovsk region | 1,5 (1,43%) | -5,8% |
Source: "City 812" according to the MiG "Insurance today».
As we can see, in some regions, the fees grew into a much more increasing degree than on average in the Russian Federation, but in some and fell (a wider list, see Insur-info.ru in the "Analytics" section). The same was with payments. At the same time, the dynamics of fees and payments in the same region coincided not always.
There is no regularity here, simply manifested the local short-term conjuncture.
For example, a year earlier (in 2016), fees in KMAO-UGRRE decreased by 47.1%, and payments are 46.6%. So, this district was where to grow in 2017. This happened: he increased both fees and payments 2 times. But if you discard this clearly extreme "breaking", it turns out that Petersburg in 2017, according to the total growth of fees and payments, it looked very decently well.
What, alas, you will not say about the ratio of these most payments and fees ("pay ratio").
A sharp question: pay ratio
In general, the pay ratio is a very important characteristic of the work of the insurance company. In a sense, even more important than the absolute size of its fees and payments. This coefficient characterizes the company from the point of view of its "willingness to pay". Alas, from all regions "DMSOVSKY" Top 5 in St. Petersburg in 2017 insurance companies They gave to the treatment of customers the smallest share of the amount that was collected before that, 65.8%.
DMS. Payout coefficients. Top 5 Regions of the Russian Federation (2017)
Source: "City 812" according to the MiG "Insurance today».
Approximately the same "medium-low" pay ratio was in St. Petersburg and in 2016 - 66.4%. This is not the lowest figure in the country, but still not worthy of praise.
For comparison: in the last "full" 2013, he amounted to 78.2% on average; In 2016 (year of the universal reaction to the crisis) - 73%, and in 2017 - 75.6%. So that the latter year You can even with satisfaction to note some growth of "payment readiness" of insurance companies.
This is how Petersburg looks like in this perspective:
DMS. Payout coefficients. St. Petersburg (2010-2017)
| Year | Fees (billion rubles) | Change for the last. Year (%) | Payments (billion rubles) | Change for the last. Year (%) | Payout ratio,% |
| 2017 | 11,98 | +8,03% | 7,82 | +7,14% | 65,89 |
| 2016 | 10,99 | +1,28% | 7,30 | -5,51% | 66,44 |
| 2015 | 10,85 | -0,5% | 7,73 | -1,96% | 71,21 |
| 2014 | 10,91 | +17,16% | 7,88 | +13,63% | 72,27 |
| 2013 | 9,31 | +15,89% | 6,94 | +17,77% | 74,51 |
| 2012 | 8,03 | +11,93% | 5,89 | +16,92% | 73,33 |
| 2011 | 7,18 | +16,31% | 5,04 | +10,50% | 70,20 |
| 2010 | 6,17 | — | 4,56 | — | 73,89 |
Source: "City 812" according to the MiG "Insurance today».
For comparison: the pay ratio in the West is 90%. True, it is necessary to take into account the "Western" level of inflation and the "Western" rates of the rise in price of medical services.
Of course, there were on the market and such companies that paid better than the rest. Compare their payable coefficients in St. Petersburg and in Russia.
DMS. Factors of paymentsc.attachments in St. Petersburg (Top-10) and in Russia as a whole (2017)
| Place in St. Petersburg | Company | The ratio of payments and fees in 2017 (%) | |
| In the market of St. Petersburg | On the federal market (a place) | ||
| 1 | Capital Polis | 82,90% | 84,26% (2) |
| 2 | Rosgosstrakh | 82,26% | 72,47% (4) |
| 3 | SOGAZ | 81,83% | 87,36% (1) |
| 4 | Reso-guarantee | 68,34% | 80,36% (3) |
| 5 | Alfapture | 65,75% | 67,77% (7) |
| 6 | Group Renaissance Insurance | 54,49% | 56,49% (9) |
| 7 | Alliance Life | 54,28% | 68,88% (6) |
| 8 | Ingosstrakh | 51,36% | 72,42% (5) |
| 9 | SPU | 27,62% | 45,92% (10) |
| 10 | VTB Insurance | 26,71% | 57,03% (8) |
| Middle Indicator for Top-10 | 59,55% | 67,05% | |
Source: "City 812" according to the MiG "Insurance today».
As can be seen, the "paid willingness" of the same DMS companies can noticeably differ at the level of the invention and at the level of "inside Petersburg". And the common degree of this willingness to pay from St. Petersburg Top 10 in 2017 was also lower than on average in Russia. What our city, of course, does not decorate.
The largest companies
The Federal Top-10 includes exclusively Moscow companies. Petersburg for the last 8 years have not appeared there.
At the end of 2010, the best DMS company from St. Petersburg was "MedExpress": then she ranked 19th in the country, having collected 792.3 million rubles. (0.92% of All-Russian volume). More in 2010, not a single Petersburg insurance company in the first thirty was not.
DMS. The largest insurance companies in Russia in terms of fees and payments. Top 10 (2017 year)
| № | Company | Fees, billion rubles. (% of the entire Russian market) | № | Company | Payments, billion rubles. (% of the entire Russian market) |
| 1 | SOGAZ | 52,8 (37,75%) | 1 | SOGAZ | 46,2 (43,65%) |
| 2 | Reso-guarantee | 12,6 (9,02%) | 2 | Reso-guarantee | 10,1 (9,59%) |
| 3 | Alfapture | 12,0 (8,60%) | 3 | Alfapture | 8,2 (7,71%) |
| 4 | Ingosstrakh | 8,5 (6,08%) | 4 | Ingosstrakh | 6,2 (5,84%) |
| 5 | Alliance Life | 6,6 (4,73%) | 5 | Alliance Life | 4,5 (4,31%) |
| 6 | Rosgosstrakh | 6,0 (4,31%) | 6 | Rosgosstrakh | 4,4 (4,11%) |
| 7 | Group Renaissance Insurance | 5,9 (4,23%) | 7 | Group Renaissance Insurance | 3,3 (3,17%) |
| 8 | SPU | 5,3 (3,76%) | 8 | VTB Insurance | 3,0 (2,84%) |
| 9 | VTB Insurance | 5,2 (3,76%) | 9 | SPU | 2,4 (2,29%) |
| 10 | Consent | 2, 8 (1,99%) | 10 | Consent | 1,7 (1,62%) |
| TOTAL | 117,9 (84,24%) | TOTAL | 90,1 (85,13%) | ||
| Rest | 22,1 (15,76%) | Rest | 15,7 (14,87%) | ||
| In total in the market | 140,00 (100%) | In total in the market | 105,8 (100%) | ||
Source: Central Bank of the Russian Federation; MiG "Insurance today».
Sogaz dominates the Federal DMS market absolutely, overtaking its closest competitor in terms of federal collection of 4.19 times.
Petersburg Registration and Federal Ambitions
In the federal Top-100 there were 10 companies whose head offices are located in St. Petersburg. According to the results of their All-Russian work, they often occupy the inconsistent places in the "collective" and "paying" ratings, so they divor into these ratings to two tables:
DMS. Volumes of fees in the federal market. Top 10 registered in St. Petersburg Insurance Companies (2017)
| Place | Company | Fees in Russia, million rubles. (% of the entire market) |
| 15 | Capital Polis | 896,0 (0,64% ) |
| 16 | MedExpress | 759,4 (0,54% ) |
| 19 | Liberty insurance | 617,7 (0,44% ) |
| 37 | Hayde | 227,3 (0,16% ) |
| 55* | * | 113,3 (0,08% ) |
| 59 | Uniti Re. | 97,6 (0,07% ) |
| 60 | Advant Insurance | 93,4 (0,07% ) |
| 63 | Help (CO) | 84,5 (0,06% ) |
| 90 | Ergo | 37,4 (0,02% ) |
| 178 | City Insurance Medical Company (GSMK) | 16,5 (0,01% ) |
Source: "City 812" according to the MiG "Insurance today».
DMS. Volume payments in the federal market. Top 10 registered in St. Petersburg Insurance Companies (2017):
| Payroll | Company | Payments in Russia, million rubles. (% of the entire market) |
| 15 | Capital Polis | 754,9 (0,71% ) |
| 18 | MedExpress | 509,8 (0,48% ) |
| 27 | Liberty insurance | 237,3 (0,22% ) |
| 33 | Hayde | 161,7 (0,15% ) |
| 41 | Uniti Re. | 121,6 (0,12% ) |
| 53 | Help (CO) | 73,4 (0,07% ) |
| 62 | Advant Insurance | 43,8 (0,04% ) |
| 73 | City Insurance Medical Company | 27,8 (0,03% ) |
| 92 * | Welfare General insurance (OS) * | 14,8 (0,01% ) |
| 102 | Ergo | 6,9 (0,006% ) |
Source: "City 812" according to the MiG "Insurance today».
History of renaming of the company: Welfare OS - " PPF insurance"-" Generally PPF Insurance "-" Region ".
Summary Easy and offensive: Insurance-born and prescribed stake in St. Petersburg medical companies In the federal market, the DMS is insignificant (the largests do not exceed 0.6-0.7%). However, in all regions, except Moscow, the position of local insurance companies is the same.
Here you are not Moscow
We will again go down from the federal level to the regional and look at the results achieved by St. Petersburg offices (branches) of local and federal DMS-companies when they were working within the boundaries of the city.
Places engaged in these companies (their branches) in "Collective" and "Payable" ratings again often do not coincide, so again we will form two separate tables.
DMS. Fees of federal insurance companies in the SPB market. Top 10 (2017 year)
| № | Company | Fees, billion rubles. (% of the SPB market) | Change for the last. Year (%) |
| 1 | SOGAZ | 2,34 (19,70%) | +12,5% |
| 2 | Reso-guarantee | 1,26 (10,64%) | -4,5% |
| 3 | Group Renaissance Insurance | 1,24 (10,48%) | -1,6% |
| 4 | Capital Polis | 0,89 (7,50%) | +12,5% |
| 5 | Alfapture | 0,81 (6,77%) | +61,8% |
| 6 | SPU | 0,78 (6,56%) | +56,1% |
| 7 | Alliance Life | 0,68 (5,77%) | -12,1% * |
| 8 | Rosgosstrakh | 0,59 (5,01%) | -32,2% |
| 9 | VTB Insurance | 0,53 (4,44%) | +263,4% |
| 10 | Ingosstrakh | 0,48 (4,01%) | +117,1% |
| TOTAL: | 9,60 (80,85%) | — | |
| Rest: | 2,27 (19,15%) | — | |
| In total in the market: | 11,87(100%) | — |
Source: "City 812" according to the MiG "Insurance today».
* Note: It seems that we have the only example of us when the assessment of the MiG "Insurance Today" is divided into an assessment given by the company's representative. So, Z.amvestler Director for Medical Insurance Branch SK "Alliance Life" In St. Petersburg, Majorova's Iphigenia claims: In 2017, the fees of this company in St. Petersburg increased by 8%. However, according toinsur.— info, For 2016, "Alliance Life" gathered 778.73 million rubles in St. Petersburg on DMS. True, for the 2015 rating, the regulator considered the results of the company with a little other name - just "Alliance". In 2016, these companies redistributed the DMS portfolios. Ms. Majorova is confident in its rightness and leads an argument: once the Central Bank of the Russian Federation "unsubscribed" a contract concluded by St. Petersburg branch in 2017, by 2016.
As we can see, only one local company has entered the St. Petersburg Top 10 - "Capital Polis", but it looks very worthy among the "federals" - as a very "strong middle pea", which has overtaken several famous "federals".
DMS. Payments for federal insurance companies in the SPB market. Top 10 (2017 year)
| № | Company | Payments, billion rubles. (% of the SPB market) | Change for the last. Year (%) |
| 1 | SOGAZ | 1,91 (24,47%) | +5,2% |
| 2 | Reso-guarantee | 0,86 (11,03%) | +10,6% |
| 3 | Capital Polis | 0,74 (9,43%) | +22,8% |
| 4 | Group Renaissance Insurance | 0,68 (8,66%) | -0,9% |
| 5 | Alfapture | 0,53 (6,75%) | +38,5% |
| 6 | Rosgosstrakh | 0,49 (6,25%) | -20,5% |
| 7 | Alliance Life | 0,37 (4,75%) | +5,1% |
| 8 | Consent | 0,32 (4,05%) | -11,0% |
| 9 | MedExpress | 0,31 (4,02%) | -3,8% |
| 10 | Ingosstrakh | 0,24 (3,13%) | +218,7% |
| TOTAL: | 6,46 (82,55%) | — | |
| Rest: | 1,36 (17,45%) | — | |
| In total in the market: | 7,82 (100%) | — |
Summary
Optional development: As part of the modernization of the OMS system, the state seeks to minimize the volume market DMS.that can negatively affect the entire health care system. In health development strategies until 2020, it is said that the work of the DMS market leads to a "reduction in accessibility and quality medical care The population serviced under government guarantees. " Based on this, the state does not support the development of the DMS market.
However, the conditions of insufficiency of funding for the health system such a position will lead to an increase in shadow payments and reduce the effectiveness of the entire OMS system. According to Expert RA, the work of the DMS market has a number of positive external effects: the growth of social stability, a decrease in information asymmetry in the market medical services, improving the effectiveness of the health care system and investment growth in construction medical centers. Considering these external effects, the state, on the contrary, should contribute to the development russian market DMS.
"Expert RA" has developed the main provisions of the DMS market development strategy that should become part of Health care system concepts. The main directions of the strategy: a clear separation of OMS and DMS systems, renewal of the product line and standardization of DMS contracts, as well as simplifying tax benefits.
Pricing is clarified: a direct dependence of the cost of medical services from the service and quality of equipment has appeared on the LPU market. A few years ago, the correlations between these indicators were not traced. The total increase in the quality of services is compared with 2006. medical institutions. In general, the evaluation of departmental clinics in all parameters turned out to be higher than private. The private polyclinic for adults revealed the inverse dependence of the cost of services from the professionalism of medical personnel.
The highest indicators for the price / quality ratio of the study were obtained:
- NUZ Central Polyclinic of Russian Railways (Polyclinic Services for Adults);
- Branch No. 5 of FSU "3 CVKG them. A.A. Vishnevsky Ministry of Defense of Russia "(polyclinic service for children);
- NUZ "Central Clinical Hospital No. 1 of JSC" Russian Railways "(hospital for adults);
- State Unitary Enterprise "Research Institute of Emergency Children's Surgery and Traumatology" Department of Health of Moscow (hospital for children).
Fiscal effect: The growth of deductions on OMS from 3.1 to 5.1% will reduce the budgets for the DMS.Especially noticeably this measure will affect the still unstable demand from small and medium-sized businesses, which grew up with the expansion of tax benefits in 2009 (the rate of assigning awards for the DMS to the cost increased from 3 to 6%). Nevertheless, the growth of the DMS market will continue at least by inflation of the cost of medical services. According to the "Expert RA" forecasts in 2011, the volume of the DMS market will be 89.6 billion rubles (+ 10%), in 2012 - 100.3 billion rubles (+ 12%).
The possibility of choosing an area and doctor oMS program, as well as the inclusion of a private clinics in the system of the individual clinics will lead to the redistribution of the DMS market. In this situation, 2 scenarios for the development of events are possible:
1) If it is possible to choose from the HDC clinic program with a high level of service and the quality of the services provided, there is no need to purchase the PMC policy. In the future, the OMS system may well provide serious Competition of the DMS.
2) High-level clinics will not want to log in into the OMS system, and instead they will include clinics low level. Then the demand for DMS will increase, and due to the lack of high-quality competition between clinics there will be no incentives for improving the service and quality of services provided by municipal clinics.
Treatment at the expense of insurers: Loss of business on DMS for 2010 exceeded 100%.The average significance of the combined loss-net coefficient for the first 9 months of 2010 was 99% (for 9 months of 2009: 90%). The main reasons for the growth of unprofitability: dumping, "cheats" of the LPU and the incorrect organization of the loss settlement system - payments are not carried out as a result of the offensive insurance case, but on the fact of visiting LPU.
7721 View
The Association of Private Clinics of St. Petersburg for the third time amounted to the rating of insurance companies selling Petersburgers policy of DMS..
In 2015, the Voluntary Medical Insurance Market formally grew up in reality. The volume of DMS fees grew by 1.6% in St. Petersburg. But it is necessary to take into account the price increase: the PMD policy went up by an average of 5-15%, services in the clinics of the city - by 10-12%.
Employers who form at least 90% of the total voluntary health insurance budget, buying PMD policies to their employees, reduced these costs. Many small companies simply excluded DMS from their social packages, large and medium-sized businesses optimized the DMS programs due to a reduction in the choice of medical institutions or refusal to insure the relatives of workers.
How these difficult conditions affected private cooperation medical clinics With insurance companies, demonstrates this rating.
Payments for private clinics
The table below shows the total rating of the amount of payments according to the clinics survey and site site.
1. RESO-WARRANTY
2. Alliance
3. SOGAZ
4. Rosgosstrakh
5. VTB Insurance
6. Alpha insurance
7. Renaissance Insurance
8. Consent
9. Ingosstrakh.
10. Capital Polis
11. MedExpress
12. Metlamif
13. Guide
14. Liberty Insurance
15. URALSIB
16. VSK.
17. British insururant
18. Energogarat, North European Branch
19. Krk Insurance
20. GSMK City Insurance Medical Company
21. Jaso.
22. Max
23. Energy Garante, Northwest Regional Branch
24. Transneft.
25. Capital Capture
26. Absolute Insurance (Former. Euro-Policy Claim)
27. Surgutneftegaz
28. Anchor
29. Swiss Garant
30. Investment and finance
31. Advant Insurance
32. RegionGarant
33. Insurance Business Group
34. Support (Former. Opening Insurance)
35. Helios.
36. SPASSKY GALOT.
Payment Discipline
The level of payment discipline of insurance companies reflects debts to clinics for 2015 as of April 1, 2016 and accuracy of compliance with the terms of payment in accordance with the terms of the contract during the entire 2015.
1. Investments and Finance, Helios
2. Insurance Business Group
3. Metlamif
4. Swiss Garant
5. British Insurance House
6. Alliance
7. Absolute Insurance (Former. Euro-Polis Claim), Surgutneftegaz, VSK, Sogaz, Rosgosstrakh, Renaissance Insurance
8. RESO-WARRANTY
9. Energogarant North-European Branch, MedExpress
10. Anchor
11. Jaso, Capital Insurance
12. Alfactory, Liberty Insurance
13. KRK Insurance, Transneft, RegionGarant, Energogarant North-West Regional Branch
14. Advant Insurance
15. Capital Polis
16. Ural Sib
16. SPASSKY GALOT.
17. Support (Former. Opening Insurance)
18. Ingosstrakh, GSMK (City Insurance Medical Company)
19. Hayde.
20. Consent
21. Max
22. VTB Insurance
In the list of insurers who have on March 30, 2016, the debt for 2015 in front of the clinics of the Association of Private Clinics, only 13 insurance companies entered. It should be noted that this list has decreased compared with last year, and in general, the financial discipline of solid insurers has grown. This is a positive dynamics, she talks about good financial condition St. Petersburg insurance market.
It is also important that the insurers have debt no more than 10% of the surveyed clinics.
In general, doctors recognize that insurers have become more noticeable to advance medical services. On the one hand, the clinic requires, trying to reduce financial risks, on the other hand, insurers themselves are ready to advance clinics, subject to discounts.
Accessibility of call centers
The quality of work of the Call-Centers of Insurance Companies was evaluated by their accessibility for the doctor's doctors, if necessary, approval of medical services.
1. Support (Former. Opening Insurance)
2. Anchor
3. RegionGarant.
4. Energy Garante, North European Branch
5. Energy Garante, Northwest Regional Branch
6. Krk Insurance
7. Swiss Garant, Capital Polis
8. Insurance Business Group, VSK, Capital Insurance
9. Jaso, Transneft
10. British Insurance House
11. Surgutneftegaz
12. Ural Sib, Guide
13. Metlamif
14. Advant Insurance, Spassky Gate
15. Alliance
16. GSMK City Insurance Medical Company
17. Liberty Insurance
18. Absolute Insurance (former. Euro-Policy Claim)
19. Renaissance Insurance
20. Investment and Finance
21. SOGAZ
22. Max
23. Consent
24. VTB Insurance
25. Alfactory
26. Medexpress
27. Helios.
28. Rosgosstrakh
29. RESO-WARRANTY
30. Ingosstrakh
Quality of programs of the DMS.
The quality of medical programs was evaluated by such a criterion as the volume of coordination of medical services, which, in essence, reflects the amount of medical care to patients on the DMS or the level of restrictions (exceptions) on insurance programs.
As clinics are interested in programs that do not limit the quality of treatment, then companies that have full programs have occupied a higher place in the ranking.
1. Metlamif
2. Alpha insurance
3. Starting insurance
4. VTB Insurance
5. Alliance
6. Capital Polis, VSK, British Insurance House, Rosgosstrakh
7. SOGAZ
8. Absolute Insurance (Former. Euro-Polis Claim)
9. Liberty Insurance
10. Transneft.
11. MedExpress
12. Renaissance Insurance
13. Consent
14. Guide
15. GSMK City Insurance Medical Company
16. Ural Sib
17. Max
18. RESO-WARRANTY
19. Insurance Business Group
20. SPASSKY GALOT.
21. Surgutneftegaz
22. Support (Former. Opening Insurance)
23. Energy Garante North European Branch, Swiss Garant, Ingosstrakh
24. Advant Insurance
25. Jaso.
26. RegionGarant.
27. Energy Garante North-West Regional Branch
28. Krk Insurance
29. Investment and finance
30. Anchor
31. Helios.
"In 2015, the trend was clearly traced, which appeared two years ago: Reducing the level of control by the Call Centers of Insurers. The insurers want to spend less on the content of the call center and give doctors more than the opportunity to make decisions on insurance events. In general, this trend cannot but rejoice, since it is aimed at increasing the satisfaction of the insured patient, the growth of efficiency and reduced costs of both parties, training doctors to a better understanding of the principles of insurance and rules of work on DMS programs, "explained cEO Associations of private clinics of St. Petersburg Alexander Solonin.
Quality of Administration of the Process of Medical Economic Examination
This rating Calculated in two parameters. The first is the quality of expert conclusions. The clinics evaluated the presence of reasonable reasons for refusal and how convincing for a physician form they were set out (see Table No. 5).
The second criterion is the deadlines for the design and transfer of expert opinions to clinics (see Table No. 6).
1. METLAF, ALFASTICHING, CAPITAL INSURANCE, CAPITAL-POLIS, Transneft, Insurance Business Group, Sports Gate, Surgutneftegaz, Support (Former. Opening Insurance), KRK Insurance, RegionGrant, Investments and Finance, Anchor, Helios, Jaso
2. Renaissance insurance
3. Alliance
4. Ural Sib, British Insurance House
5. Medexpress
6. SOGAZ
7. Max
8. Liberty Insurance, Advant Insurance, Energy Garante North-West Regional Branch, VTB Insurance, VSK,
9. Guide
10. Swiss Garant
11. GSMK City Insurance Medical Company
12. Rosgosstrakh, Absolute Insurance (Former. Euro-Polis Claim), Energogrart, North European Branch
13. Consent
14. RESO-WARRANTY
15. Ingosstrakh.
1. METLAF, ALFASTICHING, CAPITAL INSURANCE, CAPITAL-POLIS, TRANSNEFT, INSURANCE BUSINESS GROUP, SPASSKY Gate, Surgutneftegaz, support (former Ural Sib, Max, Liberty Insurance, Advant Insurance, Energogarant North-West, Guide Regional Branch, Swiss Garant, Rosgosstrakh
2. British Insurance House, MedExpress, VTB Insurance, VSK, GSMK City Insurance Medical Company, Absolut Insurance (Former
3. Jaso.
4. SOGAZ, consent
5. Ingosstrakh
1. Reso-Warranty, Sogaz
2. Renaissance insurance
3. VTB Insurance
4. Alliance, Capital Police
5. Alpharack, Liberty Insurance, British Insurance House
6. MedExpress, Metlaiff, Ingosstrakh, Rosgosstrakh
7. Absolute Insurance, Vax, Guide, Transneft, Energogrart (North-West Branch)
Sympathy clinics remained on the side of the SC "Reso-Warranty". It should be noted that the Troika Leaders also included "Renaissance Insurance" and "VTB Insurance", which last year occupied 5 and 6 positions in the rating of trust, respectively. They managed to move such large insurers as "Alliance", "Capital Polis" and "Rosgosstrakh". However, taking into account all other criteria for assessing the final rating of insurance companies looks different.
In the final table, the place is distributed based on the multiplicative indicator of the business reputation in the 6rd criteria above. Thus, according to the results of 2015, the SK "Reso-Warranty" moved from the first place on the third, "Sogaz" remained at the second, and the Alliance became the leader of the rating.
1. Alliance
2. SOGAZ
3. RESO-WARRANTY
4. RenaissanceStrack
5. Alpha insurance
6. Capital Polis
7. Rosgosstrakh
8. VTB Insurance
9. Metlamif
10. MedExpress
11. Libertyism
12. British Strakhovoom.
13. Consent
14. VSK.
15. Guide
16. Uralsib
17. Ingosstrakh
18. Capital Capture
19. Energogarant, North-European
20. Transneft.
21. Jaso.
22. Krk Insurance
23. GSMK City Insurance Medical Company
24. Absolute Insurance (formerly Euro-Polis)
25. Surgutneftegaz
26. Max
27. Energy Garante, North-West Regional Branch
28. Anchor
29. Insurance Business Group
30. Swiss Garant
31. Investment and finance
32. RegionGarant
33. Support (Former. Opening Insurance)
34. Advant Insurance
35. Spassky gate
36. Helios.
This time to survey, in addition to the private clinics, which are included in the SRO "Association of Private Clinics of St. Petersburg", another 11 largests were attracted medical organizationsactively working at the St. Petersburg market DMS. As a result, the total number of respondents amounted to 49 medical companies, which together manage more than 150 private clinics in our city. Questionnaires filled the heads of the clinics, experts, heads of departments and employees financial Services.
This year, the experts of the DMS market developed a fundamentally new method of drawing up a rating, which allows to combine indicators in several criteria that were previously evaluated separately separately.
1) The volume of payments listed by private clinics, this year was taken into account by both the clinics and information on the payment of insurance companies (on the reporting for the Central Bank from the site site, see Table No. 1).
2) The level of payment discipline - in the 2016 rating, two indicators were taken into account: the timeliness of bills of bills in accordance with the contract and the absence of debt for 2015 (see Table No. 2).
3) the availability of call centers (see Table No. 3).
4) Quality of DMS programs (see Table No. 4).
5) The quality of administration of the process of medical and economic expertise - in this ranking, were taken into account, on the one hand, the quality of expert opinions (see Table No. 5), and on the other hand - the timing of their provision to clinics (see Table No. 6).
6) Trust Clinic (see Table. No. 7).
For each of the criteria was drawn up its rating. These ratings were subsequently merged into the final, taking into account the weight coefficients whose value ranged from 3 to 30% (see Table No. 8). The biggest weight is 30% - at the indicator "The volume of payments by private clinics", the lowest weight - 3% - in the indicator "Compliance with the timing of the execution of expert opinions." The availability of the call center was estimated with a 5% coefficient. Obviously, private clinics cash flow Much more important than the availability of a call center.
Real market players of the DMS market participated in the ranking: 36 insurance companies (last year there were 39). From the register of insurers, in addition to the "dead souls", the UK was excluded, in 2015, a license was recalled or suspended. This is "Avesta", "ASK-Honey", "Hephaest", Insekoek, Oranta, "Help", as well as those with whom a significant part of the clinic terminated a contract due to the presence of financial problems.
Alexey Krylov, "City 812"
If, with thoughts about the state clinic, you already become bad, then you can buy medical insurance and be treated with comfort. We tell how much it costs and what to check before buying the policy, so as not to spend money in vain.
What depends on the price
Tariffs in the insurance business are quite difficult. The cost of the Voluntary Medical Insurance Policy (DMS) can affect several factors:
the level of the selected clinic;
additional options (dentistry, a doctor call to the house, the possibility of emergency hospitalization, etc.);
the state of your health;
your age.
Depending on all these circumstances, prices for annual service in the clinics range from several thousand to several hundred thousand rubles.
Clinic status
Everything is simple - the more prestigious clinic, the more expensive it is to be serviced. Thus, in the insurance company "Alliance Life", the policy can be purchased from 13.3 thousand rubles (service in the clinic "Oris") up to 165 thousand rubles (Clinic "Medsi" in Rorcholsky Lane), tells the head of the Individual Insurance Department of Innocent Maskaleson. In GK "Rosgosstrakh", the price variation is even wider: in the department of the insurer, correspondent comparable to.ru they said that the prices for policies begin from 17,000 in low-cost clinics up to 300 thousand in the status establishments.
Stomatology
Dental care increases the cost of the policy on average by 10-30%. Thus, in the company "Reso-Guarantee", the additional option of dental care will cost from 5.2 to 11.2 thousand rubles. And in the insurance company SCS, the addition of dental services will cost 2-15 thousand rubles.
Hospitalization
In the "Stuffing" of the Polis, it is also possible to include the possibility of emergency hospitalization - as a rule, these are several thousand rubles to the cost of insurance. For example, the CC "Consent" the possibility of emergency assistance within the Moscow Ring Road will cost an additional 3,420 rubles.
Individual parameters
To determine the exact cost of DMS for a particular person, the insurer will most likely offer to fill out a medical questionnaire. It takes several pages and contains health questions. For example, you may have to answer if you have a headache and how often do you take regularly any medicines, with what diseases you appeal to doctors before, etc. The older man, the greater the likelihood that such a survey will be mandatory.
Most of the insurers do not take into account the floor of the client. But there are exceptions. For example, in the company Ingosstrakh Polis for women is more expensive than for men.
"On the basis of statistics (not only our company, but also other insurers), women are more likely to seek medical attention. This is due to the fact that they are inclined to take care of their health. This is primarily expressed in "preventive" campaigns in a clinic with minor health complaints. Men have a certain psychological barrier in front of doctors. They seek help at much less often, but in more complex cases, which affects the severity of the disease, "explains the Deputy Director of the Ingosstrakh Medical Insurance Department Nikolay Owl.
How much is the policy standing
To understand how much the policy is on the average for people of different ages, we interviewed call centers and press services of the 10 largest insurance companies. Details about this process can be read at the end of the text. We learned the prices of insurance in which the dentistry is included, a doctor call to the house and, if necessary, the possibility of emergency hospitalization within the Moscow Ring Road. And that's what happened.
The average cost of the PMC policy in Moscow, rub.
It turned out that for people aged between the 20th and 50 years, within the framework of one company, the cost of the policy changes slightly. But the difference in the price of various companies can be significant. For example, the cost of the most affordable policy in the category of citizens up to 50 years - 29,470 rubles, the most expensive in the same category - 99,600 rubles.
The cost of the PMS policy is seriously increasing. Starting from 55-60 years, companies begin to use special coefficients that increase the price of insurance. For example, in the "reso-guarantee" for citizens over 60, the coefficient is valid, the increasing cost of the policy is 1.6 times, and for those who are over 70 years old - 2 times.
"For those who over 60, the tariffs will be individual and on average, 2-3 times higher than the standard," says Innokenti Maskaleson from Alliance Life.
There are situations in which the insurer may and at all refuse to sell the PMS policy. It has the right not to be insurance for persons who are registered in the drug treatment, psychoneurological, anti-tuberculosis, skin-venereological, oncological and other dispensaries, as well as in the Centers for the Prevention and Control of AIDS, or having the disability of the I-II group. "If we are talking about chronic diseases that lead to death, for example, diabetes of a certain group, then we have the right to not sell insurance," says Yegor Safrygin, director of the Marketing Department of the Block "Medicine".
What to check before buying
1. What is included in the policy
Each company has its own policy filling. For example, planned inspections (clovers, check up) in the classic DMS are not an insured event.
"This is a separate program developed by individual queries," says the managing director of the DMS Renaissance Insurance Group Natalya Kharina. Therefore, before buying, be sure to study, which is included in your policy, which is considered an insured case, etc. It may take time, but then you will not face unpleasant surprises.
2. In which polyclinics and hospitals can be addressed
Look at the list of medical facilities that are included in the program. "Make a choice in favor of a network clinic, which has the above-mentioned team, as well as the ability to visit not one, and at once several clinics of the network. It is better to choose those closer to geographically, "Egor Safrygin advises the director of the Marketing Department of the Block" Medicine ".
3. How can I sign up for doctors
It is important that you have the opportunity to quickly sign up for doctors. The fact is that many DMS polishes are built in such a way that you first need to call the insurance company, it can coordinate something for a long time and then gives direction. "The client should have the opportunity to directly call the clinic, which he chose, and promptly sign up for a doctor," says Yegor Safrygin.
4. What are the exceptions
Each company has its exceptions from programs. And sometimes the usual user they may seem completely illogical. Usually exceptions are prescribed at the end of the contract with the insurance. Spend time and read them.
Do not forget about the tax deduction!
If you bought a PMD policy for yourself or the closest relatives (spouse, parents, children under 18), then you can arrange tax deduction And return 13% of its cost. However, you can return no more than 15,600 rubles.
Submit an application for a tax deduction in the FNS department, by mail, through personal Area Taxpayer.
Set of necessary documents:
- declaration (available on the FTS website);
- copy of the passport;
- help 2-NDFL from work;
- application for tax refund;
- policy, license insurer, payments.
As we thought
We chose 10 insurance companies, which, according to the results of the first half of 2016, in terms of contributions in the DMS segment. In this ranking included insurance companies
IN 2015 The Voluntary Medical Insurance Market formally grew up in reality. The volume of DMS fees grew by 1.6% in St. Petersburg. But it is necessary to take into account the price increase: the PMD policy went up by an average of 5-15%, services in the clinics of the city - by 10-12%.
Employers who form at least 90% of the total voluntary health insurance budget, buying PMD policies to their employees, reduced these costs. Many small companies simply excluded DMS from their social packages, large and medium-sized businesses optimized the DMS programs due to the reduction of the selection of medical institutions or refusal to insure the relatives of workers.
How these difficult conditions affected the cooperation of private medical clinics with insurance companies, and demonstrates this rating.
This time, another 11 major medical organizations that are actively working at the St. Petersburg market of the DMS were brought to a survey other than a private clinics included in the SRO "Association of Private Clinics of St. Petersburg. As a result, the total number of respondents amounted to 49 medical companies, which together manage more than 150 private clinics in our city. The questionnaires filled the heads of the clinics, experts, heads of departments and employees of financial services.
This year, the experts of the DMS market developed a fundamentally new method of drawing up a rating, which allows to combine indicators in several criteria that were previously evaluated separately separately.
1) The volume of payments listed by private clinics, this year was taken into account by both the clinics and information on the payment of insurance companies (on reporting for the Central Bank from the site insur-info.ru, see Table No. 1).
3) the availability of call centers (see Table No. 3).
4) Quality of DMS programs (see Table No. 4).
5) The quality of administration of the process of medical and economic expertise - in this ranking, were taken into account, on the one hand, the quality of expert opinions (see Table No. 5), and on the other hand - the timing of their provision to clinics (see Table No. 6).
6) Trust Clinic (see Table. No. 7).
For each of the criteria was drawn up its rating. These ratings were subsequently merged into the final, taking into account the weight coefficients whose value ranged from 3 to 30% (see Table No. 8). The biggest weight is 30% - at the indicator "The volume of payments by private clinics", the lowest weight - 3% - in the indicator "Compliance with the timing of the execution of expert opinions." The availability of the call center was estimated with a 5% coefficient. Obviously, private clinics are much more important than the availability of a call center.
Real market players of the DMS market participated in the ranking: 36 insurance companies (last year there were 39). From the register of insurers, in addition to the "dead souls", the UK was excluded, in 2015, a license was recalled or suspended. This is "Avesta", "ASK-Honey", "Hephaest", Insekoek, Oranta, "Help", as well as those with whom a significant part of the clinic has dissolved a contract due to the presence of financial problems.
Payments for private clinics
"Previously, the payments indicator of private clinics were not taken into account, but his importance was recognized, because It reflects the experience of the insurer and the size of the client portfolio. The rating of the current year is unique in the fact that for the first time the clinic provided information on the volume of payment by insurers for insurance cases. For this, a special software was used, which guarantees the confidentiality of collecting and storing data and automatically processes the results to the level of the consolidated report, "comments the director of the EMC clinic, Chairman of the Committee on Standardization and Informatization of the SRO" Association of Private Clinics of St. Petersburg "Tatiana Romanyuk.
Payment Discipline
The level of payment discipline of insurance companies reflects debts to clinics for 2015 as of April 1, 2016 and accuracy of compliance with the terms of payment in accordance with the terms of the contract during the entire 2015.
In the list of insurers who have on March 30, 2016, the debt for 2015 in front of the clinics of the Association entered only 13 insurance companies. It should be noted that this list has decreased compared with last year, and in general, the financial discipline of solid insurers has grown. This is a positive dynamics, she talks about the good financial condition of the St. Petersburg insurance market.
It is also important that the insurers have debt no more than 10% of the surveyed clinics.
"In conditions economic instability Clinics must constantly monitor the market situation, assessing financial risks. These risks are always the same type: first the insurer begins to violate bills of payment, then the debts are accumulated, then the clinics will learn that the SC has already recalled the license and chances of the clinic to get money on debts from such insurers are zero. True, it should be said that, for example, the company "Help", who lost its license in 2015, has restored it at the end of the year. Now "Help" is making serious efforts to restore reputation and is calculated on debts with clinics, "Lev Averbach, CEO of Koriz Assistance (SPB) comments.
In general, doctors recognize that insurers have become more noticeable to advance medical services. On the one hand, the clinic is demanded, trying to reduce financial risks, on the other, the insurers themselves are ready to advance the clinics, subject to the provision of discounts.
Availability of call centers
The quality of the work of the coll centers of insurance companies was evaluated by their accessibility for the doctor's doctors if necessary for the coordination of medical services.
Rating of insurance companies operating in the DMS system
Quality of programs of the DMS.
The quality of medical programs was evaluated by such a criterion as the volume of coordination of medical services, which, in essence, reflects the amount of medical care to patients on the DMS or the level of restrictions (exceptions) on insurance programs.
"This indicator also reflects the specifics of the portfolio of insurance companies: companies capable of attracting solvent customers usually offer more filled programs. The presence of many SC abbreviated programs is talking about a certain market trend in the conditions of an unstable economy and reduced solvency, "Aleksey Vlasov emphasizes, the commercial director of Ava-Peter LLC (Ava-Peter's clinics and" Scandinavia ").
As clinics are interested in programs that do not limit the quality of treatment, then companies that have full programs have occupied a higher place in the ranking.
Rating of insurance companies operating in the DMS system
"In 2015, the trend was clearly traced, which appeared two years ago: Reducing the level of control by the Call Centers of Insurers. The insurers want to spend less on the content of the call center and give doctors more than the opportunity to make decisions on insurance events. In general, such a trend cannot but rejoice, since it is aimed at increasing the satisfaction of the insured patient, the growth of efficiency and reduced costs of both parties, training doctors to a better understanding of the principles of insurance and rules of work on DMS programs, "the Director General of the Private Clinics Association of St. Petersburg Alexander Solonin.
Quality of Administration of the Process of Medical Economic Examination
This rating was calculated in two parameters. The first is the quality of expert conclusions. The clinics evaluated the presence of reasonable reasons for refusal and how convincing for a physician form they were set out (see Table No. 5). "Often in acts simply lack reasonable arguments for the reasons for reference. Such a negligence in the work of experts and the lack of a dialogue between experts and doctors is a significant drawback, it forms a negative attitude towards the insurance company and leads to unwanted conflicts for us, "Konstantin Shako comments, the operating director of the" SMT "holding.
The second criterion is the deadlines for the design and transfer of expert opinions to clinics (see Table No. 6). "IN lately Some insurance companies allow themselves to send acts of expertise six months later and no more, without thinking that, according to the results, the examinations of the clinic lead financial and accounting, as well as explanatory work with doctors and that these work should be carried out by clinics in a timely manner, "Lion Averbach emphasized CEO "Corim Assistance (SPB)".
Rating of insurance companies operating in the DMS system
"We have certain difficulties in cooperation with some insurance companies in this matter. Medical and economic expertise is a process in which there are a lot of white spots, pitfalls and contradictions, tempting the parties to move away from the main objective of the examination, comments the deputy director of the Installation of the XXI Century Clinic, Oksana Adamenko. - And yet the main task is to provide high-quality medical care to the insured. And in this, our interests completely coincide with the interests of insurance companies. And the difficulties with the availability of call centers have both sides. We decide them, integrate the processes for faster communication. "
Rating of insurance companies operating in the DMS system
Sympathy clinics remained on the side of the SC "Reso-Warranty". It should be noted that the Troika Leaders also included "Renaissance Insurance" and "VTB Insurance", which last year occupied 5 and 6 positions in the rating of trust, respectively. They managed to move such large insurers as "Alliance", "Capital Polis" and "Rosgosstrakh". However, taking into account all other criteria for assessing the final rating of insurance companies looks different.
In the final table, the place is distributed based on the multiplicative indicator of the business reputation in the 6rd criteria above. Thus, according to the results of 2015, the SK "Reso-Warranty" moved from the first place on the third, "Sogaz" remained at the second, and the Alliance became the leader of the rating.
In more detail with the method of surveying experts and the results of the rating, you can find on the website of the SRO "Association of Private Clinics of St. Petersburg" www.acspb.ru.
