Mandatory medical insurance is. What is included in the list of free medical services provided by the Policy of the OMS? Refusal to provide free medical services. What to do

Receiving medical care for polish OMS, patients may encounter such inconveniences as long queues, insufficient paid services, Low quality service.

To avoid these troubles, the "OMS +" program was developed.

Prehistory

In early 2015, the Ministry of Health developed a new project in the framework of the Russian Health System Development Strategy for the next 15 years.

The project was called "OMS +", and its essence was to create additional medical insurance.

Patients who want to get a package medical servicesgreater than the mandatory package can purchase the "OMS +" policy. All paid procedures that were previously conducted through the Polyclinic Cassus, thanks to this program, can only be provided by a new policy.

With the help of the policy, it was planned to achieve an increase in the financing of the health system, since all hidden payments could now be carried out only through "OMS +".

The creation of such a program does not imply a reduction in the services on the ordinary policy. "OMS +" acts as an addition. The acquisition of the policy is not imposed.

The program did not become implemented throughout Russia, but only the pilot versions of the project in five regions launched: Tyumen, Lipetsk, Kirovskaya, Belgorod region, Republic of Tatarstan. The project participated a limited number of insurance companies and hospitals.

What is OMS +

OMS Plus is an additional package of services to the Mandatory Medical Insurance Program. Insurance company within the framework of mandatory insurance does not provide additional funding.

The patient must acquire the "OMS +" policy and the insurance, due to this policy, will pay the cost of additional services. Usually patients pay them independently at the Polyclinic Casse.

As a target audience of the program, citizens were considered, actively using additional services in conventional polyclinics. Such people got the opportunity to pay in advance with the discount specific medical services or the help of specialists at home, and not in the clinic.

In the volume of the "OMS +" policy, such services were to be cheaper for the end user than paid on the spot.

The project does not imply an obsessive distribution of insurance health services of individual organizations. The price of packages depends not only on the number of services included in it, but also on the degree of responsibility of the citizen for their health. Responsibility depends on the regularity of clinical examination, medical examinations, general health status, etc.

The "OMS +" includes 16 programs. Their tariffs and the price of the project participants were calculated on the basis of the content and direction. With this program, the Ministry of Health is trying to replenish financial support for health.

Insufficient amounts to ensure not only the quality of medical care, but increase the level of service.

Patients wishing to improve the quality of the service often pay extra doctors and staff without having no guarantees. Innovation is an attempt to bring shadow payments to the official level.

The first trial programs running in several areas did not meet expectations. This happened for a number of reasons:

1. Economic situation in the country
   The development of the project had to for a period with a more stable economy, and its implementation began at the time of regression in the economy. The expected demand for innovation did not follow.
2. No understanding of the principles of work
   The creators failed to carry out a clear boundary between the Policy of the OMS and the OMS + Package. Citizens did not have a complete understanding of the need for additional expenses. Some services within the package may seem optional to patients.
3. Lack of human and temporal resources
   There are no personnel in medical institutions to provide more medical services. Package OMS plus provides for a long-lasting doctor. To accomplish it, you need to either trigize the time of reception on the OMS (which cannot be done), or hire more specialists, but the project does not imply funding a staff increase.
4. Contribancy of certain conditions
   OMS + has a quantity limit laboratory studies. Assistance in the framework of mandatory insurance is not. It turned out that the paid package contains services less than free.
5. Lack of specific information
   Citizens do not want to buy a service that they are incomprehensible.

OMS + or DMS

At first glance, the "OMS +" package may seem like voluntary medical insurance. In fact, this is one of its forms, differing from the standard PMC policy as follows:

The program is similar to those that develop insurance organizations with a license for compulsory and voluntary insurance at the same time.

The Ministry of Health tried to combine two polishes, creating something average. Such a program is obtained cheaper than software, but gives a little more opportunities than mandatory insurance.

But if I decorated the policy of the DMS, you can be confident of the validity of spending, then many more questions remain around the "Program Plus".

Whether now and in which regions

The trial version of the "OMS +" program was launched in 5 regions: Tatarstan and Tyumen, Lipetsk, Belgorod, Kirov regions.

Later, private clinics of Moscow and the Moscow region joined the project.

For the first year in all regions involved in the project, only a few hundred policies were sold.

Residents of the Tyumen region can issue programs for newborns with medical care at home. Packages are divided into 3 levels depending on the number of medical services. Also insurance companies offer adult programs with video receivers.

In the Lipetsk region launched programs for pediatrics and dentistry for children.

In Kirov - programs for newborns.

In Belgorod - for adults and children.

In Tatarstan, 2 programs were introduced: "Heart under control" and "Medical support of the patient". The largest number of policies was sold in the republic.

The price of the policy varies from 2000 rubles to 50,000 rubles.

The Network Clinics "Doctor Near" in Moscow draws up the Policy "OMS +" cost from 7 thousand rubles.

Clinics "ABC-Medicine" also use innovation.

Some insurance companies create DMS products almost identical OMS. For example, program from VTB insurance.

At the moment, you can arrange the "OMS +" policy through the "DMS selection center". On the site you can calculate the approximate price, compare different types Programs and get a consultation of a specialist.

The first unsuccessful experience allowed the Ministry of Health to analyze and continue to improve "OMS +". Therefore, the final version of the project does not yet exist.

State health insurance of citizens

State health insurance of citizens is a mandatory procedure. Due to this, free medical care is provided. Insured by territorial or federal authorities.

Citizens are persons having, and the insurer is a municipal or village budget. What is included in free service If there is an OMS policy?

Professional help of medical workers can be obtained free of charge. Moreover, the planned surveys are made on the territory where a person is insured, that is, to obtain specialist services, it is necessary to purchase polis. Insurance accrual is based on contractual obligations. The issuance of the policy is made directly in organizations, in enterprises or in the funds located at different localities.

For each area, the register of services of medicine is approved. In any hospital or clinic there is a list agreed with municipal or regional authorities.

The modern program includes the following assistance areas:

• first medical;
• specialized;
• ambulance;
• used in the anesthesia of incurable pathologies.

These directions are defined by regulatory documents.

About help

The varieties of first prefigure, and what experts it is provided:

1. Medical sisters provide health support for the patient.
2. Gynecologists or obstetrician gynecologists are assisted.
3. Medical assistance is provided by district doctors, among them therapists and pediatricians.

The first help has a medical staff in a clinic, directly at the patient's house or in a daytime hospital.

The responsibilities of the specialist include:

• reception of a citizen;
• appointment procedures to clarify the diagnosis;
• determining the name of the disease;
• appointment of complex therapy;
• control over recovery.

Moreover, the acquisition of medicines does not fall into the list of free services.

Specialized assistance of physicians is provided with a patient under the supervision of day hospital.

This includes droppers, injections, massage, physiotherapy and surgery, which does not require hospitalization.

Ambulance services are divided:

1. Specialized and urgent. That is, the worsening of the well-being of a citizen does not threaten his life in general.
2. Emergency urgent or emergency. The state of the citizen is dangerous for his life.

In the presence of acute diseases, hospitalization is assigned, namely:

• blood hemorrhages;
• infarction states;
• in poisoning;
• injuries;
• infectious pathologies.

According to the order of the Ministry of Health, in the next two years there will be a complete clinitionerization of all citizens of Russia. As a result of this survey, a specific group of health will be assigned to each person.

When identifying any chronic disease The duty will be charged by the passage of medical examination as many times in the year, how much is necessary on the basis of the diagnosis.

If a person misses this examination, he will receive a message about it as an SMS message. Under the regulations entrusted rules, insurance companies will have to handle the appeals and complaints of citizens and assist in the emergence of controversial situations.

If the patient has doubts as medical services rendered to him, insurance workers will have to appoint an examination.

IN Labor Code Amendments will be introduced, which will legally enshrine the annual additional vacation day. This day will be provided to employees from 40 years to pass the closerization while maintaining the average earnings.

Polis can be decorated in paper, as before, or in the form of an electronic card, in the presence of which in medical institutions it will not be necessary to present a passport. The temporary policy will act 45 days.

In modern assistance programs, it is envisaged:

1. Ensuring free patients with chronic pathologies.
2. Examines of workers engaged in harmful or difficult conditions, as well as, whose activities are related to food.
3. Ensuring control over the state of young children, including those under guardianship or orphans.
4. Conducting pregnant examination on the eve of childbirth.
5. Inspections of only born babies on hereditary pathologies.

Pregnant service

Polis provides women in waiting for the baby the right to free medical qualified assistance. The document provides for the possibility of choosing a clinic and a physician of the future mother during the waiting period of the kid.

Upon presentation of the policy in the clinic, a woman has the right to a whole range of procedures and surveys, which include:

1. Therapeutic or prophylactic procedures.
2. Visiting a pattering nurse at home.
3. Investigation of biomaterial in specialized laboratories.
4. Hospitalization, if necessary.
5. Diagnosis of pathologies of the future child.
6. Preparation for.
7. Rules and recommendations on breastfeeding.
8. Consultations of other profile specialists.
9. The choice of the gynecologist with the consent of the specialist itself.
10. Preventive, therapeutic and diagnostic activities in the special trade systems with the right to engage in this activity.
11. Anesthesia, if necessary, operational intervention.
12. Ensuring the protection of health status information.
13. The right to refuse to help.
14. Presence in childbirth or loved ones.

If a premature child was born, then the free program is exercised to exercise such children, and operating in terms of organ transplantation.

Benefits in dentistry

Dentist services are quite expensive, so many people are puzzled what kind of help they have the right to receive without payment. For this you need to have medical insurance.

On each territory there is an individual program on which dental services are reserved, and throughout Russia, only the provision is made in the provision of an emergency assistance.

Specialized dentist's assistance extends to:

1. Treatment in district polyclinics.
2. Treatment of kids in children's clinics.

Moreover, a list of services must be approved in each institution, and the patient must be informed:

1. On varieties of services.
2. About the work of specialists.
3. About phone numbers and places of insurers.
4. About the benefits provided.

Many private medical institutions also provide services without paying and can be found from the operators.

For children, the following varieties of services are provided:

• restoration and dental enamel not affected by caries;
• treatment of silver and remineralization of teeth;
• reception and services of orthodontist.

Free service

Free adult service includes:

• reception of the doctor, consultation of a specialist and an inspection of the oral cavity;
• treatment of periodontal pathology and gingivitis, caries and pulpitis;
• elimination of exacerbation;
• extension of solid tooth tissue with damaged root;
• operational interventions;
• cleaning of teeth from stones;
• mining of the jaw bone;
• removal of destroyed teeth;
• radiography;
• treatment of salivary glands;
• physiotics;
• local and general anesthesia.

Medicinal preparations may be issued free if they are in the list of free medicines approved at the regional level. Usually, these are the means of domestic production.

Complaints on specialists

If controversial issues arise and conflict situations can be reacted with a complaint about the doctor.

Graduation qualifying work

Introduction

economic health insurance

Medical insurance is a set of insurance species providing for the obligations of the Insurer to implement insurance payments in the amount of partial or complete compensation for additional expenses of the insured caused by the appeal of the insured to medical facilities for medical services included in the medical insurance program.

IN legal attitude This type of insurance is based on the law that determines the legal, economic and organizational foundations of medical insurance of the population of Russia. The law provides the constitutional right of Russian citizens to medical care.

The relevance of the topic is that health insurance In the Russian Federation is a form of social protection of the interests of the population in health.

Object of study- OMS system in the Russian Federation

Subject of study- Activities of the insurance company Ak Bars-Honey in the OMS system.

Purpose of the study - Studying the essence and structure of compulsory health insurance in the Russian Federation.

Based on the purpose of the work, the following were delivered. tasks:

1.Consider and explore the system of compulsory health insurance in the Russian Federation.

2.Determine the main participants in the system of compulsory health insurance and its financing.

.Analyze the activities of the insurance company Ak Bars-Med LLC

To solve the tasks, the following were applied research methods: analysis of scientific and methodical literature; observation; Analysis, synthesis, comparison.

1. Theoretical foundations of the system of compulsory medical insurance in the Russian Federation

.1 Economic essence Mandatory Medical Insurance Systems in the Russian Federation

According to Art. 2 FZ dated November 27, 1992 No. 4015-1 (ed. Dated July 21, 2005) "On the organization of insurance in Russian Federation":" Insurance is a relationship on the protection of property interests of physical and legal entities upon the occurrence of certain events (insurance claims) due to cash fundsformed from insurance premiums paid by them (insurance premiums). "

The compulsory health insurance system (OMS) is one of the forms of social protection of the interests of the population. It is based on two laws: "Fundamentals of the legislation of the Russian Federation on the protection of citizens' health" and the Law of the Russian Federation "On Medical Insurance of Citizens in the Russian Federation".

Mandatory medical insurance is part of State social insurance and provides all citizens of the Russian Federation equal opportunities in obtaining medical and drugs provided at the expense of compulsory medical insurance in the amount and on the conditions that comply with compulsory medical insurance programs (Article 1 of the Law of the Russian Federation of June 28, 1991 No. 1499-1 "On Medical Insurance of Citizens in the Russian Federation").

The purpose of compulsory medical insurance is to guarantee citizens of the Russian Federation upon occupant insurance case Obtaining medical care through accumulated funds and finance preventive measures. Under the insurance case in medical insurance, not only the appearance of the disease is understood as the very fact of providing medical care for the disease. Insurance compensation Here, it acquires a form of medical care provided to the population consisting of a set of specific medical services (diagnosis, treatment, prevention). Medical insurance is carried out at the expense of deductions from the profits of enterprises or personal funds of the population by entering into relevant contracts. The health insurance agreement is an agreement between the insured and the insurance medical organization. The latter undertakes to organize and finance the provision of insured persons with a certain type and quality (or other services in accordance with the programs of compulsory or voluntary health insurance). Medical insurance on the territory of the Russian Federation is carried out in two types: mandatory and voluntary. Mandatory insurance is carried out by virtue of the law, and voluntary is carried out on the basis of a contract concluded between the insured and the insurer. Each of these forms of insurance has its own characteristics.

Your health should be taken care of and the earlier, the better. In countries with developed market economy Medical insurance is one of the most important elements Health maintenance systems.

Figure 1 - Subjects of Mandatory Medical Insurance

The basis of the OMS underlies the following basic organizational and economic and legal principles:

Universality. All citizens of the Russian Federation, regardless of gender, age, health, place of residence, the level of personal income are entitled to receive medical services included in the territorial programs of compulsory health insurance.

Statehood. Mandatory Medical Insurance Means are in state owned RF, they manage the federal and territorial foundations of OMS. Specialized insurance medical organizations. The state acts as a direct policyholder for the non-working population and monitors the collection, redistribution and use of compulsory medical insurance, ensures the financial sustainability of the compulsory health insurance system, guarantees the fulfillment of obligations to the insured persons.

Non-commercial character. All received profits from OMS operations is sent to replenishment. financial reserves Mandatory health insurance systems.

Obligation. Local executive bodies and legal entities (enterprises, institutions, organizations, etc.) are required to deduct set rate in the amount of 3.6% of the fund wages In the territorial Fund of OMS and in a certain order, and in addition, economic responsibility is carried out for violating the terms of payments in the form of penalty and / or fine.

Public Solidarity and Social Justice. All citizens have equal rights to receive medical care at the expense of OMS. The insurance premiums and payments on the OMS are listed for all citizens, but the demand for financial resources is carried out only when applying for medical help (the principle "Healthy pays for the patient"). The nomenclature and the amount of services provided do not depend on the absolute amount of contributions to the OMS.

1.2 Mechanism for implementing a mandatory health insurance system in the Russian Federation

In accordance with this law in Russia, OMS is state and universal for the population. This means that the state represented by its legislative and executive bodies determines the basic principles of OMS organizations, establishes fees of contributions, the circle of insurers and creates special state funds To accumulate contributions to compulsory medical insurance. Universality of the OMS is to provide all citizens of equal guaranteed opportunities for obtaining medical care in the sizes established by state-owned programs.

The main objective of the OMS is to collect insurance premiums and the provision of collective medical care devices to all categories of citizens on legislatively established conditions and in guaranteed sizes. Therefore, the OMS system should be considered from two points of view. On the one hand, it is an integral part state system Social protection along with pension, social insurance and unemployment insurance. On the other hand, OMS is a financial mechanism for ensuring additional budget allocations money to finance health care and payment for medical services. It should be noted that only medical care for the population is included in the scope of the OMS. Reimbursement of earnings lost during the disease is carried out already within the framework of another state system - social insurance and is not the subject of OMS.

Based on the base program in the constituent entities of the Russian Federation, the territorial programs of the OMS are developed, the amount of medical services provided, which cannot be less than the volume established by the OMS base program. However, in practice the cost territorial programs it is necessary to determine, based on the criteria laid down in the basic program, but from the amount financial meanscollected by territorial funds for the implementation of OMS in this territory of the subject of the Russian Federation.

The compulsory medical insurance system was established to ensure the conference rights of citizens to receive free medical care, enshrined in Article 41 of the Constitution of the Russian Federation.

Medical insurance is a form of social protection of the interests of the population in health.

The most important regulatory legal act regulating compulsory medical insurance is the law of the Russian Federation "On Medical Insurance of Citizens in the Russian Federation", adopted in 1991. From that moment on, the development of the new health care industry was founded - insurance medicine.

The law has established the legal, economic and organizational foundations of health insurance in the Russian Federation, identified the means of compulsory health insurance as one of the sources of funding for medical institutions and laid the foundation for the establishment of the insurance model of health financing in the country.

Compulsory medical insurance is an integral part of state social insurance and provides all citizens of the Russian Federation equal opportunities in obtaining medical and medicinal assistance provided at the expense of compulsory medical insurance in the amount and on the conditions that meet the compulsory health insurance programs.

For implementation public Policy In the field of compulsory medical insurance of citizens, federal and territorial funds of compulsory medical insurance have been created.

How are the OMS funds for funding for medical care?

The financial resources of the Compulsory Medical Insurance Fund are formed by part of a single social tax at the rates established by the legislation of the Russian Federation, a part of a single tax on imputed income for certain types of activities in the amount established by the legislation, insurance premiums for compulsory medical insurance of the non-working population paid by the executive authorities of the subjects Of the Russian Federation, local governments, taking into account territorial compulsory health insurance programs within the limits provided for in relevant health care budgets, other revenues provided for by the legislation of the Russian Federation.

Sources of funding for medical care.

Federal Law of the Russian Federation of December 29, 2006 No. 238-FZ "On Amendments to Certain Legislative Acts of the Russian Federation, due to improving the delimitation of powers" from January 1, 2008, a list of medical care types provided to citizens within the framework of state guarantees is specified. Now it includes primary health care, emergency medical care, ambulance medical care, including specialized (sanitary-air), specialized medical care, including high-tech. The law defines sources of financing.

Due to the means of compulsory medical insurance, medical assistance is paid in accordance with the Basic CMF program, which is an integral part of the State Guarantee Program and providing primary health care, specialized (except for high-tech) medical care, as well as providing the necessary drugs in accordance with the legislation Of the Russian Federation in cases of diseases (with the exception of sexually transmitted diseases, tuberculosis, HIV infection and acquired immunodeficiency syndrome), injuries, poisoning, congenital anomalies (developmental vices), deformations and chromosomal diseases, during pregnancy, childbirth, postpartum period, abortions , individual states arising from children in the perinatal period.

Due to the budget allocations of the federal budget are provided:

1.Specialized medical assistance provided in federal medical institutions, the list of which is approved by the authorized Government of the Russian Federation by the executive authority;

2.High-tech medical care provided in medical organizations in accordance with the state assignment formed in the manner determined by the Ministry of Health and Social Development of Russia;

.Medical assistance provided for by federal laws for certain categories of citizens, provided in accordance with the formed government assignment and in the manner determined by the Government of the Russian Federation;

.Additional measures to develop a preventive selection of medical care (dispensarization of children - orphans and children who are in difficult life situations, additional dispensarization of working citizens, immunization of citizens, early diagnosis of individual diseases) in accordance with the legislation of the Russian Federation;

5.Additional medical assistance provided by the therapists of precinct, pediatric-pediatric doctor, general practitioners (family doctors), medical sisters of precious doctors of therapeuts of precinct, medical sisters of district police officers, medical sisters of general practitioners (family doctors) of federal states institutions under the jurisdiction of the Federal Medical and Biological Agency;

6.Additional medical assistance provided by therapist physicians, pediatrician pediatrics, general practitioners (family doctors), medical sisters of district doctors of precinct, medical sisters of district police officers, medical sisters of general practitioners (family doctors) health care facilities municipalities that provide primary health care (and in their absence - with relevant healthcare agencies of the subject of the Russian Federation), subject to the placement in these institutions of the municipal order for the provision of primary health care;

.Ambulance, as well as primary health care and specialized medical assistance provided by federal government agencies, subordinate to the Federal Medical and Biological Agency, employees of organizations included in the list of organizations of individual industries with particularly dangerous working conditions, as well as the population of closed administrative-territorial formations, sciences of the Russian Federation, territories with human health physical, chemical and biological factors, with the exception of costs funded at the expense of compulsory medical insurance;

.Medicinal preparations intended for the treatment of patients with malignant neoplasms of lymphoid, hematopoietic and related tissues, fibrous visual, pituitary tissue, gosh disease, multiple sclerosis, and also after organ transplantation and (or) on the list of drugs approved by the Government of the Russian Federation.

It should be noted that the provision of high-tech medical care to citizens is carried out at the expense of the federal budget in accordance with the established government assignment and in the manner determined by the authorized government of the Russian Federation by the executive authority in any, regardless of the form of ownership and the level of subordination, specialized medical organizations. In accordance with Part 6 of Article 51 of the Federal Law of 29.11.2010 No. 326-FZ "On compulsory medical insurance in the Russian Federation", financial support for high-tech medical care is carried out at the expense of compulsory health insurance from January 1, 2015.

According to Part 5 of Article 51 of the Federal Law of November 29, 2010 No. 326-FZ "On compulsory medical insurance in the Russian Federation" Financial support for emergency medical care (with the exception of specialized (sanitary-aviation) emergency medical care) is carried out at the expense of compulsory medical insurance with January 1, 2013. The procedure for the transfer of budget budget budgets of the budget system of the Russian Federation to the budgets by the Compulsory Medical Insurance Fund for financial support for emergency medical care (with the exception of specialized (sanitary-aviation) emergency medical assistance) is established by federal law determining the amount of the insurance premium tariff for compulsory medical insurance of the non-working population.

The costs of budgets of the constituent entities of the Russian Federation include:

Specialized (sanitary-aviation) ambulance medical care. Specialized medical care provided in oncological dispensaries (in terms of maintenance), in leather-venereological, anti-tuberculosis, narcological dispensaries and other specialized medical institutions of the constituent entities of the Russian Federation, which are members of the health care institutions approved by the Ministry of Health and social Development Of the Russian Federation, in diseases transmitted by sexual, tuberculosis, HIV infection and the syndrome of acquired immunodeficiency, mental disorders and disorders of behavior, including related psychoactive substances;

High-tech medical care provided in medical institutions of the constituent entities of the Russian Federation in addition to the state task formed in the manner determined by the Ministry of Health and Social Development of Russia;

Medicinal preparations in accordance:

1.With a list of population groups and categories of diseases, with the outpatient treatment of which drugs and medical products are discharged according to the recipes of doctors for free, including providing citizens with drugs intended for patients with hemophilia, fibrous semiconductor, pituitary nanice, gosh disease, malignant neoplasms of lymphoid, hematopoietic and related they are tissue sclerosis, as well as after transplantation of organs and (or) tissues, taking into account drugs stipulated by the list approved by the Government of the Russian Federation;

2.With a list of population groups, with the outpatient treatment of which drugs are discharged by doctors with a 50 percent discount from free prices.

.At the expense of budget allocations local budgetsWith the exception of municipalities, the medical assistance to the population in accordance with the legislation of the Russian Federation is provided by federal government agencies, subordinate to the Federal Medical Biological Agency, are provided:

.Ambulance care, with the exception of specialized (sanitary-aviation);

.Primary health care assistance provided to citizens in diseases transmitted by sexual, tuberculosis, mental disorders and behavior disorders, including related psychoactive substances.

In accordance with the legislation of the Russian Federation, the costs of relevant budgets include providing medical organizations with drugs and other means, medical products, immunobiological preparations and disinfectants, donor blood and its components.

In addition, at the expense of the budget investments of the federal budget, the budgets of the constituent entities of the Russian Federation and local budgets in installed manner Medical assistance and other services are provided in medical facilities that are included in the nomenclature of health institutions approved by the Ministry of Health and Social Development of the Russian Federation, as well as in medical organizations that do not participate in the implementation of the OMC territorial program.

Who manages the means of OMS.

The funds of compulsory health insurance are managed by the Federal Fund of OMS and Territorial Funds of the OMS, which are created on the basis of the "Regulations on the federal fund of compulsory medical insurance" and "Regulations on the Territorial Fund for Mandatory Medical Insurance", approved by the Resolution of the Supreme Council of the Russian Federation No. 4543-1 of 24.02. 93 years old.

The provisions on the compulsory medical insurance funds lies with the legal construction, which takes into account the world experience of the most effective protection of public funds from misuse of their use. Creating OMS Foundations allows to provide financial conditions To preserve the free medical care for citizens.

Financing of the mandatory health insurance system in the Russian Federation.

Figure 1 - Financial flows in the system of compulsory medical insurance

The financial means of the state system of the OMS are formed due to the target compulsory payments of the Insured:

From the budgets of the constituent entities of the Russian Federation, funds are deducted for OMS for the inoperative population (children, students, students, pensioners, unemployed, etc.). Organs government controlled In the regions are responsible for making payments.

Payers of insurance oMS contributions For working citizens are employers. Insurance fees tariffs are established at the federal level. Until 2001, they accounted for 3.6% of wages of the insured. From 01/01/2002, insurance premiums for compulsory medical insurance of working citizens are included in a single social taxuniting the deductions of employers in Pension Fund and social insurance fund.

For calculation tax rate (contribution to OMS) use the so-called regressive scale, in accordance with which the procedure for determining changes tax base For each employee. It takes into account the size of the organization (enterprise), the income of the employee, etc. However, for most middle-income workers up to 100,000 rubles. The year of deductions to the OMS remained unchanged: 3.6% of wages - 3.4% - to the territorial fund and 0.2% in the Federal Fund of the OMS.

Figure 3 - Dynamics of the share of assets of organizations and insurance premiums

Insurance medical organizations pay for medical care (under the OMS program) the insured, provided by medical institutions working in the OMS system.

Currently, several ways are used to pay for medical services.

To pay treatment in hospitals:

1)payment according to estimates;

2)the average cost of a treated patient;

)for a treated patient under clinical and statistical groups (KSG) or medical and economic standards (MES);

)in the number of bed-days;

Payment for treatment in outpatient polyclinic institutions produce:

)by estimated costs;

2)according to the average per capita;

)for individual services;

)for a treated patient;

)combined payment method.

Currently not happened unified system Payment of medical services in the system of OMS. This provision is characteristic of the transition period in oMS organizations. Most effective way Payment of medical services To date, experts consider payment for a treated patient, i.e. Completed case of treatment.

The practice of introducing OMS in the constituent entities of the Russian Federation shows that at present, to achieve full compliance with the functioning territorial systems of the OMS, the requirements of the legislation cannot yet be.

1.3 Main members of the Mandatory Medical Insurance System

Mandatory medical insurance - a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state, aimed at ensuring that when an insured event occurred, guarantees to the insured person of medical care at the expense of compulsory medical insurance within the territory of the territorial program of compulsory medical insurance and established by this federal law cases within the basic compulsory medical insurance program;

As subjects of health insurance are: insured persons, insurers and the federal fund.

Insured persons - citizens of the Russian Federation, constantly or temporarily residing in the Russian Federation foreign citizens, stateless persons (with the exception of highly qualified specialists and members of their families in accordance with the Federal Law of July 25, 2002 No. 115-FZ "On the legal status of foreign citizens in Of the Russian Federation "), as well as persons who have the right to medical assistance in accordance with the Federal Law" On Refugees "(Watch Appendix 4):

) working, under the employment contract or civil-legal contract, the subject of which is the performance of work, the provision of services, as well as under the Agreement of the author's order or license agreement;

) who are members, peasant (farmer) farms;

) non-working citizens:

g) other non-employment contracts and not listed in subparagraphs "A" - "e" of the Citizens of this paragraph, with the exception of military personnel and equivalent to them in organizing the provision of medical care for individuals (watch Appendix 4).

Insured:

b) organizations;

6) Individual entrepreneurs engaged in private practice notaries, lawyers.

Insureders for non-working citizens referred to in paragraph 5 are the executive authorities of the constituent entities of the Russian Federation authorized by the senior executive bodies of the state of the constituent entities of the Russian Federation. These insureders are payers of insurance premiums for compulsory medical insurance of the non-working population.

Federal Fund.

The Insurer for Mandatory Medical Insurance is the Federal Fund as part of the implementation of the basic compulsory medical insurance program.

Federal Fund is a non-profit organization established by the Russian Federation in accordance with this Federal Law for the implementation of state policy in the field of compulsory health insurance.

Participants of the OMS system:

) Territorial funds.

Territorial funds - non-commercial organizationsCreated by the constituent entities of the Russian Federation in accordance with Federal Law No. 326-FZ dated November 29, 2010 "On compulsory medical insurance in the Russian Federation" (hereinafter referred to as the Federal Law) for the implementation of state policies in the field of compulsory medical insurance in the territories of the constituent entities of the Russian Federation.

Carry out:

but) separate authority of the insurer in terms of the implementation of territorial compulsory medical insurance programs within the basic compulsory medical insurance program in accordance with this Federal Law.

b) management of compulsory health insurance on the territory of the constituent entity of the Russian Federation intended to ensure the guarantees of free provision of medical care facilities in the framework of compulsory medical insurance programs and in order to ensure financial Sustainability compulsory health insurance in the territory of the constituency of the Russian Federation.

The territorial fund carries out the following insurer authority:

.participates in the development of territorial programs of state guarantees of free provision of medical care and identification of tariffs for medical care in the territory of the constituent entity of the Russian Federation;

2.accumulates the means of compulsory health insurance and manages them, implements financial support for the implementation of territorial health insurance programs in the constituent entities of the Russian Federation, forms and uses reserves to ensure the financial sustainability of compulsory health insurance in the manner prescribed by the Federal Fund;

.provides citizens' rights in the field of compulsory health insurance, including through control of volumes, deadlines, quality and conditions for providing medical care, informing citizens on the procedure for ensuring and protecting their rights in accordance with this Federal Law;

.monitors the use of compulsory medical insurance tools by insurance medical organizations and medical organizations, including conducting inspections and audits;

.collects and processes data of personalized accounting information about insured persons and personalized accounting information about medical care provided to insured persons in accordance with the legislation of the Russian Federation.

The Territorial Fund at the provision of medical care makes calculations for medical assistance provided to insured persons outside the territory of the constituent entity of the Russian Federation, which issued a policy of compulsory health insurance, in the amount established by the basic health insurance program, no later than 25 days from the date of representation of the medical The organization, taking into account the results of the control of volumes, deadlines, quality and conditions for the provision of medical care. The territorial Fund of the constituent entity of the Russian Federation, which issued a policy of compulsory health insurance, performs reimbursement of funds to the territorial foundation at the place of medical care no later than 25 days from the date of receipt of the account submitted by the territorial foundation at the place of provision of medical care, in accordance with the tariffs for the payment of medical care, Installed for a medical organization that has provided medical assistance, taking into account the results of the control of volumes, deadlines, quality and conditions for the provision of medical care.

Insurance medical organizations operating in the field of compulsory health insurance.

Insurance medical organizations (SMOs) who have a license issued by the federal executive body that performs functions to control and oversight in the field of insurance activity. Features of licensing activities of insurance medical organizations are determined by the Government of the Russian Federation.

Carry out:

but) individual authority of the insurer in accordance with federal law and contract on financial support for compulsory health insurance concluded between the territorial foundation and the insurance medical organization.

b) its activities in the field of compulsory health insurance on the basis of an agreement on the financial support of compulsory medical insurance, the contract for the provision and payment of medical care for compulsory health insurance concluded between the insurance medical organization and the medical organization.

For a more complete implementation of tasks laid in the proposed bill, you must bring in line with regulatory framework federal and regional level in the health care system and its financing. The system should also be improved financial control and streamline reporting system. Finally, the mechanisms of arbitration and mediation should be created to resolve conflict situations between the insured citizens, organizations of compulsory medical insurance and health care providers.

No. P / Parnuitions Exact results are implemented by results1. In total transition to a new system of compulsory medical insurance: ( transitional period 2005-2008): Introduction new system OMS: 2005-2008 Establishment of the income of the OMS system and its obligations to provide guaranteed medical care to the insured citizens in those constituent entities of the Russian Federation, which will conclude multilateral agreements; ensuring equal accessibility of citizens to obtaining medical care in the framework of the Basic FMS program; ensuring the transparency of financial flows and the rational use of resources of the OMS system; Creating a unified personified accounting system with the formation of individual personal accounts; Determination of the Unified Tariff of the Insurance Contribution for non-working citizens in the amount ensuring the fulfillment of the obligations of the state within the framework of the Basic FMS program to provide free medical care; in 25 constituent entities of the Russian Federation, which have entered into multilateral agreements on the co-financing of the non-working population; 2005V 47 constituent entities of the Russian Federation of the Russian Federation who have entered into multilateral Agreement on the co-financing of the non-working population; 2006 in 69 constituent entities of the Russian Federation of the Russian Federation, which have entered into multilateral agreements on co-financing the non-working population; 2007 Details of the Russian Federation20082.Proves the monitoring of health institutions2004 Preparation of proposals for phased optimization of a network of medical organizations, a change in organizational and legal forms. 3.R to optimize the network of medical organizations.2004-2008 The establishment of institutions that do not provide high-quality medical services, transfer to the hospital Replacement technology, republic. to reduce and re-refill about 15% of inefficiently working hospitals with the briefness of the provision of bows for 100 thousand population in 2004-2006 from 113 -110; In 2007-2008, up to 90-100, and by 2010 to 80-85 beds; Transforming the status of a significant part of medical institutions to state (municipal) non-profit organizations, autonomous non-commercial organizations. This will allow you to move from the direction of funds for the maintenance of the LPU to pay for the volume of medical care to a specific patient. The gradual formation of a competitive environment, the rationalization of costs and improving the quality of services to ensure the availability of high-quality medical care to all citizens of the country. By changing the organizational and legal form of the main part of state (municipal) institutions2005-20074. The structural effectiveness of the health care system, the creation and implementation of the system of hospital-replacement technologies. Changing the structure of costs in health care with the transfer of an accent on outpatient polyclinic assistance2004-2010This will allow: to reduce stationary medical care in 2005-2006 by 3-5%, in 2007-2008 10-15%, in 2009-2010 to 30 - 35 percent; increase the volumes of outpatient polyclinic aid at the above stages, respectively, 5-9%; 18-26%; Up to 55 percent, with appropriate redistribution of financing of these types of medical care. Differentiation of the partition of hospitals, depending on the intensity of therapeutic and diagnostic process. 5. Intensifying the introduction of medical and economic standards in a new system of compulsory medical insurance2005-2008 The introduction of medical and economic standards of medical care, which determine the socially acceptable and technologically reasonable minimum of medical care for each disease, will optimize the costs of the OMS program; Phased recalculation of OMS programs as medical and economic standards are introduced. Efficiency and transparency of the use of financial resources of the OMS system.6. Development of the primary healthcare service 2004-2008 The introduction of a community practitioner (family doctor), the development of health care. 7. Entering new mechanisms of combining voluntary and compulsory medical insurance 2006-2007 Funding sources for payment for medical services. 8.Prigot benefits on drugs to ensure certain categories of the population on targeted social assistance.2005-2006 Reception of budget expenditures. 9.Feed introduction of the formula for medicinal support system of medical and preventive institutions.2005-2007 Reception of costs in inpatient institutions. . Transfer to the system of state and municipal orders to provide health care organizations to the population in the budget part of the State Guarantee Program, 2005-2008 Decitation of the Procedure for the Formation of State and Municipal Plans for Medical Orders mi organizations. Improving the efficiency of the use of financial, material and labor resources, the development of a competitive environment.11. Entering new methods of remuneration of medical professionals2005-2007 The formation of medical institutions to other organizational and legal forms will increase the wages of medical workers.12. Development of the sector of paid services in health care .2004-2007 Creating conditions that contribute to an increase in the volume and development of the high-tech medical services market. Participation of citizens in co-financing medical

2. Applied aspects of the implementation of a system of compulsory medical insurance in the Russian Federation on the example of the insurance company Ak Bars-Honey LLC

2.1 a brief description of Insurance company LLC "AK BARS-Honey"

The insurance company Ak Bars-Honey was founded in 2004. The main activities are mandatory and voluntary medical insurance. Authorized capital Companies 150 million rubles. More than 3.2 million people since 2004 entrusted their health to the company's partners to medical organizations involved in the implementation of the OMS territorial program in the Republic of Tajikistan.

In all administrative districts of the Republic of Tatarstan, 45 branches and representative offices of the company are successfully operating.

The Insurance Company has concluded contracts and cooperates with all therapeutic and preventive institutions of the Republic of Tatarstan, participating in the implementation of the territorial program of the OMS in the Republic of Tajikistan.

The main tasks of the insurance company are:

1)issuance of compulsory health insurance policies to insured persons living in the territory of the Republic of Tatarstan;

2)conclusion of contracts with medical organizations for the provision and payment of medical care for compulsory health insurance;

)control of volumes, deadlines, quality and conditions for the provision of medical care in accordance with the terms of the contract. Holding planned inspections Quality of medical care is insured (in Ak Bars-Honey LLC, a new approach to assessing the quality of medical services was introduced by the method of automated technology examination of the quality of medical care (ATE KMP) on various medical profiles). Conducting examination of the quality of medical care provided (EXPM) on written statements of insured citizens. It is carried out mainly in two cases: in solving issues of compensation for unreasonable expenses of citizens during their diagnosis and treatment in the hospital and in the presence of claims to the quality of medical care provided to citizens in a medical and preventive institution.

)protection of the rights and interests of the insured: assisting the insured in solving problems arising from the receipt of medical services in medical and preventive institutions involved in the implementation of the territorial program of compulsory medical insurance of the Republic of Tajikistan;

)consulting and operational solving problems arising from the acquisition of medical care to the insured citizens in the system of compulsory medical insurance by telephone around the clock dispatch service.

)conclusion of voluntary health insurance agreements with the issuance of insurance medical policies;

)conclusion of contracts for the provision of medical, wellness and social services to citizens on voluntary health insurance with any medical and other institutions.

In order to meet the needs of insured citizens in efficient, methods of treatment, specialists of the insurance company developed a number of voluntary health insurance programs. Contracts with private clinics, leading medical institutions of Russia, near and far abroad are concluded.

The company has been successfully operating a powerful expert service - 120 external expert doctors of the highest category on various medical profiles are regularly carried out by the quality of medical care provided.

The Insurance Company "Ak Bars-Honey" is part of the All-Russian Union of Insurers, the Interregional Union of Medical Insurers, the Union of Insurers of Tatarstan.

In 2008, the insurance company Ak Bars-Honey became the laureate in the nomination "Best Medical Company" - the nomination of the Volga National Award in the field of insurance "Silver Umbrella"

In 2010, put forward and becomes the winner in the nomination

"Best Medical Insurance Organization."

In 2011, it also becomes a nominee for the title "Best Regional Insurance Company 2011".

Currently, Ak Bars-Honey LLC has good potential, significant personnel, financial and administrative resources. The company has a high credibility of its shareholders, partners and customers, develops dynamically.

In the 2013 Ak Bars-Honey LLC, in 2013, it took 251th place, collecting insurance premiums in the amount of 86 million rubles.

The economic environment in which the Group carries out its activities to the Republic of Tatarstan is a large donor region, industrial, shopping, cultural and scientific center. There are many in the republic industrial enterprises, Trade is developed. All this creates prerequisites for the existence of a quick-developing insurance market. It is important to emphasize that the insurance market of the Republic of Tatarstan is the most developed among the 14 regions of Russia included in the Volga Federal District. Over the years, the republican insurance market is confidently leading in Volga federal District. One of the objective indicators of the development of a particular insurance market Speakers the sum of the collected insurance premiums.

The economic indicators of Tatarstan, according to the results of 2014, speak of the successful development of the republic. Thus, the gross regional product rose by 2.3% and amounted to 1.520 trillion. rubles.

In 2014, the foreign trade turnover of the Republic of Tatarstan, according to the assessment, will be $ 26 billion, growth - 102.3%. The interregional turnover of the Republic of Tatarstan, according to the assessment, will be 600 billion rubles, an increase - 112%.

The above facts indicate the investment attractiveness of Tatarstan for the development of the insurance business.

The insurance market of the region is the subordinate part of the economy of the region. Potential demand for insurance servicesboth among physical and legal entities are determined by social and economic potential Region. Thus, the population of the region gives an idea of \u200b\u200bthe possible amount of insurance market development, the share of the urban population indirectly reflects the degree of perception by the population of new types of insurance, the average level of per capita income is taken into account when planning the development of voluntary types of insurance, volume industrial production characterizes the level of property interests, etc. .

The company receives income under the compulsory health insurance contract, which is classified as a service contract, since it does not contain significant insurance risk. Under the contract concluded with the territorial fund of compulsory medical insurance (hereinafter referred to as TFOMS), Ak Bars-Honey LLC participates in the Mandatory Medical Insurance Program in order to provide citizens of the Russian Federation with free medical care with a number of assigned insurers. The company receives prepayments from TFOMS and in turn implements prepayments to medical institutions for services provided by these institutions under the TFOMS program. Targets derived from TFOMS, but not listed by medical institutions at the reporting date, are reflected as obligations on targeted financing for OMS. For these services, the company receives a commission remuneration, which is reflected in the consolidated statement of comprehensive income in the composition commission income on mandatory health insurance.

Reserve of unearned premium.

The reserve of an unemployed award is created in the amount of the accrued premium under the insurance contract relating to the remaining term of the insurance contract for the reporting date and is calculated in the proportionally the remaining term of the contract based on the amount of the accrued gross premium, that is, without taking into account the accusative expenses.

Mandatory medical insurance.

Free Medical Services OMC Policy:

Emergency medical care (ambulance).

Ambulatory and polyclinic assistance, including activities on the diagnosis and treatment of diseases in the clinic, at home and in day hospital, if necessary, the provision of emergency assistance on weekends and holidays (medicinal support for outpatient treatment is not included in the OMS program).

Stationary help with:

)acute diseases and exacerbations of chronic diseases, poisoning, injuries requiring intensive therapy, round-the-clock medical observation and insulation of the patient according to the indications.

)pathology of pregnancy, childbirth, abortions.

)planned hospitalization in order to treat treatment and rehabilitation requiring round-the-clock medical surveillance, in hospitals, offices and daytime wards.

High-tech medical care, which includes a complex of medical and diagnostic services carried out in a hospital with the use of complex and unique, medical technologies.

Sanitary and hygienic education of the population, activities for diagnosis, prevention, medical rehabilitation.

Not included in free medical services on the Polish OMS:

Diagnostics, research, procedures, consultations held at home (except persons who cannot visit medical institutions for health).

Conducting in the order of the personal initiative of citizens consultation of specialists, medical examination and conduct of expertise, medical support of private events.

Hospitalization on a specially highlighted bed. Additional service services, stay in the ward of high comfort, individual post of medical worker, care and extra meals, telephone, TV, etc.

Treatment and examination on the concomitant disease in the absence of exacerbation that does not affect the severity of the course of the underlying disease.

Examination, treatment, monitoring at home (except when the patient is not able to visit the patient for the health and nature of the disease medical institution).

Anonymous medical services (except in cases provided for by the legislation of the Russian Federation).

Conducting preventive vaccinations at the request of citizens (with the exception of vaccinations performed on government programs).

Sanatorium-resort treatment (except for the treatment of children and treatment in specialized sanatoriums).

Cosmetology services.

Homeopathic services.

Dental prosthetics (with the exception of persons with which it is provided for by the current legislation).

Treatment of sexological pathology.

Rights of citizens in the field of OMS:

In accordance with the Federal Law of the Russian Federation of November 29, 2010 No. 326-FZ "On compulsory medical insurance in the Russian Federation", insured persons are entitled to:

Free provision of medical care medical organizations when an insured event occurs:

but) throughout the Russian Federation in the amount established by the basic compulsory medical insurance program;

b) on the territory of the constituent entity of the Russian Federation, which issued a policy of compulsory health insurance, in the amount established by the territorial program of compulsory medical insurance;

Selection of an insurance medical organization by submitting an application in the manner established rules compulsory health insurance;

The replacement of the insurance medical organization in which a citizen was previously insured, once during the calendar year no later than November 1 or more often in the event of a change in the place of residence or termination of an agreement on financial support for compulsory health insurance in the manner prescribed by the rules of compulsory medical insurance, by filing statements in the newly selected insurance medical organization;

The choice of a medical organization from medical organizations involved in the implementation of the territorial compulsory medical insurance program in accordance with the legislation of the Russian Federation;

Choosing a doctor by submitting an application personally or through its representative to the head of the medical organization in accordance with the legislation of the Russian Federation;

Obtaining from the territorial Fund, an insurance medical organization and medical organizations of reliable information about the types, quality and conditions for the provision of medical care;

Protection of personal data necessary for personalized accounting in the field of compulsory health insurance;

Reimbursement of the insurance medical organization damage caused in connection with the non-fulfillment or improper performance of the responsibilities for organizing the provision of medical care, in accordance with the legislation of the Russian Federation;

Reimbursement by a medical organization damage caused in connection with the non-fulfillment or improper performance of obligations for the organization and provision of medical care, in accordance with the legislation of the Russian Federation;

Protection of rights and legitimate interests in compulsory medical insurance.

2.2 Main tasks of the OMS system on the example of the insurance company Ak Bars - Honey

Mandatory medical insurance - a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state, aimed at ensuring that when an insured event occurred, guarantees to the insured person of medical care at the expense of compulsory medical insurance within the territory of the territorial program of compulsory medical insurance and established by Federal Law of November 29, 2010 No. 326-FZ "On compulsory medical insurance in the Russian Federation" cases within the basic health insurance program.

1.For the non-working population - the executive authorities of the constituent entities of the Russian Federation authorized by the senior executive bodies of the state of the constituent entities of the Russian Federation.

2.For working population - Persons who produce payments and other remuneration to individuals (organizations, individual entrepreneurs, individuals who are not recognized by individual entrepreneurs), individual entrepreneurs engaged in private practice, notaries, lawyers.

The policy of compulsory health insurance is a document certifying the right of the insured person on free provision Medical care throughout the Russian Federation in the amount provided for by the basic compulsory medical insurance program.

Table 2 - the number of insured persons on the system of compulsory medical insurance in the period from 2012 to 2014.

The number of insured by the OMS system The feet of the insured, thousand people.As of 01/01/201248 640Na 01/01/2013454 4821 01/01/2014456 406

Figure 4 - Dynamics of changes in the number of insured persons according to the OMS system in SC LLC "Ak Bars - Honey".

From the presented diagram it can be seen that the number of insured by the OMS system, in all periods almost equal.

2.3 Evaluation of the effectiveness of the work of the UK LLC "AK BARS-Honey"

Table 3 - Initial data on the profits and losses of the insurance medical organization on the system of compulsory medical insurance about target use Funds for 2012, 2013, 2014

For the 2014th of 2013, the 70th year of the target agent at the beginning of the reporting year806 662363 35810 145 ReceivedThe funds received from the territorial Fund to financial support of the OMS in accordance with the financial support contract of the OMS25 404 45522 034 81616070185 Created from the Medical Organization as a result of applying sanctions for violations identified during the monitoring of volumes, deadlines, quality and conditions for providing medical care763 58245 37058 974 Including: as a result of medical and economical controls709 2742313 in the result of the examination of the quality of medical care21 86322 41130 051 in the result of the payment of honey. The organization of fines for non-appearances for the late provision of medical care is not adequate quality 8283,011620 who received from JUR. Or Piz. Persons who hurt the health of the insured3312466 The arrival of target funds4920 5231 198 466 UsedPayment honey. Assistance to insured persons under OMS contracts29 009 13021 715 53016 169 069 Revenue into the income of insurance honey. Organizations15 97811 88911 428 Including: from the funds received from medical organizations as a result of applying sanctions for violations identified during the monitoring of volumes, deadlines, quality and conditions for providing medical assistance15 97811 88911 428 in the result of the examination of the quality of medical care6 4924 6976 884 Conducting medical and economic expertise9 0805,7044 234 Customs received from JUR. Or Piz. Persons who hurt the health of the insured-as a result of payment honey. Organization of fines for non-appearances for late provision of medical care is not adequate quality 4061 506310 Used targets - 1 222 973

Figure 5 - Dynamics of received and used means

As of January 1, 2015, the number of citizens insured for compulsory health insurance in the company amounted to 3,81 144 people.

Figure 6 - Dynamics of insurance payments and premiums under the OMS contract.

2.4 Prospects for the development of the OMS system in the Russian Federation

In the context of a rigid budget deficit, the organization of the mandatory health insurance system (OMS) was effective political and economic decisionwhich marked the formation of a fundamentally new system of legal and financial relations in the provision of medical care to the population, as well as more rational use of available health resources.

For 5 years, practically from scratch organizationally formed and operates throughout the country a system of compulsory health insurance. It consists of 90 territorial OMS Funds, 1176 branches, 424 insurance medical organizations (SMO).

Mandatory Medical Insurance Policy provided more than 82% of the population of the Russian Federation. A system for collecting insurance premiums, accounting and registration of fees of contributions has been created and operating, the number of which amounted to 3.7 million.

For incomplete 5 years of implementation of the Medical Insurance Act, more than 90 billion rubles were collected. Of this amount, insurance premiums for employees amounted to almost 56 billion rubles, payments from the budget for compulsory medical insurance of the non-working population - over 21 billion rubles. Due to the recovers of fines, penalties from payers, income from the use of temporarily free funds has been attracted by almost 13 billion rubles.

In total, more than 84 billion rubles are sent to budgetary health care system for 5 years, which is more than 30% of all health expenditures. The bulk of funds (72.4 billion rubles) was aimed at financing medical care in the framework of the territorial compulsory health insurance programs. Over the past three years, more than 50% of these funds are spent by healthcare facilities for health workers, more than 18% are more than 18% for paying medicines.

Only for the current year, the Federal Fund of the OMS was provided in subventions Financial assistance to 88 constituent entities of the Russian Federation on total more than 900 million rubles. In addition, taking into account the special complexity and uniqueness of health institutions of the federal level, they were allocated assistance in the amount of more than 107 million rubles.

The main strategic direction of the work of the federal and territorial funds was and remains to ensure the implementation of the Law of the Russian Federation "On Medical Insurance of Citizens".

One of the strategic tasks in the OMS is to ensure the constitutional law of citizens to free medical care. To this end, the Government of the Russian Federation approved the program of state guarantees to ensure citizens of the Russian Federation with free medical help. This program for the first time at the level regulatory document The concept of a per capita standard of health financing is introduced.

The implementation of territorial programs in the constituent entities of the Russian Federation will begin to begin a real restructuring of medical care.

The amount of funding for funding for compulsory medical insurance increases every year. As a result of an acute lack of funds, the actual financing of territorial compulsory medical insurance programs was in 9 months. 1998 only 37.5% of the approved annual volume.

It should be noted that in the face of a threatening increase in the financial deficit of the OMS system of 17 territorial funds, which, when checking the CRC of the Federal Fund, was revealed by non-target expenditure of funds, only one fund completely restored the consumed money. The federal fund will continue to oversee the territorial funds for the return of non-target expenditure funds.

The main reasons for the created financial situation are:

1)failure to comply with the executive authorities of the constituent entities of the law in terms of transferring payments for compulsory medical insurance of the non-working population;

2)destabilization of the financial and economic situation in the country;

)the low level of the insurance contribution rate on compulsory medical insurance of working citizens (3.6% with a need of 7.2%).

One of the options for the decision of the above problem could be the approval of a differentiated standard and the provision of the right to subjects of the Russian Federation to approve the fare of the insurance premium within the above mentioned minimum and maximum size.

About payments. Special concern is a provision with payments for compulsory medical insurance of non-working citizens of the Russian Federation.

Given that non-working citizens exceed 60% of the population of the Russian Federation, payments sent to the funds of compulsory health insurance for non-working citizens should be at least 60-70% of all incomes of the system. The real situation is the opposite: the flow of budget funds is not only in OMS, but in general, it is constantly declining, and the insurance premiums of working instead of additional becomes basic.

The solution of these problems is facilitated by the formation of new information and analytical support of the OMS system based on a comprehensive industry program informatization program.

The main tasks of the Federal Fund of the OMS are:

Improving the financial and credit mechanism for the stability of the OMS system.

Improving legislative regulation in the provision of medical care to the population at the federal and regional levels, the implementation of measures to implement the Act of Health Insurance in the constituent entities of the Russian Federation.

Improving measures to improve the quality and availability of medical care to the population.

The implementation of the main directions of informatization of the OMS system.

In conclusion, it is necessary to note the importance and relevance of educational support for the reorganization of the medical care system as an OMS. For the public, including medical, in many ways still remain incomprehensible goals and ways to transition to compulsory health insurance. It is necessary to change the situation as a short time, to be heard and understood by millions of Russian citizens in all without exception to Russian regions. Private citizens who represent their interests of public organizations and associations, political parties and movements, representatives of the federal government bodies and, above all, Russian legislators must understand with our help: why it is the OMS is a real driving force of health care reform, why without OMS impossible seriously Protect the interests of citizens in health care.

Conclusion

1.Having studied the system of compulsory health insurance in the Russian Federation, came to the fact that the system of compulsory health insurance (OMS) is one of the forms of social protection of the interests of the population. It is based on two laws: "Fundamentals of the legislation of the Russian Federation on the protection of citizens' health" and the Law of the Russian Federation "On Medical Insurance of Citizens in the Russian Federation". The purpose of compulsory health insurance is to guarantee citizens of the Russian Federation in the event of an insured event, obtaining medical care through accumulated funds and finance preventive measures. Medical insurance is carried out at the expense of deductions from the profits of enterprises or personal funds of the population by entering into relevant contracts.

2.The main participants in the system of compulsory medical insurance and its financing are: insured persons, insured and federal fund.

Insured persons - citizens of the Russian Federation, constantly or temporarily residing in the Russian Federation foreign citizens, stateless persons (with the exception of highly qualified specialists and members of their families in accordance with the Federal Law of July 25, 2002 No. 115-FZ "On the legal status of foreign citizens in Of the Russian Federation "), as well as persons entitled to medical assistance in accordance with the Federal Law" On Refugees ":

) working under the employment contract, or a civil legal contract, the subject of which is the performance of work, the provision of services, as well as under the Agreement of the author's order or a license agreement;

) independently providing yourself with work (individual entrepreneurs engaged in private practice notaries, lawyers);

) who are members of the peasant (farmer) farms;

) who are members of family (generic) communities of the indigenous small peoples of the North, Siberia and the Far East of the Russian Federation, living in the districts of the North, Siberia and the Far East of the Russian Federation dealing with traditional industries;

) non-working citizens:

but) children from birth before reaching the age of 18;

b) non-working pensioners regardless of the foundation of the pension appointment;

in) citizens studying in full-time in educational institutions primary professional, secondary vocational and higher professional education;

d) unemployed citizens registered in accordance with employment legislation;

e) one of the parents or guardians engaged in care of the child until they reach the age of three years;

6)able-bodied citizens, employed by disabled children, disabled students, persons who have reached the age of 80;

7)other non-employment contracts and not specified in subparagraphs "A" - "E" of this paragraph by citizens, with the exception of military personnel and equivalent to them in organizing the provision of medical care for individuals.

Insured:

)persons producing payments and other remuneration to individuals:

2) organization;

)individual entrepreneurs;

)individuals who are not recognized by individual entrepreneurs;

)individual entrepreneurs engaged in private practice notaries, lawyers.

Insureders for non-working citizens referred to in paragraph 5 are the executive authorities of the constituent entities of the Russian Federation authorized by the senior executive bodies of the state of the constituent entities of the Russian Federation. These insureders are payers of insurance premiums for compulsory medical insurance of the non-working population.

Federal Fund.

The Insurer for Mandatory Medical Insurance is the Federal Fund as part of the implementation of the basic compulsory medical insurance program.

Participants of the OMS system

Territorial funds - non-profit organizations created by the constituent entities of the Russian Federation in accordance with Federal Law No. 326-FZ dated November 29, 2010 "On compulsory medical insurance in the Russian Federation" (hereinafter referred to as the Federal Law) for the implementation of state policy in the field of compulsory health insurance in the territories of the Russian constituent entities Federation.

3.Under the conditions of a rigid budget deficit, the organization of the mandatory health insurance system (OMS) was an effective political and economic solution, which marked the formation of a fundamentally new system of legal and financial relations in the field of medical care to the population, as well as more rational use of the available health resources

1.On medical insurance of citizens in the Russian Federation: the Law of the Russian Federation of July 28, 1991 No. 1499-1 of the Congress of the Congress of People's Deputies of the Russian Federation and the Supreme Soviet of the Russian Federation. 1991. №27. Art. 920.

2.On the procedure for financing compulsory medical insurance of citizens for 1993: Resolution of the Supreme Council of the Russian Federation of February 24, 1993 No. 4543-1 of the Vedomosti Congress of People's Deputies of the Russian Federation and the Supreme Soviet of the Russian Federation. 1993. №17. Art. 591.

.On measures to implement the Law of the Russian Federation "On Amendments and Additions to the Law of the RSFSR" On Medical Insurance of Citizens in the RSFSR ":

.Resolution of the Council of Ministers - Government of the Russian Federation of October 11, 1993 No. 01 of the meeting of the acts of the President and the Government of the Russian Federation. 1993. №44. Art. 4198.

.Tax Code of the Russian Federation (part of the first): Federal Law of July 31, 1998 №147-ФЗ Meeting of the Legislation of the Russian Federation. 1998. №31. Art. 3824.

.On the basics of compulsory social insurance: Federal Law on July 16, 1999 No. 165-FZ "Meeting of the Legislation of the Russian Federation" 1999. №29. Art. 3686.

.About general principles Organizations of legislative (representative) and executive bodies of state authorities of the constituent entities of the Russian Federation: Federal Law of October 6, 1999 №184-ФЗ

8.Meeting of the legislation of the Russian Federation. 1999. №42. Art. 5005.

.The Constitution of the Russian Federation was adopted by a popular vote on December 12, 1993 of the RG. - 1993. - №237.

10.On the basics of compulsory social insurance: Federal Law of the Russian Federation of 16.07.2000 №165, - FZ with change. 11/29/2010. Reference and legal system "Consultant Plus": [Electronic resource] Company "Consultant Plus".

.On the budget of the federal compulsory health insurance fund for 2008 and on the planning period 2009 and 2010: Federal Law of the Russian Federation of July 21, 2007 No. 184-FZ reference and legal system "Consultant Plus".

.On the execution of the budget of the Federal Fund for Compulsory Medical Insurance for 2008: Federal Law of the Russian Federation of December 27, 2009 No. 372-FZ.

.On compulsory medical insurance in the Russian Federation (adopted by the State Duma of the FS RF 11.11.2010): Federal Law of 29.11.2010 No. 326-FZ reference and legal system "Consultant Plus": [Electronic resource. Company "Consultant Plus". - Immediate. Update 01/12/2011

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Mandatory Medical Insurance System in the Russian Federation

One of the important conditions for social protection of the country's population is to ensure its citizens necessary medical care. Health services allowing to get timely medical intervention based on medical insurance. The state provides an opportunity for its citizens and other persons to obtain compulsory medical insurance (OMS) with a sufficient range of services that are able to support people's health upon the occurrence of insured events. So what is mandatory medical insurance (OMS)? How is constitutionally protected by citizens' rights to free medical assistance? What guarantees citizens the OMS system? Reply to these and other questions in this article.

Basics of OMS

Mandatory medical insurance is a set of health protection measures, providing free medical care in the framework of current legislation, as well as the implementation of preventive measures. Insurance provides citizens with equal opportunities if medical intervention is needed. Article 41 of the Constitution of the Russian Federation guarantees every citizen the right to protect health and free medical care in state (municipal) institutions, which is carried out by paying insurance premiums, funds from the budget and other revenues. The provision of medical services is made at the expense of previous funds. The main guaranteed services include:

• Ambulance care (here does not include sanitary services);
• Primary provision of medical care;
• Medical and preventive measures;
• Specialized assistance;
• Provision of services within the framework of the existing OMS.

Implementation of the work of compulsory medical insurance occurs through specialized legal organizations - Insurance companies. Among the main tasks is considered to ensure the population with the necessary medical care through the conclusion of contracts. In addition, the funds provided by insured persons (patients) of services to therapeutic institutions, protection of the rights of the population.

Health Insurance Financing Source

To implement a program for the provision of free medical care, it is necessary to have a substantial financial base. Money battery in the OMS system is the federal compulsory health insurance fund (FOMS). The main purpose of the Fund seems to be as providing all persons involved in insurance necessary for therapeutic and drugs. Formation of funds occurs due to the following sources:

• Contributions to the FOMS of employers for their employees;
• Receipts in the form of fixed payments from IP and self-employed persons;
• Receipts from the budgets of the subjects of the Russian Federation for non-working.

Insurance contributions as revenues from employers are charged on established tariffs for wages of employees. Payers are most of the organizations and employers-entrepreneurs, with the exception of some representatives of small businesses released from paying payments of this type.

Earlier, the compulsory insurance fund was divided into federal and territorial, payments needed to be transferred to each of these structures. Starting from 2012, the territorial Fom has abolished. Currently, payments are carried out only in the federal FOMS at the main rate of 5.1%.

Polis Oms

Guaranteed medical care is confirmed by the presence of the policy. You can get this document in the insurance medical company After conclusion with her the relevant contract. The issuance of these documents in the OMS system is made to almost all persons, including:

• Citizens of the country;
• Non-working population and persons who have undergone majority;
• Temporarily or permanently residing in the territory of the Russian Federation;
• Stateless persons;
• Refugees.

The term of the policy depends on the status of the insured person. For citizens of the Russian Federation and staying constantly on the territory of the country - a non-document document. For temporarily staying, including refugees, the action of the policy is limited mental period Laying within the country.

Provisions on the rights of insured persons in the presence of the policy are listed in the law of 29.11.2010 No. 326-FZ "On compulsory health insurance in the territory of the Russian Federation". Without the presentation of the document, an individual can only count on emergency free medical care. The action of the Polis covers the whole territory of the Russian Federation. In case of refusal of medical institutions to provide free services Within the framework of the OMS, the complaint is submitted at the location of the insurance company. The presence of the OMS policy gives some rights to its owners. The following types of medical care become available with the help of the document:

• Emergency medical services;
• Outpatient treatment in clinics, including diagnostic procedures and dispensarization, while free provision of drugs in this case, as a rule, is not provided;
• Inpatient treatment, including emergency hospitalization in order to preserve health, including during childbirth and exacerbation of chronic diseases.

Often medical Policy Provides the opportunity to diagnose diseases using special equipment. The owner of the document in the presence of testimony can be a participant in rehabilitation, preventive and wellness activities. For preferential categories Population policy is needed to confirm the right to free medicines. In addition, owners document OMS It is entitled to receive a planned vaccination and pass the fluorographic examination. The presence of an OMS policy makes available basic medical services for wide segments of the population. This factor for poor and socially unprotected persons is especially important.

How to get an OMS policy?

Polis as a document confirming the right of its owner to receive free medical care, you must have with you. It is presented in the treatment in hospitals, clinics and with ambulance services.

Polis is issued in insurance companies in any regions of the country. The choice of the insurance company itself is the right of any citizen and other person. Although, as a rule, the result is determined by the territorial presence of an insurance organization. At the same time, significant differences are not observed when choosing companies. The range of services provided is the same, although some insurance companies have the right to attract customers in various bonus programs. To obtain the OMS policy, you must provide the following documents to insurance companies:

• Identification;
• Reduss;
• Other documents, depending on the status of the insured person (birth certificate, confirmation of temporary residence and other).

Often when dealing, initially insurance companies issue a temporary policy. Its action is limited to a period of 1 month, after which the current document is replaced with a current sample. The temporary policy has the same powers as permanent. If the policy is loss, the owner's name change is supposed to be replaced.

Polis, as a document of compulsory health insurance, is better to do in advance. In this case, when unexpected health problems appear, there will be no bureaucratic obstacles in obtaining medical care.

What includes free medical care?

Free medical care on which citizens are insured in the OMS system can be calculated in the basic program. A list of diseases, due to the emergence of which assistance is available on the OMS system, is quite extensive. This includes the following insured events:

• Pregnancy, childbirth, childcare;
• Infectious and bacterial diseases;
• Diseases of the endocrine system;
• Problems with digestive organs;
• Diseases of ears, eyes;
• Diseases as a result of chromosomal disorders;
• Reducing the immune forces of the body;
• Poisoning;
• Diseases of the nervous system;
• Other Insurance Cases.

The right to receive free assistance is governed by the legislation of the Russian Federation, and assistance belonging to the basic program (preventive, special, high-tech, ambulance) is regulated by Article 35 of the Federal Law of November 29, 2010 No. 326-FZ (ed. From 28.12.2016) "On compulsory health insurance in the Russian Federation. "

Conclusion

The rights of citizens to receive free medical care are governed by the Constitution of the Russian Federation, according to which they act special programs to protect the health of the population of Russia. The general mechanism of the OMS is the duty entrusted to certain persons by law, to make contributions to the OMS Foundation for insurance and protection of interests related to medical care expenditures. For the working population with such persons are employers, for non-working - regional authorities.

In the system of the OMS, all citizens of the Russian Federation are insured without exception. Right to receive insurance Polisa. There are foreigners permanently residing in Russia.

As insurers in the type of type under consideration:

• institutions;
• enterprises;
• directly state.

Enterprises are transferred to territorial or federal OMS funds 5.1% of the entire amount of wages. Medical insurance of non-working citizens pays directly to the state.

The most important link of the OMS are special funds. They are non-commercial organizations that accumulate all the money transfer in favor of the health insurance system.

They provide financial stability, as well as, if necessary, carry out material support for insurance companies.

Direct participants of the OMS are commercial insurance companies. They must have a relevant state license for insurance activities.

They conclude agreements with medical institutions to carry out their customers, issue medical policies, monitor quality and provision of medical care.

Medical institutions are the final segment of the OMS. Citizens of the Russian Federation are treated for relevant assistance. The presence of the described sample is fully eligible for free receiving medical services.

OMS law

To date, the foundation for the action of the OMS is the Federal Law "On Compulsory Medical Insurance in the Russian Federation".

The main function of this law is to regulate the relationship between all participants in the system of compulsory medical insurance (insurers, insurers, funds, state bodies).

It also determines the legal position of the subjects and objects in the OMS. The basis for the adoption and actions of the Law under consideration is the Constitution of the Russian Federation.

Complement the effect of FZ №326:

• law of 11/21/11 "On the basis of the health of the health of the Russian citizens";
• law of July 16, 1999, "On the Foundations of the OMS".

The relationship between the subjects of the OMS system is also regulated by various other provisions and acts of the regions of the Russian Federation. Each insured case is considered separately, individually.

For compliance with the law under consideration, the Federal and Regional Fund of the OMS is observed.

Each organization has a special legal legal department that performs the function of oversight in compliance with legislation in the territory of the Russian Federation.

What gives polis

The Policy of the OMS confirms the presence of a citizen with the right to receive free medical care.

With its availability, the insured person has the right to contact the following institutions:

• the clinic to which is assigned the insured;
• traumatology;
• dentistry;
• oncological departments, dispensaries;
• hospitations participating OMS.

The presence of a compulsory health insurance policy allows you to get almost any medical care without any financial costs.

This document is currently mandatory for the provision of a medical institution when contacting. If the OMS policy for some reason is absent, the individual can receive medical care on a fee.

What does he look like

Today, the policy of compulsory health insurance has a standard appearance. Moreover, its format does not depend on the services of which insurance company a citizen enjoys. Appearance Depends only on the type of medical policy.

Recently, a health insurance system reform is carried out. It was in this connection that the insurance policy of a new sample was released. It has a view plastic card, on the front side of which there is an individual card number.

Invalid Displayed Gallery.

The reverse side has the following information:

• signature of the insured;
• photography of the insurer;
• validity;
• paul and date of birth.

The policy is applied simply a copy of the image, it is not EDS. As a photo, even a picture with not very high quality can be used. The duration of the document is determined by many factors.

There is also another type of policy - temporary. It is issued for a period of 30 days in the event of a situation when plastic polis Ceremonies.

It happens if there was simply no prosecution in the face of the type of type of type in question, or it is replaced. Upon the expiration of the thirty-day period from the moment the time policy is obtained, it ceases to effect.

It is itself a paper of the format A5 and contains the following information:

• date of issue;
• signature of the insured;
• name of the representative of the insurance medical organization.

Previously, the policies of the old sample. They had a format A3 and contained information similar to the OMS submitted on the temporary policy.

Agreement conditions

The terms of the compulsory medical insurance contract were approved by the director of the Federal Fund of OMS A.M. Taranov 03.10.03.

All documents of this type should be formed only with this position, do not contradict him. Otherwise, this agreement may be considered partly invalid.

The considered document B. obligatory Contains items to avoid the occurrence of various kinds of conflicts, denotes the boundaries of responsibility.

The "Subject Agreement" section stipulates the conditions on which the insurer provides its services to the insured. In favor of the insurance company, some amount (insurance premium) is paid.

Based on this, when an insured event occurs, the company pays for its client an appeal to a medical institution.

This section refers to the insurance object - the property interest of the client. That is, in fact, the medical policy of the OMS protects its owner, first of all, from financial damage. Also in this section denotes the concept of an insured event.

Section " Insurance amountThe procedure for its introduction "discloses the two of these term in detail. The magnitude of the insurance premium, the limit of responsibility, the procedure for payment of the insurance premium and the moment of the implementation of this operation are also designated.

When designing a standard policy of the OMS, this section is absent - it is displayed in the contract between the SC and the regional (federal) Fund of the OMS. The "Treaty Terms" section defines the duration of the Agreement of the Type in question.

The Item "Rights and Responsibilities of the Parties" the obligations arising between the insured and the insurer in the case of its conclusion.

The rights of the parties are also considered as much detail. The emergence of serious violations of at least one point is a serious basis for termination of the contract.

Insurance company should ensure the confidentiality of information concerning the insured. Exception is possible only in cases stipulated by the current legislation of the Russian Federation.

Confidential is the following information:

• content of the contract, its form;
• health care condition, all available cases of medical care;
• personal policy of the insured (place of residence, home phone and other).

In the "Change and Termination of Agreement" section, situations are listed when it is possible to introduce any amendments to the text of the document.

All cases are listed when the contract can be terminated and the procedure for the implementation of this process. At the end of the contract, the details of the parties are designated: actual and legal address, phone numbers.

Validity

In various regions, various compulsory insurance policies were produced a few years ago. That is why the term of their action differs significantly. In 2011, a gradual transition to a single policy of compulsory health insurance was launched.

Today Policy this type, representing a plastic card, usually do not have the validity of the action. An exception is only the issuance of the policy of a foreign citizen.

If the physical face uses the old policy (today it is quite acceptable), then you can find out the deadline for its action directly on it itself.

Most often, this information is present in the rear of the document. Previously, the Treaty on Policyms OMS was most often for 12 months.

After that it was necessary to extend them. The end of the term of the policy is the basis for its replacement.

Required documents for registration

The list of documents required for the execution of the CHA policy, differs depending on age as well legal status Contacting the insurance company of the person.

For children over 14 years old (citizens of the Russian Federation), to obtain the policy, you must provide the following documents in the SC:

• identity card (birth certificate or other document);
• (if available).

If the paper for registration of the appropriate sample policy is provided by the parent, guardian, then the passport is required, or another document certifying the person.

If the execution of the policy is carried out by relatives, then it is required to prevent them:

• identification;
• a document that allows you to register as an insured person (power of attorney).

Citizens of the Russian Federation under the age of 18, but overcoming the age threshold at 14 years old:

• temporary identity card or passport;
• SNILS (if already available);
• certificate of the person of the representative of the insured person;
• power of attorney that allows you to register (if a representative is grandmother or grandfather);
• representation of the representative of the representative.

Persons who have reached the 18th age:

• document certifying the identity or passport;
• SNILS.

Refugees that can legally become participants in the health insurance system (the law "On Refugees") is required to be provided:

• petition;
• certificate of the appropriate sample;
• an appeal against the court decision on deprivation of refugee status in the FMS;
• a document confirming the receipt of a temporary asylum.

For individuals, permanent citizenship of not having, but possessing real estate, residence permit:

• passport of a foreign citizen;
• SNILS (if any);
• residence.

Individuals whose citizenship is missing (refugees or other) requires the following documents to participate in OMS:

• identity card and document confirming the lack of citizenship;
• SNILS (if any);
• residence.

In the absence of any document, the receipt of the insurance policy becomes simply impossible.

Contributions to insurance

Insurance contributions for OMS - payments listed in the Federal Fund for Compulsory Medical Insurance of the Russian Federation.

To date, payers of the insurance premiums of the OMS, according to Federal law "On compulsory health insurance" are:

• organizations;
• individual entrepreneurs;
• individuals who are not individual entrepreneurs (leading private practice).

The amount of insurance premiums itself is calculated and after it is paid depending on the type of organization used by the tax system, as well as other factors.

The contribution to the Federal OMS Federal Fund is 5.1% of the total wage foundation, which is paid to employees.

The duration of the estimated period on the contributions of the type under consideration is one calendar year. The reporting periods are:

• quarter;
• half year;
• nine month;
• twelve months.

Register of services rendered

The basic list of compulsory health insurance includes the following types of assistance:

• medical ambulance;
• prophylactic;
• primary healthy.

There is also a list of specialized services that are provided entirely for free or on a preferential basis.

On the compulsory medical insurance policy, you can make an abortion for free, to conduct a childbirth or postpartum period.

The OMS system provides the following types of medical care:

• dental, oncological (list approved by the Health Committee of the Russian Federation);
• implementation of preventive fluorographic studies in order to identify tuberculosis in the early stages;
• prevention of various diseases with special types of vaccines;
• preferential prosthetics, drugs;
• stationary, rendered in special outpatient compartments.

Treatment of teeth in the policy

Today, the list of services provided by the Policy of the OMS includes the treatment of teeth.

Free if available is available:

• conducting primary inspection and consultation (including for patients who are not capable of independent movement);
• drawing up a preventive map of diseases;
• treatment:
  • carious formations;
  • pulita;
  • periodontitis;
  • periodontal diseases;
  • oral diseases, mucous membrane;

• treatment of injuries by surgical intervention, extraction of foreign bodies from the channels of the teeth;
• removal of teeth and malignant formations;
• operations on the soft tissues of the oral cavity;
• the refueling of dislocations of various types.

For children under the age of 14, many polyclinics are treated:

• non-carious lesions of solid tooth tissues;
• demineralization;
• orthodontics using special removable equipment.

What are views

To date, there are three varieties of the policy of the OMS:

• a sheet of paper A5, on which a special barcode is located;
• plastic card, which is a studded electronic medium;
• electronic application with a number applied to the EEC (universal electronic card).

Earlier, until 2011, the OMC policy of a different format was produced. To date, this area of \u200b\u200binsurance is more ordered.

The legislation was amended, allowing any citizen to choose the format of the policy independently.

Policy B. in electronic format There are one important advantage over paper carrier - there is no need to extend.

The standard A5 format policy can be obtained at any Issue Point. For the receipt of universal electronic card Or a plastic card you need to visit the specialized item for issuing.

The legislation operating in the Russian Federation allows all citizens to receive medical care in full for free. Only in some cases it will be necessary to make payment, but it concerns it only very rare cases.

Most often, when visiting the clinic, it is necessary to simply provide a policy of the OMS in the registry - this will be enough.

Video: Protection of patient rights in the OMS system

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