The federal fund of compulsory health insurance (FFOMS) is a state extrabudgetary fund created to finance the medical care of Russian citizens under the OMS program. This article discusses which tasks and functions are facing the FFOMs, which it has a structure, due to which the budget is formed, with which the objectives of the fund accumulated funds are used.
Structure and control of FFOMS
FFOMs was created on February 24, 1993 by Resolution of the Supreme Soviet of the Russian Federation No. 4543-I. The Fund's activities are regulated by the Budget Code of the Russian Federation and the Federal Law "On Compulsory Medical Insurance of Citizens in the Russian Federation", as well as other legislative and regulatory acts. The Regulations on the Fund was approved on February 24, 1993, and on July 29, 1998, the charter was adopted instead. In accordance with current tax laws in paying salary, the employer must list the insurance premiums in three extrabudgetary funds:
- FFR - 22% of the employee's taxable income;
- FSS - 2.9% of the taxable income;
- FFOMS - 5.1%.
Contributions to the FFOMs are deducted with the salary by the employer and go to the fund every month. Payments to the organization of compulsory medical insurance are mandatory. The functioning of this organization is regulated by a number of legislative norms and acts, including the Budget Code, the Law on the Commitent Fedeania of the Russian Federation Citizens and the intrafundic charter. The total structural scheme of the FFOMS is presented in the diagram below.
Figure - Structural scheme of the OMS Foundation in 2018
All units make up a single system, while each has its own functions and powers in providing citizens with the right to medical care and monitoring compliance with legislation in this area. The Russian compulsory insurance system provides for funding for healthcare agencies through the work of insurance companies and funds; Such structures are required to obtain a license for this kind of activity. The scheme of interaction of organizations works as follows:
- The Insurance Company draws up an agreement with the health institution (hospital, clinic);
- Insurance company initiates the signing of a cooperation agreement with the local OMS Foundation;
- The territorial fund allocates funds transferred to the insurance organization; That consumes them to pay for medical services that are provided to citizens having an OMS policy.
In addition, legislation provides funding for healthcare institutions without the participation of insurance companies directly through regional funds and branches, but this technique is practiced less often. The use of different methods of distribution and transfer of funds is required due to the fact that in the management structure of each region there are features. When choosing a method for transfer and distribution, such moments are taken into account as the financial situation of a particular subject of the federation, political situation, national characteristics and other aspects.
In the percentage ratio, citizens of the country registered in the OMS system are unevenly attached to insurance companies. Statistics show that over 70% of people who enjoy free medicine are attached to the 15 largest and well-known insurance organizations.
Tasks and activities of FFOMS
As a state organization, the Federal Compulsory Medical Insurance Fund exists to implement the legislative standards governing the provision of budgetary medical services. In other words, the purpose of the Fund is that each person can qualify for free medical care and regulate the performance of this requirement. The range of objectives of the organization is formulated in legislative acts as follows:
- Financial support for civil rights to receive medical care in the required amount free of charge;
- The organization of money infants, which serve to ensure the stable position of the system of compulsory media;
- Development of new and support for previous programs, the distribution of insurance priorities;
- Distribution of funding for the implementation of targeted programs and projects.
Making these tasks is carried out within the framework of all activities of the Fund, and its main functions are reduced to the following:
- Monitoring and balancing finances distributed for branches and controlled funds for the implementation of basic tasks;
- Regulation of the amount of deductions that are supported by the OMS program;
- Allocating finance for the implementation of regional programs aimed at solving problems characteristic of a specific area or settlement;
- Controlling the regularity of transfer of contributions from organizations and entrepreneurs at different levels of existing funds;
- Checking costs, control over the target costs, which allows the most rational to spend money and prevent finance leaks;
- The creation and change of methodological instructions for the debt work and the interaction of funds and branches with each other;
- Making proposals for the improvement of the existing system, including the adjustment of regulatory legal provisions in order to improve the quality of work;
- Monitoring and adjusting aspects of the base program for compulsory insurance for expanding the range of services;
- Preparation of analytical reports and the transfer of information to government structures;
- Conduct training courses for staff to work in the field of public health insurance;
- Verification of regulatory documents and provisions;
- Research research in the medical insurance field;
- Cooperation with other associations at the international world level, discussion of acute problems in the field of life insurance and health;
- Development of a project on the formation of the stock budget, drawing up and transferring reports to implement budget money.
In fulfillment of established functions, the FOMS accumulates funds to ensure the financial stability of the system, alignment of financial conditions of the TFOMS in the framework of the OMS base program through the direction of the TFOMS of funds to fulfill the territorial programs of the OMS within the framework of the Basic OMS program, the National Health Project, the Pilot Project In the constituent entities of the Russian Federation aimed at improving the quality of health services.
Sources of income and articles of expenses of the Fund
The expenditure of FFOMS funds is carried out solely on the objectives determined by the legislation governing its activities in accordance with the budget approved by the Federal Law. The successful work of the FFOMs is directly related to uninterrupted budget replenishment, and the following subjects are used as:
- Legal entities (companies, individual entrepreneurs), which make insurance payments for people who are listed in the state as employees. The size of the contribution is 3.6% of the payment fund, and of which 0.2% is transmitted to the federal FOMS, and everything else is to regional divisions. From this distribution you can see that most of the paid money remains in regional funds;
- Budgets that lists contributions to citizens, officially not employed (minors, citizens in pensions, unemployed);
- Voluntary contributions made by citizens or organizations (sponsorship, donations, etc.);
- Investments FFOMS when an organization uses available free tools for investment in order to obtain short-term or long-term profits.
Russian legislation determines the list of categories within which the Fund's budget is consumed. The main costs of expenses (more than 60% of the budget funds are allocated).
The possibilities of citizens insured in the system
Any citizen has the right to apply for high-quality free assistance to doctors and medical staff, and basic rights are regulated by the OMS Foundation. The organization of the organization allows you to qualify for full assistance in Russia and outside, namely, to receive emergency medical care in the country and abroad, the choice of polyclinics, attending specialists, methods of therapy in the presence of several options, to choose an insurance organization issuing policy, and Also on receiving professional assistance.
Conclusion
FFOMS, founded in 1993, is designed to provide free medical care to citizens of the Russian Federation and monitor the implementation of the Basic FMA program. In addition, one of the main functions of the Fund is the distribution of financing into territorial funds and medical institutions of the state.
Founded in the center of an unpleasant scandal. Even at the beginning of this year, the Fund staff began to accuse him of his journalist Ksenia Sokolov in an exorbitantly bloated salary, which she established for itself personally, fraud with the funds of the Foundation.
The application to law enforcement agencies wrote a former assistant Elizabeth Glinka, and now director of the Foundation Natalia Avilova. Sokolova denied everything, but was forced to leave his post of president of the organization.
And on October 5, the Council under the President of the Russian Federation for the Development of Civil Society published an official commentary of the Investigative Committee:
"The indicated criminal case was initiated on August 1, and 2018 to Part 1 of Art. 201 of the Criminal Code of the Russian Federation at the request of the former member of the Board of the MBA "Fair Help of Dr. Lisa" Avilova N.S. On the abuse of the head of the organization Sokolova K.Ya. His authority, that, according to the applicant, could entail the causing material damage.
During the preliminary investigation, the actions of Sokolova K.Ya. By order by means of a charitable organization and the possible prevention of damage to which the proper legal assessment will be given.
The investigation is carried out by investigators of the Chief Investigation Department of the Investigative Committee of the Russian Federation and is located on a special monitoring of the Chairman of the Investigative Committee. "
In particular, as it became known to "KP", Ksenia Sokolova put in the blame that she, having occupied a high post, hired two lawyers at the same time, which, in fact, duplicated each other's functions. Damage amounted to 1 million 790 thousand rubles.
Ksenia herself is now in Germany, but actively commented on the situation on its social network page.
After the death of Lisa Glinka, my girlfriend, her husband and employees literally with tears asked me to save her business and head the foundation. I regretted them, the Foundation saved, having spent on this business, absolutely unrelated to my main profession, a year and a half, of which 8 months on the volunteer principle. In the process, one of the employees whose services as a personal PR was rejected by me, wrote a denunciation on me in the SC. For me, 4 checks were conducted. The point was still opened and investigated. I am frankly pursued by trying to make a criminal case on the abuse of powers and misuse of funds, despite the fact that I didn't even have the right to financial signature, the Ksenia Sokolov was justified.
We managed to reach the current president of Dr. Lisa Tatiana Konstantinova.
The criminal case was indeed initiated in August, and the investigators were interviewed all. Comment now and I, and Ksenia can anything. But there are documents and is not important our subjective opinion, but their content, - said Tatyana Konstantinov.
Maybe you conducted your internal service investigation?
Not. We have no time to do this, we have children who need our help. And it is still very important that the Fund in people associate with real affairs, and not with scandals, - said Tatiana.
Help "KP"
"Fair help of Dr. Liza" is an international public organization. Helps oncoboles, homeless and poor. Elizabeth Glinka herself went to Donbass several times, exported patients and wounded children from there. I transferred humanitarian aid to Syria. He died on December 25, 2016 with a crash in Sochi the plane of the Ministry of Defense of the Russian Federation.
By the way
Ex-president of the Dr. Liza Foundation accused of abuse of authority
The scandal with financial frauds in one of the most famous Dr. Liza charitable funds broke out in the summer of this year, but the public domain became only the other day. On October 5, the Council under the President of the Russian Federation for the Development of Civil Society published the official response of the Investigative Committee. As it turned out, a criminal case against the ex-president of the Foundation of Journalist Ksenia Sokolova was initiated on August 1. She is suspected of abuses of official powers. ()
The federal fund of compulsory medical insurance is a separate non-commercial state financial and credit institution.
The Federal Mandatory Medical Insurance Fund is a legal entity having an independent balance, separate property, accounts in the Central Bank of the Russian Federation and other credit institutions, printing with its name, forms and stamps of the established sample.
The FFOMs is necessary for the implementation of the state policy in the field of compulsory medical insurance of citizens as one of the parts of the State Social Insurance Program.
FFOMS operates in accordance with the legislation of the Russian Federation.
The federal fund of compulsory medical insurance performs the following functions:
· Participates in the development of a program of state guarantees of free provision of medical care citizens;
· Accumulates the means of compulsory health insurance and manages them, provides its own financial stability by forming use if reserves are necessary.
· It has the right to accrue and collect from insurers for non-working citizens arreed on insurance premiums for compulsory medical insurance of the non-working population, fines and penalties;
· Establishes reporting forms and determines the procedure for maintaining accounting and the procedure for conducting the reporting of medical care provided for compulsory health insurance;
· Issues regulatory legal acts and guidelines in accordance with the powers established by the legislation of the Russian Federation;
· Leads a single register of insured persons, a single register of medical organizations,
· Has the right to process personal data of insured persons;
· Conducts verification of the reliability of the information provided by the subjects, controls the compliance with the legislation by the subjects of compulsory health insurance;
· Other functions.
OMS system in Russia
Currently, medical insurance is carried out in Russia in two forms: binding (OMS) and voluntary (DMS). OMS is universal and implemented according to the unified rules and programs of the OMS. Programs include "guaranteed" volume and conditions for medical and drugs to citizens. DMS provides citizens to obtain additional medical services in excess of established OMS programs. DMS can be collective and individual.
The participants of the medical insurance program are:
Insured - all citizens of the Russian Federation as health care users;
Insurers - legal entities and individuals; for working - enterprises, institutions, organizations, for non-working - executive bodies;
Insurance Medical Organization (SMO), which is obliged to conclude agreements with medical institutions to provide medical care and pay for the service provided in the event of an insured event;
A medical institution that treats the insured and receives funds from the SMO;
Federal and territorial OMS funds.
Insured by OMS are: for non-working population (pensioners, children, students, people with disabilities, unemployed) - government bodies of all levels; For the working population - employers (enterprises, institutions, organizations, individuals involved in individual labor activity).
Insured by DMS are citizens themselves (individual insurance) or employers who represent the interests of their employees. At the same time, employers can finance the DMS only if there is profit, since only it can be a source of funds for DMS. DMS is carried out by various insurance companies that have received a license for this activity.
The document that guarantees a person provides medical assistance within the framework of OMS or DMS, is the insurance policy.
To collect mandatory insurance premiums in the OMS system, federal and territorial funds of compulsory medical insurance were created - FFOMs and TFOMS. FFOMS funds are state ownership. The insurers list the deductions to the FFOMS and TFOMS. TFOMS transfers funds to accounts of insurance medical organizations (SMO). SMO is organizations that have a state permit (license) for the right to do medical insurance. SMO is paid by medical institutions money for the treatment of citizens. In general, funding in the framework of compulsory medical insurance is presented in Figure 2.
Figure 2. The interaction of participants of the OMS system
Health insurance - This is one of the forms of social protection of the population in case of health loss for any reason.
Purpose of medical insurance To guarantee citizens in the event of an insured event (disease) obtaining medical care at the expense of accumulated funds and financing of preventive measures.
The Law of the Russian Federation of June 28, 1991 "On Medical Insurance of Citizens" was fully enacted from January 18, 1993. The introduction of compulsory health insurance meant for public health transition to a mixed financing system, namely to the budget and insurance system.
Budgetary funds provide funding in a part of the non-working population (pensioners, housewives, students) and extrabudgetary funds - working citizens.
The insurers are the executive bodies of constituent entities of the Russian Federation, local government and business entities as well as citizens - entrepreneurs.
To implement this law and the implementation of state policies in the field of mandatory honey. Insurance was formed by federal and territorial funds of mandatory honey. Insurance. OMS funds are independent non-commercial financial institutions. They are intended to accumulate financial resources for mandatory honey. Insurance, ensuring the financial stability of the state system of the OMS and the alignment of Fin. Resources for its conduct.
The OMS Federal Fund has been established with the Resolution of the Supreme Soviet of the Russian Federation of January 24, 1993. The federal fund assigned the following functions:
Creating conditions for the activities of territorial OMS funds to ensure funding for programs of mandatory honey. Insurance.
Financing target programs in the framework of mandatory honey. Insurance.
Development of regulatory methodological documents that ensure the implementation of the Law "On Honey. Insurance of citizens of the Russian Federation "
Organization of training specialists OMS
Participation in the creation of OMS Territorial Funds and in the development of compulsory health insurance programs.
Fund funds are formed due to:
Insurance contributions of employers in the form of mandatory deductions.
Contributions of OMS Territorial Funds for the implementation of joint programs performed at the contractual principles.
Due to the appropriations from the federal budget for the implementation of Republican OMS programs.
Due to the income from the use of temporary free financial funds of the Federal Fund.
Due to the normalized insurance stock of the fund's funds.
Due to voluntary contributions and other revenues not prohibited by the legislation of the Russian Federation.
Territorial foundations OMS Created by local authorities and operate on the basis of the Regulations on the Territorial Fund of the OMS. Which was approved by the Resolution of the Supreme Soviet on February 24, 1993.
In regions (regions, edges, republics), branches can be created. The territorial fund is created to finance territorial OMS programs. The OMS Territorial Foundation performs the following functions:
Accumulates financial funds of the territorial foundation on the OMS.
Carries out the financing of the territorial program of the OMS.
Financially loan activities to ensure the activities of the OMS system.
Aligns the financial resources of cities, districts and other territories.
Carries out control over timely and full admission to the territorial fund of insurance premiums.
Interactions with the federal fund and other territorial funds.
The main income of the OMS are insurance premiums of employers and insurance payments for the non-working population (90% of the total income)
The procedure for enrolling the amounts of insurance premiums is determined by the Federal Treasury and the Ministry of Finance. As for insurance premiums on the inoperative population, they regulate the government of the subjects of the federation and the local administration at the expense of funds provided for in budgets.
