Rating Medical Insurance Companies DMS. Ratings of insurance companies operating in the DMS market. What depends on the price

IN 2015 The Voluntary Medical Insurance Market formally grew up in reality. The volume of DMS fees grew by 1.6% in St. Petersburg. But it is necessary to take into account the price increase: the PMD policy went up by an average of 5-15%, services in the clinics of the city - by 10-12%.

Employers who form at least 90% of the total voluntary health insurance budget, buying PMD policies to their employees, reduced these costs. Many small companies simply excluded DMS from their social packages, large and medium-sized businesses optimized the DMS programs due to the reduction of the selection of medical institutions or refusal to insure the relatives of workers.

How these difficult conditions affected the cooperation of private medical clinics with insurance companies, and demonstrates this rating.

This time, another 11 major medical organizations that are actively working at the St. Petersburg market of the DMS were brought to a survey other than a private clinics included in the SRO "Association of Private Clinics of St. Petersburg. As a result, the total number of respondents amounted to 49 medical companies, which together manage more than 150 private clinics in our city. The questionnaires filled the heads of the clinics, experts, heads of departments and employees of financial services.

This year, the experts of the DMS market developed a fundamentally new method of drawing up a rating, which allows to combine indicators in several criteria that were previously evaluated separately separately.

1) The volume of payments listed by private clinics, this year was taken into account by both the clinics and information on the payment of insurance companies (on reporting for the Central Bank from the site insur-info.ru, see Table No. 1).

3) the availability of call centers (see Table No. 3).

4) Quality of DMS programs (see Table No. 4).

5) The quality of administration of the process of medical and economic expertise - in this ranking, were taken into account, on the one hand, the quality of expert opinions (see Table No. 5), and on the other hand - the timing of their provision to clinics (see Table No. 6).

6) Trust Clinic (see Table. No. 7).

For each of the criteria was drawn up its rating. These ratings were subsequently merged into the final, taking into account the weight coefficients whose value ranged from 3 to 30% (see Table No. 8). The biggest weight is 30% - at the indicator "The volume of payments by private clinics", the lowest weight - 3% - in the indicator "Compliance with the timing of the execution of expert opinions." The availability of the call center was estimated with a 5% coefficient. Obviously, private clinics are much more important than the availability of a call center.

Real market players of the DMS market participated in the ranking: 36 insurance companies (last year there were 39). From the register of insurers, in addition to the "dead souls", the UK was excluded, in 2015, a license was recalled or suspended. This is "Avesta", "ASK-Honey", "Hephaest", Insekoek, Oranta, "Help", as well as those with whom a significant part of the clinic has dissolved a contract due to the presence of financial problems.

Payments for private clinics

"Previously, the payments indicator of private clinics were not taken into account, but his importance was recognized, because It reflects the experience of the insurer and the size of the client portfolio. The rating of the current year is unique in the fact that for the first time the clinic provided information on the volume of payment by insurers for insurance cases. For this, a special software was used, which guarantees the confidentiality of collecting and storing data and automatically processes the results to the level of the consolidated report, "comments the director of the EMC clinic, Chairman of the Committee on Standardization and Informatization of the SRO" Association of Private Clinics of St. Petersburg "Tatiana Romanyuk.

Payment Discipline

The level of payment discipline of insurance companies reflects debts to clinics for 2015 as of April 1, 2016 and accuracy of compliance with the terms of payment in accordance with the terms of the contract during the entire 2015.

In the list of insurers who have on March 30, 2016, the debt for 2015 in front of the clinics of the Association entered only 13 insurance companies. It should be noted that this list has decreased compared with last year, and in general, the financial discipline of solid insurers has grown. This is a positive dynamics, she talks about the good financial condition of the St. Petersburg insurance market.

It is also important that the insurers have debt no more than 10% of the surveyed clinics.

"In the conditions of economic instability, the clinic must constantly monitor the situation in the market, assessing financial risks. These risks are always the same type: first the insurer begins to violate bills of payment, then the debts are accumulated, then the clinics will learn that the SC has already recalled the license and chances of the clinic to get money on debts from such insurers are zero. True, it should be said that, for example, the company "Help", who lost its license in 2015, has restored it at the end of the year. Now "Help" is making serious efforts to restore reputation and is calculated on debts with clinics, "Lev Averbach, CEO of Koriz Assistance (SPB) comments.

In general, doctors recognize that insurers have become more noticeable to advance medical services. On the one hand, the clinic is demanded, trying to reduce financial risks, on the other, the insurers themselves are ready to advance the clinics, subject to the provision of discounts.

Availability of call centers

The quality of the work of the coll centers of insurance companies was evaluated by their accessibility for the doctor's doctors if necessary for the coordination of medical services.

Rating of insurance companies operating in the DMS system

Quality of programs of the DMS.

The quality of medical programs was evaluated by such a criterion as the volume of coordination of medical services, which, in essence, reflects the amount of medical care to patients on the DMS or the level of restrictions (exceptions) on insurance programs.

"This indicator also reflects the specifics of the portfolio of insurance companies: companies capable of attracting solvent customers usually offer more filled programs. The presence of many SC abbreviated programs is talking about a certain market trend in the conditions of an unstable economy and reduced solvency, "Aleksey Vlasov emphasizes, the commercial director of Ava-Peter LLC (Ava-Peter's clinics and" Scandinavia ").

As clinics are interested in programs that do not limit the quality of treatment, then companies that have full programs have occupied a higher place in the ranking.

Rating of insurance companies operating in the DMS system

"In 2015, the trend was clearly traced, which appeared two years ago: Reducing the level of control by the Call Centers of Insurers. The insurers want to spend less on the content of the call center and give doctors more than the opportunity to make decisions on insurance events. In general, such a trend cannot but rejoice, since it is aimed at increasing the satisfaction of the insured patient, the growth of efficiency and reduced costs of both parties, training doctors to a better understanding of the principles of insurance and rules of work on DMS programs, "the Director General of the Private Clinics Association of St. Petersburg Alexander Solonin.

Quality of Administration of the Process of Medical Economic Examination

This rating was calculated in two parameters. The first is the quality of expert conclusions. The clinics evaluated the presence of reasonable reasons for refusal and how convincing for a physician form they were set out (see Table No. 5). "Often in acts simply lack reasonable arguments for the reasons for reference. Such a negligence in the work of experts and the lack of a dialogue between experts and doctors is a significant drawback, it forms a negative attitude towards the insurance company and leads to unwanted conflicts for us, "Konstantin Shako comments, the operating director of the" SMT "Holding.

The second criterion is the deadlines for the design and transfer of expert opinions to clinics (see Table No. 6). "Recently, some insurance companies allow themselves to send acts of expertise six months later and more, without thinking about the fact that, according to the results, the examinations of the clinic are conducting financial and accounting, as well as explanatory work with doctors and that this work by clinics must be carried out in a timely manner." Lion Averbach, CEO "Corius Assistance (SPB)".

Rating of insurance companies operating in the DMS system

"We have certain difficulties in cooperation with some insurance companies in this matter. Medical and economic expertise is a process in which there are a lot of white spots, pitfalls and contradictions, tempting the parties to move away from the main objective of the examination, comments the deputy director of the Installation of the XXI Century Clinic, Oksana Adamenko. - And yet the main task is to provide high-quality medical care to the insured. And in this, our interests completely coincide with the interests of insurance companies. And the difficulties with the availability of call centers have both sides. We decide them, integrate the processes for faster communication. "

Rating of insurance companies operating in the DMS system

Sympathy clinics remained on the side of the SC "Reso-Warranty". It should be noted that the Troika Leaders also included "Renaissance Insurance" and "VTB Insurance", which last year occupied 5 and 6 positions in the rating of trust, respectively. They managed to move such large insurers as "Alliance", "Capital Police" and "Rosgosstrakh". However, taking into account all other criteria for assessing the final rating of insurance companies looks different.

In the final table, the place is distributed based on the multiplicative indicator of the business reputation in the 6rd criteria above. Thus, according to the results of 2015, the SK "Reso-Warranty" moved from the first place on the third, "Sogaz" remained at the second, and the Alliance became the leader of the rating.

In more detail with the method of surveying experts and the results of the rating, you can find on the website of the SRO "Association of Private Clinics of St. Petersburg" www.acspb.ru.

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The Association of Personal Clinics of St. Petersburg for the third time amounted to the rating of insurance companies selling the PMC Polisters.

In 2015, the Voluntary Medical Insurance Market formally grew up in reality. The volume of DMS fees grew by 1.6% in St. Petersburg. But it is necessary to take into account the price increase: the PMD policy went up by an average of 5-15%, services in the clinics of the city - by 10-12%.

Employers who form at least 90% of the total voluntary health insurance budget, buying PMD policies to their employees, reduced these costs. Many small companies simply excluded DMS from their social packages, large and medium-sized businesses optimized the DMS programs due to the reduction of the selection of medical institutions or refusal to insure the relatives of workers.

How these difficult conditions affected the cooperation of private medical clinics with insurance companies, demonstrates this rating.

Payments for private clinics

The table below shows the total rating of the amount of payments according to the clinics survey and site site.

1. RESO-WARRANTY
2. Alliance
3. SOGAZ
4. Rosgosstrakh
5. VTB Insurance
6. Alpha insurance
7. Renaissance Insurance
8. Consent
9. Ingosstrakh
10. Capital Polis
11. MedExpress
12. Metlamif
13. Guide
14. Liberty Insurance
15. URALSIB
16. VSK.
17. British insururant
18. Energogarat, North European Branch
19. Krk Insurance
20. GSMK City Insurance Medical Company
21. Jaso.
22. Max
23. Energy Garante, Northwest Regional Branch
24. Transneft.
25. Capital Capture
26. Absolute Insurance (Former. Euro-Policy Claim)
27. Surgutneftegaz
28. Anchor
29. Swiss Garant
30. Investment and finance
31. Advant Insurance
32. RegionGarant
33. Insurance Business Group
34. Support (Former. Opening Insurance)
35. Helios.
36. SPASSKY GALOT.

Payment Discipline

The level of payment discipline of insurance companies reflects debts to clinics for 2015 as of April 1, 2016 and accuracy of compliance with the terms of payment in accordance with the terms of the contract during the entire 2015.

1. Investments and Finance, Helios
2. Insurance Business Group
3. Metlamif
4. Swiss Garant
5. British Insurance House
6. Alliance
7. Absolute Insurance (Former. Euro-Polis Claim), Surgutneftegaz, VSK, Sogaz, Rosgosstrakh, Renaissance Insurance
8. RESO-WARRANTY
9. Energogarant North-European Branch, MedExpress
10. Anchor
11. Jaso, Capital Insurance
12. Alfactory, Liberty Insurance
13. KRK Insurance, Transneft, RegionGarant, Energogarant North-West Regional Branch
14. Advant Insurance
15. Capital Polis
16. Ural Sib
16. SPASSKY GALOT.
17. Support (Former. Opening Insurance)
18. Ingosstrakh, GSMK (City Insurance Medical Company)
19. Hayde.
20. Consent
21. Max
22. VTB Insurance

In the list of insurers who have on March 30, 2016, the debt for 2015 in front of the clinics of the Association of Private Clinics, only 13 insurance companies entered. It should be noted that this list has decreased compared with last year, and in general, the financial discipline of solid insurers has grown. This is a positive dynamics, she talks about the good financial condition of the St. Petersburg insurance market.

It is also important that the insurers have debt no more than 10% of the surveyed clinics.

In general, doctors recognize that insurers have become more noticeable to advance medical services. On the one hand, the clinic is demanded, trying to reduce financial risks, on the other, the insurers themselves are ready to advance the clinics, subject to the provision of discounts.

Accessibility of call centers

The quality of work of the Call-Centers of Insurance Companies was evaluated by their accessibility for the doctor's doctors, if necessary, approval of medical services.

1. Support (Former. Opening Insurance)
2. Anchor
3. RegionGarant.
4. Energy Garante, North European Branch
5. Energy Garante, Northwest Regional Branch
6. Krk Insurance
7. Swiss Garant, Capital Polis
8. Insurance Business Group, VSK, Capital Insurance
9. Jaso, Transneft
10. British Insurance House
11. Surgutneftegaz
12. Ural Sib, Guide
13. Metlamif
14. Advant Insurance, Spassky Gate
15. Alliance
16. GSMK City Insurance Medical Company
17. Liberty Insurance
18. Absolute Insurance (former. Euro-Policy Claim)
19. Renaissance Insurance
20. Investment and Finance
21. SOGAZ
22. Max
23. Consent
24. VTB Insurance
25. Alfactory
26. Medexpress
27. Helios.
28. Rosgosstrakh
29. RESO-WARRANTY
30. Ingosstrakh

Quality of programs of the DMS.

The quality of medical programs was evaluated by such a criterion as the volume of coordination of medical services, which, in essence, reflects the amount of medical care to patients on the DMS or the level of restrictions (exceptions) on insurance programs.

As clinics are interested in programs that do not limit the quality of treatment, then companies that have full programs have occupied a higher place in the ranking.

1. Metlamif
2. Alpha insurance
3. Starting insurance
4. VTB Insurance
5. Alliance
6. Capital Polis, VSK, British Insurance House, Rosgosstrakh
7. SOGAZ
8. Absolute Insurance (Former. Euro-Polis Claim)
9. Liberty Insurance
10. Transneft.
11. MedExpress
12. Renaissance Insurance
13. Consent
14. Guide
15. GSMK City Insurance Medical Company
16. Ural Sib
17. Max
18. RESO-WARRANTY
19. Insurance Business Group
20. SPASSKY GALOT.
21. Surgutneftegaz
22. Support (Former. Opening Insurance)
23. Energy Garante North European Branch, Swiss Garant, Ingosstrakh
24. Advant Insurance
25. Jaso.
26. RegionGarant.
27. Energy Garante North-West Regional Branch
28. Krk Insurance
29. Investment and finance
30. Anchor
31. Helios.

"In 2015, the trend was clearly traced, which appeared two years ago: Reducing the level of control by the Call Centers of Insurers. The insurers want to spend less on the content of the call center and give doctors more than the opportunity to make decisions on insurance events. In general, such a trend cannot but rejoice, since it is aimed at increasing the satisfaction of the insured patient, the growth of efficiency and reduced costs of both parties, training doctors to a better understanding of the principles of insurance and rules of work on DMS programs, "the Director General of the Private Clinics Association of St. Petersburg Alexander Solonin.

Quality of Administration of the Process of Medical Economic Examination

This rating was calculated in two parameters. The first is the quality of expert conclusions. The clinics evaluated the presence of reasonable reasons for refusal and how convincing for a physician form they were set out (see Table No. 5).

The second criterion is the deadlines for the design and transfer of expert opinions to clinics (see Table No. 6).

1. METLAF, ALFASTICHING, CAPITAL INSURANCE, CAPITAL-POLIS, Transneft, Insurance Business Group, Sports Gate, Surgutneftegaz, Support (Former. Opening Insurance), KRK Insurance, RegionGrant, Investments and Finance, Anchor, Helios, Jaso
2. Renaissance insurance
3. Alliance
4. Ural Sib, British Insurance House
5. Medexpress
6. SOGAZ
7. Max
8. Liberty Insurance, Advant Insurance, Energy Garante North-West Regional Branch, VTB Insurance, VSK,
9. Guide
10. Swiss Garant
11. GSMK City Insurance Medical Company
12. Rosgosstrakh, Absolute Insurance (Former. Euro-Polis Claim), Energogrart, North European Branch
13. Consent
14. RESO-WARRANTY
15. Ingosstrakh.

1. METLAF, ALFASTICHING, CAPITAL INSURANCE, CAPITAL-POLIS, TRANSNEFT, INSURANCE BUSINESS GROUP, SPASSKY Gate, Surgutneftegaz, support (former Ural Sib, Max, Liberty Insurance, Advant Insurance, Energogarant North-West, Guide Regional Branch, Swiss Garant, Rosgosstrakh
2. British Insurance House, MedExpress, VTB Insurance, VSK, GSMK City Insurance Medical Company, Absolute Insurance (Former. Euro-Policy Claim), Energy Garante North-European Branch, Reso-Warranty
3. Jaso.
4. SOGAZ, consent
5. Ingosstrakh

1. Reso-Warranty, Sogaz
2. Renaissance insurance
3. VTB Insurance
4. Alliance, Capital Police
5. Alpharack, Liberty Insurance, British Insurance House
6. MedExpress, Metlaiff, Ingosstrakh, Rosgosstrakh
7. Absolute Insurance, Vax, Guide, Transneft, Energogrart (North-West Branch)

Sympathy clinics remained on the side of the SC "Reso-Warranty". It should be noted that the Troika Leaders also included "Renaissance Insurance" and "VTB Insurance", which last year occupied 5 and 6 positions in the rating of trust, respectively. They managed to move such large insurers as "Alliance", "Capital Polis" and "Rosgosstrakh". However, taking into account all other criteria for assessing the final rating of insurance companies looks different.

In the final table, the place is distributed based on the multiplicative indicator of the business reputation in the 6rd criteria above. Thus, according to the results of 2015, the SK "Reso-Warranty" moved from the first place on the third, "Sogaz" remained at the second, and the Alliance became the leader of the rating.

1. Alliance
2. SOGAZ
3. RESO-WARRANTY
4. RenaissanceStrack
5. Alpha insurance
6. Capital Polis
7. Rosgosstrakh
8. VTB Insurance
9. Metlamif
10. MedExpress
11. Libertyism
12. British Strakhovoom.
13. Consent
14. VSK.
15. Guide
16. Uralsib
17. Ingosstrakh.
18. Capital Capture
19. Energogarant, North-European
20. Transneft.
21. Jaso.
22. Krk Insurance
23. GSMK City Insurance Medical Company
24. Absolute Insurance (formerly Euro-Polis)
25. Surgutneftegaz
26. Max
27. Energy Garante, North-West Regional Branch
28. Anchor
29. Insurance Business Group
30. Swiss Garant
31. Investment and finance
32. RegionGarant
33. Support (Former. Opening Insurance)
34. Advant Insurance
35. Spassky gate
36. Helios.

This time, another 11 major medical organizations that are actively working at the St. Petersburg market of the DMS were brought to a survey other than a private clinics included in the SRO "Association of Private Clinics of St. Petersburg. As a result, the total number of respondents amounted to 49 medical companies, which together manage more than 150 private clinics in our city. The questionnaires filled the heads of the clinics, experts, heads of departments and employees of financial services.
This year, the experts of the DMS market developed a fundamentally new method of drawing up a rating, which allows to combine indicators in several criteria that were previously evaluated separately separately.
1) The volume of payments listed by private clinics, this year was taken into account by both the clinics and information on the payment of insurance companies (on the reporting for the Central Bank from the site site, see Table No. 1).
2) The level of payment discipline - in the 2016 rating, two indicators were taken into account: the timeliness of bills of bills in accordance with the contract and the absence of debt for 2015 (see Table No. 2).
3) the availability of call centers (see Table No. 3).
4) Quality of DMS programs (see Table No. 4).
5) The quality of administration of the process of medical and economic expertise - in this ranking, were taken into account, on the one hand, the quality of expert opinions (see Table No. 5), and on the other hand - the timing of their provision to clinics (see Table No. 6).
6) Trust Clinic (see Table. No. 7).

For each of the criteria was drawn up its rating. These ratings were subsequently merged into the final, taking into account the weight coefficients whose value ranged from 3 to 30% (see Table No. 8). The biggest weight is 30% - at the indicator "The volume of payments by private clinics", the lowest weight - 3% - in the indicator "Compliance with the timing of the execution of expert opinions." The availability of the call center was estimated with a 5% coefficient. Obviously, private clinics are much more important than the availability of a call center.
Real market players of the DMS market participated in the ranking: 36 insurance companies (last year there were 39). From the register of insurers, in addition to the "dead souls", the UK was excluded, in 2015, a license was recalled or suspended. This is "Avesta", "ASK-Honey", "Hephaest", Insekoek, Oranta, "Help", as well as those with whom a significant part of the clinic has dissolved a contract due to the presence of financial problems.

Alexey Krylov, "City 812"

What the article will help: you will learn 9 nuances that will make it easier to choose an insurance company.

The DMS program attracts highly qualified personnel to the company, motivates employees without increasing wages, reduces the frequency and duration of stay on the hospital. Specialists who are in demand in the market will not even meet with a potential employer, if he does not offer a medstrash. By purchasing DMS staff, you will reduce tax payments. However, all the advantages can be obtained, only carefully choosing an insurance company. What parameters should pay attention to first?

Insurance company rating.
Status Insurance companies are assigned independent rating agencies. For example, Expert RAEX (RAEX) is a Russian and international rating agency accredited under the Central Bank and the Ministry of Finance of Russia. Status is assigned on the basis of financial indicators of insurers: from the best A ++ (the maximum level of creditworthiness / financial reliability / financial stability) to the worst D - (the object is in a state of default). Choose insurance companies with a rating not lower than B ++ (moderate level of creditworthiness / financial reliability / financial stability). Such a rating gives the hope that the company's financial sustainability will allow it to fulfill its obligations and attract highly qualified specialists to the execution of contracts.

License for DMS.
The regulator in the field of insurance is the Central Bank. Data on valid, suspended and revoked licenses can be clarified on the Bank's website. If the insurance company has been withdrawn or suspended a license, it does not have the right to conclude new and extend the existing contracts. If the license restrictions entered into force at the time of the insurance contract, according to paragraph 4.1 of Article 32.8 of the Law of the Russian Federation of 27.11.1992 NO4015-1 "On the Organization of Insurance In the Russian Federation" in connection with the review of the license, insurance contracts and reinsurance agreements are terminated after 45 Calendar days from the date of entry into force of the decision of the insurance supervision authority to revoke a license. Interrupted the contract for this reason, you will return part of the funds - the difference between the payment for which the insurance contract was concluded, and the period of which he acted.

Volume of fees.
Insurance insurance fees can be viewed on insurance sites (for example, "insurance today", "711.ru"), on the website of the Central Bank in the section "Publishing the reporting of the subjects of the insurance business" and on the sites of insurers in sections related to the disclosure of financial information. These information is presented in the form of a rating, where companies are indicated as leaders with the highest fees. The volume of charges shows how active the insurance company works in this direction: the more fees, the greater the interactions with other market participants - therapeutic institutions, brokers, partners who are not involved in insurance, but ready to provide discounts on services to customers of insurance companies. This allows the insurer to receive the most favorable tariffs for customers and conditions. Wholesale prices are always cheaper than retailers, tariffs for insurance companies and individuals may differ within 30-70%.

Affiliate network.
With a large number of medical facilities, the insurer cooperates, the more clinics in the program he will be able to offer your company in any price segment, from economy to premium. The number of clinics and hospitals on the network, in general practice, does not affect the price of the company's employee insurance program. But the wider the proposed network, the more convenient to use insurance: each employee can pick up the clinic next to the house, office. And the wider geographical covering can provide an insurance company, the higher the probability to ensure all employees with high-quality medical help. The price from the region does not depend. Only included risks and a set of medical institutions affect the cost of services. The rule also works for Moscow, and for regions.

Insurance amounts.
Insurance amount - a limit of payments for risks for each insured person for the entire insurance period or the amount, within which the Insurance Company pays the costs of the owner of the policy of medical services. Now the main insurers in the DMS market establish such insurance amounts, it is almost impossible to exhaust.

Reviews of the company.
Collect and analyze reviews about the intended insurance company on insurance sites:
"Banks.ru", "Compare.ru", ASN. Inscribe colleagues and partners. Get acquainted with insurers in specialized portals, survey employees. Of course, often reviews are subjective in nature, but with their sufficient quantities (at least 10-15) it is possible to identify positive and negative trends, for example: the quality of the dispatching panel, the speed of resolving issues. Please note whether there were appeals to the insurer in the event of negative feedback and what were the responses. Working with complaints and complaints is an indicator of a professional and reliable market participant taking care of their clients and reputation.

Contract price.
Evaluating the proposals of various insurance companies, make sure that they compare the price identical parameters. It is worth comparing: a list of risks, a set of medical institutions for each risk, the volume of services and exceptions. The cost of the voluntary health insurance contract varies from ten thousand rubles for the budget level clinic to several hundred thousand rubles for international medical centers.

Services for a fee.
Find out why your employees will have to pay separately. Preventive measures, cosmetology services, family planning services and other are usually not included in the DMS programs. Also, not all insurers include outpatient treatment of oncological and occupational diseases in programs, restrictions on analyzes, immunological, allergological research are introduced.

Service services.
Find out what services is ready to provide you with the company. For example:
Personal curators that respond to all issues that arise and promptly solve problems;
Personal account, where you can get all the information on the policy without contacting the insurer, make an appointment in the online mode;
Additional discounts on other products of the company (OSAGO, CASCO, property insurance);
Additional services and bonuses (trace of traveling abroad, discounts from partner companies, expansion of the insurance program).

Who to instruct the analysis of the insurance market.
Usually in large and medium-sized companies this task is performed by HR service staff or procurement service. But more efficiently, if both departments will interact when choosing an insurer.

Medical insurance within the framework of the Insurance OMS system is available to everyone. The Polis of OMS allows you to get free help, but it is possible to wait for it indefinitely, because the queue of the suffering sometimes stretches for months, for example. DMS Insurance solves this problem, but the high cost of the policy often scares potential customers. What DMS programs have and whether a simple Russian can afford a voluntary medical staff?

The DMS programs differ from each other not only worth, but also a list of services, a list of medical and preventive institutions that can provide medical assistance and the amount of this aid. The PMC policy may include only those services that the client needs, the cost of insurance depends on their number and reputation of medical institutions.

How are the conditions for DMS programs formed?

Almost all offers about DMS Insurance are formed according to typical schemes. Thus, the insurance company independently determines the list of rendered basic services to which additional procedures or medical services can be added, coordinated individually with the client.

The basic services of the basic programs of DMS usually include outpatient polyclinic treatment, hospital services, a call to the doctor's house, dental treatment and ambulance. There are many restrictions in such policies. Here are just some of them:

• the basic programs do not provide expensive diagnostics (a number of analyzes, tomography or specialized studies requiring unique reagents);
• hospital services are usually limited in time (usually 10-15 days);
• emergency assistance The policyholder can cause no more than a certain number of times (3/5) for a specific period (week / month).

Insurance companies also sometimes offer round-the-clock help on the duty phone number ("Medical Remote"). In this case, the dispatcher will be able to advise on general issues, call an ambulance, record on reception to a specialist. Each client oversees the manager, if necessary, it will help solve controversial issues or orient the insured person during the occurrence of the insured event.

In addition to the main proposals, insurers are withdrawn to the market and special products aimed at helping in special cases. These include the PMD policies for the elderly; pregnant women; family programs; assistance programs athletes, tourists; Account assistance programs; protection against ticks; Polyses for rehabilitation treatment in sanatoriums or overseas clinics. The insurance premium in such programs may be higher than the basic ten times.

Comparative analysis of DMS programs

In order to be clearly seen how the DMS programs offered by various insurance companies are distinguished, comparative tables are presented below with the characteristics and cost of the services offered.

Company "Ingosstrakh".

One of the largest and oldest insurance companies in Russia, having a high rating of reliability a ++. Here are the main DMS insurance programs offered by Ingosstrakh Company:

The main programs of Voluntary Insurance of the company "Ingosstrakh"

A significant difference in the cost of servicing between policies of different types is formed by the list of services and the reputation of the LPU, which are maintained by the insured person.

Among the advantages of buying the PMC policy in Ingosstrakh's company, you can allocate:

• the possibility of treating individual diseases that are often exceptions in other insurance programs (diabetes, epilepsy, skin, professional diseases);
• carrying out expensive types of diagnosis (hormonal, genetic studies);
• dental treatment without surcharge;
• 24-hour help dispatcher on telephone;
• your network clinics "Be healthy";
• high level of service;
• payment of hospital services in the event of the expiration of the contract for this period;
• system of discounts when buying PMD policies;
• availability of special offers.

Company "Reso-Warranty"

A large insurance company providing a wide range of services having a high reliability rating at the A ++ level. Here are the basic DMS insurance programs offered by the company "Reso-Warranty":

The main programs of the DMS company "Reso-Guarantee"

The total cost of the PMD policy, the proposed "reso-guarantee" also depends on the reputation of the level of therapeutic medical centers. At the same time, the Basic Voluntary Insurance Program "Doctor Reso" includes the following services:

• outpatient maintenance;
• medical assistance at home;
• ambulance.

In addition to basic insurance in the PMD policy, you can include:

• diagnosis for adults and children;
• dental treatment;
• emergency hospital.

Among the benefits of buying a DMS policy in the company "Reso-Warranty" can be allocated:

• the ability to call the ambulance, a doctor to the house;
• receipt of consultations An unlimited number of times;
• emergency assistance is found throughout Russia;
• individual discounts in hospitals are possible;
• the amount of insurance premium does not change during the contract;
• the possibility of paying the insurance premium of parts;
• 24-hour dispatching service;
• discount programs at the conclusion of the contract of DMS;
• special policies for individual cases.

Company "ROSGOSSTRAKH"

The largest Insurance Company of Russia, which has been providing insurance programs since 1921. Works with private and corporate clients. Ranking Reliability is high - a ++. Here are the main DMS insurance programs offered by Rosgosstrakh:

The main programs of the DMS company ROSGOSSTRAKH

Complex medical insurance from Rosgosstrakh company includes the following services:

• polyclinic and outpatient activities;
• dentistry;
• ambulance;
• emergency hospital.

Depending on the number and quality of services, the status of therapeutic institutions the cost of the PMC policies will change.

Also, Rosgosstrakh offers customers special programs:

• to protect against tick bites;
• package "Guest" for foreign citizens;
• the Health Program will protect against the effects of injuries, acute or exacerbations of chronic diseases;
• policy "Hepatitis Protection";
• help with an accident.

Here is the list of the main advantages of DMS from Rosgosstrakh company:

• large selection of insurance programs;
• 24-hour help and support;
• highly qualified clinics and doctors;
• discounts and promotions when buying insurance;
• service in medical institutions throughout Russia;
• individual approach.

Company "Russian Standard Insurance"

Founded in 2003. It offers customers a lot of insurance products in a different price range. Our customers "Russian Standard Insurance" offers the following DMS programs:

The main programs of the DMS company "Russian Standard Insurance"

The cost of the PMC policy, the proposed companies depends on the quality and number of events held, medical centers for circulation. The basic program of DMS from the company "Russian Standard Insurance" includes the following services:

• techniques of doctors;
• analyzes, surveys;
• ambulance;
• call a doctor at home;
• registration of the hospital sheet;
• recovery treatment.

Expand the basic packages by adding the following services:

• emergency hospitalization;
• dentist services.

An emergency hospital can be added to the selected policy, which will cost 4,000 - 19,000 rubles, depending on the type and quality of assistance.

Company "Renaissance Insurance"

Since 2008, it has been providing services for insuring individuals and legal entities. The company has proven itself in the field of tourist insurance and has high reliability ratings. In the DMS segment, Renaissance Insurance offers several products, the cost of which changes when connecting and disable various options, and choosing certain medical organizations. Here is the comparative characteristics of some programs offered by Renaissance Insurance

The main programs of the DMS company Renaissance Insurance

For an additional fee, you can add ambulance services and emergency hospital.

Instead of imprisonment

Analysis of DMS proposals offered by various insurance companies shows a very large variation in both the volume of services and the cost of the policy. Obviously, it is not possible to withdraw some average values \u200b\u200bin this case - in some cases, the choice of one program or another will rather be due to the need of the insured in certain services, rather than a basic service package offered by the insurance.

However, the choice of insurance company and the insurance program should be approached. Of great importance is the reliability of the organization on which the scope and quality of the obtained medical services depends. After all, it is the company that will oversee every step of the insured person and the work of the physicians, in controversial situations will present and protect the interests of the client and guarantees (or does not guarantee) the payment of reimbursement on the insurance case in full.

Summary

Optional development: As part of the modernization of the OMS system, the state seeks to minimize the volume of the DMS market, which can adversely affect the entire health care system. In the health development strategy until 2020, it is said that the work of the DMS market leads to a "reduction in the availability and quality of medical care to the population serviced under the state guarantee program." Based on this, the state does not support the development of the DMS market.

However, the conditions of insufficiency of funding for the health system such a position will lead to an increase in shadow payments and reduce the effectiveness of the entire OMS system. According to Expert RA, the work of the DMS market has a number of positive external effects: the growth of social stability, a decrease in information asymmetry in the medical services market, improving the efficiency of the health care system and the growth of investment in the construction of medical centers. Given these external effects, the state, on the contrary, should contribute to the development of the Russian DMS market.

Expert RA developed the main provisions of the DMS market development strategy, which should be an integral part of the concept of the development of the health care system. The main directions of the strategy: a clear separation of OMS and DMS systems, updating the product line and standardization of DMS agreements, as well as simplifying the use of tax breaks.

Pricing is clarified: a direct dependence of the cost of medical services from the service and quality of equipment has appeared on the LPU market. A few years ago, the correlations between these indicators were not traced. The total increase in the quality of medical institutions was noted compared to 2006. In general, the evaluation of departmental clinics in all parameters turned out to be higher than private. The private polyclinic for adults revealed the inverse dependence of the cost of services from the professionalism of medical personnel.

The highest indicators for the price / quality ratio of the study were obtained:

1. NUZ Central Polyclinic of Russian Railways (Polyclinic Services for Adults);
2. Branch No. 5 of FSU "3 CVKG them. A.A. Vishnevsky Ministry of Defense of Russia "(polyclinic service for children);
3. NUZ "Central Clinical Hospital No. 1 of JSC" Russian Railways "(hospital for adults);
4. State Unitary Enterprise "Research Institute of Emergency Children's Surgery and Traumatology" Department of Health of Moscow (hospital for children).

Fiscal effect: The growth of deductions on OMS from 3.1 to 5.1% will reduce the budgets for the DMS.Especially noticeably this measure will affect the still unstable demand from small and medium-sized businesses, which grew up with the expansion of tax benefits in 2009 (the rate of assigning awards for the DMS to the cost increased from 3 to 6%). Nevertheless, the growth of the DMS market will continue at least by inflation of the cost of medical services. According to the "Expert RA" forecasts in 2011, the volume of the DMS market will be 89.6 billion rubles (+ 10%), in 2012 - 100.3 billion rubles (+ 12%).

The possibility of choosing an LPU and a physician according to the OMS program, as well as the inclusion in the system of a private clinic will lead to the redistribution of the DMS market. In this situation, 2 scenarios for the development of events are possible:

1) If it is possible to choose from the HDC clinic program with a high level of service and the quality of the services provided, there is no need to purchase the PMC policy. In the future, the OMS system may well provide serious Competition of the DMS.

2) High-level clinics will not want to enter the OMS system, and the lower level clinics will be included instead. Then the demand for DMS will increase, and due to the lack of high-quality competition between clinics there will be no incentives for improving the service and quality of services provided by municipal clinics.

Treatment at the expense of insurers: Loss of business on DMS for 2010 exceeded 100%.The average significance of the combined loss-net coefficient for the first 9 months of 2010 was 99% (for 9 months of 2009: 90%). The main causes of unprofitability growth: dumping, "cheats" of the LPU and the incorrect organization of the loss settlement system - payments are not carried out as a result of the occurrence of the insured event, but on the fact of the visit to the LPU.