Insurers go to the people

From 2019, the changing pattern of provision of primary health care within the MHI. This was announced by the head of the organization of the MHI Federal Fund of obligatory medical insurance Svetlana Kravchuk. However, it is not a medical component, and the control of insurers, and feedback with patients.

All the years of the compulsory medical insurance system in the country, insurance companies have been criticized for the fact that their activity is no insurance component as such, they are engaged solely in the redistribution resulting from the Federal Fund and the least care about the protection of patients ‘ interests. And after the chamber has published the amounts used by the insurance companies on their own needs, and raised the issue of their exclusion from the system, talking about the fact that without them it is possible to do, started at the highest level. The point in this debate has put President Vladimir Putin declared that the current model should not be broken, and reformed.

The first step in reform was the creation of the Institute for insurance attorneys who have engaged in informing of insured persons. In particular, sending TEXT messages about the approaching time of passing the examination. Now the insurers intend to develop channels of feedback are insured with insurance representatives.

According to Kravchuk, the centre starting from January 2019 of the Federal project Development of primary health care the establishment of quality management systems of medical care and accompany the patient in the treatment process, including protection of his rights. And one of the main indicators of development of the project, the proportion of health facilities primary care, which will operate the contacts. This may be the post insurance representative, telephone, the terminal to communicate with the insurance company. In 2019 this share is expected to be 30.7 percent across Russia in 2020 47.8 percent, by 2024 73%.

Another indicator of the project the number of regions of Russia, which will open offices for the protection of the rights of the insured.In 2019 it will be developed under the legal framework, in 2020, similar offices will be opened in 36 regions in 2021 in 48 regions, and by 2024, all 85. The purpose of these offices work with citizens ‘ complaints, and the effectiveness of innovations will be the share of complaints resolved in the pretrial order. According FFOMS, today insurance companies decide out of court for more than 50% of conflict situations, and by 2020 this figure is expected to grow to 65.1% , to 2024, not less than 77%.

Changing approaches to the control of expert activities of insurance companies. Territorial funds responsibility monthly analysis of morbidity and mortality. With the growth of citizens for medical aid more than 10%, will impose control over the causes of such a surge. Insurers will be required to carry out the examination and to submit proposals to improve the quality of medical care. And health facilities to conduct analysis of the identified violations by the insurers and send them a plan of measures on elimination of violations. Expertise at all levels of care will create a system of management quality in each region, say in Ffose. Will decrease the incidence is unknown, but it is obvious that the amount of paperwork in hospitals will grow even more.

Irina Reznik