According to the results of 2012-2013, in the market of voluntary health insurance several leading insurance companies with a high reliability rating of A ++ were formed.

According to statistics, for 2011-2013. there is a positive trend in the development of voluntary medical insurance.

Table 1. Analysis of voluntary medical insurance in the Russian Federation. RA expert.

	Insurance Company/ group	Contributions thousand rubles	Payments thousand rubles	Contributions 2012 thousand roubles.	Payout %	Growth rate of contributions %
	IC "SOGAZ"
	OSAO "RESO-GARANTIYA"
	SG "Alliance"
	IG "Ingosstrakh"
	IC "ROSGOSSTRAKH"
	SG "Alfastrakhovanie"
	SC "Consent"
	SG "TRANSNEFT"
	SG "Renaissance"
	Surgutneftegaz LLC
	SG "MAKS"
	SG "UralSib"
	SOAO "VSK"
	IC "ENERGOGARANT"
	SG "Chulpan"
	IC VTB Insurance
	CJSC ALICO
	SG "SG MSK"
	SZAO "Medexpress"
	CJSC "GUTA-Insurance"

The promotion of VHI programs that include critical illnesses will become a driver of the health insurance market in the context of the reduction of VHI programs by enterprises. The complication of the economic situation forced corporate clients to optimize their insurance budgets, which led to a reduction in the growth rate of VMI contributions (by 3.9 percentage points per year, to 5.8% for 9 months of 2013 compared to the value for the same period in 2012). At the same time, according to the forecast of Expert RA, in the case of active promotion of products that include critical illnesses, the share of retail insurance in total premiums for VHI by 2020 may reach 10-15%, the share of insurance against critical illnesses - 12-18%.

As the crisis in the economy intensifies, corporate clients begin to refuse VHI or reduce insurance programs. The complication of the economic situation (GDP growth rates slowed down and amounted to 1.2% for 9 months of 2013 against 3.0% for 9 months of 2012) forced enterprises to optimize their insurance budgets, which led to a reduction in the growth rate of VHI premiums (by 3. 9 percentage points for the year, up 5.8% for 9 months of 2013 compared to the value for the same period in 2012). At the same time, VHI still remains the corporate segment of insurance. The retail segment of VHI, although developing, remains extremely small (6.0% of total VHI premiums in 2012, 5.3% in 2011). The volume of payments under CHI increased by 60.8% over 9 months of 2013 compared to the value for 9 months of 2012 and amounted to 843.4 billion rubles.

In 2013, the VHI market grew due to inflation, according to Expert RA, the volume of VHI contributions amounted to 115-117 billion rubles (+ 6-7% compared to the value of 2012). The medium-term outlook depends on how quickly VHI programs that include critical illnesses are brought to market. If the demand for such products in the early stages of implementation is insignificant (negative scenario), in 2014 the growth rate of contributions will decrease and amount to 4-6%, in 2015 - 6-10%. In case of successful entry of such products to the market (positive scenario), despite the development of the crisis, the growth rate of VMI contributions in 2014 will be 7-9%, in 2015 - 10-15%.

In the absence of legislative initiatives to synergize the CHI and VHI markets, the growth drivers of the health insurance market will be programs that include critical illnesses. Mass start of sales of such products is expected in 2014. Given the high cost of critical illness care, the potential demand for such VHI programs is very high. In the event of a positive scenario, the share of retail insurance in the total VMI premiums may reach 10-15% by 2020 (the product will also be of interest to individuals: its cost will be comparable for corporate clients and clients - individuals), the share of critical illness insurance is 12-18%. If the product is not in high demand, the share of retail insurance in the total VHI premiums will practically not increase (it will be 6-7%), the share of critical illness insurance will be at the level of 4-6%.

As the crisis in the economy intensifies, corporate clients begin to refuse VHI or reduce insurance programs. The aggravation of the economic situation forced enterprises to optimize their insurance budgets, which led to a reduction in the growth rate of VHI premiums (Fig. 1) (by 10.7 percentage points per year, to 5.8% in 2013 compared to the value for 2012 year). The volume of payments under compulsory medical insurance increased by 18.8% in 2013 compared to the value for 2012 and amounted to 1,059.3 billion rubles. The growth drivers of the health insurance market will be programs that include critical illnesses. Mass start of sales of such products is expected in 2014. The medium-term outlook depends on how quickly VHI programs that include critical illnesses are brought to market. If the demand for such products in the early stages of implementation is insignificant (negative scenario), in 2014 the growth rate of contributions will decrease and amount to 4-6%, in 2015 - 6-10%. In case of successful entry of such products to the market (positive scenario), despite the development of the crisis, the growth rate of VMI contributions in 2014 will be 7-9%, in 2015 - 10-15%.

Figure 1. Forecast of the dynamics of VMI contributions Expert RA.

The aggravation of the economic situation has led to a reduction in the rate of growth of VMI contributions. In the absence of legislative initiatives on the synergy of VHI and CHI, which could become a powerful driver for the development of the segment, programs that include critical illnesses will be the source of growth.

In the context of the difficult economic situation, many enterprises reduced their insurance budgets, primarily due to the cost of voluntary medical insurance. Companies abandoned voluntary health insurance programs or reduced the volume of services received. As a result, over the year, the growth rate of voluntary health insurance premiums decreased by more than 10% and amounted to 5.8% in 2013 compared to 2012.

In the context of a slowdown in the growth rates of corporate voluntary medical insurance premiums, the share of retail voluntary medical insurance remains low.

The volume of CHI payments is growing. In 2013, it amounted to 1 trillion 162.5 billion rubles. The share of voluntary health insurance in the structure of health insurance is declining: in 2012 it amounted to 9%, which is 1.9% lower than in 2012.

Market leaders of voluntary medical insurance have increased their market share. The shares of SOGAZ and RESO-guarantee increased by 0.6% year-on-year, amounting to 21.6% and 7.7% in 2013, respectively.

The leaders of the OMC have changed. MAKS-M moved from second to first place, ROSNO-MS took third place.

The concentration in the health insurance market continues to grow. It amounted to 68.1% in 2013, which is significantly lower than in 2012. The share of the top 20 in voluntary health insurance was 82.4% in 2013. We forecast that in 2014 this share may exceed 85%.

The share of Moscow and St. Petersburg in the total premiums for voluntary health insurance increased. This is due to the fact that large corporations enter into insurance contracts in Moscow and St. Petersburg, as well as the fact that there are not enough polyclinics in the regions. Many regional enterprises prefer attachment programs rather than voluntary health insurance programs.

There are no legislative initiatives on the synergy of compulsory medical insurance and voluntary medical insurance. According to our estimates, if the place of voluntary medical insurance were determined in the healthcare system, then already in 2017 the volume of the VMI market could grow by 4-5 times. But today the compulsory medical insurance and voluntary medical insurance programs are duplicated.

IN existing conditions the growth driver of the voluntary health insurance market will be programs that include critical illnesses. Such programs include mainly the risks of oncological diseases. Their price varies from 200 to 700 US dollars. Treatment is provided in Russian and foreign clinics. Insurers are planning an active start of sales of such programs in 2014. Basically, sales at the first stage will be carried out through corporate clients, and retail clients will join in the subsequent stages. The key advantage of insurers in this segment will be the high-quality component of service and customer support under such contracts.

We give two market development forecasts - a negative and a positive scenario, which depend on how actively insurers will promote such programs to the market. In the event of low demand for such programs, the growth rate of voluntary health insurance premiums in 2014 will decrease and will not exceed 6%, and in 2015 will amount to 6.1%. In case of successful promotion of voluntary medical insurance programs that include critical illnesses, the growth rate in the voluntary medical insurance market will be somewhat 7-9% in 2014 and 10-15% in 2015.

The long-term forecast depends on the activity of insurers in promoting programs from critical diseases and the demand of clients for them. In 2020, in the event of a negative scenario, the share of the segment of voluntary medical insurance against critical illnesses in the total premiums for voluntary medical insurance will not exceed 6%, in the case of a positive scenario, it may reach 18%. At the same time, the development of such programs gives a chance for the development of retail voluntary health insurance, since they have a grace period and there is no worsening selection. The cost of such programs for both corporate and retail clients is approximately the same, so the desire of individuals to buy programs will be great. As for the forecast of payments for compulsory medical insurance, then, according to the Federal Compulsory Medical Insurance Fund, the market will grow by 15-20% for the next two years.

According to the Law of the Russian Federation "On health insurance of citizens of the Russian Federation" /2/, "voluntary medical insurance is carried out on the basis of voluntary medical insurance programs and provides citizens with additional medical and other services in excess of established programs compulsory health insurance. In fact, this provision of the law is not respected: many HMOs offer VHI programs covering medical services provided by the basic CHI program.

State statistics show high rates of growth in the contributions of individuals and legal entities to voluntary medical insurance and the volume of paid medical services provided to the population. But VHI has not yet become the main form of private health financing. Paid medical services developed at a faster pace than VHI /15/.

Let's bring comparative analysis insurance premiums and insurance payments for voluntary and compulsory types of medical insurance according to the FSIS.

Table 2.7 Analysis of insurance premiums and insurance payments by types of medical insurance for 2005-2006, million rubles

It follows from the table that CHI is developing at a faster pace than VHI. So, if the growth rate of insurance premiums under the voluntary form of health insurance was 119.5%, then under its mandatory form, this figure was 141.0%. Similarly, for insurance payments: the growth rate was 107.9% and 140.3%, respectively, with voluntary and compulsory medical insurance.

It should be noted that in the "classic" risky form, VHI is carried out only by some Russian insurers when insuring certain individuals and legal entities. At the same time, the tariffs for this type of insurance are quite high. This is due to the fact that due to the insignificant distribution of VHI, there is a large amount of unprofitability of the sum insured. Namely, this statistical indicator is used as the basis for calculating tariffs for voluntary types of insurance. As a result, insurers who need to have sufficient insurance reserves to cover their obligations under risk insurance are forced to sell insurance services at a high price, ensuring the accumulation of the necessary reserves. Few Russian insurers and insurers can afford to work in such conditions.

Until now, the main part of the VHI programs has been the options for providing "one-off" medical services - the so-called "monopolies" or "deposit insurance schemes". In these cases, the role of the insurer is reduced to organizing the provision of medical care to the patient within the amount slightly less than that which he paid. At the same time, funds from citizens and their employers initially go to the insurance organization, allowing the medical institution to transfer responsibility for accounting for these funds, formalizing contractual relations with patients, etc. to it.

Taking into account that the patient or his employer, when acquiring a monopolis, pays for the necessary services immediately before receiving them, we can state that there are no signs of insurance risk in this scheme. When concluding a contract, the size of the “insurance payment” is known in advance - the price of the service. Also, the main advantage of the VMI system is missing - the possibility of planning individual costs for medical care. From a theoretical point of view, funds received by a medical institution when operating under a monopoly scheme cannot be considered VMI funds. However, this form of service provision is the main one in the actual activities of medical insurance organizations, carried out under the name VHI.

Insurance under VMI programs is carried out by both individuals and their employers. Today, about 1.5% of Russian enterprises and organizations and 80% of foreign companies whose representative offices operate on the territory of the Russian Federation pay contributions for the VHI of employees. According to OJSC ROSNO, Russian enterprises provide 55% of the volume of collected insurance premiums for VHI, foreign - 35%

Considering the features of the combination of CHI and VHI in our country, it is also necessary to pay attention to the following circumstance. Persons insured under VHI programs usually hardly use the services paid for by compulsory medical insurance. Contributions paid for such persons to the MHI system become lost money for these persons.

Thus, a comparative analysis of VHI and compulsory medical insurance showed an unsatisfactory state and weak development of VHI in the Russian Federation, as well as the absence of a combination of VHI and compulsory medical insurance, which is well developed in foreign countries. The combination of VHI and CHI allows both forms of health insurance to complement each other and makes them more effective for both insurers and insured persons.

Introduction

Conclusion

Annex A

Annex B

Introduction

The process of formation of market relations in Russia has affected all spheres of economic and social activity, including healthcare, which affects the interests of every person and predetermines, to a certain extent, indicators of the health of the nation, the quality and standard of living of the population.

Insurance plays an ever-increasing role in the development of a market economy in Russia (the share of insurance in GDP Russian Federation in 2011 was about 2.5%), while about half of the insurance market belongs to health insurance: its share in the total collection of insurance premiums is about 50%. Basically, this is compulsory health insurance, however, voluntary health insurance also contributes to the development of the market.

Voluntary health insurance is a form of health insurance in case of loss of health, which provides the possibility of full or partial reimbursement of medical expenses. The social and economic significance of voluntary medical insurance is to supplement the guarantees for medical care provided to the population free of charge through the system of budgetary financing of medical institutions and compulsory medical insurance.

Voluntary health insurance is one of the most promising types of insurance. In modern socio-economic conditions, when free medicine is losing credibility, it is voluntary medical insurance that comes to the fore.

Voluntary health insurance is one of the most important mechanisms for attracting funds designed to reduce the deficit in health care financing and provide the population with the opportunity to receive quality medical care. However, development Russian market Voluntary health insurance is hampered by numerous problems.

IN scientific research still quite a bit of space is devoted to the analysis of long-term voluntary health insurance, which is a private and most complex type of market insurance, although some of its provisions may find application in the system of compulsory health insurance.

In this regard, the study of the system of voluntary medical insurance in Russia is of particular relevance.

Object of study term paper the system of voluntary medical insurance.

The subject of the study is the market of voluntary medical insurance in the Russian Federation.

The purpose of the study is the current state of the voluntary medical insurance market of the Russian Federation and the direction of its development.

In connection with the goal in the course of the course work, it is necessary to solve a number of problems, namely:

study the theoretical foundations of the organization of voluntary medical insurance, including determining the socio-economic significance of voluntary medical insurance and revealing the specifics of concluding voluntary medical insurance contracts, as well as considering the possibility of using voluntary medical insurance as a tool for motivating enterprise personnel;

explore the current state of the system of voluntary medical insurance by studying the market for voluntary medical insurance in Russia and abroad;

consider the main programs of voluntary medical insurance;

determine the main directions of development of the voluntary medical insurance system in Russia;

to identify key problems in the development of the Russian market of voluntary medical insurance.

The information basis of the study was the data of the Federal Service for financial markets of the Russian Federation, the rating agency "Expert RA", as well as monographs and articles by domestic and foreign experts on the theory of insurance, legal acts of the Russian Federation and materials from periodicals.

medical insurance russia voluntary

1. Theoretical basis voluntary medical insurance organizations

1.1 Voluntary health insurance: content, classification of types

Voluntary health insurance is a set of types of insurance that provide for the obligations of the insurer for insurance payments in the amount of partial or full compensation for the additional expenses of the insured person, caused by his application to a medical institution for medical services included in a specific health insurance program.

Voluntary health insurance provides citizens with additional medical services in excess of those established by compulsory health insurance programs. However, the differences between voluntary health insurance and compulsory health insurance are as follows:

) voluntary health insurance, in contrast to compulsory health insurance, is not a branch of social, but commercial insurance;

) voluntary medical insurance, as a rule, is an addition to the system of compulsory medical insurance, providing citizens with the opportunity to receive medical services in excess of those established in compulsory medical insurance programs or guaranteed within the framework of state budgetary medicine;

) participation in voluntary medical insurance programs is not regulated by the state and depends on the needs and capabilities of the insured. Individuals and legal entities that conclude medical insurance contracts for their employees can act as insurers. The collective form of voluntary health insurance is very widespread.

) voluntary medical insurance is based on the principles of equivalence and closed distribution of damage between participants in this insurance fund, while compulsory health insurance uses the principle of collective solidarity. Under a voluntary medical insurance contract, the insured person receives certain types of medical services and in the amounts for which the insurance premium was paid. Voluntary health insurance provides policyholders with higher quality medical care that meets the individual requirements of the client.

A more detailed comparative description of the two forms of health insurance is presented in Appendix A.

The trend towards an increase in the population's expenses for financing medical services in the form of direct payment and voluntary medical insurance is also typical for Russia, where the reform of the healthcare system towards the introduction of insurance principles of financing began in 1992. In dynamics, the population's expenses for medical services tend to grow rapidly .

It is known that the financing of medical services through voluntary medical insurance is much more profitable than their direct payment, and this circumstance opens up broad prospects for the development of voluntary medical insurance.

From an economic point of view, voluntary health insurance is a mechanism for compensating citizens for expenses and losses associated with the onset of an illness or accident.

The subject of voluntary medical insurance is the health of the insured person, which is at risk of damage as a result of adverse events or diseases of the insured person, causing the need to apply to medical institutions for medical care.

The object of voluntary medical insurance is the property interests of the insured person associated with additional costs for receiving medical care in connection with contacting medical institutions.

According to global standards, health insurance covers two groups of risks arising from a disease:

the cost of medical services for the restoration of health, rehabilitation and care;

loss of earnings due to the inability to perform professional activity, both during the illness and after it with the onset of disability.

The need for voluntary health insurance depends on the extent to which the risk of disease is covered by compulsory health insurance.

The narrower the range of guarantees for compulsory health insurance, the higher the demand for voluntary health insurance, and vice versa. In addition, the demand for voluntary health insurance is determined in many cases by the desire to receive better and more specialized medical care and a high level of service in a medical institution (private room, nurse, treatment by leading specialists and some other services).

The whole variety of types of voluntary health insurance services can be classified according to various criteria.

So, according to the economic consequences for a person, two types of voluntary medical insurance are distinguished:

insurance of costs associated with treatment, restoration of health;

insurance for loss of income caused by the onset of the disease.

The set of guarantees for voluntary medical insurance is different in individual insurance companies, depending on what programs of voluntary medical insurance they work under. Therefore, it is customary to single out the main types of health insurance and additional types(options). The former include insurance for the costs of outpatient and inpatient medical care. These guarantees compensate for the cost of treatment necessary for health reasons.

Additional insurance includes types of insurance that cover the cost of related services or specialized medical care.

Depending on the amount of insurance coverage, there are:

full medical expenses insurance;

partial insurance of medical expenses;

insurance costs for only one risk.

Comprehensive health insurance provides a guarantee to cover the costs of both outpatient and inpatient treatment.

Partial insurance covers the cost of either outpatient treatment or inpatient or specialized treatment at the option of the insured.

Depending on whether there is an imposition of two forms of health insurance - compulsory and voluntary, for the same insurance risk, we can distinguish:

additional voluntary medical insurance;

independent voluntary medical insurance.

Supplementary voluntary health insurance provides coverage for expensive surgeries, for attracting leading specialist doctors, choosing a hospital and a doctor, providing comfortable conditions for treatment, care, and some others.

Independent voluntary health insurance offers medical policies:

citizens who are not covered by compulsory health insurance;

for treatment in private clinics and private practitioners;

certain groups of the population with special treatment (children, women and some others);

to provide medical insurance when traveling abroad.

Thus, the form of voluntary medical insurance provides citizens with the opportunity to expand the range of medical services provided by the compulsory medical insurance program and the opportunity to receive better medical care. Also, participation in voluntary medical insurance programs depends entirely on the needs and capabilities of the insured.

1.2 The use of voluntary medical insurance as an effective tool for motivating employees of an enterprise

Today, the portfolio of the insurer in the field of voluntary medical insurance mainly contains contracts with legal entities. This is primarily due to the fact that the policy of voluntary medical insurance on large enterprises has long been an integral part of the social package of employees and is used by employers as one of the methods of additional motivation. Insurance market experts note that it is easy to sell a voluntary medical insurance policy compared to other types of collective insurance, since this is the first product from which employers begin to form a social package.

According to statistics, today almost 90% of all contributions for voluntary health insurance are paid by employers under corporate insurance contracts, that is, the main client of the insurer for voluntary health insurance are legal entities. Medical insurance is a form of additional workers' compensation.

The international practice of staff motivation confirms the fact that the absence of voluntary medical insurance reduces the competitiveness of the employer in the labor market, especially for skilled workers.

According to a survey conducted by the Research Center of the Superjob.ru recruiting portal in 2013 among 1,000 representatives of domestic enterprises and organizations, 66% of companies with more than 5,000 employees either already provide their employees with a package of voluntary medical insurance services.

According to surveys, the most popular services within corporate voluntary health insurance programs are usually:

service in polyclinics (96.8% of respondents);

ambulance services (85.5%);

calling a doctor at home (83.2%);

dental services (81.8%);

emergency hospitalization (75.9%).

Also quite popular for corporate insurance are vaccination of employees, planned hospitalization and medical examination.

Within the framework of standard insurance programs of voluntary medical insurance, each company pays for a different amount of medical services.

The mechanism of relationships between subjects of voluntary medical insurance that arise when employers insure their employees can be represented as shown in Figure 1.

Figure 1 - Scheme of relationships between subjects of voluntary medical insurance in collective insurance

When determining the legal status of an employer in the system of voluntary medical insurance, it was established that insurers in voluntary medical insurance are individual citizens with civil capacity, and/or enterprises representing the interests of citizens. Therefore, according to Figure 1, the employer acts as an insured.

Insurance organizations are legal entities that provide health insurance and have a license to engage in health insurance, that is, it is an insurer.

Medical institutions in the health insurance system are licensed medical and preventive institutions, scientific research and medical institutes, other institutions providing medical care, as well as persons providing medical activity both individually and collectively.

The employee in this relationship scheme is the object of insurance, to which the employer's concern for his health is directed, which is one of the manifestations of the management's social responsibility in relation to its work team. On the onset insured event the employee applies to a medical institution (specified in the contract of voluntary medical insurance), while from the point of view of the medical institution, the "employee" in the framework of the presented scheme is a patient, to whom the activity of this institution is directed, the financing of which is made at the expense of the insurer under the contract on voluntary health insurance .

In world practice, the use of voluntary medical insurance as an effective tool for motivating the personnel of an enterprise involves:

A differentiated approach in the formation of a voluntary medical insurance program, that is, the scope of services and services depends on the role of the employee in the company and on his contribution to the overall result.

The following are used as the main criteria for differentiating the voluntary medical insurance program:

employee position. Higher positions, as a rule, involve a greater volume of services and services, which stimulates employees to career growth;

the work experience of the employee in the company and his qualifications. This allows you to secure the most valuable employees in the organization;

the nature of the work performed, taking into account professional characteristics and risks. This makes it possible to ensure the targeted nature of the provision of services, to carry out early detection of occupational diseases.

Thus, a differentiated approach allows you to increase the efficiency and loyalty of the staff.

Creation of comfortable conditions for managers and highly qualified specialists. In order to increase the efficiency and loyalty of managers and highly qualified specialists, the insurance programs formed for them provide for medical services in the best clinics in Russia (and, if necessary, in leading foreign clinics).

Thus, a properly selected insurance program allows you to provide medical services with high quality and service with minimal loss of working time.

Formation of insurance programs for honored workers. Providing voluntary medical insurance to pensioners, honored workers has a positive impact on the psychological climate in the team.

This increases the loyalty of the staff, shows that the employer cares about the employees even after their retirement.

Development of co-financing of voluntary medical insurance. Practice shows that the development of co-financing of voluntary medical insurance programs by the employee and the employer increases the rationality of the demand for medical services.

In addition to reducing the employer's costs for voluntary health insurance, co-financing has a positive impact on the employee's attitude to their health.

In other words, co-financing makes it possible to increase the responsibility of employees when choosing voluntary medical insurance programs.

In conclusion, it is worth emphasizing once again that collective voluntary health insurance is beneficial both to the organization itself and to its employees. So for the organization as a whole, the advantages of corporate programs of voluntary medical insurance are that:

a company that cares about the health of its employees develops a positive image, which also works to attract valuable personnel;

expenses for voluntary medical insurance can be charged to the cost (and, accordingly, reduce the taxable base for income tax) in an amount not exceeding 6% of the wage fund;

contributions to voluntary health insurance are not subject to taxes (on profits, on personal income), which allows employers to significantly save on staff motivation compared to other types of compensation, salary increases;

The voluntary medical insurance policy ensures the reduction of morbidity, the general improvement of employees, which leads to a reduction in loss of working time and an increase in labor productivity.

In turn, the employee of the organization:

receives high-quality and timely medical care;

receives guarantees for the protection of their interests in disputable situations with a medical institution, the possibility of obtaining compensation in case of poor quality medical services;

can get the necessary advice from the insurer, which allows you to get targeted and qualified assistance. In addition, even if the requested service is outside the scope of the voluntary health insurance contract, the insurer will help find a solution that is suitable in terms of quality and price.

1.3 Specifics of concluding a voluntary medical insurance contract

The contract of voluntary medical insurance is one of the most difficult to apply in practice. First of all, this is due to the lack of a satisfactory legislative framework.

On January 1, 2011, the Law of the Russian Federation dated June 28, 1991 "On the health insurance of citizens in the Russian Federation" became invalid. At the same time, the Federal Law of November 29, 2010 "On Compulsory Medical Insurance in the Russian Federation" does not apply to voluntary medical insurance. Civil law relations in the field of voluntary medical insurance are regulated only by the Civil Code of the Russian Federation and the Federal Law of the Russian Federation of November 27, 1992 "On the organization of insurance business in the Russian Federation" (last amended on December 28, 2013), which contain only general provisions on insurance contracts.

A voluntary medical insurance contract is an agreement between the insured and the medical insurance organization, according to which the insurer undertakes to organize and finance the provision of medical care to insured persons under agreed medical insurance programs, and the insurant undertakes to pay insurance premiums in a timely manner.

Medical insurance (both voluntary and compulsory) differs in that it can function only on the basis of two contracts - the actual contract on voluntary or compulsory health insurance, as well as a contract for the provision of preventive care (medical services). The contract for the provision of medical and preventive care is an agreement between the insurer and medical institutions, according to which a medical institution undertakes to provide insured persons with medical care of a certain volume and quality, as well as within a specific time frame within the framework of health insurance programs, and the insurer undertakes to finance these services.

Contracts for the provision of medical and preventive care (both in individual and collective health insurance) refer to contracts in favor of a third party. Such a conclusion can be drawn as a result of the analysis of Article 430 of the Civil Code of the Russian Federation. Firstly, the debtor (medical institution) is obliged to fulfill the obligation to the third party specified in the contract, that is, the insured citizen. Secondly, insured citizens have the right to demand from the debtor the performance of the obligation in their favor. The rights of insured persons are regulated by Article 1064 and Article 1068 of the Civil Code of the Russian Federation, as well as the Federal Law of the Russian Federation of November 21, 2011 "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation".

Voluntary medical insurance contracts are divided into two types: collective and individual. These contracts differ in subject composition. In individual contracts, there are three subjects - the insurer, the policyholder and the medical institution. In this case, the insured is the person in whose favor the contract is concluded in order to receive medical care. Individual contracts of voluntary medical insurance do not apply to contracts in favor of a third party, since they are concluded in favor of the insured. In collective agreements, insurers are organizations acting in the interests of employees, insurers - insurance medical organizations, insured - citizens working in organizations under an employment contract. Such contracts, by their legal nature, relate to contracts in favor of a third party.

According to clause 2 of Article 942 of the Civil Code of the Russian Federation, when concluding a personal insurance contract, an agreement must be reached between the insured and the insurer on the insured person, on the nature of the event in the event of which insurance is carried out in the life of the insured person (insured event), on the amount of the insurance amount about the duration of the contract.

In most cases, a voluntary medical insurance contract is concluded from the moment the text of the contract is signed. However, the contract may provide otherwise.

This means that there are two options:

the contract may provide for a condition according to which it is considered concluded from the moment the text of the contract is signed. In practice, this option is the most common;

The contract may enter into force on the date of payment of the first insurance premium.

In practice, the term of a voluntary medical insurance contract and the term of insurance often do not coincide. In this case, the norm of clause 2 of article 957 of the Civil Code of the Russian Federation applies. According to this article, insurance stipulated by an insurance contract shall apply to insured events that occurred after the entry into force of the insurance contract, unless the contract provides for a different period for the commencement of the insurance. This means that, firstly, the parties to the contract of voluntary medical insurance may provide that payment is subject to, including medical care, which was provided before the conclusion of this transaction. Secondly, the contract may also provide for the reverse situation, namely, payment only for those medical services that will be provided from a later moment than the moment the contract was concluded.

In practice, such a measure as the suspension of a voluntary medical insurance contract is often used. Suspension of the contract is a kind of sanction on the part of the insurer in case of delay in payment of the insurance premium by the insured. The insurer has the right to suspend the contract of voluntary medical insurance unilaterally by notifying the insured about it. During the suspension of the contract, the medical institution provides the insured with medical services only at their expense. In other words, suspension means a break in the term of insurance and is a period of time when the relevant events are not recognized as insured events.

In the field of voluntary medical insurance, the issue of the sum insured is highly controversial. We are talking about the sum insured for each insured person under a collective health insurance contract and for the insured under an individual health insurance contract. Some lawyers believe that subparagraph 3 of paragraph 2 of Article 942 of the Civil Code of the Russian Federation should apply, in which the amount of the insurance amount is indicated as essential condition any personal insurance contract. Indication of the amount of the sum insured not only does not contradict the law, but is expressly provided for by it. Other experts, on the contrary, believe that in voluntary medical insurance contracts, the indication of the sum insured is not mandatory.

Since until January 2011 the Law of the Russian Federation "On Health Insurance of Citizens in the Russian Federation" was applied, the sum insured was not one of the essential terms of medical insurance contracts and could not be agreed upon in the contract. Currently, clause 2 of Article 942 of the Civil Code of the Russian Federation is applied, in which the sum insured is listed as an essential condition of a personal insurance contract. Thus, in contracts concluded after January 2011 (from the moment the Law of the Russian Federation "On Medical Insurance of Citizens in the Russian Federation" became invalid), the sum insured must be indicated.

At the same time, in practice, voluntary medical insurance contracts in most cases indicate the sum insured for one insured person. This is due to the convenience of calculations. Since the expected volume of services for each insured person may change during the term of the contract, it is advisable to give the policyholder the right to change the amount of the sum insured by signing an additional agreement with the insurer. In the contract, it is necessary to provide for the obligation of the insured, in case of receiving medical services in an amount exceeding the sum insured, to pay an additional insurance premium in the amount and terms specified in the supplementary agreement.

In accordance with paragraph 1 of Article 450 of the Civil Code of the Russian Federation, amendment and termination of the contract are possible by agreement of the parties, unless otherwise provided by the Civil Code of the Russian Federation, other laws or the contract.

The amounts of insurance premiums for voluntary medical insurance are established by agreement of the parties. The repayment of a part of insurance premiums from an insurance medical organization in case of voluntary medical insurance is carried out in accordance with the terms of the contract.

A lot of controversy arises about the insured event in health insurance. An insured event in health insurance is when the insured person seeks medical care at the medical institution specified in the contract and receives assistance within the framework of an agreed program of voluntary medical insurance. In accordance with Article 9 of the Federal Law of the Russian Federation "On the organization of insurance business in the Russian Federation", an insured event is an event that has occurred, provided for by the insurance contract or the law, upon the occurrence of which the insurer is obliged to make an insurance payment to the insured, the insured person, the beneficiary or other third parties . An event considered as an insured risk must have signs of probability and randomness of its occurrence.

Thus, voluntary health insurance provides citizens with the opportunity to receive a number of medical services in excess of those established by compulsory health insurance programs of higher quality.

In addition, the use of voluntary medical insurance by employers is an effective tool for motivating and encouraging staff, helping to reduce staff turnover and attract highly qualified specialists. That's why medical insurance is one of the forms of additional compensation to employees along with the payment of rest.

The specificity of the conclusion of health insurance contracts is that their purpose is to provide medical care under the relevant health insurance programs. Medical assistance can be both random and planned. The main thing is that this medical service should be included in the voluntary medical insurance program.

2. Analysis of the current state and practice of voluntary medical insurance

2.1 Analysis of the Russian market of voluntary medical insurance

Today, medical insurance is one of the most popular types of insurance in the Russian Federation. The level of its development is characterized by the following data. In 2012, the total volume of medical insurance in our country amounted to 699 billion rubles (excluding insurance for those traveling abroad). Of these, 604 billion rubles (that is, 86%) fell on compulsory medical insurance (OMI), 95 billion rubles (that is, 14%) - on voluntary medical insurance (VHI), as shown in Figure 2. For 2012 compared to 2011, the compulsory health insurance market increased by 24.3%, the voluntary health insurance market by 13.3%.

Figure 2 - Structure of the Russian health insurance market in 2012

The growth of the compulsory health insurance market was associated with an increase in the rate of insurance premiums for compulsory health insurance for the working population from 3.1% to 5.1%, as well as with an increase in premiums for the non-working population.

The growth of the voluntary health insurance market is mainly due to inflation. In 2012, the likelihood of new incentives for the growth of the voluntary health insurance market was extremely small. The client base of the voluntary medical insurance market has already been formed, and the appearance of new large clients is quite rare. According to the Expert RA rating agency, the volume of the voluntary medical insurance market in 2012 reached 107 billion rubles, and in 2014 this figure will approach 140 billion rubles (provided there are no macroeconomic "shocks" and significant legislative changes).

The dynamics of insurance premiums for voluntary health insurance is shown in Figure 3.

Figure 3 - Dynamics of insurance premiums for voluntary medical insurance

Voluntary medical insurance is in demand mainly by corporate clients. They account for about 95% of contributions collected under voluntary health insurance programs.

This can be explained, on the one hand, by the growth of social responsibility of business, when insurance of employees becomes an integral part of the compensation package, and, on the other hand, by the desire of insurance companies to work with corporate clients, since when insuring collectives, risks are evenly distributed among all employees. It was in the field of corporate insurance that one of the few steps was taken to stimulate the voluntary medical insurance market - an increase in the rate of attributing premiums for voluntary medical insurance to the cost price from 3% to 6% of the wage fund. In 2012, this measure was most demanded by small and medium-sized businesses.

Low demand from private clients is due to low incomes of the population and the high cost of a voluntary medical insurance policy. The volume of the retail voluntary medical insurance market for 2012 is 5% (Fig. 4).

Figure 4 - Structure of the voluntary medical insurance market in 2012

The profitability of retail voluntary health insurance is low, which leads to higher prices for private clients than for corporate ones.

The high unprofitability of retail voluntary health insurance is due to the fact that a private client seeks to make the most of the insurance - to visit the clinic as many times as possible in order to recoup its cost. In addition, there is a worsening selection, since insurance is purchased mainly by people who already have a certain type of disease.

During the crisis, there was a redistribution of clients from the corporate sector of voluntary medical insurance to the retail one. Employees of companies who have lost their social packages began to purchase voluntary medical insurance policies themselves. With the recovery from the crisis and the return of corporate clients to voluntary health insurance, retail demand declined.

Since the demand of individual customers is small, the supply of insurers is appropriate.

For individuals, there are also tax incentives - this is tax deductions for medical care and contributions for voluntary medical insurance in the amount of 120 thousand rubles. However, few people know about this, there are difficulties with making a deduction, and you can get it only after purchasing a voluntary health insurance policy.

The concentration of the voluntary health insurance market is increasing every year. If at the end of 2011 the 20 largest insurers in the segment of voluntary medical insurance accounted for 74% of premiums, then at the end of 2012 this figure increased to 77.6%.

In 2011, 390 insurance companies were engaged in voluntary health insurance, at the end of 2012 - 354. The reduction in the number of companies is not due to the refusal to provide insurance to universal insurers, but to the revocation of licenses from small companies with a weak reputation and engaged in "pseudo-insurance". The growth in concentration occurred due to the redistribution of contributions in favor of larger and more reliable companies.

As part of the modernization of the compulsory health insurance system, the state seeks to minimize the volume of the voluntary health insurance market, which may adversely affect the entire health care system.

Building an efficient market for voluntary health insurance has positive externalities for the healthcare system and society as a whole:

growth of social stability;

reduction of information asymmetry in the market of medical services;

the possibility of reducing the shadow financing of the health care system;

growth of investments in the construction of medical centers.

As well as in the entire insurance industry, two or three leaders can be identified in the voluntary medical insurance market, whose share in total premiums is significantly higher compared to other insurers (Appendix B).

The largest player in this market is the SOGAZ Group of Companies.

JSC ROSNO, JSC ZhASO, OSAO Ingosstrakh, OSAO Reso-Garantiya follow with a significant margin from the leader, the data on contributions of which are presented in Table 1.

Table 1 - Leading companies in terms of insurance premiums in voluntary medical insurance in 2012

RankCompaniesContributions, billion rubles1OJSC SOGAZ15.92OJSC ROSNO6.93OJSC ZhASO6.14OJSC Ingosstrakh5.35OJSC RESO-Garantiya4.9

The practice of conducting voluntary health insurance in Russia shows that there are a number of difficulties and problems that hinder the further effective development of voluntary health insurance.

Short review of the state of the voluntary medical insurance market showed that the Russian market of corporate voluntary medical insurance has passed the stage of extensive development, when the increase in premiums was ensured by attracting new enterprises and the main criterion for choosing an insurer was the price of insurance. The next stage is the intensive development of the market, which involves competition by improving the quality of service, complicating and increasing the service component of insurance products, as well as further concentration of the market.

2.2 Foreign experience of voluntary medical insurance

The most developed system of voluntary health insurance in the United States, where it entered its heyday in the distant 30s. In total, in the United States today more than one and a half thousand companies are engaged in health insurance, and more than 160 million people, that is, almost 70% of the entire population of the country, are covered by the voluntary health insurance system. Voluntary health insurance provides up to a third of the funding for American health care, which is considered the most expensive in the world. More than three-quarters of the volume of voluntary health insurance in America is group (corporate) insurance, which is carried out by firms in relation to their employees.

In the US, health insurance is voluntary and almost entirely provided by employers. Health insurance is the most common type of workplace insurance, but employers are not required to provide it at all. Not all American employees receive such insurance. Yet in the largest companies, health insurance is almost an indispensable condition.

There are many types of health insurance. The most common is the so-called compensatory insurance, or "fee-for-service" insurance. With this form of insurance, the employer pays the insurance company an insurance premium for each employee provided with the appropriate policy. The insurance company then pays for the checks presented by the hospital or other health care provider or doctor. Thus, the services included in the insurance plan are paid for. Typically, the insurance company covers 80% of the cost of treatment, the rest must be paid by the insured himself.

There is an alternative - the insurance of the so-called "managed" services. The number of Americans covered by this type of insurance is rapidly increasing. In this case, the insurance company enters into contracts with doctors, other medical workers, as well as with institutions, including hospitals, for the provision of all services provided for by this type of insurance. Typically, medical institutions receive a fixed amount, which is paid in advance for each insured.

The differences between the two described types of insurance are very significant. Fee-for-service insurance pays for services that are actually provided to patients. With "managed services" insurance, medical institutions receive only a fixed amount per insured patient, regardless of the volume of services provided.

Thus, in the first case, healthcare workers are interested in attracting clients and providing them with a variety of services, while in the second case, they are more likely to refuse to prescribe additional procedures to patients, at least they are unlikely to prescribe them more than necessary.

In America, insurance medicine with its voluntary health insurance guards the health of its clients, guaranteeing not only payment for the medical service provided, but also high-quality treatment with traditional medicines. No insurance company will cover the cost of treatment using hypnosis, acupuncture, homeopathic or herbal remedies. From the point of view of insurance medicine, such therapy is unconventional and the effect of its use is controversial.

Health insurance in the US has another feature. There is a certain credit of trust in medicines prescribed by a doctor. But if the result from their use is insufficient and the disease progresses slowly but steadily, the next only correct stage of treatment for the clients of the insurance company is not prescribing drugs, but surgical treatment. The United States ranks first in the number of coronary artery bypass grafts.

One of the basic principles of health insurance is the high efficiency of medical care. With regard to treatment costs, the insurance company covers the costs associated with applying the only correct treatment with a high success rate. Of course, the cost of heart surgery is very high, but less than the cost of drugs that need to be taken for quite a long time. And the effect of conservative therapy is not always desirable. Therefore, insurance companies prefer to incur large expenses, but once.

Americans are serious about their health. On the one hand, insurance companies protect their clients from unprofessional medical care, on the other hand, Americans trust their doctors and do not buy medicines without a specialist's recommendation.

As for voluntary health insurance in European countries, here in most cases it is being intensively developed as an addition to state financing of medicine, expanding the range of treatment and preventive services and financial opportunities for healthcare.

For example, in small Israel, which is famous for the highest level of medical care, more than 70 companies (including foreign ones) operate in the voluntary health insurance system, despite the fact that four of the largest insurance companies control half of this market.

The voluntary health insurance system covers almost a fifth of Israelis who use services not included in the basic programs of compulsory insurance funds, including nursing and patronage care (mainly for the elderly). The State Commission for Health Analysis in Israel believes that the role of voluntary health insurance will continue to grow steadily.

In Germany, an alternative (and supplement) to compulsory health insurance is voluntary (private) health insurance, which applies to citizens who, due to high incomes or professional activities, are not subject to compulsory health insurance, as well as to those persons who have the means and desire to receive additional alternative assistance to compulsory health insurance.

The existence of two different forms of health insurance in the country is a positive factor that stimulates competition in the medical services market, which creates conditions for a more efficient and dynamic development of the existing healthcare system in Germany, improvement of the services offered and innovative activity. The main factor that determines the difference between compulsory and private health insurance systems is the income, the amount of which exceeds the mandatory health insurance threshold (today it is 40,034 euros per year), which is the reason for applying for the services of the private health insurance system.

As a rule, entrepreneurs or representatives of free professions, as well as employees whose incomes exceed the limit established by law, become participants in this system. At the same time, voluntary (private) health insurance also means the possibility of obtaining additional medical care in excess of the mandatory insurance system, which is relevant for all categories of the population. This is important if the insured in the compulsory health insurance system wants to receive a more extended set of medical services.

According to statistics, about 15% of the population are insured in the voluntary health insurance system, 80% - in the compulsory health insurance system, 3% of which simultaneously use additional services from voluntary health insurance programs.

Unlike compulsory voluntary health insurance, it offers a larger volume of medical services. For example, within the framework of voluntary health insurance, there is a free choice of a hospital, as well as improved conditions for staying in it, services of a personal doctor, reimbursement of up to 100% of the costs associated with inpatient treatment (in compulsory health insurance, as a rule, part of the costs is reimbursed by the patient).

Compared to compulsory health insurance, in which the amount of contributions does not depend on the degree of probability of an insured event, contributions in the voluntary health insurance system are formed taking into account individual risk. Private insurance companies use a large number of different regional and professional tariffs for this. Since age characteristics have a significant impact on the amount of insurance premiums, the most favorable rates in voluntary health insurance are for young people.

It should be noted that in recent years the volume of expenses of the German population in voluntary health insurance has been constantly increasing by an average of 5%. A significant difference from the system of compulsory health insurance is that for each age group of those insured in voluntary health insurance there is its own financing of their expenses. Under conditions of general complication demographic situation in all European countries (an increase in the number of pensioners in relation to the working part of the population), such a system for the formation of insurance premiums does not depend on this one.

The distinguishing features of voluntary health insurance include higher sickness benefits (they are insured separately), reimbursement of expenses for spa treatment, the possibility of receiving full medical care abroad (since it is not required to conclude an additional insurance contract to the main one), as well as exemption from paying premiums in case of not seeking medical help for 1 to 6 months.

The advantage of voluntary health insurance is also that the insured can, within a wide framework, independently choose the amount of medical care and services he wants, as well as their combinations. The choice of one or another set of medical services depends on the insurance program.

German insurance companies operating in the private health insurance market do not directly limit the amount of medical care provided. The insured person must himself ensure that the medical services he needs are covered by the scope of insurance under the contract, which means that he must independently decide which form of treatment or examination suits him best. In Germany, both in compulsory health insurance and in the system of private health insurance, the state legislates the principles of its functioning and standards, and also exercises control over its activities.

Thus, the systems of voluntary health insurance operating in Germany and the USA, performing the same functions as the system of compulsory health insurance, are both an alternative and a significant addition to compulsory health insurance. Having different organization and principles of work, each of the systems at the same time is aimed at solving one problem - the provision of affordable, highly qualified medical care to the entire population of the countries, which could be a positive example of the implementation and existence of an effective health insurance system in the conditions of structural restructuring of the economy and social sphere of Russia.

2.3 Analysis of voluntary health insurance programs

Voluntary health insurance products include three main types of coverage - an outpatient clinic (service in a polyclinic), a hospital (treatment in a hospital, as well as hospitalization services, necessary surgeries and others), and spa services. A few years ago, when analyzing voluntary health insurance products, experts limited themselves to this classic set, since special medical services were not as popular as they are today. Individual companies supplemented the minimum set with special products, for example, insurance for medical services in connection with pregnancy and childbirth, the treatment of chronic diseases in specialized medical institutions. However, such actions were not of a systematic nature, since the products were expensive, and their quality did not match the price.

The first two types are classic insurance services that have been in stable demand for many years and are guaranteed to bring profit to insurers in the future.

With sanatorium and resort services, the situation is more complicated - the tax legislation removes it from the scope of tax benefits (payment for sanatorium and resort vouchers can be accepted as payment for medical expenses only if a contract for medical care has been concluded with sanatorium and resort institutions and these institutions have a license for medical activities).

Voluntary health insurance in most cases is a set of medical services (package), focused on a certain category of insured people. Packages may differ in terms of the set of services, the volume of services provided, the territory of the policy, the age of the insured persons, and so on.

Table 2 - Main types of voluntary medical insurance programs

PackageTypical contentEstimated costBasicHealth insurance for an adult aged 18-60. Usually includes a house call, outpatient treatment, hospitalization, emergency medical care, dental care (with a number of exceptions) 30-40 thousand rubles per person per year up to 18 years old. Includes outpatient care, laboratory diagnostic tests, treatment procedures, emergency medical care, dental care (with a few exceptions), hospitalization, house calls. 50-60 thousand rubles Pregnancy and childbirth The program provides for a comprehensive examination and monitoring of women at any stage of pregnancy by a personal obstetrician-gynecologist. 36-162 thousand rubles Dentistry Includes only dental care. Usually in a larger volume than in the basic package. 2-25 thousand rubles Traveling abroad Travel insurance. Medical care when traveling abroad in case of illness and injury. From 1 euro per person per day Special insurance for athletes, drivers, extreme sportsmen. individually

A large number of emerging medical insurance programs in the field of maternal and child health should also be included among specialized products - policies for women and children of different ages, differing in the volume of medical services provided and cost.

New products for Russia also include products for insurance against critical illnesses recently offered by large companies (such life-threatening diseases as heart attack, stroke, cancer, AIDS, and others). According to the Russian classification, they are at the intersection of voluntary medical insurance and accident and illness insurance. Their advantage lies in the fact that by paying a small contribution today, the insured is guaranteed to protect himself from possible expenses in the event of such a disease, the amount of which significantly exceeds the savings of the average Russian. Naturally, the insurance is not valid if the disease was already known at the time of the conclusion of the contract.

In the West, consumer preferences are given to this particular group of policies; in terms of popularity, it outstrips even traditional outpatient care policies. This is quite understandable, given that the likelihood of an insured event, on the one hand, is tangible enough for the insured to be afraid of it and positively perceive insurance as a way of protecting against it, and on the other hand, not so great that increased rates make insurance too expensive and repel client. In turn, the costs that such a policy saves the patient from are very significant.

Thus, in this type of insurance, the essence of risk insurance is realized to the greatest extent - the temporal and spatial distribution of damage from random events, which is extraordinary for an individual, but normal for an insurance company that has combined contributions from a large number of customers. In addition, Western insurers often introduce a cumulative component into health insurance - you can capitalize contributions for a number of years. However, we should not forget that, unlike the Russian market abroad, the main share of receipts and payments from voluntary medical insurance falls on individual contracts individuals, and not on collective insurance agreements for employees of enterprises. Insurance products for the treatment of deadly diseases are designed primarily for individual insurers, which complicates their promotion on the Russian market.

According to the results of the survey, outpatient services, hospitalization, ambulance, doctor call at home and dentistry.

In 2011-2012 11% of Russian companies reduced the budgets of voluntary medical insurance programs for employees through certain categories personnel, 24% - reduced the cost of voluntary medical insurance policies for all employees, 65% of employers did not revise the budget for voluntary medical insurance.

Pricing in the market of voluntary medical insurance has a number of features. First of all, attention should be paid to the fact that a high price is not always a real indicator of the usefulness and quality of a medical service. The increase in the cost of the policy is also influenced by such factors as the reputation and prestige of the clinic, the number of patients (the so-called economies of scale effect - the more patients, the cheaper the service for each, and, on the contrary, a purely individual approach leads to an increase in prices), organization production process in a medical institution (large volumes of space and capacity, irrational workload of personnel lead to an increase in the cost of the policy), the availability of equipment and the timing of its purchase, the number and qualifications of personnel, and so on.

Extended coverage is also not always a positive thing, since not all services included in the program are really necessary for the client, and you have to pay for them anyway. So the rule "you can't buy health" confirms its validity - the speed and guarantee of a patient's cure is not directly dependent on how much he paid for his medical policy. In connection with the need to provide narrower, and therefore cheaper coverage that meets the needs of a particular client, the sector of special health insurance services began to actively develop.

Thus, the development of the segment of voluntary medical insurance in Russia today is going in a positive way. This situation is related to the development of post-crisis trends - most insurance companies have increased their insurance budgets after overcoming the crisis. The recovery of demand for voluntary medical insurance programs is also evidenced by official data: in 2011, the volume of the Russian voluntary medical insurance market grew by 13.3%, amounting to 95 billion rubles. The concentration of the voluntary health insurance market is also increasing every year.

The study of world achievements in the field of health insurance, as well as the problems that arise in the creation and functioning of the system of insurance medicine, allows using the experience developed countries on the Russian insurance market and avoid repeating mistakes when modernizing the domestic insurance model.

3. Prospects for the development of voluntary medical insurance

3.1 Main problems of development of voluntary medical insurance in Russia

Based on the practical experience of conducting voluntary medical insurance by Russian insurance companies, a number of difficulties and problems that face an insurer engaged in voluntary medical insurance can be identified.

Firstly, this is the imperfection of the legislative framework, namely:

the absence of a special federal law on voluntary medical insurance;

discrepancy between existing legislative documents.

Secondly, the low insurance culture of the population: citizens acquire voluntary medical insurance policies not to protect themselves from unforeseen costs in the event of an insured event, but to "treat" at the expense of the insurance company. This forces most insurance companies to limit or completely exclude insured individuals from their insurance portfolio for voluntary medical insurance.

Thirdly, complex civil law relations in the system "Treatment and preventive institution - medical insurance organization". This is perhaps the main problem that all insurers who provide voluntary health insurance face.

The main criterion for an insurance company when choosing a medical institution to serve those insured under voluntary health insurance is the final result of the activities of a medical institution - the onset of objective changes in the state of human health, allowing him to continue to perform his functions in society. Another important factor is the satisfaction of the patient with the quality of medical services provided in the institution.

Currently, in the Russian Federation there is no unified methodology for assessing the activities of medical institutions, both by insurers and in general in the healthcare system.

Many of the approaches used in this case are often subjective, the different orientation of the evaluation and analytical indicators reduces the information content and objectivity of the estimates obtained, their comparability, and, therefore, makes it difficult to realistically evaluate the activities of medical institutions.

The introduction into practice of a single indicator, the so-called rating of a medical institution, would allow standardizing the evaluation criteria, which would undoubtedly have a positive impact on the formation of an accessible and transparent market for medical services, where the insured, as the end consumer of medical services, would have the opportunity to choose based on objective data, and the medical institution - to form its image.

The fundamental document regulating the relationship between a medical institution and an insurance company is a contract for the provision of medical services. Therefore, when concluding such an agreement, special attention is paid to coordinating the disputed points in such a way as to optimally balance the interests of the contracting parties.

An integral part of the contract for the provision of medical services is the Voluntary Medical Insurance Program, the approval of which sometimes takes longer than the approval of the contract itself. In fact, the Voluntary Medical Insurance Program is an order from an insurance medical organization to a medical institution. Unfortunately, quite often a medical institution seeks to maximize the scope of medical services provided to a particular patient, based primarily on the available diagnostic and treatment capabilities, but not with the goal of providing economical and adequate medical care to the patient's state of health.

Even more acutely, the lack of standards in the formation of the names of paid medical services affects the formation of relationships between a medical institution and an insurance company. Each medical institution creates its own list of paid medical services, based on rules and approaches that are clear to him alone. As a result, there is a lot of information, but it is almost impossible to track the overall picture and trends.

Unfortunately, in many medical institutions, the development of a list of medical services (the formation of a price list) is entrusted to employees with an economic education, who approach this task accordingly. As a result, the price list sometimes includes, under the guise of medical services, something that is not actually a medical service. This applies to an impressive list of medicines, tools, consumables, services and more.

This situation is negative for everyone: for medical institutions, for insurance companies, and ultimately for patients.

The next problem in the relationship between a medical institution and an insurance company is the control of the volume and quality of medical services provided. The lack of unified medical and economic standards for the provision of medical care and a unified approach (system) in naming paid medical services significantly reduces the possibilities of medical and economic expertise as a control tool.

The existing few state medical and economic standards for the provision of medical care were developed, firstly, many years ago, and secondly, in relation to individual nosological forms, and also in the conditions of a low-budget system of compulsory medical insurance. They are more focused on saving public funds, do not take into account the use of new and effective technologies for diagnosis and treatment.

Existing terminology used in current normative documents Russian Federation, defines the quality of medical care from the perspective of a consumer of medical services by four characteristics: accessibility, safety, optimality, patient satisfaction.

At the same time, accessibility is understood as a guaranteed necessary minimum of medical services. The safety of medical care is the ratio of two interrelated elements of the service: benefit and harm. With safe medical intervention, the harm should not be greater than the benefit. Optimality - the choice of medical technologies, taking into account the characteristics of the health status of a particular patient, his diagnosis, individual characteristics (age, gender, concomitant diseases), the current level of achievements in medical science and technology and optimal cost. And finally, patient satisfaction is the correspondence of the quality of the received medical care to the needs, including the expected ones, of the patient.

The main legally defined tasks of the insurance company to control the volume and quality of medical care are:

realization of the rights of the insured to receive medical care of adequate quality under the Voluntary Medical Insurance Programs;

control of the validity, effectiveness (to achieve a result according to the determined outcome and economic feasibility) of the medical services prescribed to the insured persons.

And the choice of a potential policyholder in favor of a particular company ultimately depends on how effectively the insurance company copes with solving these problems.

3.2 Prospects for the development of voluntary medical insurance in Russia

According to the Health Development Strategy until 2020, the operation of the voluntary health insurance market leads to "a decrease in the availability and quality of medical care for the population served under the program state guarantees"Based on this, the state does not support its development. However, the latest study showed that in the context of insufficient funding for the health care system, such a position will lead to an increase in shadow payments and a decrease in the efficiency of the entire health insurance system.

The development of the voluntary health insurance market is currently taking place without explicit participation from the state:

in the development strategy of the insurance industry in the Russian Federation for 2010-2014. no specific measures for the development of the voluntary medical insurance market have been prescribed;

the reform of the compulsory health insurance system does not specify the place of voluntary health insurance in the health care financing system;

the concept for the development of health care in the Russian Federation until 2020 states that voluntary health insurance "leads to a decrease in the availability and quality of medical care for the population served under the program of state guarantees";

The instructions of the President of the Russian Federation to develop a set of measures to stimulate voluntary demand for personal insurance and draw up standard contracts for the main types of personal insurance have not been fully implemented so far.

An exception is the increase in the deduction rate for the cost of expenses for voluntary medical insurance of employees from 3 to 6% of the amount of labor costs (from 01.01.2009). However, this measure is more likely to support business than to develop a system of voluntary medical insurance.

Paying attention to changes in Russian legislation And Russian system health care, several directions for the development of voluntary health insurance can be identified.

First, the most discussed direction today is the promotion of contracts for voluntary health insurance in conjunction with compulsory health insurance ("VMI + CHI"). Such a product involves the provision of a volume of medical services agreed in advance between the insurer and the client within the framework of the compulsory medical insurance system, the rest of the services - in the voluntary medical insurance system. Here it is necessary to clearly understand that clients expect from voluntary health insurance not so much wide medical coverage as qualified medical staff and a high level of service provided. However, it is unlikely that clients will be willing to accept a significant increase in the share of services provided under the compulsory health insurance system in order to reduce the cost of health insurance. Indeed, in this case, the client will feel the contrast between district and private (or departmental) medical institutions. Without losing the status of the voluntary medical insurance system as a medical service with a high level of service, within the framework of the VHI+OMS product, it is possible to "redirect" to the compulsory medical insurance system only a small set of medical services, the provision of which will be convenient for clients of nearby medical institutions.

There is another alternative to "VHI+OMS" contracts, where voluntary health insurance really acts as an extension to the system of compulsory health insurance: only those who are not easily accessible within the framework of voluntary health insurance are state system healthcare medical services. The latter includes treatment with the use of high-tech equipment, organ transplantation, treatment of serious diseases, and so on. In this case, the cost of voluntary medical insurance policies will be low, which will allow clients to significantly reduce staff costs.

In general, the insurance product "VHI + MHI" has both positive and negative sides. The disadvantages include the obvious decrease in the value of voluntary medical insurance for staff: the overwhelming majority of medical services will be received by clients in the system of compulsory medical insurance. Nevertheless, despite the significant difference from the traditional broad medical coverage, the presence of such a voluntary medical insurance policy will help increase staff loyalty. In addition, the VHI+OMS product will contribute to the development of the state healthcare system.

Another direction in the development of the voluntary medical insurance market is the development of joint insurance products, when the risk is distributed between the medical institution and the insurer.

For example, a health care institution undertakes to cover the costs of patients when inpatient care up to 7 days, and everything over is covered by the insurer. To date, such a practice of interaction almost does not exist. This approach allows insurers to solve the problem of imposing unnecessary services on the insured, since the medical institution will not be interested in "promoting" patients. For a medical institution, such a scheme is also beneficial: it allows you to get additional profit, subject to a balanced regulation of the health of patients.

Joint products open up new horizons not only for corporate clients, but also for the retail market. At the moment, only a few insurers offer individuals boxed products with an "as a matter of fact" calculation, where the insurer bears all the risk. Most insurance companies, however, are ready to sell to individuals only programs with a pay-as-you-go basis, when the risk is borne only by a medical institution. Accordingly, firstly, much more medical institutions will be ready to work with a joint scheme of interaction than in the case of "attachment", and, secondly, when sharing risks between a medical institution and an insurer, it is possible to develop comprehensive programs, rather than truncated insurance programs.

The third direction is to develop a new scheme of interaction between participants in the voluntary medical insurance market, which is applicable to corporate clients. In the current practice, the insurance program can include both one medical institution and a fixed set of them (network). In both cases, the insured may apply for medical assistance under a voluntary medical insurance policy only in a medical institution from the "permitted" list. Appeals to other medical institutions are not covered by the insurance company. Under the new model of interaction, the insured are allowed to apply to a medical institution outside the "allowed" list, while part of the costs is covered by the insurer. Thus, the insured have a choice: to apply to a medical institution from the "permitted" list free of charge, or to other medical institutions with the condition of partial payment for services.

The main feature of the new interaction scheme is one insurance program for the entire client team, which is compensated by the ability to apply to a medical institution outside the "permitted" list. The following advantages can be distinguished:

) for corporate clients:

reduction in the cost of a contract for voluntary medical insurance;

no restrictions in the choice of a medical institution;

) for insurers:

reduction of information asymmetry;

referral of the insured to profitable providers;

) for a medical institution:

increased competition;

increase in client flow.

Another solution to the identified problems can be long-term voluntary health insurance, which is a private and most complex type of market insurance. In its use and formation tariff policy it is necessary to take into account the territorial differentiation of the population, the heterogeneity of living conditions in the federal districts of the country, as well as in individual regions within the district.

Leading domestic insurance companies have an extensive branch network covering many regions of Russia. Therefore, the task of determining the optimal net tariff for long-term voluntary medical insurance is especially relevant.

The advantages of long-term voluntary health insurance are that:

the conclusion of long-term medical insurance contracts will allow Russian insurers to significantly increase the amount of insurance coverage, including the risk of serious diseases requiring long-term and expensive treatment. This will become possible, since over a long period of time the insurance company will be able to create significant insurance reserves, the funds from which, without prejudice to financial condition companies, it will be possible to subsequently send the insured person for treatment;

the introduction of long-term health insurance into the personal insurance system will help solve the problem of the lack of a mass product for individuals, which is central problem the Russian market of voluntary medical insurance;

when concluding long-term medical insurance contracts, it will be possible to include in insurance coverage such a socially important risk as medical care for patients;

long-term voluntary medical insurance will make it possible to form insurance reserves taking into account the average individual risk during the life of the insured in terms of its expected duration and taking into account the formation of an accumulative reserve. Then the system of long-term voluntary medical insurance will operate on a cumulative basis throughout the life of the insured;

long-term voluntary health insurance will ensure a reduction in the amount of insurance premiums, which will make them more accessible to a wide range of the population.

Thus, characterizing the current state of the Russian insurance market, we can note the following. The system of voluntary medical insurance in Russia has not yet been fully formed, which is due not only to internal factors of its development, but also to macroeconomic processes. Significant shortcomings and problems in the organization of medical insurance that need to be eliminated have been identified.

Conclusion

Voluntary health insurance has existed in Russia since 1991, and today it accounts for a tenth of all insurance premiums.

The social and economic significance of voluntary medical insurance is to supplement the guarantees for medical care provided to the population free of charge through the system of budgetary financing of medical institutions and compulsory medical insurance. This concerns, first of all, expensive types of treatment and diagnostics, the use of modern medical technologies, the provision of comfortable conditions for treatment, the implementation of those types of treatment that are not included in the scope of "medical care for vital indications."

In addition, voluntary health insurance differs significantly from compulsory health insurance in several ways:

compulsory health insurance - non-commercial, and voluntary health insurance - commercial insurance;

Compulsory health insurance builds its work on the principle of insurance solidarity, that is, it equalizes the rights of all insured people, regardless of their income level and capabilities. Voluntary medical insurance is based on the principles of insurance equivalence, that is, under a voluntary medical insurance contract, the insured person receives those types of medical services and in the amounts for which the insurance premium was paid. At the same time, voluntary health insurance provides policyholders with higher quality medical care that meets the individual requirements of the client;

participation in voluntary medical insurance programs is not regulated by the state and depends on the needs and capabilities of the insured. In voluntary medical insurance, the rules and methodology for calculating insurance premiums are developed by the insurance organization and are only agreed upon by the supervisory authorities for insurance activities. The remaining conditions are regulated by agreements concluded by the subjects of the system.

Voluntary medical insurance is in demand mainly by corporate clients. They account for about 95% of contributions collected under voluntary health insurance programs. At many Russian enterprises, voluntary medical insurance has become an integral part of the social package, which has its advantages both for employees and for the enterprise as a whole.

Its most important advantage is that it reduces the costs of the enterprise, which arise due to the disability of employees and lost time. Also, a company that takes measures to protect the health of its employees has a positive reputation. And to create a good reputation in modern conditions is an important matter, since in the market, in addition to ordinary competitors, there are many companies that would like to get qualified personnel. It is also necessary to mention the tax benefits that the company receives when insuring its employees.

Among the many advantages of corporate voluntary medical insurance, as the main one for employees, one can note the guarantee of the provision of highly qualified medical care and an individual approach to the problems and complaints of the patient. Also, for clients of insurers under voluntary medical insurance programs, it is beneficial that they can choose a package of additional services, as well as receive background information and services not only in the best clinics of the capital, but if necessary, in other regions of the country.

As for the current state, in 2012 the volume of the Russian market of voluntary medical insurance grew by 13.3%, amounting to 95 billion rubles. The growth of the voluntary health insurance market is mainly due to inflation. The concentration of the voluntary health insurance market is also increasing every year. If at the end of 2010 the top 20 insurers in the segment of voluntary medical insurance accounted for 74% of premiums, at the end of 2011 this figure increased to 77.6%.

The practice of conducting voluntary medical insurance in Russia shows that there are a number of difficulties and problems that hinder the further effective development of voluntary medical insurance, namely:

imperfection of the legislative base;

low incomes of a significant part of the population, leading to a shortage of mass demand for commercial health insurance;

low insurance culture of the population;

medical institutions sometimes raise prices several times a year, which forces insurance companies to take on additional costs.

Possible ways Solutions to identified problems can be:

development of programs that take into account the joint functioning of voluntary and compulsory health insurance systems;

rational distribution of risks between the medical institution and the insurer;

development of long-term voluntary medical insurance.

List of sources used

1. Civil Code of the Russian Federation, part one: federal law of the Russian Federation of November 30, 1994 No. 51 - FZ [Electronic resource]. - Access mode: #"justify">. Civil Code of the Russian Federation, part two: federal law of the Russian Federation of January 26, 1996 No. 14 - FZ [Electronic resource]. - Access mode: #"justify">. Civil Code of the Russian Federation, part three: federal law of the Russian Federation of November 26, 2001 No. 146 - FZ [Electronic resource]. - Access mode: #"justify">. On compulsory health insurance in the Russian Federation: Federal Law of the Russian Federation dated November 29, 2010 No. 326 - FZ // Rossiyskaya Gazeta. Federal release. - 2010. - No. 5353.

On the organization of insurance business in the Russian Federation: Federal Law of the Russian Federation of November 27, 1992 No. 4015-1 - FZ [Electronic resource]. - Access mode: #"justify">. On the basics of protecting the health of citizens in the Russian Federation: Federal Law of the Russian Federation of November 21, 2011 No. 323 - FZ // Rossiyskaya Gazeta. Federal release. - 2011. - No. 5639.

Kuznetsova, O.V. Voluntary insurance: practical guide / O.V. Kuznetsova. - M.: URAIT. - 2012. - 75s.

Insurance: textbook [Text] / ed. T.A. Fedorova. - 2nd ed., revised. and additional - M.: The Economist. - 2011. - 875s.

Options for the development of the VHI market in Russia // Modern insurance technologies. - 2011. - No. 3. - P.42-47.

Govorov, A.M. Voluntary medical insurance in the Russian Federation: development experience and prospects for the provision of quality medical services / A.M. Govorov, I.S. Cherepanova // Bulletin of Roszdravnadzor. - 2013. - No. 1. - P.50-53.

Dedikov, S.V. Contract of voluntary medical insurance / S.V. Dedikov // Civilist. Scientific and practical journal. - 2010. - No. 4. - P.32-45.

Zhukova, M.V. On the development of the VHI system within the framework of the socio-economic model of health care / M.V. Zhukov // Izvestiya TulGU. Economic and legal sciences. - Tula: TulGU. - 2010. - 381 p.

Ilinykh, Yu.M. The current state of voluntary medical insurance in Russia / Yu.M. Ilinykh // Bulletin of the Altai Academy of Economics and Law. - 2011. - No. 2. - P.52-54.

Lavrova, Yu. Compulsory health insurance - the experience of Germany / Yu. Lavrova // Finance. - 2013. - No. 8. - P.82-85.

Ovchinnikova, Yu.S. Contract of voluntary medical insurance: main features and problems of application / Yu.S. Ovchinnikova // Law and Economics. - 2011. - No. 8. - P.25-30.

Pletneva, S. VHI market in Russia: from expectations to realities / S. Pletneva // Personnel management. - 2012. - No. 7. - P.78-83.

Povaliy, A.S. Trends in the development of the world market of insurance services / A.S. Povaliy // Russian Foreign Economic Bulletin. - 2011. - No. 1. - P.64-70.

Rodionov, A.S. Topical issues of long-term voluntary medical insurance / A. S. Rodionov // Finance, money turnover and credit. - 2010. - No. 9 (70). - P.220-223.

Suglobov, A.E. Accounting for expenses for voluntary medical insurance and life insurance / A.E. Suglobov // Consultant accountant. - 2012. - No. 2. - P.41-46.

Fedorova, T.A. Medical insurance and public health protection / T.A. Fedorova // Finance. - 2013. - No. 10. - P.48-51.

VHI market strategy. Waiting for professional treatment [Electronic resource] // High technologies in medicine. - 2012. - No. 4. - Access mode: #"justify">. VMI Market: Dimensional Indicators [Electronic resource]. - Access mode: #"justify">. Tersina, O. CHI and VHI system in the USA [Electronic resource] / O. Tersina. - Access mode: #"justify">. The structure of the medical insurance market [Electronic resource]. - Access mode: #"center"> Annex A

Table A.1. Comparative characteristics of health insurance forms

Comparison criteriaCompulsory health insuranceVoluntary health insuranceType of activityNon-commercial Commercial Insurance industryPersonal insuranceScale (by population coverage) General or massIndividual or group No. 326 - Federal Law "On Compulsory Medical Insurance in the Russian Federation" The most general provisions contain: the Civil Code of the Russian Federation; Federal Law of the Russian Federation of November 27, 1992 No. No. 4015-1 - Federal Law "On the organization of insurance business in the Russian Federation" Insurance rules Determined by the state Determined by insurance organizations insurance contractUsing income from insurance activitiesOnly for the main activity of health insuranceFor any commercial and non-commercial activities

Annex B

Table B.1. List of insurance companies leading in terms of insurance premiums in the voluntary medical insurance sector in 2012

Item No. Name of the insurance companyInsurance premiums, billion rublesIncrease compared to 2011, % Insurance payments, billion rubles Growth vs. 2011, % Payout ratio, %1SOGAZ15.921%15.315%96%2ROSNO6.938%4.731%69%3ZHASO6.15%5.36%86%4INGOSSTRAKH5.3-4%4.9- 16%93%5RESO-GUARANTEE4.948%3.10%64%6ALFASTRAKHOVA-NIE3.926%2.624%68%7ROSGOSSTRAKH3.5150%2.257%65%8VOILO-INSURANCE COMPANY2.567%1.660%64%9RENAISSANCE INSURANCE GROUP2.43 3 %1.4-12%60%10MAX2.054%1.567%73%11CONSENT1.8-0.8166%47%12CAPITAL INSURANCE1.76%1.5-12%90%13SURGUTNEFTEGAZ1.536%1.440%96%14URALSIB1, 50%1.3-7%86%15TRANSNEFT1.427%1.043%67%16PROGRESS-GARANT1.025%0.814%81%17ENERGOGARANT1.0-23%0.6-14%66%18YUGORIA0.9-25%0, 80%92%19MEDEXPRESS0.8-0.50%63%20INNOGARANT0.7-0.620%91%

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Voluntary health insurance (Market overview)

Compulsory health insurance services satisfy people less and less. And high-quality protection under voluntary medical insurance policies is becoming better and more affordable. Moreover, insurance companies are beginning to take a serious interest in individual citizens - individuals. We offer readers an overview of the possibilities of this market.

help yourself

Voluntary health insurance (VHI) is gradually becoming an incubator of civilized medicine in our country. Thanks to VHI, opportunities for advanced medical technologies and new services are opening up for the general population, and the level of service is increasing. Today, VHI and free CHI coexist like two parallel worlds. This is despite the fact that often the services for them are provided in the same medical facility. How to get into the "good" world of medical services? This is usually done through insurance at your facility. But gradually, insurance companies are beginning to be interested in individual customers. Today in St. Petersburg you can choose exactly the program that suits you the most. Insurance companies now want to insure individuals. And it's time for us, those individuals, to learn how to choose the very best.

The peculiarity of the situation is that violent advertising campaigns encourage manufacturers to do a lot of pleasant things for people - more than before. But the campaigns are running. What is happening now in the insurance market is not just a temporary campaign. Insurers are beginning to focus on a new category of customers. The best way win their sympathy - behave like a human being.
Insurance companies show people their willingness to delve into their problems informally. Here is a typical case: a client of an insurance company, insured under the Outpatient and Home Doctor programs, suffered a mild stroke. The hospital doctors sent him home, prescribing medications and monitoring by a neurologist. Due to health reasons, he could not go to the clinic, and according to VHI, his program did not provide for a home visit by a specialist. But the very next day, the company sent their doctor to his house, and the doctor observed the patient for a long time. In fact, the company did it at its own expense.
Of course, it is possible to assume advertising intent in the actions of insurers - the client will tell his friends about what happened. But this is the essence of civilized business. His law: to be noble is beneficial. And it is a sin for clients not to take advantage of excellent opportunities.
As for insurers, good deeds are contagious. If it is possible to combine humanity with profitability, any normal businessman will do so. In the field of VHI, this leads to the development of new programs and their "human" execution.
In the St. Petersburg market, such a trend is taking shape today. Of course, you can use its fruits "not for your money." To do this, you need to influence the management of your enterprises. There are many means: trade unions, collective agreement, public opinion.

DMS - THE MAGIC WAND OF MANAGERS

Numerous studies of consulting agencies and expert organizations show that VMI today can be one of the most effective elements in the field of personnel management. Only many managers of small and medium-sized enterprises do not yet know about it.
If the company does not have enough funds to increase salaries, its management is faced with the destruction of the motivational system. Good employees leave or start working carelessly. Losses from theft and fraud increase, labor productivity decreases. Punitive measures do not help, the threat to the economic security of the enterprise is growing. And what to do? The company has no money to increase salaries! A competent leader in such cases resorts to additional motivation.
An agency workshop gave the following example. There was a huge turnover at one service industry enterprise. The theft began. It was impossible to hire new good workers or keep old ones, since the salary was 3,500 rubles. The company's income made it possible to raise wages by 300-400 rubles a month, but the management did not believe that this amount would change anything in the attitude of employees to duties.
Then the expert, after an interview with the staff, offered to issue VHI insurance for the team, as well as pay 3,000 rubles in the form of bonuses ("the thirteenth salary") at the end of the year. For the enterprise, the conclusion of the VHI agreement meant the payment of an insurance premium of about 600 rubles per year for each employee. But the volume of medical services that an employee could receive was dozens of times higher than this amount.
The company's expenses for VHI and the bonus cost just the money that it could have spent on an inefficient salary increase. Interestingly, after that, the turnover decreased by half, theft almost stopped. A year later, out of increased profits, the company raised salaries by 2,000 rubles a month and got rid of difficulties with staff.
Why has VMI become the favorite of workers' sympathies today? Two interrelated reasons can be named: the formation in society of the concept of "values ​​of health" and the steady deterioration of the latter among the majority of the population. The insurance coverage of VHI is in stark contrast to the powerless OMS machine. Faced with a caring attitude towards their health, a person will appreciate it much more than the presentation of a diploma or a random ticket to a boarding house. And positive reactions from quality VMI service transferred to the person who provided it. To the "home company".

Prepared by Sergey Dovbnya.

Specialists - about DMS

Experts from insurance companies answer questions from Komsomolskaya Pravda about the problems and trends of VHI.

— Is there a growing interest of individual citizens in VHI insurance, and which groups of the population buy these policies the most?

Alexandra Bogdanova, Director of VHI, IC "ASK-Med":

- Over the past six months, the demand for VHI policies has grown significantly. Most of all, the topic of VHI is of interest to parents, because helping children with CHI system is getting worse due to a shortage of district doctors and an overload of free institutions. Insurance companies offer parents more than infrastructure quality treatment. Programs "family doctor" allow you to monitor the child constantly and prevent severe forms of disease. In addition, VHI is becoming popular with migrants, people from other regions and even countries. VHI for them (in the absence compulsory medical insurance policy and unformed documents for work) is the only way to receive permanent medical care.

— What VHI programs are most in demand by citizens?

Alexey Kuznetsov, director of IC "Capital-Polis":

— In our opinion, VHI family programs have the best prospects. Consumers already understand the benefits of treating the whole family with one doctor. Constant monitoring by a family doctor is especially effective in chronic diseases. Such a doctor not only helps patients recover, but also provides prevention, early diagnosis and the establishment of a healthy lifestyle. The experience of our company shows that one of the most promising areas for the development of VHI programs is the creation of Family Medicine Centers in different parts of the city. This saves the client time and money.

— What VHI programs, in your opinion, are the most promising?

Valery Ovsyannikov, General Director of IC "Virilis":

— From our point of view, VHI programs for children and adolescents are one of the most promising areas of insurance. Firstly, because children are still our future, and the health of children is the health of the nation (although, perhaps, it sounds hackneyed). Secondly, because by purchasing a VHI policy, parents acquire both peace of mind and confidence that the necessary medical care in the right amount and at the right time will be provided to their child. And, finally, today we are well aware that you have to pay for high-quality medical services and, often, pay a lot. The company's liability limit under all VMI agreements for pediatrics is many times higher than the amount that parents pay when concluding the agreement, and this is an extremely important circumstance.

— What VHI clients are most interesting for insurance companies?

Tatyana Voloshina, director of the medical insurance center of the Russkiy Mir insurance company:
— To date, insurance companies are most interested in collective agreements with enterprises. As a rule, enterprises acquire comprehensive insurance programs that include outpatient and inpatient treatment, and an ambulance call. Due to the large number of insured, the company minimizes premiums, and the insurance company provides a wide range of services. And insured workers benefit the most from this.

- Why is a VHI policy better than applying for paid medicine on "your own behalf" for a specific disease?

Inna Vishnevskaya, head of the voluntary medical insurance department of IC "RESO-Garantia":

- Firstly, in the case of treatment "on their own behalf", the patient will have to pay the full cost of treatment - in some cases, the funds may not be enough. Secondly, medical institutions in such cases tend to inflate prices and impose additional services. The VHI policy protects the patient from unnecessary expenses and loss of time. Thirdly, the voluntary health insurance system is just a system. The specialist will direct you exactly where you need it. Choosing a clinic on their own, the patient runs the risk of being a victim of advertising or incompetent advice. And finally, the insurance company is the guarantor of the protection of the rights of the patient.

A mature business protects itself from employee illness

A new insurance project is able to solve a whole range of problems for an employee and an organization

When a person begins to take care of his health, this means that he has reached maturity and shows elementary responsibility towards himself and his loved ones. And when a leader takes care of the health and medical protection of his subordinates, it means that his business has reached maturity. The manager looks ahead and plans the attitude of the staff towards the company, the quality of their work, the safety of the business and the maximum effect from the funds spent on motivation. VMI today allows you to solve a whole range of problems of the employee and the organization.
CEO Aleksey Nikolayevich Kuznetsov, IC Capital-Polis, noted on this occasion: “In recent years, organizations have been entering into more and more VHI agreements. Managers understand that today VHI has become the basis of a system of non-material incentive measures. it is included in the cost.
Indeed, if a person gets sick less, labor productivity increases and working time is saved. And if you still get sick, then the insurance company makes the chain of calls to various specialists optimal. Without queues, confusion and unreasonable bureaucracy.
VHI attracts highly qualified employees and stabilizes the situation in the team. Fear-protected employees feel valued to the organization. As a rule, this gives rise to a reciprocal feeling in them.
In addition, VHI is also a kind of inflationary insurance. The prices of medical institutions grow by an average of 20-30% per year. An insurance company negotiates with a medical institution to keep prices and discounts for its customers.
The company "Capital-Policy" has been specializing as a medical insurance company for 8 years. This made it possible to acquire a unique experience, which the company embodied in the insurance project "People's Policy". It will be carried out on the basis of the company's Family Medicine Center under the "Your Personal Doctor" insurance program. The project offers both individual and corporate insurance. The quality of insurance coverage really makes the project unique.
The heads of organizations can offer their employees a personal doctor for quite reasonable money, who will take care of their health and coordinate the actions of specialists. In addition to increasing the effectiveness of treatment and prevention of diseases, such a measure really raises the relationship between the employee and the employer to a new qualitative level. This can be especially interesting for small and medium businesses.
In small teams, the personal factor is especially important and can be easily corrected by means of proper management. "Personal Doctor" from the "People's Policy" project is the best suited for the recovery of small and medium-sized business organisms. Moreover, the prices for corporate insurance make the project undoubtedly affordable for many customers.
By offering the People's Policy project on the St. Petersburg market, the Capital-Policy company promotes a new quality of treatment, understanding and relations between all participants in VHI.

Protecting mothers and children...

IC "Virilis" offers effective insurance coverage to the most beloved and most vulnerable people: pregnant women, mothers, babies and children.
Insurance company "Virilis" provides customers with a wide range of insurance services. However, there is an area where IC "Virilis" occupies a leading position in the insurance market - programs to protect mothers and children. Working in this area requires special care and attention. It is here that the company "Virilis" has raised the level of services to the height of real quality and has no competitors.
"Virilis" offers to insure against an accident, possible complications during childbirth or after childbirth for a mother or child. Of course, none of the parents wants to allow this even in their thoughts. But the manifestation of responsibility towards the unborn child cannot harm his birth. Rather, on the contrary.
With a policy price of 200 rubles, the liability of the insurance company is 10,000 or more. Every third woman giving birth in our city is insured in Virilis.
In addition, the company offers VHI policies for monitoring during pregnancy. These policies guarantee a woman an attentive, individual attitude and high-quality medical protection in any worthy institution of the city.
But even after the birth of a child, "Virilis" helps parents by offering special programs for children of the first year of life and children from one to seventeen years old. Especially for children of different age groups, a program has been developed that includes a set of measures to prevent diseases specific to the age of the insured child. These programs involve the arrival of doctors at home, including a speech therapist and an exercise therapy specialist. It is these VHI policies that happy parents can give their children.

RESO guarantees quality and care

Real help to people can only be provided with impeccable technology.

Insurance company "RESO-Garantiya" occupies a strong position among the leaders in the field of VHI. The company can offer a set of quality insurance programs to both organizations and individuals. The complex includes outpatient and children's programs, dental care, inpatient, spa, rehabilitation treatment and others. Programs can be combined at very different levels of prices, volumes of assistance and choice of services.
Managers can create a package for their employees based on the capabilities and needs of the enterprise. When planning an insurance strategy, you should remember: discounts apply when renewing the VHI contract. After the first period of cooperation, the company already represents the health situation in the team and goes to reduce the fee for the contract. In addition, after a year of quality service under the VHI program, there are much fewer patients at the enterprise!
And people insured under good VHI programs will always remember how genuine medical care differs from ordinary ordeals in hospitals and clinics.
For 10 years of work, "RESO-Garantiya" was able to build up an impeccable technology for providing all types of medical care to its wards. The company relies on the work of its own structure of services - therapists, emergency medical services, family doctors. Naturally, their own doctors treat the matter with the appropriate level of responsibility and professionalism. These are people who do not work "on the stream". For them, a high level of service is indeed the norm. After all, VHI means an individual approach to each patient.
In addition, RESO-Garantia has established contacts with almost 500 medical institutions. Among them are leading medical centers with the most advanced technologies and technical equipment in medicine.
The company "RESO-Garantia" is respected by all partner medical institutions. A client with a VHI policy "RESO-Garantia" will always be provided with high-quality medical care, and additional requests will be fulfilled.
And for individual clients "RESO-Garantiya" can offer programs of emergency assistance, personal doctor, nurse patronage.
Clients of "RESO-Garantia" renew their VHI contracts and recommend us to their friends. This is the best advertisement for our work. After all, together with the policy "RESO-Garantia" gives its customers attention and care. And with the start of the work of its own medical center, the service of the insured will rise to a qualitatively new level.
As a result, having once met and started cooperation, we no longer part with our wards. Good friends are not lost, they are treasured!
"Russian world" everywhere at the highest level
Russkiy Mir Insurance Company offers all types of VHI programs in St. Petersburg and the Leningrad Region
For insurance companies, a sign of a high level of VHI development is the presence of their own medical center or their own ambulance service.
Russkiy Mir is the only company in St. Petersburg that has both. Own medical center, medical ambulance service, round-the-clock dispatcher, own doctors - such an infrastructure allows you to make the treatment process continuous. The disease can be detected and treated from the moment a mild ailment appears. It is clear that this means a huge advantage for the client. The disease does not start, precious time is not wasted, costs are reduced. In addition, Russkiy Mir provides policyholders with any worthy medical facility in St. Petersburg to choose from for their programs. St. Petersburg hospitals, medical units, institutes cooperate with the Russkiy Mir company - everyone who is known as a manufacturer of quality medical services. This choice in the "Russian World" is really huge.

PROGRAMS FOR EVERYONE

In the same way, among the VHI programs of the Russkiy Mir, any client can find the one that suits him.
The Russkiy Mir company offers organizations and individuals a full range of medical protection. These are outpatient programs and programs for planned and emergency hospitalization, ambulance, children and families ... Convenient combinations of medical services for the client are offered at a standard or elite level. The conclusion of the VHI agreement is a creative process aimed at the benefit of the client.
Among the VHI programs there are programs that are especially convenient for organizations, such as "office doctor". Its meaning is in regular medical examinations, prevention and early diagnosis of diseases. Reception takes place right in the office, at a convenient time for the organization. This saves time and money for the employer and the insured. And in time, noticed and cured diseases no longer threaten losses in the future.
Citizens are traditionally attracted by the system of family doctors of the Russkiy Mir insurance company.
A family doctor is in charge of the health of the whole family: first of all, he helps health not to turn into "illness". If any disorders occur, then the help of a permanent specialist helps to cope with them as quickly as possible.
With this approach, the disease will not be able to cause serious damage to the health of family members. The family doctor is especially important for chronic patients. In combination with the supervision of a family doctor, nursing patronage, home procedures and other medical services that the client wants to include in the contract are possible.
Voluntary health insurance policies from the Russkiy Mir company make high-quality medicine affordable for both Petersburgers and residents of the Leningrad Region. This is served by the system of branches of the company.