According to the Law of the Russian Federation “On Health Insurance of Citizens of the Russian Federation” /2/, “voluntary health insurance is carried out on the basis of voluntary health insurance programs and provides citizens with additional medical and other services in addition to those established by compulsory health insurance programs.” In fact, this rule of law is not observed: many health insurance providers offer voluntary health insurance programs that cover medical services provided for in the basic compulsory health insurance program.

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

Let us provide a comparative analysis of insurance premiums and insurance payments for voluntary and compulsory types of health insurance according to the Federal Social Insurance Fund.

Table 2.7 Analysis of insurance premiums and insurance payments by type of health insurance for 2005-2006, million rubles.

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

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

Until now, the bulk of VHI programs have been options for providing “one-time” medical services - the so-called “monopoly” 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 an amount slightly less than that which he paid. In this case, funds from citizens and their employers initially go to the insurance organization, allowing the medical institution to shift responsibility for accounting for these funds, formalizing contractual relations with patients, etc. to it.

Considering that the patient or his employer, when purchasing a monopoly, 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 amount of the “insurance payment” is known in advance - the price of the service. Also missing is the main advantage of the VHI system - the ability to plan 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 VHI 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 VHI programs is provided by both individuals and their employing organizations. Today, about 1.5% of Russian enterprises and organizations and 80% of foreign companies whose representative offices operate in the Russian Federation pay contributions for voluntary health insurance for employees. According to OJSC ROSNO estimates, Russian enterprises provide 55% of the volume of collected insurance premiums for VHI, foreign enterprises - 35%

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

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

Introduction

Chapter 1. Theoretical foundations of the organization of voluntary health insurance and their impact on the healthcare system in Russia 10

1.1 Socio-economic importance of voluntary health insurance 10

1.2 Features of the functioning of the voluntary medical insurance market in the Russian Federation 19

1.3 General characteristics and distinctive features of compulsory and voluntary health insurance 36

Chapter 2. Development and current state of the Russian voluntary health insurance market 55

2.1 Analysis and dynamics of development of the voluntary health insurance market 55

2.2 Features of the design of insurance products and its impact on the cost of a VHI policy 91

2.3. Marketing policy of insurers in the VHI market 109

Chapter 3. Development prospects and proposals for modifying the voluntary health insurance model of the Russian Federation 116

3.1 Main directions for improving the voluntary health insurance market and its place in the healthcare reform system 116

3.2. Proposals for modifying the existing model of voluntary medical insurance in Russia at the present stage 125

Conclusion 155

List of used literature 168

Applications

Introduction to the work

Relevance of the research topic. Currently, the Russian health insurance market is undergoing significant changes. Adopted on January 1, 2011, Federal Law No. 326 “On Compulsory Medical Insurance (CHI)” significantly changed the healthcare system in the country: the model of compulsory medical insurance financing has changed; Every citizen is given the right to choose a medical institution and a doctor. At the same time, the development of the voluntary health insurance (VHI) market itself, in the context of the modernization of compulsory health insurance, was not ensured by the new law on compulsory medical insurance.

Currently in the Russian Federation there is a situation where state obligations to provide the population with free medical care of the required volume and quality are not fully supported by financial resources. It is possible to receive a wider range of high-quality medical services, both directly in medical institutions and through the voluntary health insurance system.

In modern conditions, voluntary health insurance serves as a complement to free forms of providing the population with medical services. However, the question of the rational relationship between compulsory health insurance and voluntary health insurance has not been developed at the moment. The development of VHI provides significant opportunities for improving healthcare, being inherently a civilized form of development of the Russian health insurance system. Since financing medical services through VHI is much more profitable than paying for them directly, this circumstance opens up broad prospects for the development of VHI.

The voluntary health insurance system in Russia has not yet been fully formed, which is due not only to internal factors of its development, but is also a direct consequence of macroeconomic processes. This is due, on the one hand, to the involvement in the VHI system of a large number of market entities interested in its intensive development, and, on the other hand, to the lack of a ready-made mechanism for overcoming a number of social, economic and legislative restrictions that do not allow the system to move to the next stage of development.

In this regard, a comprehensive analysis of the features of the VHI segment in modern conditions in order to identify its trends and development prospects, as well as the development of methods for improving the activities of insurers in the VHI market is a relevant area of ​​modern science.

Degree of development of the problem

Currently, the problems of development of the voluntary health insurance sector attract the attention of many authors.

Scientific developments in the field of formation and development of the insurance market are presented in the works of scientists: V.D. Arkhangelsky, A.P. Arkhipov, Akhvlediani Yu.T., IT.Balabanov, M.I. Braginsky, V.B. Gomelli, A.A. Gvozdenko, A.I. Gisburga, V.V. Droshneva, E.F. Dyuzhikova, E.I. Ivashkina, I.A. Kuznitsova, L.A. Orlanyuk-Malitskaya, L.I. Reitman, Yu.A. Spletukhov, D.S. Tulenta, Yu.B. Fogelson, V.V. Shakhov, A.K. Shikhova, R.T. Yuldasheva and others.

The problems of forming a voluntary medical insurance market in Russia are reflected in the works of: N.B. Grishchenko, E.T. Kagalovskaya, L.I. Korchevskaya, K.E. Turbina N.P. Sakhirova, G.V. Chernova, T.A. Fedorova, I.M. Sheiman and others.

An analysis of available domestic literature sources shows that issues related to the prospects for the development of VHI in Russia are quite controversial today and are widely discussed both among health care organizers and among practitioners. However, there is still no common point of view on solving this problem. Issues related to the analysis of the VHI segment and the methodology for its implementation are poorly developed. There is no comprehensive approach to studying the specifics of the activities of insurers in the VHI segment.

Thus, insufficient conceptual elaboration of the problem under study and the need for its further understanding determined the relevance, purpose and objectives of the study.

Purpose and main objectives of the study. The purpose of the dissertation research is to substantiate proposals for modifying the existing VHI model that meets modern market development requirements in the country.

Realization of the goal required solving the following tasks:

systematize conceptual approaches to the concept of “voluntary health insurance”, analyze existing interpretations and clarify the author’s interpretation of the concept of “voluntary health insurance”;

study the distinctive features of compulsory and voluntary health insurance in the Russian health insurance system;

Analyze the dynamics of the VHI market over a 5-year period and systematize the main factors influencing the development of the VHI market in the Russian Federation at the present stage;

Research the existing VHI model in insurance companies, the Russian health insurance market and their marketing policies and determine the possibility of developing the VHI market;

Determine the main directions for reforming the development of the voluntary health insurance market and develop a set of proposals to improve the organization and optimize the functioning of the VHI system.

The object of the study is the VHI market of the Russian Federation.

The subject of the dissertation research is economic relations that arise in the process of interaction between subjects of the voluntary health insurance market.

The theoretical basis of the dissertation research was the work of domestic and foreign authors on the issues of voluntary health insurance, as well as materials from discussions, scientific and practical conferences, numerous theoretical works, journalistic materials and information from official websites of government bodies of the Russian Federation and constituent entities of the Russian Federation on the Internet.

The methodological basis for considering the problems of the dissertation was general scientific methods, as well as methods of structural-functional and institutional analysis. During the work, the following research methods were used: system analysis, graphical and economic-mathematical modeling, abstract-logical, comparative and economic-statistical methods. The combination of various scientific methods contributed to the formation of the author’s position on a number of significant provisions related to the chosen topic.

The information base of the study was made up of laws of the Russian Federation, regulatory and instructional documents of the Federal Insurance Supervision Service and the Ministry of Finance of the Russian Federation, defining the conditions for carrying out insurance activities, statistical and analytical materials of the Federal State Statistics Service (Rosstat), the Federal Insurance Supervision Service (FSSN), the All-Russian Union insurers (VSS), rating agency "Expert RA". When writing the work, scientific publications in periodicals, materials and documents of individual insurance companies, thematic Internet resources, information and analytical materials, as well as expert opinions, assessments and calculations of researchers were used.

The scientific novelty of the dissertation research lies in the substantiation of theoretical provisions and the development of directions for modifying the existing VHI model to improve the organization and increase the optimization of its functioning. During the study, the author obtained the following results that have scientific novelty:

1. A definition of voluntary medical insurance is given as a system of economic relations, during which the policyholder is provided with guarantees of full or partial compensation by the insurer for those expenses that arise in connection with the insured person applying to a medical institution for medical care provided in accordance with the program provided for by the VHI agreement ;

2. The peculiarities of the functioning of the compulsory medical insurance and voluntary medical insurance segments in the medical insurance sector of the Russian Federation have been identified, which consist in a different combination of voluntary and compulsory medical insurance, as well as ensuring a balance in the volume of state guarantees for the provision of free medical and voluntary medical insurance to the population;

3. The main trends in the development of the VHI segment over a 5-year period were determined and the financial indicators of the VHI market were identified; as well as positive and negative factors influencing the development of the VHI segment of the Russian Federation at the present stage; 4. Based on a study of the existing model in the most successful insurance companies, distinguished by their ability to attract clients, high financial performance and their position in the voluntary health insurance segment, the features of the marketing policy of insurance companies in the Russian voluntary medical insurance market were identified. The possibility and necessity of developing the voluntary health insurance market in the context of the modernization of compulsory health insurance, which consists in the legislative consolidation of VHI, increasing the efficiency of control over the volume of services provided and a real significant improvement in the quality of service for the insured, for which it is necessary to determine specific measures for the development of the VHI market and its place, has been proven in the country's healthcare system;

5. A set of measures has been developed to modify the existing VHI model, aimed at improving the organization of the VHI system to optimize the volume and structure of consumption of medical services provided under VHI programs.

The theoretical and practical significance of the results of the dissertation research lies in the fact that conceptual approaches to the development of voluntary health insurance in modern conditions have been developed and theoretically substantiated. The information obtained during the comprehensive multifaceted study served as the basis for the development of comprehensive measures for the development of voluntary health insurance and proposals for optimizing the functioning of insurance companies operating in the voluntary health insurance market, and also contributed to the further development of medical services provided under VHI programs. It is advisable to use the dissertation materials when preparing lecture courses on the disciplines “Insurance”, “Insurance of foreign economic activity; when developing and conducting seminars for students and conducting scientific research.

Testing and implementation of research results.

The results of the research, in particular, the marketing policy of insurance companies, as well as the set of measures proposed in the dissertation aimed at improving the organization of the VHI system, are successfully used in the practical activities of SK SOGLASIE LLC.

The main provisions and results of the dissertation research were published in 6 scientific works with a total volume of 6.7 pp, including 3 articles in publications recommended by the Higher Attestation Commission of the Ministry of Education and Science of the Russian Federation.

Structure and scope of the study. The structure of the work corresponds to the stated goal and objectives of the study and has the following form.

Socio-economic importance of voluntary health insurance

The supply of an insurance product in the form of voluntary medical insurance on the insurance market was a response to the emergence of corresponding demand among various categories of individuals and legal entities - market participants. In turn, the demand for a specific insurance service was generated by the following circumstances.

firstly, the adoption in June 1991 of the RSFSR Law “On Medical Insurance of Citizens in the RSFSR”, as a result of which the procedure for financing healthcare was changed;

secondly, the limitations of the basic (territorial) compulsory health insurance program, which determines the volume and conditions for the provision of medical care to Russian citizens;

thirdly, a decrease in the quality of free medical services provided within the framework of budgetary healthcare, and the emergence of paid medical care provided by self-supporting medical institutions (departments).1

As a result of the above reasons, a need arose to receive medical services not provided within the framework of budgetary healthcare. It became possible to fulfill this need either by direct payment for the medical care received.

A feature of medical services is their almost absolute lack of alternatives. The purpose of voluntary health insurance is to compensate insured citizens for expenses associated with the occurrence of an insured event.

Voluntary health insurance is a supplement to compulsory (social) health insurance. Within its framework, insurance is provided that provides payment for services provided in excess of the compulsory health insurance program. In the conditions of licensing insurance activities in Russia, the Federal Insurance Service of the Ministry of Finance of the Russian Federation defined the concept of VHI as “a set of types of insurance that provide for the insurer’s obligations to make insurance payments in the amount of partial or full compensation for additional expenses of the insured caused by the insured’s application to medical institutions for medical services included in the program Voluntary medical insurance."

As was substantiated by T.A. Fedorova, the emergence and development of VHI is associated with the presence of a number of prerequisites. Voluntary health insurance appears and develops successfully in conditions when there is a need for full or partial payment for medical services. If medical care is fully funded by the state, then there is no need for additional health insurance.2

Recently, voluntary health insurance (VHI) has become increasingly popular in Russia. If just a few years ago the majority of people received medical care under compulsory health insurance, then recently

2 Fundamentals of insurance activities: Textbook / Under. ed. T.A. Fedorov. - M.: BEK, 2008, an increasing number of Russian citizens are also entering into an agreement on voluntary health insurance (VHI).

When concluding a voluntary health insurance agreement, a potential client of a medical institution is given the opportunity to reduce one-time (often quite high) costs of paying for medical care. In addition, a VHI agreement usually provides for the insurer’s control over the quality of medical services provided to the insured person and their compliance with the list guaranteed by the voluntary health insurance program.

Analysis and dynamics of development of the voluntary health insurance market

Currently, voluntary medical insurance is one of the most popular types of insurance coverage in Russia. Evidence of this is the growth rate of the industry, which has been around 20 - 25% for several years now. The VHI market is growing at a fairly high rate, which, since 2000, has consistently outpaced the average growth rate of the entire insurance market as a whole.

The author has revealed that one of the main prerequisites for the active development of VHI is the obvious increase in effective demand, the growth of social responsibility of business and the understanding that VHI can be used as part of a social package. The system of motivating employees through a social package is becoming increasingly in demand among the country's employers. They are prompted to do this by the situation of supply and demand in the personnel market.

Having analyzed the current trend in the VHI market, we can state that voluntary health insurance is in demand mainly by corporate clients. They account for about 90% of contributions collected under VHI programs. There are several explanations. On the one hand, this is the growth of social responsibility of business, when employee insurance is becoming an integral part of the compensation package in an increasing number of companies. In addition, firms have tax benefits when using VHI programs and a collective insurance agreement is 50-70% cheaper.16

The collected contributions for voluntary health insurance from individuals account for only 5-10%. This is explained by the fact that it is easier for individuals to contact a medical institution directly, bypassing the insurance company, because unlike legal entities that receive tax benefits when purchasing voluntary health insurance policies, private clients do not have such benefits.

In addition, it is easier for the insurance companies themselves to work with corporate clients, because when insuring large groups, the risk is evenly distributed among the company’s employees (the healthy pays for the sick principle works), that is, there is no need to conduct a medical examination and risk assessment for each insured. In addition, with VHI for individuals, anti-selection (worsening selection) of risks occurs, in which people who apply for insurance policies are mainly people who already know that in the near future they will have to use medical services. All this significantly increases the cost of voluntary health insurance policies for individuals, and makes them less attractive compared to corporate insurance.

Main directions for improving the voluntary health insurance market and its place in the healthcare reform system

Analysis of the development of the VHI market at the present stage and the adoption of a new law on compulsory health insurance (CHI) in Russia on January 1, 2011, which has greatly changed the healthcare system as a whole (a citizen now has the right to choose a doctor, a clinic, and his policy is valid anywhere in the country ), showed that the voluntary health insurance (VHI) market segment was outlawed. Based on the current situation, the development of the VHI market in the Russian Federation, accompanied by the adoption of a new law on compulsory medical insurance, which does not specify the place of VHI in the healthcare financing system and the Strategy for the Development of the Insurance Industry in the Russian Federation for 2008-2012 does not indicate a single specific measure for market development VHI. In addition, the concept for the development of healthcare in the Russian Federation until 2020 states that VHI “leads to a decrease in the availability and quality of medical care for the population served under the state guarantee program”49 This state of affairs forces insurers to think about the prospects for the development of VHI and how to improve the efficiency of insurance companies. companies.

Currently, the Russian Constitution and legislation guarantee Russian citizens the receipt of almost all types of medical care: from consultation with a general practitioner to inpatient treatment. There is no such broad program of government guarantees in any country in the world. In many countries, the state guarantees the bare minimum - primary health care and measures to ensure health care (control of infectious diseases, sanitary measures, etc.). In our country, the range of medical services is very wide, but in fact, many types of medical care cannot be obtained or their quality will be extremely low. Government commitments are not backed by real funding. Having analyzed the report on the progress of the implementation of the Program of State Guarantees for the provision of free medical care to citizens of the Russian Federation in 2009, one can see that the costs of state sources of financing provision in 2009 amounted to 1,378.6 billion rubles and increased by 53.6%. The state guarantee program was financed from budgets of all levels (63.3%) and funds from the compulsory medical insurance system (36.7%). The sources of financing were the Federal budget - 391.6 billion rubles, the consolidated budgets of the constituent entities of the Russian Federation amounted to 481.6 billion rubles (34.9% of all expenses) and the funds of the compulsory medical insurance system amounted to 505.4 billion rubles in 2009.50

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 health insurance in our country amounted to 699 billion rubles (excluding insurance for those traveling abroad). Of these, 604 billion rubles (that is, 86%) were for compulsory health insurance (CHI), 95 billion rubles (that is, 14%) were for voluntary health 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 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 low. The client base of the voluntary health insurance market has already been formed, and the emergence of new large clients is quite rare. According to the Expert RA rating agency, the volume of the voluntary health insurance market at the end of 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 medical insurance are presented in Figure 3.

Figure 3 - Dynamics of insurance premiums for voluntary health insurance

Voluntary health 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 employee insurance becomes an integral part of the compensation package, and, on the other, by the desire of insurance companies to work with corporate clients, since when insuring teams, 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 - increasing the rate of attribution of premiums for voluntary medical insurance to cost from 3% to 6% of the wage fund. In 2012, this measure was most in demand by small and medium-sized businesses.

Low demand from private clients is due to low incomes of the population and the high cost of voluntary health insurance policies. The volume of the retail voluntary health insurance market in 2012 was 5% (Fig. 4).

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

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

The high loss rate of retail voluntary medical insurance is due to the fact that a private client strives to make the most of the insurance - to visit the clinic as many times as possible in order to recoup its cost. In addition, worsening selection occurs, 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 health insurance to the retail sector. Company employees who lost social packages began purchasing voluntary health insurance policies themselves. With the recovery from the crisis and the return of corporate clients to voluntary health insurance, retail demand has decreased.

Since the demand of individual clients is small, the supply of insurers is corresponding.

There are also tax benefits for individuals - these are 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 in obtaining a deduction, and you can only receive it 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 voluntary health insurance segment 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 medical insurance, and at the end of 2012 - 354. The reduction in the number of companies is not due to the refusal of insurance by universal insurers, but to the revocation of licenses from small companies that have a weak reputation and are engaged in “pseudo-insurance.” The increase 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 is trying to minimize the volume of the voluntary health insurance market, which can negatively affect the entire health care system.

Building an effective voluntary health insurance market has positive external effects for the healthcare system and society as a whole:

growth of social stability;

reducing information asymmetry in the medical services market;

the possibility of reducing shadow financing of the healthcare system;

increased investment in the construction of medical centers.

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

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

The companies OJSC ROSNO, OJSC ZHASO, IJSC Ingosstrakh, IJSC Reso-Garantiya, the data on contributions of which are presented in Table 1, follow with a significant gap from the leader.

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

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.

A brief review of the state of the voluntary medical insurance market showed that the Russian market for corporate voluntary medical insurance has gone through a 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 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.

Market development also requires positive initiatives on the part of the legislature and supervisory authorities, qualified and tangible marketing efforts, including the development of effective mechanisms for the sale of voluntary health insurance on the part of insurance companies.

The survey showed that low awareness of clients about all the benefits of VHI has a negative impact on the motivation to purchase VHI programs. Insurance companies need to use marketing principles to reach potential clients, including both individuals and business executives, so that they understand all the benefits that VHI provides. In addition, it is necessary to study the peculiarities of the formation of medical care needs in each specific region. A systematic and continuous analysis of the needs and demands of key consumer groups (individuals and organizations) is needed.

Our research has shown that insurance companies have significant opportunities to attract customers.

Thus, along with residents of nearby regions, residents of the Chelyabinsk region also experienced the consequences of the Chernobyl disaster. A large number of area residents were busy working to eliminate the consequences of the accident. In this regard, most of them experience changes in the thyroid gland and systemic osteoporosis. Consequently, this contingent can be offered separate VHI programs that require the availability of, for example, equipment such as a computed tomograph in the medical center.

From a marketing point of view, the buyer does not need the product as such, he needs a solution to his health problems. These problems can be solved most effectively in comprehensive medical centers, where there are doctors of all specialties and an in-house pharmacy with an arsenal of new modern pharmaceuticals, all types of examinations, tests, mandatory treatment can be carried out, psychological assistance and physical therapy can be offered. It is on this basis that the health problem as a whole should be solved.

To more effectively serve targeted groups, two types of marketing efforts can be proposed. For insurance companies operating in the VHI market, the following marketing efforts can be proposed:

Promoting the distinctive qualities of the product - creating new insurance products - the "Pediatrician" program, "Pregnancy and obstetric care", "Personal cardiologist", etc.

The introduction of individual voluntary health insurance policies for such a promising segment as migrants who do not have compulsory health insurance policies.

Undoubted damage to voluntary health insurance is caused by the inadequate pricing policy of medical institutions. Moreover, the population is often asked to pay for services already paid for from the compulsory medical insurance fund. This practice is no exception; it is also typical for other regions of the country.

One of the manifestations of market orientation is the opening of private clinics by private insurance companies. Developing relationships with consumers (patients) is the task of all members of the organization, and not just the insurance sales department. In order to improve the quality of medical care and increase the profits received by insurance companies, it is necessary to develop a network of their medical centers with the latest material and technical base, capable of providing assistance on the principle of “attachment”, including to insured individuals.

The approach to a product (service) as a solution to a problem affects all components of marketing and, especially, such a component as distribution: convenient, easy access to the solution - the introduction of a preliminary appointment by phone at a time convenient for the client, the work of medical representatives, the allocation individual assigned doctors.

It should also be noted that various marketing studies show that, for objective reasons in the country, current attempts to commercialize medicine lead to two inevitable results:

Firstly, to the accelerated formation of the medical-industrial complex of Russia with its own special goals, which in many ways do not coincide with the interests of the majority of the population;

Secondly, the inhibition of the development of socially effective medical technologies (cheap and effective systems of prevention and preventive therapy).

World and Soviet experience shows that the best way out of this situation is free medicine. Many states (Sweden, Great Britain and others) follow this path, or consider it more effective. For example, in France, during the election campaign, some candidates for the post of head of state promise to switch to free healthcare. In our country, it is almost impossible to escape the commercialization of the sphere of medical care for the population under the current conditions. Therefore, it is necessary to look for a way out that can mitigate these negative consequences as much as possible.

In our opinion, one of these solutions may be a deeper division of powers between the social and commercial health insurance systems, as well as targeted stimulation of the development of both medical and insurance complexes in accordance with the specifics of the tasks they solve and the segments of the population they serve.

Summarizing the above, we will highlight the advantages that, in our opinion, determine the prospects for the development of the voluntary health insurance system.

Firstly, voluntary health insurance currently brings enormous benefits to all participants in the paid medical services market. For the first time, insured clients have the opportunity to receive exactly the medical care they would like to receive, which consists of:

Real care and assistance from the medical representative of the insurance company in choosing a medical institution that is optimal in terms of price-quality ratio;

Ensuring timely and priority provision of assistance;

Service by a trusted doctor (the most competent specialist who has been selected in advance by the insurance company), who would be interested in ensuring that everything necessary and possible is done for the client at the highest level;

A feeling of complete protection for each insured person on the part of the insurance company, who is not left alone for a minute with the arbitrariness that often exists in health care facilities (which is especially dangerous during obstetrics and pediatrics).

In addition, every head of an institution who purchases voluntary health insurance programs for his employees receives enormous benefits, since the image of the enterprise and the prestige of jobs are significantly increased. The manager really has the opportunity to help an employee valuable to the team not only financially (for example, in carrying out a very expensive operation, even if at the moment there is no profit at the enterprise), but also organizationally (after all, contracts with leading clinics, as a rule, , have already been concluded, and it will take very little time to organize assistance). Moreover, VHI funds can pay for necessary expensive medications that are not included in the list provided for by compulsory medical insurance. Medical institutions also benefit from participating in the VHI market, receiving huge financial resources that go towards developing the institution’s material and technical base and for additional incentives for employees.

Secondly, insurance companies concluding voluntary health insurance contracts are beginning to take a direct part in the development of the material and technical base of healthcare, creating their own health care facilities. Today, depending on the risk or deposit type of insurance, the profits of insurance companies can fluctuate within small limits at fairly low figures, since the bulk of the funds ultimately goes to medical institutions. If the founders of insurance companies open their own medical institutions, then both the insurance companies themselves and the clients, for whom everything possible will be done at the modern level, and the local health care system as a whole, will benefit from this.

Thirdly, with the increase in the number of insurance companies working with individuals, the protection of well-off people who are able to independently buy a voluntary health insurance policy from the arbitrariness of enterprise managers who, for various reasons, do not want to take care of the health of their employees, increases. Unfortunately, there are company managers who try to get rid of a sick employee under any pretext.

Fourthly, there are cases when people need medical care who, for some reason, do not have a compulsory medical insurance policy. These include, for example, migrants who do not have registration in a given region at the time of their illness.

Fifthly, a very important advantage of VHI is the presence in large insurance companies of highly qualified medical experts and lawyers who are ready to really stand up for the interests of their insured.

Many years of experience of insurance companies in the field of voluntary medical insurance and increased interest in this type of insurance on the part of the largest domestic enterprises allow us to speak of voluntary medical insurance as the most important and promising source of healthcare financing at this stage and in the future.

Voluntary health insurance (VHI) is a form of social protection of the population’s interests in health care, expressed in a guarantee of payment for medical care in the event of an insured event at the expense of funds accumulated by the insurer.

The purpose of VHI is to guarantee to insured persons in case of illnesses or damage to health the provision of medical care and services that are not included in the compulsory medical insurance program, but provided for by VHI programs. At the same time, the insurer guarantees full or partial compensation for expenses that an individual is forced to bear when visiting medical institutions. However, competition among insurers encourages them to develop VHI programs with a wider range of medical services and their different composition. Some of them are reflected in compulsory medical insurance programs.

VHI includes a much larger volume of medical services than compulsory medical insurance. If, within the framework of compulsory health insurance, medical institutions participating in the territorial compulsory medical insurance program provide a certain list of medical services, determined by this program and paid to the institution at the rates approved by the tariff agreement, then the medical services received by the insured patient within the framework of voluntary medical insurance may include expensive complex medical services (in the field of dentistry, ophthalmology, plastic surgery, etc.), and pediatric patronage of a commercial clinic, and expensive tests, and much more.

As part of the voluntary health insurance program, the insured patient can receive not only medical, but also other services: part 5 of Art. 1 of the Law of the Russian Federation “On Medical Insurance of Citizens in the Russian Federation” No. 1499-1 of June 28, 1991, the task of this type of medical insurance is to ensure that insured citizens receive additional medical and other services in addition to the established compulsory medical insurance programs. In other words, the contract may provide for the patient to use a superior ward, receive improved nutrition, related services, etc.

Voluntary health insurance relations are regulated by an agreement, the form of which is established by Decree of the Government of the Russian Federation No. 41 of January 23, 1992.

In voluntary health insurance, the subjects of insurance are the citizen, the policyholder, the insurer, and the medical institution. (Fig. 2)

) medical insurance organizations providing compulsory medical insurance (according to the law, a medical insurance organization, in addition to medical insurance, does not have the right to carry out other types of insurance activities, but has the right to simultaneously provide compulsory and voluntary medical insurance);

) other insurance organizations licensed to provide voluntary types of health insurance.

Insured for voluntary health insurance are individual citizens with civil legal capacity and/or enterprises representing the interests of citizens. If the court recognizes the insured as incapacitated in whole or in part during the validity period of the VHI contract, his rights and obligations are transferred to a guardian or trustee acting in the interests of the insured.

Medical insurance organizations are legal entities that provide voluntary medical insurance and have a state permit (license) for the right to engage in voluntary medical insurance.

health insurance voluntary compulsory

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A standard VHI policy does not provide for payment of insurance compensation. The insurance company pays bills for medical services provided to the owner of the VHI policy directly to medical institutions. Thus, the insured pays only once when purchasing a VHI policy, and all costs for treatment are borne by the insurance company. If it is necessary to receive medical care, the insured person contacts the insurer's control center (this may be a coordinating doctor) by telephone, which is specified in the insurance contract (insurance policy). The insured person provides his first and last name, his policy number and the reason for the request, after which the coordinating doctor provides all the necessary information regarding the further actions of the insured person. When applying for medical help or related services (transportation to a medical facility, etc.), you must present a VHI policy and an identity document. When visiting a doctor, it is recommended to have with you extracts and certificates from other medical institutions related to the disease for which you are seeking medical help. Payment of insurance compensation is carried out by the insurer by transferring funds to the account of the medical institution for the actual medical care provided. If the insured person, in agreement with the insurer, paid for the cost of medical care provided or purchased medications according to prescribed prescriptions, the amount spent is returned to him based on the documents provided. The insurer has the right to refuse to pay for medical services if the insured person received services that were not provided for in the insurance contract, and also did not follow the doctor’s recommendations, which led to a deterioration in his health. The insurance contract defines the conditions under which the insurer will refuse to pay insurance compensation.

A VHI agreement is an agreement entered into voluntarily by the parties. The voluntariness of VHI lies in the fact that the insurance contract with the insurer is concluded at one’s own request, equivalence is determined by the choice of the VHI program for which the policyholder pays an insurance premium, urgency implies the presence of a certain time for which the insurance contract is concluded, since one of the essential conditions in the insurance contract is term of the contract.

Voluntary health insurance is divided into:

Individual - each person, at his own request and at his own expense, issues a VHI policy. He selects the choice of an insurance company, the list of services and many other factors individually, based on his needs.

Collective - an organization issues a voluntary health insurance policy for its employees, adding it to the social package. That is, while a person works for this organization, he has the right to receive paid medical services for free, this is a very powerful means of motivation. It is the presence of a good VHI policy in the social package that is the decisive condition when a person chooses his place of work and the factor that keeps a person at his job, because upon dismissal, the employee is obliged to hand over his VHI policy. The advantage of group insurance is its lower cost.

Voluntary health insurance is in demand mainly by corporate clients. They account for about 90% of contributions collected under VHI programs. There are several explanations. On the one hand, this is the growth of social responsibility of business, when employee insurance is becoming an integral part of the compensation package in an increasing number of companies. At the same time, voluntary health insurance programs at many enterprises, especially in high-tech industries, are no longer considered only as a way to provide financial incentives for employees, but also as an important tool for increasing business efficiency by improving staff health. On the other hand, it is often much easier for citizens to contact a medical institution directly, bypassing the insurance company. After all, unlike companies that have tax benefits when using VHI programs, individuals do not receive such benefits.

It is also easier for the insurance companies themselves to work with corporate clients, since when insuring large groups, the risks are evenly distributed among all employees, and accordingly, there is no need to conduct a survey and assess the risks for each insured person. In addition, with VHI for individuals, anti-selection (worsening selection) of risks occurs, in which people who apply for insurance policies are mainly people who already know that in the near future they will have to use medical services. All this significantly increases the cost of voluntary health insurance policies for individuals, and makes them less attractive compared to corporate insurance.

The most common voluntary health insurance programs in Russia are:

• ·Outpatient care, eliminating expensive diagnostic methods.
• ·More expanded program: specialist services, the ability to take tests at home and in the clinic, inpatient treatment, dentistry, emergency care, assistance abroad.
• ·Comprehensive insurance for the whole family.
• · Travel insurance: insurance is valid for the entire trip.
• ·Standard policy: emergency care for injuries or poisoning, acute diseases, exacerbation of one of the chronic diseases; emergency dentistry; the doctor's consultation; hospitalization, etc.
• ·Help at home. Insurance for those who are unable to get to the clinic. Includes consultation with a specialist at home, blood tests, injections, cardiogram, etc.
• ·Call a paid ambulance. Insurance - both separate and as part of a specific insurance package.
• ·Personal doctor: consultations, examination, referral and prescriptions from a personal general practitioner.
• ·Dentistry: emergency care, regular examinations, treatment, etc.
• ·Emergency and planned inpatient care. Insurance is relevant if you have chronic diseases, if there is a risk of going to the hospital, if there are indications for staying in the hospital.
• ·Pregnancy and childbirth: support and observation during pregnancy, hospitalization and delivery, postpartum support.
• ·Children's programs: preventive examination, consultations with specialists, vaccinations, emergency care, etc.
• · Sanatorium and rehabilitation program.
• ·Treatment abroad.
• ·Insurance programs for the elderly.

Voluntary health insurance is carried out at the expense of the profits (income) of enterprises and personal funds of citizens through the conclusion of an agreement. The amounts of insurance premiums for voluntary health insurance are established by agreement of the parties. The insurance premium is the insurance payment that the policyholder is obliged to pay to the insurer in accordance with the voluntary health insurance agreement.

Tariffs for medical and other services under voluntary health insurance are established by agreement between the medical insurance organization and the enterprise, organization, institution or person providing these services. The insurance tariff is the rate of insurance premium per unit of sum insured or object of insurance. Tariffs must ensure the profitability of medical institutions and the modern level of medical care.

Pros of VHI:

• ØFreedom of choice. The citizen himself chooses the insurance company, program and medical institutions from those that are offered to him.
• ØSaving time. You won’t have to wait in queues and wander around the city in search of a decent medical facility.
• ØHigh quality medical services.
• ØThe opportunity to receive services that are not available under the compulsory medical insurance policy.
• ØProtection of the interests of the insurer by the insurance company in the event of controversial issues.
• ØWide list of services provided and a wide selection of institutions where these services are provided.
• ØThe ability to choose an insurance package in accordance with your requirements and needs - a minimum package, home care, etc.
• ØThe ability to make an appointment with a doctor via the Internet without leaving home.
• ØAttitude of staff towards patients, taking into account the interest of staff in their work.

Disadvantages of VHI:

• ØVHI insurance is paid for by the citizen, and the services are very expensive.
• ØThe risk of imposing on a citizen services that he does not need.
• ØThe qualifications of specialists providing VHI services do not always correspond to what is stated.
• ØExclusions from insured events not covered by insurance. Many people miss this moment. Certain diseases (the list is very wide) are not covered by VHI insurance.
• ØVHI does not provide treatment for certain significant diseases (for example, tuberculosis, diabetes, mental and sexually transmitted diseases) - only diagnostics, and then for a fee.

VHI in Russia is gaining popularity. Moreover, if previously such policies were purchased mainly by employers for their subordinates, now our citizens turn to insurance companies on an individual basis. The insurance market participants themselves associate this with an increase in the level of prosperity among the population, with economic growth in the country, as well as with the development of the Russian insurance market. The reasons may be that compulsory health insurance is not very effective.