Russia has reformed its mandatory health insurance system to improve governance and clarify responsibilities of stakeholders
Russian Federation has enforced a Law on the Reform of the Mandatory Health Insurance (MHI) System since January of this year. The document enabled the transfer of the powers of insurers in controlling and financing of medical care to the Federal office of the Mandatory Medical Insurance Fund (MHIF) for care provided by the so-called “federal medical institutions”(national tertiary care providers). Thus, the Federal Fund will directly carry out payments for medical care, and will control the volume and quality of care provided by the federal medical organizations, and will also be engaged in filing claims for harm caused to the insured person.
Under this new law, the Government sets standards for the volume of specialized (tertiary and secondary) medical care, including high-tech care, as well as their tariffs. The activities of federal medical organizations will be carried out in accordance with contracts signed directly between them and the MHIF.
In addition, a new procedure is introduced to enlist the federal medical organizations in the unified register of the MHI system, and new rules are defined for concluding an agreement between a federal medical organization and the MHIF.
The new law also reduces the allocated maximum amount of funds set for administrative costs borne by a medical insurance organization for case management from 1–2% to 0.8–1.1% of the income for a case received by a medical organization. This will save up to 6.8 billion rubles by 2023, which can be spent on the implementation of territorial mandatory health insurance programs.
According to the law, some of the former MHIF powers were transferred to the Ministry of Healthcare of the Russian Federation, such as the power to establish the procedure for monitoring the volume, timeframes, quality and conditions of medical care provision within the MHI, as well as defining mechanisms for funding medical care.
Photo credit: Izvestiya, https://iz.ru/1107226/2021-01-01/v-rossii-vstupil-v-silu-zakon-o-reforme-sistemy-oms