About the system of compulsory medical insurance

Health Development Development Concept in the Russian Federation until 2020, developed
Ministry of Health and Social Development, put on an open discussion. From what
Our medicine will be, the health and well-being of millions depends
Russians. Questions about the system of compulsory medical insurance
Deputy Minister of Health and Social Development of the Russian Federation
Veronika Skvortsova.

Does Russia need a system of compulsory medical insurance

- Veronica Igorevna, what's new you are ready to offer Russians?

- Medicine system. It is represented in the new concept, it can be called state budget and insured. Unless, of course, keep in mind a gradual transition to strengthening the state-insurance system with consistent inclusion of expenditure obligations within the budget component. According to different estimates, the middle class is from 20 to 40 percent in Russia: the predominant majority of our country's inhabitants are socially and economically vulnerable, it needs to be careful. And it defines the health development vector.

- State as in Soviet times, everything takes on?

- Soviet health has their advantages. It was a monopoly and state budget, which allowed mass prophylactic and anti-epidemic programs. Therefore, with moderate financing and low population, there was a very low level of many diseases in the country. However, the monopoly system did not allow to take into account the individual needs of each person. And now, in the conditions of a market economy and political democratization, it is no longer possible to implement the state monopoly mechanism. We are going to form a unified solidarity system of compulsory medical insurance - this will ensure warranty of free medical care from the state.

- The concept provides for the introduction of single-channel financing of medicine through the system of compulsory medical insurance. Why it is necessary?

- The consolidated budget will allow you to more effectively redistribute health resources, improve state control over the provision of medical care. Not violating laws that provide for the distribution of powers between federal, regional and municipal authorities, we will be able to create competition in part of the quality of medical care through the system of compulsory health insurance.

On the territorial principle of health, state guarantees and drugs

- Apparently, the territorial principle of health care will now prevail. Does this not contradict the constitution that guarantees an equal right to medical care regardless of the place of residence?

- Concept just emphasizes this equality. We create a single financial field in the health system. Any citizen who has a compulsory health insurance policy may apply to any medical and prophylactic institution if it is accredited to provide an appropriate assistance type, and to any doctor with a relevant license. But you need to imagine the difference in the possibilities of implementing this right. The expanses of our country are huge, and the population density varies. Therefore, if we do not think over the system of rapid delivery of the patient to the institution if necessary, its constitutional right may not be implemented. The concept provides a series of steps to improve the availability of medical care. These include the creation of inter-district specialized departments aimed at treating socially significant diseases: first of all these are acute myocardial infarction and brain strokes, heavy combined injuries. These branches will be deficient on the territory of each region so that it is possible to deliver a patient from anywhere in the hospital for 30-40 minutes.

- State guarantees are impossible without uniform standards. But they were developed before, now there will be new?

- Attempts to proceed to standardization of medical care have been taken over the past 7-10 years. However, as a rule, medical professional communities constituted these documents without coordination with economists. Therefore, they either had a minimum level, not corresponding to the modern quality of medical care, or, on the contrary, could be inadequately inflated. This led to a paradoxical situation when each region and even every medical and preventive establishment accounted for own standards. Now single standards will be created on the basis of evidence-based medicine and, taking into account international experience. However, at the same time they will be subjected to an economic expertise and justification.

- This is an attempt to compromise between the fact that modern medicine is able to do, and the fact that it can afford financially?

- It is necessary to find this Golden Balance. It is the standards that will allow to manage the quality of medical care provided.

- Another important problem is the concept of dosage insurance that is going to introduce in Russia. It is already compiled?

- Her preparation is now ends and will soon begin an open discussion. Drug Equipment will be gradually incorporated into the system of compulsory medical insurance. The principle of solidarized participation based on co-financing by citizens of the value of the virtual drugs.

About the demographic problem, financing and crisis

- One of the concept objectives declared a decision of a demographic problem in the country. Is there too many obligations takes on medicine?

- The maturity of the health care system in any country is determined how much prevention priority is presented. In countries with developed medicine, there are no differences between health and health care. These concepts make up a two-way integer. Prevention worldwide is carried out in two directions. First, mass prevention. For example, in Finland, applying only two measures - restriction of salt and animal fats in products - managed to seriously reduce mortality from vascular diseases. Secondly, the individual prevention of diseases for people from high risk groups. The ideologist and the first, and the second destination is the Ministry of Health and Social Development. It also defines their mechanisms and targets, ensures monitoring, evaluating results. We recently told about our strategy on the WHO Executive Committee. Our program was highly appreciated, and Russia proposed to coordinate the system of preventive measures in Eastern Europe and Central Asia.

- And what to be with another WHO recommendation for Russia - to increase health financing?

- We hope that the transition to the insurance premiums system will lead to the fact that the amount of compulsory medical insurance will increase significantly. This will allow transfer to financing in this system and ambulance medical care, and many types of high-tech aid. Calculations that were conducted in October and early November 2008, showed that if we continued to develop in terms of our economy with a pre-crisis rate, this would significantly increase the perverse financing of health care. Making calculations together with the Ministry of Economic Development, we planned to go out by 2020 on an indicator of medicine expenses at least 5.2-5.5 percent of the internal gross product. According to the purchasing power parity of the ruble, this corresponds to 10-11 percent of the internal gross product.

- How will the financial crisis affect the implementation of the concept?

- It becomes in the period of financial shocks especially relevant. After all, this is essentially one of the most significant anti-crisis measures. Steps that are meant in the concept should significantly increase intra-separable economic efficiency. And the prevention measures will result in much more efficient to use the existing financial resources.