What are there any problems in voluntary medical insurance? What is a deterrent? Answers to these questions you will find in the article.
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Voluntary medical insurance
Almost all Russian insurance companies are in voluntary medical insurance in one degree or another, but most of them are extremely low. Such insurers, as a rule, work in a narrow niche, serving the insurance interests of only one or more affiliate enterprises. In essence, in such cases it is about tax saving schemes that have little in common with real insurance. At «Circuit» Operations are complied with all formalities required for taxes: a certain alleged risk part is included in the policy, in reality is impossible. In fact, there is a simple payment for medical services.
Real insurance - risky, in which the insured makes a statistically calculated insurance payment, and receives those services that will be required by medical testimony. It is the real DMS that most actively develops in the last three or four years, while the volume of pseudo-radiation «Circuit» Operations are shrinking. The long-term development-oriented insurers earn due to their main activities - the protection of risks, and not from commission for dubious operations.
Real medical insurance are mainly engaged in the leaders of the DMS market - the leading universal federal insurers in which more than half of all contributions are in this segment. So, only about a dozen companies provide medical protection for most major production complexes in Russia, at the same time providing services to medium and small businesses, as well as private clients.
While voluntary medical insurance is in demand mainly corporate clients. «The development of corporate DMS is due to the fact that the policy in this case not only performs a protective function, but is part of the company's social package, the tool for the formation of its employees, - explains the director of the Department of Medical Insurance in the Moscow region of Rosno Peter Yverbaum. - In addition, the cost of corporate DMS is significantly lower than the cost of the policy for an individual, since in this case the risk antisection is small. Polants of voluntary medical insurance of individuals often acquire people already having difficulty health. As part of the corporate insurance, the percentage of such clients is significantly lower».
DMS programs in many enterprises, especially in high-tech industries, are already considered not only as a way of material incentives for employees, but also as an important tool for improving business efficiency by improving personnel health. Yes, and citizens are often easier to contact the medical institution directly, bypassing the insurance company. Indeed, unlike firms that have tax breaks when using DMS programs, individuals do not receive such benefits. All this significantly increases the cost of the PMC fields of individuals and makes them less attractive compared to corporate insurance.
According to the head of the Personal Insurance Department «Rosgosstraha» Karina Marcaryan, «Previously, individuals went to the insurance company, when they needed expensive medical services, that is, when the insured event was already accomplished; Now the picture is changing and appear persons interested in classical insurance».
Unlikely in the near future, the DMS sector is waiting for a rapid development. In order for it to become a truly massive type of insurance, there must be significant changes regarding not only the level of well-being of people, but also their psychology.
Deterrent factors
The most important restraining factors are low incomes of a significant part of the population and the delay of the formation of the middle class, which leads to a shortage of mass demand for commercial health insurance. The solution to the problem could be the transition from the redistribution of budget funds through an ineffective general health insurance system to direct subsidies of the population in the implementation of contributions to the DMS. When subsidizing from the state, insurance companies could turn into a powerful and effective tool for financing therapeutic institutions, or creating their own medical infrastructure, or investing in already existing clinics. But, apparently, the officials from medicine are not ready for such radical innovations.
Often the development of DMS impede therapeutic institutions themselves. Management and ordinary staff of medical institutions are often easier and more comfortable to work without the participation of the insurance company, receiving the treatment of treatment «in black». This contributes to low competition in the medical services market, on which not demand, and the proposal dictates its terms. Medical institutions capable of fully maintenance of DMS programs are missing. In many even big cities there are only a few hospitals or a clinic, with which insurers could work. Widespread previability «gray» Medicine also does not contribute to improving the culture of obtaining paid medical services.
The conflict, which inevitably arises between the insurance company and the medical organization, is that the medical institution seeks to in every way to increase the receipt of payments from the insurance company, providing excessory services, and the insurance company seeks how much it is possible to reduce them. But ultimately, despite the contradictory of interests, the medical organization and the insurance company are allies, since they are both interested in maintaining the client base and the development of their joint business, so conflicts are usually solved in working order.
«The insurer to compose between the client and the clinic to control the quality and sufficiency of medical services, - notes Deputy General Director of the Group «Renaissance insurance» Sirma Gotovat. - In addition, he has two tools: medical examination and application of rational medicine technologies - office doctors, curators doctors. It is to them first of all applies to the client and then their recommendations towards the necessary specialists, the definition of the treatment plan».
Among the factors inhibiting the development of the voluntary health insurance market, the most critical problems with tax legislation in this area. According to the law of deductions to the DMS, which can be attributed to the cost, should not exceed 3% of the company's remuneration fund. At the same time, in social packages of large foreign companies up to 40% of the costs of personnel relate to indirect cash payments, including medical insurance, and pension plan, and life insurance.
As one of the mechanisms for stimulating the development of DMS, it is possible to increase the size of the deduction from the taxable base when calculating income tax on the amount of insurance premiums paid under DMS agreements. In addition, it would be worth released from taxation funds sent by insurance organizations to the formation of a reserve of preventive measures for DMS. While the solution of many problems restraining the development of DMS, a long-term issue, bringing the tax legislation in the field of medical insurance in line with the modern needs of the economy would give a significant impetus to the development of DMS in a very short time.
