Experts explained how compulsory health insurance is being replaced by paid services

The compulsory health insurance policy (CHI) in Russia has ceased to be a guarantee of free treatment. Doctors force patients to use commercial services, which is directly contrary to the law. Experts discussed how the country came to live like this on the air of the Public News Service.

In district clinics, Russians are increasingly being denied services under compulsory and even voluntary health insurance policies (compulsory medical insurance and voluntary medical insurance, respectively), forcing people to rely on commercial services with payment through the cash register.

“The compulsory health insurance system is underfunded by 50%,” says the founder of compulsory medical insurance in Russia, professor, honored economist Vladimir Grishin. – Therefore, the insurance policy that each of us has is not filled with money. When we come to a medical institution, we are faced with a shortage of resources, which the head doctors are trying to fill with paid medical services.

The amount of insurance premiums for unemployed citizens is, by and large, a random figure. It is four times less than the required amount.

Another problem: in 2008, the Ministry of Health issued an order to include paid services in the general financial plan for medical institutions, along with compulsory medical insurance funds. In fact, this is an economic bomb, which has led to the fact that chief doctors are planning the volume of paid services.

The second mistake is that Russia abandoned the principles of the Semashko system (a model of a national healthcare system in which medical care is provided by a hierarchical system of government agencies united in the Ministry of Health and financed from the national budget).

“If I need to see an ophthalmologist, for some reason they first make an appointment with a therapist, and he already gives me a referral to an ophthalmologist, who can see me only in two weeks,” continues the economist. “But my eye hurts, and in two weeks I might go blind.” Naturally, I take the money and go to an appointment with a paid ophthalmologist, who will see me within an hour. I want to emphasize that a specialist should see me within an hour, not a day, much less two weeks, because we are talking about the condition of the patient’s most important organ.

Such actions on the part of doctors are common speculation when someone can warm their hands, says Semyon Galperin, president of the Interregional public organization Doctors’ Defense League. Naturally, in order to make money, you need to sell a medical service not at the price that is officially established by the insurance system, but at the price that the patient will pay if he has no other choice.

“I came to the conclusion that an insurance system has never been formed in Russia,” says the president of the organization. – The patient, who is an insurer all over the world, is not such in our country. And the insurance company is not an insurer. Our policyholder is the employer or executive body at the place of residence of the person who pays the state. And the insurer is the federal fund, which the employer pays. The insurance system we have built is based on the relationship between the executive body and the federal fund. According to the law, the patient does not have the opportunity to make a claim even if his rights are clearly violated. What does this have to do with insurance?

Most Russians cannot pay for treatment. But there are cities and small towns where commercial medicine, in principle, cannot exist due to the insufficient income of all residents without exception. What should such patients do?

The function of insurance companies is to distribute cash flows, the expert continues: “If we look at who owns insurance companies, we will see that their owners are either officials or relatives of officials. We need to remove these intermediaries, and urgently.”

There is Article 41 of the Constitution, according to which everyone has the right to health care and medical care. But this article has long been forgotten; no one implements it.

– Both the state, which does not want to finance medicine in full, and the chief doctors are interested in the current system, because they have budgetary flows for compulsory health insurance, and funds for voluntary health insurance can be used wisely. And the citizens, apparently, are also happy with everything, since they obediently go to paid clinics. And those who cannot, put up with their situation. But this situation cannot exist forever, especially on the eve of the demographic hole. It’s not for nothing that the president declared 2024 the Year of the Family, the expert says.

The economist proposes opening a personal account for every Russian at birth, where, until the age of 18, funds will be received for medical, health and preventive purposes from the state, employers or philanthropists (depending on the social status of the young citizen). It would seem that this is the solution to the problem – at least for the future generation. But no.

Do you know why my proposal is bad? All services in such accounts are as if under a magnifying glass. I will say more: in some regions they have already tried to introduce something like so-called medical certificates, but officials abandoned them because everything is too transparent. But officials want to make money on paid services,” complains the distinguished economist.