As you know, it’s good where we are not. For many years it was customary to scold national medicine and envy foreign medicine, especially Western medicine. But is there really medical care abroad? How is our current MHI (Mandatory Health Insurance) system different and how does it compare to healthcare models in other countries? “KP” decided to examine these issues.
NUMBERS AND FACTS
– In 2022, health spending in the United States was 16.5% of GDP. In Russia: 3.8%.
– At the same time, in the Russian Federation every citizen has the right to receive a compulsory medical insurance policy and all necessary medical care. In the United States, in 2022, about 26.5 million people did not have health insurance. Failing that, you will have to pay for each appointment with the doctor, examination and operation on your own. And even an ambulance. The latter costs more than $1,000. The poor sometimes do not receive even minimal health care.
BUDGET OR INSURANCE?
What determines the availability and quality of medical care? Most people are sure how much money is spent on healthcare in the country. But, as we see in the example of the United States (see above), numbers are not everything. After all, huge sums of money can be spent irrationally, and at the same time a part of the population can be completely deprived of support. At the same time, with a relatively modest budget, everything can be arranged so that everyone in need receives the necessary medical care.
Experts explain that the very principle of collecting and distributing financial resources for health care plays an important role. Today in the world there are two main approaches, countries choose one of them or a mixed type.
– According to the budget model, medical services are paid directly from the state budget. As you know, it is fraught with a variety of taxes that are poured into a boiler. Money is then directed from this cauldron to various needs, including healthcare.
– Under the insurance model there is a special fund. It is full of contributions that are strictly aimed at specific goals. In other words, contributions are paid precisely so that citizens can receive medical services when they need them.
In a word, the budget can be distributed and redistributed according to different needs, but contributions to the fund cannot.
HOW IN PRACTICE
What different countries have you chosen?
Countries that have opted for the insurance model or combined with insurance elements include Germany, France, the Netherlands, Austria, Belgium, Greece, Italy, South Korea, Singapore, Switzerland, China, and the United States.
Exclusively budget healthcare in the UK, Denmark, Portugal, Sweden, Finland and Belarus.
Until the early 1990s, our country lived with a budget model. In 1991 the law “On Medical Insurance of Citizens of the Russian Federation” was adopted, and in 1993 the Federal Fund for Compulsory Medical Insurance (FFOMS) appeared. Since then the compulsory health insurance system has been put in place. This year he turned 30 years old.
WHAT IS BETTER? PROS AND CONS
There are two sides to every coin, and drugs have both a therapeutic effect and a secondary effect. Similarly, the main models (safe and cheap) have their pros and cons.
In an earlier study, Sergey Shishkin, director of the Center for Health Policy at the Higher School of Economics, and Igor Sheiman, a professor at the Higher School of Economics, compared the effectiveness of health systems in several dozen countries.
Speaking of the insurance model, experts point out the following advantages:
* CHI operates on the principle of “money follows the patient.” This allows citizens to choose where to receive treatment: in which state, municipal, non-state or departmental medical organizations.
Today in Russia, we can choose to receive medical care not only in a municipal district clinic, but also choose a departmental or even private clinic operating on the CHI system (a list of such medical organizations in your region can be found at the website page of the CHI territorial fund).
* Thanks to compulsory health insurance, patients can receive medical care outside their place of residence: in another town, in another region. While in the budget system the choice is limited by the boundaries of the patient’s territory, experts say.
* Another very important advantage: the MHI system examines the quality of medical care and guarantees the protection of patients’ rights.
In our country, everyone who has a CHI policy has a free assistant, consultant and advocate – an insurance representative. This is the name of the specialists of the insurance medical organizations (HMOs) that issue compulsory medical insurance policies, participate in the payment of medical care and control its quality. If you have questions or complaints, have problems in the clinic or hospital, you should contact your insurance representative for help. The call center phone number for the CMO that issued your policy is easy to find on the insurance company’s website.
But what about the budget model? Of course, it also has its advantages. Among them:
– reduction of general health care costs: the government can regulate the prices of medical services;
– Reduction of administrative expenses. Thus, there are no “intermediaries” between the state and medical organizations in the form of compulsory health insurance funds and insurance medical organizations (at the same time, as noted above, under the insurance model, they provide independent control over the quality of medical care). take care and protect the rights of patients);
– Often, in countries with a budgetary model, the proportion of citizens’ personal expenses on health care is lower (in many countries, compulsory health insurance provides for contributions from both employers and employees from their salaries. But in Russia, for example, the latter do not pay – we will talk more about this later).
Where people are most satisfied with healthcare
Studies show that, in general, the level of satisfaction of the population with the state of medical care in countries with CHI is higher than in countries with a budget model.
In addition, with the insured medicine, mortality is reduced. In general, this figure is 12% less than with the budget model. The authors of a study from the Higher School of Economics came to this conclusion after comparing data from 28 post-socialist countries.
CHI IN THE RUSSIAN FEDERATION AND ABROAD: WHAT IS THE DIFFERENCE?
1. Who pays for medical services?
In Singapore, famous for its health system, the employer deducts 17% of the health insurance, and for workers under 55 years of age, up to 20%, that is, one fifth of the salary (the older the percentage decreases). . In Switzerland, the employer does not pay any insurance premium for CHI. The full amount falls on employees for whom individual compulsory health insurance plans are provided (depending on age, place of residence and various benefits). On average, the contribution is about 500 francs a year (about 55 thousand rubles at the current exchange rate).
In the vast majority of countries, both employers and employees themselves pay MHI insurance premiums out of their own salaries. Russia is one of the few countries in the world where only the employer pays contributions to compulsory health insurance. Not a penny of employee income is withheld.
2. “Your surcharge”
In several countries, compulsory health insurance provides for a deductible. This means that up to a certain amount, the patient pays for medical care with her portfolio. And only if the price of the treatment exceeds said “limit”, the costs are covered by the insurance. So, in Switzerland, compulsory health insurance necessarily includes a deductible from 300 to 2500 Swiss francs (from 32 to 275 thousand rubles). The lower the deductible, the higher the premiums.
In many countries, working citizens have to pay out of their salaries for health care under compulsory health insurance. In addition to the franchise (see above), for example, in some states there is a family principle for the formation of compulsory health insurance funds. With this approach, employees and/or employers pay not only for themselves, but also for non-working family members. This condition is valid in Estonia, Croatia, the Czech Republic and Slovenia.
In Russia, citizens do not have any additional payments under compulsory health insurance.
3. Medical insurance.
In Germany, patients pay 10% of the price of each prescribed drug out of their wallet, but not more than 10 and not less than 5 euros per pack. In China, citizens receive both a partial refund for purchased drugs and a full refund if their prescribed drugs are on a special limited-refund list. At the same time, imported medicines are often excluded from the catalog of health insurance products in favor of products made in China. In Switzerland, the MHI covers the cost of purchasing all medicines prescribed by a doctor and included in a specific list, mainly generic medicines. This list is constantly updated and now contains 2,300 items.
In several foreign countries there is a special type of health insurance: medical insurance. With this approach, insurance companies pay all or part of the cost of drugs prescribed by doctors for outpatient treatment. The different states have their own characteristics (see examples above).
HOW ARE WE?
In our country, the necessary drugs are provided to patients free of charge in the hospital (hospitals), as well as in the provision of urgent and urgent care. In addition, there are preferential categories of citizens who receive medicines free of charge or at a discount for outpatient (home) treatment. These are the disabled, veterans, people with certain diseases (diabetes, cancer, bronchial asthma, multiple sclerosis, etc.).
In Russia, too, the introduction of drug insurance has been under discussion for a long time. It has many followers among experts. “I consider this to be the most effective lever in the current realities,” said Vladimir Grishin, professor-economist with 40 years of experience in the health sector, PhD, doctor of economics, researcher at the Financial University of the Government of the Federation of Russia. he told KP in an interview. According to the expert, drug insurance, in addition to its unconditional benefits for citizens, will help, among other things, to reduce the corruption component at each stage of drug pricing. As a result, the drugs will be cheaper. And thanks to the fact that patients will have better medicines, it will be possible, in particular, to prevent exacerbations of serious chronic diseases and dangerous complications. And ultimately this will reduce the cost of health care (expensive operations will be less frequent, for example) and social services.
How accessible is healthcare? Is it easy to get to the doctor?
In Russia, according to the rules, the waiting period for the appointment of specialist doctors (cardiologist, neurologist, endocrinologist, etc.) does not exceed 14 working days. Yes, now this rule is not observed everywhere. But it is enshrined in law and steps are being actively taken to implement it. But, for example, in the UK the “18 week rule” officially applies. This means that no more than 18 weeks should pass from the time of making an appointment with a specific specialist, the appointment of a planned surgical intervention, until the provision of said medical service.
Also among the important indicators by which the availability of healthcare can be judged are the number of doctors and the availability of hospital beds (the latter turned out to be especially relevant during the COVID-19 pandemic).
IN PLACE OF DEPARTURE
– Basic compulsory health insurance program. [в России] it is constantly expanding. Its funding is also increasing every year – stated Ilya Balanin, Chairman of the Federal Fund for Compulsory Medical Insurance. – In addition, new modern services appear, such as a digital policy, a digital patient profile (Komsomolskaya Pravda wrote in detail about them). Thanks to the computerization of health care, the doctor will be constantly aware of the state of his patient’s health, explained the director of the FFOMS. And CHI policyholders will not only be able to receive necessary medical care in a personal appointment with a doctor, but also have access to remote consultations and other services. All of this expands our ability to maintain health and increases the chances of active longevity.