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Budget of the health insurance fund. Territorial compulsory health insurance fund. Expenses of the federal compulsory medical insurance fund

15.02.2024

Considering the fact that the vast majority of citizens of the Russian Federation monthly contribute funds to the compulsory medical insurance fund in the form of taxes, policyholders are interested in the procedure for forming the compulsory medical insurance budget, its approval and the further distribution of finances among medical institutions. In addition to the insurance premiums of working citizens, there are other items for replenishing the MHIF budget provided for by law. The safety stock of the FFOMS budget is aimed at maintaining the financial sustainability of the compulsory medical insurance structure and stimulating the proper implementation of compulsory medical insurance programs in the regions. What is the budget of the Federal Compulsory Health Insurance Fund (FFOMS)? What funds are used to form the FFOMS budget, as stated? How are revenues and expenses, budget deficits and surpluses determined? We will answer these questions in this article.

Sources of funding for the Federal Compulsory Medical Insurance Fund

One of the basic principles of compulsory health insurance is the stability of the financial system of compulsory health insurance, ensured on the basis of the equivalence of insurance coverage with compulsory health insurance. The budget of the Federal Compulsory Medical Insurance Fund is made up of revenue, expenditure and normalized safety stock. FFOMS budget revenues consist of:

  • Insurance premiums paid to compulsory medical insurance by business entities;
  • Funds allocated from the federal and regional budgets for the development of the compulsory medical insurance system;
  • Voluntary donations from individuals and legal entities;
  • Income received as a result of the placement of temporarily free funds;
  • Funds received in the form of fines.

The largest share in the expenses of the Federal Compulsory Health Insurance Fund is occupied by subsidies to equalize the financial conditions of the activities of territorial compulsory health insurance funds within the framework of the basic compulsory health insurance program, including the use of funds from the normalized safety stock. Thus, FFOMS budget expenses are usually associated with:

  • Providing funds to territorial compulsory medical insurance funds in order to ensure the fulfillment of obligations provided for by the powers of the constituent entities of the Russian Federation;
  • Implementation of government and presidential regulations, as well as federal laws in the field of healthcare;
  • Performing management functions.

To maintain the financial stability of the structures included in the compulsory medical insurance and to stimulate the fruitful activities of territorial funds in the implementation of compulsory medical insurance programs, the so-called safety rationed stock has been created. Where the safety stock funds will go is determined annually by the Federal Law on the Compulsory Medical Insurance Fund budget. The procedure for using safety stock funds is determined by the Ministry of Health.

Legislative framework and procedure for forming the FFOMS budget

The formation of estimates of income and expenses of the FFOMS is regulated by tax and budget legislation, as well as government documents on other obligatory payments. The procedure for drawing up a draft budget usually includes the following steps:

  1. The MHIF Board develops a project and submits it for consideration by the Ministry of Health and Social Development of the Russian Federation.
  2. The Ministry of Health, being the coordinator of extra-budgetary funds, submits the project for consideration by the Government of the Russian Federation.
  3. The government, after studying the document, submits it to the State Duma in the form of a draft Federal Law.
  4. The State Duma considers the provisions of the document and approves it as a Federal law.

According to paragraph 2 of Article 145 of the Budget Code of the Russian Federation, the law on the FFOMS budget is adopted simultaneously with the adoption of the state budget for the next financial year. The procedure for submitting a report on budget implementation involves the same sequence of steps as during its preparation. When drawing up the FFOMS budget, the total number of insured persons, current and projected inflation, the value of GDP, and the forecast for wage growth are taken into account.

Single-channel financing of health care

The gradual transition to single-channel financing of the country's healthcare began in 2011, simultaneously with the adoption of the law on compulsory medical insurance. The transition program was completed in 2015 when new health care financing rules were announced. What has changed with the adoption of new legal norms? Before the adoption of the law on compulsory medical insurance, healthcare was financed 60% from the state budget and 40% from insurance funds. The transition to a single-channel financing scheme means a significant reduction in funds allocated for health care by federal and regional budgets, and a noticeable increase in the role of the Federal Fund in organizing the financing of participants in the compulsory medical insurance system.

Federal and regional budgets continue to pay for medical care necessary for the treatment of tuberculosis, mental disorders and a number of other diseases that are generally considered socially significant. In addition, federal and regional funds are used for repairs, property maintenance, and equipping medical institutions operating in the compulsory medical insurance system with medical equipment. All other financial obligations are assigned to the Federal Compulsory Medical Insurance Fund. Most experts in the field of health insurance believe that such a move will ensure transparency of cash flows and allow managers of medical institutions to use resources in accordance with real needs.

Federal budget deficit and surplus

According to the regulatory act regulating the fund's budget for 2017, 2018 and 2019, balance will be achieved by attracting the remaining funds as of January 1 of the new financial year. The amounts of planned income and expenses of the fund for the indicated years are reflected in the table below.

Table - Structure of the FFOMS budget for 2017-2019, billion rubles.

Year
Income
Expenses
2017
1 705,9
1 735
2018
1 841,1
1 911,7
2019
2 067,4
2 022,3

Thus, the budget deficit in 2017 is projected to be 29.1 billion rubles, in 2018 - 70.6, and in 2019 a budget surplus of 45.1 billion rubles is expected. However, despite the fact that the budget increases every year, problems with spending funds (including inappropriate spending) do not disappear anywhere. In addition, there are clear differences in regional health care financing.

A feature of state compulsory health insurance funds in Russia is that they form a two-level e a system that includes FFOMS and TFOMS. These funds are interconnected, have common goals and objectives, but are formed and used autonomously.

The income of the state compulsory health insurance funds is intended to provide sources of financing for the process of providing medical and medicinal care to citizens guaranteed by the legislation of the Russian Federation. Despite a certain commonality of revenue sources, each of the levels of the funds under consideration has its own characteristics in the formation of the revenue base of budgets.

IN FFOMS budget the following are credited types of income:

■ arrears, penalties and fines on contributions to the FFOMS,

■ income from the placement of temporarily free FFOMS funds,

■ fines, sanctions, amounts received as a result of compensation for damage,

■ gratuitous receipts,

■ interbudgetary transfers from the federal budget transferred to the Federal Compulsory Medical Insurance Fund,

■ other income.

The main income source for the formation of the FFOMS are insurance premiums.

IN TFOMS budgets the following are credited types of income:

■ mandatory insurance contributions

■ arrears and penalties on contributions to the TFOMS,

■ income from the placement of temporarily free funds of the TFOMS,

■ fines, sanctions, amounts received as a result of compensation for damage,

■ gratuitous receipts,

■ interbudgetary transfers from the Federal Compulsory Medical Insurance Fund,

■ interbudgetary transfers from the budgets of constituent entities of the Russian Federation transferred to the TFOMS, including revenues as insurance premiums for compulsory medical insurance of the non-working population,

■. other supply.

The structure of TFOMS income is heterogeneous across different entities RF, but in general their composition is dominated by revenues from insurance premiums and transfers from the budget of the Federal Compulsory Medical Insurance Fund and from the budgets of the constituent entities of the Russian Federation.

Expenditures from compulsory health insurance funds are aimed at financing state-guaranteed medical and pharmaceutical care for the population. FFOMS expenses are designed to ensure the financial sustainability of the entire system of compulsory health insurance by equalizing the conditions for financing territorial programs and financing certain activities in the field of health insurance. TFOMS expenses are associated with the direct financing of health insurance programs in the constituent entities of the Russian Federation.

FFOMS budget expenditures can be divided into the following groups:

■ expenses for equalizing the financial conditions of the TFOMS activities (87% of all expenses);

■ expenses for financing targeted programs in the field of health insurance (10.5%);

■ expenses for computerization of the compulsory health insurance system (1%);

■ expenses for maintaining the FFOMS management staff (1%);

■ other expenses (0.5%).

Costs for equalizing the financial conditions of the territory the main direction of spending FFOMS funds. They are carried out in order to implement the basic program of compulsory health insurance, including the formation of safety stock standards for the Federal Compulsory Compulsory Medical Insurance Fund. Equalization costs are financed in the form of interbudgetary transfers from the FFOMS budget. The decision to provide funds for these expenses is made by a special FFOMS commission of the same name based on applications received from territorial funds.

Expenses for financing targeted programs compulsory health insurance ranks second in importance after the costs of equalizing territorial funds. Targets and plans are developed by the relevant ministries and approved by the Government of the Russian Federation in accordance with the direction of state policy in the field of health insurance. These programs include, for example, a program for the prevention of effective mass diseases (flu vaccinations, etc.), programs for the protection of motherhood and childhood, a set of programs within the framework of the national project “Health”, etc.

The costs of computerizing the compulsory health insurance system and maintaining the management apparatus of the Federal Compulsory Medical Insurance Fund can be collectively classified as management costs. In addition to the material and technical support for the activities of the Federal Fund and the payment of its management personnel, these include costs for training and retraining of personnel, organizational activities and scientific research, international cooperation and information support, etc.

Other FFOMS expenses include expenses for the maintenance and rental of buildings and other real estate, expenses for placing temporarily free funds of the fund and normalized safety stock funds on bank deposits and in government securities, etc.

TFOMS expenses are directly related to the financing of the process of providing free medical services and drug provision to needy categories of the population. Expenses of territorial funds can be divided into the following groups:

■ expenses for financing the territorial compulsory health insurance program (more than 90% of all fund expenses);

■ expenses for financing certain activities in the field of health care (about 7%);

■ administrative expenses (more than 2%);

■ other expenses (0.5%).

The bulk of TFOMS expenses are allocated to finance territorial compulsory health insurance programs . This kind of territorial programs are developed on the basis of a program approved by the Government of the Russian Federation, included as part of the State Guarantee Program for providing free medical care.

This Program includes:

- list of types and volumes of medical care provided for free;

- basic compulsory health insurance program;

- a list of types of medical care provided at the expense of budgets of all levels;

- per capita financing standards healthcare.

The basic program determines the scope and conditions for the provision of medical and drug care. An integral part of the expenses under consideration are expenses for maintaining the insurance business of municipal insurance medical organizations (payment of actually provided medical care), for (formation of standard insurance stock, etc.

Insurance medical organizations are legal entities that are independent economic entities that have the necessary ­ the authorized capital (capital) required for the implementation of health insurance. The provision of funds from territorial funds to medical insurance organizations is carried out on the basis of differentiated standards per person.

In turn, medical insurance organizations direct these funds to pay actually provided free medical services and preventive institutions , who directly provide medical care to the population. If the function of fears ­ is carried out by the territorial fund itself, then its funds are transferred not to the medical insurance organization, but directly to the treatment and preventive institution. All Russian citizens at their place of work or place of residence are issued insurance policies, I give ­ entitled to receive a free guaranteed volume of medical services.

According to the Federal Compulsory Compulsory Medical Insurance Fund of some constituent entities of the Russian Federation, medical institutions do not spend compulsory health insurance funds effectively enough.

TFOMS expenses for financing individual events in the field of healthcare include, for example, such directions and expenditures as payment for expensive types of medical care for certain categories of citizens, provision of medical care in case of mass diseases, in areas of natural disasters, catastrophes, etc.

Costs for managing the activities of the TFOMS and their branches are the costs of remuneration of management personnel and logistics, organizational and information support, etc.

Other expenses of TFOMS are associated with the rental and maintenance of real estate, with the costs of placement and temporarily available funds, the costs of issuing and replacing insurance policies, etc.

CONTROL QUESTIONS

1. What is the specificity of the economic content of extra-budgetary funds as a part of the public finance system?

2. Name the main sources of financing the expenses of the Pension Fund of the Russian Federation.

3. For what purposes was the Social Insurance Fund of the Russian Federation created?

4. What is the reason for the division of state compulsory health insurance funds in Russia into federal and territorial funds?

The Federal Compulsory Medical Insurance Fund (MHIF) and territorial compulsory medical insurance funds (TFOMS) do not belong to the subjects of health insurance, but they play an extremely important role in the compulsory medical insurance system.

In accordance with the Budget Code of the Russian Federation (as amended on July 31, 1998 No. 145-FZ), a state extra-budgetary fund is a fund of funds formed outside the federal budget and the budgets of the constituent entities of the Russian Federation and intended for the implementation of the constitutional rights of citizens to pensions and social insurance , social security in case of unemployment, health care and medical assistance. Moreover, the budgets of state extra-budgetary funds belong to the first level of the budget system of the Russian Federation, and the budgets of territorial state extra-budgetary funds - to the second level.

Chapter 17 of the Budget Code, dedicated to state extra-budgetary funds, contains a definition of their legal status, the procedure for drawing up, approving and monitoring the execution of their budgets.

Federal Compulsory Medical Insurance Fund created jointly by the legislative and executive authorities of the Russian Federation, to which it is accountable.

Federal and territorial compulsory medical insurance funds in accordance with Art. 12 of the Law were created to implement state policy in the field of compulsory medical insurance; they are independent non-profit financial and credit institutions.

The Decree of the Government of the Russian Federation “On approval of the charter of the Federal Compulsory Medical Insurance Fund” dated July 29, 1998 No. 857 approved the Charter of the Compulsory Medical Insurance Fund, in accordance with which its The main tasks are:

    financial provision of citizens’ rights to medical care established by the legislation of the Russian Federation at the expense of compulsory medical insurance funds;

    ensuring the financial sustainability of the compulsory medical insurance system and creating conditions for equalizing the volume and quality of medical care provided to citizens throughout the Russian Federation within the framework of compulsory medical insurance programs;

    accumulation of financial resources to ensure the financial stability of the compulsory medical insurance system.

Main functions MHIF:

    carries out equalization of financial conditions for the activities of TFOMS to ensure financing of compulsory medical insurance programs;

    develops and makes proposals on the amount of contributions for compulsory medical insurance;

    exercises control over the timely and complete transfer of insurance contributions to compulsory medical insurance funds with the Federal Compulsory Medical Insurance Fund and the state tax service authorities of the Russian Federation;

    carries out, together with the TFOMS, control over the rational use of funds in the compulsory medical insurance system, including through inspections and audits;

    carries out organizational and methodological activities to ensure the functioning of the compulsory medical insurance system;

    makes, in the prescribed manner, proposals for improving legislative and other regulations on compulsory medical insurance issues;

    collects and analyzes information on the financial resources of the compulsory medical insurance system, and submits materials to the Government of the Russian Federation;

    participates in the development of the basic compulsory medical insurance program.

In addition, it provides the study of experience and conducts research work on compulsory medical insurance issues.

Financial resources of the Federal Compulsory Medical Insurance Fund are federal property, are not included in budgets or other funds and are not subject to withdrawal.

Financial resources of the Federal FundCompulsory medical insurance are formed due to:

    parts of the single tax on imputed income for certain types of activities in the manner prescribed by law;

The Federal Compulsory Medical Insurance Fund annually develops a budget and a report on its implementation, which, upon the proposal of the Government of the Russian Federation, are approved by federal law.

Management of the Federal Fund is carried out by a collegial body - the board and a permanent executive body - the director. The Board of the Federal Fund, consisting of 11 people, is approved by the Government of the Russian Federation with a term of office of 3 years. Its composition may include representatives of federal legislative and executive authorities, public associations. Board meetings are held at least once every 3 months.

The competence of the Federal Fund Board, in particular, includes resolving the following issues:

    approval of long-term work plans;

    consideration of draft budgets of the Federal Fund and reports on its execution;

    approval of the procedure for allocating financial resources to equalize financial conditions;

    activities of territorial compulsory medical insurance funds within the framework of the basic program;

    review of draft basic compulsory health insurance programs;

The Director and First Deputy Director of the Federal Compulsory Medical Insurance Fund are appointed and dismissed by the Government of the Russian Federation. The Director manages current activities, is personally responsible for its results and is accountable to the Board of the Federal Fund.

The audit commission exercises control over the activities of the Federal Fund. In addition, the board, as necessary, but at least once a year, appoints an audit of the activities of the Federal Fund, carried out by a specialized organization that has the appropriate license. A report on the results of this inspection is submitted to the Government of the Russian Federation.

Territorial funds Compulsory medical insurance created on the territory of each subject of the Russian Federation by the legislative and executive authorities of the subject, to which they are accountable.

According to the Regulations on the Federal Compulsory Medical Insurance Fund, approved by Resolution of the Supreme Council of the Russian Federation dated February 24, 1993 No. 4543-1, The main objectives of the TFOMS are:

    Ensuring the implementation of the Law of the Russian Federation “On medical insurance of citizens in the Russian Federation”;

    Ensuring the rights provided for by the legislation of the Russian Federation in the compulsory medical insurance system;

    Ensuring the universality of compulsory health insurance for citizens;

    Achieving social justice and equality of all citizens in the compulsory medical insurance system;

    Ensuring the financial sustainability of the compulsory medical insurance system.

Main functions of the TFOMS:

    Accumulates financial resources of the Territorial Fund for compulsory medical insurance of citizens;

    Provides financing for compulsory medical insurance provided by medical insurance organizations;

    Aligns the financial resources of cities and districts allocated for compulsory medical insurance;

    Provides loans to insurers in case of a justified shortage of funds;

    Develops rules for compulsory medical insurance of the territory.

It also participates in the development of the territorial compulsory medical insurance program and tariffs for medical services under compulsory medical insurance, monitors the rational use of compulsory medical insurance funds, and performs other functions related to the functioning of the compulsory medical insurance system.

Management of the activities of territorial compulsory medical insurance funds is carried out by the board and its permanent executive body - the executive directorate, headed by the executive director.

The board includes representatives of the legislative and executive authorities of the constituent entities of the Russian Federation, including financial authorities, health care and social protection authorities, as well as representatives of the professional medical association, trade unions, and insurers.

The functions of the board include:

    determination of long-term objectives of the Federal Compulsory Compulsory Medical Insurance Fund;

    participation in the approval of candidates for the position of executive director with the relevant executive authority;

    coordination of the territorial compulsory medical insurance program;

    establishing the procedure for the deduction of financial resources to the TFOMS by its branches;

    approval of annual reports on the activities of the TFOMS;

    submission for approval to government authorities of regulations on improving the compulsory medical insurance system;

    formation of an audit commission.

The candidacy of the executive director of the TFOMS, the rules of compulsory medical insurance of a constituent entity of the Russian Federation are approved by the relevant executive authority. The executive director forms the executive directorate of the TFOMS, the structure and composition of which is also approved by the relevant executive authority.

During the period between board meetings, the executive directorate resolves all issues related to the activities of the TFOMS, except those that fall within the exclusive competence of the board.

To carry out its tasks, TFOMS can create branches in cities and regions of a constituent entity of the Russian Federation that carry out their activities in accordance with the regulations approved by the executive director of TFOMS.

Financial resources of territorial fundsCompulsory medical insurance are formed due to:

    parts of the unified social tax at rates established by the legislation of the Russian Federation;

    parts of the single tax on imputed income for certain types of activities in the manner prescribed by law;

    insurance premiums for compulsory medical insurance of the non-working population, paid by executive authorities of the constituent entities of the Russian Federation, local governments, taking into account territorial compulsory medical insurance programs within the limits of funds provided for in the relevant budgets for healthcare;

    other income provided for by the legislation of the Russian Federation.

    financial resources of compulsory medical insurance funds are in the state property of the Russian Federation, are not included in the budgets or other funds and are not subject to seizure.

From the funds received into the accounts of the territorial fund, part of the unified social tax, part of the single tax on imputed income, subject to credit to the territorial fund, insurance contributions for compulsory medical insurance of the non-working population, the TFOMS carries out:

    financing of medical insurance organizations according to differentiated average per capita standards for payment of medical care within the framework of the territorial compulsory medical insurance program;

    payment for medical services provided to citizens insured by the territorial fund (in the case of compulsory medical insurance provided by the territorial fund);

    financing of healthcare activities within the framework of regional target programs approved in accordance with the established procedure for medical institutions operating in the compulsory medical insurance system;

    formation of a standardized safety stock intended to ensure the financial stability of the compulsory medical insurance system in the territory of the subject;

    formation of funds intended to provide them with managerial functions according to the standard established in agreement with the board of the TFOMS.

The audit commission exercises control over the activities of the territorial fund. In addition, the board, as necessary, but at least once a year, appoints an audit of the activities of the territorial fund, carried out by a specialized organization that has the appropriate license. A report on the results of this inspection is submitted to the representative and executive authorities of the constituent entity of the Russian Federation.

The Russian Federation was created in 1991 in accordance with the Law of the RSFSR of June 28, 1991 “On compulsory health insurance in the RSFSR”. It defines the legal, economic and organizational foundations of health insurance for the population in Russia. This Law introduced health insurance in the country. Its purpose is to guarantee citizens, in the event of an insured event, receiving medical care from accumulated funds and financing preventive measures.

Health insurance is a type of general insurance of citizens, provides all citizens of the Russian Federation with equal opportunities to receive medical and pharmaceutical care at the expense of compulsory health insurance.

The purpose of health insurance is to guarantee citizens, in the event of an insured event, receiving medical care from accumulated funds and providing preventive measures.

The subjects of health insurance are a citizen, a policyholder, a medical insurance organization, and a medical insurance institution.

Financial resources intended for compulsory health insurance are directed to the federal and territorial extra-budgetary compulsory health insurance funds, which were created to implement state policy in the field of compulsory health insurance.

Financial resources of compulsory health insurance funds are state property and are not included in the federal and regional budgets.

Compulsory health insurance funds are formed due to:

  • parts of insurance premiums of enterprises, organizations, institutions and other economic entities, regardless of the form of ownership, for compulsory health insurance in the amounts established by the Federal Assembly of the Russian Federation;
  • allocations from federal and regional budgets for the implementation of compulsory health insurance programs;
  • voluntary contributions from legal entities and individuals;
  • income from the use of temporarily free financial resources of funds.

The compulsory health insurance fund is structurally composed of the Federal Fund and territorial compulsory health insurance funds. These funds operate in accordance with the Regulations on Federal Compulsory Medical Insurance and the Regulations on Territorial Compulsory Medical Insurance, approved by resolutions of the Supreme Council of the Russian Federation of February 24, 1993. The funds of the funds are state property, are not included in budgets, other funds and are not subject to withdrawal .

Federal and territorial compulsory health insurance funds, their budgets

The introduction of compulsory health insurance in our country in 1993 and the creation of the Federal Compulsory Health Insurance Fund, as well as territorial compulsory health insurance funds, contributed to the emergence of fundamentally new approaches to the organization of financial mechanisms of medical care based on insurance methods. The accumulated experience is reflected in the Federal Law of November 29, 2010 No. 326-FE “On Compulsory Health Insurance,” which regulates processes related to this type of insurance. However, the insignificance of contributions for compulsory health insurance (until recently, of the 26% UST rate, this part was 3.1%, respectively - 1.1 and 2.0%) limited its costs in regulating the provision of funds from territorial funds, as well as the possibility of compulsory medical insurance. insurance. As a result of innovations that became reality in 2009, 5.1% of the UST rate is allocated for compulsory medical insurance, including for the formation of the Federal Compulsory Medical Insurance Fund - 2.1%, territorial - 3%. This is natural - the main costs of health insurance are borne by territorial funds. The Federal Fund is a source of equalization of medical insurance conditions in the regions. Territorial compulsory medical insurance budgets receive support from the corresponding budgets for medical insurance of the non-working population.

The most important problems that have not yet been resolved include:

  • balance of the compulsory health insurance program (hereinafter referred to as compulsory medical insurance) with available financial resources;
  • lack of effective mechanisms for equalizing the conditions for the implementation of the basic compulsory medical insurance program both in individual constituent entities of the Russian Federation and within each of them. The portion of insurance premium receipts centralized in the Federal Compulsory Medical Insurance Fund (FFOMS) is insufficient to provide targeted financial assistance;
  • the severity of the problem of sufficiency of insurance premiums for full medical insurance, including for the non-working population, the lack of mechanisms for economic incentives for constituent entities of the Russian Federation to make these payments in full, as well as mechanisms for collecting funds not paid into the budget in court.

Today, the problem of balancing the compulsory health insurance program with the available financial resources has not been resolved. In recent years, the types and volumes of medical care envisaged by the program exceed the financial capabilities of the budget and compulsory medical insurance funds. It is not possible to overcome the negative trend of outstripping growth of expenses over income, and there is an annual deficit in the basic compulsory medical insurance program. In table Figure 2.12 shows the dynamics of income and expenses of the Federal Compulsory Medical Insurance Fund in the pre-crisis period (2001-2005), the fund’s expenses to equalize the financial conditions of the activities of territorial compulsory medical insurance funds, and to create a normalized safety stock.

Territorial funds compulsory health insurance directly implements the function of paying for health insurance services. However, their volume in a country with a population of more than 140 million people is insignificant - about 517.5 billion rubles. in 2009, 587.1 billion rubles. in 2010 and 661.8 billion rubles. in 2011

Federal Law of November 29, 2010 No. E26-FZ “On Compulsory Medical Insurance in the Russian Federation”, as well as Federal Law of November 29, 2010 No. 313-FE “On Amendments to Certain Legislative Acts of the Russian Federation in Connection with the Adoption The Federal Law “On Compulsory Medical Insurance in the Russian Federation” establishes the procedure for providing subventions from the budget of the Federal Compulsory Medical Insurance Fund to territorial compulsory medical insurance funds for the implementation of expenditure obligations of the constituent entities of the Federation for the implementation of the powers delegated to them, as well as other interbudgetary transfers to the named territorial funds (Art. 26). They pay for medical services in accordance with agreements concluded with representatives of territorial medical organizations.

Three directions for the development of health insurance in the Russian Federation remain relevant:

  • strengthening the financial base of insurance;
  • creation of a unified system of standards on which insurance medicine should be based;
  • development of the regulatory framework.

As can be seen from table. 1, the main expenses of the Federal Compulsory Medical Insurance Fund were financial support for territorial funds. The importance of centrally implemented program activities within the framework of compulsory health insurance increased.

Table 1. Dynamics of income and expenses of the Federal Compulsory Medical Insurance Fund before modernization of the health care system in 2002-2005, billion rubles.

Indicator name

Alignment of financial conditions for the activities of territorial MHIFs, creation of safety reserves

In the subsequent period, the FFOMS increased (up to 105.85 billion rubles in 2010 and 268.6 billion rubles in 2011, including due to growing transfers from the federal budget (4.73 billion rubles in 2010). and 18.29 billion rubles in 2011).

An increase in the volume of funds entering the compulsory medical insurance system through the Federal and territorial funds will allow in most constituent entities of the Russian Federation to increase the per capita standard for financing territorial compulsory medical insurance programs and increase tariffs for payment of medical care. But these funds are not enough to radically improve the compulsory medical insurance system. The existing compulsory health insurance funds in the constituent entities of the Federation still have a weak financial base. Some financial support for these funds comes from the Federal Compulsory Medical Insurance Fund. Due to the replacement of the unified social tax with insurance payments, contributions to the compulsory medical insurance system have increased. However, funds are still scarce. In the short term, the problem of sufficiently effective support of territorial compulsory medical insurance funds with contributions from local budgets for medical insurance of the non-working population cannot be solved. It turns out that a decrease in the share of the working population, on whose wages the unified social tax was previously calculated, and now - insurance premiums, may negatively affect the ability to provide medical care to the non-working part of the population. And this is in a context where the modernization of the healthcare system, carried out since 2005, is aimed at increasing the accessibility and quality of medical care for the entire population, including those who are no longer working, who, due to age-related health problems, more often seek medical help.

To correct the situation, the insurance premium rate is increased. Besides:

  • the program of state guarantees for the provision of free medical care to citizens of the Russian Federation is being specified;
  • there is a transition from a budget-insurance system of financing healthcare to a predominantly insurance system;
  • The medical care system is being restructured.

For this purpose, the current legislation is being improved (Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Health Insurance in the Russian Federation”; Federal Law of November 29, 2010 No. 313-FE “On Amendments to Certain Legislative Acts” of the Russian Federation in connection with the adoption of the Federal Law “On Compulsory Health Insurance in the Russian Federation”).

The measures that are planned to be implemented as part of the modernization of the healthcare system and compulsory health insurance are not accompanied by a radical increase in the size and share of total healthcare expenditures. However, without sufficient financial resources, it is impossible to begin restructuring and modernizing the industry. A prerequisite for the successful implementation of the reform is real financial support. It seems that the restructuring of health insurance should proceed simultaneously with a gradual increase in resources. However, it is extremely important to create all the conditions for regulating prices for medicines in order to reduce them, to minimize losses associated with violations of financial discipline in the field of compulsory medical insurance, known from the criminal case, at the end of which the Fund’s employees were brought to criminal liability. In August 2009, the head of the Fund, a number of his deputies and senior officials who had introduced “highly profitable” schemes for placing orders at high prices for medicines from pharmaceutical companies and “supply” from the standpoint of personal enrichment were sentenced to long terms of stay in a maximum security colony. » medicines from territorial compulsory medical insurance funds. Most of those sentenced to prison were required to pay large fines. The “financial controllers” of the Fund’s control and audit department were also brought to criminal responsibility, who “did not notice” the action of the mechanism for placing an order for the supply of medicines at monopoly high yen, which automatically emasculates government support for patients at the expense of the Fund.

The main unresolved problems in equalizing the conditions for the provision of free medical care:

  • insurance principles of healthcare financing have not been properly implemented;
  • insurance mechanisms that promote the development of competition have not been introduced; the required minimum amount of financial resources has not been introduced into the real financial turnover of the health insurance system:
  • Health care workers are among the lowest paid categories. The system and level of remuneration do not stimulate them to perform high-quality and effective work. Within the framework of the national project “Health”, wages for medical personnel increased, but unevenly, and therefore there is unjustified differentiation;
  • the increase in the cost of new medical technologies and rising health care costs, which exacerbates the problem of economic efficiency in the use of resources:
  • increasing import dependence on medicines and medical equipment and equipment purchased at high prices;
  • the absence of system-forming laws regulating the healthcare sector did not allow the formation of the unity of this social institution, and the transition to private law regulation of these relations led to a weakening of the regulatory function of the state;
  • the existing multi-channel financing and different legal regime for spending financial resources from budgets of all levels, compulsory and voluntary health insurance, paid services is one of the reasons for their ineffective spending;
  • there is a loss of consistency and controllability of the industry with the remaining management bodies at all levels;
  • contradictory status of medical institutions.

According to the Constitution of the Russian Federation, state and municipal medical institutions provide free medical care to citizens, and the norms of the Civil Code of the Russian Federation determine that an institution is recognized as an organization created by the owner to carry out managerial, socio-cultural or other functions of a non-profit nature and is financed by him in full or in part. This is reminiscent of the notorious resolution “Execution cannot be pardoned.”