2023: ФИНАНСОВОЕ ОБЕСПЕЧЕНИЕ МЕДИЦИНСКОЙ ПОМОЩИ: НА СТАЖЕ ОХРАНЫ ЗДОРОВЬЯ ЧЕЛОВЕКА И ЗАЩИТЫ ИНТЕРЕСОВ ЗАСТРАХОВАННОГО НАСЕЛЕНИЯ

The fight against the spread of COVID 19 coronavirus in 2020-2022 was a serious burden on health care in general, including the system of compulsory health insurance. Materials revealing goals, objectives and results of implementation of territorial programs of compulsory medical insurance in the Voronezh region during the period of spread of new coronavirus infection COVID-19 are considered. Problems related to the mechanisms of financial support of the territorial program of compulsory medical insurance in the epidemiological situation were noted.

Methodologies for assessing of KPI of medical activity in medical organizations with attached population used to pay for medical care per capita financing standard from insurance funds have been successfully implemented and started to use by the Territorial Fund of Compulsory Health Insurance of the Belgorod Region. Selection of information from the paid medical care registers received by the Territorial Fund of Compulsory Health Insurance from medical organizations, data of The Ministry of Health of the Belgorod Region and Medical information and analytical center of the Belgorod Region used to measure KPIs of medical organizations. 27 medical organizations were assessed for the first performance indicator cluster «Adult population (18 years and over)». 28 medical organizations were assessed for the second performance indicator cluster «Children’s population (0-17 years inclusive)». 25 по medical organizations were assessed for the third performance indicator cluster «Providing obstetric and gynaecological care». For all performance indicator clusters the achievement of the maximum possible or the lowest possible value was estimated at 1 point.

Besides it was foreseen the possibility of stimulating not only medical organizations the quality of preventive and medical care in which is increasing in comparison with the previous but also leading in relation to competing medical organizations. For that reason, if the result of the medical organization was better than the average of the current indicator for the Belgorod Region medical organizations were awarded an additional 0.5 points.

Thus in 2022 in the Belgorod region financial interest of medical organizations in obtaining additional funds by achieving key performance indicators as well as teamwork of the Territorial Fund of Compulsory Health Insurance of the Belgorod Region with medical organizations improved the health of the attached population.

Examination of the quality of medical care (ECMP) was carried out by experts of the quality of medical care of insurance medical organizations (SMO) and the Territorial Fund of compulsory medical insurance of the Voronezh region (TFOMS VO) to identify violations in the provision of medical care in order to improve the quality of medical care to insured persons and to realize the rights of citizens of the Russian Federation (RF) to receive free medical care of guaranteed volume and quality.

Analysis of results of carried out control and expert measures in medical organizations carrying out activities in the field of compulsory medical insurance in the Voronezh region insurance medical organizations for paid cases of providing medical care in dynamics over the past three years with the aim of introducing specific recommendations into the practical activities of the MO aimed at improving the quality of providing medical care to insured citizens in the Voronezh region.

Currently, the system of collection and analysis of medical statistics in Russia, reflecting all socio-economic features of the country, is the basis for evaluation and forecasting of the industry, and it is extremely important that the information is complete and reliable. Medical statistics is aimed at solving the most pronounced modern problems in the health of the population. The main problems are the need to reduce morbidity, mortality and increase the life expectancy of the population. Accordingly, the basic information at this stage should be subordinated to the solution of this problem.

The article deals with the issues of obtaining high-tech medical care by residents of the Voronezh region. The data on the volume of high-tech medical care (HTMC) in medical institutions of the Voronezh region and in federal medical centers are presented. Conclusions are drawn that the volume of HTMC provided by medical organizations in the Voronezh region exceeds the established standard indicators of provision per 100 thousand people. The statistics of applications insured by LLC "Medical Insurance Company "INKO-MED" (MSC "INKO-MED") regarding the receipt of VMP in various medical profiles for 2021 and 2022 were analyzed. The main reasons for the appeals of insured persons are listed, including appeals related to receiving referrals to federal centers.

The main reasons why persons insured under the compulsory medical insurance program cannot receive VMP in their region are described. Concrete examples are given of the assistance of the department for the protection of the rights of the insured in sending applicants to federal medical centers in Moscow on the condition of providing assistance at the place of residence. Conclusions are drawn about the prospects for the development of the activities of the IIC "INKO-MED" to accompany the insured persons when they independently apply for obtaining a VMP in federal centers.

The program of state guarantees for the free provision of medical care to citizens in the Voronezh region establishes a list of types, forms and conditions of free medical care, list of diseases and conditions, provision of medical care for which is provided free of charge, categories of citizens whose medical care is provided free of charge, standards of the amount of medical care, standards of financial costs per unit of the amount of medical care, per capita funding standards, the procedure and structure for the formation of tariffs for medical care and its methods of payment, as well as the procedure, conditions for the provision of medical care, target values  of criteria for the availability and quality of medical care.

In the article, a comparative analysis of the results of the implementation of the Program of state guarantees for the free provision of medical care to citizens in the Voronezh region in 2021 was carried out on the basis of data from the report on the form of federal statistical observation No. 62 "Information on resource provision and on the provision of medical care to the population."

The main goal of CHI is to accumulate and capitalize insurance premiums and provide medical care to all categories of citizens at the expense of the collected funds on legally established conditions and in guaranteed amounts.

One of the elements of the formation of financial support for the system of compulsory health insurance is insurance premiums for compulsory health insurance of the non-working population.

The materials revealing the essence, purpose, objectives and financial results of the accumulation of insurance premiums for compulsory health insurance of the non-working population are considered, the dynamics of the share of insurance premiums for compulsory health insurance of the non-working population in the total funding of the compulsory health insurance system for the period from 2013 to 2023 is analyzed. on the example of the Voronezh region.

This article analyses the norms of current legislation regulating the procedure and conditions for including legal entities and individual entrepreneurs in the register of medical organisations operating in the sphere of compulsory health insurance (the Register of MOs). The author considers certain aspects of the notification character of this procedure through the prism of notification of non-resident organisations that do not have licensed separate structural units in the territory where they intend to be included in the Register of MOs, and also focuses on the positive consequences of forming positive judicial practice on the issue of denying the inclusion of such organisations in the Register of MOs.

This article provides an analysis of the legal nature of the contract on the financial provision of compulsory medical insurance, the ways of development of this area of activity of territorial funds of compulsory medical insurance.

The article discusses the features of the formation of career trajectories of students, effective motivational tools that help students build their career trajectory while studying at a medical university.