Health insurance. Who pays for illness?

First of all, medical insurance is a method of social protection of human health that guarantees a person will receive medical care at the expense of the organization providing the insurance.

There are two types of medical insurance: compulsory and voluntary. The first type, which is free of charge, is mandatory for all citizens of the Russian Federation; consequently, Russians who do not have a medical insurance policy cannot receive medical care even at outpatient clinics in their own city and region. The second type is most often paid or provided at the employer's expense, which may affect the list of medical services provided and the territorial scope of insurance coverage.

There is no choice to be made regarding the first type of insurance, as it is compulsory for all citizens of Russia. Voluntary insurance is merely a paid supplement to it, used because of long queues and the quality of services provided at free outpatient clinics.

Concluding an employment contract in the Russian Federation entails the issuance of a compulsory medical insurance policy (OMS policy for short). In addition, OMS policies are issued to pupils of general education schools and students of higher education institutions, technical schools and colleges. Pensioners and people who for whatever reason are not employed receive insurance policies from insurance societies, which are most often located in central city hospitals.

Compulsory medical insurance policies are subject to periodic replacement, and with the entry into force of the new federal law in 2011, one must first also obtain a “temporary certificate”, which has to be exchanged for an insurance policy within a month.

A significant drawback of OMS is the limited number of medical institutions where the insured person can receive care, and far from all state institutions will be ready to admit a person in need of medical care immediately. Moreover, monitoring of compliance with the terms of the OMS contract can only be carried out if both parties — the policyholder and the insurer — agree to it.

Compulsory medical insurance covers services provided to Russians free of charge. These include primary medical care, emergency medical care and specialized medical care, which is provided only in certain cases.

Perhaps the main disadvantage of compulsory insurance is that it does not cover all therapeutic and preventive medical services, but only a small portion of them. In voluntary medical insurance, these services are provided in full, or certain services can be chosen as provided for by the tariff plan selected by the policyholder. However, a long list of services is far from the only advantage of voluntary medical insurance.

The main advantage of voluntary medical insurance is saving time and money. Those insured voluntarily do not have to queue at the medical centre — this is due both to the large number of patients who use only free services and therefore do not queue at paid clinics, and to the pay rates of doctors, who as a result do their work well and as quickly as possible.

Referrals issued at paid and free clinics are another distinctive feature. Whereas a person using free compulsory medical insurance is most often forced to go with referrals to other medical institutions, for example to have a fluorography done, holders of paid medical policies receive all services in different rooms of the same medical institution. Equally important is the fact that all necessary care, including referrals and the services provided under them, is paid for by the insurance company.

The insurer, having assumed obligations under the contract, constantly monitors the quality of services provided by medical institutions and protects the policyholder's interests if a dispute with a medical worker does arise. The policyholder can obtain advice on any issue relating to a medical institution and its individual staff members from the insurance company's experts completely free of charge.

Considering all of the above, voluntary insurance can not only be more reliable than free insurance but also covers a wider range of medical services. Voluntary insurance offers a free choice of the medical organization where diagnosis and treatment will take place, whereas compulsory insurance is limited to a handful of institutions that provide services free of charge.