| The government approved the crude law on compulsory medical insurance The government does not intend to delay reform of the compulsory health insurance system and wants to begin updating at the beginning of 2005. Yesterday, at a meeting in the White House, a very crude draft law on compulsory medical insurance, prepared by the Ministry of Economic Development, was approved. Within a month, the document will literally be finalized in a hurry under the control of Deputy Prime Minister Galina Karelova, and then submitted to the State Duma so that deputies have time to begin considering it before the end of the spring session. Otherwise, as the deputy head of the Ministry of Economic Development and Trade, Mikhail Dmitriev, who prepared the law, explained, the start date for the reform will have to be postponed again, which means that the final goal will also be delayed - eliminating the funding gap in the compulsory medical insurance system. Without this, there is no need to talk about improving the quality of medical care and transforming the insurance policy from just another bureaucratic certificate into a full-fledged instrument that provides guarantees of free treatment.
According to the ministry's calculations, it will be possible to balance income and expenses in compulsory health insurance and, therefore, to finally ensure the full implementation of the program of state guarantees for the provision of free medical care by 2008. According to the head of the Federal Compulsory Medical Insurance Fund, Andrei Taranov, a deficit of tens of billions of rubles is caused primarily by the fact that the constituent entities of the federation do not fully pay contributions for the non-working population. Employers, who pay for the insurance of their employees as part of the unified social tax, on the contrary, have, on the contrary, increased their contribution to the budgets of compulsory medical insurance funds in recent years. The Ministry of Economic Development and Trade believes that even taking into account the reduction of the unified social tax promised by the government, the funds received from enterprises and companies should be enough to serve working Russians.
Other billions, which are missing today, as Mr. Dmitriev explained, should appear from three sources. Firstly, it is expected that the constituent entities of the federation will increase contributions for the non-working population to the territorial compulsory medical insurance funds by 20 billion rubles. To stimulate them, the government is ready to begin co-financing the provision of medical care to pensioners and children in the regions. But this money will be allocated only to those areas where local authorities fulfill their obligations to compulsory medical insurance funds. This year, as in 2003, as an experiment, the role of a “stimulator” will be played by the Pension Fund, which will transfer about 6 billion rubles to bona fide regions. By 2008, subsidies will come from the federal budget and, according to Mr. Dmitriev, will amount to at least 17 billion rubles. Another 10 billion is planned to be received through greater centralization of funds in the Federal Compulsory Medical Insurance Fund. Today, the FFOMS receives only 0.2% of the 3.6% in the unified social tax transferred to health insurance, the rest goes to territorial funds. The Ministry of Economic Development and Trade, as Mikhail Dmitriev assured the Vremya Novostei newspaper correspondent, proposes dividing money between the center and the regions in a ratio of 40:60 (that is, increasing the share of the Federal Compulsory Medical Insurance Fund to 1.2%). This will allow the center to support poorer regions to ensure equality in medical care for all Russians. Today, there is an eightfold difference in insurance premiums between the rich and sparsely populated “oil” districts and the poor republics in the south.
However, so far the issue of redistribution of revenues from the Unified Social Tax, as well as a number of other key aspects of the reform, has remained unresolved. At yesterday's government meeting, Prime Minister Mikhail Kasyanov called for synchronizing the modernization of the compulsory health insurance reform with the government's plans to reduce social tax. Simply put, wait until Chapter 24 of the Tax Code is updated. However, meeting the persistent wishes of the head of the Ministry of Economic Development and Trade German Gref, the head of the Ministry of Labor Alexander Pochinok and Deputy Prime Minister Galina Karelova, who called for a quick start to move towards “reducing total inequality in the receipt of medical care by citizens,” the head of government still did not “wind up” the bill, which was once already returned to the authors from the White House with very unflattering reviews.
Departments are also instructed to finally come to a common point of view on the issue of which organizations should perform the function of insurers in the compulsory medical insurance system. The Ministry of Finance insists that compulsory health insurance should be their exclusive sphere of activity, thereby blocking the way to this market for currently existing insurers. The Ministry of Economic Development and Trade believes that creating companies from scratch and developing a regulatory framework for them will delay the already stalled reform. The heads of ministries also wanted to cross spears on this issue several times at yesterday's meeting. The head of the Ministry of Economic Development and Trade, German Gref, rushed to explain to his colleague Alexei Kudrin that there are no specifics for insurers in compulsory medical insurance. “There is a simple and understandable Russian word “beneficiary,” he tried to explain, but Mikhail Kasyanov interrupted the discussion and recommended that his subordinates clarify the relationship elsewhere. As a result, as the deputy head of the Ministry of Economic Development and Trade later explained, only one detail is finally clear: “the participation of insurance organizations in compulsory medical insurance in any case will require them to have a license for this type of insurance.” Oleg VOLKOV, Vera KUZNETSOVA |
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