It's better not to get sick for two years

Health insurance reform delayed

The start of the reform of the compulsory health insurance system in Russia has been postponed for a year, or even two. Deputy Minister of Economic Development Mikhail Dmitriev announced this yesterday at a press conference. According to him, the law on compulsory health insurance, which was returned from the White House to the Ministry of Economic Development and Trade for revision in July, is unlikely to be adopted by the State Duma before the spring session of 2004. “Then we will need seven other legislative acts and at least 23 government regulations, and their preparation will take at least six months, most likely even a whole year,” explained Mr. Dmitriev. As a result, already in the current version of the law, which, as planned in the spring, was supposed to come into force on January 1, 2004, 2005 is prescribed as the starting point for the reform, but it is quite possible that fundamental changes in the compulsory medical insurance system will begin in January 2006. “We are doing everything possible to avoid this scenario, since in any case the first three years of reform will be a transition period,” says Mr. Dmitriev. “That is, nationwide, the new system of compulsory insurance will start working only in 2008 or 2009.”

Let us recall that the main goal of the reform is to eliminate the financial deficit in the compulsory medical insurance system and improve the quality of medical care for insured Russians. According to experts from the Ministry of Economic Development and Trade and managers of the federal compulsory medical insurance fund, the chronic underfunding of medical institutions in Russia is caused by the fact that the constituent entities of the federation do not pay insurance premiums for the unemployed population untimely and not in full. If employers, by paying the unified social tax, thereby fulfill their obligations both to the state and to their employees (part of the unified social tax in the amount of 3.6% of the wage fund consists of contributions to compulsory medical insurance), then the regions are in no hurry to fill territorial funds. Only in recent years has the situation stabilized a little, however, according to the calculations of the director of the Federal Compulsory Medical Insurance Fund Andrey Taranov, the spread in payments between prosperous and disadvantaged regions is enormous. In the “oil” regions, local budgets transfer 3-4 thousand rubles a year for each unemployed person, and in the “backward” regions the bill runs into hundreds. Mikhail Dmitriev and other developers of the reform propose to stimulate lagging regions with budget subsidies, but to pay extra only to those who independently managed to fulfill their obligations to the compulsory medical insurance system. In addition, the Ministry of Economic Development and Trade proposes to increase that part of the unified social tax that directly goes to the federal fund (from the current 0.2% to at least 1%) - in order to support the deficit territorial compulsory medical insurance funds from the center.

However, the MEDT bill, which contained many other proposals, was considered too crude by the government. As Mr. Dmitriev said yesterday, he received more than 70 comments. It has not yet been possible to eliminate them all. Although, trying to make the law convenient for all interested departments, MEDT experts have already pretty much watered down the document, depriving it of several ideas that are quite attractive to ordinary citizens. In particular, if it was previously assumed that Russians would be given the opportunity to choose between compulsory and voluntary health insurance (and those who purchased a VHI policy were promised to return part of the unified social tax paid by the employer), then the current version of the bill no longer mentions this. That is, to receive medical care of a higher quality, as before, you will have to insure twice.

In the meantime, Mr. Dmitriev’s team will further refine the bill and get it approved by the authorities, the Pension Fund will be responsible for supporting territorial compulsory medical insurance funds. This year, the Pension Fund of Russia is transferring additional funds to the regions for medical care for older people. According to the head of the fund, Mikhail Zurabov, by the end of this year, according to the government’s decision, about 1.5 billion rubles will be allocated to support 15 regions. “Postponing the start of the reform by a year does not mean that the experiment with the use of Pension Fund funds will stop,” Mikhail Dmitriev tried to reassure the public yesterday. “The fund’s draft budget for next year already plans 6 billion rubles for these purposes, and the number of regions participating in the experiment will increase.” True, it should be noted that the list of regions benefited by money from the Pension Fund does not include the most “problematic” ones, for the sake of which the next social reform was largely launched. As the deputy head of the Ministry of Economic Development and Trade explained, these federal subjects simply “turned out to be technically unprepared.”

Oleg VOLKOV