Translated material
The cure for theft
Insurers can be connected to the DLO system
As early as next year, insurance companies may be recruited to help government agencies monitor the implementation of the additional drug supply program (ADS). Of course, if they are not afraid of huge debts and the general financial opacity of the system built by the Ministry of Health and Social Development.The interest of insurers in participating in this project is quite high, and it seems that they can find understanding among officials, to whom the prosecutor’s office in November clearly demonstrated what happens to the “extreme” in large social projects of the state.
After recent arrests in the Federal Compulsory Health Insurance Fund (FFOMS), which is responsible for the distribution of free medicines for beneficiaries, all interested parties - officials, pharmaceutical manufacturers and experts - are waiting for changes in the DLO system. Not only personnel, but also functional. It is likely that the fund will be relieved of its duties as curator of the financial side of the program (in whole or in part) and will once again become an organization engaged exclusively in planning and accounting, as it was before the advent of DLO.
Insurers have been aiming for the position of distributor and controller of budget funds since the inception of this social project in 2004. Let us recall that they were preparing to participate in the DLO program at the stage of its development, but at the last moment, under pressure from the State Duma, the government decided to refuse their services, preferring the FFOMS. The latter received the functions of the main “treasurer” - checking the validity of issuing preferential prescriptions, monitoring and allocating funds. There are different versions of why the choice was this way (they spared money from the state treasury to pay for the services of commercial companies, they were afraid of the corruption of these companies themselves, etc.), but the fact remains that a year and a half of work without insurance ended in a huge scandal. The money allocated for DLO in 2006 (29.08 billion rubles) ran out completely within six months; the State Duma added an additional 10 billion rubles. There is not enough to pay for all the prescriptions already purchased, and the leaders of the FFOMS ended up in pre-trial detention.
Supporters of the transition from the simple distribution of budget funds for medicines to the use of insurance methods are already timidly hinting that the problem of overspending might not have existed if the system had initially been built in the way that the leaders of the Ministry of Health and Social Development also intended. And some express their readiness to help officials rectify the situation. “Today, I don’t see any obstacles to the resumption of participation of insurers in the DLO system,” Vladimir Skvortsov, general director of the Alfa-Insurance group, told Vremya Novostey. “In 2004, officials decided to do without insurers, although the players had already carried out preparatory work, which was frozen.” In his opinion, the inclusion of insurers in the DLO system is quite logical; sooner or later such a decision must be made.
The insurance business also has a parliamentary lobby in the person of deputy Alexander Koval, who combines his Duma duties with the leadership of the All-Russian Union of Insurers. The deputy-insurer is actively fighting for the implementation of the law on the mandatory participation of his colleagues in the distribution of medicines at public expense. For his services, he asks, frankly, not much - only 3% of the program budget, in 2006 this is approximately 1 billion rubles. “The profitability of the business is low. Those players who are ready for large projects and consider medical insurance as a priority area of development will work in the market. There will definitely not be a rush,” the head of Alfa-Insurance is confident. But we should not forget that those few companies that will receive all the money from the program will acquire a completely new status. So the interest of the players is obvious here. First of all, large ones - ROSNO, RESO, Alfa-Strakhovanie, MAX, etc.
The leaders of the Ministry of Health and Social Development and Roszdravnadzor have so far refused to discuss the possibility of returning to the old scheme, which they themselves actively discussed at one time. But at the same time, they do not deny the need to draw organizational conclusions from the arrests of FFOMS leaders. The chairman of the board of directors of the Pharmexpert Marketing Research Center, Yuri Krestinsky, also considers the fund’s removal from the implementation of the drug benefit program to be very likely. “Everyone knew that the fund did not have enough staff to control all levels, and the insurance companies would have as many people as they needed,” he explained to Vremya Novostei. “In addition, insurers can take on the burden of cash gaps and control the register of beneficiaries.”
But the practical inclusion of a new link in the work on the program is possible only on a principle close to compulsory car insurance, Mr. Krestinsky is sure. That is, 100% of the country's population will have to have insurance for medications, only some will be paid, others will be free, and others will be partially paid.
“This is how we insure cars: everyone is required to have MTPL, but some can also afford CASCO,” another marketer, CEO of DSM Group Alexander Kuzin, agrees with his colleague. In his opinion, only in this way will insurers be able to obtain a sufficient amount of available funds so as not to be afraid of disruptions in the supply of medicines, lack of working finances and, ultimately, arrests.