Umshwalense Nemithi - Iyini? Health Insurance Fund

I nokuhlinzekwa ngokunakekelwa kwezempilo izinga kuyingxenye ebalulekile futhi ebalulekile ohlelweni zokuvikeleka komphakathi yezakhamuzi. Nomaphi lapho isakhamuzi, noma yini e isimo sakhe sezimali, angakwazi uthole ukunakekela kwezokwelapha ehloniphekile phezu okuvela isimo esingalindelekile.

Ukuthuthukiswa imboni yomshuwalense wezempilo

Imakethe umshwalense iyingxenye kohlelo kwezomnotho, kanye nokuthuthukiswa ubudlelwane emakethe kudinga ukuba balolonge umshwalense emakethe yasekhaya kuhambisana nezidingo zomhlaba wonke kanye namazinga. zokuvikeleka komphakathi izakhamuzi akukwazi esinqunyiwe noma bakhethe, ngakho wo hlinzeka unomphela kudinga iziphathimandla ukuba nizifeze zonke izingxenye zayo.

umshuwalense wezempilo zokuzithandela iyathinteka. Ngoba namuhla isakhamuzi ngasinye kuwukuphela kwendlela ukuze uthole izinga eyanele kwezokulapha ezanele. Ukuthuthukiswa imboni yomshuwalense wezempilo ngesikhathi samanje ogodla ngenxa yezizathu eziningana, okuyizinto ukunciphisa ezinkulu e lwezempilo lukahulumeni ngezimali, base impahla yisikhathi, ukuntuleka kwemithi, ukuthuthukiswa izinkomba lokubala ubuningi babantu yezwe kanye nezinga isifo izakhamuzi 'nabanye abaningi. Namuhla, kukhona njalo eziningi eziphikisanayo nezinkinga endaweni komshwalense wezempilo, edinga ucwaningo olwengeziwe.

umshwalense Ukuqondanisa

Izinga ukusekelwa ngokwezimali kwezempilo eRussia akayena ngempela eyanele, esithinta ukuphila kwezakhamuzi nasebunyeni izinga yokwelashwa. Okuphansi amaholo odokotela kanye esasimenyezelwa isiqinisekiso somthetho-sisekelo usizo khulula emkhakheni wezempilo, it is ngeshwa bayakhuthazwa ukunikeza abezemisebenzi yosizo oludingekayo. Ngakho-ke, esikhathini umkhakha kwezempilo namuhla isekelwe ukuzenzela, okuyinto kubonakala iminikelo yesihle futhi esingalindelekile ithenda zomthetho. Ngakho, isabelo nezindleko zomphakathi ngezindleko ezihilelekile Imininingwane ku imithi eRussia imayelana 56% kuphela, kuyilapho emazweni - EU uthi - mayelana 76%. Okunengi uxhaso kuyadingeka imali izindleko sabantu, kuyilapho abanye (4%) e-Russia (azungeze 40%) - ku umshwalense yokuzithandela wezokwelapha kanye nosizo yesihle.

umshwalense Nemithi - iyona siqu umshwalense umkhakha. It wenziwa 2 amafomu main: ngokuzithandela ayimpoqo. Ngokusho imithetho, umshwalense yokuzithandela lezi zinhlobo ezilandelayo: wezokwelapha umshwalense ( ezempilo njalo), umshwalense izindleko zokwelapha kanye umshuwalense wezempilo. i-Health Insurance Act akuvunyelwe ezilawulwayo.

Uma ucabanga ukuthi ukwanda nokuxhaswa komphakathi we umkhakha ukunakekelwa kwezempilo kuyinkinga ngenxa yesimo esinzima sezomnotho ezweni, udinga ukuthola ezinye izindlela lokubakhipha imali ukwazi ukungena kule mboni. In the ukungabikho ifomu esiyisibopho umshuwalense wezempilo yokuzithandela ongaxazulula inani elikhulu izinkinga.

Ukuhlaziya emakethe umshwalense

umshwalense wezempilo - lo mkhuba kwezenhlalo, ngakho isidingo lolu hlobo umshwalense ukhula phakathi kwabantu njalo ngonyaka. Izinga izinkokhelo LCA izivumelwano, enye yazo isici ukwanda yonyaka kunombolo ixazululwe izimangalo umshwalense.

Ukuhlaziya emakethe umshwalense kuphakamisa agumenti mayelana LCA ukulahleka iningi abaholi umshwalense. Ngokucacile yomshuwalense njengoba uhlobo umsebenzi ibhizinisi ngenxa yokuthi ukuthi imali engaphezulu ye uhlobo oluthile lomshuwalense kuyinto inkampani yomshuwalense, aba maningi amathuba esihambelanayo umshuwalense ukwanda njengoba izimali sikhule ngokulingana ne izibopho umshwalense.

It eqoshiwe ukwanda 2013 umshwalense net izinkokhelo umshuwalense wezempilo okuqhubekayo ngu 34,2% uma kuqhathaniswa nonyaka ka-2011. Net umshuwalense for umshuwalense wezempilo uma ukugula futhi bathambekele ukwandisa - pheze ngesiquntu. Kodwa ngokuvamile kukhona ngokweqile umshuwalense phezu izinkokhelo, okuyinto iphuzu omuhle imisebenzi izinkampani zomshuwalense.

Esinye sezizathu ukulahlekelwa umkhakha ngokuthi ukukhula kwenani izicelo zamakhasimende for medical aid ngenxa Ukuwohloka kwesimo sempilo, labantu asebekhulile, befuna amakhasimende, ukungapheleli underwriting amasevisi, ukusetshenziswa yamanani kwezomnotho engenabulungisa, inhlangano abampofu umsebenzi ukukhokhela ukulahlekelwa, ephansi ikhasimende-orientation ezikhungweni zezempilo kanye prophylactic yomphakathi, ulele izindleko zokwenza ibhizinisi, kuhl .. ikhomishini izimali kwabalamuli umshwalense - nabathengisi amasevisi LCA.

umshwalense yokuzithandela

Namuhla kwakhiwa isakhiwo esiqondile emkhakheni yokuzithandela umshuwalense wezempilo e-Russia. Isakhiwo emakethe LCA yasekhaya kuhlanganisa zikahulumeni kokuqondisa imisebenzi umshwalense, izinhlangano umshwalense yangasese, izinkampani zomshuwalense, wabathengi umshwalense, wezokwelapha, Usizo inkonzo futhi abathengi.

Njengoba kufakazelwa imiphumela yocwaningo, ukuphikiswa okukhulu ekuthuthukiseni the umshuwalense wezempilo yokuzithandela ukungabi intela nendlela yokukhuthaza, ngoba inkampani, ezinye zazo kufanele ukhokhe 41% yokukhokha umshwalense, akhokhe yabo emva kwentela evela inzuzo inetha. Lesi simo ihlobene ukungabi khona izinzuzo intela, kakhulu kubambezela inqubo detenizatsii kwezinsizakalo zempilo.

Lapho sabele izindleko komshwalense wezempilo zokuzithandela izindleko zokuphatha kanye emkhathini wezulu, ithi ezimbili-ukusetshenziswa, izindleko ezihlobene nokuhlinzekwa kwemisebenzi, kanye ngemva komnikazi lapho umuntu enezinkinga ezihambisana ukuzimisela lemali kwamanani nezindleko esinjalo zokubika intela sikhathi, kungakhuphula izinga izinsizakalo zezempilo, okuzokwenza ukunikeza push ezinhle detenizatsii emkhakheni ezempilo kanye nokwanda izimali kuya amabhajethi zendawo nesimo.

Umshwalense njengoba ingxenye zokuvikeleka komphakathi izakhamuzi

Umkhuba umshuwalense wezempilo kuholela esiphethweni sokuthi izifundo Awekho kokuvusayo kwezomnotho: I-izinkampani zomshuwalense - ngcono impilo yabo; ngoba isikhungo sezokwelapha - ukuhlinzeka abezemisebenzi yosizo oludingekayo. Ngakho-ke kubalulekile ukuba sisebenzise mshini ukukhuthazwa izifundo ngokwethula uhlelo umshuwalense wezempilo. Kuyoba ukhuthaze izinkampani zomshuwalense ukuthuthukisa futhi ukwandisa izici ikhwalithi impilo yabo, ukuvimbela ukuwohloka yayo, ungawakhi ingozi ezidingekayo esimweni sabo somzimba.

umshwalense Nemithi - liyisici kwesimiso zokuvikeleka komphakathi izakhamuzi, esinikela isinxephezelo iziguli imali yokukhokhela izindleko zokwelashwa. Futhi, umshuwalense wezempilo ngokuzikhethela ngaphezu iziqiniseko saziso nokukhokhwa kwezintela kwezinsizakalo zokwelashwa. umbuzo Ingxoxo ezihlobana izinkinga okwandayo umthwalo phezu Isikhwama amaholo, ilawula umshwalense wezokwelapha, umshwalense wokuphindaphinda kanye neminye imisebenzi.

Umshwalense e CIS

Izinkinga komshwalense wezempilo njengoba isici ukuvikelwa komphakathi sasisempini anhlobonhlobo ososayensi zakwamanye amazwe Russian - zezomnotho kanye nodokotela. impumelelo Obalulekile kule ndawo nomthelela ekuthuthukiseni izisekelo ezicatshangelwayo zokuvikeleka komphakathi zezakhamizi, ikakhulukazi ekuthuthukiseni apharathasi lomqondo kanye nokwethulwa izinyathelo ezingokoqobo.

Nokho, umbuzo uyasala ukunikezwa usizo lwezempilo kubantu abasendaweni engaphansi isimo sethu, ayeyile CIS amazwe, kanye kazwelonke yanoma yiziphi amazwe CIS, wafika e-Russia isikhathi esithile. umnotho ubhekene nezimo ezinzima ukuthi kukhona isici umnotho yoshintsho, nokukhuthaza umphakathi kaningi phesheya, ikakhulukazi emazweni CIS. Vala kwezomnotho, ubungane nezibopho zomkhaya futhi isici yokuhlawula.

Nokho, ubungozi empilweni yomuntu, kukhona njalo, kungakhathaliseki ukuthi bakuphi ku-ithikithi uhambo izivakashi (uma umshwalense liyadingeka), noma ngokuzimela. Isidingo ukwelashwa izakhamuzi abangenayo leli phepha ukuze bangabhekani, njengoba umshwalense wezempilo, kusikisela inkinga luyingxenye zezimali. Yileyo ndlela esizwa ngayo ukwelashwa kulamanye emave uzokhokhelwa? ERussia, isibonelo, kukhona umshuwalense wezempilo ayimpoqo, owawuthi ukwelashwa kuphela izakhamuzi Russian inikezwa mahhala. Leso simo esikhona eBelarus. Ngakho, kunenkinga ikakhulukazi ukuphepha kwezakhamizi Russian emazweni CIS, okuyinto ingakamiswa ixazululwe futhi kwizindawo theory, noma umkhuba.

Umshwalense kokushiya esikhathini esiseduze phesheya

Zokuzithandela umshuwalense wezempilo e-Russian Federation kuyaqhubeka kukhula, futhi ibonisa ukuqwashisa izakhamizi nesidingo sokuvikela impilo. Minyaka yonke nabaningi abantu baya kwenkathi esihambisana phesheya. Isibalo izivakashi phesheya luyanda njalo ngonyaka.

Phakathi uhambo kukhona kungenzeka izakhamuzi Russian bangase bazithole besesimweni esinzima (ukugula, ukulimala, nokunye. D.). Ukuze siphendule le nezindaba kudinga ulwazi oluthile, isibonelo, lapho ukuthola umshwalense wezempilo, okuyinto kuthanda ngesikhathi esifanayo izindleko impahla. Nokho, njengoba umthetho, labo abaya kwelinye izwe ukuze izitholele izihlobo noma abangane, abancikile ezingosini ze yokuthi begula futhi izonikezwa izimali ezidingekayo ukuze bathole ukwelashwa (kukhona inertia ethile yokucabanga, lapho ukwelashwa eSoviet Union kwaba khulula).

Ngezinye izikhathi, usizo lwezempilo kungenzeka esiphuthumayo (lapho ngemva kokulunywa umkhaza, izifo ezibangelwa amagciwane, ukulimala kanye nokunye okufana nalokho. D.). Ukuhlaziya isimo inikeza ngezizathu kufakazela ukuthi ukuhlinzekwa kosizo lwezokwelapha kuya izakhamuzi zaseRussia Kwenziwa ngenkokhelo kwamanye amazwe. Ngakwelinye ihlangothi, abezinye izizwe ensimini ka iRussia yayinabantu ithuba ukuze zithole ukwelashwa mahhala. Ukuze kuqinisekiswe zokuvikeleka komphakathi izakhamuzi uma ukungabi nampilo phesheya bamenyiwe ukuba kusebenze Ukusungulwa kwalolu (ezisebenzayo ilungiselelo lomthetho) isingeniso nsuku izivumelwano komshwalense wezempilo ayimpoqo ngokusebenzisa Health Insurance Bureau phakathi kwamazwe CIS neRussia.

Ikhadi phesheya

Uma umngcele ku imoto yabo, Amasiko angase hlola inqubomgomo wakho wezempilo. Uma uya zifike ngezindiza, izitimela noma ibhasi, intengo ithikithi kuzomele sifake ukukhokhelwa umshwalense. Umgwaqo ohlongozwayo ikhadi impilo saziso phesheya kuzokwenza yonkhe izindleko zokwelashwa (inpatient, sinenkonzo yokunakekela iziguli emakhaya), bathenge imikhiqizo, uthole ukunakekela kwezokwelapha, ezintweni zokuhamba, ezokuthutha ambulensi, futhi uma ukufa - ukwenza kuthutha we isidumbu ukuze lizwe ekhaya.

ikhadi okuyimpoqo yezokwelapha travel kwezilwandle zizolokhu zibaliwe zivezwe ngamunye ezweni umhlanganyeli yephrojekthi. Le nqubomgomo umshuwalense wezempilo kungenziwa ikhishwe esikhathini esiyizinsuku ezingu-90. Ikhadi phesheya kufanele abe isitatimende esicacile ngendlela efanayo, okuyinto uzobe kuvunyelwa bonke abahlanganyeli project. umshwalense wezempilo akukwazi ngamaphesenti ayikhulu ikhava isiqinisekiso ukwelashwa izindleko phesheya. Kwzimangalo umshwalense ungafaki:

• ukuphathwa izifo eziningi ezingokwengqondo;
• ukwelapha izifo, ukulimala eholela kusuka izenzo ekhubazekile;
• kokulimala esimweni utshwala noma izidakamizwa;
• isigenco esiwela kwesokudla, ngaphandle uma kudingeka ngenxa yokulimala;
• ukuze kunakekelwe amazinyo, ngaphandle uma umuntu has amazinyo ezinzima;
• ekwelapheni izifo ezihambisana ne-AIDS kanye nezifo Venereal;
• ekwelapheni yizihlobo nabangane abaseduze ka kwesamba, lapho yena ungenisile;
• kokulimala endaweni bayaye bazame ukuzibulala;
• ukuqaliswa isisu, ngaphandle ezimweni lapho lisongela ekuphileni sowesifazane;
• kokuqhuba ukuhlola esicelo ngomshuwalense sika;
• ukwelashwa Spas nokuningi.

Medical Insurance Bureau

Health Insurance Bureau (SME) - kuyinto inhlangano kuphela izinhlangano umshwalense kuleli zwe. Le nhlangano kungase kuhilele kwenani elithile umhlobo negcwele amalungu, ezifeza umshwalense yezokwelapha phesheya. Okungukuthi, abangabantwana ubulungu isimo esiyinhloko ukuthi kungenzeka sifeza lesi lomshuwalense. Amalungu Bureau banelungelo ukubala umshuwalense wezempilo umshuwalense wezempilo premium Isikhwama "ikhadi yezokwelapha Kuyisibopho phesheya." Bureau, kuyobe ukuhlinzekela isiphetho ngesikhathi esifanele futhi qualitative izicelo umshwalense ngaphansi kwalezi izinkontileka. I umshuwalense wezempilo wonke amalungu SME uzokwazi ukwenza izinkokhelo ngesikhathi Isikhwama nesineke abadinga imishanguzo phesheya, ukuhlinzeka usizo lwezempilo, kuthutha sabantu namakhaya abo uma kwenzeka ushona. Medical Insurance Bureau uyokwenza njengoba engenzi nzuzo.

Uhlelo oluhlongozwayo "irekhodi yezokwelapha okuyimpoqo ka phesheya" inikeza:

1) kusungulwa i-National Health Insurance Bureau, lapho yakhiwa zonke izinkampani zomshuwalense enifeza ayimpoqo umshwalense impilo phesheya;

2) umshuwalense wezempilo okuphoqelekile okwenziwa ezikhungweni abantu bewela umngcele isimo eyabo ukuvakashela amazwe CIS isikhathi esithile (izinsuku ezingu-90);

3) ukuba khona uhlaka olufanele zomthetho ku Health Insurance, elawula umsebenzi izinkampani zomshuwalense kule ndawo.

izimali umshwalense wezempilo we Russian Federation

Okuphoqelekile Health Insurance Fund sidalwe kuzo ukuze sikhokhele lolu izakhamuzi Russian izindleko zokunakekelwa kwezempilo. umshwalense wezokwelapha okuyimpoqo - kuyinto share ebalulekile Umshwalense Wavelonkhe.

I yezinjongo eziyinhloko Isikhwama:

• sokuphatha ukugeleza okunengqondo izimali;
• nokukhokhwa izinhlelo ezibhekele.

Income sikhwama iminikelo ezilandelayo:

• umshuwalense wezempilo kusukela isabelomali isimo;
• iminikelo wamabhizinisi;
• ukusetshenziswa okwesikhashana izimali khulula kwesiKhwama.

Imisebenzi esemqoka ye-Federal Fund CHI zihlanganisa:

• izimali imithi;
• ukunqwabelana imithombo yezimali;
• ekunakekelweni kwempilo - ukusetshenziswa kwezinhlelo sikahulumeni.

uhlelo Wendawo komshwalense wezempilo ayimpoqo sifaka imali ngqo ezikhungweni zezempilo. Umshwalense umnikelo izinga elilingana 3.6% maqondana inkokhelo avarage. umshuwalense e okuyimpoqo umshuwalense wezempilo Isikhwama ezihlobana izindleko. Ukukhokhwa lwezempilo, emphakathini kanye izimali zempesheni ngokuthi intela esihlanganisiwe nomphakathi.

izici Key

Kulokhu osekushiwo, kungenzeka ukuhlonza eziyinhloko ezithinta the umshuwalense wezempilo e izimo zanamuhla ukusebenza emakethe umshwalense:

• ukuntengantenga komnotho kuleli zwe, okwenza abantu baziphatha izindleko zezimali kuphela izidingo zokuphila.
• umthetho abangaphelele (isibonelo, lokhu kubonakala ukungabi khona intela nendlela yokukhuthaza).
• Khulisa yokuthengisa umthamo kanye ukubaluleka kwemithi.
• Ukwandisa nesibopho emphakathini webhizinisi umshwalense (ukwanda yisabelo umshwalense iqembu abasebenzi izinhlelo VHI ukuthi kukwenza kungenzeki ukugwema isinxephezelo umqashi sezindleko zokwelashwa).
• monopolization Iningi zokwelashwa emakethe kwenza nezikhungo zezokwelapha ukwandisa ukubaluleka amasevisi anikezwa kanye nobungako.
• Okuphansi umshwalense nesiko izakhamuzi.

Kufinyeta, singasho ukuthi mancane amathemba okuthi ukuthuthukiswa umshuwalense wezempilo, kuhlanganise uhlobo yokuzithandela, esiduduzayo. I isabelo LCA emakethe umshwalense kuyanda, izinkampani zomshuwalense ubani ukunikeza izinkonzo LCA, beba wokuncintisana kakhudlwana, okwandisa isithakazelo sabantu lolu hlobo yomshuwalense kanye kwengqondo like.