Health insurance is the social protection of the population. In Russia, the state strives to fully protect the health of the population. Disability due to illness is a social risk. In case of illness, every citizen of the Russian Federation has the right to free medical care under the policy of compulsory health insurance. Often, employers for their employees draw up a policy of voluntary medical insurance (VHI). In the article, we will consider in detail what CHI and VHI are. How are policies different? Who can buy DMS. Is it worth buying a voluntary health insurance policy at your own expense?
Health insurance and its types
Turning to a clinic or hospital, each person wants to receive qualified assistance in in full. Health insurance in Russia has two forms: compulsory (CHI) and voluntary health insurance (VHI). Unfortunately, the CHI policy does not cover most of the costs. To get full medical care, you often have to pay extra out of your own pocket. In such a situation, patients think about purchasing a voluntary medical insurance policy. So, let's see how it differs and what are the advantages of VHI and CHI.
What is OMS
Compulsory health insurance implies a guarantee of free medical care for all citizens of the Russian Federation. But the CHI includes only a certain list of free services and medicines. This list is established by law. Payment for treatment under compulsory medical insurance is carried out at the expense of contributions, which the employer transfers monthly to the federal budget, which is 5.1% of the salary of each employee.
Compulsory medical insurance coverage does not always provide assistance in full.
What is DMS
Voluntary health insurance provides for assistance under a pre-selected insurance program. Insurance companies provide a wide range of services to choose from.
The VHI policy allows patients to receive assistance in medical and preventive institutions that are not part of the compulsory medical insurance system. Also, with VHI, services are provided in more comfortable conditions and in a shorter time. The policy is paid for by the insured.
The main differences between CHI and VHI
When they first hear about VHI or think about buying it, the first question arises, how does the MHI policy differ from the VHI policy. For clarity, we have listed all the main differences in the table.
| CHI | VHI | ||
|---|---|---|---|
| pros | Minuses | pros | Minuses |
| Outpatient care | |||
| for free | to make an appointment with a doctor | doctor's appointment in | to narrow-profile |
| available only in municipal clinics | any clinic specified in the insurance contract | specialists are directed by the therapist/pediatrician | |
| long waiting list for an appointment with specialists of a narrow profile | You can book an appointment right away | Scheduled examinations and receipt of certificates not related to the certificate of incapacity for work are not included. | |
| Need a referral from a GP/pediatrician | flexible working hours for doctors | ||
| Enrollment is only possible at specific times. | new modern equipment | ||
| old, often non-working equipment | |||
| if additional examinations are required in diagnostic centers, a preliminary appointment is required, as a rule, a patient gets a free referral to a specialist in 1-2 months | |||
| dental care | |||
| for free | old equipment | modern equipment | no prosthetics |
| queues | no queues | ||
| there is no way to take a panoramic picture for free | all X-ray equipment is in the clinic, images are made of any complexity | ||
| anesthesia for a fee | good anesthesia, which is selected taking into account the characteristics of the patient | ||
| composite materials, removable dentures, poor quality crowns | all high quality materials | ||
| Ambulance and hospitalization | |||
| ambulance arrives on call and, if necessary, hospitalizes | to adults can go within 2-3 hours | ambulance arrives on call in a short time, hospitalizes if necessary | ambulance call and hospitalization are an additional option in the insurance contract |
| quickly comes to the children, within 20 minutes | lack of free places in public hospitals, even small children are placed in corridors and boxes | Availability of free places in comfortable rooms | |
| Complicated or specialized tests/examinations (CT, MRI, biopsy, etc.) | |||
| are made on a general basis on the recommendation of a doctor | waiting in line can take several months | if it is stipulated in the contract - they are made free of charge without the need to wait in line | by doctor's prescription |
| additional costs may apply | |||
| Who is eligible to apply for CHI and VHI policies? | |||
| citizens of the Russian Federation, or foreign citizens who have a residence permit in the Russian Federation | all categories of citizens | Depending on the insurance company, restrictions may apply (for example, for foreign citizens or persons over a certain age, etc.). | |
In favor of the CHI policy, I would like to say that not all municipal clinics in St. Petersburg are the same. There are state medical institutions, where the queues are smaller and x-rays will be done immediately and physiotherapy will be prescribed. But there are few of them and they do not change the overall picture of free medicine. Unfortunately, exemplary clinics also have old equipment and cheap materials.
Who should buy a VHI policy
The table shows the undeniable advantages of the VHI policy. The purchase of a VHI policy is especially important for newborns and the elderly, because they need to undergo examinations more often than others.
A standard VHI contract for children usually covers the treatment of all common childhood illnesses. The VHI policy may cover supervision by a personal pediatrician, home care (including collection of tests), vaccinations. The purchase of VHI will save pregnant women from constant queues at the antenatal clinic and unnecessary hassle, childbirth is not included in this program.
The presence of a VHI policy allows you to be treated in private clinics in comfortable conditions and at a convenient time. VHI is valid on the territory of a certain administrative unit - a subject of the Russian Federation, for example, in St. Petersburg and Leningrad region. Depending on the chosen insurance
The contract program can cover the treatment of most diseases. The VHI policy provides for the issuance of disability certificates.
VHI and CHI- These are types of health insurance designed to cover the patient's expenses for examination, treatment and rehabilitation.
The main difference between these types of insurance is that:
- VHI is voluntary health insurance;
- CHI This is compulsory health insurance.
CHI carried out on state level and is social in nature. The CHI policy is issued free of charge to every citizen of the Russian Federation, including persons without a fixed place of residence and persons with temporary registration. Thus, the state assumes the cost of treating its citizens.
Since OMS is state view health insurance, then tariffs for services to a medical institution are imposed from above. It is clear that they are far from real market value on the verge of profitability. Therefore, compulsory medical insurance services are provided only by state institutions with often very limited logistical capabilities. In addition, we can often experience a complete lack of enthusiasm among key performers - doctors and nurses, which we understand is due to low level payment for their work.
Things are much better with VHI where services are paid from the funds of the insured. The VHI policy is acquired by citizens independently or is included in social package for employees of the enterprise. VHI provides the patient with more high level medical care due to the presence of a powerful material and technical base and in the most optimal timing(no lines).
Thus, VHI guarantees the patient the provision of paid medical services and has more opportunities, while the CHI policy is limited to a list of free medical services. However, compulsory health insurance includes what is most often not covered by the VHI policy - disability, oncology, health care for mothers and children, etc. These insured events are not included in the standard VHI package and are paid additionally.
Differences and terms of insurance under compulsory health insurance and VHI policies are discussed in detail in the table.
VHI and CHI: differences
| CHI | VHI |
| Who is eligible for a policy? | |
|
Citizens of the Russian Federation, or foreign citizens who have a residence permit in the Russian Federation. |
Depending on the insurance company, restrictions may apply (for example, for foreign citizens or persons over a certain age, etc.). |
| Regulatory documents | |
|
Legislation of the Russian Federation: form, conditions for concluding an agreement, conditions for rendering medical services. |
Civil Code of the Russian Federation: conditions for concluding and terminating an agreement. Legislation of the Russian Federation: conditions for the provision of medical services. |
| Choice of medical institution | |
| Is not provided. Treatment or appointment with a specialist is carried out on the basis of a referral from the attending physician (therapist) in the institution to which the insured is assigned |
Possibility to be treated in any institution from the list established by the insurance contract. The list is agreed upon at the stage of conclusion of the contract. The more extended it is, the more expensive cost policy. |
| Visit to a general practitioner and specialist doctor | |
|
Appointments with the doctor take place on a first-come, first-served basis or by appointment. |
By appointment in medical institutions included only in the VHI system. Priority in service in medical institutions included in the CHI and VHI system. |
| Possibility of influencing clinics or doctors | |
|
Provided by the legislation of the Russian Federation. |
Quality control of medical services is carried out by the insurance company. Some VHI agreements provide for fines/compensations in favor of the insured in the event of poor-quality medical services. |
| Choosing a specific specialist | |
| Possible from those doctors who work in a medical facility that provides treatment. | |
| The conclusion of the council of doctors | |
| Provided in case of emergency. | Provided in advanced insurance programs. |
| Medical equipment | |
|
Medical institutions are not always equipped with the necessary equipment. Often the equipment is outdated or missing. |
Clinics are mostly equipped with the necessary equipment. It is possible to use the resources / equipment of several clinics at the same time. |
| Medical preparations | |
| In the course of treatment, both foreign drugs and their Russian counterparts can be used. | In the course of treatment, both foreign drugs and their Russian counterparts can be used. Most often, imported drugs. |
|
What diseases are/are not covered? |
|
| Covers the treatment of most diseases. Detailed list here: Standards of care | At the stage of conclusion of the contract, you can choose required list covered diseases. The wider it is, the higher the cost of the policy. |
| Treatment of critical illness | |
|
Covered. |
Not included in standard packages. By agreement with the insurance company, it can be covered both in Russia and abroad. The cost of such a policy is quite high. |
|
Simple analyzes and studies |
|
| Are covered. | Covered, but most often with restrictions on the number of similar tests / studies in a certain period of time. |
| Complicated or specialized tests/examinations (CT, MRI, biopsy, etc.) | |
| Produced on a general basis or for a fee. Waiting in line can last several months. It is carried out according to the prescription of a doctor. | If it is stipulated in the contract, they are made free of charge without the need to wait in line. It is carried out according to the prescription of a doctor. |
|
Hospitalization |
|
|
Enabled. |
Included if this option is provided in the insurance contract. The terms of the insurance contract may provide for staying in a single ward or in a ward with increased comfort. |
| Rehabilitation | |
|
Included in the policy. It is carried out in the order of the general queue, sometimes according to quotas. |
It is provided if this option is provided for in the insurance contract. The list of rehabilitation measures should be agreed upon at the stage of concluding the contract. |
| Physiotherapy | |
|
Enabled. The list of physiotherapeutic measures is limited by the capabilities of the medical institution. |
Enabled. Quantity and age restrictions may apply. |
|
Expensive and high-tech treatment and drugs |
|
|
Covered on a first-come, first-served basis, often by quotas. |
Agreed with the insurance company as an additional condition. Treatment can be carried out both in Russia and abroad. |
|
Vaccination against influenza, ticks, other seasonal or non-critical diseases |
|
|
Provided in accordance with the national calendar of preventive vaccinations. |
It is provided if this option is provided for in the insurance contract. |
|
Cosmetic surgery and aesthetic prosthetics |
|
|
Not covered. Orthopedic care and dental prosthetics are provided only to certain categories of citizens. |
Cosmetic surgeries - only by individual agreement with the insurance company. Cosmetic dentistry - only if the disease occurred as a result of an accident during the validity of the policy. |
| Consultations and treatment abroad | |
| Not provided. | There are insurance programs that provide consultations and treatment abroad. The cost of such a policy is quite high. |
|
Individual conditions |
|
| Not provided. | By agreement with the insurance company. |
| Related (non-medical) services | |
| They don't turn out. |
The policy may provide for Additional services, as payment for travel to a medical institution, reimbursement of funds for the purchase of medicines, etc. |
Thus, VHI- This is, of course, a very convenient form of health insurance. Of course, the VHI policy is not cheap. Therefore, it is necessary to be very careful when choosing an insurance company, a list of medical institutions and a set of insurance risks provided for by the insurance program.
Health insurance is a social protection citizens, aimed at protecting the health of the population through the provision of medical services and the prevention of diseases. Medical insurance and its types Since 1993, medical insurance has existed in Russia in two forms: compulsory and voluntary. Compulsory health insurance (CHI) is typical for countries with a socially oriented market economy and is part of the system social insurance states. Voluntary (additional) insurance (VHI) is an independent type of health insurance that serves as an addition to the mandatory one. The difference between compulsory medical insurance and VHI When applying to a medical institution, any patient wants to receive qualified and competent help from doctors.
OMS and DMS - the main differences
Being the owner of two policies at once, the insured has the right to seek help from both public and private clinics. These health insurances can be used simultaneously.
When to apply for VHI It is obvious that voluntary medical insurance programs offer more advanced opportunities for diagnosing and treating diseases. Hospitals or departments that serve the clients of the insurer are comfortable and equipped with good equipment.
However, is it necessary to spend money on this type of insurance? Do not forget that the VHI policy does not cover preventive examinations, purchase medicines, psychiatric treatment, pregnancy and childbirth.
What is the difference between oms and dms?
Attention
It so happened that Russians have a rather wary attitude towards medicine. High-quality free medicine, alas, has long sunk into the past, and what remains of it today can hardly be called full-fledged medical care.
Almost every one of us today has a compulsory health insurance policy, but those who have actually tried to be treated with it understand that there is not much help from it. You will be treated by random doctors in public institutions, you will not be able to choose a specialist, since doctors from state institutions are so busy that they are unlikely to take another patient, even if they have expressed a desire to be treated by them.
The difference between OMS and VHI and when it is worth issuing such a policy
Cosmetic surgeries - only by individual agreement with the insurance company. Physiotherapy included. It appears in accordance with statutory standards.
The list of physiotherapeutic measures is limited by the possibilities of honey. institutions. Usually included. Restrictions (for example, age restrictions) may apply.
Important
Rehabilitation Covered in most cases, on a first come, first serve basis. In some cases, treatment is provided by quotas. In the process of treatment, Russian analogues of drugs and medical equipment can be used.
It is provided if this option is provided for in the insurance contract. An extended list of rehabilitation measures may be agreed with the insurance company.
What is regulated The form and conditions for concluding an MHI agreement are regulated by the Legislation of the Russian Federation.
What is the difference between oms and dms
Inpatient care Scheduled hospitalization is carried out on a first come, first served basis, which often takes up to 4 months Hospitalization is carried out in a short time, because there is no priority, rooms are available at any time Hospital rooms are often overcrowded, so they accommodate 7-15 people they are comfortable and designed for a maximum of two people wages Medical staff salaries are paid from commercial funds, therefore, it is high and, accordingly, the level of service is many times higher Is it worth additionally applying for VHI Clinics are equipped with modern equipment Therefore, the examination and treatment of severe types of diseases, often complicated due to crisis phenomena, is carried out using the latest technologies.
The difference between oms and dms
You can find an insurer with its own fleet of ambulances. Possibility to choose a specific specialist and obtain a medical commission’s opinion Not provided Provided in programs that cover a wide range of services Vaccination Provided in accordance with the preventive vaccination calendar Provided in rare cases if it is included in the policy Differences in the features of dental, cosmetic, inpatient, etc.
assistance We use Russian analogues of foreign materials and medicines, old equipment. You usually have to stand in line to get help.
Apply the best means, medicines, tools and hardware installations. Patient service is fast. This is a complete list of differences between CHI and VHI.
DMS and OMS: what is the difference and is there one?
The disadvantage of compulsory health insurance is that it does not cover all types of therapeutic and preventive medical services that a citizen may need. Voluntary health insurance also has its advantages. One of the most enjoyable of them is the freedom of choice. The insured independently draws up an insurance program and selects medical institutions from those offered.
At the same time, the insurer advises him on all issues, but the last word in the choice still remains with the insured. An important nuance can be considered the time savings provided by voluntary medical insurance. There is no need to look for a decent medical institution or push in lines under the door of a doctor's office.
What is different:: compulsory and additional health insurance
Expanded opportunities to receive additional medical care or preventive health care in addition to the mandatory basic program insurance 4 Assistance is provided free of charge, and funds for its provision are provided from territorial insurance funds insurance policy paid by the insured in accordance with the terms of the contract concluded between him and the insurer 5 List of medical institutions that participate in social program, determined by the territorial fund of medical insurance The insurance company independently attracts specially selected clinics to provide quality medical services 6 Financing comes from voluntary contributions, taxes and other items state budget Source financial support voluntary insurance– the insured persons themselves or their employers 7 Tariffs and prices for honey.
OMS and DMS differences table
Service at another facility is provided only when it is impossible to get help at the place of residence. Patients are treated first and can go to any hospital from the list that they have chosen when applying for insurance Special tests Performed on a first-come, first-served basis additional fee or according to the generally accepted rules medical organization They are done if necessary in the direction of a specialist, however, they can be free of charge if it is stipulated in the contract.
As a rule, they are held out of turn. Inpatient treatment Included Included if covered by the policy. You can also immediately decide on the conditions of hospitalization: general or single room, comfort level, etc.
Ambulance Provided according to current legislation It turns out, if it is stipulated in advance.
Dms and oms difference
Leverage of influence on clinics or doctors Provided by the legislation of the Russian Federation. Quality control of medical services is carried out by the insurance company. Some VHI insurance contracts may provide for fines / compensation in favor of the insured in case of poor quality medical services. The conclusion of the consultation of doctors, the choice of a specific specialist Not provided or provided only in emergency cases. Provided in advanced insurance programs. Vaccination against influenza, ticks, other seasonal or non-critical diseases Provided in accordance with the national calendar of preventive vaccinations. It is provided if this option is provided for in the insurance contract. Travel insurance coverage Absent. Depends on the terms of the contract.
What is the difference between oms and dms
Pragma Consult offers you to apply for VHI under the following programs: Program *** Cost of an annual individual policy * ** (rub.) I category II category III category IV category VIP Category "Dentistry" (The number of applications under the policy is unlimited) 15 0007 500 “Outpatient care” Dispatch desk + Home help + Outpatient care + Ambulance + Nurse services Remote Control + Home Help + Outpatient Care + Ambulance + Nurse services + Planned and emergency hospital 36 60018 300 46 60023 300 61 40030 700 76 00038 000 158 60079 300 program.
All citizens of Russia have the right to receive medical care. So, free medical services can be obtained by issuing a policy of compulsory medical insurance (CHI). This document is obtained by a citizen in accordance with the law, and the law regulates the procedure for obtaining the necessary medical services. Treatment is paid for by the compulsory health insurance fund from federal budget. IN this fund every month contributions are made by the employer in whose organization the insured person is registered compulsory medical insurance policy. To receive emergency medical care or contact the clinic at the place of residence, you must have this document on hand.
Of course, not all therapeutic and surgical procedures are covered by a free CHI policy. In addition, the quality of the services provided depends only on the specific clinic and the staff working in it, on the qualifications of health workers. Also, the compulsory health insurance policy does not include the cost of transporting the patient or the purchase of medicines.
The VHI (Voluntary Medical Insurance) policy is an extended version medical insurance, which includes predefined categories of services in a particular hospital. The owner of the VHI policy can independently choose which categories of specialists, types of medicines and tests will be included in his insurance. The scope of services and the list of medical institutions can be expanded at the choice of the applicant.
In addition, a voluntary medical insurance policy will allow you to avoid unnecessary financial expenses and save time, get the insured person any necessary services out of turn. The owner of the insurance can protect himself for the future: for example, take out a policy for expensive treatment in case of serious illnesses and injuries. This type of insurance is used by travelers, people whose work is associated with health risks, outdoor enthusiasts and those involved in extreme sports. The policy is issued at the expense of the owner, the insured or the employer (if the organization cooperates with the insurance company).
Fundamental differences between VHI and OMS
One of the main differences between a voluntary medical insurance policy and a compulsory medical insurance policy is insurance premium at registration (in fact, you buy a VHI policy), as well as the services and clinics chosen by the personally insured. The MHI policy covers the treatment of most diseases. The main difference in the regulations is that the form of concluding an MHI agreement is fixed at the legislative level, while VHI clients draw up an agreement in accordance with Civil Code RF. But the conditions of medical services for VHI are also regulated by the Legislation of the Russian Federation.
Analyzes and procedures for VHI
The owner of the VHI policy has a priority in service - he does not need to wait in line or sign up in advance. Compulsory health insurance covers the cost of almost all simple tests and studies. The same analyzes are also carried out for VHI, however, there may be restrictions on the number of studies of the same type. But complex analyzes and studies in the presence of compulsory medical insurance are paid separately. When applying for a voluntary insurance policy, they can be entered into the contract in advance. The same situation is with vaccination: in the presence of CHI, the patient is vaccinated in accordance with the national calendar of preventive vaccinations, and VHI owners indicate the selected vaccinations at will in the insurance contract.
In addition, the compulsory medical insurance policy includes the immediate hospitalization of the insured, if circumstances so require. The VHI policy also includes hospitalization if there is given condition in the contract, but the insured may stay in a separate room or a room of increased comfort, if such is indicated in the document. The same goes for emergency medical care. At the same time, some insurance companies can provide their customers with ambulances with a dispatcher console.
A citizen receiving medical assistance under compulsory medical insurance cannot choose a polyclinic, he will either have to visit a free one at the place of residence, or go to a paid medical institution. The VHI insured person has the right to receive treatment in any pre-selected clinic, in addition, he can use the resources of several institutions at once. VHI implies the possibility of undergoing treatment abroad.
Patients of free clinics and holders of CHI policies do not have the right to choose a specific specialist, and a meeting of a medical council is held only in an emergency. In the same case, the owner of the VHI policy can pre-select any specialist from the insurance program.
An advantageous difference between VHI and compulsory medical insurance is the possibility of obtaining insurance for those traveling abroad. In some cases, this item can be included in the voluntary insurance policy, while it is simply absent in the mandatory one.
For the most part, treatment with expensive drugs and using high technology under the compulsory medical insurance policy, it passes in the order of priority (with the exception of privileged categories of citizens). In the treatment in this case, analogue Russian medicines and preparations can be used. VHI insurance can include high-tech treatment, expensive drugs, and even procedures abroad. The same distinction applies to cosmetology, or aesthetic prosthetics and rehabilitation.
The compulsory medical insurance policy includes a large list of physiotherapy procedures that are carried out in accordance with the medical legislation of the Russian Federation. True, the list may be limited to a specific medical institution: in some clinics, procedures may simply not be provided. Physiotherapy is also included in the VHI policy, but the contract may specify age restrictions.
How can I get a VHI policy
Insurance companies offer options for registration of many voluntary health insurance programs. Exist family programs, children's programs, programs for pregnant women. For corporate clients group insurance is possible, and you can also choose separate insurance options for travelers and foreigners, or only dental policies.
Design medical policy easy: choose the right one insurance company, you can apply for it at the office of the organization, or online on its website. If you do not yet know which insurance company you should apply to, use the convenient insurance policy calculator at Vyberu.ru. Indicate your gender, age and desired insurance conditions, and the service will select a number of offers for you based on your requests.
To date, there are two types of health insurance - compulsory and voluntary.
CHI- This is compulsory health insurance, which is based on payments of a single social tax. Compulsory medical insurance provides all citizens of the Russian Federation, regardless of gender, age, place of residence and social status, equal opportunities in receiving medical care provided at the expense of financial resources Compulsory medical insurance, in the amount and on conditions corresponding to the programs of compulsory medical insurance.
Under the compulsory medical insurance policy, you can receive services in district clinics at the place of residence, as well as vital services in municipal hospitals, call an ambulance.
VHI is voluntary health insurance. The VHI program includes a list of medical services under the insurance contract that will be paid by the insurer, indicating the total sum insured or individual sums insured for each type of assistance, as well as medical institutions where the insured can receive assistance.
The VHI policy carries an additional package of services, namely:
- Calling a paid ambulance, which is qualitatively different from the state one.
- Calling a highly qualified family doctor who does not work in a polyclinic, but is in a contractual relationship with an insurance company.
- Outpatient care in a good private clinic, departmental clinic, VIP and business class clinics.
- Hospitalization in a superior ward (single-double, with a shower, with a TV, etc.).
- Dentistry.
- Spa treatment.
In addition, VHI differs from CHI in the following ways:
CHI - social, and VHI - commercial insurance.
CHI builds its work on the principle of insurance solidarity, that is, it equalizes the rights of all insured, regardless of their income level and capabilities. VHI is based on the principles of insurance equivalence, that is, under the VHI agreement, the insured receives those types of medical services and in the amounts for which the insurance premium was paid. At the same time, VMI provides policyholders with higher quality medical care that meets individual requirements client.
Participation in VHI programs is not regulated by the state and depends on the needs and capabilities of the insured. For example, in compulsory health insurance, rules, programs, the amount and procedure for paying insurance premiums, standard forms of contracts, a list of medical institutions, and the cost of medical services are developed and approved by the authorities. In VHI, the rules and methodology for calculating insurance premiums are developed by the insurance organization and are only agreed upon by the supervisory authorities for insurance activities. The remaining conditions are regulated by agreements concluded by the subjects of the system.
By VHI policy All services are provided within the framework of the insurance program. Insurance program- this is a list of medical services that will be paid by the insurer when the insured person contacts a medical institution.
The advantage of VHI is that you personally (or your employer) take part in the formation of the insurance program you need, determine the types and scope of services, choose the medical institutions where you would like to be served and treated.
Insurance companies believe that the main problem One of the obstacles to the development of voluntary medical insurance in Russia is the lack of medical institutions capable of providing high quality medical services. Fortunately, Unilab Independent Laboratory is an exception to the rule. Profit is not an end in itself for us, the main thing is the quality of medical services provided to patients. We use advanced diagnostic database and guarantee a high level of medical care and services.