The best companies for voluntary medical insurance. VHI programs for individuals. The best client is a rich foreigner

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For the third time, the Association of Private Clinics of St. Petersburg compiled a rating of insurance companies selling VHI policies to St. Petersburg residents.

In 2015, the voluntary health insurance market was formally growing, but in reality it was shrinking. The volume of VHI collections increased in St. Petersburg by 1.6%. But we must take into account the rise in prices: VHI policies have risen in price by an average of 5-15%, services in city clinics - by 10-12%.

Employers, who form at least 90% of the total voluntary health insurance budget, by purchasing voluntary health insurance policies for their employees, reduced these costs. Many small companies have simply excluded VHI from their social packages, large and medium business optimized VHI programs by reducing the choice of medical institutions or refusing to insure relatives of employees.

How these difficult conditions affected the cooperation of private medical clinics with insurance companies is demonstrated by this rating.

Payments to private clinics

The table below shows the total ranking by the volume of payments according to a survey of clinics and the website.

1. RESO-Garantiya
2. Alliance
3. SOGAZ
4. Rosgosstrakh
5. VTB Insurance
6. AlfaStrakhovanie
7. Renaissance Insurance
8. Consent
9. Ingosstrakh
10. Capital-Polis
11. Medexpress
12. MetLife
13. Hyde
14. Liberty Insurance
15. UralSib
16. VSK
17. British Insurance House
18. Energogarant, North European Branch
19. KRK Insurance
20. GSMK City Medical Insurance Company
21. ZHASO
22. MAX
23. Energogarant, North-Western regional branch
24. Transneft
25. Capital Insurance
26. Absolute insurance (formerly ISK Euro-Polis)
27. Surgutneftegaz
28. ANCHOR
29. Swiss-Garant
30. Investments and Finance
31. Advant insurance
32. Regiongarant
33. Insurance business group
34. Support (formerly Opening insurance)
35. HELIOS
36. Spassky Gate

Payment discipline

The level of payment discipline of insurance companies reflects the presence of debts to clinics for 2015 as of April 1, 2016 and the accuracy of meeting payment deadlines in accordance with the terms of the contract throughout 2015.

1. Investments and Finance, HELIOS
2. Insurance business group
3. MetLife
4. Swiss-Garant
5. British Insurance House
6. Alliance
7. Absolute insurance (formerly ISK Euro-Polis), Surgutneftegaz, VSK, SOGAZ, Rosgosstrakh, Renaissance Insurance
8. RESO-Garantiya
9. Energogarant North European Branch, Medexpress
10. ANCHOR
11. ZHASO, Capital Insurance
12. AlfaStrakhovanie, Liberty Insurance
13. KRK Insurance, Transneft, Regiongarant, Energogarant North-Western regional branch
14. Advant insurance
15. Capital-Polis
16. Ural Sib
16. Spassky Gate
17. Support (formerly Opening insurance)
18. Ingosstrakh, GSMK (City Medical Insurance Company)
19. Hyde
20. Consent
21. MAX
22. VTB Insurance

The list of insurers with debt for 2015 to the clinics of the Association of Private Clinics as of March 30, 2016 included only 13 insurance companies. Let us note that this list has shrunk compared to last year, and in general the financial discipline of reputable insurers has increased. This is a positive dynamic, it speaks of good things financial condition Petersburg insurance market.

It is also important that insurers have debt to no more than 10% of the surveyed clinics.

In general, doctors admit that insurers have begun to pay significantly more in advance for medical services. On the one hand, clinics require this, trying to reduce financial risks, on the other hand, insurers themselves are ready to make advance payments to clinics, subject to providing them with discounts.

Availability of call centers

The quality of work of insurance company call centers was assessed by their availability to clinic doctors if approval was required medical services.

1. Support (formerly Opening insurance)
2. ANCHOR
3. Regiongarant
4. Energogarant, North European Branch
5. Energogarant, North-Western regional branch
6. KRK Insurance
7. Swiss-Garant, Capital-Polis
8. Insurance business group, VSK, Capital Insurance
9. ZHASO, Transneft
10. British Insurance House
11. Surgutneftegaz
12. Ural Sib, Gaide
13. MetLife
14. Advant insurance, Spassky Gate
15. Alliance
16. GSMK City Medical Insurance Company
17. Liberty Insurance
18. Absolute insurance (formerly ISK Euro-Polis)
19. Renaissance Insurance
20. Investments and Finance
21. SOGAZ
22. MAX
23. Consent
24. VTB Insurance
25. AlfaStrakhovanie
26. Medexpress
27. HELIOS
28. Rosgosstrakh
29. RESO-Garantiya
30. Ingosstrakh

Quality of VHI programs

The quality of medical programs was assessed according to such a criterion as the volume of coordination of medical services, which, in essence, reflects the volume of services available to patients. medical care for VHI or the level of restrictions (exceptions) for insurance programs.

Since clinics are interested in programs that do not limit the quality of treatment, companies with prevailing complete programs, ranked more than high place.

1. MetLife
2. AlfaStrakhovanie
3.Capital Insurance
4. VTB Insurance
5. Alliance
6. Capital-Policy, VSK, British Insurance House, Rosgosstrakh
7. SOGAZ
8. Absolute insurance (formerly ISK Euro-Polis)
9. Liberty Insurance
10. Transneft
11. Medexpress
12. Renaissance Insurance
13. Consent
14. Hyde
15. GSMK City Medical Insurance Company
16. Ural Sib
17. MAX
18. RESO-Garantiya
19. Insurance business group
20. Spassky Gate
21. Surgutneftegaz
22. Support (formerly Opening insurance)
23. Energogarant North European Branch, Swiss-Garant, Ingosstrakh
24. Advant insurance
25. ZHASO
26. Regiongarant
27. Energogarant North-Western regional branch
28. KRK Insurance
29. Investments and Finance
30. ANCHOR
31. HELIOS

“In 2015, a trend that appeared two years ago was clearly visible: a decrease in the level of control on the part of insurers’ call centers. Insurers want to spend less on maintaining a call center and give doctors more possibilities make decisions on insurance events yourself. In general, this trend cannot but rejoice, since it is aimed at increasing the satisfaction of the insured patient, increasing efficiency and reducing costs for both parties, training doctors to better understand the principles of insurance and the rules of work under VHI programs,” explained CEO Association of Private Clinics of St. Petersburg Alexander Solonin.

Quality of administration of the medical and economic examination process

This rating was calculated based on two parameters. The first is the quality of expert opinions. Clinics assessed the presence of justifiable reasons for refusing payment and the manner in which they were presented in a convincing manner for the doctor (see Table No. 5).

The second criterion is the timing of registration and transfer of expert opinions to clinics (see Table No. 6).

1. MetLife, AlfaStrakhovanie, Capital Insurance, Kapital-Polis, Transneft, Insurance Business Group, Spasskie Vorota, Surgutneftegaz, Opora (formerly Otkritie insurance), KRK Insurance, Regiongarant, Investments and Finance, ANCHOR, HELIOS, ZHASO
2. Renaissance Insurance
3. Alliance
4. Ural Sib, British Insurance House
5. Medexpress
6. SOGAZ
7. MAX
8. Liberty Insurance, Advant Insurance, Energogarant North-Western Regional Branch, VTB Insurance, VSK,
9. Hyde
10. Swiss-Garant
11. GSMK City Medical Insurance Company
12. Rosgosstrakh, Absolut insurance (formerly ISK Euro-Polis), Energogarant, North European branch
13. Consent
14. RESO-Garantiya
15. Ingosstrakh

1. MetLife, AlfaStrakhovanie, Kapital Insurance, Kapital-Polis, Transneft, Insurance Business Group, Spasskie Vorota, Surgutneftegaz, Opora (formerly Otkritie insurance), Regiongarant, KRK Insurance, Investments and Finance, ANCHOR, HELIOS, Renaissance Insurance, Alliance, Ural Sib, MAKS, Liberty Insurance, Advant Insurance, Energogarant North-West, Gaide regional branch, Swiss-Garant, Rosgosstrakh
2. British Insurance House, Medexpress, VTB Insurance, VSK, GSMK City Medical Insurance Company, Absolut Insurance (formerly ISK Euro-Polis), Energogarant North-European Branch, RESO-Garantiya
3. ZHASO
4. SOGAZ, Consent
5. Ingosstrakh

1. RESO-Garantiya, SOGAZ
2. Renaissance Insurance
3. VTB Insurance
4. Alliance, Capital-Polis
5. AlfaStrakhovanie, Liberty Insurance, British Insurance House
6. Medexpress, MetLife, Ingosstrakh, Rosgosstrakh
7. Absolut insurance, VSK, Gaide, Transneft, Energogarant (North-Western branch)

The sympathy of the clinics remained on the side of IC "RESO-Garantia". It should be noted that the top three in this indicator also included Renaissance Insurance and VTB Insurance, which last year occupied 5th and 6th positions, respectively, in the trust rating. They managed to move such large insurers as Alliance, Capital-Policy and Rosgosstrakh. However, taking into account all other evaluation criteria, the final rating of insurance companies looks different.

In the final table, places are distributed based on the multiplicative indicator of business reputation according to the 6 above criteria. Thus, at the end of 2015, IC RESO-Garantiya moved from first place to third, SOGAZ remained in second, and Alliance became the leader of the rating.

1. Alliance
2. SOGAZ
3. RESO-Garantiya
4. RenaissanceInsurance
5. AlfaStrakhovanie
6. Capital-Polis
7. Rosgosstrakh
8. VTB Insurance
9. MetLife
10. Medexpress
11. Liberty Insurance
12. British Insurance House
13. Consent
14. VSK
15. Hyde
16. UralSib
17. Ingosstrakh
18. Capital Insurance
19. Energy Garant, North European Branch
20. Transneft
21. ZHASO
22. KRK Insurance
23. GSMK City Medical Insurance Company
24. Absolute insurance (formerly ISK Euro-Policy)
25. Surgutneftegaz
26. MAX
27. Energogarant, North-Western regional branch
28. ANCHOR
29. Insurance business group
30. Swiss-Garant
31. Investments and Finance
32. Regiongarant
33. Support (formerly Opening insurance)
34. Advant insurance
35. Spassky Gate
36. HELIOS

This time, in addition to private clinics that are members of the SRO "Association of Private Clinics of St. Petersburg", 11 more large ones were involved in the survey medical organizations, actively working in the St. Petersburg voluntary health insurance market. As a result, the total number of respondents was 49 medical companies, which together manage more than 150 private clinics in our city. The questionnaires were filled out by clinic directors, medical experts, heads of departments and employees financial services.
This year, voluntary health insurance market experts developed a fundamentally new methodology for compiling a rating, which makes it possible to combine indicators according to several criteria that were previously assessed only separately.
1) The volume of payments transferred to private clinics this year was taken into account both according to clinic data and information on payments from insurance companies (according to reporting to the Central Bank from the website, see table No. 1).
2) Level of payment discipline - the 2016 rating took into account two indicators: timely payment of bills in accordance with the agreement and the absence of debt for 2015 (see Table No. 2).
3) Availability of call centers (see Table No. 3).
4) Quality of VHI programs (see Table No. 4).
5) The quality of administration of the medical and economic examination process - this rating took into account, on the one hand, the quality of expert opinions (see Table No. 5), and on the other hand, the timing of their provision to clinics (see Table No. 6).
6) Trust of clinics (see Table No. 7).

For each of the criteria, a rating was compiled. These ratings were subsequently combined into a final one, taking into account weighting coefficients, the value of which varied from 3 to 30% (see Table No. 8). The highest weight - 30% - is for the indicator “volume of payments to private clinics”, the lowest weight - 3% - for the indicator “compliance with deadlines for issuing expert opinions”. Call center availability was assessed at a rate of 5%. It is obvious that private clinics cash flow much more important than call center availability.
The rating included real players in the VHI market: 36 insurance companies (last year there were 39). In addition to the “dead souls”, insurance companies whose licenses were revoked or suspended in 2015 were excluded from the register of insurers. These are “Avesta”, “ASK-med”, “Hephaestus”, INSOTEK, “Oranta”, “Help”, as well as those with whom a significant part of the clinics terminated the contract due to the presence of IC financial problems.

Alexey KRYLOV, “City 812”

IN In 2015, the voluntary health insurance market was formally growing, but in reality it was shrinking. The volume of VHI collections increased in St. Petersburg by 1.6%. But we must take into account the rise in prices: VHI policies have risen in price by an average of 5-15%, services in city clinics - by 10-12%.

Employers, who form at least 90% of the total voluntary health insurance budget, by purchasing voluntary health insurance policies for their employees, reduced these costs. Many small companies have simply excluded VHI from their social packages; large and medium-sized businesses have optimized VHI programs by reducing the choice of medical institutions or refusing to insure relatives of employees.

How these difficult conditions affected the cooperation of private medical clinics with insurance companies is demonstrated by this rating.

This time, in addition to private clinics that are members of the SRO “Association of Private Clinics of St. Petersburg,” 11 other large medical organizations actively working in the St. Petersburg VHI market were involved in the survey. As a result, the total number of respondents was 49 medical companies, which together manage more than 150 private clinics in our city. The questionnaires were filled out by clinic directors, medical experts, heads of departments and financial services employees.

This year, voluntary health insurance market experts developed a fundamentally new methodology for compiling a rating, which makes it possible to combine indicators according to several criteria that were previously assessed only separately.

1) The volume of payments transferred to private clinics this year was taken into account both according to clinic data and information on payments from insurance companies (according to reporting to the Central Bank from the website insur-info.ru, see table No. 1).

3) Availability of call centers (see Table No. 3).

4) Quality of VHI programs (see Table No. 4).

5) The quality of administration of the medical and economic examination process - this rating took into account, on the one hand, the quality of expert opinions (see Table No. 5), and on the other hand, the timing of their provision to clinics (see Table No. 6).

6) Trust of clinics (see Table No. 7).

The rating included real players in the VHI market: 36 insurance companies (last year there were 39). In addition to the “dead souls”, insurance companies whose licenses were revoked or suspended in 2015 were excluded from the register of insurers. These are “Avesta”, “ASK-med”, “Hephaestus”, INSOTEK, “Oranta”, “Pomoshch”, as well as those with whom a significant part of the clinics terminated the contract due to financial problems with the insurance company.

Payments to private clinics

“Previously, the indicator of payments to private clinics was not taken into account, but its importance was recognized because it reflects the insurer's experience and the size of its client portfolio. Rating current year is unique precisely because for the first time clinics provided information on the volume of payments by insurers for insured events. For this purpose, a special software, which guarantees the confidentiality of data collection and storage and automatically processes the results to the level of a consolidated report,” comments Tatyana Romanyuk, director of the EMC clinic, chairman of the standardization and informatization committee of the SRO “Association of Private Clinics of St. Petersburg.”

Payment discipline

The level of payment discipline of insurance companies reflects the presence of debts to clinics for 2015 as of April 1, 2016 and the accuracy of meeting payment deadlines in accordance with the terms of the contract throughout 2015.

The list of insurers with debts to the Association’s clinics for 2015 as of March 30, 2016 included only 13 insurance companies. Let us note that this list has shrunk compared to last year, and in general the financial discipline of reputable insurers has increased. This is a positive trend; it indicates the good financial condition of the St. Petersburg insurance market.

It is also important that insurers have debt to no more than 10% of the surveyed clinics.

“In conditions of economic instability, clinics must constantly monitor the market situation, assessing financial risks. These risks are always of the same type: first, the insurer begins to violate the deadlines for paying bills, then debts accumulate, then the clinics find out that the insurance company’s license has already been revoked and the chances of the clinic to receive money for debts from such insurers are zero. True, it should be said that, for example, the Pomoshch company, which lost its license in 2015, regained it at the end of the year. Now “Help” is making serious efforts to restore its reputation and pay off debts with clinics,” comments Lev Averbakh, General Director of “CORIS Assistance (SPb).”

Availability of call centers

The quality of work of insurance company call centers was assessed by their availability to clinic doctors when it was necessary to coordinate medical services.

Rating of insurance companies operating in the VHI system

Quality of VHI programs

The quality of medical programs was assessed by such a criterion as the volume of coordination of medical services, which, in essence, reflects the volume of medical care available to patients under VHI or the level of restrictions (exclusions) under insurance programs.

“This indicator also reflects the specifics of the portfolio of insurance companies: companies that are able to attract solvent clients usually offer more comprehensive programs. The presence of reduced programs among many insurance companies indicates a certain market trend in conditions of an unstable economy and reduced solvency,” emphasizes Alexey Vlasov, commercial director of AVA-PETER LLC (AVA-PETER and Scandinavia clinics).

Since clinics are interested in programs that do not limit the quality of treatment, companies with more complete programs took a higher place in the ranking.

Rating of insurance companies operating in the VHI system

“In 2015, a trend that appeared two years ago was clearly visible: a decrease in the level of control on the part of insurers’ call centers. Insurers want to spend less on call center maintenance and give doctors more opportunity to make decisions on insurance events themselves. In general, this trend cannot but rejoice, since it is aimed at increasing the satisfaction of the insured patient, increasing efficiency and reducing costs for both parties, training doctors to better understand the principles of insurance and the rules of work under VHI programs,” explained the General Director of the Association of Private Clinics of St. Petersburg Alexander Solonin.

Quality of administration of the medical and economic examination process

This rating was calculated based on two parameters. The first is the quality of expert opinions. Clinics assessed the presence of justified reasons for refusing payment and the manner in which they were presented in a convincing manner for the doctor (see Table No. 5). “Often the acts simply do not contain substantiated arguments for the reasons for refusing payment. Such negligence in the work of experts and the lack of dialogue between experts and doctors is a significant drawback; this creates a negative attitude in the doctor towards the insurance company and leads to conflicts that are undesirable for us,” comments Konstantin Sharko, operating director of the SMT holding.

The second criterion is the timing of registration and transfer of expert opinions to clinics (see Table No. 6). "IN Lately some Insurance companies allow themselves to send examination reports six months or more later, without thinking that based on the results of examinations, clinics maintain financial and accounting records, as well as explanatory work with doctors, and that this work clinics must be carried out in a timely manner,” emphasized Lev Averbakh, General Director of CORIS Assistance (SPb).

Rating of insurance companies operating in the VHI system

“We have certain difficulties in interacting with some insurance companies in this matter. Medical and economic examination is a process in which there are a lot of blind spots, pitfalls and contradictions that tempt the parties to move away from main goal examination,” comments Oksana Adamenko, deputy director of the “XXI Century” network of clinics. “And yet our main task is to provide quality medical care to the insured. And in this our interests completely coincide with the interests of insurance companies. And both sides have difficulties with the availability of call centers. We solve them, integrate processes for faster communication.”

Rating of insurance companies operating in the VHI system

The sympathy of the clinics remained on the side of IC "RESO-Garantia". It should be noted that the top three in this indicator also included Renaissance Insurance and VTB Insurance, which last year occupied 5th and 6th positions in the trust rating, respectively. They managed to move such large insurers as Alliance, Capital-Policy and Rosgosstrakh. However, taking into account all other evaluation criteria, the final rating of insurance companies looks different.

More detailed information about the methodology for questioning experts and the results of the rating can be found on the website of the SRO “Association of Private Clinics of St. Petersburg” www.acspb.ru.

General situation in the voluntary health insurance market

At the end of 9 months of 2015, it grew by only 3%. Unlike other types of insurance - or, which are quite feverish for various reasons, VHI remains a kind of quiet haven, where everything goes on as usual and without major shocks.

According to the figures, VHI for 3 quarters changed as follows. Insurance premium collections amounted to 108.5 billion rubles, an increase of 3.2% compared to 2014. Payments insurance compensation grew a little faster - plus 5.8% to 73.5 billion rubles.

The overall disbursement rate (the ratio of disbursements to collections) increased by 1.6 percentage points to 67.7%.

Market concentration

As for the concentration of the market in the hands of leading players, here VHI keeps pace with all other types of insurance.

For 9 months of 2015 30 largest companies accumulated 91.7% of all collections in the country. A year earlier, this figure was 90.1%.

The main reason for the increase in concentration is the policy of the Central Bank of the Russian Federation aimed at systematically clearing the market of unscrupulous insurers. The revocation of licenses frees up market shares, which are naturally distributed among existing players.

There is no need to talk about monopolization, because within the “thirty” fees are distributed quite evenly. Except that due to the emphasis on needs oil and gas sector holds a third of the entire voluntary health insurance market. Which mirrors where a third of the fees come from.

Top 30 VHI insurers

Now let's take a look at what the rating of the largest insurance companies for VHI looks like.

The first is the castling of companies and , exchanging 3 and 5 places, respectively. Despite the fact that VHI became the main priority of the Alliance, the active restructuring of the company and the refusal of a number of types of insurance still affected medical fees (minus 11%).

The second one made it into the top ten. Having declared a battle against auto insurance and opened its arms to voluntary health insurance, the company is actively increasing its turnover - an increase of more than 70% of the volume of collections in 2014.

The most interesting, as usual, is at the bottom of the rating.

Four newcomers appeared in the top 30 at once. Companies, Independent insurance group and significantly improved their box office figures and confidently took their debut places in the top thirty leaders.

Of the significant drops, only the company left a trace, with the caveat that in 2014 the insurer took 32nd place with collections of 301 million rubles. At the beginning of 2015, the company completely curtailed its business health insurance, and in November the Central Bank of the Russian Federation revoked its license.

Stay tuned. Analytics on insurer ratings are published on a regular basis.

Summary

Unnecessary development: as part of the modernization of the compulsory health insurance system, the state seeks to minimize the volume of the voluntary health insurance market, which may negatively affect the entire health care system. The healthcare development strategy until 2020 states that the operation of the VHI market leads to “a decrease in the availability and quality of medical care for the population served under the state guarantee program.” Based on this, the state does not support the development of the voluntary health insurance market.

However, in conditions of insufficient funding for the healthcare system, such a position will lead to an increase in shadow payments and a decrease in the efficiency of the entire compulsory medical insurance system. According to Expert RA, the work of the VHI market has a number of positive external effects: increased social stability, reduced information asymmetry in the medical services market, increased efficiency of the healthcare system and increased investment in the construction of medical centers. Given these external effects, the state, on the contrary, should promote development Russian market VHI.

“Expert RA” has developed the main provisions of the strategy for the development of the VHI market, which should become an integral part of the concept for the development of the healthcare system. The main directions of the strategy: a clear separation of the compulsory health insurance and voluntary health insurance systems, updating the product line and standardization of voluntary health insurance contracts, as well as simplifying the application tax benefits.

Pricing is becoming clearer: a direct dependence of the cost of medical services on the service and quality of equipment has appeared in the healthcare facility market. Just a few years ago, there was no correlation between these indicators. In addition, compared to 2006, there was a general increase in the quality of services medical institutions. In general, the ratings of departmental clinics in all respects were higher than those of private clinics. In private clinics for adults, an inverse relationship between the cost of services and the professionalism of medical personnel was revealed.

According to the results of the study, the highest indicators in terms of price/quality ratio were:

National Health Institution Central Polyclinic of JSC Russian Railways (outpatient services for adults);
Branch No. 5 of the Federal State Institution “3 TsVKG im. A.A. Vishnevsky Ministry of Defense of Russia" (outpatient services for children);
National Health Institution "Central Clinical Hospital No. 1 of JSC Russian Railways" (hospital for adults);
State Institution "Research Institute of Emergency Pediatric Surgery and Traumatology" of the Moscow Department of Health (hospital for children).

Fiscal effect: an increase in contributions to compulsory health insurance from 3.1 to 5.1% will lead to a reduction in budgets for voluntary health insurance. This measure will have a particularly significant impact on the still unstable demand from small and medium-sized businesses, which increased with the expansion of tax benefits in 2009 (the rate attributing VHI premiums to production costs increased from 3 to 6%). Nevertheless, the growth of the VHI market will continue, at least due to inflation in the cost of medical services. According to Expert RA forecasts, in 2011 the volume of the voluntary health insurance market will be 89.6 billion rubles (+10%), in 2012 - 100.3 billion rubles (+12%).

Possibility to choose health care facilities and doctors according to compulsory medical insurance program, as well as the inclusion of private clinics in the compulsory medical insurance system will lead to a redistribution of the VHI market. In this situation, 2 scenarios are possible:

1) If you can choose a clinic with a high level of service and quality of services provided under the compulsory medical insurance program, there is no need to purchase VHI policy. In the future, the compulsory health insurance system may well provide serious competition to voluntary health insurance.

2) Clinics high level will not want to enter the compulsory medical insurance system, but instead clinics with more low level. Then the demand for voluntary health insurance will increase, and due to the lack of high-quality competition between clinics, there will be no incentive to improve the service and quality of services provided by municipal clinics.

Treatment at the expense of insurers: the loss rate of the VHI business in 2010 exceeded 100%. The average value of the combined net loss ratio for 9 months of 2010 was already 99% (for 9 months of 2009: 90%). The main reasons for the increase in unprofitability: dumping, “cheating” of health care facilities and incorrect organization of the loss settlement system - payments are made not as a result of the occurrence insured event, but on the fact of visiting a health care facility.

The share of Russians' spending on healthcare in their total spending over the past 15 years has increased from 2.2% to 3.6%. This reverse side saving the state on free medicine. It is clear that with this trend, no one will refuse a voluntary health insurance policy (VHI), especially if it is paid for by the employer. But the macroeconomic situation of the last 2.5 years has forced employers to save on VHI. And workers must adapt to these savings. How does this affect the position of insurance companies? We analyze the Russian and St. Petersburg TOP-10.

On a federal scale

According to Central Bank Russia, federal tax for voluntary health insurance (VHI) in 2016 increased compared to the level of 2015 by 6.8% - to 137.8 billion rubles. (compared to RUB 129 billion in 2015).

Detailed processing of all indicators of the insurance market has been carried out for many years by the Insurance Today Group. This time the VHI market estimates were as follows:

VHI. TOP 10: largest insurance companies (Russia, 2016)

№	Company	Receipts, billion rubles (% of total market)	№	Company	Payments, billion rubles (% of total market)
1	SOGAZ	44,33 (32,17%)	1	SOGAZ	37,81 (37,57%)
2	RESO-Garantiya	11,68 (8,47%)	2	RESO-Garantiya	8,05 (8%)
3	Alliance Life	9,67 (7,02%)	3	Inogosstrakh	6,46 (6,42%)
4	AlfaInsurance	8,99 (6,52%)	4	AlfaInsurance	6,30 (6,26%)
5	Rosgosstrakh	8,04 (5,83%)	5	ZHASO	5,53 (5,5%)
6	Inogosstrakh	7,73 (5,61%)	6	Alliance Life	4,56 (4,53%)
7	Renaissance Insurance	5,74 (4,17%)	7	Rosgosstrakh	4,45 (4,42%)
8	ZHASO	5,27 (3,82%)	8	Renaissance Insurance	3,16 (3,15%)
9	VTB Insurance	4,58 (3,33%)	9	VTB Strazovanie	2,61 (2,6%)
10	VSK	4,30 (3,12%)	10	VSK	2,21 (2,19%)
Total		110, 33 (80,06%)	Total		81,14 (80,63%)
Total by market			Total by market

Another very important indicator the work of an insurance company (perhaps even more important than the absolute value of fees) is the share of payments from the volume of money collected by the insurer. In 2016, this share in the VHI market in Russia on average was 73%. For comparison: in the first “crisis” year of 2015 it was 77.3%, in the last relatively “well-fed” year of 2014 – 76.7%, and in 2013 – 78.2%.

WITHratio of payments and fees, %(Russia, 2016)

№	Company	Payout to fee ratio (%)
1	ZHASO	104,98
2	SOGAZ	85,29
3	Ingosstrakh	83,52
4	AlfaInsurance	70,03
5	RESO-Garantiya	68,94
6	VTB Insurance	57,07
7	Rosgosstrakh	55,36
8	Renaissance Insurance	55,12
9	VSK	51,35
10	Alliance Life	47,15
Average		73,54

Source: City 812.

As we can see, the top part of the TOP 10 in terms of collections was comprised primarily of insurance companies whose share of payments was noticeably lower than in the ideal scenario (73–78%). But, apparently, their lack of readiness to pay was compensated by reliability, size branch networks and brand recognition.

Regionally

In 2016, 51 insurance companies operated in the St. Petersburg VHI market (it is calculated separately from the regional one), and the 6 most unlucky of them sold VHI in amounts ranging from 2 thousand to 71 thousand rubles.

VHI. TOP 10: largest insurance companies in St. Petersburg (2016)

№	Company	Receipts, billion rubles (% of total market)	№	Company	Payments, billion rubles (% of total market)
1	SOGAZ	2,07 (18,86%)	1	SOGAZ	1,82 (24,92%)
2	RESO-Garantiya	1,33 (12,06%)	2	RESO-Garantiya	0,78 (10,68%)
3	Renaissance Insurance	1,26 (11,50%)	3	Renaissance Insurance	0,68 (9,37%)
4	Rosgosstrakh	0,88 (7,98%)	4	Rosgosstrakh	0,62 (8,47%)
5	Capital-Polis	0,79 (7,20%)	5	Capital-Polis	0,60 (8,23%)
6	Alliance Life	0,78 (7,08%)	6	AlfaInsurance	0,38 (5,22%)
7	VSK	0,499 (4,54%)	7	Agreement	0,36 (4,93%)
8	AlfaInsurance	0,497 (4,52%)	8	Alliance Life	0,35 (4,84%)
9	Medexpress	0,46 (4,21%)	9	Medexpress	0,33 (4,48%)
10	Agreement	0,42 (3,79%)	10	Uralsib	0,22 (3,021%)
Total			Total		6,15 (84,16%)
Total by market			Total by market

Sources: Central Bank of the Russian Federation; MIG “Insurance today”.

As can be seen from the table, the VSK company, a participant in the regional TOP-10 in terms of collections, is not included in the same top in terms of payments, and SG UralSib is the opposite. These two companies destroyed the complete unity of the two regional TOP-10.

It is worth noting that in the St. Petersburg ranking of the largest VHI insurers there was a place for two local companies - Capital-Policy and Medexpress. At the same time, they look very respectable in a rating based on the ratio of fees and payments (see below).

TOP 10 by ratio of payments and fees, %(St. Petersburg, 2016):

Source: City 812.

Due to the discrepancy between the two top 10, we were able to rank only 9 companies out of 51 operating in the St. Petersburg market in 2016. As we see, in St. Petersburg, IC Soglasie spent money on the treatment of its clients much more actively than in the country as a whole, and Ingosstrakh, on the contrary, did not even make it into the top 10 according to this criterion.

The best client is a rich foreigner

In 2015–2016, the St. Petersburg voluntary health insurance market actually stood still in terms of collection volumes. But in each insurance company individually, the results differed more dramatically.

For example, in the St. Petersburg branch of the AlfaStrakhovanie company in 2016, fees decreased by 3%. The head of the VHI department of the branch, Lydia Berezka, explains this by the fact that client companies, while maintaining the number of their insured persons and the volume of services for them, nevertheless choose more economical options for VHI programs for some clients.

It is clear that with this approach, you can save money only by downgrading the class of medical institutions.

In turn, in the larger Rosgosstrakh, VHI fees in 2016 decreased by 49.5%. There were also clients here who stopped insuring themselves altogether. Viktor Possokhov, head of the VHI department at Rosgosstrakh-North-West, says: “Of my clients who were insured for 10–15 years, approximately 10% of enterprises stopped insuring themselves under VHI and went nowhere. Those. not a single insurance company agreed to serve them under the conditions they set.”

Viktor Posokhov gives a price guide: the cheapest corporate program, which includes only emergency assistance and emergency hospitalization, costs 2.5–3.5 thousand rubles per person per year for large groups. That is, in 2016, enterprises decided to save on such small amounts.

However, there are also insurance companies in the regional top 10 that have demonstrated growth in all criteria - both in the number of insured people and in the volume of voluntary health insurance programs paid for them. For example, the deputy director for medical insurance of the St. Petersburg branch of the Alliance Life insurance company, Iphigenia Mayorova, reported that in 2016 this branch collected 8% more than in 2015. (778.7 million rubles instead of 720.7 million).

“In St. Petersburg, our collections are more or less constant, there is a slight increase. New clients are primarily IT companies,” noted Iphigenia Mayorova. “In 2016, all our insurers maintained voluntary health insurance for their employees in the same amount, and even with an increase.”

At the end of 2016 – beginning of 2017, renewable voluntary health insurance contracts at Alliance Life increased in price by 5–7%. The same, according to Ms. Mayorova, will happen in 2017.

“This is inevitable, since medical inflation in 2016 was 8.2%,” says Mayorova. – Some medical institutions increased prices in the fourth quarter of 2016, and the rest - in the first quarter of 2017. On average by 7%."

Ms. Mayorova explains the reasons that this company’s fees are not only maintained, but also growing: “Our clients are, after all, mostly foreign enterprises. And by industry affiliation - tobacco workers, automakers, programmers. Such enterprises suffer less during a crisis.”

Who is in charge in the “insurer-clinic” pair?

In the last few years, insurers have been dictating the market. Thus, Viktor Possokhov (Rosgosstrakh - North-West) says: “The main trend of last and present years is a decrease in the flow of insured people (and therefore patients) to clinics. Therefore, last year the RGS decided to terminate contracts with those clinics with which it did not work in 2016 (although there were contracts) or worked in small volumes (5-10 thousand rubles a year is essentially nothing). We have already terminated 150 contracts out of the existing 480, and this process continues. About 50 clinics remain on the priority list. We convinced the companies that buy VHI of this: it’s better to have fewer clinics on the VHI list, but all of them are very reliable, and the main thing is that the insurance company has confidence in them.”

Galina Sergeeva, Deputy Director for personal insurance the northwestern branch of the British Insurance House IC (its fees in St. Petersburg in 2016 increased by 8.2%). According to Sergeeva, the outflow of clients in the branch in 2016 was 15%, but the remaining programs did not decrease at all. They have not decreased, partly because BSD carefully selects medical institutions personally for each of its clients.

“Each medical institution decides to change prices for its services based on many factors. This includes the profile of the medical institution, the volume of services provided, the volume of work under VHI, and many others,” she explains. “Of course, there is an increase in prices, but not for all types of services... And not even in all health care facilities... Therefore, we also have the opportunity to choose an option that suits everyone and remain flexible in relation to our clients.”

Small insurance companies are being forced to be even more creative. For example, Alexander Lazarev, vice-president of IC MetLife (collections in St. Petersburg in 2016 increased by 9.6%) says: “Last year, in order to help clients maintain the content of VHI programs, we began to pay more attention to issues of medical examination and evaluate the work of medical institutions on the basis of the so-called medical and economic standards (MES). MES are based on determining the cost of standard treatment programs. Then, based on this cost, the price for the entire range of services provided to the patient is calculated. He never overpays at all and even saves.”

This year MES will undergo further computerization.

“Our plans for 2017 include automation of processes for processing invoices from clinics,” says Lazarev. “This will not only increase the efficiency of our accounting department, but will also allow us to eliminate the subjective human factor when working with our partners.”

Employees are involved in co-financing

According to Galina Sergeeva from the British Insurance House, in 2016 and 2017 the share of corporate clients, which offer their employees to partially pay for voluntary health insurance. The employer can pay, depending on his assessment of the employee, from 30 to 100% of the price of voluntary health insurance.

Ms. Sergeeva categorically disagrees with the widespread thesis that only those who know in advance about their illnesses and 100 percent intend to receive treatment under VHI agree to co-finance VHI.

“Not all employees refuse additional payments, because people are accustomed to VHI (primarily the service, as well as the ability to choose health care facilities and a doctor),” she says. “And an additional payment of 50% of 16–20 thousand rubles (i.e., the price of a business-level program), paid throughout the year from salary, is quite feasible for any employee.”