LEGAL REGULATION OF FINANCIAL RELATIONSHIPS IN THE FIELD OF COMPULSORY HEALTH INSURANCE
( Pp. 269-274)
More about authors
Borisov Daniil V.
rukovoditel sluzhby yuridicheskoy praktiki
LLC «Kapital Meditsinskoye Strakhovaniye»
LLC «Kapital Meditsinskoye Strakhovaniye»
Abstract:
The purpose of the study is to analyze the theoretical and legal aspects of the functioning of such a social institution as compulsory health insurance. The task of the study is to reveal the essence of this institution, along the way determining the possibilities of its improvement in modern conditions, as well as the development prospects and problems affecting the activities of its main subjects. The author draws attention to the fact that in the field of legal regulation of the interaction of the participants in these relations, there are significant contradictions, most of which concern the issue of allocating and using the necessary means. Conclusions. With the main conclusions, the author confirms the opinion of researchers about the insufficient regulation of issues related to the determination of the existing order of financial interaction between medical organizations and insurance companies, and believes that the Russian authorities need to make a partial correction of the provisions that define it. The author of the study connects this, first of all, with the imperfection of the compulsory health insurance system itself, which is a mixed model of a semi-social type, where the role of medical insurance organizations, as well as their legal status, is initially strongly dependent on other subjects of the relations under consideration. The author considers the need for amendments to be paramount in solving this problem, by which the vector of control over the quality and validity of the provision of necessary medical services will be shifted towards their executors (medical institutions). At the same time, the author proposes to bring the issue of interpretation and use of some concepts contained in the sources of law regulating the procedure for the implementation of compulsory health insurance in the mainstream of legislative correction. Also, this study raises the question of the need to expand the powers of insurance organizations in terms of independent determination of the quality and quantity of services provided by medical organizations.
How to Cite:
Borisov D.V., (2021), LEGAL REGULATION OF FINANCIAL RELATIONSHIPS IN THE FIELD OF COMPULSORY HEALTH INSURANCE. Economic Problems and Legal Practice, 3 => 269-274.
Reference list:
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Sobolev K.E., Pirogov M.V. Novatsii 2020 goda v pravilakh obyazatel nogo meditsinskogo strakhovaniya. Bukhuchet v zdravookhranenii. 2020. № 9. S. 70-80.
CHamkin P.A. Problemy i perspektivy reformirovaniya sistemy obyazatel nogo meditsinskogo strakhovaniya v Rossii. Ekonomika i upravlenie: problemy, resheniya. 2020. T. 1. № 11 (107). S. 68-80.
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Minzdrav Rossii utverdil poryadok ispol zovaniya sredstv normirovannogo strakhovogo zapasa FOMS // Elektronnyy resurs . Sayt Federal nogo fonda obyazatel nogo meditsinskogo strakhovaniya. Dostup: URL: http://www.ffoms. gov.ru/system-oms/ (data obrashcheniya: 25.05.2021).
Obzor sudebnoy praktiki Verkhovnogo Suda RF N 4 (2018) (utv. Prezidiumom Verkhovnogo Suda RF 26 dekabrya 2018 g.) // Byulleten Verkhovnogo Suda RF. Avgust. 2019. N 8.
Opredelenie SK po ekonomicheskim sporam Verkhovnogo Suda RF ot 18 oktyabrya 2018 g. N 308-ES18-8218 po delu N A15-6379/2016 Sud otmenil prinyatye ranee sudebnye akty i vzyskal dolg po dogovoru na okazanie i oplatu meditsinskoy pomoshchi po obyazatel nomu meditsinskomu strakhovaniyu, poskol ku pri otsutstvii dokazatel stv togo, chto okazannye uslugi ne vkhodyat v programmu OMS, i pri otsutstvii faktov narusheniya meditsinskoy organizatsiey trebovaniy, pred yavlyaemykh k predostavleniyu meditsinskoy pomoshchi, meditsinskie uslugi, okazannye sverkh ob ema, ustanovlennogo resheniem komissii po razrabotke territorial noy programmy OMS, dolzhny priznavat sya podpadayushchimi pod strakhovoe obespechenie po OMS i podlezhashchimi oplate v polnom ob eme. // Dokument opublikovan ne byl.
Korablev V.N. Ekonomicheskie problemy meditsinskogo strakhovaniya v RF. Zdravookhranenie Dal nego Vostoka. 2020. № 4 (86). S. 22-28.
Sobolev K.E., Pirogov M.V. Novatsii 2020 goda v pravilakh obyazatel nogo meditsinskogo strakhovaniya. Bukhuchet v zdravookhranenii. 2020. № 9. S. 70-80.
CHamkin P.A. Problemy i perspektivy reformirovaniya sistemy obyazatel nogo meditsinskogo strakhovaniya v Rossii. Ekonomika i upravlenie: problemy, resheniya. 2020. T. 1. № 11 (107). S. 68-80.
SHaripova L.I. Lichnoe strakhovanie: neobkhodimost i osobennosti. Struktura lichnogo strakhovaniya. Colloquium-journal. 2020. № 32-1 (84). S. 18-20.
SHumaeva E.A., Grinchuk V.I. Analiz zarubezhnykh sistem gosudarstvennogo obyazatel nogo meditsinskogo strakhovaniya. Universitetskaya klinika. 2020. № 2 (35). S. 84-91.
Minzdrav Rossii utverdil poryadok ispol zovaniya sredstv normirovannogo strakhovogo zapasa FOMS // Elektronnyy resurs . Sayt Federal nogo fonda obyazatel nogo meditsinskogo strakhovaniya. Dostup: URL: http://www.ffoms. gov.ru/system-oms/ (data obrashcheniya: 25.05.2021).
Obzor sudebnoy praktiki Verkhovnogo Suda RF N 4 (2018) (utv. Prezidiumom Verkhovnogo Suda RF 26 dekabrya 2018 g.) // Byulleten Verkhovnogo Suda RF. Avgust. 2019. N 8.
Opredelenie SK po ekonomicheskim sporam Verkhovnogo Suda RF ot 18 oktyabrya 2018 g. N 308-ES18-8218 po delu N A15-6379/2016 Sud otmenil prinyatye ranee sudebnye akty i vzyskal dolg po dogovoru na okazanie i oplatu meditsinskoy pomoshchi po obyazatel nomu meditsinskomu strakhovaniyu, poskol ku pri otsutstvii dokazatel stv togo, chto okazannye uslugi ne vkhodyat v programmu OMS, i pri otsutstvii faktov narusheniya meditsinskoy organizatsiey trebovaniy, pred yavlyaemykh k predostavleniyu meditsinskoy pomoshchi, meditsinskie uslugi, okazannye sverkh ob ema, ustanovlennogo resheniem komissii po razrabotke territorial noy programmy OMS, dolzhny priznavat sya podpadayushchimi pod strakhovoe obespechenie po OMS i podlezhashchimi oplate v polnom ob eme. // Dokument opublikovan ne byl.
Keywords:
legislation, territorial program, health insurance, financing.
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