The problems of paying for medical care provided to residents of other subjects of the Russian Federation within the framework of compulsory medical insurance

The legislation guarantees citizens the right to receive medical care under a compulsory health insurance policy (CHI) throughout the Russian Federation. But in some cases, in accordance with current legislation, a referral is required to receive medical care. This also applies to situations where a citizen receives medical care outside of the subject of the Russian Federation where the citizen is insured. The system of such referrals to medical organizations located in another region is more or less regulated only when they are sent to Federal medical organizations. The situation is further compounded by the fact that the Supreme court contrary to law, making decisions, actually leveling a direction. At the same time, payment for medical care provided outside the region in which the MHI policy is issued depends on the payment of this assistance from the Territorial Fund of this region. This leads to numerous delays in payment and, as a result, reduces the interest of medical organizations in providing medical care to "nonresidents". Patients suffer as a result. All this raises the question of the need to improve the current mechanism for conducting inter-territorial settlements in the MHI system.

Authors: F.  N.  Kadyrov [9] O.  V.  Obukhova [3] Yu. V. Endovitskaya [6]

Tags: compulsory medical insurance18 federal  compulsory  medical  insurance  fund1 insurance medical organizations4 inter- territorial  settlements1 medical organizations23 payment for medical care4 standardized  insurance  stock.1 territorial  compulsory  medical   insurance  funds1