Medical insurance: new approaches
The Bank of Russia is seeking feedback from professional and expert communities on the prospects of developing medical insurance, the new principles governing the regulation of medical insurers (MIs), and the proposed creation of integrated supervision over MI operations. The regulator presents these initiatives in its consultation document.
Medical insurance programmes are a key component of mandatory insurance, and the Bank of Russia believes they should meet heightened requirements both when a MI requests market access and during ongoing operations .
The document explores a proposed change to the notification requirements within the procedure of granting access to the mandatory insurance market: to a regulatory approval system. This would be achieved through special qualification criteria a company must meet in order to be included into the Register of Regional Mandatory Insurance Funds. The proposed criteria include the minimum number of specialised medical doctors, the minimum amount of experience working in the medical insurance sector, the availability of up-to-date IT systems to enable the speedy handling of medical company accounts and assessment of corporate performance, as well as a fully functional call centre to support policy holders 24/7.
Moreover, the specifics of mandatory insurance bring about the need for a multifaceted approach to control and supervision over medical insurers in regards of their compliance with regulatory requirements established by the Bank of Russia, the Ministry of Healthcare and the Federal Mandatory Medical Insurance Fund. Any supervisory action, the authors believe, must be based on jointly developed principles and criteria of good practice in medical insurance.
The report lays down proposals intended to boost the efficiency of interactions between medical insurers and health facilities. In particular, there are plans to use a public ranking system for medical companies.
The document also includes a study into the option of creating an integrated information system - to keep records of health care services rendered and payment sources, and establishing a public fund spending framework (setting the proportion of medical insurers’ costs financed out of regional mandatory insurance funds) and rolling out control measures.
The Bank of Russia welcomes any feedback, including responses to the questions in the consultation paper, as well as any proposals or comments, before or on 17 November 2017 at: burkavtsovayav@cbr.ru