Inshuwalansi Medical - ndi chiyani ichi? Fund Insurance Health

Dongosolo la chisamaliro khalidwe thanzi ndi mbali yofunika kwambiri ndi yofunika ya dongosolo zodzitetezera pa umoyo wa nzika. Kulikonse kumene nzika, chirichonse chinali pa nthawi yake ndalama, akhoza kupeza chithandizo wamakhalidwe zachipatala pa zosayembekezereka wa zinthu sizimadziwika.

Kukula kwa makampani inshuwalansi

Msika inshuwalansi ndi mbali yofunika ya dongosolo la zachuma, ndi chitukuko ubale msika amafuna kuumba zoweta inshuwalansi msika zoletsedwa ndi malamulo a mayiko abwino. zodzitetezera pa umoyo wa nzika sangakhale tsankho kapena kusankha, kotero makonzedwe ake okhazikika amafuna akuluakulu kuti achite zonse mwa zigawo zake.

Zaufulu inshuwalansi yotero. Chifukwa lero aliyense nzika ndi njira yokha ene yakwendera mlingo okwanira kusamalira bwino zachipatala. Kukula kwa makampani inshuwalansi pa nthawi ino akugwira zifukwa zingapo, ndiwo kuchepetsa zikuluzikulu ndalama zaumoyo, chakale zinthu m'munsi, kusowa kwa mankhwala, zizindikiro chitukuko zaziwerengero a dziko ndi mlingo wa matenda nzika 'ndi ena ambiri. Masiku ano, pali nthawi zonse zambiri zotsutsana ndi mavuto m'dera la inshuwalansi omwe amafunika liwunikidwenso.

kulungamitsidwa inshuwalansi

Mlingo thandizo chisamaliro chaumoyo ndalama Russia singakwane ndithu, zokhudza miyoyo ya anthu ndi khalidwe la mankhwala. Low malipilo a madokotala ndi kulengezedwa ndi chitsimikizo oyendetsera dziko la ufulu thandizo mu gawo la zaumoyo, n'zomvetsa chisoni osati akulimbikitsidwa kupereka chofunika chithandizo. Choncho, makampani chisamaliro chaumoyo lero apuma pa Kudzidalira, amene akuwonekera mu zopereka zaufulu ndi zosayembekezereka malamulo wachifundo. Choncho gawo la zolowa anthu mu zolowa okwana pa mankhwala mu Russia ndi okha 56%, pomwe mayiko - EU membala limati - za 76%. Zambiri ndalama n'kofunika ndalama ndalama ya anthu, pamene ena (za 4%) mu Russia (kuzungulira 40%) - mu zaufulu inshuwalansi mankhwala ndi thandizo lachifundo.

inshuwalansi Medical - ndi munthu inshuwalansi malonda. Iwo ikuchitika m'njira 2 chachikulu: zaufulu ndi mokakamizidwa. Malinga ndi malamulo, inshuwalansi zaufulu za mitundu zotsatirazi: zachipatala inshuwalansi ( thanzi mosalekeza), inshuwalansi ya ndalama zachipatala ndi inshuwalansi. Act Health Insurance ndi malamulo okhwima okhudza.

Poganizira kuti kuwonjezeka ndalama anthu a makampani zaumoyo ndi mabvuto chifukwa cha mavuto a zachuma mu dziko, muyenera kupeza njira yina yobweretsera ndalama ku makampani. Popeza mawonekedwe kuvomerezedwa inshuwalansi zaufulu angathetse ambiri ndithu mavuto.

Analysis wa inshuwalansi msika

Health inshuwalansi - kukuchititsa zimenezi chikhalidwe, kotero kufunika kwa mtundu wa inshuwalansi ikukula mwa anthu chilichonse. Mlingo wa ndalama LCA zimenezi, mmodzi amene Chinthu ndi chiwerengero cha nambala zodzinenera inshuwalansi kuthetsedwa.

Analysis wa inshuwalansi msika zinagwira mfundo za LCA chitayiko chifukwa ambiri a atsogoleri inshuwalansi. Kulunjika inshuwalansi monga mtundu wa bizinesi chifukwa chakuti ndalama zambiri mtundu enieni a inshuwalansi ndi inshuwalansi kampani, wamkulu Mwina ofanana inshuwalansi premiums kuchuluka monga revenues kukula malinga ndi udindo inshuwalansi.

Izo zinalembedwa kuwonjezeka mu 2013 malipiro inshuwalansi ukonde inshuwalansi mosalekeza thanzi ndi 34,2% poyerekeza ndi chaka cha 2011. Net inshuwalansi premiums kwa inshuwalansi vuto la matenda amakonda kuonjezera - ndi pafupifupi theka. Koma ambiri pali owonjezera inshuwalansi premiums pa ndalama, zomwe ndi mfundo zabwino m'zochitika za kampani ya inshuwalansi.

Chimodzi mwa zifukwa zimene makampani imfa otchedwa kukula kwa chiwerengero cha zopempha kasitomala thandizo kuchipatala chifukwa kuwonongeka kwa khalidwe la umoyo, okalamba anthu, makasitomala, kupanda ungwiro underwriting ntchito, ntchito tariffs chuma oipa, gulu osauka a ntchito ndi kuthetsa zomvetsa m'munsi kasitomala lathu la boma mankhwala ndi prophylactic, mpweya mtengo wochitira malonda, kuphatikiza .. ntchito malipiro a intermediaries inshuwalansi - ogulitsa zithandizo LCA.

inshuwalansi zaufulu

Today anapanga dongosolo lolozeka m'munda wa inshuwalansi kwawo ku Russia. Kapangidwe ka LCA zoweta msika zikuphatikizapo boma matupi kuyang'aniridwa ndi ntchito inshuwalansi, mayanjano inshuwalansi payekha, kampani ya inshuwalansi, inshuwalansi osinthitsa, zachipatala, Thandizo utumiki ndi ogula.

Mogwirizana ndi zotsatira za kafukufuku ankatsutsa kwambiri kutukula za inshuwalansi zaufulu ndi kupanda zolimbikitsa msonkho, chifukwa kampaniyo, zina mwa kulipira 41% ya malipiro inshuwalansi, kulipira kwawo pambuyo msonkho kwa phindu ukonde. Zimenezi ndi zogwirizana ndi kusapezeka kwa ubwino msonkho, kwambiri kubweza ndondomeko detenizatsii la umoyo.

Pamene kupatsa ndalama za inshuwalansi yaufulu kwa ndalama zaboma ndi pamutu, wapawiri-ntchito, ndalama kugwirizana ndi makonzedwe a misonkhano, komanso pambuyo kuthetsa mavuto kugwirizana ndi mtima wa ndalama n'zosangalatsa kumva za ndalama zimenezi kwa nyengo malipoti msonkho, angadwale khalidwe la umoyo, amene adzakupatsani Kankhani wabwino detenizatsii m'munda wa umoyo ndi revenues kuchuluka kwa ndalama m'dera ndi boma.

Inshuwalansi mchitidwe kuteteza moyo wa nzika

Mchitidwe inshuwalansi chimatitsimikizira kuti anthu sali zolimbikitsa zachuma: chifukwa inshuwalansi akuda - bwino thanzi lawo; kwa bungwe mankhwala - kupereka chofunika chithandizo. Choncho m'pofunika kutsatira njira ya kukondoweza mwa nkhani ndi kukhazikitsa pulogalamu inshuwalansi. Amalimbikitsa inshuwalansi akuda kusintha ndi kuwonjezera makhalidwe khalidwe la umoyo wawo, kupewa kuwonongeka ake, sapeka chiopsezo kofunika chikhalidwe chawo thupi.

inshuwalansi Medical - ndi mbali ya dongosolo zodzitetezera pa umoyo wa nzika, amene amathandiza malipilo odwala ndalama kuchipatala. Nayenso zaufulu inshuwalansi ndi kuwonjezera kukutsimikizira kuvomerezedwa ndi malipiro a chithandizo. Mafunso ikukhudzana mavuto a kuwonjezeka katundu pa thumba malipiro, asaaonerera inshuwalansi mankhwala, inshuwalansi ya mwendo ndi ntchito zina.

Insurance mu CIS

Mavuto a inshuwalansi monga chikhalidwe mchitidwe chitetezo ankachita nawo osiyanasiyana onse achilendo ndi Russian asayansi - chuma ndi madokotala. zikayenda bwino kwambiri malowa achititsa kuti chitukuko cha maziko ongolankhula zodzitetezera pa umoyo wa nzika, makamaka chitukuko cha zida za cilamulo ndi kumayambiriro zothandiza.

Komabe, funso n'lakuti makonzedwe a thandizo la mankhwala kwa anthu a mkhalidwe wathu, amene anapita ku maiko CIS, ndi mitundu aliyense wa maiko CIS, anafika ku Russia kwa nthawi zina. mavuto a zachuma amene ali khalidwe la zachuma transformational olimbikitsa anthu nthawi zambiri kupita kudziko lina, makamaka m'mayiko CIS. Close zachuma, mabwenzi ndiponso achibale komanso ndi chinthu woyendayenda.

Komabe, vuto ndi thanzi la munthu, pali nthawi zonse, kaya ndi pa alendo ulendo tikiti (pamene inshuwalansi chofunika), kapena payekhapayekha. Kufunika kwa chithandizo nzika amene alibe chikalata, monganso malamulo inshuwalansi, zikusonyeza vuto mwangwiro ndalama. Umu ndi mmene mankhwala a ochokera m'mayiko akunja ilipiridwa? Mu Russia Mwachitsanzo, pali mokakamizidwa inshuwalansi, malinga ndi zimene chithandizo okha Russia amaperekedwa kwaulere. Zinthu ngati alipo Belarus. Choncho, pali vuto makamaka kuteteza nzika Russian m'mayiko CIS, amene silinakwaniritsidwe kuthetsedwa kapena maudindo ongolankhula, kapena kuchita.

Insurance kusiya mu pafupi kunja

Zaufulu inshuwalansi latsopano la Russia akupitiriza kukula, kusonyeza kuzindikira za nzika za kufunika thanzi. Chaka ambiri a anthu kupita ku nthawi lolingana kunja. chiwerengero cha alendo anapita kudziko lina zikuchulukirachulukira chaka chilichonse.

Pamaulendo pali kuthekera kwakuti nzika Russian akhoza kupeza okha mavuto (matenda, kuvulala, ndi zina zotero. D.). Kuthana ndi mavuto amenewa amafuna ena odziwa Mwachitsanzo, komwe kupeza inshuwalansi thanzi, umene pa yemweyo ndalama chuma nthawi. Komabe, monga ulamuliro, anthu amene amapita kunja kwa achibale ndi mabwenzi, usadalire chakuti iwo ali odwala, ndipo iwo adzakhala allocated ndalama zofunika mankhwala (pali inertia ena amaganizira, pamene chithandizo ku Soviet Union anali wopanda).

Nthawi zina, thandizo kuchipatala angakhale pangozi (pamene Mafunso Chongani kuluma, matenda tizilombo, kuvulala ndi ngati. D.). Analysis wa zinthu amapereka malo kunena kuti makonzedwe a thandizo la mankhwala kwa anthu a Russia ikuchitika kwa amalipiritsa limati zina. Nawonso alendo pa dera la Russia anali ndi mwayi wolandira chithandizo kwaulere. Pofuna kuonetsetsa chitetezo ndi chithandizo kwa anthu pa nkhani ya imfa ya thanzi kunja mukupemphedwa kugwiritsa ntchito woyendetsa (ndi applicable riziki mosavomerezeka) oyamba pa maziko contractual inshuwalansi mokakamizidwa thanzi mwa Health Insurance Bureau pakati pa mayiko CIS ndi Russia.

Khadi anapita kudziko lina

Ngati inu kuwoloka malire pa galimoto zawo, miyambo onani wanu inshuwalansi thanzi. Ngati muli paulendo ndi ndege, sitima kapena basi, lamatikiti mtengo pazikhalanso malipiro inshuwalansi. Akufuna kuvomerezedwa thanzi khadi zopita kunja zidzathandiza kuphimba ndalama zonse za mankhwala (inpatient, outpatient), mankhwala kugula, kupeza chithandizo, kayendedwe, zoyendera ambulansi, ndi vuto la imfa - kuti repatriation thupi la womwalirayo dziko kunyumba.

Mokakamizidwa zachipatala khadi kuyenda kunja adzakhala chomveka lililonse dziko ophunzira cha polojekiti. lamuloli inshuwalansi akhoza linapereka kwa masiku 90. Khadi zopita kunja ayenera kukhala ndi mawu omveka bwino a mooneka, zomwe anagwirizana ndi gulu lonse polojekiti. inshuwalansi sangakhale kwathunthu chitsimikizo chivundikiro chithandizo ndalama zopita kunja. Pakuti zonena inshuwalansi sakuphatikizapo:

• chithandizo cha matenda maganizo
• zochizira matenda, kuvulala chifukwa zochita wrongful;
• kuvulala bwinobwino boma la mowa kapena mankhwala;
• opaleshoni pulasitiki, koma pamene iwo ayenera chifukwa choipa;
• chisamaliro mano, kupatula munthu ali a mano aakulu;
• zochizira matenda kugwirizana ndi AIDS ndi matenda venereal;
• chithandizo cha achibale ndi mabwenzi apamtima ya inshuwaransi, limene akukhala;
• kuvulala bwinobwino kuyesa kudzipha;
• kukhazikitsa mimba, koma pa nthawi imene linaopseza moyo wa mkazi;
• akuchititsa diagnostics kwa pempho insurer a;
• chithandizo spas ndi zambiri.

Medical Insurance Bureau

Health Insurance Bureau (SMEs) - ndi kucheza kokha mabungwe inshuwalansi mu dziko. Bungweli chingakhale cha nambala inayake Mnzake ndi zonse mamembala, amene amachita inshuwalansi chamankhwala anapita kudziko lina. Ndiko kuti, umembala ndi chikhalidwe chachikulu kuthekera kukwaniritsa mtundu wa inshuwalansi. Mamembala a Bureau ali oyenera kuwerenga mu inshuwalansi inshuwalansi umafunika thumba "khadi Lamulo zachipatala anapita kudziko lina." The Bureau, nayenso, adzapereka yake ndi Mkhalidwe kuthetsa zodzinenera inshuwalansi pansi Mapangano izi. The inshuwalansi mamembala onse a SME adzatha kulipira pa nthawi thumba mtima thandizo la mankhwala kunja, kupereka chithandizo, repatriation wa anthu kunyumba kwawo ku mwambo wa imfa. Medical Insurance Bureau adzachita monga gulu sanali phindu.

Akufuna ntchito "Yokakamiza mbiri mankhwala a anapita kudziko lina" amapereka:

1) kukhazikitsidwa kwa National Health Insurance Bureau, amene wapangidwa ndi inshuwalansi akuda zonse zikugwira ntchito mokakamizidwa inshuwalansi oyendayenda kunja;

2) inshuwalansi mokakamizidwa thanzi la anthu ankawoloka boma malire a zawo kukaona mayiko CIS kwa nyengo zina za nthawi (masiku 90);

3) kuli yoyenera malamulo chimango pa Insurance Health, amene nthawi ntchito za inshuwalansi akuda mderali.

ndalama inshuwalansi Akuluakulu a ku Russia

Kuvomerezedwa Health Fund Insurance analengedwa ndalama Russian nzika mtengo wa zaumoyo. Mokakamizidwa zachipatala inshuwalansi - ndi gawo tsinde la National Insurance.

Zolinga zikuluzikulu za thumba:

• kayendetsedwe ka otaya zomveka ndalama;
• malipiro a mapulogalamu akulimbana.

thumba ndalama ndi zopereka zotsatirazi:

• inshuwalansi ku bajeti boma;
• zopereka amakampani;
• ntchito osakhalitsa ufulu ndalama za Fund.

Ntchito yaikulu ya Fund a Chi Federal monga:

• ndalama za mankhwala;
• kudzikundikira chuma;
• mu zaumoyo - kukhazikitsa ma boma.

Kupititsa dongosolo la inshuwalansi mokakamizidwa thanzi amapereka ndalama mwachindunji kwa mabungwe zachipatala. Insurance mlingo chopereka wofanana 3.6% poyerekezera ndi malipiro avarage. Insurance premiums mu ndi mokakamizidwa thumba inshuwalansi ikukhudzana bwanji ndi ndalama. Malipiro a zachipatala, chikhalidwe ndi ndalama penshioni otchedwa logwirizana msonkho chikhalidwe.

zinthu zofunika kwambiri

Kuyambira takambiranazi, n'zotheka kuzindikira zinthu zazikulu zimene zimakhudza inshuwalansi mu zikhalidwe makono a ntchito kwa inshuwalansi msika:

• Zachuma mu dziko, zomwe zimachititsa anthu amachita ndalama ndalama yekha kwa katundu wochepa.
• Ungwiro malamulo (mwachitsanzo, izi zimaonekera, pakalibe zolimbikitsa msonkho).
• Kuwonjezera malonda voliyumu ndi mtengo wa mankhwala.
• Kuwonjezeka udindo chikhalidwe cha malonda inshuwalansi (kuwonjezeka mu gawo la inshuwalansi gulu la ogwira ntchito mapulogalamu VHI kuti kukhala kosatheka kupewa bwana malipiro a ndalama zachipatala).
• Ambiri monopolization wa zaumoyo msika zimapangitsa mabungwe mankhwala kuwonjezera phindu lake ndi kuchuluka kwa utumiki.
• Low inshuwalansi chikhalidwe nzika.

Kuti adzimvera, tikhoza kunena kuti ziyembekezo za chitukuko cha inshuwalansi, kuphatikizapo mtundu zaufulu zolimbikitsa. Cholowa cha LCA mu inshuwalansi msika ali likutukuka, inshuwalansi akuda amene amapereka zithandizo LCA, akukhala mpikisano zambiri, kuchuluka chidwi cha anthu mtundu wa inshuwalansi ndi maganizo ngati.