Inshuwalansi: chikhalidwe, cholinga ndi mitundu ya inshuwalansi latsopano la Russia

zinthu Chiwerengero, kusintha zofunika boma m'munda wa ndalama bajeti kwachititsa kuwonjezeka mu udindo wa zaumoyo magwero payekha ndalama. M'mayiko mofulumira osauka inshuwalansi pali mankhwala Zogwirizana chitetezo cha moyo ndi thanzi la makasitomala. Russia si zosiyana. Taganizirani mitundu ikuluikulu ya inshuwalansi latsopano la Russia.

mtima

M'pofunika kusiyanitsa mawu akuti "inshuwalansi mankhwala" ndi "inshuwalansi". Mbali yoyamba tikulankhula za njira zaumoyo ndalama, ndipo chachiwiri - zochita. Tikambirana mwatsatanetsatane chikhalidwe ndi mitundu ya inshuwalansi.

Mawu amenewa amanena mawonekedwe zodzitetezera pa umoyo mu umoyo wa anthu. Cholinga chake - mu chochitika chochitika inshuwaransi kupereka nzika ndi mwayi wolandira chithandizo chifukwa kudzikundikira ndalama ndi ndalama njira njira. Mitundu ya inshuwalansi ndi lamulo ndi zaufulu chitetezo.

Akamanena za ndondomeko umenewu uli mwayi wotenga kachirombo kugwirizana ndi thanzi labwino (zosakhalitsa kapena okhazikika) ndalama kugwirizana ndi kuchira ake. Zambiri ndi insurer ndi chikalata mgwirizanowo. Chinthu chimene pachiswe kupeza ndalama anakhumudwitsa mogwirizana ndi mankhwala a munthu inshuwaransi ku malo chamankhwala kuchipatala. Mtengo wa chopereka kuchita masamu zochokera Mwina wa zosayembekezereka ya mwambowu inshuwaransi, ukupeza ya kasitomala, zaka wake ndi zinthu zina. omumvera ndi: nzika ya inshuwaransi, bungwe zachipatala.

mfundo za kugwira ntchito inshuwalansi thanzi ndi kuliika pa mlingo malamulo:

• Russian nawo mapulogalamu inshuwalansi mokakamizidwa thanzi (Chi) ;
• mlingo komanso ndi zinthu kupereka chithandizo kwa anthu mu chimango cha OMC;
• chiwerengero cha ntchito ufulu;
• PB nawo nzika mu inshuwalansi zaufulu (LCA), lomwe lili ntchito pa pulogalamu MLA;
• mitundu DMS ndi OMS.

The mbali malamulo a nkhani

Ufulu m'munda wa thanzi nzika enshrined Art. 41 ya malamulo oyendetsera dziko Russian ndi chilamulo "Pa inshuwalansi mankhwala mu Russian Federation". Mu malamulo amenewa limati anthu onse ali ndi ufulu zaumoyo. Pa mabungwe a boma ndi oyang'anira tauni ndi ufulu, ndiye likuvutika bajeti, ndalama za inshuwalansi ndiponso revenues ena. M'dzikoli ndipo sanali anthu pa gawo la Chitaganya cha Russia, pansi pa MLA. Kuti, zaumoyo ayenera kukwaniritsa zofuna za anthu kukhalabe mlingo wa thanzi kaya njira ndalama.

inshuwalansi: mitundu, kusiyana

Pa gawo Russian akhoza anapereka lamulo mokakamizidwa zaufulu ndi mayiko inshuwalansi. mitundu yonse atatu amasiyana mtengo, khalidwe ndi kuchuluka kwa utumiki. mfundo MHI ndi kuvomerezedwa kwa anthu onse akukhala mu gawo la Chitaganya cha Russia. Popanda kwaulere yekha chisamaliro pangozi. Ngati insurer akufuna kulandira osiyanasiyana ntchito quality ambiri kapena abwino, kumakhaladi VHI. Alendo amene amapita kunja m'dera la Chitaganya cha Russia adzakhala kupereka apereke inshuwalansi padziko lonse yokha.

Chi

kulumala chiopsezo amatanthauza chiopsezo zimenezi, amene sadalira munthu, kwache imbaendesa munthu ku mtengo kwambiri. Zikukhudza anthu komanso anthu onse. Ndi chidwi kukhala umoyo wa anthu onse.

Mokakamizidwa inshuwalansi ndi mtundu wa inshuwalansi chikhalidwe. Iwo amaonetsetsa chitetezo vuto la matenda anthu onse mofanana. Mokakamizidwa inshuwalansi - ndi mtundu wa chitetezo katundu, amene amaonetsetsa kuti anthu onse, kaya akhale a kugonana, msinkhu ndi chuma chawo mwayi wofanana chithandizo. Iwo akuyendera mwa dongosolo la ndalama (boma ndi dera lawo) ndi mabungwe apadera. Otsiriza zolimbitsa OMS ntchito tsiku ndi malonda. Inshuwalansi akuda ndi intermediaries pakati pa ndalama ndi mabungwe kupereka kwa anthu. Organization ndi ulamuliro wa dongosolo lonse ikuchitika kudzera maziko - mabungwe osakhala phindu limene ntchito mogwirizana ndi malamulo Russian.

MHI zimachokera ndi premiums inshuwalansi (zopereka mtengo msonkho umodzi wa 3.6%), malipiro kwa bajeti. Mu dongosolo ili, inshuwalansi akuda ndi olemba ntchito anzawo, amene ayenera kulowa mapangano mokomera antchito, amalonda ndi makonzedwe onse akuluakulu misinkhu yonse.

mfundo MHI

chikalata ichi certifies lamanja la nzika kulandira ufulu chithandizo operekedwa mu chimango cha pulogalamu. Lili deta za mwini za ndondomekoyi, chiwerengero mgwirizano ndi kampani ya inshuwalansi, chilemba cha ubwenzi chipatala chinachake.

inshuwalansi zili pa gulu lirilonse inshuwalansi mwa anthu m'gulu la Chi m'kaundula. Atadzuka ku dera lonse la Chitaganya cha Russia. Ngati inu kusintha dzina Full, malo okhala, deta chikalata kapena kudziwa kusiyana kulikonse, mfundo n'kofunika kuti adzathe kulembetsa pasanathe mwezi umodzi. Za imfa ya malamulo azidziwitsidwa olembedwa inshuwalansi, kenako chitani ndondomeko m'malo.

pulogalamu ntchito

Kuchuluka ndi zikhalidwe chopezera njira yodzera kwa chikalata wapadera Ufumuyo. Pulogalamu zofunika mwakuchita Utumiki wa Health ndi ovomerezedwa ndi boma. Pa maziko iyi mapulogalamu dera. Iwo mwachindunji mitundu yaikulu ya inshuwalansi, chiwerengero ndi khalidwe la misonkhano, kapangidwe tariff, njira thandizo malipiro. Ufulu wa anthu inshuwaransi kwa MLA ili paliponse la Russia.

Monga mbali ya dongosolo lenileni amapereka chithandizo chofunika, njira, chisamaliro apadera pochiritsa anthu ndi matenda:

• Matenda, parasitic (kupatula matenda venereal, TB ndi AIDS);
• khansa, khungu, matenda endocrine dongosolo;
• okhudza kudya, wamanjenje, mkodzo dongosolo;
• matenda a m'thupi;
• diso, khutu ndi kupuma matenda;
• zoopsa;
• matenda a dongosolo minofu ndi mafupa;
• anomalies kobadwa nako akuluakulu;
• matenda a chitetezo cha m'thupi;
• chromosomal kuvutika;
• mimba, pobereka ndi mimba.

pulogalamu Kupititsa zikuphatikizapo:

• mndandanda wa matenda ndi mitundu ya thandizo anapereka kwa nzika likuvutika appropriations bajeti ndi njira Kupititsa thumba la Chi;
• Ndondomeko makonzedwe a chithandizo kwa magulu ena a anthu;
• mndandanda wa mankhwala ofunika ndi mankhwala, zomwe ndi zofunika kwambiri potipatsa chithandizo;
• mndandanda wa mankhwala amene mankhwala ufulu kapena 50% kuchotsera;
• mndandanda wa mabungwe kuti mbali mu pulogalamuyi.

Medorganizatsii nawo ntchito oyandikana, angathe kupereka ntchito analipira:

1. Mu zikhalidwe zina kuposa anthu operekedwawo mu pulogalamuyi, kuphatikiza pa pempho:

• kukhazikitsidwa kwa munthu positi mednablyudeniya pa m'chipatala;
• ntchito mankhwala kuti Usawasimbire kwa wofunikira.

2. Kupereka chithandizo mosadziwika.

3. Non-okhala, anthu stateless amene alibe mfundo MHI.

4. kudziletsa chithandizo cha munthu inshuwaransi kupatula milandu la mwadzidzidzi, apadera, chithandizo.

ntchito analipira anapereka kuposa ndi mabuku kungakupatseni a Chi. Mgwirizanowo limatchula mitundu ndi mabuku chithandizo, amene anapereka kwaulere. Kukana lowani pangano si chifukwa cha kuchepetsa kuchuluka kapena khalidwe la utumiki pansi pulogalamu boma.

Zaufulu inshuwalansi mankhwala

Kuti chithandizo owonjezera osachepera zofunika kuti apereke LCA ndondomeko. Pakati kasitomala ndi inshuwalansi kampani anaphedwa mgwilizano umene, chosinthana yambiri lolipiridwa ndi insurer a undertakes ndalama za mtengo wa kuchiza matenda kapena kuvulala zoopsa.

Malinga mawonekedwe a ndalama kuonetsetsa mitundu ya zaufulu inshuwalansi: pulayimale ndi zina. Mbali yoyamba tikulankhula kulipira ndalama mankhwala (ie. E. The insurer salandira ndalama dzanja). Komanso, inshuwalansi amapereka ndondomeko malipiro omwe sanaphatikizidwe m'gulu la OMC (chithandizo komanso mano ndi ntchito yopanga, mankhwala a khansa ndi zina zotero. D.), Ndipo mtengo mosadziwika (imfa ya zasungidwa chifukwa kulumala, chisamaliro umayi, ndi zina zotero. D.) .

LCA tingasonyezere payekha kapena gulu. Yachiwiri ndi otchuka kwambiri padziko lonse. Mu nkhani iyi, insurer amachita ngati kampani (bwana) ndi inshuwaransi munthu - antchito ake. Malinga ndi pangano, nzika akhoza kulandira chithandizo cha mankhwala nthaŵi zina. Izi mitundu ya inshuwalansi latsopano la Russia ntchito pa maziko kwawo. Ndiko kuti, ndondomeko ndi kugula kasitomala, osati kuvomerezedwa.

malipiro

Tariff mitengo kwa LCA mopitirira pamaziko a ziwerengero zachipatala, zofunika zizindikiro zaziwerengero (amayembekezeka kukhala ndi moyo, amafa), odwala ndi m'chipatala. malipiro chimadalira pa nthawi ya mgwirizano. Pakuti pachaka mitengo mfundo mopitirira pamaziko a amayanjana ya inshuwaransi kwa gulu linalake zaka. Malipiro anapangidwa likuvutika zopereka panopa. Tariffs kwa Mapangano nthawi yaitali kuganizira osati zaka, komanso zinthu zaziwerengero, ziwerengero odwala pa nthawi ya mgwirizano. Ndalama zopereka za ndalama panopa ndi nkhokwe anawapanga malipiro m'tsogolo.

tariffs

Medical inshuwalansi, cholinga, mitundu ya zomwe akambirana kale, umalimbana kuteteza zofuna chuma cha anthu ku mwambo wa kulemala. Koma LCA anthu amene ndi makhalidwe munthu thanzi wosiyana ntchito pafupifupi ndi Mwina wa matenda ndi apamwamba.

Tariff mitengo pa malamulo otere kusiyanitsidwa kwambiri. Iwo kusintha kwa gulu limeneli, malinga ndi zotsatira za Kupenda dokotala:

• Gulu 1 - pafupifupi wathanzi anthu amene alibe mbiri banja. Pali ana, matenda kupuma, appendicitis, chophukacho; makhalidwe palibe choipa; sakugwira ntchito ntchito woopsawo.
• Gulu 2 - anthu ndi chiopsezo cha matenda, mbiri banja la shuga, mtima, pochechnymi- ndi gallstone, matenda okhudza ubongo. A mbiri kuvulazidwa ubongo zoopsa; Pali zizoloŵezi zoipa; ntchito mu zinthu zoipa kupanga.
• Gulu 3 - anthu wamphamvu ndi matenda aakulu; kuledzera, asamakhale ndi nkhawa; akudwala gwero lachisokonezo, matenda oopsa, matenda ischemic mtima popanda angina.

mitengo tariff ndi kusiyanitsidwa pa magawo onsewa, ndipo masamu payokha aliyense malangizo.

kuphwanya ufulu

Onse a mitundu ya inshuwalansi pansi pa mfundo. Mu mwambo wina mfundo zimenezi lamanja la nzika kuti akalandire chithandizo khalidwe mankhwala amaonedwa kuyan'anila:

• oletsedwa kutolera ndalama kwa ogwira ntchito zachipatala kuti muthandize ndalama zotchulidwa pulogalamu boma;
• oletsedwa kutolera ndalama ndalama zipatala thandizo, referrals, mankhwala kwa mankhwala;
• kugula mankhwala ndi malonda mednaznacheniya kuchokera pa ndandanda anavomereza mapulogalamu likuvutika odwala;
• kuchedwa popereka chithandizo;
• chokana kupereka thandizo pansi pa MLA.

Kuti mudziwe zambiri pa zimene yonse ya inshuwalansi ntchito mu chigawo chomwe mufuna akhoza kuwapeza, ndi thumba m'zigawozo Chi mu Komiti thanzi.

mchitidwe lonse

umoyo kupezeka - tingafunse m'dziko lililonse. Mitundu patsogolo pa inshuwalansi mwachuluka amadalira miyambo zakale. Mu US, mitundu yonse ya inshuwalansi ntchito ndi zopereka zaufulu. M'mayiko ambiri, osati pulogalamu ya ndalama pagulu. Kwa iwo, LCA kukufunikira. Achikulire ndi anthu osauka nawo mapulogalamu boma. Koma anthu onse ntchito, mabwana kulipira VHI. Mu UK ntchito National Health Service. VHI anapanga m'njira kuti makasitomala akhoza zolipirira kuchipatalako komwe sanakonze opaleshoni kapena kuwongolera chithandizo. M'mayiko ena mu msika sekondale zikukwaniritsidwa mitundu ya inshuwalansi mankhwala nzika umalimbana malipiro zina zomwe si ataphimbidwa ndi ndondomeko mwachizolowezi. Ku Ulaya, pali kulimbikitsa ndondomeko boma. Koma gwero lofunika kwambiri pa malamulo a ndalama za inshuwalansi lamulo.