Subject. The article deals with the assessment of quality indicators of the territorial compulsory health insurance fund management, using the Orenburg Oblast case. Objectives. The purpose is to identify problems affecting the quality of fund management and consider possible solutions. Methods. The study draws on methods of systematization, analysis, and comparison. Results. We assessed the management quality of the Territorial Compulsory Medical Insurance Fund of the Orenburg Oblast by analyzing a set of indicators, like the accuracy of budget preparation, proportion and structure of budget funds used for other than intended purposes, proportion of insured persons, proportion of working and non-working population, number of complaints received by the fund and their structures, and others. Conclusions. Improving the quality of management of territorial compulsory health insurance funds in the Russian Federation is an integral part of strategy for healthcare system development, which, in turn, should ensure effective use of financial resources, improve accessibility and quality of medical care for the population, increase trust and satisfaction of citizens with the compulsory health insurance system.
Keywords: insurance medicine, compulsory medical insurance, fund revenue, fund expense, management quality
References:
Shishkin S.V. [Evolution and prospects of Compulsory Health Insurance in Russia]. Ekonomicheskaya politika = Economic Policy, 2023, vol. 18, no. 1, pp. 8–33. URL: Link (In Russ.)
Malysheva A.A. [The role of territorial compulsory medical insurance funds in the distribution of compulsory medical insurance funds]. Elektronnoe prilozhenie k Rossiiskomu yuridicheskomu zhurnalu, 2021, no. 1. (In Russ.) URL: Link
Shinkareva O.V., Egorova E.N. [Federal compulsory health insurance fund: Analysis of the receipt of insurance premiums]. Sotsial'naya politika i sotsiologiya = Social Policy and Sociology, 2023, vol. 22, no. 3, pp. 108–115. (In Russ.)
Kadyrov F.N., Obukhova O.V., Bazarova I.N., Endovitskaya Yu.V. [Financing of the compulsory health insurance system in 2022]. Menedzher zdravookhraneniya, 2022, no. 1, pp. 79–84. URL: Link (In Russ.)
Kostyrin E.V., Saakyan O.O. [Compulsory medical insurance in the Russian Federation: An economic and legal view]. Vestnik Altaiskoi akademii ekonomiki i prava = Bulletin of the Altai Academy of Economics and Law, 2023, no. 12-3, pp. 440–445. URL: Link (In Russ.)
Linnik S.A., Avdeev S.N., Tumenko E.E. et al. [Costs of compulsory health insurance funds for the treatment of COPD patients in some regions of the Russian Federation]. Menedzher zdravookhraneniya, 2024, no. 2, pp. 23–34. URL: Link (In Russ.)
Abubakirov A.S., Zudin A.B. [The comparative analysis of mandatory and voluntary medical insurance in national and international practice]. Problemy sotsial'noi gigieny, zdravookhraneniya i istorii meditsiny = Problems of Social Hygiene, Public Health and History of Medicine, 2021, vol. 29, no. 2, pp. 313–315. URL: Link (In Russ.)
Kozaeva O.T., Les' I.V. [Analysis of systems of compulsory health insurance (CHI) and voluntary health insurance (VHI), problems and perspective directions of development]. Ekonomika i upravlenie: problemy, resheniya, 2019, vol. 14, no. 3, pp. 141–146. (In Russ.)
Kobyakova O.S., Starodubov V.I., Kadyrov F.N. et al. [New system of control measures in relation to medical organizations within the framework of compulsory health insurance]. Menedzher zdravookhraneniya, 2021, no. 5, pp. 72–79. URL: Link (In Russ.)
Andriyanova A.A., Andriyanova L.S., Kornienko M.V. [The economic analysis of provision of medical services via medical insurance in Russia]. Problemy sotsial'noi gigieny, zdravookhraneniya i istorii meditsiny = Problems of Social Hygiene, Public Health and History of Medicine, 2021, vol. 29, no. 5, pp. 1060–1065. URL: Link (In Russ.)
Gavrilov V.A., Smolin A.A., Fefilova M.A. [Examination of the quality of medical care in medical institutions of the Udmurt Republic working within the system of compulsory medical insurance]. Zdorov'e, demografiya, ekologiya finno-ugorskikh narodov = Health, Demography, Ecology of Finno-Ugric People, 2021, no. 1, pp. 5–11. (In Russ.)
Bulka A.A., Matvienko E.V., Khmelevskaya I.G. et al. [Satisfaction of the population of Kursk Oblast with the availability and quality of outpatient medical care in the implementation of compulsory medical insurance]. Mezhdunarodnyi nauchno-issledovatel'skii zhurnal = International Research Journal, 2022, no. 3-2, pp. 165–168. URL: Link (In Russ.)
Obukhova O.V., Sychev Yu.P., Kadyrov F.N., Bazarova I.N. [Accounts payable of medical organizations operating in the compulsory health insurance system]. Menedzher zdravookhraneniya, 2021, no. 10, pp. 77–83. URL: Link (In Russ.)
Kadyrov F.N., Obukhova O.V., Endovitskaya Yu.V. [The problems of paying for medical care provided to residents of other subjects of the Russian Federation within the framework of compulsory medical insurance]. Menedzher zdravookhraneniya, 2020, no. 3, pp. 69–77. URL: Link (In Russ.)
Kadyrov F.N., Obukhova O.V., Mitroshin P.V., Chililov A.M. [Prospects for the financial provision and functioning of the compulsory health insurance system]. Menedzher zdravookhraneniya, 2024, no. 2, pp. 116–126. URL: Link (In Russ.)
