The patient's word: Russians appreciated the plans to transfer the powers of the CFR to the territorial funds of the Compulsory medical insurance

Amendments to the law "On Compulsory medical insurance", adopted by the State Duma in the first reading, among other things, provide for the possibility of transferring the powers of medical insurance organizations (CFOs) to territorial compulsory medical insurance funds (TFOMS) by the head of the region for a period of at least three years. This project caused a significant public outcry: not only experts, but also ordinary citizens joined the discussion. A recent VTsIOM survey showed that patients see a risk of reducing the quality and accessibility of medical care due to the fact that insurance representatives will no longer be able to protect their interests. For more information, see the Izvestia article.

Opinion of patients

At the end of October, the VTsIOM analytical Center, commissioned by the All-Russian Union of Patients, presented the results of a survey of Russians about possible changes in the compulsory health insurance system.

From the data presented, it follows that the majority of respondents (63%) understand that they would hardly be able to defend their rights on their own in controversial medical situations, only 15% of respondents are sure of the opposite. At the same time, 44% believe that employees of the insurance company will be able to better protect their interests, 13% believe that representatives of the territorial compulsory health insurance fund will be more successful in this task, 24% do not see a difference.

— The results of the study on possible changes in the compulsory health insurance system show a number of risks associated with compliance with guarantees of independence of control and quality of medical care. The main risk is the deterioration of the available protection mechanism. Currently, almost two thirds of respondents request professional support in disputes related to medical care, meaning that the disappearance of an independent insurance representative deprives patients of the usual format for protecting their rights in this area, and calls into question the possibility of feedback," says Natalia Daudrich, head of the research unit at the VTSIOM Analytical Center.

Another risk, she said, is the merger of the controller and the supervised system, which often leads to a decrease in the effectiveness of protecting patients' rights.

"At the same time, for the majority of Russians, when receiving medical services under an MHI policy, the independence of supervisory structures is perceived as an important priority, and two thirds explicitly state that in a situation of choice they would prefer the protection of their rights by non—involved insurance organizations," she concluded.

Thus, the scales of public opinion are clearly tipped in favor of an external system for evaluating medical care.

— Modern society has the right to demand from the state not just the proclamation of the right to medical care, but its real provision with mechanisms that not only guarantee accessibility, but also protect the interests of the patient himself. In this regard, the key question becomes: who should be the guarantor of quality and fairness in the compulsory health insurance system? The authors of the survey rightly point out that today the majority of citizens trust an independent third—party structure, an insurance company, to act as a controller and advocate for the interests of patients. This is not a tribute to fashion or the insurance lobby, but a logical public request: that the one who checks should not be related to the one he checks," Timur Gizitdinov, Deputy General Director of SMK RESO—MED LLC, said in a comment to Izvestia.

The expert also drew attention to the fact that 75% of the survey participants are unaware of the proposed amendments, and called for a broader public discussion.

The essence of the changes

On October 22, the State Duma adopted in the first reading a bill providing for amendments to Federal Law No. 326-FZ "On Compulsory Medical Insurance." According to the text of the document, the heads of regions will have the right to transfer the powers of medical insurance organizations to territorial compulsory medical insurance funds for a period of at least three years. Previously, TFOMS could perform such functions only if there were no medical insurance organizations included in the register on the territory of the subject.

— This opportunity will be an additional incentive for existing insurance companies to better fulfill their obligations to insured citizens, as at any time the governor will be able to decide on the transfer of their powers to the territorial compulsory health insurance fund. I am sure that such an innovation will improve the efficiency and transparency of the compulsory health insurance system," Sergei Leonov, head of the Duma Committee on Health Protection, told RIA Novosti.

According to Interfax, the draft law received conceptual support from the Ministry of Finance of the Russian Federation, the Ministry of Economic Development of the Russian Federation, the State Legal Administration of the President, as well as the Accounts Chamber, however, subject to consideration of the comments submitted at the stage of preparation for the second reading.

Possible risks

At the same time, the expert community notes that medical insurance organizations play an important role in ensuring quality control of medical services provided: they monitor compliance with treatment standards, protect the rights of insured persons and help resolve disputes between patients and medical institutions. Experts fear that depriving the CFR of the ability to control the process of providing medical care will negatively affect the quality of public services.

According to the All-Russian Union of Insurers (VSS), CFOs play a significant role in budget savings. Thus, in 2024, about 19 billion rubles were returned to the compulsory health insurance system due to medical and economic expertise and examination of the quality of medical care. The volume of financial support for the CFR for the same period reached 25.2 billion rubles, for the TFOMS this figure was 21.2 billion rubles. At the same time, the volume of examinations in the CFR is 25 times greater than in the TFOMS, and their effectiveness is three times higher.

A comparative analysis of the activities of CFOs and TFOMS also showed that the number of consultations per year from insurance medical organizations is 8.5 times more, and the number of complaints from insured persons reviewed is 9.5 times more.

In addition, experts point to the possible risks of corruption, since the decision to include or exclude a particular insurance company from the compulsory health insurance system will now depend solely on the regional authorities. Thus, the lack of a transparent decision-making mechanism creates conditions for abuse and unfair allocation of resources.

Experts warn that reducing the number of insurers in the compulsory health insurance system can lead to a deterioration in the conditions for providing medical care to citizens. In particular, there is a possibility of a shortage of qualified personnel, an increase in the burden on the remaining medical organizations and an increase in queues for obtaining the necessary procedures and consultations of doctors.

Thus, the proposed changes require a thorough analysis of the possible consequences and the development of mechanisms to prevent negative effects on patients and the healthcare system as a whole.