A big and common cause: the VMI market is looking for a balance

Representatives of insurance companies, private clinics, the expert community and major employers discussed scenarios for the development of voluntary medical insurance at a round table in the editorial office of the Komsomolskaya Pravda media group. The market is growing rapidly, but medical inflation is also breaking records. The question is whether the participants will be able to come to an agreement. Details from the meeting of the Vostok discussion club can be found in the Izvestia article

LMS becomes the standard

According to Expert RA, the voluntary health insurance market in Russia ended 2024 with a volume of 328 billion rubles.

The increase was almost 30%. This is the best indicator among all types of insurance not related to life insurance. There have also been major structural changes in the market. LCA has ceased to be a privilege of large corporations and residents of the capital.

Andrey Ryzhakov, Director of Medical Insurance at AlfaStrakhovanie JSC, stated that today 40% of the company's portfolio is regional business, including small territories where such programs were not even heard of five years ago. In turn, the head of the medical insurance unit, Maria Sakhina, explained this by staff starvation. Companies don't just buy policies — they have to improve programs year after year to retain employees. This is especially noticeable in regions where the compulsory health insurance system cannot cope with the load.

Svetlana Pevneva, Deputy General Director of the insurance broker Remind, cited as an example the story of one of the employers that it was the availability of a standardized VMI policy in the regions that helped him win the competition and retain engineers in his company.

Request for prevention

Large businesses no longer consider VMI only as a loyalty tool. Sergey Dudin, head of the Department of Occupational Medicine at Polyus Management Company, said that the company, due to its specifics, came up with non-standard solutions: follow-up examinations based on the results of medical examinations, extended medical examinations.

— We have built a whole system of employee health care from the moment of admission to retirement. There is an entrance control, a medical check-up once a year. And we have a medical provider who provides on-site service for workshop therapists. They are supported by the continuity of medical data, and we are assisted by VMI and colleagues who help us implement follow—up examinations," said Sergey Dudin.

Corporate packages increasingly include the treatment of serious diseases, including cancer. But the main trend of the last two years has been prevention. Alla Kanunnikova, a member of the Board of the Medsi Group of Companies, is convinced that VMI programs should include elements of preventive medicine.

"These services are needed to manage future risk, unprofitability, labor productivity and the number of sick leave," she said.

Larisa Popovich, Director of the Institute of Health Economics at the National Research University of Higher School of Economics, recalled that only 10-13 million working people have access to VHI today. And this segment has actually become a pilot site.

— The experience gained in VMI and private clinics should be used more widely and replicated, — the expert believes.

At the same time, in her opinion, voluntary insurance should not duplicate compulsory insurance: its task is to complement the system.

Insurers are essential

During the discussion, the participants discussed in detail the question of whether an employer can go to the clinic directly, without an insurer. The risk analysis eventually showed that failure to cooperate with the insurance company could affect all parties.

Maxim Zverev, Commercial Director of the Alfa-Center for Health network, confirmed that about half of the patients in his network come through insurance companies. In his opinion, it is possible to work without VMI, but the volumes will not be comparable. His colleague, the commercial director of the Sova clinic, Irina Sych, shared her negative experience. A year ago, in one of the regions, the company dramatically increased the prices, which led to the termination of the contract with the insurer.

"In the end, no one won," she stressed. — It is more difficult and expensive to restore relationships than to maintain them.

Between two fires

Irina Sych called the activities of insurance companies "filigree work with minimal marginality." Maxim Remnev, head of the AlfaStrakhovanie Medical Examination Department, explained: profitability in this business is low, while insurers are responsible for quality and are forced to restrain tariff increases under pressure from employers. According to him, insurers have to predict the situation two to three years in advance in order to offer predictable conditions to customers. And not all clinics are ready for this.

Andrey Ryzhakov admitted that medical inflation in 2024-2025 has become one of the most painful topics. According to Svetlana Pevneva, who collects quarterly data from insurers, it amounted to 12.6% in the third quarter of 2025.

Ryzhakov is convinced that the solution lies in complex work. The employer must clearly understand what they want to get for their money.

— The insurance company is a professional assistant who is able to offer the best solution.

Technologies and long-term contracts

The participants of the round table see a way out in technological and structural restructuring. Alla Kanunnikova named systemic factors affecting the cost of medical services: staff shortages, rising salaries for doctors, rising prices for equipment and consumables, and utility bills. All this inevitably affects the price. But, she says, clinics have the tools to curb growth. Its network of clinics is actively implementing AI solutions for automating routine processes and concluding long-term contracts with fixed KPIs.

Commercial Director of Polyclinics.Julia Trofimova emphasized the need to optimize operational processes and make more active use of co-payment and franchise mechanisms.

"There are few customers who are ready for this, and the transition is difficult, but it increases consumer awareness," the expert noted.

According to Victoria Petrakova, transparent and long-term agreements with insurers are fundamentally important for clinics. When both sides understand the financial model for three years ahead, it becomes possible to predict unprofitability and plan workload.

The future belongs to personalization

Summarizing the discussion about new products, Svetlana Pevneva emphasized that the future belongs to integration. A competent LMS program today is a designer assembled for a specific team, taking into account its gender and age composition, geography and professional risks. Checks, medical examinations, and dynamic monitoring are not alternatives to insurance, but its components.

Maria Sakhina spoke about comprehensive staff health management products. These include the examination of employees, the detection of chronic diseases and individual support. According to her observations, the effect of such programs is noticeable not only in reducing the number of sick days, but also in changing people's behavior.

The employer as an investor

A separate topic of discussion was the economic efficiency of VMI. Sergey Dudin from Polyus Management Company spoke about the metrics system built in the company. They analyze disability reports, work with anonymized Social Fund data, and track the top 5 diseases. Based on the results of this analysis, advanced cardiological screening was added to the medical examination program.

Dudin recalled the mechanism of discounts to the social insurance tariff. If the company keeps injury rates at a good level and conducts medical examinations on time, it can claim a significant discount. And the company reinvests the saved funds in the health of its employees.

Larisa Popovich is sure that employers need not just reports on the number of sick days, but real metrics that link investments in health with labor productivity and the cost of human capital. And the task of all market participants is to find such metrics.

Finally, one of the important trends is the focus of all market participants not on treatment, but on prevention. Including critical illnesses. The clients themselves are also interested in this.

— People now don't just want to go to the clinic for VMI or compulsory medical insurance. They want to be healthy. This is a completely natural desire of any person. To be healthy, and not to visit a doctor and not to undergo unnecessary tests, — Maxim Remnev considers.

Concluding the discussion, Andrey Ryzhakov stressed that medical insurance is a business of long—term relationships. Maxim Remnev added that insurers today perform not only a financial, but also a controlling function. Without independent expertise, the clinic is left alone with the temptation to earn more. But the task is not total control, but partnership, where everyone understands that the overall success is the health of the patient.