Medical Insurance Fund Research Articles

Budgets of state extra-budgetary funds: legal regulation in the modern period

This article analyzes the legal features of the budgets of state extra-budgetary funds as targeted centralized funds. The legal status of state extra-budgetary funds as legal entities is characterized, and attention is paid to the issue of their organizational and legal form. It is concluded that the Social Fund of Russia, its bodies and divisions constitute a centralized system, however, the system of the Compulsory Medical Insurance Fund and territorial funds, which have significant powers, is decentralized. In addition, general issues of budgetary regulation of funds are considered: the procedure for drawing up and approving budgets, types of income and expenses that assume a targeted nature, the formation and approval of reporting documentation.

Evaluating the effect of health insurance reform on health equity and financial protection for elderly in low- and middle-income countries: evidences from China

BackgroundTo achieve Universal Health Coverage (UHC), China have implemented health system reform to expend health coverage and improve health equity. Scholars have explored the implementing effect of this health reform, but gaps remained in health care received by elderly. This study aims to assess the effect of implementing health insurance payment reform on health care received by elderly, as well as to evaluate its effect on cost sharing to identify whether improve financial protection of elderly under this reform.MethodsWe identified hospitalization of 46,714 elderly with cerebral infarction from 2013 to 2023. To examine the determinant role played by DRGs payment reform in healthcare for elderly and their financial protection, this study employs the OLS linear regression model for analysis. In the robustness checks, we validated the baseline results through several methods, including excluding the data from the initial implementation of the reform (2021), reducing the impact of the pandemic, and exploring the group effects of different demographic characteristics.ResultsThe findings proposed that implementing DRGs payment reduces drug expenses but increases treatment expense of chronic disease for elderly in China. This exacerbates healthcare costs for elderly patients and seems to be contrary to the original purpose of health care reform. Additionally, the implementation of DRGs payment reduced the spending of medical insurance fund, while increased the out-of-pocket of patients, revealing a shift in health care expenses from health insurance fund to out-of-pocket.ConclusionsThis study shares the lessons from China’s health reform and provides enlightenment on how to effective implement health reform to improve health equity and achieve UHC in such low- and middle-income countries facing challenges in health financing.

Health performance assessment modeling and its application to compact medical communities in China.

Some regions in China have already implemented capitation payment or capitation budget management for medical insurance funds. However, there remains a shortage of adequate tools and methodologies to accurately quantify differences in population health risks. Therefore, this paper constructs a health performance assessment model that comprises four steps. The first step is to categorize all participants into health risk groups based on whether they have contracted with a family doctor, their age, sex, and the type of consultation. The second step is to categorize health risk groups based on differences in healthcare resource utilization. The third step is to analyze health performance by examining healthcare resource utilization year over year. The fourth step is to apply the assessment results to assist local finance bureaus and medical insurance bureaus in developing incentive schemes. According to cost weights, the health risk groups are split into six classes: insured residents without health care visits, healthy insured person, slightly ill insured patients, ill insured patients, more seriously disease patients, and severely ill insured patients. We evaluate one compact medical community's health performance by examining changes in the proportion of resource usage group size and expense. From 2019 to 2021, both the proportion of patients with severe and ultra-severe diseases and the proportion of costs in the sample increased, according to changes in resource utilization levels. This result indicates that the population's overall health has not improved and that the compact medical community is still primarily focused on treating diseases, with poor implementation of health maintenance measures and minimal improvement in health performance.

The Acceleration or Suppression: Aging in China

The article aims to verify whether the aging population suppresses the economic consumption level of Chinese residents, depending on the economic situation in China. To diversify the sample, the work searched the situation of expenditure of countries in China. Using daily data over the period 2014-2021, the work estimates the correlation between the elderly dependency ratio and economic consumption through the expenditure approach of GDP and the Hodrick and Prescott Filter model. The work adds cyclical components to the correlation equation, indicating the manner of detrending to test the objective outcome of the GDP index. The work concludes that the GDP index is closely connected with medical insurance fund expenditure, leading to the working population paying more attention to healthcare problems. The level of the elderly dependency ratio depends on the medical insurance fund expendituresocial pension insurance funds, and government health expenditure.

Spatiotemporal Analysis of HIV/AIDS Incidence in China From 2009 to 2019 and Its Association With Socioeconomic Factors: Geospatial Study.

The Joint United Nations Program on HIV/AIDS (UNAIDS) has set the "95-95-95" targets to ensure that 95% of all people living with HIV will know their HIV status, 95% of all people living with HIV will receive sustained antiretroviral therapy (ART), and 95% of all people receiving ART will achieve viral suppression (<1000 copies/mL). However, few countries have currently achieved these targets, posing challenges to the realization of the UNAIDS goal to eliminate the global HIV/AIDS epidemic by 2030. The Chinese government has implemented corresponding policies for HIV/AIDS prevention and control; however, it still faces the challenge of a large number of HIV/AIDS cases. Existing research predominantly focuses on the study of a particular region or population in China, and there is relatively limited research on the macro-level analysis of the spatiotemporal distribution of HIV/AIDS across China and its association with socioeconomic factors. This study seeks to identify the impact of these factors on the spatiotemporal distribution of HIV/AIDS incidence in China, aiming to provide scientific recommendations for future policy development. This study employed ArcGIS 10.2 (Esri) for spatial analysis, encompassing measures such as the imbalance index, geographical concentration index, spatial autocorrelation analysis (Moran I), and hot spot analysis (Getis-Ord Gi*). These methods were used to unveil the spatiotemporal distribution characteristics of HIV/AIDS incidence in 31 provinces of China from 2009 to 2019. Geographical Detector was used for ecological detection, risk area detection, factor detection, and interaction detection. The analysis focused on 9 selected socioeconomic indicators to further investigate the influence of socioeconomic factors on HIV/AIDS incidence in China. The spatiotemporal distribution analysis of HIV/AIDS incidence in China from 2009 to 2019 revealed distinct patterns. The spatial distribution type of HIV/AIDS incidence in China was random in 2009-2010. However, from 2011 to 2019, the distribution pattern evolved toward a clustered arrangement, with the degree of clustering increasing each year. Notably, from 2012 onwards, there was a significant and rapid growth in the aggregation of cold and hot spot clusters of HIV/AIDS incidence in China, stabilizing only by the year 2016. An analysis of the impact of socioeconomic factors on HIV/AIDS incidence in China highlighted the "urbanization rate" and "urban basic medical insurance fund expenditure" as the primary factors influencing the spatial distribution of HIV/AIDS incidence. Additionally, among social factors, indicators related to medical resources exerted a crucial influence on HIV/AIDS incidence. From 2009 to 2019, HIV/AIDS incidence in China was influenced by various socioeconomic factors. In the future, it is imperative to optimize the combination of different socioeconomic indicators based on regional incidence patterns. This optimization will facilitate the formulation of corresponding policies to address the challenges posed by the HIV/AIDS epidemic.

The settlement mechanism of diagnosis-intervention packet payment scheme in China：A policy review and lessons learned

The settlement of the medical insurance fund is the key point of the implementation of the big data diagnosis & intervention packet (DIP) under the regional global budget. This study proposed the framework with key methods for the settlement of DIP on medical insurance funds through on-site survey and policy literature analysis. The results show that the settlement framework, featuring “Fund pre-allocation”, “Monthly pre-settlement” and “Annual settlement”, integrates ideas of both the pre-payment system and post-payment system. “Monthly pre-settlement” being the key part of the settlement process, plays an important role in breaking down the year-end pressure of medical insurance management organizations and healthcare institutions, and guiding providers' reasonable behaviors. “Annual settlement” acts as the core link of settlement, which determines the annual medical insurance fund payment amount of healthcare institutions, which needs to rely on and integrate key elements such as regional global budget, DIP grouping database and correction, and healthcare institution supervision and assessment. The settlement process, measurement methods, and key parameters must be clarified by introducing settlement and related supporting policies, which provide technical support and institutional guarantees for the implementation and effectiveness of the DIP reform.

Analysis and discussion on the pharmaceutical centralized procurement implementation - a case study of a large provincial hospital in China.

Unaffordable medical treatment and inflated drug prices have become a challenging issue for lawmakers worldwide. To reduce the financial burden and standardize the pharmaceutical market, the Chinese government has issued several detailed regulations, including the measures of drug recruitment and procurement in one and volume purchasing to not only ensure the high quality of approved drugs but also lower the cost of the production and sell procedure. In this work, to have a thorough overview of the enforcement of these regulations, we attempted to critically analyze the data of our hospital's centralized procurement of drugs from 2019 to 2022. We identified some concerns, such as the difficulty in determining the "quantity" of drug procurement, out-of-stock of collectively procured drugs, difficulty in managing the preallocation of associated funds, incomplete centralized procurement systems, etc. Therefore, it is essential to promote a multidimensional strategy, including the combination of the medical insurance reform and drug centralized procurement policies, strict controlling of the forecast quantity of drugs to ensure stable drug supply, improvement of the relevant policies for retaining the surplus of centralized procurement drug medical insurance funds, secureness of the drug procurement system platform, and available reference and guidance for subsequent centralized quantity procurement of drugs.

Clinical Evaluation of Dural (Spinal) Membrane Repair Materials

To select high-quality and cost-effective dural (spinal) membrane repair materials, in order to reduce the cost of consumables procurement, save medical insurance funds, and optimize hospital operation and management. Taking the BS06B disease group (spinal cord and spinal canal surgery without extremely severe or severe complications and comorbidities, mainly diagnosed as congenital tethered cord syndrome) as an example, a retrospective analysis was conducted on the relevant data of surgical treatment for congenital tethered cord syndrome conducted in our hospital from January 2021 to June 2023. Safety and efficacy indicators in clinical application (incidence of postoperative epidural hemorrhage, incidence of postoperative purulent cerebrospinal meningitis, incidence of cerebrospinal fluid leakage, surgical duration, and postoperative hospital stay) were compared. There was no difference in safety and effectiveness between different brands of dura mater repair materials. For the repair of small incisions in dura mater surgery, high-quality and cost-effective dura mater repair materials can be selected to reduce hospital costs and control expenses for the disease group.

Enhancing pooling levels strengthens the risk resilience of healthcare insurance: a case study of basic medical insurance fund operations data in Gansu, China

BackgroundIn China, enhancing the pooling levels of basic health insurance has consistently been regarded as a pivotal measure to promote the refinement of the healthcare insurance system. From 2020 to 2022, the widespread outbreak of COVID-19 posed new challenges to China’s basic health insurance.MethodsThe research utilizes Data Envelopment Analysis (DEA), Malmquist index assessment, and fixed-effects panel Tobit models to analyze panel data from 2020 to 2022, assessing the efficiency of basic health insurance in Gansu Province.ResultsFrom 2020 to 2022, the average overall efficiency of the municipal pooling of Basic Medical Insurance for Urban and Rural Residents was 0.941, demonstrating a stable trend with a modest increase. The efficiency frontier regions have expanded from 5 (35.71%) to 7 (50%). Operational efficiency exhibited a negative correlation with per capita hospitalization expenses and per capita fund balance but a positive correlation with per capita accumulated fund balance and reimbursement rates for hospitalized patients. In 2021, compared to 2020, the county-pooling Basic Medical Insurance for Urban Employees saw a decline of 0.126 in overall efficiency, reducing the efficiency frontier regions from 8 to 3. However, from 2021 to 2022, the municipal-coordinated Basic Medical Insurance for Urban Employees experienced a 0.069 increase in overall efficiency, with the efficiency frontier regions expanding from 3 to 5. Throughout 2020 to 2022, the operational efficiency of the Urban Employee Basic Medical Insurance showed a consistent negative correlation with per capita fund balance.ConclusionFrom 2020 to 2022, the overall operational performance of basic health insurance in Gansu Province was satisfactory, and enhancing the pooling level is beneficial in addressing the impact of unforeseen events on the health insurance system.

County medical community, medical insurance package payment, and hierarchical diagnosis and treatment-Empirical analysis of the impact of the pilot project of compact county medical communities in Sichuan Province.

Hierarchical diagnosis and treatment (HDT) is an important exploration direction to alleviate the rising pressure of health expenses and medical insurance fund expenditure in China, and to maintain and protect the public health in this country. In recent years, the construction of compact county medical communities (CCMC) has become the primary approach for implementing the HDT. Utilizing the quasi-natural experiment of the pilot project of CCMC in Sichuan Province in 2019, coupled with county-level data extracted from the ' Sichuan Provincial Health Statistics Yearbook ' spanning the years 2008 to 2021, this research evaluates the effect of the pilot project of CCMC on promoting HDT under the medical insurance package payment model. The results show that the pilot project of CCMC has significantly increased the number of consultations per capita of medical and health institutions in pilot counties by 0.434 times, of which the number of consultations per capita of primary medical institutions has increased by 0.340 times; the number of hospitalizations per capita in public hospitals and primary medical institutions in pilot counties increased significantly, and the surgery rate of inpatients in public hospitals increased by 5% compared to before the pilot. There was no significant impact on the allocation of medical facilities and human resources in the pilot counties. Therefore, the construction of CCMC under the medical insurance package payment mode has promoted the realization of the county-level HDT. These findings provide valuable insights for healthcare policy, especially in developing and implementing effective strategies for HDT in county-level medical institutions.

Influence of medical and social factors on patients’ satisfaction at the center for reproduction and family planning with medical care

BACKGROUND: The constant increase in the number of commercial medical organisations providing medical care using assisted reproductive technology (ART) and compulsory medical insurance funds necessitates the need to control the quality of medical services in this area. An important tool for this control is conducting sociological surveys of women undergoing infertility treatment using in vitro fertilisation (IVF) both in paid and free forms.&#x0D; MATERIALS AND METHODS: Using a random sampling method, an anonymous survey was conducted on 398 patients of the Center for Reproduction and Family Planning in St. Petersburg, which provided medical care for infertility treatment using ART both at the expense of compulsory medical insurance and in paid form. The significance of differences in indicators was assessed using Student’s t-test for quantitative indicators. The significance of differences between qualitative characteristics was checked using contingency tables and Pearson’s chi-square test (χ2). Differences were considered significant at р 0.05.&#x0D; RESULTS: Despite the high level of patient satisfaction with the provision of medical care using ART, 9.0% of women were partially or completely dissatisfied. Compulsory medical insurance funds were paid for infertility treatment using IVF for 12.1% of patients. The majority of patients paid for medical care themselves (87.9%), of which 13.1% of women believed that the cost of medical services in the center was excessive (χ2=29.08; р=0.000), and 10.9% thought that the cost does not correspond to the level of medical services provided (χ2=25.74; р=0.000). There was no significant influence of age (χ2=4.78; р=0.311), place of residence (χ2=1.79; р=0.409), presence of children (χ2=2.21; р=0.331), employment (χ2=2.91; р=0.233) and forms of payment for treatment (χ2=4.69; р=0.096) on the distribution of patients according to the degree of satisfaction with medical care. At the same time, it was determined that marital status (χ2=6.88; р=0.032) and income level (χ2=60.01; р=0.000) are factors that influence the degree of satisfaction of women with infertility treatment using ART.&#x0D; CONCLUSION: Many medical and social factors have been identified to significantly affect satisfaction with medical care, such as the patient’s marital status and income level. Simultaneously, the economic form of payment for treatment did not have a significant effect on the degree of satisfaction.

Clinical-economic evaluation of distance education and blood glucose level monitoring in adults with diabetes mellitus

Background. Health Technology Assessment (HTA) in the Russian Federation has been performed for drugs, not for other medical technologies, which leads to decision making difficulties today. Aim. This study aimed to assess the clinical and economic efficiency of distance education and monitoring of blood glucose levels in patients with diabetes mellitus (DM) of both types. Materials and methods. The HTA was prepared using Markov model with a cost-effectiveness analysis methodology. The number of DM complications depending on glycated hemoglobin level with distance education and blood glucose level and without, that has been used for modeling cost of distance education and blood glucose monitoring as well as cost of drugs’ therapy and hospital admission due to DM complications with methodology and source of Obligatory Medical Insurance Fund on 30-yy horizon of modeling. Results. Distance education and blood glucose monitoring in DM patients leads to decrease in complication level as well as mortality, and acceptable additional financial costs from the 5th year of modeling for DM type 1 and from the 6thyear of modeling for type 2 without insulin dose changing. Conclusion. Clinical-economic reasonability of distance education and DM patients’ monitoring are demonstrated in this work. These results should be considered in the decision-making process for HTA budget financing.

Economic efficiency of information management technology for the quality of dispensary observation in patients with coronary artery disease of the last access

Purpose. To economically substantiate the developed technology of information management of the quality of dispensary observation of patients with coronary heart disease using dynamic monitoring and evaluation of digital personalized data on the provided medical care.&#x0D; Materials and methods. To improve the efficiency of dispensary observation for angina pectoris, since 2018, the regional health care system of the Orenburg region has been implementing a technology for managing the quality of dispensary observation based on the analysis of big data on medical services and information integration “emergency medical care (EMC), hospital — Territorial Compulsory Medical Insurance Fund + Medical information-analytical center — polyclinic”. To assess the effectiveness of this technology in a group of angina pectoris patients with dispensary observation in the amount of 13,208 patients, we compared the results for 2017 and 2019. &#x0D; the total cost of treatment per year in the polyclinic, EMC, and hospital, economic losses from deaths and financial costs per unit of efficiency. Angina pectoris patients without a myocardial infarction during the observed period of time was taken as a unit of effectiveness. The data were processed using linear statistics and parametric comparison methods. The Statistica 10 software package was used.&#x0D; Results. Financial costs for the treatment of angina pectoris for 2017 and 2019 did not differ significantly from each other. The economic losses from premature death have been almost the same over the years. At the same time, the financial costs per unit of efficiency in angina pectoris patients in 2019 accounted for only 76% of the same indicator for 2017, the difference in this indicator was significant.&#x0D; Limitations. To assess the effectiveness of information management technology, we analyzed the clinical and economic results of dispensary follow-up for two years in 13,208 patients with angina pectoris, which is a sufficient reference sample.&#x0D; Conclusion. The technology of information management of the quality of dispensary observation in coronary artery disease is cost-effective, manifested by a significant reduction in financial costs per unit of efficiency. The analysis of large databases of electronic data on medical services is a tool for economic evaluation of the effectiveness of healthcare management technologies.

Methodological approaches to assessing the effectiveness of financial and economic activities of a healthcare institution

The article reveals a set of issues related to the development of methodological and information support for evaluating the effectiveness of financial and economic activities of healthcare institutions. A critical analysis of existing approaches presented in regulatory and recommendation documents of various legal status, as well as a review of publications by Russian and foreign authors showed that for use in management practice, existing developments need to be improved, adapted to the socio-economic conditions of health care institutions, whose management needs an objective assessment not only of the medical component, but also an analysis the efficiency of using the entire range of resources generated within the framework of the state task, the sources of which are funds from the federal and regional budgets, the compulsory medical insurance fund and income from the provision of paid services. The directions of developing a system of evaluation indicators of effectiveness and efficiency, improving the information base for their analysis, control and forecasting are proposed.

Research on the risk governance of fraudulent reimbursement of patient consultation fees.

The fundamental medical insurance fund, often referred to as the public's "life-saving fund," plays a crucial role in both individual well-being and the pursuit of social justice. Medicare fraudulent claims reduce "life-saving money" to "Tang's monk meat", undermining social justice and affecting social stability. We utilized crawler technology to gather textual data from 215 cases involving fraudulent health insurance claims. Simultaneously, statistical data spanning 2018 to 2021 was collected from the official websites of the China Medical Insurance Bureau and Anhui Medical Insurance Bureau. The collected data underwent comprehensive analysis through Excel, SPSS 26.0 and R4.2.1. Differential Auto-Regressive Moving Average Model (ARIMA (p, d, q)) was used to fit the fund safety forecast model, and test the predictive validity of the forecast model on the fund security data from July 2021 to October 2023 (the fund security data of Anhui Province from September 2021 to October 2023). The outcomes revealed that fraudulent claims by health insurance stakeholders adversely impact the equity of health insurance funds. Furthermore, the risk management practices of Medicare fund administrators influence the publication of fraudulent claims cases. Notably, differences among Medicare stakeholders were observed in the prevalence of fraudulent claims. Additionally, effective governance of fraudulent claims risks was found to have a positive impact on the overall health of healthcare funds. Moreover, the predictive validity of the forecast model on the national and Anhui province's fund security data was 92.86% and 100% respectively. We propose four recommendations for the governance of health insurance fraudulent claims risk behaviors. These recommendations include strategies such as "combatting health insurance fraudulent claims to preserve the fairness of health insurance funds", "introducing initiatives for fraud risk governance and strengthening awareness of the rule of law", "focusing on designated medical institutions and establishing a robust long-term regulatory system", and "adapting to contemporary needs while maintaining a focus on long-term regulation".

Policy Evaluation of the Reform of Ambulatory Patient Groups Based on Access, Quality, and Cost of the Iron Triangle Value Chain in China

Objective. As part of the efforts to build a practical, effective, and diversified medical insurance payment method, it is crucial for China to deepen the reform of ambulatory patient groups (APGs). This study was aimed to explore the mechanism and effect of this policy from three dimensions, including medical expenses, medical insurance funds, and medical services. Methods. In 2020, China’s pilot reform of APG was initiated in Jinhua City, Zhejiang Province. Descriptive statistics, correlation analysis, and OLS regression analysis were utilized to evaluate the effect of the APG reform in Jinhua. Results. The implementation of the reform can contribute significantly to establishing a comprehensive medical service governance mechanism of classified settlement and coordinated promotion. It also plays a critical role in safeguarding people’s lives and health by promoting the high-level development of medical insurance systems and public hospitals, optimizing the quality of medical services, and improving the efficiency of medical insurance funds. Conclusion. Through the lens of policy evaluation, our findings can provide useful experience for the implementation of the outpatient medical insurance payment method in developing countries.

International comparison of the financing mechanism of basic medical insurance and its implications for China

Background: For more than 20 years, China's basic medical insurance system has realized the span from "system construction" to "improving quality and efficiency". At present, as the core issue of medical insurance system design, the current financing mechanism is difficult to adapt to the current situation and tasks. Objectives: Based on the theory of social equity, this paper uses literature analysis and comparative research to analyze the forms of social health insurance financing in four developed countries: Germany, the United States, Singapore and the United Kingdom. On this basis, it makes a systematic reference and reflection on the financing mechanism of basic medical insurance in China. Methods: The author adopts the method of literature analysis and comparative study. Through the existing research literature and the theoretical analysis of the medical insurance financing mechanism, the conceptual connotation and dimension of the basic medical insurance financing mechanism are further summarized and analyzed, which provides the reference and theoretical basis for the writing ideas of this paper. By analyzing and comparing the typical practice of the social medical insurance model in four developed countries, the basic ideas, main practices, direction goals, principle adherence, implementation results, realistic difficulties and obstacles of obtaining medical insurance financing are discussed. This paper analyzes the development status of medical insurance financing mechanism between China and four developed countries by means of classification, induction and comparison, and puts forward the optimization path based on the experience of the latter's fair practice. Results: it proposes that the current funding mechanism of China's basic medical insurance has three problems: An unbalanced funding structure and unreasonable sharing of responsibility; low level of coordination and unfair funding method; and dynamic growth mechanism of endogenous medical insurance funding has not yet been established. Main Contribution to Evidence-Based Practice: On the basis of the international experience, the author puts forward some enlightening reform measures to solve the existing problems in China: first, through the reasonable definition of the rights and responsibilities of multi-stakeholder, to construct the appearance of fair implementation; Second, reform the existing fixed financing methods and establish a fair financing mechanism linked to income; The third is to improve the actuarial mechanism of fund adjustment and promote the dynamic and sustainable growth of medical insurance funds. We will further optimize the financing mechanism of basic medical insurance and promote the high-quality and sustainable development of China's basic medical insurance.

What are people’s attitudes toward medical insurance fraud whistleblowers? a study from China

PurposeMedical insurance fraud has caused huge losses to countries around the world, and public reporting has become an important means to combat medical insurance fraud. The attitude of medical insurance fraud whistleblowers affects people’s reporting behavior, and understanding people’s attitude toward medical insurance fraud whistleblowers provides a basis for further improving the system and policy of public participation in medical insurance fund supervision.MethodsWe adopted the questionnaire method to conduct a national cross-sectional survey of the Chinese public and analyzed the data using Chi-square tests, Fisher’s exact tests, and binary logistic regression models.ResultsA total of 837 respondents were included, and 81.8% of the population had a supportive attitude toward medical insurance fraud whistleblowers, with gender, whether they had used medical insurance reimbursement, and present life satisfaction being statistically significant (P < 0.05).ConclusionThe public is generally supportive of medical insurance fraud whistleblowers, and women, those who have used medical insurance for reimbursement, and those who are satisfied with their lives are more likely to be supportive of medical insurance fraud whistleblowers.

A Study on the Balance of Income and Expenditure in the Urban and Rural Residents' Medical Insurance Fund in the Northern Mountainous Region

A Study on the Balance of Income and Expenditure in the Urban and Rural Residents' Medical Insurance Fund in the Northern Mountainous Region

Формирование бюджета территориального фонда обяза-тельного медицинского страхования (на примере Тверского ФОМС)

The problem of effective and rational budget formation of state off-budget funds is becoming more and more urgent today. The processes of budget formation of the off-budget funds are studied to ensure income growth, optimize expenses, and to increase their efficiency and transparency. Territorial compulsory medical insurance funds (TCMIF) are created by the executive authorities of all subjects of the Russian Federation. The purpose of territorial funds is to implement state policy in the field of medical insurance on the territories of the subjects of the Russian Federation. The purpose of the analysis of the process of forming TCMIF budget of Tver region is to assess the possibilities of the fund to implement the state policy in the field of compulsory medical insurance (CMI) in Tver region. The analysis of TCMIF budget formation of Tver region in 2021-2023 made it possible to make a conclusion that the available financial resources of the fund allowed to finance medical care provided to the population by medical organizations of Tver region, to cover the expenses of medical organizations of Tver region with the CMI funds and to pay for medical care by insurance medical organizations timely and in full volume.