Amendments to the law “On Compulsory Health Insurance”, drafted by the Health Ministry, have been submitted to the State Duma. The bill would allow regional governors to remove insurance medical organizations from the CHI system in their regions and transfer their powers to territorial funds. The main functions involved are oversight of care quality and protection of patients’ rights.
At present, CHI funds formed from employer and state insurance contributions move through a system of funds and insurance medical organizations. These organizations pay for services provided and handle patient complaints when medicines are not supplied, examinations are delayed, or care procedures are violated. According to the All-Russian Union of Insurers, such organizations receive about 1,500 inquiries every month concerning access to treatment in state clinics and hospitals.
Under the draft law, territorial CHI funds would work directly with medical institutions, transfer money to them, and at the same time assess their performance. Critics of the initiative argue that the promised savings are unlikely to materialize, while the risk of conflicts of interest would increase because both hospitals and the funds are part of the same state healthcare system and answer to the same ministry.
“Territorial funds are being given the role of both operator and controller of their own activity. In this model, no fair and independent review or protection of citizens’ rights is possible,” said Aleksei Starchenko, a member of the public council on patients’ rights under Roszdravnadzor.
Representatives of patient organizations say insurers remain the only independent link between the state, medical institutions and citizens. They argue that insurance representatives help resolve conflicts, support patients and monitor treatment quality. Each year, insurance medical organizations conduct about 30 million reviews and identify more than 5 million defects affecting the accessibility and quality of care.
Sources in the patient community warn that without independent oversight, clinics may begin saving money by refusing examinations more often, shortening appointment times and delaying hospitalization. They also note that if some regions keep the current model while others transfer these functions to territorial funds, patients will face unequal conditions.
At present, if a patient is denied an examination, receives improper treatment or is not given a referral, that person can обратиться to an insurance company, which reviews the case, can impose sanctions on the clinic and, if necessary, defend the patient’s rights in court. If the amendments are adopted, complaints could formally be sent to territorial funds, but it remains unclear whether they are prepared for that role. They would need to build call centers, digital feedback services, expert review systems and staff training from scratch. Otherwise, critics of the reform say, patients will increasingly have to go straight to court, the prosecutor’s office or supervisory authorities.