Citizens do not know what they are entitled to under CHI policy

Russians are not sure about their rights in the health insurance system (CHI). Often times, free health care is said to be inaccessible, according to the Chamber of Accounts. According to the investigators, it is necessary to review the entire system of protecting the rights of patients and, in some cases, change the law.

Citizens are entitled to be referred to a clinic in their region and abroad, to change their clinic no more than once a year. However, they cannot exercise this right: if the clinic is not in the same region as the health insurance organization, it cannot receive legal funding per person. Citizens have the right to change their insurance company under the CHI, however, residents of the 23 regions have no choice, as they have one insurance company for the entire region.

Patient complaints are not registered. Medical insurance companies treat all calls from people as inquiries. What happened was that they often told people about the lack of meetings with doctors and tests, about the long wait for health care.

Citizens, as a rule, go to the courts themselves to protect their rights, although this is possible and necessary through the National Fund of Compulsory Health Insurance (TFOMS). But in two years they did not issue a single judgment, said Galina Izotova, the deputy chairman of the Chamber of Accounts. In rare cases, the rights of patients in court are represented by health insurance organizations, although legally this is not in their power. Out of 1.5 thousand claims in 2019-2020, 97% were submitted by patients, the third was satisfied – 235 – in 2019 and 271 – in 2020.

In almost half of the regions, people cannot request the TFOMS remotely, because their information systems do not provide it, the inspector said.

And the results of inspections of medical institutions, according to him, do not lead to improving the availability and quality of their services. “Patient complaints about the quality of health care, and violation of the waiting time, except for oncological diseases, are not permanent. There is no special tool set up to check the waiting time for health care, “said the vice president of the Chamber of Accounts.

The Ministry of Health and FFOMS agreed that the system needed to be reformed. “Of course, citizens are not aware of their own rights. Therefore, the system should be made vertically so that all its participants can work,” Deputy Minister of Health Volodymyr Zelenskyy concluded.

The auditors have submitted proposals to the government for changes to the law before the end of the year.


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