DMS and OMS : differences

DMS and OMS : differences
Today in Russia are two types of health insurance - Obligatory (CBOs) and voluntary (LCA).Consider their differences, before making a choice.

CHI - the minimum necessary for each

Compulsory health insurance (MHI) guarantees to every citizen of the Russian Federation, regardless of his social class free assistance when the insured event (sickness).

pay for services from public funds (received from taxpayers) in the framework of the program the MLA.

List CHI basic program services is quite wide and includes primary health care, prevention and first aid, treatment of virtually all known medical conditions, including heavy.

Dental care, preferential provision of medicines and prostheses (dental, ophthalmic, otic), treatment of oncological diseases, help with acquired immunodeficiency syndrome (AIDS) prevention and treatment of tuberculosis, help addicted patients, and people with mental health problems - all includedin the basic benefits package.

Pregnancy and childbirth care in the postpartum perio

d, the observation, if necessary, treatment of the child in children's hospitals also have a program of this type of insurance and free.

Important!

view of the fact that the registration of the newborn OMC policy takes some time, medical care during this period, he received under the policy of the MLA of his mother.

Medical assistance OMC is usually in the regional polyclinics, clinics, public hospitals, in short, to the institutions to which you are attached to your home.

However, if the insured event occurred on a trip in the territory of the Russian Federation, you are required to be treated at the place of your residence, upon presentation of an insurance policy, which is necessary in advance to bring.If you wish to replace the doctor or clinic, you have every right to do so, to ask for information to the insurance company that issued your policy.

most important health insurance organizations in early 2012, according to Wikipedia, called "MAKS-M" (14% of the market), "ROSNO-MS" (12% of the market), "SOGAZ-Med" (9% of the market)"Rosgosstrakh-Medicine" (6% of the market) and CJSC "Capital Health insurance" (5% of the market CHI) (the latter two companies are part of a group of "Rosgosstrakh" companies).

Possible disadvantages CHI

Often, though not always enjoy using the CHI system, faced with such features of the program.

1. Queues

Talk about what to spend waiting at the doctor's office a half-day, perhaps, no one needs.Introduction of the system of electronic record to the doctor at the coupons may have partially solved this problem, but a living place, as well as a string of wanting to "just ask" or take a certificate at the same time has not been canceled.

2. The need to be booked in advance or sent to an additional medical facility

is often necessary to carry out a consultation procedure, or at the right doctor is necessary to wait a long time, pre-recorded, sometimes for several months.

In addition, it may be that the doctor is not even the most narrow specialization in the clinic at the place of your attachment is missing, ill, he went on vacation, or even one of the entire area (big cities, and even the capital is no exception).

This means that you get a referral to another medical facility, where you will help, but how far will have to go, you can not predict in advance.If your state of health does not allow to wait, most likely, a diagnostic procedure (eg, ultrasound), you will immediately, but in the absence of technical possibilities to go to another clinic or hospital care is necessary.

3. The difficulty of obtaining quota free conduct complex operations

If you find yourself seriously ill, you need expensive high-tech treatment.In certain cases, the State will pay it to you by issuing a special quota.But to obtain it is necessary to collect a lot of information and documents that require time and considerable forces.

Usually this in critically ill just do not, so there may need help from relatives or money savings "for a rainy day" to carry out the same operation for the money.

4. The need to pay for additional services

CHI program covers not everything, and sometimes you need something to pay extra.For example, treatment of the tooth will hold you for free, but the seal of a material that looks like a real tooth and last longer than cement, install an extra cost.

And it is not arbitrary and is not fraud, just such supplies basic CHI program can not be paid.

Differences LCA - every whim for your money

Voluntary Health Insurance (VHI) - is the provision of medical services that are not included in the list of the MLA program, or in a broader scope than planned, as well as in the normal way, but to those whoThey are not entitled to free health care on the territory of the Russian Federation.

services policy LCA are exactly the amount by which the contract was concluded with the insurance company, working on such a system.It is carried out on the basis of the contract medical institution (private or public).

service on DMS system can be either a one-time (tooth extraction, receiving a medical specialist), and long-term (maintenance of pregnancy, the baby's first year of life monitoring, etc.), and their cost will vary accordingly.

medical insurance in the system VHI for their employees and their families can offer employers, which is an advantage for the employees, who can visit a doctor and get treatment near the place of work and without waiting in line, as well as take, for example, a child to a rarespecialist, which is difficult to find in the district hospital.

positive difference paid health care is that the right doctor will see you at a convenient time and without long waiting times.

most likely disadvantages LCA

1. The need to pay for each additional step

All manipulations in the course of the treatment, beyond prescribed in the contract, paid in addition, not always the most humane price.This includes additional injections, use of medication, surveys or any further measures that need arose.

For example, in the contract for the observation of the child up to a year prescribed three consultation neurologist and your baby needed more for health reasons.Kindly pay.

Another example could be paid labor.The contract is usually plain text specifies that it applies only to the cost of childbirth in a natural way, in case if there is a need for an emergency caesarean section, the amount is quite another.But who can predict in advance for a delivery?

2. Refusals to severe cases

Paradoxically, part of the terms of the contract LCA is the lack of patient severe diseases, to prevent potential risks to health and life during treatment.

For example, if a pregnant diabetes or a heart condition, to sign a contract with her, most likely will not want to.Perhaps the contract will be stated that in the event of complications responsible insurance company is not responsible.Before the free medicine are all equal.

3. The same thing that the MLA, but for a fee

not always services are based on the LCA of elite medical institutions of highly qualified doctors, to get to that "mere mortals" impossible.It may be that you will be treated in the district hospital the same doctors that are the usual method.This does not mean that the quality of health care will be worse, simply will not have the entourage.

LCA and OMC: the reasonable compromise

Choosing whom to entrust their health - a private matter of each citizen.Often, after weighing all the pros and cons, the patients are laid on them the right to free medical services, but in some special cases referring to paid professionals.

For example, to resolve contentious issues, for faster results, or if the right doctor is not near a hospital.In this case there is no overpayment for something you can get under the policy of the MLA.

should also mention travel insurance.Medical insurance going abroad is not provided compulsory medical insurance program, but can not leave the country without it.In this case, to purchase VHI anyway necessary.

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