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Will health risk insurance become a “safety bag” for russian patients?

21.03.2014

An expert session “The role of health risk insurance to increase the availability of specialized medical care” became one of the most remarkable information events of the Russian Public-Private Partnership Week which was held on March 11-13 in Moscow. This expert session was initiated by the Ministry of Health and the non-profit partnership “Equal Right for Life” brought together leading experts in medicine, social economy and business insurance, representatives of public and patient organizations.

The reason for the expert session was a joint initiative of VTB Insurance and NP "Equal Right for Life" for the insurance of population for possible detection of cancer. The session was opened by the adviser to the Minister of Health of the Russian Federation for Communications and Public-Private Partnership Igor Lanskoi, who noted that the main purpose of the event is to learn the opinion of experts on the prospects of voluntary health insurance as an additional source of funding for the Russian health care.
The necessity of health insurance is obvious to everyone, but until now the main insurer in Russia is the government. "Our way is traditionally a unique one," said Sergey Kraevoy, Deputy Russian Minister of Health of the Russian Federation. "All European countries, even the countries of the former Soviet bloc, has travelled a long way from fee-for-service medicine to a partially paid one, therefore, private health insurance is well developed in the western countries. Only in the USSR there was a generation of people who were born, lived and died having free medicine; the state took almost full responsibility for their health." Sergey Kraevoy is sure that current realities require turning away from paternalism in health care: "Now we begin to understand that the budget is not enough to cover the needs of everyone who requires a complex and expensive specialized medical care. We have to look for alternative sources of funding. One possible way is to create insurance packages where a patient insures oneself or his/her loved ones for the risk of occurrence of certain disease instead of buying a voluntary health insurance policy. The point is whether the Russian insurance business is able to offer products which will provide reliable protection for a person in case of illness and at the same time will serve the development of national health care?"
 
Recently there were intense debates about the great gap between the rights declared by the laws and the reality in which patients, doctors, health care system and the government are situated. Dmitry Borisov, executive director of NP "Equal Right for Life" and Deputy Chairman of the Russian Association of Oncologists, believes that the system of solidary payments is capable to decrease this gap and become a kind of "safety bag" for patients: "The United Nations and the World Health Organization in their official documents encourage the development of mechanisms to reduce direct and critical payments, which a patient has to make at the time when disease is detected. It's not just a recommendation, but a political document based on which countries shall build their internal policies. An illness always means risk and damage, first of all the financial one, not only physical and moral. The government must take it into account and create sustainable mechanisms to protect the population and the health system as a whole. In our country, we have the highest one-year mortality rate with every third patient dying within the first year after diagnosis. In Russia, cancer kills 300 thousand people every year, this is 10 times more than the number of road accident victims. Now we have three million cancer patients; the problem of cancer affects more than 12% of population and all these people together with patients are at the financial risk associated with providing of treatment. Over the past 10 years, the budgetary funding of cancer care increased more than 14-fold. But this money is not enough: every third package of anti-cancer medicines in our country is bought by patients for their own money. People tend to buy cheap medicines; they are not able to buy the more expensive, high-quality and effective ones, which may be present in the lists within the system of state guarantees, but nonetheless, access to them is limited due to objective reasons – there is not enough money in the country".

It is a known fact that public-private partnerships and developed insurance system multiply the financial capacity of the patient. Dmitry Borisov said in this regard: "In the G8 countries, where such mechanisms were developed for centuries, except for Russia, governments actively use the insurance resource for the protection of the population against the financial risks in particular. Now, when the Russian Ministry of Finance has declared a decrease of health care speeding in terms of percentage of GDP, it becomes clear to all that we need to find additional sources of financing."

David Melik-Guseinov, Director of Center for Social Economy is sure that the development of public-private partnership (PPP) and new insurance models will provide required funds for the medical industry. However, additional mechanisms of protection against the risks associated with socially significant diseases shall not mean that a patient refuses from state benefits due to him or her under the mandatory medical insurance. "If the burden of financing is rationally divided between the government and the patient, this will undoubtedly have a positive impact on the quality and availability of treatment. In this way, a person insured against cancer will have a choice: whether receive insurance money and go abroad for treatment, or spend it for domestic health care. Half million rubles in addition to mandatory medical insurance means an opportunity to get extra services, promptly and in full," said David Melik-Guseinov.

Head of Product Marketing at VTB Insurance Maksim Shaporin stated that risk insurance programs can help stabilize state funding for cancer treatment, provide necessary funds for patients, and enable them to properly and effectively use existing facilities and infrastructure of the Russian health care system. "The insurance program Manage Your Health was created taking into account problems that a person may face in case of cancer is diagnosed, and to solve those problems; it includes additional features for the insured person," said Maksim Shaporin. “In addition to significant cash payment (up to 2.4 mln rubles) in case cancer or other critical illness is detected, the insured person will be included in the unique system of tracking and assistance in order to organize patient treatment, including free verification of diagnosis by highly qualified doctors, development of an effective disease management plan, selection of specialized medical institution and organization of treatment in Russian or foreign clinics, as well as psychological and legal assistance." According to the expert, this insurance product is integrated primarily in the Russian health care system and contributes to retaining the money inside it instead of letting it go abroad.

Dmitry Borisov commented the program presented by VTB Insurance as follows: "For a person who is diagnosed with cancer the system of government guarantees is available and he or she has the declared rights backed by a limited budget. Can people protect themselves in this situation? Well, actually he or she can do this, provided that a special assistance system is added to the financial component provided under the voluntary insurance; the former allows obtaining all necessary expert assistance. It’s true when money accumulated by the insurance company is not just money for treatment, but co-financing, in addition to funds spent by the government. Only in this situation maximum possible assistance will be provided to a person and a real precedent will be created to divide the financial burden between the government and the private sector."
The relevance of risk insurance programs for health care is supported by the leading national experts, Chief Oncologist of the North-West Federal District Georgy Manikhas and Chief Oncologist of the Volga Federal District and the Republic of Tatarstan Rustem Khasanov. Georgy Manikhas: "There is no country in the world that can afford provision of full cancer treatment (using up-to-date technologies and innovative medicines) only at the expense of the state budget, even the USA, where cancer is officially declared as threat to national security." Rustem Khasanov: "State budget is not able to provide full treatment in compliance with current protocols. The mandatory medical insurance standards remind me a father who tells his son: ‘Take three rubles and do yourself well!’ Of course, we must maintain MMI, but there is need for other options as well."

It’s impossible to state that the rights of patients are equal within the MMI, not least because the rates for treatment are different in regions: for example, 43,000 rubles per patient are allocated in Moscow; 7,000 in St. Petersburg and 5,000 in Kazan. Even in prosperous Moscow there is the problem of underfunding. According to the calculations made by "Equal Right for Life" together with Center for Social Economy, the standard rate of treatment for breast cancer (with rates used within MMI) is about 106,000 rubles (early stage disease) and 276,000 rubles (metastatic disease). This acute social problem requires new sources of funding and additional "safety bags" for patients.

Deputy Russian Minister of Health of the Russian Federation Sergey Kraevoy summed up the results of expert session: "When a person is in grief - it is important for him or her to get help. He or she has the right for it guaranteed by the state. But often the opportunities offered within the MMI system are not enough to save live of a patient: for example, necessary medicine may not included in the essential medicines list, or it is in the list but is not available in the pharmacy, or only a cheaper drug with lower efficiency is available while the patient cannot wait… Unfortunately, we have to admit that under the state guarantees a patient cannot get affordable, quality and, most importantly, timely assistance in full. Simply because some diseases require immediate action and drugs that are not included in standard coverage rates under MMI. Therefore, the most important task for today is finding new funding mechanisms."

Russian Public-Private Partnership Week is a major national discussion platform bringing together representatives of government bodies, leading Russian and foreign experts, private business leaders and representatives of the financial and banking community. This event is aimed at promoting the best practices of PPP projects for the benefit of raising Russians' living standards.

Non-profit Partnership "Equal Right for Life" was created in 2006, by initiative of the country’s leading oncologists. Its mission is to attract the attention of all the strata of the Russian society to problems associated with prevention, diagnosis and treatment of cancer. The message of the program “Equal Right to Life” is the equality of rights of Russian patients and Russian clinical oncologists to the information about advances in the world’s oncology, and equal opportunities to use state-of-the-art methods of diagnostics and treatment of cancer. The NP “Equal Right to Life” carries out its activities in more than 100 cities of Russia in three main areas: modernization of material and technical resources of Russian medical institutions for cancer care; educational events for Russian oncologists; promotion of healthy lifestyles, prevention and early diagnosis of cancer among the population. In 2013, NP "Equal Right for Life" was granted a consultative status with the Economic and Social Council of the United Nations.

VTB Insurance was established in 2000 and is now a part of the biggest international financial group VTB. The authorized capital of VTB Insurance is 7.7 bln rubles. Branches and sales offices of the Company are situated in more than 90 major cities of Russia. According to the results of nine months of the year 2013, the total amount of fees of “VTB insurance” reached almost 25 bln rubles. According to this figure, the insurer is among top ten market participants. The Company has the highest financial strength ratings according to Russian and international rating agencies.