Что такое ОМС+: что в нее входит, плюсы и минусы, сколько стоит полис, в каких регионах работает программа

OMC


Получая медицинскую помощь по полису ОМС, пациенты могут столкнуться с такими неудобствами как длинные очереди, недостаточный объем бесплатных услуг, низкое качество сервиса.

Чтобы избежать этих неприятностей, была разработана программа «ОМС+».

Предыстория

В начале 2015 года Минздравом был разработан новый проект в рамках стратегии развития системы здравоохранения России на следующие 15 лет.

Проект был назван «ОМС+», а его суть заключалась в создании дополнительной медицинской страховки.

Пациенты, которые хотят получить пакет медицинских услуг, больший, чем обязательный пакет, могут приобрести полис «ОМС+». Все платные процедуры, которые раньше проводились через кассу поликлиники, благодаря этой программе, могут оказываться только по новому полису.

При помощи полиса планировалось добиться увеличения финансирования системы здравоохранения, поскольку все скрытые платежи теперь могли бы проводиться только через «ОМС+».

Создание такой программы не предполагает сокращение услуг по обыкновенному полису. «ОМС+» действует как дополнение. Приобретение полиса не навязывается.

Программу не стали внедрять по всей России, а запустили только пилотные версии проекта в пяти регионах: Тюменская, Липецкая, Кировская, Белгородская область, республика Татарстан. В проекте участвовало ограниченное количество страховых компаний и больниц.

Что такое ОМС+

ОМС плюс — это дополнительный пакет услуг к программе обязательного медицинского страхования. Страховая компания в рамках обязательной страховки не оказывает дополнительного финансирования.

Пациент должен приобрести полис «ОМС+» и страховая, за счет этого полиса, оплатит стоимость дополнительных услуг. Обычно пациенты оплачивают их самостоятельно в кассе поликлиники.

Как целевая аудитория программы рассматривались граждане, активно пользующиеся дополнительными услугами в обычных поликлиниках. Такие люди получили возможность заранее оплатить с дисконтом конкретные медицинские услуги или помощь специалистов у себя дома, а не в поликлинике.

В объеме полиса «ОМС+» такие услуги должны были стать дешевле для конечного потребителя, чем оплаченные на месте.

Проект не предполагает навязчивое распространение страховых медицинских услуг отдельных организаций. Цена на пакеты зависит не только от количества входящих в него услуг, но и от степени ответственности гражданина за свое здоровье. Ответственность зависит от регулярности диспансеризации, медосмотров, общего состояния здоровья и т. д.

В «ОМС+» входит 16 программ. Их тарифы и цену участники проекта рассчитывали сами, исходя из содержания и направления. При помощи этой программы Минздрав пытается пополнить финансовое обеспечение здравоохранения.

У системы обязательного медицинского страхования недостаточное количество средств, чтобы обеспечить не только качество медицинской помощи, но повысить уровень сервиса.

Пациенты, желающие улучшить качество сервиса, часто доплачивают врачам и персоналу, не имея при этом никаких гарантий. Нововведение — это попытка вывести теневые платежи на официальный уровень.

Первые пробные программы, запущенные в нескольких областях, не оправдали ожиданий. Это произошло по ряду причин:


  1. Экономическая ситуация в стране
    Разработка проекта пришлось на период с более стабильной экономикой, а его реализация началась в момент регресса в экономике. Ожидаемого спроса на нововведение не последовало.
  2. Нет понимания принципов работы
    Создателям не удалось провести четкую границу между полисом ОМС и пакетом ОМС+. У граждан не сложилось полного понимания необходимости дополнительных расходов. Некоторые услуги в рамках пакета могут показаться пациентам необязательными.
  3. Отсутствие человеческих и временных ресурcов
    В медицинских учреждениях нет персонала, для оказания большего объема медицинских услуг. Пакет ОМС плюс предусматривает длительный прием врача. Чтобы его выполнить, необходимо либо урезать время приема по ОМС (чего делать нельзя), либо нанять больше специалистов, но проект не предполагает финансирование увеличения штата.
  4. Противоречивость некоторых условий
    ОМС+ имеет ограничение количества лабораторных исследований. Помощь в рамках обязательного страхования – нет. Получилось что оплачиваемый пакет содержит услуг меньше чем бесплатный.
  5. Отсутствие конкретной информации
    Граждане не хотят покупать услугу, которая им непонятна.

ОМС+ или ДМС

На первый взгляд пакет «ОМС+» может показаться добровольным медицинским страхованием. На самом деле это одна из его форм, отличающаяся от стандартного полиса ДМС следующим:

ОМС+ ДМС
Страхователем является сам пациент Страхователем может быть работодатель
Программа применяется только в тех учреждениях, в которых используется система ОМС (в обычной поликлинике) Полис может применяться в любых учреждениях, предусмотренных договором страхования (есть возможность выбирать)
Приобрести дополнительный пакет можно только в страховой компании, которая обслуживает гражданина по ОМС Приобрести полис ДМС можно в любой компании, независимо от страховщика по ОМС
Невысокая цена (в среднем от 10000 рублей в год) В зависимости от включенных в договор услуг цена может возрасти в десятки раз
Имеет сильно ограниченный набор услуг Включает большое количество привилегий
Нет возможности выбирать специалиста Есть возможность выбирать специалиста

Программа похожа на те, которые разрабатывают страховые организации имеющие лицензию на обязательное и добровольное страхование одновременно.

Министерство Здравоохранения попробовало совместить два полиса, создавая нечто среднее. Такая программа получается более дешевой, чем по полису ДМС, но дает немного больше возможностей, чем обязательное страхование.

Но, если оформляя полис ДМС, можно быть уверенным в обоснованности трат, то вокруг «программы плюс» остается еще много вопросов.

Действует ли сейчас и в каких регионах

Пробная версия программы «ОМС+» была запущена в 5 регионах: Татарстане и Тюменской, Липецкой, Белгородской, Кировской областях.

Позднее к проекту присоединились и частные клиники Москвы и Московской области.

Страховыми компаниями, продающими «ОМС+» стали «Макс», «Югория-Мед», «Согаз», «Росгосстрах» и «АК БАРС-Мед».

За первый год во всех регионах, участвующих в проекте, было продано всего несколько сотен полисов.

Жители Тюменской области могут оформить программы для новорожденных с медицинской помощью на дому. Пакеты делятся на 3 уровня в зависимости от количества медицинских услуг. Также страховые компании предлагают программы для взрослых с видеоприемами.

В Липецкой области запустили программы по педиатрии и стоматологии для детей.

В Кировской – программы для новорожденных.

В Белгородской – для взрослых и детей.

В Татарстане были введены 2 программы: «Сердце под контролем» и «Медицинское сопровождение пациента». В республике продалось самое большое количество полисов.

Цена полиса изменяется от 2000 рублей до 50000 рублей.

Сеть клиник «Доктор рядом» в Москве оформляет полисы «ОМС+» стоимостью от 7 тысяч рублей.

Клиники «АВС-Медицина» также используют нововведение.

Некоторые страховые компании создают продукты ДМС почти идентичные ОМС. Например, программа «ОтЛичная поликлиника» от ВТБ Страхование.

На данный момент можно оформить полис «ОМС+» через «Центр подбора ДМС». На сайте можно рассчитать примерную цену, сравнить разные виды программ и получить консультацию специалиста.

Первый неудачный опыт позволил Минздраву провести анализ и продолжить совершенствовать «ОМС+». Поэтому окончательной версии проекта еще не существует.


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A fascinating fact is that, according to a research performed when, Puerto Ricans are the happiest nation on the planet. If this is true, it would certainly imply that the well-known declaration that money does not bring happiness has a grain of reality in it. It is estimated that nearly half of the citizens of Public Relations deal with hardship, which can be seen while circumnavigating the island. Given That Puerto Rico is an island, it is most definitely an airplane Or a ship, if you wish to attach on PR during a cruise in the Caribbean. The primary flight terminal in San Juan the resources is well gotten in touch with major United States cities. From what I bear in mind, our trip from Atlanta lasted 3 hours It is best to rent a car in Puerto Rico and also circumnavigate the island in this way. We had the possibility to utilize the public Puerto Rico transportation just once, in the form of a ferryboat, and if all the remainder works according to comparable regulations, I highly advise this car than aggravating Idea — it’s actually worth leasing a car with a higher suspension. We did not know regarding it as well as we made a decision to buy some little gingerbread as a result of the most effective cost. We rapidly regretted this choice, because some corners of Puerto Rico are best explored with a 4×4 SUV. Caribbean, an island between the Caribbean Sea and also the North Atlantic Sea, east of the Dominican Republic, purposefully situated on the Mona Strait — a vital course to the Panama Canal; San Juan is one of the biggest and best all-natural harbors in the Caribbean; a lot of small rivers and high hills in the facility of the country guarantee great watering of the country; the south shore is relatively completely dry; in the north, an abundant strip of coastal plains. 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Tourism is traditionally an important income source, it is estimated that Puerto Rico was gone to by virtually 5 million people in 2004. 2001-03 saw a decrease in financial growth, primarily as a result of the United States economic downturn; in 2004-05 there was an economic growth, and also in 2006-07 it fell again. Puerto Rico is among the most dynamically developing Caribbean countries. The diversified market has actually surpassed farming as well as is now the main source of income. Given that the 1950s, American firms have been investing on the island, urged by the duty-free exchange with the USA and also tax obligation incentives. The island is subject to US minimum wage regulation. Sugar production reduced, and the milk sector and also livestock production ended up being the main income source. Tourism has actually been an essential source of income for years. It is estimated that in 1999 Puerto Rico was checked out by 5 million vacationers. The prognosis for 2000 is good, gave that the financial boom in the US and also the growth patterns in tourism as well as construction proceed. Everyone wanted a piece of the New Globe, as well as everybody wanted to eliminate to get it. Nowhere is this more noticeable than the Castillo San Felipe del Morro. Formally called La Ruta del Lechón, the Pork Highway is specifically what it seems like: a three-mile stretch of road where every restaurant focuses on pork. The most popular sort of pork is lechón, a special meal in Puerto Rico that includes spit-roasting a whole pig with a blend of sauces and also seasonings. Obtain your blood pumping with a journey to the Toro Verde Theme park in main Puerto Rico. It offers ziplines, rope training courses and also rock climbing challenges that are assured to make you pee your pants a little when you recognize simply what you have actually gotten yourself into! The park’s piece de resistance is «The Beast,» which is detailed in the Guinness Publication of Globe Records as the longest zipline on the planet. With cobbled roads, busy plazas and vivid homes that stack with each other like foundation of yellow, blue, eco-friendly, orange and turquoise, Old San Juan is among one of the most vibrant places to visit in Puerto Rico. This is why areas like Isla Culebrita exist. Isla Culebrita is an uninhabited island off the coast of eastern Puerto Rico. It’s only concerning a mile long, and also accessibility is restricted to ferries and water taxis. Museo de Las Americas There are lots of museums in Puerto Rico, but only a handful are really about Puerto Rico. The Museo de Las Americas is among these valuable areas. It has artefacts, tokens as well as fabrics from lots of aboriginal groups that lived in Latin America prior to it was conquered, and also it can take you on a multi-continental trip with history. If you like to consume, Mayaguez is the city for you. It’s home to everything from fine dining establishments to open-air coffee shops with huge, colorful umbrellas, so you’ll have lots of options when your stomach starts growling. El Yunque National Forestis Treatment greater than 28,000 acres, the El Yunque National Park is a lush, moist jungle where thick vegetation covers every little thing from slithering snakes to croaking tree frogs. It’s the only tropical rain forest in Puerto Rico, and also site visitors come from throughout the Carribean to witness both its elegance and also biodiversity. Situated in the city of Cabo Rojo on the most southern tip of Puerto Rico, the Los Morrillos Lighthouse is just one of those gorgeous places that you can just discover in the Caribbean. 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In addition, United States mobile networks run generally below. As well as at the very same rates for calls, messages and also network — a blessing, specifically when it involves the Web! Specifically given that the wifi in many places in Puerto Rico was so bad. The main languages are Spanish as well as English — however the huge bulk of homeowners talk instead the previous. Puerto Rico lies in the moist equatorial climate area, and also the ordinary yearly temperature level is around 25 levels Celsius. The traveler season runs from December 15 to April 15, as well as exotic heavy rainfalls most often take place in the high period. As well as it became real — throughout our week-long keep it really did not rain only one day. Luckily, the rainfall, although it was putting down, came really swiftly and after 15-20 minutes the tornado mored than and also the sunlight was beaming once more. A fascinating reality is that, according to a research performed once, Puerto Ricans are the happiest nation on the planet. If this is true, it would certainly mean that the well-known statement that cash does not bring happiness has a grain of fact in it. It is estimated that nearly half of the residents of PR have problem with destitution, which can be seen while circumnavigating the island. Given That Puerto Rico is an island, it is absolutely an airplane Or a ship, if you want to link on PR during a cruise ship in the Caribbean. The primary airport terminal in San Juan the capital is well connected with major United States cities. From what I remember, our flight from Atlanta lasted 3 hrs It is best to rent an auto in Puerto Rico as well as circumnavigate the island this way. We had the possibility to utilize the public Puerto Rico transport only as soon as, in the form of a ferryboat, as well as if all the rest works according to similar policies, I strongly recommend this automobile than aggravating Tip — it’s truly worth renting an auto with a greater suspension. We did not know about it and also we made a decision to acquire some small gingerbread due to the best rate. We quickly regretted this choice, since some corners of Puerto Rico are best explored with a 4×4 SUV. Caribbean, an island between the Caribbean Sea as well as the North Atlantic Sea, east of the Dominican Republic, strategically located on the Mona Strait — a crucial route to the Panama Canal; San Juan is just one of the largest and best natural harbors in the Caribbean; a large number of little rivers and high mountains in the facility of the nation guarantee good irrigation of the nation; the south coastline is fairly dry; in the north, an abundant strip of coastal plains. No person flies to Puerto Rico to see its cool federal government buildings. You desire fun in the sunlight. The good news is that Flamenco Beach will certainly meet your musings and afterwards some. Not only does it provide white sand and blue water that vibrates coming up, but it likewise boasts washrooms, lifeguards, food kiosks, volleyball internet and also tourist terminals where you can lease devices for things like snorkeling as well as scuba diving. Puerto Rico’s economic climate is among one of the most dynamically creating in the Caribbean. The diversified industry has actually plainly surpassed agriculture as the main driving force of the economic situation and also an income. Given that the 1950s, American business have been spending heavily on the island, encouraged by duty-free accessibility to the US market and tax breaks. The island has United States base pay laws. Sugar production shed its prominent placement in agriculture to dairy products and also livestock manufacturing. Tourism is typically a crucial income source, it is estimated that Puerto Rico was seen by virtually 5 million individuals in 2004. 2001-03 saw a decrease in economic growth, primarily as a result of the US economic crisis; in 2004-05 there was a financial growth, and also in 2006-07 it dropped again. Puerto Rico is one of one of the most dynamically developing Caribbean countries. The varied industry has outshined agriculture as well as is now the main income source. Because the 1950s, American firms have actually been spending for the island, urged by the duty-free exchange with the UNITED STATES as well as tax rewards. The island undergoes United States minimum wage legislation. Sugar production decreased, and also the dairy products industry and also livestock production ended up being the main income. Tourist has been an important income for many years. It is estimated that in 1999 Puerto Rico was checked out by 5 million travelers. The prognosis for 2000 is great, provided that the financial boom in the US and also the growth trends in tourist and construction continue. Every person wanted a piece of the New Globe, and also everybody wanted to combat to get it. Nowhere is this even more evident than the Castillo San Felipe del Morro. Formally referred to as La Ruta del Lechón, the Pork Freeway is precisely what it sounds like: a three-mile stretch of road where every dining establishment specializes in pork. One of the most preferred type of pork is lechón, an unique recipe in Puerto Rico that includes spit-roasting a whole pig with a mix of sauces and spices. Get your blood pumping with a trip to the Toro Verde Adventure Park in main Puerto Rico. It supplies ziplines, rope courses and also rock climbing up difficulties that are guaranteed to make you pee your pants a little when you understand just what you have actually obtained into! The park’s main attraction is «The Beast,» which is listed in the Guinness Publication of World Records as the lengthiest zipline worldwide. With cobbled streets, busy plazas and vibrant houses that stack together like building blocks of yellow, blue, environment-friendly, orange as well as turquoise, Old San Juan is among one of the most vivid areas to go to in Puerto Rico. This is why locations like Isla Culebrita exist. Isla Culebrita is an uninhabited island off the coastline of eastern Puerto Rico. It’s just concerning a mile long, and also access is limited to ferryboats as well as water taxis. Museo de Las Americas There are many museums in Puerto Rico, however only a handful are in fact concerning Puerto Rico. The Museo de Las Americas is one of these valuable places. 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It’s perched on top of white limestone cliffs that are bordered by salt marshes and also lagoons, and the waves crash against the high cliffs with a violence that’s stunning however gorgeous. Cayo Santiago is a tiny stretch of land off the eastern coastline of Puerto Rico.

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