1. Coming back to the system of state financing and state control over the healthcare system, keeping the obligatory insurance contributions of the legal entities as an additional source of financing. The “Nizhni Novgorod OMI System” could serve as a model in this particular case. In Nizhni Novgorod region no OMI fund was ever set up, and the obligatory insurance contributions of the enterprises are accumulated by the territorial department of finance and distributed among the districts according to the capitation norm. In case of such an alternative of OMI transformation the above mentioned problems will be really resolved. However the problems inherent to the system of administrative control over the healthcare are bound to reproduce themselves. Among such problems are inefficiency, lack of incentives for improvement of quality, inadequacies of the institutes of protection of the patients’ rights, etc. In the long run the society will lose.
2. Simplifying the OMI model. It includes such measures as expulsion of the private insurance companies from the number of OMI members, strengthening the state control over the financing and crediting operations of the funds, limiting their functions and giving them different titles, for example “hospital cashiers", etc.
This method allows to resolve most of the problems, resulted by the reform. It preserves a number of the key elements of the medical insurance such as the insurance contributions, separation of the healthcare providers from the healthcare customers. It provides the foundation for the future healthcare development and consequently for the improvement of the healthcare efficiency. However replacement of all the existent regional OMI systems by a new simplified system does not seem justified. In the cases where the introduction of the OMI model fixed in the legislation is successful enough any interruptions in the course of the reform seem inappropriate.
3. Preserving the basic principles of the OMI model fixed by the legislation, shaping the admissible transitional models.
The above-mentioned simplified OMI system could be used as a transitional model. Such transitional models are admitted for an unlimited period of time. This method allowing to resolve the most acute problems leaves intact the existent infrastructure of medical insurance and provides prerequisites for the broad-scale introduction of the medical insurance system with more favorable business conditions.
4. Implementing the basic OMI model to the fullest extent in all regions and achieving the realization of the Government’s obligation to finance the OMI of non-active population. Today, however any attempt to bring the already started reform to its end seems unrealistic. In fact means a possibility of keeping the situation the way it is now. It only remains to be hoped that the OMI funds and healthcare authorities manage to come to terms with each other and make the existing conflict of interests less acute. As the country gets out of the economic crisis the medical insurance system should start to work and the current problems will dissolve by themselves. This method however is associated with the perpetuating instability and inherent contradiction that may surface in very acute forms if business situation in the sector does not improve.
From the long-term prospective of the domestic healthcare system development the third option is most preferable. Selection of option number one seems however the most likely.
Most Important Business Regulations
On April, 1 the President of the Russian Federation signed the Federal Statute (hereinafter FS) "On changes and amendments to the Russian Federation Statute "On the value-added tax" (№25-ФЗ) lifting VAT, in particular, off all services connected with housing. On April, 3 the President also signed the FS "On power supply saving" (№28-ФЗ), and on April 15 - the FS "On changes and amendments to the Criminal code of the Russian Federation and Criminal proceedings code of the Russian Federation " (№30 - ФЗ) under the FS "On the continental shelf of the Russian Federation".
On March 19 the Federation Council enacted the decree №94-СФ "On urgent measures of food security of the Russian Federation".
Among Gosduma’s decrees the Decision of March, 13 №141 - ПГД "On the Federal Statute "On raising the minimal size of pensions, the order of indexing and re-calculation of federal pensions in the Russian Federation” and decree "On non-payment of wages and salaries at the enterprises and companies of the military-industrial complex complex" should be noted.
On April, 19 Gosduma signed and ratified the Agreement between the Republic of Byelorussia, the Kazakhstan Republic, Kirgiz Republic and the Russian Federation on deepening integration in economic and humanitarian areas, and also the Agreement on the creation of the Russian and Belorussian Association (signed on April, 2 by Presidents of Russia and Byelorussia).
Among the Presidential Decrees are worth to note the Decree №382 of March, 15 "On the improvement of the system of the state control of transportation complexes in the Russian Federation", the Decree №395 of March 19 "On All-Russian industrial design exhibition", the Decree №399 of March 20 "On the extension of the period of transfer to the federal ownership of the shares of the Russian Joint Stock Company Gazprom", the Decree №408 of March, 21 "On the adoption of the comprehensive program of measures to provide for the rights of contributors and stockholders", the Decree #413 of March 22 " On changes and amendments to the decree of the President of the Russian Federation №2063 of November 4, 1994 “On measures for state regulation of the security market in the Russian Federation", the Decree №420 of March 23 “On the development of federal target program "Your home ", the Decree №424 of March 27 “On certain measures to augment government support for science and high education in the Russian Federation", the Decree №430 of March 29 "On the state support for the citizens in the field of construction and purchasing housing", the Decree №431 “On the new stage of the implementation of the State target program “Housing””, the Decree №440 of April, 1 “On The concept of transition of the Russian Federation to steady development", the Decree №443 “On measures to stimulate the creation and the operations of the financial and industrial groups", the Decree #491 of April 4 “Оn priority government support activities for the small businesses in the Russian Federation”, the Decree №494 of April 8 "On measures of restitution of savings of the Russian Federation citizens ", the Decree #537 of April, 13 "On government support activities for the retooling of the Joint Stock Company “Magnitogorsk metallurgical complex", the Decree №541 “On improvement of the efficiency of the state control over privatization of the enterprises and the organizations in the defense complex”, the Decree №550 of April 15 “On pressing measures to the betterment of social security of the citizens of the Russian Federation”, the Decree of April 18 "On measures of stabilization of the economic situation and development of the reforms in the agro-industrial complex".
On April 13 the President issued the directive #188-рп "On provisions for participation of the Russian Federation in The Council of Europe".
The RF Government took a number of important decisions including #290 of March 16 "On the establishment of the scientific and technical park “Novosibirsk", the decision №307 of March, 20 "On the governmental coordination and advisory bodies", the decision №298 of March, 21 "On amendments to the decision of the Russian Federation Government "On the introduction of a single system of the compulsory expert evaluation of the amount, quality and prices of exported commodities", the decision №300 "On invalidation of some decrees of the Russian Federation Government concerning the registration of contracts at merchandise exports", the decision №309 "On measures for the enforcement of the Federal statute "On the federal budget for 1996", the decision №315 "On the approval of the calculation procedure for the inflation index applied for indexing the cost of the fixed assets and other assets of the enterprises in case of their sale for the purposes of determining the taxable profit", the decision №324 of March, 22 "On the integrated plan of actions of implementation in 1996 by the Russian Federation Government of the Message of the President of the Russian Federation to the Federal Meeting entitled “Russia for which we are responsible (On the situation in the country and principal policy directions of the Russian Federation)" and the Program of the Russian Federation Government entitled "Reforms and development of the Russian economy in 1995-1997 ", the decision #327 of March, 23 "On the adoption and submittance for the approval to the President of the Russian of Federation of “The basic provisions of the regional policy in the Russian Federation", the decision №341 "On the Federal target program "Energy-saving electrical equipment (for 1996 - 1997)", the decision №356 of April, 1 “Оn partial variation of the import custom tax approved by the decree of the Russian Federation Government of May 6, 1995, the decision №454 "On the adoption of the import custom tax rates", the decision №378 of April 3 "On the indexation of the rates of the land tax in 1996", the decision №387 "On the additional measures in support of youth in the Russian Federation", the decision of #395 "On the adoption of the work procedure with projects financed by IBRD loans ", the decision #421 of April 12 “On revaluation of the fixed assets of oil-mining and refinery companies “.
On March, 21 the Government issued several interesting directives, in particular, directive №422-р concerning issuance and circulation of the bonds of the inter-regional loan aimed at the development of the innovation activities, the decision №424-р specifying a listing of the share certificates of the Joint Stock Companies established in the course of privatization (except for the Joint Stock Companies producing the merchandises and services having strategic implication for the national security) scheduled for transfer to the RF subjects; the decision №426-р concerned with finalization of the programs of the long-term development of the Far Eastern Region.
From among the number of departmental papers the following are worth to note:
RF Central Bank letter #255 of March 15 "On the inter-bank settlements organization on the territory of the Russian Federation", the RF Ministry of Finance letter #04-03-01, the RF Government Tax Service letter #ВГ-6-03/ of 187 of March, 18 "On the excise payments procedure ", RF Government Tax Service letter #ВЗ-6-09/185 of March, 18 “On the formalization of the tied credit for agricultural commodity producers".
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