scholarly journals Features of the competitive environment in the compulsory health insurance market

Author(s):  
N. E. Popova ◽  
T. S. Sergienko

In the context of increasing concentration in the medical services market, one of the key areas of the industry's development is expanding the opportunities for private medical organizations to participate in the MHI and developing competition between medical organizations participating in the MHI system. In the work the analysis of the competitive environment in the market of mandatory medical insurance for 2015-20018 years, the reasons to reduce insurance companies on the market of OMS over the years, as well as the consequences of this event, considered leaders by revenues and shares in the market during 2016-2018, the identified indicators of the level of concentration in these regions, the analysis of market OMS of the SFD identified the problematic aspects and ways of increasing the effectiveness of competition between health insurance organizations, the built Matrix porter services OMS, identified obstacles (obstructions), faced by entities when entering into the market of medical services in the MHI system.

2021 ◽  
Vol 70 (3) ◽  
pp. 79-88
Author(s):  
M. Myhailyuk ◽  
T. Roman ◽  
Ya. Tanchak

The current state of voluntary health insurance in Ukraine is analyzed in this paper. The place of voluntary medical insurance in the insurance market of Ukraine is determined. The essence, purpose, objectives, features, advantages and disadvantages of voluntary health insurance as one of the funding sources for medical sector are considered as well. The programs under which voluntary health insurance is currently implemented are listed, these are mainly personal and corporate ones. The main tendencies are investigated, relative indicators of the functioning level of voluntary health insurance market are calculated. The problems of voluntary health insurance are identified and measures for such insurance development in Ukraine are proposed. Our investigation is devoted, particularly, to the identification of the main problems in the development of voluntary health insurance in Ukraine. The authors investigated the availability of voluntary health insurance for population, analyzed the state of industry reforming in a certain period and substantiated the consequences of the reform impact on the voluntary health insurance market in Ukraine. The dynamics of the health insurance market indicators is analyzed on the basis of the size of gross insurance premiums and payments, as well as the calculated indicator - the insurance payments coefficient. In particular, insurance payments for voluntary health insurance in the regional context, by regions in individual insurance companies for a certain period of time are analyzed. The method of compiling the rating of insurers on the basis of insurance premiums and payments is proposed. It is determined that the level of medical services is growing, as well as the trust in voluntary health insurance in Ukraine. The main problems of the voluntary health insurance system functioning are highlighted and recommendations for improving the quality and availability of health insurance in Ukraine are proposed. These recommendations take into account a set of economic, legal and social factors of the insurance market development. Measures for state authorized bodies and private insurance companies that provide the extension of voluntary health insurance in Ukraine are proposed.


2018 ◽  
Vol 1 (2018/1) ◽  

The health insurance market in Poland reflects global trends – such as the rising awareness of personal health impact on quality of life. As a consequence, the health insurance market has seen substantial growth during the last years, which is forecasted to continue at over 20 percent more than life or P&C insurance globally. However, private health insurance has not yet unlocked its full potential.


2019 ◽  
Vol 6 ◽  
pp. 72-82
Author(s):  
Liliia Hala

In recent years Ukraine against the background of systemic crisis trying to reform socially-oriented areas of society, including voluntary health insurance, which must combine market and social burdens. Under these conditions, an important scientific and practical research is forecasting financial indicators of domestic insurance companies. Aim. Conducting analysis and forecasting of the basic indicators that characterize the financial state of development of the domestic health insurance market. Materials and methods. Research materials were selected from the official websites of the National Commission which carry out state markets regulation of financial services and the League of Insurance Organizations of Ukraine for 2009–2018 years. We used historical, analytical and comparative, systematic, logical, hypothetical-deductive, mathematical and statistical methods. Results. To forecast the financial indicators of the health insurance market in Ukraine (gross insurance premiums and payments; operations transferred to reinsurance, including non-residents; net insurance premiums and payments) for 2019–2020 years; the time interval was set from 2009 year. According to the results of the calculations, we obtained regression models for different financial indicators (6 models). With the help of the selected mathematical tools, the main financial indicators of the market development for 2019–2020 years were forecasted. The analysis of the data revealed that the highest value growth rate (%) in 2020 year will be characteristic of reinsurance operations, including those transferred to non-residents (49.06 %) and the lowest - to gross insurance payments (14,41 %). It is established that the indicator of net insurance payments since 2010 year has been steadily decreasing (from 78.19 %), and according to the forecasted data in 2019 year it may be equal to 46.77 %, and in 2020 year – 44.98 %, the trend will continue to decrease. However, this indicator since 2016 year (53.9 %) and the data forecast for 2019–2020 years are in the regulatory range (from 30.0 % to 60.0 % for different types of insurance activities). Conclusions. According to the results of the research, it is established that in spite of the financial and economic crisis since 2014 year, the domestic health insurance market is characterized by positive dynamics of growth of the main financial indicators (gross insurance premiums and payments, net insurance premiums and payments). At the same time, there is a tendency to decrease the level (%) of net insurance payments indicator from 78.19 % in 2010 year to the forecast in 2020 year – 44.98 %.


2018 ◽  
pp. 148-156
Author(s):  
Olha KNEYSLER ◽  
Lesia SHUPA

Introduction. The current practice of functioning of the medical sector shows the existence of problems that impede the introduction of compulsory health insurance in Ukraine, the effective development of its voluntary form. At the same time, the problems of development of medical insurance under the influence of crisis phenomena of the national economy are deepening. The purpose of the article is to develop recommendations for improving medical reform in Ukraine. Results. The most controversial moment in the reform of health care was the rejection of free medicine, the right to which is enshrined in the Constitution of Ukraine. However, budget medicine in Ukraine will still remain, however, in what volumes and at what stages of provision of medical services or medical care is not yet defined in the Ministry of Health of Ukraine. The negative trend of the contracted health model is the creation of an authorized body that will not only implement health policy but, in fact, formulate this policy: to define state guarantees, needs for medical services and to check the quality of these services. And this is a huge threat, because Ukrainian medicine will be in a worse situation than it is now. We believe that the policy-making function should remain under the Ministry of Health of Ukraine. The negative aspect of modern medical reform in Ukraine is the lack of requirements for the formation of medical treatment protocols. This can be explained by the fact that patients will continue to prescribe treatment that is untrue. Instead, for the health insurance, the insurance company would monitor costs and control the appointment of treatment for the patient, the price of medical services. In this context, we propose to adopt the Law of Ukraine “On Compulsory Health Insurance”, which stipulates and clearly defines the rights and obligations of the insurer, the insurer, the list of services, their price, a single register of insured persons, the formation of the Social Health Insurance Fund and a differentiated approach to categories of the population. Conclusions. The experience of developed countries of the world proves that achieving this goal is possible through the introduction of insurance medicine. Insurance medicine is a real alternative to budget financing, which is no longer capable of ensuring the constitutional right of citizens to receive unpaid health care. The development of health insurance is an objective need, which is dictated by the need to ensure that healthcare receives funds. At the moment, the study of the question of the necessity of introducing compulsory health insurance is probably very relevant to all. Successful market reforms in Ukraine are impossible without the formation of an effectively organized health insurance market that can guarantee the preservation and strengthening of human health, improving the quality of medical services and the level of human life.


2019 ◽  
Vol 17 (2) ◽  
pp. 541-549 ◽  
Author(s):  
Olga Kneysler ◽  
Olha Kryvytska ◽  
Lesia Shupa ◽  
Iryna Huzela

The main purpose of this investigation is to distinguish the problematic tendencies of the health insurance market development in Ukraine and the competitive positions of the leading insurance companies on it. Accordingly, the issues of complex analysis of key indicators of the insurers’ competitiveness, and the issues of establishing the factors that determine the level of competition in the market become very urgent. The first 30 insurers out of 50 were taken for the study, and they received about 90% of insurance premiums for voluntary health insurance in Ukraine in 2017. The authors have made the assessment of the competitive environment of the health insurance market of Ukraine using the concentration index and the indicator of market competition, which resulted in defining the advantages and disadvantages of their application. Taking into account that the abovementioned indicators for assessing the competition in the insurance market can provide only approximate results, which indicates the inadequacy of the conclusions about the effectiveness of business processes management on it, the authors offered a scientific methodological approach to assessing the market environment with the use of an integrated indicator of the voluntary health insurance market competitiveness. Herewith, such an integrated indicator is calculated in terms of three segments of the market: sickness insurance; voluntary medical insurance (continuous health insurance); medical expenses insurance, simultaneously taking into account the behavior of two indicators – concentration and market competition. As a result of the research, it was found that the highest level of market concentration is typical for sickness insurance and it indicates a high monopoly in the market in terms of this segment. Thus, the integrated indicator allows to make a comprehensive investigation of market behavior of the market participants and to reveal the problematic tendencies of its competitive environment.


Author(s):  
Lilia Olegovna Avdeeva ◽  
Elena Igorevna Kozyrenko

The article touches upon the problem of financing health care in the world today, which is carried out mainly at the expense of budget funds, employers, population and enterprises in different proportions. The share of each of these sources in the total amount of funds allocated by society to health care determines the model of financing this economic sector. The budget model of financing the health care does not fully cover the needs of the population in the guaranteed volume of free medical care. In recent years, such sources as direct payment for medical services and voluntary health insurance programs have brought a certain amount of money to the Russian health care system. The conducted analysis of the financial support of the health care system in Russia proved that the cost of the program of state guarantees increases throughout the whole period. Means of compulsory medical insurance as well as budgetary allocations of the entities of the Russian Federation are used to finance the program of State guarantees. The volume of compulsory health insurance funds is increasing, the growth rate of compulsory health insurance in 2017 outpaced the rate assigned by the program. In 2016 revenue growth and spending cuts brought the Federal Fund of compulsory medical insurance to a deficit-free budget, but in 2017 the growth of spending outpaced revenue growth, which leads to a deficit. There can be seen the positive dynamics of growth rates of insurance premiums for voluntary health insurance. Currently, underfunding of territorial programs is compensated by the population independently through the use of voluntary health insurance and paid medical services. The main objective of the further transformation of compulsory medical insurance system is stated to increase the volume of financing of the system. In the process of adjusting state obligations the deficit of financial provision of territorial programs of state guarantees should be taken into account, which has already been redistributed due to its insecurity, but without legislative consolidation. The reserve of redistribution will be the increase in payments under contracts of voluntary medical insurance and funds received by medical organizations from the provision of paid medical services.


Author(s):  
M. V. Sochinskaya ◽  

The article examines the models of health insurance in Western countries. A comparative analysis of forms of social insurance and sources of financing payments for four models of medical insurance is carried out. The practical aspects of the functioning of compulsory health insurance in Germany are investigated, its positive features are revealed. Attention is paid to medical insurance, which provides insurance in case of loss of health for any reason. It provides greater accessibility, quality and completeness to meet the diverse needs of the population in the provision of medical services, and is more effective than government funding of the health care system. In addition, the social and economic efficiency of health insurance related to reimbursement of citizens' expenses related to receiving medical care, as well as other expenses aimed at maintaining health, depends on how comprehensively the concept of developing insurance medicine in the country has been worked out. The positive and negative aspects of health insurance are analyzed. The forms of health insurance are considered: compulsory health insurance and voluntary health insurance. It was found that one of the first countries where health insurance was introduced was Germany. There are two types of health insurance in Germany: public and private. Germany's state health insurance is compulsory. That is, every employee, as well as persons trained in production (Auszubildende), are subject to compulsory state health insurance and must be members of one of their freely chosen state health insurance funds. At the same time, if a person wishes to receive medical services that are not included in the list of compulsory health insurance, he can conclude a supplementary health insurance contract with the insurance company. Voluntary health insurance allows you to choose an inpatient medical institution and the conditions of stay in it, special services of a personal physician.


2014 ◽  
Author(s):  
Sabrina Corlette Corlette ◽  
Kevin W. Lucia Lucia ◽  
Justin Giovannelli Giovannelli

2020 ◽  
Author(s):  
Jane Sung ◽  
Olivia Dean ◽  
Asha Saavoss ◽  
Robert Saunders

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