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Methodology of establishing and implementation of health insurance conditions and programs


Author: Iurie Malanciuc
Degree:doctor of medicine
Speciality: 14.00.33 - Social Medicine and Management
Year:2006
Scientific adviser: Constantin Eţco
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 15 November, 2006
Approved by NCAA on the 21 December, 2006

Abstract

Adobe PDF document0.46 Mb / in romanian

Thesis

CZU 368.9.06 (478)(043.2) M17

Adobe PDF document 2.44 Mb / in romanian
207 pages


Keywords

insured, insurant, insurance event of voluntary medical insurance, conditions of voluntary medical insurance, program of volunatry medical insurance, insurance premium, insured risk, insurance sum

Summary

The health insurance has been initiated in the Republic of Moldova in 1990 year.

On the basis of studying the health insurance conditions and programs in several countries, we have elucidated the principles and methods of their establishing and analyzed the principles of segmentation of medical services and medical marketing. The need of hierarchysation of medical services for population within the health insurance has been analyzed as well. The analysis of insurance programs in many countries emphasizes the need of a marketing study of the health protection system and social protection.

The examination of health insurance programs provided the opportunity to find the most appropriate, in our opinion, method of calculation of insurance premiums which is common for both optional and compulsory types of medical insurance.

The analysis of the optional and compulsory health insurance conditions and programs proves the need of a continuous junction of these two types of insurances in spite of their different goals. As a result of reciprocal completion of these insurances the social protection of the population significantly increases and the medical institutions highly benefit from additional incomes.

The studies made within the present work prove for certain the priorities of administration of the optional health insurance over the compulsory health insurance. The obtained data indicate an efficiency increased by 30% of the optional insurance. These performances have been achieved as a result of implementation of modern service providing technologies and administration of rendering medical assistance to individuals enjoying optional medical insurances.

The studying of the contemporary methods of establishing different systems of health and social protection allowed concluding that the most efficient system is the system combined with the state administration of all participants in the process.

The need of assisting the patient within the process of providing medical assistance to him in medical institutions has been also proved in the present work. As a result of this assistance the patient benefit from a major comfort in receiving services and avoids important financial expenses and saves the time. On the basis of these results it is proposed to create assistance centers for patients regardless of their status.