ANALYSIS EXPERT IN SYSTEM COMPULSORY HEALTH INSURANCE OF THE RYAZAN REGION FOR THE YEARS 2016-2017

Aim. Analysis of expert activity in the system of compulsory medical insurance for development of measures to increase the quality and availability of medical care. Materials and Methods. Analysis of expert activity in the system of compulsory medical insurance (CMI) in the Ryazan region was conducted from the data of report Form №PG for 2016-2017. In accordance with Order №230 of 13.12.2011, the territorial register of experts of the medical care quality was formed in the region and posted on the Internet on the official website of the territorial fund of compulsory medical insurance of the Ryazan region. Results. The analysis showed 14.4% increase in the amount of complaints in 2017 as compared to 2016 with this, a share of substantiated complaints out denial of medical care upon CMI program significantly increased from 2.4% in 2016 to 8.4% in 2017, as well as a share of complaints about taking money for medical care rendered within the scope of CMI from 39.2% in 2016 to 43.4% in 2017. The amount of the violations revealed by the planned expertise of the quality of medical care increased 4.6% in 2017 as compared to 2016 Also some insignificant amount of defects of the quality of medical care was noted that influenced the course and outcome of the disease, or created a risk of complications, from 15.7% in 2016 to 15.9% in 2017. Conclusions. A significant increase in the defects of the quality of medical care was found with reduction of the defects of execution of medical documentation. In the structure of violations, a share of defects that influenced the course and outcome of the disease or created a risk of complications, increased insignificantly. The volume of financial penalties of medical insurance organizations to medical institutions on the basis of the results of the expertise of the quality of medical care did not show any significant changes.