FINANCIAL AND LEGAL ASPECTS OF THE ACTIVITY OF COMMISSIONS FOR THE DEVELOPMENT OF TERRITORIAL HEALTH INSURANCE PROGRAMS: PROBLEMS OF REALLOCATING MEDICAL CARE VOLUMES AND JUDICIAL PRACTICE

One of the subjects of financial legal relations in the allocation and use of compulsory health insurance funds is the commission for the development of the territorial compulsory health insurance program. The article examines the financial and legal aspects of its activities, as well as the problems associated with the reallocation of medical care volumes and financial support under the compulsory health insurance system among healthcare organizations during the year. Currently, the commission has extensive authority in the allocation and reallocation of medical care volumes and funding. Its decisions directly affect the financial support of healthcare organizations, often leading to conflicts, particularly in cases of providing medical care beyond the planned volumes. An analysis of judicial practice reveals that most disputes between the commission and healthcare organizations are resolved in favor of the commission. The Supreme Court of the Russian Federation emphasizes that healthcare organizations must promptly appeal the commission’s decisions if they disagree with the allocated or reallocated volumes of medical care. However, the lack of clear deadlines for reviewing such appeals creates legal uncertainty. A study of regional practices (e.g., Saratov, Sverdlovsk and Tyumen regions) identified significant variations in the procedures and timelines for reviewing applications for the reallocation of medical care volumes, exacerbating conflicts. The author concludes that it is necessary to legally establish a 30-day deadline for reviewing appeals from healthcare organizations, which would standardize the procedure and reduce the number of legal disputes. It is proposed to amend paragraph 12 of the Regulations on the Commission’s Activities, approved by Order No. 108n of the Russian Ministry of Health dated February 28, 2019, with a provision ensuring transparency in the commission’s work and protecting the rights of compulsory health insurance system participants.

commission for the development of the territori- al CHI program, medical care, financial legal relations, health- care, judicial practice, reallocation, entities, compulsory health insurance / CHI, legal regulation, healthcare organizations

Malysheva A. A. Financial and legal aspects of the activity of commissions for the development of territorial health insurance programs: problems of reallocating medical care volumes and judicial practice. Biznes. Obrazovanie. Pravo = Business. Education. Law. 2025;2(71):268—273. DOI: 10.25683/VOLBI.2025.71.1327.