INFORMING CITIZENS ABOUT THEIR RIGHTS IN THE MANDATORY HEALTH INSURANCE SYSTEM: DIGITAL SOLUTIONS

Abstract

Introduction. The implementation of the constitutional right to free medical care generally depends on the extent to which the insured persons understand their rights and the procedures within the mandatory health insurance system. The present information channels are based on a model of mass, non-personalized communication. Digital dialogue services demonstrate high potential for automating standard requests. The aim of this study is to provide a scientific justification for the need for a specialized digital assistant focused on clarifying the rights of insured persons in the mandatory health insurance system.

Materials and methods. The empirical basis consists of data from the Federal Mandatory Health Insurance Fund on the activities of territorial funds in 10 regions of the Siberian Federal District. Statistical and structural analysis of the dynamics of enquiries and complaints, comparative analysis of public information channels, calculation-based analysis of the potential effect of implementing a digital assistant, and an integral assessment of social effectiveness using min–max normalization of four indices have been applied.

Results and conclusions. It has been found out that 97–99% of enquiries are standard requests for clarification and in most cases do not confirm an actual violation of rights, which creates a substantial potential for standardized automation. The average complaint rate in the Siberian Federal District increased by 19.3% over the study period, while a pronounced interregional differentiation in enquiry rates persists. The calculations show that a conservative scenario of automating 30% of standard enquiries would enable the digital assistant to handle 180,000–300,000 requests per year, free up tens of thousands of person-hours, and reduce the number of complaints driven by information deficits. The integral indicator of the social effectiveness of information activities increases by 15.5%. A conceptual and methodological model of a digital assistant has been proposed.

Discussion. It is substantiated that information interaction in the compulsory medical insurance system is not only a management issue but also a legal one, driven by systemic information inequality. The potential of a digital assistant for ensuring the realization of insured persons' rights and improving social efficiency by eliminating regional and communication barriers has been explored.