Practical proposals for the development of a system of mutual settlements for medical care for labor migrants between the Russian Federation and labor-exporting countries

Balynin Igor' Viktorovich ORCID: 0000-0002-5107-0784 PhD in Economics Associate Professor; Department of Public Finance, Faculty of Finance; Financial University under the Government of the Russian Federation 49 Leningradsky ave., Moscow, 125468, Russia igorbalynin@mail.ru Other publications by this author     Ragozin Andrei Vasil'evich PhD in Medicine Director of the Center for Problems of Organization, Financing and Interterritorial Relations in Health Care of the Institute of Regional Economics and Interbudgetary Relations, Financial University under the Government of the Russian Federation 125468, Russia, Moscow, Leningradsky ave., 49 AVRagozin@fa.ru Other publications by this author

Grizenkova Yuliya Viktorovna ORCID: 0000-0003-3387-468X PhD in Economics V.N.S., Department of Housing Mortgage Lending and Financial Instruments of the Real Estate Market; Financial University under the Government of the Russian Federation 49 Leningradsky Ave., Moscow, 125468, Russia gryzenkova@yandex.ru Other publications by this author

Introduction

The relevance of the study of issues related to the organization of medical care for migrants who carry out their work in the Russian Federation is beyond doubt. This, for example, is confirmed by the following facts:

- an increase in the number of citizens arriving in Russia on a visa for work purposes (1.4 times in 2023 compared to 2022);

- an increase in the number of public services for issuing work permits to foreign citizens (1.24 times in 2023 compared to 2022) and patents (1.04 times in 2023 compared to 2022) [The Ministry of Internal Affairs of Russia. Access mode: https://мвд.рф/dejatelnost/statistics/migracionnaya/item/47183542 /, accessed: 08/01/2024].

An analysis of research on humanitarian issues of national security in the context of migration policy has shown that domestic authors study the foreign practice of its organization ^[1] and the specifics of the process of integration of young migrants and immigrants into Russian society ^[2], assess the impact of external labor migration flows on the labor market and economic growth of the host territory ^[3]. The issues of categorization of migrant workers' remittances and their impact on the economies of donor and recipient countries are also raised ^[4].

It should be noted that foreign scientific thought also raises issues related to the study of the peculiarities of the organization of migration of the population. In particular, attention is paid to the context of the relationship between migration, education and sustainable development goals ^[5], migration policy issues in the EU countries ^[6], in the context of threats to national security ^[7]. In turn, Pattillo, M., Stieglitz, S., Angoumis, K., & Gottlieb, N. raise the issue of racism in providing medical care to migrants ^[8]. A number of studies in foreign scientific literature have been conducted on the example of the organization of medical care for migrants during the COVID-19 pandemic ^[9-11], the results of which clearly indicate the need to strengthen transnational and interstate ties in its provision.

In domestic and foreign scientific publications, the authors also pay attention to the organization of medical tourism, emphasizing the versatility of both factors and significance ^[12-14]. Also, within the framework of this direction, the authors considered regional peculiarities ^[15-17], behavioral aspects ^[18], features and prospects of development in the context of sanctions pressure on the Russian Federation ^[19].

Methodology and research conditions

The research is based on the use of a set of methods: data analysis and synthesis, induction and deduction.

It is important to note that this study is especially significant in the context of the implementation of the National Security Strategy of the Russian Federation, approved by Decree of the President of the Russian Federation [Decree of the President of the Russian Federation dated 07/02/2021 No. 400 "On the National Security Strategy of the Russian Federation"]. This strategic document identifies mutually beneficial international cooperation, state and public security among the areas.

As you know, labor is one of the main factors of production. According to some authors, it is even the only factor of production ^[20]. The authors of this article consider this opinion controversial due to the presence of other factors of production, but agree that issues of labor relations organization should be given special attention in order to ensure the achievement of national development goals of the Russian Federation ^[3,4]. However, issues related to the development of a system of mutual settlements for medical care for migrant workers between the Russian Federation and the exporting countries of labor have not been reflected in these scientific publications.

The results of the study

First of all, it should be noted that it is possible to divide all migrant workers into two groups: legal and illegal. Let's look at each of the groups in more detail. Thus, the analysis shows that there are serious problems with the organizational and legal regulation of the process of providing medical care to illegal migrant workers and its financial support. The current Russian legislation guarantees them only the provision of emergency medical care. It is important to note that the basis for making decisions on classifying the care provided as emergency or urgent (which is not guaranteed to illegal labor migrants) is the presence/ absence of a threat to the patient's life [Federal Law No. 323-FZ of November 21, 2011 "On the Basics of protecting the health of Citizens in the Russian Federation"]. Accordingly, the identification of the presence / absence of such a threat is carried out by a doctor.

It is important to note that there are problems with legal migrant workers. Thus, since 2023, many migrant workers have been exempted from the obligation to purchase voluntary health insurance policies. The authors consider this decision to be controversial. On the one hand, this facilitated their employment processes and reduced the amount of expenses for carrying out their work in the territory of the Russian Federation. Moreover, the inclusion of migrants in the compulsory health insurance system has significantly expanded the scope of guarantees for free medical care, which has become equal to that possessed by Russians. On the other hand, this increased the burden on employers, since they now have to pay insurance premiums for compulsory medical insurance, and also created prerequisites for transferring financial risks from insurance organizations to the budget system of the Russian Federation. Under the contract of voluntary medical insurance, the insurer was the insurance organization that is the insurer, and for compulsory medical insurance, the Federal Compulsory Medical Insurance Fund.

Prior to this decision, all migrant workers from other countries were required to present a voluntary health insurance policy when applying for employment. However, it is important to note that the minimum amount indicated is relatively small. It amounts to 100,000 rubles and insurers for voluntary medical insurance of migrant workers are not required to include a number of risks in such policies. Examples of such risks are clearly shown in Figure 1.

Figure 1. Examples of risks that are not included in the list of mandatory coverage for voluntary health insurance policies by foreign migrant workers.

Source: [Instruction of the Bank of Russia dated 09/13/2015 No. 3793-U "On minimum (standard) requirements for the conditions and procedure for the implementation of medical insurance in terms of voluntary medical insurance for foreign citizens and stateless persons located on the territory of the Russian Federation for the purpose of their employment"].

An analysis of the data in Figure 1 allows us to conclude that it is debatable whether 5-10 items should be excluded, as well as the importance of taking 1-4 items into account in a voluntary health insurance policy. Undoubtedly, this will lead to an increase in the cost of this policy, however, and the formation of an objectively necessary set of risks, medical assistance in the event of which it is important to provide the migrant.

In the context of active interstate interactions with other donor countries of migrants, it is advisable to regulate the issues of financial provision of medical care to them in the relevant agreements. According to the authors, as part of the pilot project, it is advisable to develop a system of mutual settlements for medical care for migrant workers between the Russian Federation and the exporting countries of labor in the territory of the EAEU. This system of mutual settlements should include several key substantive areas. The first direction is the general provisions within which the subject of regulatory regulation should be fixed. It seems that special attention should be paid here to the terminological apparatus, within which it is necessary to distinguish between legal and illegal migrants, including in order to create opportunities for applying additional penalties to those persons who violated migration legislation. For example, this may be due to the envisaged inclusion in the rules of the right of the exporting country of labor to require a migrant to compensate for the costs of paying for medical services provided to him in the importing country from among the EAEU countries in case of illegal stay. The second area is the mechanisms for organizing payment for medical care. Within the framework of this direction, it is necessary to ensure the regulation of issues related to the organization of financial flows. Most likely, additional amendments to the Budget Codes of the Russian Federation and other EAEU member states will also be required, since, in the opinion of the authors, a special form of inter-budgetary transfers will be required. The third direction is the procedure for interaction of public authorities of the EAEU countries in regulating these settlements: it seems advisable to involve financial authorities (for example, from the Russian Federation: the Ministry of Finance of the Russian Federation), diplomatic authorities and structures (for example, from the Russian Federation: The Ministry of Foreign Affairs of Russia; embassies of the countries).

Discussion of the results of the study

The results obtained make it possible to eliminate the existing problems of providing full-fledged medical protection for migrants from other countries while minimizing the financial burden on the budgets of the budgetary system of the Russian Federation. When a migrant carries out his work in another country, it is advisable to provide medical assistance at the place of its implementation. However, it does not seem fair to provide financial support for its provision from the budgets of the budgetary system of the State in which the person is located. The organization of interstate settlements will eliminate this problem.

Unfortunately, the study also showed the lack of publicly available detailed information on the amount of expenditures of the budgets of the budgetary system of the Russian Federation for the provision of medical care to migrant workers. It is important that these statistics should be carried out only in the context of the types/forms and conditions of their provision, both in general for all budgets of the budgetary system of the Russian Federation and in the context of each budget.

It seems that it is necessary to collect and systematize these statistics with details in the following areas:

- the geographical homeland (exporting country) of the migrant worker;

- the professional field of activity of a migrant worker;

- the region of activity of the migrant worker in the territory of the Russian Federation;

- the amount of the migrant worker's salary.

It is recommended to pay special attention to the following indicators:

- the amount of expenses of insurance medical organizations within the framework of providing medical care under voluntary health insurance policies for migrant workers;

- the amount of expenses of migrant workers to pay for medical care provided to them (within the framework of paid services both in state/municipal health institutions and in commercial organizations). It seems that when forming these statistics, prerequisites will arise for an additional quantitative assessment of the economic efficiency of organizing the import of migrant workers from other countries. It is important to note that these results can be used taking into account the National Security Strategy of the Russian Federation.

Conclusions and further directions of research

The analysis showed that despite the presence of a large number of migrants on the territory of the Russian Federation and the dynamics of their growth, the organization of the system of medical care for them remains poorly considered in the scientific literature. At the same time, the attempts made in 2023 to adjust the current legislation in the field of health insurance for migrants, in the opinion of the authors, not only did not solve the existing problems, but also formed the prerequisites for the emergence of new ones. Therefore, the authors propose the modernization of legislation, taking into account the minimization of financial risks and the assignment of the obligation to pay for medical care to the public authorities of the country from which the corresponding migrant arrived. As a pilot project, it is advisable to start implementing these changes from the countries with which the closest socio-economic ties are built: with the states that are members of the EAEU.

The results of this scientific research will be in demand, first of all, by the President of the Russian Federation, who approved the National Security Strategy, as well as by the Russian Government, which annually approves the Program of state guarantees of free medical care to citizens. It is important to note that these results also have practical significance for the Ministry of Health of the Russian Federation as the federal executive authority responsible for the implementation of state policy in the field of healthcare.

The indirect effects of the implementation of the author's proposals are primarily associated with ensuring the achievement of the national development goals of the Russian Federation for the period up to 2030. Firstly, this will ensure an increase in the targeting and efficiency of the use of budgetary funds in healthcare. Secondly, it will have a positive impact on the growth of protection for both migrants and citizens of the Russian Federation. Thirdly, it will contribute to strengthening interstate relations, and will also be able to act as an additional factor in the development of medical tourism as one of the drivers of socio-economic growth in our state.

As part of further study, it seems advisable to focus on studying the specifics of the implementation of the author's recommendations in the professional context of migrants.

Thanks. The article was prepared based on the results of research carried out at the expense of budgetary funds under the state assignment of the Financial University under the Government of the Russian Federation.