Model for formation funding norms of the territorial CHI program with regard to risky loading

Abstract

Purpose: The article is devoted to the modeling of the territorial program of compulsory health insurance (CHI) in the context of the insured risk. Discussion: Under the assumption that the demand of the insured population for medical services inherent in the territorial CHI program is determined by the intensity of manifestation of insured risk factors in a constituent unit of the Russian Federation, the author proposes to use the means of fuzzy mathematics and expert evaluation methods to identify relative intensities of the insured risk factors manifestations and factors relevant to risks. Results: To assess the intensity of the insurance event the author develops a hierarchical structure of the insured risk and a method of forming fuzzy relative intensities of a risk factors manifestation. The author proposes a fuzzy set model to form financing norms of the territorial CHI program, which is based on the principle of adaptation the federal norms of funding to the specific character of a constituent unit of the Russian Federation. The results of the author's empirical studies confirm the suitability of the developed model to justify the territorial CHI program in the context of the particular constituent unit of the Russian Federation.