Compulsory medical insurance is not public medicine. A person may not be satisfied with state medicine and he may use compulsory medical insurance.
OMS is compulsory insurance, not state insurance. You can insure within these mandatory frameworks with anyone who provides such a service. And this CHI operator can send you to be treated not necessarily to a state clinic, but to the one with whom he concludes an agreement.
CHI and state clinics and hospitals are connected only by cheapness.
In theory , the reformers dreamed that people would not go to a bad state clinic and that it would not receive money from the CHI operators. Thus, financing will be regulated.
In practice, this does not happen for the simple reason that often people have nowhere else to go and they have too little money. This is an objective fact, the data on the poverty of the population are published by the government itself.
Why is it necessary to insure at all? This is a mechanism for the implementation of the constitutional right to health care and medical care. Anyone can break a leg. Get poisoned. To become a victim of a major accident, terrorist attack. And according to the law, he has the right to medical assistance. Calling an ambulance for you lying on the street with a heart attack will also be a passer-by not on a card in your wallet, but on a regular emergency phone number.
This is the general minimum level that compulsory health insurance should guarantee.
There are also infections that need to be fought massively, regardless of someone's desires. Tuberculosis, for example.
If you impose the payment of this tax on the citizens themselves, they will simply stop paying contributions. As a result, when they need medical care, they will not be eligible for free (they didn’t pay the fees), and the free one may not be affordable.
Because the right to minimum free health care is guaranteed by the constitution. And to realize this right, you need funds. And these funds are guaranteed, in turn, by obligatory deductions to the compulsory medical insurance.
Everything can be redone if desired, but one always pulls a bunch of another. And the question is, at whose expense will all this be organized?
In addition, the employer makes all contributions for an employee. In all other cases, no one makes any deductions. That is why our free medicine is so bad.
Because then it will be necessary to introduce differentiation in the accounting departments of the enterprises where these people work, since the employee will have to inform the employer whether it is necessary to pay contributions to the MHIF for him or not. You can, of course, transfer payments to the MHIF from employers to the employees themselves and force everyone to pay from their wallet in reality, and not virtually. Well then, maybe something will change, but I'm afraid the MHIF budget will collapse completely.