New model of guaranteed amount of free medical care to be introduced in Kazakhstan in 2018

The Ministry of Healthcare of Kazakhstan, as part the execution of the Head of State's order of 10.01.2018, suggests new approaches to the formation of the list of the Guaranteed Amount of Free Medical Care and the package of medical services in the Compulsory Social Health Insurance.

The size of financing of the guaranteed medical care provided by the Social Health Insurance Fund this year is 923.8 billion tenge, including 776.9 billion tenge for the purchase of medical services.

"Along with this, new providers of medical services have appeared. For example, with relatively the same amounts of guaranteed medical service financing, there was an increase in the number of providers of medical services, the number of which in the first quarter of this year amounted to 1390, which is 349 (or 33.5%) more than last year (1041)," Health Minister Yelzhan Birtanov said May 29, 2018, at a government meeting.

He also added that the implementation of this model of guaranteed medical care is supposed to be implemented in 3 stages. First of all, under the existing conditions, a full audit of services in the Medical Care package will be carried out for maximum specification and optimization through prioritizing and limiting non-priority medical services. Second, deployment of a new Medical Care model simultaneously with the introduction of the CSHI will be carried out. This stage will be characterized, on the one hand, by the definition of clear boundaries of the state obligations under the Guaranteed Medical Care and ensuring the policy aimed at the prevention and priority development of primary health care, on the other — a full-scale transition to the CSHI system and its further development. And third, the lists of guaranteed medical care and CSHI will be regularly updated taking into account the development of medical technologies.

For the improvement of the guaranteed medical care, the following is proposed:

• to reduce the number of diseases subject to dynamic monitoring (optimization of dispensary diseases from 254 to 25, with increasing access to primary health care in cases of demographic damage, reducing the burden on the medical workers).
• to eliminate obsolete/inefficient diagnostic methods (excluding 16 consultations of specialized doctors, more than 900 consultation and diagnostic services, limiting the provision of diagnostic and laboratory services).
• to redistribute the patient flow to a more economically favorable level of hospital-replacement care (priority treatment of diseases at the level of inpatient care (769/529 diagnoses, surgeries and manipulations).

"If the proposed approaches on the step-by-step implementation of the new model of the guaranteed medical care are approved, additional work to adjust the 3-year budget will be carried out, including in terms of the state's spending on health," Yelzhan Birtanov summed up his speech.

For reference: In the CSHI system, medical assistance will be aimed at improving the quality of life of every person: expensive laboratory and diagnostic services; out-patient drug support for diseases not covered by the guaranteed medical service; access to inpatient care; planned inpatient care; rehabilitation treatment and medical rehabilitation.

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