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Today, 95% of Kazakhstanis participate in compulsory health insurance system — how are preparations for introducing medical insurance carried out in 2020?

Friday, 15 November 2019, 15:46:09

In Kazakhstan, according to the instructions of the First President – Elbasy Nursultan Nazarbayev and President Kassym-Jomart Tokayev, from Jan.1, 2020, it is planned to launch compulsory social health insurance. It is noted that the implementation of the insurance system is designed to improve the quality and accessibility of medical services. In an exclusive interview with PrimeMinister.kz, Chairman of the Board of the Non-Commercial Joint-Stock Company “Social Health Insurance Fund” Aibatyr Zhumagulov spoke about the changes entailed by the introduction of the new system.

— Aibatyr Nyshanbaevich, as far as we know, the Fund is already the operator of the guaranteed volume of free medical care. You are also an operator of social health insurance. Please tell us how many people today are potentially insured?

— The Fund has been engaged in distribution for several years as a purchaser of medical services. We already have about two years of experience in the guaranteed volume of free medical care. All mechanisms, including procurement, interaction with medical organizations, have been worked out over these two years. The next step, as President Tokayev said, we should start the system of compulsory medical insurance from Jan. 1. It was noted that we no longer have the right to make a mistake. In principle, today, we believe that our readiness is at a high level. The work is being carried out in various directions, including improving the processes that exist today, including integration issues.

If we talk about the number of conditionally insured, then in our estimation, this is approximately 95% of the total number. In principle, this is a very good indicator for the insurance system. In the world, it is also believed that 95% is a very good indicator in terms of access to medical services.

Most importantly, the guaranteed volume of free medical care will remain. In principle, for the funds that are available today, we are sending about 1 trillion tenge to free medical care. She will also stay the next year. Expect some kind of deterioration is definitely not worth it. Of course, there is additional funding under the CSHI.

— What are the benefits of the insurance? Citizens who have not formalized their status, self-employed, who have not entered the deduction system, what services they can no longer claim? What could be an incentive to enter the system of compulsory health insurance?

— We have an assignment — to develop a mechanism for including uninsured citizens in the system for a short period. Today, in principle, work is underway. Dec. 1, we will complete this work. The point is that if suddenly some citizen is not insured or outside the system, then he can pay the medical insurance debt at the same medical institution. This is around 2,000 tenge in one month. Having paid these funds, he can enter the system. We set the time for ourselves - within half an hour from the moment of payment until the moment of assignment of status. Thus, the risk is that even if a citizen is uninsured for certain reasons, he always has a chance to enter the system.

The system starts Jan. 1, but we have a grace period — the first quarter, when all citizens will be considered insured. That is, in the first quarter, all services within the guaranteed volume of free medical care and the volume of assistance within the framework of the compulsory health insurance will be available to everyone.

If we talk about the future, the insurance system allows the injection of additional funds. The fact that medicine is underfunded today is well known to everyone. The President sets the goal — by 2025 to bring health care financing to 5%.

— The contribution system varies: for employers a certain percentage, for employees — a different one. Could you tell us more about this?

— I would like to dwell on the main group — employees. To date, contributions to the Fund are already taking place in the form of 1.5% of the salary of the employee. Here the employer pays. Thanks to this, about 220 billion tenge has already accumulated in the Fund, which will be used for financing next year. Starting in 2020, the threshold is increasing. If we talk about hired workers, then the employer will pay 2% and 1% will be withheld by the employer. This is the main article that citizens need to know.

There are other categories. For individual entrepreneurs, farmers, peasant farms and others — the mechanisms we have are clearly defined.

— Currently, on behalf of the First President – Elbasy Nursultan Nazarbayev and the Head of State Kassym-Jomart Tokayev, the Government is applying a set of measures to support socially-sensitive segments of the population, including large families, low-income families. About 58% of insured citizens belong to the preferential category. How will medical services be provided to this category?

— Our system is called social health insurance. The word “social” is important here because we have a clear 15 categories of citizens. In total, they make up 58%, for which the state deducts contributions. Today, the state has allocated funds in the republican budget. This is about 11 million citizens. Most of these, of course, are children, students, pensioners, people with disabilities, recipients of targeted social assistance. Money will come from the budget to the Fund, which will finance medical organizations with these funds. The mechanism is debugged. Already today, citizens can see the status of insurance on the Fund's website, as well as in a telegram bot, where you can even ask questions if suddenly any citizen is uninsured or does not find himself in a particular category. Financing of this group will be made at the expense of the state.

— As part of advocacy, it is often said that with the transition to a social insurance system, the availability of medical services will be increased. Tell us, please, how will this go? Today, citizens often turn to us with the facts that some clinics have stated that about 5 patients a month will be able to receive expensive services such as magnetic resonance imaging. Will the introduction of a new system solve this problem? How will the increase in accessibility, and especially in the countryside, be built?

— The main goal of implementing the insurance is to increase the availability of medical services. Thus, additional funds are being poured into healthcare. We expect an increase in financing only through our line by 1.5 times. If this year about 1 trillion tenge was collected, then next year we expect financing of medical services up to 1.5 trillion tenge. This gives us the opportunity to finance certain types of expensive medical services that are currently unavailable, including computed tomography, MRI and other types of services that are in great demand today. We will have the opportunity to increase the funding for these services. I think we will close most of the services through the health insurance system.

Medical assistance in rural areas will be provided by local district hospitals and clinics within the framework of the guaranteed volume of medical care and compulsory medical insurance. In the absence of any type of medical service, the medical organization must enter into a co-fulfillment agreement with the relevant organization and refer patients there. As part of monitoring the implementation of contractual obligations of suppliers, the Health Insurance Fund checks the quality and availability of medical care. All contractual relationships with healthcare providers are patient-centered.

— That is, now if clinics do not provide services, will it be considered illegal?

— Here I would like to note how the Fund we are a purchaser of medical services. Here we are now setting ourselves the task for the next year — protecting the rights of patients. So that citizens clearly know what they can count on, if suddenly they are limited in some services, then in this situation we, as the Fund, protect patients so that the medical organization is obliged to provide these services under the contract. Over the next year, this will be our main task.

— Before our interview, we looked at the website of the Social Health Insurance Fund, where we found a list of medical organizations that currently provide services within the guaranteed volume of free medical care. Do we understand correctly, these same companies will provide services within the framework of social health insurance? Where can citizens appeal if companies refuse to provide services? Is there a single call center?

— Today we are waiting for the connection of private medical organizations. When concluding contracts, we do not divide by ownership, the main thing for us is that the medical organization can provide certain medical services in their regions. Starting this year, the number of medical organizations will increase, and by the period of implementation of the compulsory medical insurance system, their number will increase to 2 thousand. Recently, we held a presentation of the electronic procurement portal, where we plan to launch the process of concluding contracts. Also, citizens can contact the Fund’s contact center by dialing 1406. Here they can express their comments and get advice. The questions will be regularly monitored.

— What about the quality of medical services? We understand that this is the responsibility of the Ministry of Healthcare, but will the Fund, for its part, build criteria for private organizations that provide medical services?

— In terms of quality control of medical services, the Fund also has functionality. As part of the guaranteed volume of free medical care, we monitor the quality of services provided, we do not apply any administrative measures, but we have contractual relations with medical organizations. That is, those or other services for which we pay must meet certain standards. If they deviate from the standards, we have penalties in this regard, which we have the right to apply. Starting next year, this area will be improved, first of all, these are issues of automation and transparency of the process.

— From Sep. 1, 2019, the pilot insurance project has been implemented in the Karaganda region. The pilot will end in December, but can we now speak about intermediate results?

— I think that the right choice of the region was made, because the leadership and infrastructure of the region allowed us to implement regulatory procedures. Those or other technical issues and the pilot are already giving positive results, which we plan to broadcast in the future. In particular, we are talking about regulatory acts, as part of the pilot, we identified shortcomings and made changes to the regulations. There were also opportunities to determine tariffs for services that are not provided as part of the guaranteed amount of free medical care, that is, we were able to estimate the cost of these services, which will also influence the tariffs formation process in the future. However, the pilot project did not use all of the insurance services, as certain funds were allocated. In general, I believe that the pilot had a positive impact on the process and the system implementation.

— Thank you for the interview!


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