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On free medical care, quota distribution and innovations in domestic healthcare — interview with Lyazat Aktayeva

Thursday, 13 June 2019, 21:03:57

First President – Elbasy Nursultan Nazarbayev in the Address “Growing Welfare of Kazakh Citizens: Increase in Income and the Quality of Life” emphasized that the quality of medical services is an essential component of the population’s social well-being. Read the Vice Minister of Healthcare Lyazat Aktayeva’s report on the provision of free medical care in an exclusive interview by РrimeМinister.kz.

— Lyazat Meyrashevna, please tell me, what types of medical care are free for all categories of citizens and which — for certain segments of the population?

— Today, medical care is provided free of charge within the framework of the guaranteed volume of free medical care to citizens, oralmans, foreigners, stateless persons permanently residing in the territory of Kazakhstan. In general, the guaranteed amount of free medical care includes the main types of medical care. This is the first medical aid, pre-medical care, which is provided by paramedical personnel, qualified care, which is provided by general practitioners, general practitioners, pediatricians, specialized care provided by narrow specialists, high-tech medical services and medical and social care. This is all included in the scope of guaranteed free medical care.

— What categories of citizens have top priority in the distribution of aid? How are quotas for expensive transactions formed? Are there separate queues for large families or families with children with special needs?

— There are two types of medical care — emergency and planned. There is no priority in emergency medical care, because there the bill goes for hours and even for minutes. Therefore, when indications arise for emergency medical care, it is necessary to call 103 or to independently contact a medical organization for emergency medical care. As for planned medical care, it is regulated through the portal "Hospitalization Bureau." The doctor gives a referral for hospitalization if there is an indication and includes the name and diagnosis of the patient in the information system — the portal “Hospitalization Bureau.” A medical organization is determined where medical services are provided according to the patient’s disease profile. Then, depending on the availability of a bed place, the day of hospitalization will be determined. It is clear that the day of hospitalization does not coincide with the day when it is posted on the portal, hospitalization may be delayed. Therefore, it is called planned. But if, in the process of waiting for medical care, the patient will have emergency indications for hospitalization, again, in case of urgency, hospitalization is immediately ensured.

As for a separate line-up for inpatient treatment, one must be guided by medical indications: emergency or planned. There is no separate order. But at the same time, in the guaranteed volume of free medical care there is a social assistance for vulnerable groups of the population. It concerns expensive medical services: it is these categories of the population that are provided on a priority basis. These include children, pregnant women, mothers of many children, awarded with “Altyn Alka,” “Kumis Alka,” pendants, disabled people of groups 1, 2, 3, old-age pensioners, disabled people of the Great Patriotic War and recipients of targeted social assistance. Therefore, in any medical organization in which a patient appears from these categories, a referral to an expensive medical service is issued as a matter of priority. For example, on computed, magnetic resonance, positron emission tomography and others.

— How many citizens were able to receive treatment, including prompt treatment, according to state quotas for the first quarter of 2019?

— In the first quarter of this year, 1,800 people received medical care for high-tech medical services. Such services are not provided by all medical organizations. For this, it is necessary to have an adequate human resources and material and technical base. For example, this is a transplantation of kidneys, fetal cells, implantation of bone conduction. There are high-tech services for which the Public Health Committee permits depending on the criteria. Then, when concluding a contract with the Social Health Insurance Fund, this service is provided free of charge. We have a positive trend in increasing the volume of high-tech medical services. If we compare the annual figures, then in 2016 about 71 thousand people received high-tech medical services, then in 2018 it was already 105 thousand people. As more medical organizations begin to provide high-tech medical services, they can go on to the category of specialized medical care, where there is no quota, i.e. there is no limit on volumes. The limits themselves are determined in connection with the demand of the population, that is, if there is a need for these technologies, for example, in arthroplasty of 1000 patients, then, having tracked the historical volume of services rendered over the past years, it is determined that this year, taking into account population growth, that amount of population. That is, the limitation of certain services necessarily takes into account the demand of the population for this technology.

— What are the deadlines in waiting for medical care, as with urgent and planned forms of waiting?

“Emergency conditions are those cases where an urgent medical care is needed, so there is no waiting time.” Waiting for planned hospitalization is tracked hrough the portal "Hospitalization Bureau." Today, 44 thousand people are waiting for their planned hospitalization in the Hospitalization Bureau. If you look at the profiles, then the largest proportion is accounted for by ophthalmologic patients, that is, patients who have eye diseases, orthopedic patients, who need mainly endoprosthetic replacement. The queue waiting time can reach several months, but these are diseases where the waiting time does not affect the patient's health.

— Tell us how the lists of diseases for which there is free medical care have changed? Will the list of socially significant diseases change?

— Today, the list of socially significant diseases, as before, includes 13 diseases. This list has not changed, but last year there was a discussion on changing this list. We revised it in order to avoid duplication of diseases that may be on several lists. For example, such as diabetes, which is present in socially significant diseases and major diseases that determine the disability of the population due to the occurrence of complications. In the end, we decided not to change this list. Why do lists appear at all? We are talking about the need for full financial support of diagnostic services and therapeutic measures for these diseases, so it is important, first of all, to financially fill the diagnostic treatment tactics of these patients. From Jan. 1, 2020, the system of compulsory health insurance begins to function. Additional financial resources will come to the health care system. Therefore, the unmet need of the population for diagnostic services with the implementation of the insurance will be met. Then maybe we will come back to change lists. To date, these lists of diseases have not changed.

— What changes can occur in the system of medical care for state guarantees and insurance? What is the difference between these documents?

— From Jan. 1, 2020, there will be several packages of medical care. The main one is guaranteed free medical care. The second is the insurance package. The third is an optional package. Additional package due to paid services or other sources permitted by law. The guaranteed volume of free medical care, as today, will be provided to all citizens of Kazakhstan. The insurance package is insured patients. That is, this medical care in addition to the guaranteed volume of free medical care. What will be in the package, which will be reimbursed due to the guaranteed volume of free medical care and provided free of charge to the population? These include ambulance, air ambulance, primary health care, palliative care. Along with this, in the guaranteed pachage with socially significant and major diseases that determine disability and mortality. These are the 25 major diseases, which include hypertension, diabetes, chronic heart failure, and others. These diseases will provide free consultative and diagnostic assistance, diagnostic services, specialist consultations, planned inpatient care, and outpatient drug support. In addition, emergency inpatient care will be provided to the entire population, regardless of whether you are insured or not. It will be in the guaranteed amount of free medical care. What is not included in the guaranteed amount of free inpatient care will be included in the insurance package. This results in consulting and diagnostic services for those diseases that are not included in the guaranteed amount of free medical care, outpatient drug provision, free distribution of medicines for those diseases that are not included in the guaranteed care, and planned inpatient care. It is very important to have the status of the insured. The availability of the insurance package will be for those who are insured. In the system of compulsory medical insurance there is a preferential category of citizens. These are 15 categories of citizens whose status allows not to pay contributions themselves, but the state pays. For them, the insurance package will also be free. These categories include children, unemployed pregnant women, recipients of social assistance, students, mothers of many children, awarded with Altyn Alka, Kumis Alka pendants, disabled people 1, 2, 3 categories and disabled children. Along with the preferential categories, the number of which is about 11 million citizens, those employees will be insured for which employers deduct. This is about 5 million people. There is a category of citizens who pay a single cumulative payment. They will also be insured in the compulsory health insurance system.

— How is the quality of work of medical workers, whose functions include the provision of free services, is controlled?

— In every medical organization there is a patient support service, which in the same place, according to the “here and now” principle, solves cases of citizens turning to them, their dissatisfaction with the quality of medical care. Each medical organization has a deputy chief physician in charge of auditing quality medical care. Here it is very important that our citizens, in case of their dissatisfaction with medical assistance, could immediately resolve their questions. There is also an external control, there is the possibility of contacting the Public Health Committee with a statement in case of poor quality medical care. During the first quarter of 2019, 1,100 appeals from citizens were received. Of these, about half are considered. Of those considered, 22% are reasonable. Based on the results of substantiation, administrative penalties are taken in accordance with the Code of Administrative Offenses. In cases where damage is caused in the provision of medical care, the materials are sent to the authorities of the Department of Internal Affairs for legal assessment.

— How advanced is Kazakhstan medicine in the implementation of gentle treatment, complex operations with the help of modern innovative technologies? What treatment is available today?

— Kazakhstan medicine develops quite quickly in accordance with the trends in the world. Doctors are guided by clinical protocols for diagnosis and treatment, which are compiled on the basis of internationally recognized clinical guidelines. Technology is being introduced. At the same time, there is a list of diseases in which it is impossible to provide medical care to patients in our country and therefore patients are sent abroad. Last year, 89 patients were sent. This is mainly for those technologies where equipment is not represented in our domestic clinics or our doctors do not own these technologies. For example, the gamma knife, which will be introduced at the National Scientific Center for Neurosurgery, and from next year we will not send abroad. Proton therapy for tumor diseases is planned to be implemented at the completion of the construction of the National Oncology Research Center. That is, from year to year the number of technologies due to which they are sent abroad in the country is increasing. Three services are actively developing: cardiac surgery, neurosurgery, orthopedics, where all the latest, innovative technologies that exist in the world are presented. In neurosurgery, neuronavigation is introduced, in orthopedics — new endoprostheses for joint problems. The Cardiac Surgery Center is the first in the world to have an artificial heart transplant. Therefore, our domestic medicine is in step with world technologies. The most important thing that underlies the introduction of new technologies is the principle of cost-efficiency. It is very important that the costs that go to the introduction of these technologies determine the effectiveness of the quality of medical care.

— Lyazat Meyrashevna, thank you for the interview.

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