We expect tangible effect of increasing availability and quality of medical aid — Yelzhan Birtanov on implementation of Compulsory Social Health Insurance

June 18 at the Government meeting chaired by Prime Minister Askar Mamin, new approaches to the provision of medical care in the light of the introduction of Compulsory Social Health Insurance were approved.

On behalf of the First President – Elbasy Nursultan Nazarbayev, given in the Address to the People of Kazakhstan dated Jan. 10, 2017, a new model of guaranteed free medical care and a package of health care in the compulsory social health insurance system have been developed. They will take effect on Jan. 1, 2020.

Minister of Healthcare Yelzhan Birtanov reported on the developed three-tier system of medical support for the population.

The first level of this system will ensure the provision of the guaranteed healthcare at the expense of the state budget for all citizens of Kazakhstan, oralmans and permanently residing foreigners. This package includes such types of free medical care as primary health care at the place of attachment, ambulance, air ambulance and emergency hospital care, a full range of medical care for socially significant diseases and major chronic diseases, including drug provision.

The second level is the compulsory social health package for the insured population, which will provide services in excess of the guaranteed package and will include counseling, diagnostic, planned inpatient care and free drug coverage for a wide range of diseases, hospital replacement care and rehabilitation.

The third level is medical services that are not included in the guaranteed healthcare and compulsory insurance packages. They are provided for a fee or at the expense of voluntary medical insurance.

“Projects of medical care packages were worked out in detail by experts, agreed upon by the Regional Healthcare Departments, interested government bodies, Atameken National Chamber of Entrepreneurs, reviewed and approved by the public council of the Ministry of Healthcare,” Birtanov said.

Reporting on new approaches to the provision of medical care, the minister noted that the Ministry of Healthcare and akims are implementing a plan of measures to improve the quality and accessibility of primary medical and social care for 2019-2020.

At present, the number of population attached to primary health care organizations is 18.7 million. At the same time, in the information systems 785 thousand unattached citizens were identified, which is more than 4% of the population.

In general, from Jan. 1, 2020, compulsory health insurance is considered to cover 94.5% of the population.

“According to our forecasts, the number of independent payers will be about 1 million people, including 770 thousand non-actualized self-employed citizens,” said Birtanov.

Birtanov stressed that the introduction of the guaranteed package and compulsory insurance in the first place is aimed at increasing the availability of medical care for socially vulnerable groups of the population. Today, eight socially vulnerable categories of citizens, including children, pregnant women, mothers of many children, retirees, etc., have been determined by law to receive individual medical services. Since 2020, the introduction of the insurance has defined 15 vulnerable categories of citizens by law. These persons (their number will be about 10.9 million people) will be insured by the state.

As part of the insurance implementation, the availability of a number of services will be expanded, including three times increase in funding for expensive diagnostic services, 2.3 times increase in funding for dental services.

In order to ensure the timely implementation of the insurance from 2020, all the necessary regulatory legal acts will be adopted until Sep. 1. By Oct. 1, the basic information systems of the Ministry of Healthcare will be integrated with the information systems of government agencies, medical service providers, and automation of the choice of medical service providers. Until Jan. 1, 2020, contracts will be concluded with providers of medical services for 2020 with their willingness to work in the healthcare system.

To prepare for the full-scale implementation of the insurance, it is planned to conduct piloting from Sep. 1, 2019 jointly with the akimat of the Karaganda region. As part of the pilot, the provision of some services from the insurance package, identification of the status of the insured, separate accounting of funds will be tested.

“In general, together with local executive bodies, a large-scale preparatory work is being carried out for the insurance: a regulatory framework has been formed, explanation is being carried out, issues of automation, equipment and digitalization of the healthcare sector are being addressed. We expect a tangible effect of increasing the availability and quality of medical care for the population, including the financial security of two packages. In general, we can talk about a high degree of readiness for the introduction of the insurance system and new approaches to providing medical care,” Birtanov said.

On the readiness to provide medical care in the system of compulsory social health insurance, Akim of the Karaganda region Yerlan Koshanov, Almaty Akim Amandyk Batalov, Akim of North Kazakhstan Region Kumar Aksakalov were heard.

Deputy Prime Minister Gulshara Abdykalikova, in turn, noted that for the continuous operation of the system of compulsory medical insurance, a number of activities should be carried out by the end of the year.

Until Sep. 1, 2019, all regulations will be aligned with the new approaches of the guaranteed volume of free medical care and the package of medical care in the compulsory social health insurance system. In addition, by Oct. 1, 2019, work will be completed on the integration of all information systems of state bodies with the Social Health Insurance Fund. At the same time, an assessment of financial stability up to 2050 is being carried out under various scenarios on the basis of actuarial calculations. It is planned to continue informational and explanatory work within the framework of compulsory social health insurance in the second half of the year.

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