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Providing medical services, supporting rural medicine, working during pandemic — results of Social Health Insurance Fund for 2020 and first quarter of 2021

Monday, 17 May 2021, 18:27:25

Durinf the briefing at the Central Communications Service under the President of the Republic of Kazakhstan, Chair of the Board of the Social Health Insurance Fund Bolat Tokezhanov spoke about the financing of medical care and the participation of the population in the Compulsory Social Health Insurance in the first quarter of 2021.

Tokezhanov said that 1.8 trillion tenge is provided for the provision of medical care in 2021, including the guaranteed volume of free medical care (guaranteed volume of medical care) — 1.1 trillion tenge, compulsory medical insurance — 700 billion tenge.

As of April 1, the Fund signed contracts for the provision of medical services to the population with 1,363 providers in the amount of 1.46 trillion tenge.

Tokezhanov noted that in 2021 outpatient and inpatient care will become more accessible for Kazakhstanis, support for rural health care, screening programs, nursing care, and patronage services will be provided. A significant proportion of funding is provided for child health care. In particular, the implementation of the Ansagan Sabi program to increase quotas for IVF and Qamkorlyq — for medical rehabilitation of children with special needs.

Additional funds were allocated for antenatal monitoring — 29.7 billion tenge, preventive examinations of children from 0 to 5 years old — 12 billion tenge, as well as the development of school medicine — 22.5 billion tenge.

The head of the Fund stressed that the results of the provision of medical care for the 1st quarter show that the healthcare system has adapted to work in the difficult conditions of the ongoing coronavirus pandemic, and there is a dynamic growth in medical services provided to the population.

“The volume of consultative and diagnostic assistance at the polyclinic level has increased. Thanks to the growth in funding, the number of these services increased by 20% compared to the first quarter of 2020. 22.4 million services were provided for the amount of 37.7 billion tenge. This is 3.4 million services more than in the first quarter of 2020,” he said.

It should be noted that in 80% of cases, payment for consultative and diagnostic services is made by the Fund at the expense of the Social Health Insurance funds. First of all, this concerns high-precision diagnostics — CT and MRI.

Particular attention is paid to the provision of drugs to patients from target groups. 152.4 billion tenge was allocated for outpatient drug provision in 2021, of which, within the guaranteed volume of medical care — 122.3 billion tenge, compulsory medical insurance — 30.1 billion tenge.

It is worth noting that the Fund allocates funds for the purchase of medicines in advance in the form of advance payments in order to avoid delays in purchasing the necessary medicines.

In general, the number of patients provided with medicines increased by more than 1.5 times. If in the first quarter of 2020 it was 74 thousand patients, then this year 190 thousand people were provided with the necessary medicines. The Fund has repeatedly raised the issue of coverage of all patients subject to drug provision to health departments. This year, there has been a shift in solving this problem, and in the future, this issue will also be monitored, since the Fund fulfills its obligations to SK-Pharmacy and medical organizations to finance drug provision for patients.

The Health Insurance Fund supports the development of rural medicine by improving the availability of consultative and diagnostic assistance. Last year, 100 mobile medical complexes were purchased for residents of remote rural settlements. Thus, today the villagers are served by only 149 PMHs, inside which you can get consultations from specialized specialists, undergo examinations, including screenings, pass laboratory tests, get a referral for hospitalization, and get vaccinated. In the first quarter, through mobile medical complexes, or, as they are called "polyclinics on wheels," 120 thousand services worth 231.9 million tenge were provided to villagers.

During the briefing, Tokezhanov also informed that in the first quarter, 183 billion tenge was received in the compulsory health insurance system in the form of contributions and deductions. The largest amount was made by the state contributions for beneficiaries — 95.4 billion tenge, or 52% of all receipts. Employers' contributions for their employees totaled 44.4 billion tenge (24%), employee contributions — 35.2 billion tenge (19%). The share of contributions by individual entrepreneurs, payers of the CSP, independent payers working under GPC contracts was 5%. As of April 1, 84.4% of the population of Kazakhstan are participants in medical insurance, which is 15.9 million people.

Speaking about the results of the first quarter, it is necessary to note the role of the Fund in financing measures to combat coronavirus.

“The main amount of funding is provided for the payment of wage supplements to health workers involved in the fight against COVID-19. In January, 50.5 thousand health workers received allowances in the amount of 13.9 billion tenge, in February 51.7 thousand employees received allowances for 13.8 billion tenge. In March, the amount of payments is 14.7 billion tenge to 53.2 thousand employees,’’ Bolat Tokezhanov said.

In addition, funding for measures to combat coronavirus infection amounted to 71.6 billion tenge. Of these:

for medical care and services to prevent the spread of CVI — 15.6 billion tenge, more than 95 thousand people were hospitalized and treated in quarantine and infectious diseases hospitals;

  • for PCR diagnostics services — 10.3 billion tenge, 1.3 million PCR tests were carried out;
  • for the visits of mobile brigades — 3 billion tenge, 526.9 thousand visits were carried out;
  • for hospital services at home — 33.3 million tenge, 1,057 patients were treated at home.

The Fund continues to work on protecting the rights of patients. Through the official feedback channels of the Foundation — the 1406 contact center, the Qoldau 24/7 mobile application, the Foundation's website www.fms.kz, Saqtandyrybot in Telegram, the blog of the Minister of Health and the website of the Ministry of Health in the 1st quarter, more than 250 thousand requests were received. Of these, 2,475 were complaints from the population.

“TOP-5 complaints are the issues of refusal to provide medical care (35.7%), the quality of medical services provided (20.3%), referrals for receiving services included in the guaranteed volume of medical care and compulsory health insurance, on a paid basis (10.7%) , identification of actually not rendered services in information systems (10.6%), refusal to provide medicines (8.5%)," said the chair of the board of the Social Insurance Fund.

Bolat Tokezhanov also noted that in order to systematically address these issues, it is necessary at the regional level to work to improve the infrastructure provision of healthcare facilities, staffing, as well as to strengthen the work of the Patient Support Services and Internal Audit, which are in all medical organizations and their task is to protect the rights the patient.

During the briefing, Bolat Tokezhanov also spoke about monitoring the quality and volume of medical services provided to the population. So, according to the results of the 1st quarter, experts of the Fund revealed 203.6 thousand defects, taking into account fines, the amount amounted to 3.5 billion tenge. Of these, services actually not provided amounted to 3,823 cases in the amount of 29.3 million tenge, including fines.

“Starting this year, to prevent violations by suppliers, the Fund has introduced proactive monitoring. Now, if a defect is detected, the supplier must eliminate the errors within 45 days. Otherwise, he will face fines. This innovation will help to increase the availability and quality of medical services and make more trusting relationships with suppliers,” the head of the Fund emphasized.

Thus, since the beginning of the year, 61,362 potential defects have been identified for the amount of 610 million tenge. Out of 61 thousand defects based on the results of proactive monitoring, medical organizations were fined only for 10.4 thousand defects.

“The first experience has shown that medical organizations are interested in correcting the situation and preventing further defects, the 'vicious' practice of hiding defects has been overcome, which did not allow analyzing, identifying the causes of defects and correcting the situation in a planned way,” said Bolat Tokezhanov.

Also, according to Tokezhanov, as of April 1, the Fund signed contracts with 1,363 medical service providers, of which 688 clinics are private. Last year there were 635 entities, the share of the private sector is growing every year, and serious competition is developing in the market. This is an opportunity for the patient to choose the best clinic. The lists of providers of medical services are posted on the website of the Fms.kz fund.

For reference: In the regional context, there is a high share of private suppliers in the cities of Shymkent, Nur-Sultan and Almaty: 72%, 66% and 55%, respectively. Low in Kostanay (30%), Akmola (30%) regions and West Kazakstan region (22%).

A significant increase in funding for the following types of assistance is envisaged:

- PHC by 17%;

- inpatient care by 42%;

- medical assistance to the rural population by 30%;

- palliative care by 96%;

- medical and social assistance to HIV-infected and AIDS patients by 36%;

- oncohematology by 26%.

As for the issue of drug provision that is of particular concern to the population, here the Medical Insurance Fund provides 152.4 billion tenge for the purchase of drugs at the polyclinic level, of which 122.3 billion tenge is within the guaranteed volume of medical care, and 30.1 billion tenge in the compulsory health insurance package. If earlier 74 thousand patients were provided with medicines, then this year their number has grown to 190 thousand people.

It is worth noting that the Fund directs funds for the purchase of medicines in advance, in the form of advance payments, in order to avoid delays in purchasing the necessary medicines. We fulfill our obligations to medical organizations and SK-Pharmacy in terms of financial support.

Summing up his speech, the head of the Fund said that even in the face of the fight against the pandemic, which continues to take away an impressive part of financial resources, the volume of planned medical care continues to increase in the most important areas for the population.

“We remember that last year Kazakhstani medicine experienced a colossal burden, thousands of patients were deprived of the opportunity to receive routine medical care, but now all medical organizations in the country continue their work as usual. In the first quarter, we received an increase in medical services provided to the population,” he said.

In the first quarter alone, 800 thousand laboratory tests, over 500 thousand services of CT, MRI, ultrasound, radiography, and 7 million screening tests were financed.

Based on the results of monitoring inpatient care for the 1st quarter of this year. there is an increase in the number of surgical interventions using the latest medical technologies by 25%. Since the beginning of the year, 1,602 operations have been carried out in medical organizations of the country.

This year, 526 in vitro fertilization procedures have been performed. For example, last year only 59 IVFs were carried out in the 1st quarter.

The Fund continues to stimulate the development of medical rehabilitation, incl. on an outpatient basis. Thus, the number of medical organizations providing rehabilitation assistance in Kazakhstan has increased almost 10 times over two years, to 610 clinics. At the outpatient-polyclinic level, 2.8 million rehabilitation services were provided in the amount of 2.7 billion tenge.

Coronavirus infection is dangerous for those who have had postcoid complications. The Fund supports the development of rehabilitation in the country in every possible way, incl. postcovid, which allows you to prevent in the early stages the development of dangerous chronic diseases, the treatment of which may require impressive financial costs from the health care budget.

Speaking about the results of the 1st quarter, it is necessary to note the role of the Fund in financing activities in preventing the spread of CVI, diagnostics and treatment of patients with coronavirus infection.

The main amount of funding is provided for the payment of wage supplements for medical workers involved in the fight against coronavirus. Thanks to these allowances, the salary of doctors in infectious diseases hospitals has reached 1 million tenge and more.

In January 2021, 50.5 thousand medical workers received allowances in the amount of 13.9 billion tenge, in February 51.7 thousand medical workers received allowances in the amount of 13.8 billion tenge. In March, the amount of payments is 14.7 billion tenge to 53.2 thousand doctors.

In total, accrued in the form of allowances is 42.4 billion tenge for the 1st quarter.

In the 1st quarter, funding for measures to combat coronavirus infection amounted to 71.6 billion tenge, including:

  • for allowances for medical workers — 42.4 billion tenge;
  • for medical care and services to prevent the spread of CVI — 15.6 billion tenge, more than 95 thousand people were hospitalized and treated in quarantine and infectious diseases hospitals;
  • for PCR diagnostics services — 10.3 billion tenge, 1.3 million PCR tests were carried out;
  • for mobile brigade visits — 3.0 billion tenge, 526.9 thousand visits were carried out;
  • for hospital services at home — 33.3 million tenge, 1,057 patients were treated at home.

During 2020, about 1.9 million PCR tests were performed. In the first three months of this year, 1.3 million studies have already been funded to detect the CVI virus. In addition, last year the Fund financed 550 thousand visits of mobile brigades. This year, in the first quarter alone, over half a million visits were made to patients with symptoms of coronavirus.

“One of the main directions of the Fund's work is feedback from the population and protection of patients' rights. Our services provide the population with qualified information and consulting support, accepting complaints, questions and suggestions for processing,” said Tokezhanov.

In the first quarter of this year, to the official feedback channels of the Fund — contact center 1406, mobile application Qoldau 24/7, the Fund's website www.fms.kz, Saqtandyry-bot in Telegram, the blog of the Minister of Health and the website of the Ministry of Healthcare.

Chair of the Board of the Fund stressed that the Foundation takes an uncompromising position in relation to the violation of patients' rights to affordable and high-quality medical care. One of the levers of influence is the examination and monitoring of the quality and volume of medical services provided to the population by the Medical Insurance Fund.

According to the results of the 1st quarter, the experts of the Fund identified 203.6 thousand defects, including fines, the amount amounted to 3.5 billion tenge. Of these, for actually not provided services, the so-called registrations, amounted to 3,823 cases in the amount of 29.3 million tenge, including fines.

Starting this year, the Fund for the Prevention of Violations by Suppliers has introduced a new type of monitoring — proactive monitoring.

Now, if a defect is detected, the supplier must, within 45 calendar days from the date of signing the conclusion, eliminate the identified defects and unfulfilled obligations. If the defects are not eliminated within the specified period, financial penalties will be followed.

In the 1st quarter, proactive monitoring was carried out in 321 medical organizations. The main remarks of the Foundation's experts, identified during the monitoring, were:

  • incorrect documentation in information systems;
  • deviations from the standards of diagnosis and treatment;
  • understaffing and under-equipping with medical equipment, which directly affects the availability and quality of medical services.

In general, 61,362 potential defects were identified for the amount of 610 million tenge. The first experience showed that medical organizations are interested in correcting the situation and preventing further defects, the vicious practice of hiding defects has been overcome, which did not allow analyzing, identifying the causes of defects and correcting the situation on a planned basis.

In the form of contributions and deductions for the compulsory health insurance in the 1st quarter, 183 billion tenge were received. The largest amount of receipts was made by the state contributions for beneficiaries - 95.4 billion tenge, or 52% of all receipts. Thus, the state continues to maintain its social obligations to the population.

Employers' contributions for their employees totaled 44.4 billion tenge (24%), employee contributions — 35.2 billion tenge (19%). The share of contributions by individual entrepreneurs, payers of the Unified Single Payment, independent payers working under GPC contracts was 5%.

For reference:

  • state contributions — 95.4 billion tenge or 52.1% (last year — 73.2 billion tenge, an increase of 30% [the rate increased from 1.4% to 1.6%]); deductions from employers — 44.4 billion tenge or 24.2% (last year — 36.8 billion tenge, an increase of 21%);
  • employee contributions — 35.2 billion tenge or 19.2% (last year — 12.7 billion tenge, an increase of 2.8 times [the rate increased from 1% to 2%]);
  • contributions of individual entrepreneurs and individuals engaged in private practice — 4.5 billion tenge or 2.4% (last year — 1.6 billion tenge, an increase of 2.8 times);
  • persons working under contracts — 1.6 billion tenge or 0.9% (last year — 0.4 billion tenge, an increase of 4 times);
  • payers of the Unified Single Payment — 372 million tenge or 0.2% (last year — 114 million tenge, an increase of 3 times);
  • independent payers — 1.5 billion tenge or 0.8% (last year — 93 million tenge, an increase of 16 times).

The Fund continues to work to increase the coverage of the population with health insurance. As of April 1, 84.4% of the population of Kazakhstan are participants in medical insurance, which is 15.9 million people.

Another 2.9 million Kazakhstanis remain outside the compulsory health insurance system, which creates certain problems with the accessibility of this part of the population to medical services of the compulsory health insurance package.

However, they always have the right to receive medical services within the guaranteed volume of free medical care.

Of the uninsured, 2 million people are unstable payers. That is, deductions and (or) contributions have ever been received for them, but they are not regular, as a result of which a debt is formed and there is no insurance status in health insurance, because a one-time or two-time payment of the Unified Single Payment or a contribution as an independent payer does not give the right to receive medical services in the package of compulsory health insurance for all 12 months. It is important to observe the regularity of payments.

Another 922 thousand people have never paid contributions to the compulsory health insurance. I would like to note that their number is decreasing: at the beginning of the year there were one and a half times more — 1,428 thousand people.

For reference: A low rate of insurance is noted in Kostanay (77.0%), Almaty (77.3%), Turkistan (77.9%), Zhambyl (79.6%), Kyzylorda (80.3%), Shymkent (79.5%).

The highest rates of population insurance are in Atyrau (85.8%) and Mangystau (85.1%) and Akmola (85.1%) regions.

It should be noted the importance of interdepartmental work to involve the population in the compulsory health insurance — together with local executive bodies, with the involvement of Atameken NCE, territorial divisions of the State Revenue Committee and medical organizations.

Updating the lists of SME workers remains a problem. Recall that last year, by decision of the Government to support during the pandemic, small and medium-sized businesses were exempted from mandatory payments, incl. for compulsory health insurance.

To identify their employees in the CSHI system, SME organizations had to enter them into the database to ensure the status of insurance.

At present, about 20% of employers (61,233 SMEs) from among those exempted from payment of contributions have not updated the lists of their employees. In this connection, these workers do not have the status of insured and are limited in obtaining medical care.


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