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In first quarter of 2020, guaranteed volume of medical care and medical insurance services to be available to everyone

Friday, 15 November 2019, 16:23:53

In the first quarter of 2020, the insurance system will work on preferential terms for everyone, all citizens will be considered insured and will be able to receive medical care for free. This was announced by the Chairman of the Board of the Social Health Insurance Fund Aibatyr Zhumagulov in an exclusive interview with PrimeMinister.kz.

Starting Jan. 1, 2020, medical organizations working on a contractual basis with the Social Health Insurance Fund will begin to provide medical assistance to citizens of the country as part of compulsory social health insurance. One of the principles of the insurance is the obligation to pay deductions and (or) contributions. Insured citizens are persons who regularly pay their contributions and deductions. It is important to be insured.

“If we talk about the number of conditionally insured, then according to 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,” Zhumagulov said.

According to the chairman of the board, until Dec. 1, 2019, a mechanism will be developed to include uninsured citizens in the system. The point is that, if suddenly some citizen is not insured or outside the system, then he can pay medical insurance debt at the same medical institution.

“This is in the region of 2000 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 speaker explained.

The system starts Jan. 1, but the first quarter of the year will be preferential when all citizens are 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.

It is worth noting that the implementation of the insurance does not cancel the guaranteed volume of free medical care. The state will continue to finance the guaranteed volume of medical care - this is ambulance, primary medical care, emergency medical care, medical care for major chronic diseases and socially significant diseases.

From Jan. 1, 2020, medical care will be provided in two packages: guaranteed for all and insured under social health insurance. The insurance guarantees equal access to health care for all insured citizens, regardless of the size of contributions and contributions. It is enough that these deductions be made regularly.

The insurance package includes:

  • consultative diagnostic services, namely the reception of narrow specialists, professional examinations of adults and children. The main advantage is that expensive diagnostic services like tumor markers, PCR, hormones will be free, this requires the appointment of a local therapist, tests can be handed over in private laboratory clinics working under an agreement with the Fund and its branches. In addition, expensive diagnostic services such as CT and MRI will also be free for the insured, this will require the direction of specialized specialists;
  • ambulatory drug provision in excess of the guaranteed volume;
  • planned inpatient care;
  • inpatient care;
  • rehabilitation treatment and medical rehabilitation.

Taking into account the introduction of the insurance, in aggregate, the health budget in 2020 for the country will be about 1.6 trillion tenge, including 573 billion tenge — as revenues to the insurance system. In general, total funding will increase by 52% from the level of 2019.


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