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Children's rehabilitation: What will change after implementing compulsory social health insurance

Friday, 22 November 2019, 16:41:01

In the Address “Constructive Public Dialogue – the Basis of Stability and Prosperity of Kazakhstan,” President Kassym-Jomart Tokayev set the task to improve medical and social support for children with a diagnosis of cerebral palsy. Government of Kazakhstan is taking measures to fulfill the instructions of the Head of State, including expanding the network of small and medium-sized rehabilitation centers for children within walking distance. The PrimeMinister.kz prepared a review on the work currently underway in this direction.

Kassym-Jomart Tokayev instructed to pay special attention to families in whose care are children with disabilities.

Only according to official statistics, more than 80 thousand children are registered on disability. We must create equal opportunities for people with special needs. I spoke about this within the framework of my election platform,” the president said in his Address, while instructing the government to allocate at least 58 billion tenge for these purposes over three years.

The Minister of Healthcare Yelzhan Birtanov, speaking at a briefing in September at the site of the Government, said that by the end of 2019, an Action Plan will be developed and adopted to improve medical and social support for children diagnosed with cerebral palsy. It will include measures to expand the network of small and medium-sized rehabilitation centers for children within walking distance. It was emphasized that this type of care, first of all, should be organized on the basis of primary health care.

At the same time, the Ministry of Healthcare is already implementing the Roadmap for the organization of rehabilitation care for children with cerebral palsy in Kazakhstan for 2019-2020.

According to the instructions of the First President – Elbasy Nursultan Nazarbayev, within the framework of public-private partnership in Nur-Sultan, it is planned to create a rehabilitation center for 350 beds, of which: pediatric cardiology — 15 beds, rehabilitation neurological children — 40 beds, neurosurgical children — 20 beds, traumatological nurseries — 16 beds. An application for this project (business plan, financial and economic model) is under development by a private partner.

Plans are also being developed for the development of rehabilitation assistance in the region. Within the framework of the Qamkorlyq Road Map, it is planned to open rehabilitation centers in Atyrau, East Kazakhstan, West Kazakhstan, Kostanay, Pavlodar, Turkistan, Mangystau, Almaty, North Kazakhstan, Aktobe regions.

Along with this, to further improve the quality of medical services provided in this area, a group of regional coordinators for rehabilitation services were trained on improving the rehabilitation service in a foreign clinic (Lithuania) from Oct. 14 to 27, 2019. Work in this direction continues. In November 2019, master classes were held for multidisciplinary groups from the regions on the basis of Medical Education Organizations in Nur-Sultan and Karaganda.

Where Can Children Get Medical Rehabilitation Course?

Currently, medical rehabilitation for children is in 12 rehabilitation centers, including 3 centers of the republican level and 9 rehabilitation centers of the regional level. There are 1,273 beds in 12 rehabilitation centers. In 2018, medical rehabilitation services were provided to more than 30 thousand children. Of these, more than 5 thousand children with cerebral palsy.

Children with a diagnosis of cerebral palsy at least 1 time per year receive rehabilitation assistance at the republican level: in the Republican Children's Rehabilitation Center JSC, in the Aksai Children's Hospital, in the Balbulak Children's Rehabilitation Center, the Qassietti Zhol RC, Zhuldyz-ai.

In addition, there are 39 departments of rehabilitation treatment and medical rehabilitation around the clock for children in hospitals with 1,384 beds in the republic.

The total number of children who underwent medical rehabilitation during the year was 10,881. Of these, the number of children with cerebral palsy was 4,024.

To increase the availability of assistance to children, a network of rehabilitation organizations is developing in the regions. On a regular basis receive treatment at the place of residence in the state medical rehabilitation centers of neurological and mixed profile.

What are Special Social Services?

Today, in the country, children with disabilities in order to overcome social problems that have arisen and expand opportunities for participation in society on an equal footing with other citizens are provided with special social services in a hospital, semi-hospital, home care.

So, in the field of social protection of the population there are four stationary medical-social institutions for children with a violation of the musculoskeletal system. About 200 children receive help per year. Also, in 16 medical and social institutions about 2 thousand children with neuropsychiatric pathologies are admitted annually.

It should be noted that currently the provision of services in a semi-hospital and at home is an alternative to the existing network of stationary organizations and is aimed at keeping the child in the family.

About 2 thousand disabled children are covered with special social services in 50 day care organizations. In these departments, work is carried out by psychologists, defectologists, speech therapists, physical therapy instructors, masseurs, etc. Persons attending departments receive support for domestic services, medical rehabilitation, assistance in drawing up eligible benefits and allowances, psychological and pedagogical assistance.

The opening of these departments contributed only last year to the return of 727 children from boarding schools to families and the employment of 856 parents.

Along with this, the country is actively developing and operating a service for providing social assistance at home to families with children with disabilities. So, in 205 departments more than 13 thousand children are covered with special social services. At the same time, the child is not closed in the family, but has the opportunity to develop through attending classes with speech therapists, psychologists, various groups, sports sections, hippotherapy, art therapy together with parents.

A large positive effect in the provision of special social services was obtained as a result of the placement of the state social order in the non-governmental sector. If in 2014 the number of non-governmental organizations providing special social services amounted to 62, covering more than 3,482 people, now more than 11,048 people, including over 3 thousand children, receive special social services in 177 non-governmental organizations.

What Free Rehabilitation Services Available at Children's Hospital?

In Kazakhstan, almost all children's hospitals have departments where children with a diagnosis of cerebral palsy and neurological disorders can undergo a full rehabilitation. At the same time, if you can get into the republican rehabilitation centers once a year, then in the departments of children's hospitals, small Kazakhstanis can undergo rehabilitation every two months.

For example, in the multidisciplinary city children's hospital No. 1 of Nur-Sultan in the Department of Pediatric Neurology, about 600 children diagnosed with cerebral palsy undergo rehabilitation every year. There are different types of rehabilitation assistance: in addition to physical therapy, these are various types of massage, taping, occupational therapy, Montesori, art therapy, music therapy, finger-and-finger gymnastics for the development of large and fine motor skills of hands, classes on the blackboard for the development of sensory-cognitive processes, classes on apparatus for the restoration of posture, the services of a children's speech therapist to restore speech, a child psychologist - to restore mental activity.

According to Yerzhan Zhumabekov, deputy chief physician of the Multidisciplinary City Children's Clinical Hospital №1, comprehensive and timely rehabilitation started allows children diagnosed with cerebral palsy to be trained along with healthy children and lead a full-fledged lifestyle.

According to the deputy head doctor, the duration and frequency of rehabilitation depends on the severity of the disease.

Today, medicine does not stand still. The number of both medical devices and methods of treatment is growing. Our hospital is equipped with all necessary modern technologies in order to introduce the child to society and put him on his feet. Comprehensive assistance is provided to children with cerebral palsy,” said Zhumabekov.

The Department of Pediatric Neurology, in which rehabilitation is carried out, is designed for 30 patients of a 24-hour hospital and a 10-day hospital. The child receives treatment depending on the diagnosis and degree of the disease. If the child can move independently, he is sent to a day hospital. Serious patients are monitored 24 hours a day. It is also convenient for parents.

At the same time, Zhumabekov said that in pursuance of the order of the Head of State in 2020, on the basis of the City Children's Hospital No. 1, it is planned to open a new department of children's rehabilitation that can accept 50 patients at a time. Here children with neurological disorders and diagnoses of “cerebral palsy”, Down syndrome from all regions of the republic will undergo rehabilitation. Patients will be admitted to the department as planned, through the Hospitalization Bureau Portal.

This will be a large department aimed purely at rehabilitation. After all, now we have a department of pediatric neurology, and children with various neurological diseases are coming to us. And now we will focus only on children with cerebral palsy, Down syndrome, and various contractures. The bed capacity will be increased: if we now have 10 beds in a day hospital, then there will be 20 beds in the new department,” said Zhumabekov.

How to Get Rehabilitation Quota?

In order to get into rehabilitation, you need to contact the clinic at the place of residence. When applying, the district doctor together with the head of the clinic make a decision on the need for hospitalization of the child. Then the doctor draws up a referral taking into account the wishes of the parents and if there are free beds, indicating the code and date of hospitalization and registers the child’s data in the Hospitalization Bureau Portal, Unified Health Information System of Kazakhstan.

The parent is given a coupon for planned hospitalization, where there is a code according to which on the website of the Portal Bureau of Hospitalization website you can track the queue for planned hospitalization, as well as view information about the availability of free beds in the hospital. Data is strictly confidential.

The hospital within two days from the date of registration of the application on the Portal determines the preliminary date of planned hospitalization.

After the hospital determines the date of hospitalization, the doctor issues a referral for planned hospitalization.

When planning hospitalization in a hospital, the patient needs to have the following documents with him:

  • Identification;
  • Results of all analyzes and diagnostic studies;
  • Hospitalization coupon;
  • Referral to hospitalization with the seal and signature of the first head of the medical organization that sent for planned hospitalization.

It must be remembered that hospitalization without the presence of the entire package of documents is impossible and the hospital has the right to refuse hospitalization to the patient.

What will Change with Introduction of Insurance System?

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. Participation in the system is mandatory. Each citizen must make monthly contributions and deductions to the Health Insurance Fund for compulsory health insurance in an amount that is set separately for each category of citizens.

Fifteen categories of citizens from socially vulnerable segments of the population are exempted from paying contributions to the Social Health Insurance Fund. The list of those exempted from compulsory insurance includes both children and disabled people. Therefore, medical care for children with disabilities will be provided free of charge.

In the multidisciplinary city children's hospital No. 1 of Nur-Sultan, they noted that the conditions for hospitalization also remain unchanged. The guaranteed volume of free medical care and the volume of inpatient care for patients will not change. Medical services will be provided in the same volume without restrictions.

Patients will also be referred, there will be no restrictions and delays in the provision of medical care by us. The volume that was before the insurance remains free,” said Zhumabekov.

What Support Measures Provided for Parents to Care for Children with Special Needs?

Social protection for families with children with disabilities is an integral part of a holistic support system for families with children.

According to the Ministry of Labor and Social Protection of the Population, in accordance with the Law on State Social Benefits on Disability and on the occasion of the loss of the breadwinner, children with disabilities are entitled to receive state social benefits on disability. The amount of the benefit depends on the group and cause of disability, as well as on the size of the subsistence level.

In connection with the increase in the cost of living, their sizes are guaranteed to increase annually by inflation.

However, it should be noted that their sizes were doubled in 2016. So, in addition to the annual increase due to a change in the cost of living by 7%, the size of state social benefits for disability from Jan. 1, 2016, was increased by an additional 25%. From Jan. 1, 2017, the amount of these benefits was increased by 7% due to a change in the cost of living.

A significant increase in the amount of benefits to people with disabilities was carried out from Jan. 1, 2018. As you know, according to the results of the revision of the structure of the living wage, its value increased to 16% compared to 2017, which accordingly entailed an increase in the size of state social disability benefits.

Since the beginning of this year, the size of state social disability benefits has been increased by another 5%.

Since 2010, the state allowance of 1.5 of the minimum wage is paid to parents, guardians and adoptive parents raising a disabled child until they reach the age of majority. Its size since July 1, 2019 is 41,578 tenge. Since the beginning of this year, 84.8 thousand people have received this benefit in the amount of 30.6 billion tenge.

From July 1, 2019, a allowance for the care of a disabled person of the first group from childhood was introduced. Its size is 41,578 tenge. Since the introduction of the allowance, 13.6 thousand people have received it in the amount of 4.9 billion tenge.

Children with special needs also have the following rights: to help the state in rehabilitation, to develop and implement an individual rehabilitation program, socialization, social adaptation and social integration in normal living conditions, social services; on education and training in ordinary and special educational institutions, on the protection of health.

In accordance with the rehabilitation potential, an individual rehabilitation program is developed for a disabled child, which defines a set of rehabilitation measures, including medical, social, and professional rehabilitation measures aimed at restoring and (or) compensating for impaired and lost body functions.

On the basis of an individual rehabilitation program, people with disabilities are provided with prosthetic and orthopedic help, technical auxiliary (compensatory) means, special means of transportation, and spa treatment in accordance with the approved list and procedure for providing.

The Ministry of Labor of the Republic of Kazakhstan reported that work is ongoing to expand the List of technical auxiliary (compensatory) means and special vehicles. So, from Jan. 1, 2018, people with disabilities, including children with visual impairments, are provided with a self-explanatory Braille font, collapsible alphabet in Braille, needle threaders, sewing needles for people with visual impairments.

As noted by the Ministry of Labor and Social Protection of the Population, the Concept of Social Development of the Republic of Kazakhstan until 2030 stipulates that by 2025 an integrated model for the provision of social services and social assistance will be built in Kazakhstan aimed at preventing social ill-being.


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