Medical insurance in Kazakhstan, anti-epidemiological measures and Healthy Nation Project — as discussed at the collegium of the Ministry of Healthcare

A meeting of the collegium of the Ministry of Healthcare was held Sep. 7, 2021. The meeting was attended by the Minister of Healthcare Alexey Tsoy, First Vice Minister of Healthcare Marat Shoranov, Vice Minister of Healthcare Azhar Giniyat and Chair of the Board of the NJSC Social Health Insurance Fund Bolat Tokezhanov.

During the collegium, the main provisions of the Address of the Head of State to the people of Kazakhstan of Sep. 1, 2021, the implementation of the State Program for the Development of Healthcare for 2020-2025 and approaches to the formation of the Healthy Nation Project for 2021-2025, issues of professional liability insurance of medical workers, improving the sanitary and epidemiological service and ensuring the biological safety of the Republic of Kazakhstan, the implementation of compulsory social health insurance and the supply of drugs and medical devices to the medical organization were considered.

As Minister of Healthcare Alexey Tsoy noted, the country's health system has been counteracting the challenges posed by the CVI pandemic for the second year in a row. The measures taken make it possible to keep the epidemiological situation in the country. In the republic, work continues on organizing and conducting vaccination of the population against CVI, all resources of the health care system have been mobilized.

“49,705 medical workers are involved in anti-epidemic measures, 9,100 doctors are in reserve. Further training in the demanded specialties was provided to 11 thousand 800 specialists. 4 641 young specialists have been assigned to the regions. The salaries of 247 thousand medical workers were increased: doctors by 30%, nurses by 20%. To bring medical care to the population closer, mobile medicine is being actively introduced. Until the end of 2021, it is planned to cover up to 2.6 million people by means of mobile medical complexes,” Tsoy said.

As part of the development of e-health, a number of solutions have been implemented, due to which the time for registration of blood sampling has been reduced by 2.5 times, by 5 times — an appointment with a district doctor and narrow specialists, by 3.5 times — the appointment of referrals for laboratory and diagnostic tests, 5 times — registration of home call services and obtaining the results of laboratory tests.

Despite what has been done, the complex epidemiological situation and challenges faced by the country's health care system require new solutions. In his Address to the people of Kazakhstan dated Sep. 1, 2021, the Head of State noted the need to accelerate the procurement of vaccines registered by the World Health Organization, as well as given a number of other instructions aimed at creating a National Biosafety Forecasting System, providing high-tech equipment that meets international standards for sanitary and epidemiological examination laboratories, developing feldsher-obstetric and medical centers and medical outpatient clinics in 137 support settlements.

"All instructions given by the President of the Republic of Kazakhstan in the Address to the people of Kazakhstan dated Sep. 1, 2021 ‘Unity of People and Systemic Reforms — Solid Foundation for the Country's Prosperity’ will be implemented by the Ministry of Health within the specified time frame," the minister said.

According to the First Vice Minister of Healthcare Marat Shoranov, the Ministry has been implementing the State Program for the Development of Healthcare of the Republic of Kazakhstan for 2020-2025 for more than one and a half years, which is currently being transformed into the National Project "High-quality and affordable healthcare for every citizen" Healthy Nation" for 2021-2025.

The state program is aimed at achieving four target indicators this year. This is an increase in life expectancy to 73.3 years, a decrease in the risk of premature mortality from cardiovascular, oncological, chronic respiratory diseases and diabetes to 18.1%, a decrease in maternal mortality to 16.8 per 100 thousand live births, a decrease in infant mortality up to 9.9 per 1,000 live births.

“The state program is also aimed at achieving the 31st performance indicator, of which 17 are planned in 2021,” said Marat Shoranov.

In addition, Shoranov announced the national project "High-quality and affordable health care for every citizen Healthy Nation" for 2021-2025, which consists of 4 directions, includes 8 tasks and 20 indicators.

The national project will be a consistent successor to the state program. This project, according to him, will be implemented using the mechanisms of project management, with the implementation of the project approach in the public administration system.

Vice Minister of Healthcare Azhar Giniyat, in turn, said that the ministry is currently developing a system of professional liability insurance for medical workers with the possibility of payment of compensation by insurance companies for harm to the life and health of a citizen, as well as pre-trial mediation of conflicts and disputes.

So, according to her, today in society there is an unfair attitude towards medical workers. In international practice, medical workers are highly respected and protected by the compulsory professional liability insurance system by decriminalizing their practice.

“As part of the execution of the order of the Head of State Kassym-Jomart Tokayev, the ministry has developed a draft law ‘On Amendments and Additions to Certain Legislative Acts of the Republic of Kazakhstan on Health Issues,’ aimed at improving the status of medical workers, protecting the rights of patients and improving the quality of medical care. At the same time, for the realization of the rights guaranteed by the state for patients to compensation for harm, it is necessary to gradually introduce a system of compulsory professional liability insurance of medical workers. This approach will improve the quality of the medical care provided and, in general, will affect the rating of the health care of the Republic of Kazakhstan in the international arena,” Giniyat said.

To develop the bill, an analysis of the received and considered applications of individuals and legal entities for 2018-2020 was carried out, as well as an analysis of criminal cases initiated against medical workers for 2017-2020. According to statistics, about 300 cases are brought up annually for improper performance of professional duties in relation to medical workers under Article 317 of the Criminal Code of the Republic of Kazakhstan. Criminal cases are often initiated against surgeons, obstetricians-gynecologists, traumatologists and anesthesiologists.

Taking into account the experience of previous years, based on an analysis of international practice, as well as on the results of discussions held with the participation of the public, government bodies and insurance companies, a model of imputed professional liability insurance of medical workers through existing insurance companies was adopted, the insured will be the employer — a medical organization, and the implementation licensing of medical workers in the future will allow distributing the liability of participants in the professional liability insurance system of medical workers.

“Payment of compensation for the harm caused to the patient will be made by the insurance company in cases determined by the Ministry of Healthcare. In case of refusal to pay and dissatisfaction, the patient has the right to go to court. When applying to the court, the payment is not made,” said the vice minister.

Within the framework of the draft law "On Amendments and Additions to Certain Legislative Acts of the Republic of Kazakhstan on Healthcare Issues", it is proposed to expand the competence of the authorized body in terms of regulating the insurance system, expand the competence of local executive bodies in terms of taking social measures in relation to medical workers, as well as increasing the responsibility of subjects health care in terms of professional liability insurance of medical workers and strengthening the role of the internal audit service in the analysis of complaints.

At present, the Concept of the draft law is going through the stages of approval in accordance with the Rules of legislative work of the Government of the Republic of Kazakhstan.

As of July 1, 2021, 83.5% of the population of Kazakhstan are participants in health insurance, which is 15.85 million people. This was announced by Bolat Tokezhanov, chair of the Board of the Social Health Insurance Fund.

He noted that the Fund carried out work to return 38 thousand citizens to the CSHI system in accordance with the Law of the Republic of Kazakhstan on CSHI, who paid for the last 3 months, and also took measures to pay contributions for the CSHI for self-payers.

“At the same time, more than 3 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,” said Tokezhanov.

Thus, among the uninsured, 1.6 million people are unstable payers. This means that deductions and (or) contributions have ever been received for them, but they are not regular, which is why arrears are formed and there is no insurance status in health insurance. After all, single payments of the UCP or the contribution as an independent payer do not give the right to receive medical services in the compulsory health insurance package for all 12 months. It is important to keep payments regularly.

Another 1.5 million people have never paid contributions for compulsory health insurance.

According to the chair of the board of the Fund, compared to the beginning of 2021, the number of insured Kazakhstanis decreased by 2% or 328,038 people. So, according to the fund, the largest number of uninsured is noted among residents of Kostanay (23.2%), Almaty (22.3%), Turkistan (21.8%) and Zhambyl (20.2%) regions.

Bolat Tokezhanov named a number of pressing problems with the coverage of the population in the compulsory health insurance system, among them he highlighted the identification and updating of the self-employed population, the inaccessibility of medical care in the compulsory health insurance system for the unemployed and the dropout of hired workers from the compulsory health insurance system.

“As for foreigners and stateless persons who have received a residence permit, they are working on the issue of integrating the information systems of the Fund with the information systems of the Ministry of Internal Affairs for the automatic assignment of insurance status in the compulsory health insurance system,” he said.

Thus, according to the head of the Fund, it is necessary to increase the efficiency of the work of the regional headquarters to involve the population in the compulsory health insurance system with the active participation of local executive bodies, health departments, medical organizations, Atameken NCE and territorial state revenue bodies.

In addition, it is necessary to note the role of the Fund in financing measures to prevent the spread of COVID-19, diagnose and treat patients with coronavirus infection. In total, 219 billion tenge was allocated to finance measures in the framework of the fight against CVI for the first half of the year, including 197.6 billion tenge at the expense of the guaranteed volume of medical care, 21.4 billion tenge — at the expense of the compulsory medical insurance. Of these, 112.8 billion tenge were paid for medical services, and allowances for medical workers involved in measures to combat COVID amounted to 106.2 billion tenge.

As Tokezhanov recalled, financial support for doctors has been provided since March 2020 in the form of premiums for the risk of contracting coronavirus infection in three risk groups: Group I — 850 thousand tenge; Group II — 425 thousand tenge; III group — 212.5 thousand tenge. In total, by June of this year, about 229 billion tenge was allocated for these purposes.

At the same time, it was noted that thanks to the priority vaccination of physicians since February 2021 (coverage of almost 100%), it was possible to significantly reduce the risks of disease among them. In this connection, the payment of premiums for the risk of infection in August-September will be carried out in the amount of 50% of the established values ​​for each risk group. (I group — 425 thousand tenge; II group — 212.5 thousand tenge; III group — 106.25 thousand tenge).

"In accordance with the instructions of the Head of State given at the expanded meeting, instead of the system of allowances, further stimulation of doctors from October this year will be carried out in accordance with the rules for supporting and motivating medical workers, which will act regardless of the epidemiological situation," he stressed.

Additional payments for work in anti-epidemic measures in the framework of the fight against coronavirus infection COVID-19 will be received by:

  • medical, middle and junior medical personnel of infectious diseases hospitals, provisional and quarantine hospitals;
  • resuscitation doctors;
  • medical personnel, nurses and drivers of the ambulance service, mobile teams of primary health care, medical aviation;
  • employees of the emergency departments of emergency hospitals, PHC organizations;
  • as well as health workers providing quarantine regime at checkpoints;
  • virologists and laboratory assistants-virologists of the SES;
  • bacteriologists and laboratory assistants-bacteriologists of SES,
  • doctors and ambulances for receiving and sampling SES, drivers, nurses and disinfectants of SES.

The additional payment for professional risks will be carried out with the application of a correction factor to the established size of the official salary for 14 services.

In addition to the above services, they will be supplemented by medical workers of the obstetric service, the pediatric hospital service, the pulmonary service, nuclear medicine, the radiation diagnostics service, the pathological service, and the primary health care service.

In connection with this change, the salary will be increased for the priority specialties of doctors and nurses (the amount of additional payments will be from 1.5 to 6 minimum wages or from 63,750 tenge to 255,000 tenge).

Also, the head of the Fund added that the largest amount of receipts in the first half of the year was made by the state contributions for beneficiaries in the social insurance system. So, in the first six months of this year, 372.8 billion tenge was received, which corresponds to 53% of the fulfillment of the plan of receipts from the annual plan.

From the total amount of receipts:

  • state contributions for privileged categories of citizens — 182.1 billion tenge (in 2020, over the same period, 146.6 billion tenge were received); employers' deductions amounted to 94.1 billion tenge (for the same period in 2020, this amount was 76 billion tenge);
  • in the 1st half of 2021, employees contributed 81.8 billion tenge (in 2020 this amount was 31.3 billion tenge);
  • contributions of individual entrepreneurs and individuals engaged in private practice amounted to 7.7 billion tenge (3.2 billion tenge was contributed by this category of payers for the same period in 2020);
  • 3.1 billion tenge for compulsory health insurance was paid by citizens working under GPC contracts (in 2020 this figure was 0.8 billion tenge). Over the past 6 months, CAP payers contributed 760 million tenge to the medical insurance system, for the same period in 2020 — 1.9 billion tenge.

The category of self-payers contributed 3 billion tenge for compulsory health insurance for 6 months of 2021. In the same period in 2020, this amount was 180 million tenge.

It is also important to note that the growth in the volume of medical care provided in the first half of the year was due to the compulsory health insurance. This indicates that the healthcare system has adapted to operate in the challenging environment of the ongoing coronavirus pandemic.

Thus, the volume of consultative and diagnostic assistance at the polyclinic level has increased. The number of consultations and diagnostic services increased by 31% compared to the same period in 2020. In total, 41.1 million services were rendered for 70 billion tenge, which is 12.7 million more than in the first half of 2020.

Moreover, the compulsory health insurance has made it possible to significantly increase the provision of drugs at the outpatient level. The list of diseases has expanded from 45 to 138, in which patients are provided with free medicines.

“At the same time, in information systems, data on the services provided, financed by the per capita standard (PHC, school medicine), are not entered in full. Medical organizations need to carry out a full data entry on these services,” the head of the Fund emphasized.

At the same time, Bolat Tokezhanov focused on the data of specialized medical care. Thus, in the past six months, more than 434.3 thousand patients were treated routinely in hospitals of the country at the expense of medical insurance. For this, 51.2% of the volume of financing of all inpatient care was directed to the compulsory health insurance system.

“376 thousand operations were carried out in medical organizations. The number of patients awaiting planned hospitalization for 10 days and more has decreased by 42%,” the head of the Fund said.

Tokezhanov also added that the Fund continues to stimulate the development of medical rehabilitation, including at the outpatient level. At the same time, the number of providers of these services increased 20 times, from 64 to 618 medical organizations, and the volume of financing for the services provided amounted to over 22 billion tenge.

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