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Thursday, October 17th, 2019

Compulsory Social Health Insurance to reduce people’s spending on healthcare by 2 times – Lyazat Aktayeva on introduction of insurance medicine

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President Kassym-Jomart Tokayev, in his Address to the people of Kazakhstan, paid special attention to the introduction of Compulsory Social Health Insurance. The system will start from Jan. 1, 2020. Moreover, as the Head of State emphasized, free medical care will remain available to every Kazakhstani. Vice Minister of Healthcare Lyazat Aktayeva told what exactly will change in the healthcare system in an exclusive interview with PrimeMinister.kz.

Lyazat Meirashevna, the issue of introducing medical insurance has a two-year history. The Fund itself earned in July 2017, but the launch of the system was postponed twice. And finally, the President announced the transition to insurance medicine. What is the country’s willingness?

We can say that we had a good enough preparatory period for working with self-employed citizens, updating their status, preparing information systems and legal acts, for training medical workers. Over the years, all the shortcomings that took place earlier were eliminated. Today, the healthcare system is in a high level of readiness for the implementation of insurance system.

The fund during this time has already become a full-fledged single payer of medical services within the guaranteed volume of free medical care, worked out the procurement procedure to the smallest detail, and developed a high-quality base of suppliers medical organizations. And this despite the fact that today deductions and contributions are made only for employees, and only recently began to be made self-employed. Branches have been created, teams have been formed, the procurement of medical services that will be implemented in the system of compulsory medical insurance has also been introduced.

The only thing that remains for us to complete by Jan. 1, 2020 is to update the status of citizens, to keep records of the insured or uninsured. And the second is to perfect the system of separate accounting of medical services in free and insurance packages. For this, we need medical information systems.

You mentioned the actualization of the status of citizens. According to the latest data from the Ministry of Healthcare, about 600 thousand people remain out of data. How much is it?

This is only 5% of the population who do not yet realize all the benefits that the compulsory health insurance system provides. In any case, we are aware of the potential risk that the health insurance system may face tomorrow because of these citizens. Therefore, it is now very important for us to convey to the population all the obvious advantages of insurance medicine and their risks of non-participation. We conduct outreach in this direction, and we think that by the end of the year we will engage them in the insurance system.

If you look from the other side, we show a fairly high level of involvement 95% of the population, with 80% recommended by international experts, with whom developed countries switched to insurance medicine. This is a kind of indicator that we have already exceeded. Moreover, many countries have introduced a purely insurance model, while in our country it is socially oriented. That is, we maintained the guaranteed volume of free medical care, which minimized the risk of non-receipt of medical care by the population. This was clearly indicated by the Head of State in his Message, this is guaranteed by paragraph 2 of Article 29 of the Constitution of the Republic of Kazakhstan and Article 34 of the Code “On the Health of the People and the Health Care System.”

Sep. 1, the Project was launched in pilot mode in the Karaganda region. What does it provide?

Before a full-scale launch, we had to test the system in order to eliminate and fix all the flaws. A project office has been created in the region, which will conduct daily monitoring. We will also go there on a weekly basis, meet with health workers, heads of the Health Departments and raise all relevant questions for us on the spot, what else needs to be improved so that the transition to insurance medicine will be painless for the country.

As part of this pilot, we provided the opportunity for all local residents, regardless of their participation in the system, to undergo preventive examinations and receive rehabilitation assistance until Dec. 31.

The president noted that over three years, including insurance funds, an additional 2.3 trillion tenge will be allocated for the development of healthcare. What funding is supposed to provide guaranteed free volume of medical care?

In fact, the volume of financing of the guaranteed volume of medical care will remain at the same level as it is now. This is about one trillion tenge per year. The money that comes to the insurance package will be in addition to the existing amount of financing. It is due to this that we are talking today about increasing volumes, improving the quality and accessibility of medical care.

What medical services will remain in the free package, and what can be obtained only in the insurance?

All emergency assistance entered the guaranteed volume of medical care. That is, if the patient has any complaints, the temperature rises, pain appears, he goes to the doctor and, regardless of the insurance status, receives medical care for free. Primary health care, ambulance and palliative care, air ambulance – all this remains in a guaranteed package.

But the free package also provides a complete list of medical care for socially significant diseases and 25 major chronic non-infectious diseases, such as diseases of the cardiovascular system, respiratory system, oncology, diabetes mellitus, and mental disorders that give high disability and mortality. In this case, consultative-diagnostic, hospital-replacing, planned inpatient care, outpatient drug support, and medical rehabilitation for tuberculosis will be free of charge. The same services will be available in the insurance package for all insured. For this package to expand further it is important that our population actively participates in the health insurance system and makes monthly contributions and deductions to the system. At the same time, we say that for 15 privileged categories, including children, pensioners, disabled people, mothers with many children, the state will pay. Whereas hired workers, employers, individual entrepreneurs, self-employed, independent payers will pay for themselves.

You talked about the advantages of the system. What exactly is it about?

There are so-called expenses of the population, when citizens independently, from their own funds, pay for treatment, diagnostic services and expert advice. Including guaranteed free services. This was due to underfunding of the industry. As a result, we received an increase in pocket expenses of the population in the total expenditures on health care up to 40%. While international experts say that we can talk about the sustainability of the health care system if the costs of the population do not exceed 20%. This has become the main prerequisite for the transition to insurance medicine.

The insurance should reduce private costs by half, which, in turn, will increase the availability of medical care. And the competitive environment in which medical organizations will operate will increase the quality of this assistance.

As far as we know, in fact the system will work not from Jan. 1, but from April 1. During these three months, will Kazakhstanis be able to receive medical care in an insurance package?

That’s right. Until this period, all citizens will be considered conditionally insured. But in April, with insurance, they will need to pay off the debt for the first three months. Therefore, we clearly declare that the medical insurance system will fully work as of Jan. 1, 2020.

Thanks for the interview!

Source: Prime Minister of the Republic of Kazakhstan

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