Monday, 18 November 2019, 13:15:43
At the government session chaired by Prime Minister Askar Mamin, the Minister of Healthcare Yelzhan Birtanov reported on the progress in implementing the pilot project on introducing compulsory social health insurance in the Karaganda region.
Objectives of Pilot Project
The main goals of the CSHI pilot in the Karaganda region, which started Sep. 1, 2019, are testing the mechanism for identifying the insurance status of citizens applying for medical care, keeping separate records of services within the guaranteed volume of free medical care and compulsory social health insurance and preparing for the full-scale implementation of the insurance system from January 2020.
An additional 2.3 billion tenge was allocated from the budget for the implementation of the Pilot, including 1.7 billion tenge to increase the availability of consultative and diagnostic services, including professional examinations, and about 600 million tenge to expand medical rehabilitation.
Within the framework of the pilot, a project team was created in the main 5 areas: development of legal acts, digitalization, procurement and payment of medical services, ensuring regular payments, outreach.
“One of the main issues in the effective implementation of CSHI is still the involvement of the entire population of the country in the system. Today, 97% of the population is defined in the republic, 98% in the Karaganda region. In the Karaganda region, the status of 32 thousand people has yet to be updated. In general, the status of 593 thousand people needs to be updated in the republic,” Birtanov informed.
Citizens who are not currently predictably insured will be able to become participants in the system as independent payers.
As for the readiness of information systems, the preparatory work has been fully completed in the Karaganda region. In the Karaganda region there are two information systems. One is for hospitals and clinics, the second is for emergency care.
First Results of Pilot Project
“As part of a pilot in the Karaganda region, the availability of consultative and diagnostic services has significantly increased. For example, the availability of computed tomography increased by 78%, medical rehabilitation — by 73%, consultative and diagnostic services — by 42%. In general, the accessibility of medical services for the population is increasing,” said Birtanov.
Regarding the indicators of the pilot being conducted, regulatory legal acts were introduced in the Karaganda region. On digitalization — 100% integration has been carried out. For the purchase of medical services — the Health Insurance Fund is completing work in this direction. From Dec. 1 to 31, 2019, the Fund will carry out the selection and conclusion of contracts for medical services under the packages of the guaranteed volume of medical care and medical insurance. Work is also underway on the sustainability of payments.
At the same time, work is underway to strengthen outreach among the population and by the end of the year 100% implementation of the plan will be ensured.
“In general, we can say that in the Karaganda region the pilot project was carried out at a high level. Work on preparation for the introduction of the insurance in the republic continues,” the minister of healthcare noted.
Akim of the Karaganda region Zhenis Kassymbek noted that as part of the pilot in the region, a lot of work has been done on digital infrastructure. All medical organizations of the region are united on one digital platform and integrated with republican information systems. An electronic health passport was created for each citizen attached to the clinic. In rural areas, work is underway to 100% connect medical institutions to the Internet through public-private partnerships. Kassymbek emphasized that the first results of the pilot on the implementation of OSMS in the territory of the Karaganda region prove the advantage of high-quality and timely medical care for the population.
Readiness for Full Implementation of CSHI
According to the minister, for the full implementation of the insurance system, from Jan. 1, 2020, work continues in the following main areas:
1. Regulatory support;
2. Actualization of the self-employed population;
3. Ensuring regularity of payments;
4. Technical readiness;
With the introduction of CSHI, the cost of 1 insured will increase by 57%.
Today, payment to the CSHI system is carried out through 25 second-tier banks, including remotely through 7 Internet banking portals. Starting Dec. 15, 2019, self-service terminals will be installed in all medical organizations.
Chairman of the Board of the NJSC Social Health Insurance Fund Aibatyr Zhumagulov, reporting on the Fund’s readiness to implement the insurance system, noted that work on the formation of the principles and institutional foundations of the system began back in 2015. To date, a database of potential health care providers has been formed. This list includes 1,940 medical organizations. Of these, 60% are private. In addition, the Fund, within the framework of free medical care and compulsory medical insurance, completed the development of a procurement plan for medical services for 2020.
Deputy Prime Minister Berdibek Saparbayev, in turn, noted that in the issue of introducing compulsory health insurance, special attention should be paid to the timely payment of a contribution by employers for their employees.
Yelzhan Birtanov noted that the introduction of CSHI will increase the availability of certain types of medical care by 7 times.
Tariff growth will be from 10% to 20%. This will increase the salary of doctors from next year by 30%. The level of equipment with medical equipment will increase from 70% to 73%. The introduction of the system will reduce current "pocket" expenses in 2020 — by 30%, and by 2025 — almost 2 times.
In general, there is a high degree of readiness for the implementation of the CSHI system.