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Public pressure on mandatory health insurance made the leaders give a press-conference - P4H Network

Public pressure on mandatory health insurance made the leaders give a press-conference

The growing pressure and criticism from health care providers on the alleged lack of funds at the Social Health Insurance Fund before the calendar year (same as budget year) made the leadership speak out about the status of the health insurance.

A press conference was given by the CEO of the Social Health Insurance Fund, his deputy and the Director of MoH Department for Coordination of Mandatory Social Health Insurance.

According to the CEO of the Social Health Insurance Fund Aidyn Ashuev, thanks to the social health insurance system, people now can receive certain medical services that were previously available only for a fee. In 7 months of 2022, the Health Insurance Fund financed 95 million consultations of specialist physicians and diagnostic examinations, including CT, MRI, PET, and 12.6 thousand expensive operations, of which about 4 thousand were IVF services.

As Mr Ashuev noted at the briefing, the mandatory social health insurance (MSHI) system was introduced to minimize the financial risks in healthcare, which are inevitable with the growing public and private spending on health care.

“The introduction of the MSHI system was supposed to increase financing of medical services, reduce out-of-pocket expenses of the population, ensure equal access to medical care for the entire population, increase salaries for medical workers, increase competition for quality among medical organizations, and expand the list of free outpatient medicines. Within 2.5 years of introduction of mandatory social health insurance, significant results have already been achieved,” summarized A. Ashuev.

According to Ashuev, previously underfunded types of medical services received additional funding thanks to the MSHI. The number of health care providers has increased significantly, with more than half of them (52%) being private.

It was also mentioned that the Social Health Insurance Fund pays special attention to feedback from people through all communication channels. “Over 7 months, the Unified Health Information Call Center received almost 460,000 calls. And 93% of the calls were of consultative nature, such as to clarify access to care,” said Aidyn Ashuev.

In addition, the Fund carries out an audit function to check the quality of care and to use financial incentives (withholding of payment) for substandard care. As the head of the Fund emphasized, in 7 months of this year, the Fund revealed inconsistencies in more than 882 thousand cases, which were classified as defective and financial fines applied to health care providers reached 11.8 billion tenge.

The CEO of the Fund announced plans to improve the work of the mandatory social health insurance system. To ensure transparency, the Fund has developed and is piloting an information system that provides for depersonalized cross-check and end-to-end monitoring. In addition, it is planned to introduce an individual verification mechanism to confirm the fact of a patient receiving medical service. The head of the Fund also mentioned Patient Support and Internal Audit services available in medical organizations. Together with providers, systematic approaches are being developed to improve care efficiency, said the leader.

Gulzhan Shaikhybekova, director of the department for coordinating the MSHI of the Ministry of Healthcare of the Republic of Kazakhstan, in turn noted that in light of the recent instruction from the Head of State to review approaches to financing health care, it is planned to implement a number of changes. “We are working out the issue of additional financing for the guaranteed volume of free medical care (about 200 billion tenge annually) and additional financing for state contributions to compulsory health insurance for 15 protected categories of the population (in 2023 – additional 232 billion tenge, in 2024 – 306 billion tenge, in 2025 – 354 billion tenge). It is also planned to legally regulate the consolidation of two financial flows (free benefits package and insured package) to simplify the administration of funds and for their effective use,” she noted.

Source: Ministry of Healthcare