Society • 17 January, 2020

How is the implementation of medical insurance taking place?

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From Jan. 1, 2020, Kazakhstan have introduced compulsory health insurance. Read about the practical implementation of the compulsory social health insurance system, whether the quality and availability of medical services have changed, and, most importantly, whether the population has felt an improvement in the provision of medical services with the introduction of the health insurance in the review by PrimeMinister.kz.

Polyclinics and hospitals from Jan. 1 provide medical care to the population in two packages at once — according to the new guaranteed volume of free medical care, which, as before, remains available to every citizen of the country, and in a new package of compulsory social health insurance. Until April 1, all Kazakhstanis considered conditionally insured, regardless of whether they make contributions to the Health Insurance Fund or not.

The Ministry of Healthcare emphasized that it is too early to talk about any significant results from the introduction of the compulsory social health insurance, but nevertheless, most patients already recognize that service has improved in state clinics, and consultative and diagnostic assistance has become much more accessible. All paid diagnostics, including expensive studies like MRI, CT, ELISA, PCR, for which earlier people had to pay from their own pockets, became completely free. If the doctor refused to receive medical services, and there are indications for this, you can always contact the single contact center of the Medical Insurance Fund at 1,406 and leave a request indicating your contacts for feedback. The Social Health Insurance Fund, as the Ombudsman for Patients' Rights, urges Kazakhstanis not to be left alone with their problems and to protect their rights to receive medical care.

 

97% of Population Participate in Compulsory Social Health Insurance

According to the Ministry of Healthcare, today 97% of the population is already updated in the databases of the Ministry of Health of the Republic of Kazakhstan and are potentially participants in the insurence system. According to the remaining 3% of citizens, this is about 550 thousand people, work continues. More than 88% of the citizens of the actualized population already have insurance status, of which 54%, or 10 million people belong to the preferential categories of citizens, the rest are employees, sole proprietors, persons working under state agreements, self-employed citizens and self-payers. The latter, we have almost 2.2 million people, or 12% of the population.

 

Almost 250 billion tenge accumulated in the Social Health Insurance Fund

The total amount of deductions and contributions from employers and individual entrepreneurs during the period from July 1, 2017, to Dec. 31, 2019, amounted to 246.9 billion tenge.

Of these, 237.7 billion tenge (96.3%) are attributable to employer contributions, 9.2 billion tenge (3.7%) are contributions from individual entrepreneurs and individuals working under civil law contracts.

By regions, the largest amounts still come from the cities of Almaty and Nur-Sultan, as well as from the Karaganda region. All funds received for the insurance are stored in the National Bank, with which a trust management agreement has been concluded, and subsequently will be used to pay for services provided under the CSHI.

 

 What is Included in CSHI Package, What Remains Unchanged?

All primary health care, emergency and ambulance services remained in the guaranteed volume of free medical care. Each person, as before, can make an appointment with the local doctor at the place of attachment, receive referrals for basic tests and diagnostics, and a doctor’s consultation on the control and treatment of the disease.

If the local doctor / therapist has established a disease that is socially significant, the main chronic or dangerous, such a patient will be provided with a full range of medical services, including consultations of narrow specialists, all the necessary diagnostic examinations, treatment in day and night hospitals, medical rehabilitation, palliative care (supportive therapy for patients with severe illnesses), regardless of his participation in the CSHI system. These are diseases such as oncology, diabetes mellitus, arterial hypertension, coronary heart disease, HIV, hepatitis, tuberculosis, etc.

If the identified disease is not socially significant or chronic, the patient will be able to receive consultative and diagnostic, inpatient, inpatient care only if regular payments are made to the Health Insurance Fund and there is an insurance status.

Dental care is fully transferred to the insurance package, and is provided only to certain privileged categories. Scheduled — extraction of teeth using anesthesia, preparation and application of fillings from composite materials of chemical curing for pregnant women and children under 18 years of age. In secondary educational organizations, preventive examinations of the oral cavity and closure of fissures (natural grooves and grooves located on the tooth enamel on the chewing surface of the teeth) will be free for students. Emergency — anesthesia, preparation and fillings from composite materials of chemical curing, tooth extraction with anesthesia, periostotomy, opening of abscesses for children under 18 years of age, pregnant women, participants of the Second World War, pensioners, disabled people of groups 1, 2 and 3, mothers with many children, awarded Kumis Alka and Altyn Alka, recipients of targeted social assistance, patients with infectious, socially significant and dangerous diseases for others. And from March 1, the same assistance will be provided to two additional categories of the population: non-working people caring for a disabled child or a disabled person of the first group since childhood.

Orthodontic care — correction (orthodontic plate) for cleft palate (cleft palate) will remain free for children with congenital maxillofacial pathology.

Correction for various types of dentoalveolar anomalies (malocclusion, micrognathia of the jaw) from March 1 will become available to children from low-income families aged 6 to 12 years with various types of dentoalveolar anomalies.

Medical rehabilitation in the guaranteed volume of free medical care will be provided only to patients with tuberculosis and undergoing tuberculosis. In other cases, after acute conditions and surgical interventions, rehabilitation treatment will be available in the CSHI package.

It is worth noting that a free medical care package is provided to foreigners permanently residing in the country in the same amount as citizens of the country. This is all primary health care, emergency and ambulance.

 

Work on Integration of Medical Information Systems

All medical information systems were tested as part of a pilot in the Karaganda region, all identified deficiencies were eliminated. To date, 20 information systems have already been integrated with the systems of the Fund, the Ministry of Healthcare, specialized government agencies and the National Bank for accounting contributions and payment for services.

Separation of patients by insurance status in information systems occurs automatically when contacting a particular medical institution. Receptionists, doctors, nurses see the status of each of their patients. Until April 1, each person has a status insured, regardless of whether he began to pay contributions to the Health Insurance Fund or not, he will have access to the OSMS package, to the benefits that this system provides. To continue to receive medical services in this package, it will be necessary to make contributions for CSHI, including payment for the previous three months of using the package.

 

How do Kazakhstanis Pay Deductions and Contributions?

Starting this year, employers pay 2% of wages for employees, and will pay 3% after 2022. In addition, 1% is deducted from the employee’s salary, and 2% will be deducted from 2021. Employees under GPC agreements pay for themselves in the same way as workers, 1% of income this year and 2% from 2021. Individual entrepreneurs pay for their employees as employers. For themselves — 5% of 1.4 times the minimum wage (1 minimum wage in 2020 is equal to 42,500 tenge), or 2,975 tenge. Self-employed pay a single aggregate payment in the amount of 1 MCI, or 2,651 tenge — for the city, 0.5 MCI, or 1,326 tenge — for the village. This amount is allocated to pension savings — 30%, to medical insurance (to the SMS Fund) — 40%, to the social insurance fund — 20%, and for income tax — 10%. All other categories of the population pay contributions as independent payers — 5% of 1 wage, or 2,225 tenge.

You can pay the fee through any second-tier bank or Kazpost branch, through mobile banking, as well as through the payment systems Kassa 24 and Kiwi. Especially for the convenience of patients, hospitals and polyclinics of the city have Kassa 24 terminals where you can pay a fee instantly and without commission.

 

Employers will be Fined For Non-Payment

The most important problem for the CSHI system today is the irregularity (non-payment / insufficient payment) of payments by employers for their employees. According to the law “On Compulsory Social Health Insurance,” Kazakhstanis, who stop paying contributions, after three months stop receiving medical care in the CSHI system. Therefore, it is important that employers make timely contributions for their employees.

All revealed facts of non-payment of contributions and deductions are transferred to the territorial bodies of state revenues to carry out the necessary work with the taxpayer.

In accordance with Article 92-1 of the Code of the Republic of Kazakhstan “On Administrative Offenses,” failure to fulfill or improper fulfillment by the employer of duties on deductions and contributions for the compulsory medical insurance, whether it is failure to pay, late or incomplete payment, entails a warning. When re-committing these acts within a year after the imposition of an administrative penalty, a fine is imposed on small businesses or non-profit organizations in the amount of 20%, for medium-sized businesses — in the amount of 30%, for large businesses — in the amount of 50% of the amount of non-listed deductions.

In addition, penalties in the amount of 1.25% for each day of delay, including the day of payment, are foreseen for indebtedness under CSHI for individual entrepreneurs and employers.

 

All Medical Workers are Ready to Implement CSHI

Throughout 2019, all medical workers underwent training and received clarifications on the changes that were made to each of the areas of the healthcare system - the rules for the provision of primary medical and social assistance, consultative diagnostic, inpatient replacement, inpatient care, and medical rehabilitation. Each health worker received a clear guide to the list of packages of the guaranteed volume of medical care and health insurance. At each seminar, business processes were discussed, according to which medical organizations should already work today, having concluded an agreement with the Medical Insurance Fund for the provision of medical services to the population.

 

Employee has Right to Control Contributions to CSHI

Upon request, the Fund may provide information on the status of employees — insured or not insured — and by the amount of funds contributed for the requested period. The employer, in turn, is obliged to submit to the employees for whom contributions are paid information about the funds calculated and withheld on a monthly basis no later than the 15th day of the month following the reporting month. The employee can also independently obtain a certificate of the amounts transferred for him to the Health Insurance Fund at the Center for Population Services.

All Citizens are Required to Pay System Fees.

It is worth noting that CSHI is not voluntary medical insurance, but mandatory. Therefore, in accordance with the requirement of the Law “On CSHI”, all citizens are required to pay contributions to the system. The state undertakes to make contributions for 15 preferential categories of citizens. Among them are children under 18 years old, pregnant women, pensioners, disabled people, mothers with many children, awarded with Kumis alka and Altyn alka pendants, full-time students, non-working citizens and oralmans, prisoners in prison.

If representatives of privileged categories have not determined the status of insurance, they can contact the Center for Public Services and provide all the necessary documents for inclusion in the list of privileged categories. Unemployed need to officially register as such at the Employment Center. Persons without a specific place of residence need to restore documents and also register as unemployed. Students need to contact the leadership of their university for listing. More detailed information can be found on the number of the single contact center of the Medical Insurance Fund 1406.

You can find out your status on the website www.egov.kz, on the website www.fms.kz or in the Telegram bot Saqtandyry by IIN number, having received a certificate from the Public Service Center about participation in the CSHI system as a consumer of medical services, or contact a medical institution place of attachment.

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