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Implementation results of Densaulyq State Program, modern medical technologies, social insurance, or how healthcare system of Kazakhstan is improving

Friday, 14 February 2020, 21:57:00

As part of the implementation of state programs in the healthcare sector, elements of market mechanisms were introduced and modern medical technologies were transferred. The Densaulyq State Program for 2016-2019 is aimed at consolidating and developing the results achieved, solving problems in health issues in accordance with new challenges, and has also become the basis for the systematic development of the industry until 2050. The implementation of the Program contributed to the sustainability and dynamic development of a socially-oriented national healthcare system in compliance with the principles of universal coverage, social justice, and the provision of quality medical care in accordance with the key principles of the World Health Organization policy strategy. Read the review by PrimeMinister.kz to learn what results have been achieved in the healthcare system as part of this state program and what can the implementation of the Compulsory Social Health Insurance change in the medical sector of the country.

As a result of the implementation of the Densaulyq State Program, life expectancy reached 73.15 years in 2018 (the plan for 2019 is 73.13 years). The health index was 0.818 in 2018 (2019 plan is 0.815). The level of satisfaction of the population with the quality of medical care in 2018 amounted to 47.84% (2019 plan — 48%).

Measures have been taken to regulate the prices of medicines, introduce the ethical promotion of medical devices, evaluate healthcare technologies, expand the list of free outpatient medicines, and improve the formulary system.

Measures are also being taken to reduce the burden on the PHC doctor and staff shortages, increase the salaries of medical workers, and introduce medical information systems in PHC organizations.


Optimization of medical infrastructure

It is planned to optimize the state healthcare infrastructure through horizontal and vertical integration and the merger of medical organizations. At the national level — until 2025, the integration of existing research health care organizations into university clinics will be carried out in accordance with the message of the Head of State.

In general, in the framework of optimizing the state infrastructure, the main focus will be on the release and redistribution of inefficiently used resources in the hospital sector, which provides for the optimization of medical and diagnostic processes for the provision of medical services demanded by the population (PHC, rehabilitation, palliative care, etc.), centralization and decentralization of the provision some medical services.

The implementation of these measures will ensure the differentiation and management of the bed capacity, depending on the intensity of treatment and, accordingly, the coordinated development of outpatient, inpatient replacement, inpatient and rehabilitation care.

The new State Standard provides for the following changes.

At the district level for outpatient organizations, medical outpatient clinics open for every 1,500 people served (instead of 2,000 people). For other objects, the parameters are saved. In the hospital sector, concentration of medical care at two levels is supposed: district and inter-district hospitals.

So, on the basis of a number of district hospitals, inter-district hospitals will be organized, so that specialized medical care in narrow profiles (urology, neurology) will become more accessible to the rural population.

At the city and regional levels, it is planned to open GP sites from 1,500 served populations. Particular emphasis is placed on the disaggregation of primary care by opening primary care centers. Consultative and diagnostic assistance is concentrated at the level of hospital organizations, specialized centers will be developed on the basis of multidisciplinary hospital organizations.

Thus, in comparison with 2016, by 2025 it is planned to increase the number of primary care centers and clinics at the rural level from 207 to 253, medical outpatient clinics from 1323 to 1393. At the city level, the number of diagnostic centers and clinics from 187 to 206, primary care centers from 7 to 36, medical dispensaries from 61 to 99.


Drug supply and introduction of Disease Management Programs

In 2018, the centralization of drug provision was carried out, measures were taken to ensure transparency in the procurement of drugs through online broadcasts, and electronic registration of the issuance of free drugs was introduced. Full automation of the drug supply system with the transition to electronic prescriptions is planned until the end of 2020.

In 2019, the list of drugs purchased for free provision increased by 108 items, compared to 2018. Considering a 40% reduction in marginal prices in the list of the single distributor, 22.1 billion tenge were saved during the purchase for 2019.

In addition, within the framework of the State Program, disease management for three diseases have been introduced: arterial hypertension, chronic heart failure, and diabetes mellitus.

The programs allow forming a joint responsibility of people for their health and manage the disease, in order to prevent complications and unnecessary hospitalizations. More than one and a half million people were covered by dynamic monitoring, of which 462.5 thousand people (28.4%) were involved in the health care facilities.

The process of the program attraction shows good dynamics, so by the end of 11 months, 553,869 people (30.4%) were involved in the program, for the same period of 2018 — 218 ,471, of which more than half of the active participants — 356,475 (64.3% )

The program shows its effectiveness — there is a decrease in hospitalization among patients participating in primary care (1.6%), among patients on long-term care (5.1%).


Support for young professionals

To solve the problem of staff shortages, the number of grants for training in medical universities of the country is increasing annually, social support is being introduced for young specialists in the regions, and training of medical workers is being carried out at the expense of budget funds.

The distribution of young specialists this year is carried out using the platform of the Electronic Labor Exchange enbek.kz.

It should be noted that the distribution of internship and residency clinical graduates this year was carried out in accordance with the application for needs from the regions.

In 2018, out of 706 (15%) young professionals who arrived in the countryside, only 355 (50%) were granted lifting allowances, 102 (14%) were allocated housing, 134 (19%) were provided with a budget loan.

In 2019, of the 720 young specialists who arrived in the countryside, 658 provided lifting allowances, including 205 with a diploma in the village program, 157 at the expense of local executive bodies, 296 at the expense of medical organizations, housing was allocated, including rental — 618, a budget loan was granted to 66 specialists.

Medical organizations on the Enbek.kz portal posted information on current vacancies, indicating social support measures provided by local executive bodies.

This year, as part of the Year of Youth, the size of the lifting allowance has been increased from 70 to 100 MCI and should be at least 252,500 tenge.

At present, the indicator of the supply of medical personnel per 10 thousand population is: in cities 56.8, in villages 16.1, the largest shortage of medical personnel is observed in Akmola (447), North Kazakhstan (416), West Kazakhstan (378) , Karaganda (361), Kostanay (324) regions and Almaty (321).

The following specialists are not enough in the republic: GPs (834), pediatricians (266), general practitioners (259), resuscitation anesthetists (347), obstetrician-gynecologists (201), neonatologists (137), ophthalmologists (154), neuropathologists (154), psychiatrists (176), specialists in radiation diagnostics (141).


Health digitalization and unique medical technology

The volume of high-tech medical services in 2016 amounted to 71,637, in 2017 — 81,623, in 2018 — 105,841, in 2019 — 8,688.

Of these, the number of services provided using unique technologies: in 2016 — 1,039, 2017 — 1,136, 2018 — 1,363, in 2019 — 1,476.

Unique medical technologies include new medical technologies based on modern achievements of science and technology.

In addition, a three-level system of medical support for the population was developed and approved.

The new guaranteed package of primary health care model defines clear boundaries of state obligations and implements the universally recognized international standard for universal coverage of basic health services.

To optimize the work processes of medical workers, state medical organizations are working on the transition to paperless medical records. Sixty-two forms of primary medical documentation are excluded, 234 forms are kept in electronic format.

To improve the availability of medical care to the population, mobile applications have been introduced. This allows you to improve the quality of the medical staff, optimize the queue in clinics and increase patient convenience.

Due to pre-registration through electronic services, live queues are reduced by 30%.

The computer equipment of healthcare organizations is 98%, coverage to the level of the district center and 92% coverage below the level of the district center.

Medical information systems contain 17.7 million local electronic health passports, created and filled out, which is 94.69% or the total population.

As part of the digitalization of the healthcare system, the implementation of an electronic health passport and the integration of healthcare IP with the IP of medical organizations are being implemented.

In general, the digitalization of the healthcare system will be implemented through the implementation and development of medical information systems and mobile applications.

This implementation will consist of the following components:

  • Artificial Intelligence;
  • Patient and physician access to electronic health passport;
  • Single data warehouse;
  • Integration platform.

An electronic passport is a collection of patient data, diagnoses made by the attending physician, a quality management system for medical services, payment systems, an analytical system, medical statistics, and also big data.

Big data will accumulate over four years from 2018 to 2021, data will come from mobile applications, medical information systems, through e-government, as well as through government agencies.

Collection and storage of data on the patient’s health will be carried out from the moment of birth and throughout his life.

Along with this, the participation of the patient in the collection and reliability of data on the state of his health will be ensured, and patients will also be provided with constant access to electronic data 24/7.

In order to increase the digital skills and awareness of medical workers, the Ministry, together with akimats and developers of medical information systems, provides ongoing training to nurses, young specialists who have re-entered skills.

Awareness-raising campaign among the population on the use of web / mobile applications and other digital healthcare solutions is also being conducted.

To date, 22 information systems operate in the Ministry of Healthcare.

To fully launch the CSHI from the above systems, 10 information systems must be integrated with medical information systems.

At the moment, integration has been carried out on all 10 information systems that provide data integration and provides them to users in a unified form.

Integration with the portal “An additional component of the per capita standard” has been implemented in terms of receiving visits to primary health care organizations and patronage of newborns at home.

In order to ensure accounting for the services rendered, integration with the Unified Payment System has been implemented in terms of determining the source of financing and obtaining data on specialized services (blood centers, ambulance services, pathology bureau).

To determine the source of funding during hospitalization, integration with the Portal "Hospitalization Bureau" was implemented.

At the same time, integration with the IS “Medicinal Supply” was implemented in terms of obtaining information about medicines under purchase contracts of the Single Distributor within the framework of the guaranteed volume of medical care and medical insurance.

In addition, integration with the Register of Pregnant and Women of Fertile Age was implemented in terms of obtaining information on the collection and deregistration of pregnant women.

Also, integration with the Electronic Register of Dispensary Patients has been implemented in terms of obtaining information about dispensary patients.


Compulsory Social Health Insurance

On Jan. 1, 2020, the full-scale introduction of the CSHI system was launched throughout the country.

Currently, most of the by-laws and regulations on the provision of medical care at all levels (primary health care, consultative diagnostic, inpatient, hospital-replacing care and medical rehabilitation) necessary for the implementation of the CSHI system and the new model of the guaranteed volume of medical care have been adopted and updated.

The introduction of CSHI provides for a three-level system of medical support for the population.

The first level ensures the provision of the guaranteed volume of medical care at the expense of the state budget for all citizens of the Republic of Kazakhstan, oralmans and permanent residents of foreigners.

This package includes the following types of free medical care: ambulance and air ambulance, primary health care at the place of attachment; emergency inpatient care, palliative care, a full range of medical care for socially significant diseases and major chronic diseases, including drug provision.

The second level is the CSHI package for the insured population, which will provide services in excess of the guaranteed volume of medical care and will include: consultative, diagnostic assistance and free prescription drug support for a wide range of diseases; inpatient care, planned inpatient care, rehabilitation and rehabilitation

The third level is medical services that are not included in the guaranteed and insurance packages. They are provided for a fee or through voluntary health insurance.

The new guaranteed package model defines clear boundaries of state obligations and implements the universally recognized international standard for universal coverage of basic health services.

As part of the launch of a pilot project for the implementation of CSHI in the Karaganda region, an integration service was implemented to determine the status of insurance of citizens.

To determine the status of insurance and obtain relevant and timely information about CSHI for citizens of the Republic of Kazakhstan, information plugins have been developed that are posted on the websites of interested organizations, and bots have been developed in Telergam (@SaqtandyryBot) and WhatsApp (+7 700 103 1406).

The Roadmap for the Automation of the Public Service “Issuance of information on participation as a consumer of medical services and the transferred amounts of deductions and (or) contributions to the CSHI system” was approved, an agreement was signed on the implementation of integration of IS Saqtandyrý with the Electronic Government Portal.

As regards the integration of the information system of state bodies, the IS Saqtandyrý Foundation has been launched, which allows determining the status of insurance in the CSHI system. Work is underway to integrate it with the IS NAO State Corporation “Government for Citizens” to exchange data on 15 privileged categories of citizens and assign them the status insured in the CSHI system.

Information on preferential categories is generated in the IS of the Ministrey of Labor and Social Protection of the Population on the basis of data from the IS of 6 central government agencies.

To date, integration has been carried out and data from Is of five state bodies (Ministry of Healthcare, Ministry of Internal Affairs, Ministry of Justice, Ministry of Finance, MLSPP) in 12 categories has been transmitted.

Along with this, the issue of transferring data on the remaining three categories (children, students, people actually raising a child under 3 years old) is being decided.

As of Jan. 1, 2020, data of individuals have been transferred from the state database:

  • children — 6,304,830 people
  • unemployed persons raising a child before they reach the age of 3 years — 156,631 people
  • full-time students — 680,317 people


Public Health Management Action Plan 2018-2021

The plan provides for the implementation of measures for interagency cooperation, including on healthy lifestyles and healthy eating, the prevention of behavioral risk factors aimed at reducing the burden of noncommunicable diseases and improving public health.

In the framework of the State Program to increase solidarity and the development of public health, an Action Plan for 2018-2021 is being implemented. A system for evaluating the performance of the public health service has been developed and implemented. Work is underway to actively combat the illicit trafficking of narcotic drugs, smoking and non-smoking tobacco products.

In order to reduce the salt content in food products, a memorandum was signed with the Atameken National Chamber of Entrepreneurs and Kazakhstani producers. Mass events are actively held as part of the promotion of a healthy lifestyle. The implementation of the national vaccination calendar against 21 infections is ongoing. Immunization reached 97%.

To implement health promotion programs, local executive bodies, educational organizations, as well as the non-governmental sector are systematically involved. A number of memoranda of understanding have been concluded with international and national non-governmental and commercial organizations, including the public association Nur Otan, Temekisiz, the Uyatemes.kz project on sexuality education, and a number of medical universities.

Work is underway on collaboration with the World Health Organization, the United Nations Children's Fund and the United Nations Population Fund to provide methodological and technical support for improving public health services.

Implementation of a new project, Healthy Cities and Regions for Health, has begun, under which expansion of cooperation with the population, local executive bodies, business and the non-governmental sector is envisaged to improve the infrastructure and create an environment that is safe and favorable for maintaining and promoting health.

In order to prevent behavioral risk factors for diseases, interdepartmental measures have been taken, including economic ones (phasing out excise taxes on tobacco products, improving the rules for selling tobacco products according to the experience of developed countries; prohibition of indirect advertising by the tobacco industry), ensuring the protection of non-smoking rights clean air (expanding the smoking ban zone in public places), advocacy work, intensification of information coverage to promote a healthy lifestyle.

In order to legislatively consolidate the joint responsibility of citizens for their health, the draft Code of the Republic of Kazakhstan “On the Health of the People and the Health Care System” provides for norms aimed at increasing joint responsibility for maintaining the health of not only citizens but also employers, namely, preventing people who are not passed mandatory medical examinations, preventive examinations, the creation of conditions by employers to undergo preventive medical examinations, etc.

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