During audit activities conducted by the Department of Internal State Audit for the Turkestan Region, a number of violations were identified in the provision and financing of medical services. In particular, based on the results of monitoring medical services provided by Talgat Clinic LLP in 2023, non-compliance with established patient appointment standards during specialist consultations was identified.
The monitoring results established that in 6,248 cases, specialist consultations exceeded the established appointment standard, resulting in an unjustified accrual of 21,118.3 thousand tenge.
According to the current Standard for the organization of primary health care in the Republic of Kazakhstan, the working hours of a PHC organization doctor are 8 hours per day. At least 6 hours of this time must be allocated to patient appointments. The remaining working time is designated for working with medical documentation, including assessing the patient's condition and conducting necessary corrective measures, as well as preparing for patient appointments with pre-prepared results of laboratory and diagnostic tests.
Furthermore, the specified Standard establishes the duration of patient appointments by a PHC doctor. Thus, 15 minutes are allocated for an unscheduled patient appointment, 10 minutes for a scheduled appointment, and 10 minutes for a preventive examination. For patients with chronic diseases subject to dynamic monitoring, a motivated consultation must be conducted with a duration of at least 30 minutes.
These standards are aimed at ensuring the quality and accessibility of medical care, as well as the effective organization of the doctor's working time.
Recording medical services in a volume exceeding the established working hours and appointment standards raises the question of the actual provision of such services and the justification for their financing. In this regard, when monitoring medical services, special attention is paid to their compliance with established regulatory requirements.
The 6,248 cases identified at Talgat Clinic LLP and the resulting accrual of 21,118.3 thousand tenge indicate the need for strict compliance with established standards in the provision and recording of medical services.
Funds allocated for medical services must be spent justifiably and exclusively on actually provided services that meet the established requirements. In this regard, medical organizations need to plan and record the volume of services provided in accordance with established standards.
One of the main areas of control activities conducted by the Department of Internal State Audit for the Turkestan Region is ensuring the legality, justification, and efficiency of the use of funds allocated within the framework of the state healthcare system and the compulsory social health insurance system.
Such control activities are aimed at increasing the transparency of reporting by medical organizations, preventing payment for medical services that do not meet established requirements, and ensuring the effective and targeted use of compulsory social health insurance funds.