No.

Questions

Answers

From the population

one

What will I get, as a citizen of the country, from the implementation of compulsory health insurance?

Firstly, medical assistance in any clinic chosen by you personally on the territory of the Republic of Kazakhstan. In this case, the costs of the clinic will be fully covered by the Foundation;

Secondly, you will be exempted from all types of additional payments for medical care provided under the packages of guaranteed medical care and compulsory health insurance;

Thirdly, the ability to receive monthly information about the contributions transferred in your favor to the FSMS and the services you received in medical organizations;

Fourthly, the protection of the rights and interests of insured citizens by the Fund in the event of poor-quality service or violation of rights as a participant in the OSHI.

Fifth, the introduction of the compulsory health insurance system will improve the quality of medical care.

2

We all remember the experience of the MHIF in 1996-1998.

Where is the guarantee that this will not happen again now?

Any transformations carried out in society have both positive and negative sides.

From this point of view, our experience of creating insurance medicine in 1996-1998 cannot be perceived only critically, it has its unconditional advantages.

The most important result of this reform is the preservation of the network of health care facilities and the availability of medical care to the entire population of the country by attracting additional funds from the economy.

For example, the absence of such a specialized program led to the transfer of preschool institutions to private hands, the consequences of this are still felt.

In addition, the economic realities of the 90s are incomparable with the current situation. As we all remember, 20 years ago, many enterprises experienced serious financial difficulties, most of them were in bankruptcy, accumulated huge wage arrears. The economic crisis has become the main reason for widespread non-payments, including to the Medical Insurance Fund.

The situation with the Fund was aggravated by the fact that local executive bodies, called upon to ensure stable deductions for the economically inactive population, also found themselves in a difficult situation.

Today we are witnessing a significant growth in employment in the economy. More than 6.5 million hired workers work at domestic enterprises; monthly employers donate 53 billion tenge to the Unified Accumulative Pension Fund and 23 billion tenge to the Social Insurance Fund in favor of their employees. It is worth noting that the state assumes the obligation to pay contributions to the FSMS for the economically inactive population.

When creating a modern OSHI system, past mistakes were taken into account.

First, as it was said, the economic situation is much better, the total number of working citizens exceeds the number of non-working people. According to the Committee on Statistics of the Ministry of National Economy of the Republic of Kazakhstan, the share of unemployed citizens is only 2.5% of the total population

Secondly, mechanisms have been created to control the activities of the Fund:

-The only Shareholder of the Fund is the Government of the Republic of Kazakhstan,

-introduced corporate governance,

- well-known political and public figures are included in the Board of Directors,

- The Public Council was created, which included representatives of the Parliament, various NGOs, NPP "Atameken".

- The financial statements of the Fund will be officially systematically posted on the Fund's website, published in the media and provided to the Shareholder

Thirdly, according to the legislation, a reserve for unforeseen expenses is created in the amount of 3% of the assets of the Fund,

Fourth, mechanisms of harmonization and balancing of the income and expenditure side of the Fund have been introduced. This means that the volume of medical services will be purchased taking into account the collected funds.

The safety of the Fund's assets is ensured by:

1) regulation of the Fund's activities by establishing norms and limits that ensure financial stability;

2) implementation of investment activities through the National Bank of the Republic of Kazakhstan;

3) accounting of all operations on investment management of the Fund's assets in the National Bank of the Republic of Kazakhstan;

4) maintaining separate accounting of the Fund's own funds and assets;

5) conducting an annual independent audit;

6) submission by the Fund of regular financial statements in the manner prescribed by the legislation on accounting and financial reporting;

7) determining the list of financial instruments for investing the assets of the Fund.

3

How can the introduction of compulsory health insurance help solve the problem of financial “thanks” to medical workers?

Citizens, by deducting contributions, are already paying for their possible hospitalization or appeal to the clinic. In this regard, system participants should not make additional payments, except for the contributions established by the OSMS system.

Thus, gradually, with the development of insurance medicine, the problem of informal payments for medical care will lose its relevance.

The code of honor of medical workers stipulates that in relations with patients, medical workers must not allow the facts of financial and other extortions in relation to patients, make efforts to suppress such actions by their colleagues.

The Fund will be entitled to monitor the fulfillment of the terms of the contract for the purchase of services by visiting the health care subject providing medical care.

It is important to remember that a citizen, giving “informal monetary reward,” also bears responsibility, therefore, in this matter, as in many other areas of life, it is worth showing a civic position.

4

I am a mother of three, divorced, I do not officially work, I do not receive alimony, there are part-time jobs. How can I be with the OSHI?

First, for your children up to 18 years of age, the state will contribute to the Social Health Insurance Fund.

Secondly, if you do not work and are busy caring for a child under 3 years old, then during this period the state will also make contributions to the compulsory social health insurance system for you.

In other cases, in order to maintain the possibility of receiving medical care, you need to:

a) contact the Employment Center at the place of residence, where you will be offered employment options in accordance with your qualifications and work experience. If the proposed options do not suit you, then you receive the status of unemployed, and in this case the state assumes obligations to pay contributions to the FSMS for you.

b) Another option, you can register with the tax authorities as an individual entrepreneur and make contributions yourself in the amount of 5% of the 2 minimum wage (minimum wage).

C) If you are not satisfied with the two previous options, then you independently make contributions to the Medical Insurance Fund through a second-tier bank in the amount of 5% of 1 minimum wage.

5

Tell me if medical services will be provided to insured citizens throughout the Republic of Kazakhstan, business travelers, people on vacation, for example. Or only at the place of registration?

Medical services within the framework of compulsory social health insurance (OSHI) packages are provided throughout the territory of the Republic of Kazakhstan, if you are attached to a clinic.

If you are on a business trip or vacation in Kazakhstan, then you have the right, if necessary, to receive free emergency medical care at any state clinic or hospital. You can receive further planned treatment at your clinic upon attachment.

If you are on vacation or on a business trip abroad, then you must purchase voluntary health insurance for arriving and staying in the country. Compulsory health insurance of the Republic of Kazakhstan does not apply to the territory of other countries.

6

What should citizens do when they join the compulsory insurance system?

First of all, as part of the attachment campaign, you need to attach to the polyclinic at the place of residence, where the citizen can receive the necessary medical care, as well as call the local doctor at home. Or choose a clinic on the territory of your city or district, not at the place of residence, where you intend to be serviced and issue an attachment. However, in this case, you must agree that you will not be visited by a doctor at home and patronage of children at home.

The attachment can be carried out both in the clinic and online through the e-government portal egov.kz. When applying for an attachment to the clinic, you need to have an identity document with you and write a statement in any form.

In addition, when contacting the registrar, it is important to clarify to which category of the population within the framework of the compulsory health insurance you belong: privileged categories, an employee, an individual entrepreneur or a representative of the inactive population. The order and amount of insurance payments depends on this.

7

For citizens employed in seasonal or non-permanent jobs, how will their income be taken into account?

During the period of work, the citizen will deduct from the income received, and during the period of absence of work:

- or deducts independently in the amount of 5% of the minimum wage,

- either must apply to the Employment Center at the place of residence to register as unemployed. In this case, the state will deduct the contributions for it.

8

How will medical assistance be provided to foreigners working in the Republic of Kazakhstan, labor migrants?

According to clause 2 of article 2 of the Law of the Republic of Kazakhstan "On compulsory social health insurance", foreigners and stateless persons permanently residing in the territory of the Republic of Kazakhstan, as well as oralmans, enjoy the rights and bear responsibilities in the compulsory social health insurance system on an equal basis with citizens of the Republic of Kazakhstan, unless otherwise provided by this Law. Medical assistance is provided to labor migrants within the framework of interstate agreements. For example, on the territory of five countries of the Eurasian space (Russia, Kazakhstan, Kyrgyzstan, Armenia and Belarus), ambulance and emergency medical care is provided free of charge. If there are no such agreements, then labor migrants will receive medical assistance within the framework of the VHI and have the right to receive guaranteed medical care for acute diseases,

nine

How will medical assistance be provided to the unemployed, unproductively self-employed and other categories of the economically inactive population of the country? How many are there in the country?

Until 2020, this category of the population will receive the entire package of medical care, with the exception of routine inpatient care.

At the same time, this category of the population will be given the opportunity to:

a) contact the Employment Center at the place of residence, which will offer employment options in accordance with qualifications and work experience. If the proposed options are not suitable, then the person receives the status of unemployed, and in this case the state undertakes to pay contributions to the FSMS within the allotted time.

b) register with the tax authorities as an individual entrepreneur and make contributions in the amount of 5% of the 2 minimum wage (minimum wage).

c) independently, through a second-tier bank, make contributions to the Medical Insurance Fund in the amount of 5% of the minimum wage.

ten

Does the OSMS provide for the transfer of the accumulated funds to relatives at the death of the payer?

No, it is not provided, social health insurance is not a funded system. Regardless of the amount of contributions of each payer, all categories of the population will have the same access to medical services.

eleven

Regarding HIV infection within the framework of the compulsory health insurance: what is the mechanism, is it included in the list of insurance, financing, etc. (to what extent will it affect)?

Medical services related to HIV infections will be provided within the guaranteed volume of free medical care, since HIV is one of the socially significant diseases. As the insurance package expands, HIV medical services will be provided through the social health insurance package.

12

Tell me, up to what age children are exempt from contributions to the CHI system?

Children under 18 years of age, students studying full-time in organizations of secondary, technical and vocational, post-secondary, higher education, as well as postgraduate education, persons who completed full-time training in organizations of secondary, technical and vocational, are exempted from contributions to the FSMS, postsecondary, higher education, as well as postgraduate education for three calendar months following the month in which the studies are completed .

13

Does the CSHI provide for the receipt of sanatorium-resort treatment?

No, spa treatment is not provided. But within the framework of social health insurance, it is planned to expand rehabilitation assistance for a number of diseases (stroke, heart attack, oncology, transplantology) at the expense of insurance funds.

14

Where can I find out about medical organizations that have entered into an agreement with the Health Insurance Fund of Kazakhstan on a territorial basis?

On the official website of the Medical Insurance Fund, a list of medical organizations that have concluded a contract with the FSMS will be posted, and information can also be obtained from the information services of the Fund.

In general, the lists of medical organizations involved in the provision of medical care to the population within the framework of the GHBPM and OSHI are available on the websites of regional and city health departments.

15

Can the FSMS reimburse the costs spent on medicines prescribed by a doctor in a commercial clinic that has not entered into an agreement with the FSMS?

Reimbursement by the Social Health Insurance Fund of medicines prescribed by a doctor of a commercial clinic will be in the event that an agreement has been concluded between the clinic and the FSMS.

At the same time, the provision of medicines in the OSHI system is carried out when providing outpatient and polyclinic care in accordance with the list of medicines and specialized medical products approved by the authorized body for free or preferential provision of certain categories of citizens with certain diseases.

16

The polyclinics lack office equipment, and the one that is, is outdated, so it takes 40 minutes to wait for a prescription or a referral for tests (this is the situation in polyclinic 6). Plus, the admission schedule is not respected. Plus, the medical staff is forced to conduct double reporting - paper and electronic. As a result, in order to get to a narrow specialist, you first need to stand near the therapist's office for half a day, and then another 2-3 weeks to get an ultrasound scan or other examination. In such conditions, patients who do not have money for a paid doctor lose valuable time, the disease passes into another stage. Will this problem be resolved by the time of transition to medical insurance? How?

First, under the conditions of the social health insurance system, only those medical organizations can participate in the competition for the provision of medical services, for which the number of medical workers, technical equipment and the structure of the organization of medical care meets the established minimum requirements.

Secondly, only those who can provide quality medical care can win the competition.

As for rural health care, they, as the only provider of services, will be required by the Medical Insurance Fund to annually improve the quality of medical care provided.

Thirdly, from 2018, hospitals and clinics will have the possibility of technical re-equipment, since from this year the Fund will allocate funds for depreciation deductions.

Fourth, the existing information system already today allows you to make an appointment through E-GOV, through the portals of the medical organizations themselves. By the time the OSHI is introduced, all organizations must have access to the IT systems of the OSHI.

17

Will the medical insurance compensate for the medications prescribed by the doctor and what diseases will the 100% reimbursement affect?

The provision of medicines in the compulsory health insurance system is carried out when providing outpatient and polyclinic care in accordance with the list of medicines and specialized medical products approved by the authorized body for free or preferential provision of certain categories of citizens with certain diseases.

eighteen

Is it possible for an insured person in the compulsory health insurance system to be treated outside the republic for free?

No. The Medical Insurance Fund will pay for the rendered medical services only in the territory of the Republic of Kazakhstan.

19

How can I find out on my own whether my employer pays a contribution to the FSMS?

You can get information about your contributions through special online services, the Call Center of the Medical Insurance Fund, as well as by contacting the clinic for attachment.

In addition, according to the Law on Compulsory Social Health Insurance, the employer is obliged, on a monthly basis, no later than the 15th day of the month following the reporting month, to provide employees with information on the funds transferred for health insurance.

twenty

If I belong to an unproductively self-employed population, I have temporary earnings, and I am not registered as unemployed, then do I need to deduct contributions to the FSMS, if so, how much interest and from what?

If you belong to the category of unproductive self-employed, then until 2020 you will be provided with the entire package of medical care free of charge, with the exception of planned inpatient care.

We would recommend you:

register as an individual entrepreneur and make deductions from the declared income,

or - apply to the Employment Center for employment or obtaining unemployed status;

or - you can also independently make contributions to the FSMS through second-tier banks in the amount of 5% of 1 minimum wage or 1,414 tenge monthly to a single account of the State Corporation "Government for Citizens".

21

When I change my place of work, I have a break of 1-2 months before moving to a new job, will the package of medical services be valid under the compulsory health insurance system?

According to the proposed rates, within 3 months from the month for which the last payment was made, the right to medical assistance in the OSHI remains, while the obligation to pay contributions for 3 months (arrears) remains. After this period, you must pay the missed premiums (but not more than 12 months) in order to return to the compulsory insurance system.

22

When I go to a private laboratory, will the health insurance fund pay for my costs for the tests?

The Foundation will not directly pay for laboratory services. But they will be free for you if you applied to the laboratory in the direction of the polyclinic that signed a contract with the Fund.

In the OSHI system, outpatient and polyclinic care is provided, including consulting and diagnostic assistance from a polyclinic specialist and specialized specialists;

23

How to find out if a person is insured?

If you are an employee, then according to the law, the employer is obliged to provide you with information on the calculated (withheld) and transferred deductions and (or) contributions on a monthly basis, no later than the 15th day of the month following the reporting month.

In other cases (but also as an employee), this information can be checked through the portal, at the Fund (or its branches) and at the clinics where you are assigned.

24

When does a person become insured in the compulsory health insurance system from the moment of concluding an employment contract or from the payment of the first installment by the employer?

From the moment the funds are credited for you to the Fund's account with the National Bank.

The right to medical care in the OSHI system is reserved for persons for whom the payment of contributions or contributions to the Fund and preferential categories exempted from paying contributions to the Fund have been made.

25

If citizens included in the category of exempt from payment of contributions work at the same time (mothers on parental leave under 3 years old, pensioners, disabled people, students, etc.), how will the contributions be calculated?

The state pays contributions for preferential categories. Employers are exempted from paying contributions for the following persons:

1) children;

2) those on leave in connection with the birth of a child (children), adoption (adoption) of a newborn child (children), caring for a child (children) until they reach the age of three years;

3) recipients of pension payments, including participants and invalids of the Great Patriotic War;

4) mothers with many children, awarded with pendants "Altyn alka", "Kumis alka" or previously received the title "Mother Heroine", as well as awarded with the orders of "Maternal Glory" I and II degree;

5) disabled people;

6) full-time students in organizations of secondary, technical and vocational, post-secondary, higher education, as well as postgraduate education.

26

Now doctors practice referral of patients for analysis to private laboratories that provide paid services at fairly high rates. Will they be covered by insurance?

The Health Insurance Fund will not pay directly for laboratory services. But they will be free if you applied to the laboratory in the direction of a polyclinic that has signed a contract with the Foundation.

In the OSHI system, outpatient and polyclinic care is provided, including consulting and diagnostic assistance from a polyclinic specialist and specialized specialists.

27

Do private medical organizations now provide inpatient and outpatient services within the guaranteed volume of medical care? How will the situation change with the introduction of compulsory health insurance?

The fund will purchase medical services both within the guaranteed volume of medical care and compulsory health insurance on a competitive basis from public and private clinics.

The competition will be held in 2 stages.

At the first stage, each medical organization enters its technical, economic and medical data into the Unified Register of Service Providers.

In accordance with the submitted data, the Foundation assesses their compliance with the established minimum standards.

In case of a positive conclusion, the medical organization is admitted to the second stage of the competition.

At the second stage, the Fund assesses the volume of services provided, their cost and quality of services provided in previous years (established criteria).

If the resource provision of a medical organization meets the established minimum standards, and the services provided to the established quality criteria, then the medical organization will be selected as a potential service provider.

Medical care in the OSHI system is provided to consumers of medical services on the terms of the contract for the purchase of services, concluded on the basis of the procurement of services for the provision of medical care in the OSHI system, between the health entity and the Fund in accordance with the Law "On the OSHI".

Thus, the best public and private clinics with appropriate resource provision and experienced specialists providing qualified assistance will have the opportunity to provide medical care.

28

Will the amount of medical assistance for the insured be somehow limited, or can you go to the doctors, do the examinations as many times as you like? Will I have to pay extra in excess of contributions if I visit the clinic often?

You have the right to contact a medical organization that provides services under the compulsory health insurance and to which you are attached as many times as necessary to treat your disease, but the entire amount of medical care received will depend on the indications and prescriptions of the doctor. The services included in the compulsory health insurance package will be provided in full and no additional fees will be required.

29

Will voluntary health insurance continue? Will services be duplicated in compulsory health insurance or voluntary medical insurance?

Voluntary health insurance is not excluded. Certain types of medical services that are not included in the compulsory health insurance package can be paid for through voluntary medical insurance, for example: dentistry for adults, mandatory periodic examinations for workers working in hazardous industries, spa treatment, etc. It all depends on the desire and financial capabilities of an individual or an enterprise ... An individual or an enterprise (on the basis of a collective agreement) can choose a VHI service package that does not duplicate services in the OSHI package.

thirty

Does the patient have to buy at their own expense and bring their syringes to the treatment room at the polyclinic to perform the procedures prescribed by the attending physician?

No, they must be available from the medical organization if you receive medical care within the guaranteed volume of medical care and compulsory health insurance.

31

For example, the state paid contributions for a person, then he goes into the category of the self-employed population. Will there be breaks or double insurance?

Double insurance is excluded, because when you change your status and register as an individual entrepreneur, this information is reflected in the tax authorities and goes to the Medical Insurance Fund. If you were unemployed and then changed your status, then the state accordingly suspends the payment of contributions.

32

How will medical assistance be provided to stateless persons?

Foreigners and stateless persons permanently residing in the territory of the Republic of Kazakhstan enjoy the rights and bear obligations in the system of compulsory social health insurance on an equal basis with citizens of the Republic of Kazakhstan.

33

Will vaccinations be part of the insurance coverage?

Preventive vaccinations are included in the basic free package of medical services guaranteed by the state for all citizens of the country (GBMP).

34

They say that in order to receive medical insurance, unemployed people need to obtain unemployed status. But what if there is no suitable job in the village, and there is not enough income to open an individual entrepreneur, only 2-3 cows and a vegetable garden. It turns out that tomorrow we will be denied medical assistance?

You will not be denied help, since there is a guaranteed amount of free medical care for all citizens. This is an ambulance and medical aviation; medical care in case of socially significant diseases and in emergency cases, preventive vaccinations, outpatient care with outpatient drug support (until 2020).

In addition, you can deduct contributions to the Medical Insurance Fund on your own through the Kazpost offices in rural areas, through second-tier banks in the amount of 5% of the minimum wage and thus receive full rights to services under insurance.

35

How will hospitalization payments be made?

Payment for a treated case in a hospital is made from the Fund for the insured person at rates established by the Ministry of Health on the basis of acts of services rendered and taking into account the results of control of contractual obligations on the quality and volume of medical services, the results of state control and supervision in the field of health care, the exercise by citizens of the right choice of a health care subject.

36

Does the transfer of employer's contributions depend on the employee's salary?

Yes, the employer calculates and transfers deductions at the established rates from the employee's income, including wages.

The object of calculation of deductions is the employer's expenses paid to the employee in the form of income accrued by employers, with the exception of income from which deductions and contributions are not paid, determined by the authorized body.

37

The deduction of contributions to the CSHI will be charged on the accrued salary or salary with withholding taxes (pension; income)

The deduction of contributions is made from the accrued wages:

"The object of calculation of deductions are the employer's expenses paid to the employee in the form of income accrued by employers, except for income from which deductions and contributions are not paid, determined by the authorized body."

38

Will it be possible to go to any hospital or polyclinic (including a private one) without attachment or referral?

In case of emergency, medical assistance will be provided without attachment and referral.

Citizens have the right to choose a medical organization that provides inpatient care in the compulsory health insurance system in cases of receiving planned medical care. Citizens have the right to choose a medical organization in the compulsory health insurance system from the moment they acquire the right to medical care in the compulsory health insurance system.

39

If the current system is working properly, why do we still need compulsory medical insurance?

The need to create a new effective health care system is long overdue. Among the key problems that prompted the introduction of the social health insurance system are the lack of solidarity and employers in health care, the financial instability of the system, and an insufficiently effective structure of medical care.

As a result, the lack of solidarity between citizens and employers in health protection has led to the fact that the burden of ensuring health protection lies only with the state, and citizens have become characterized by a consumer attitude to health care.

Today, the current health care system is unable to solve several key problems:

1) Lack of competition among medical organizations in attracting patients.

In the current system, the state acts as the only provider of services that evenly distributes funds among all medical organizations to ensure the availability of medical care.

At the same time, the even distribution in practice has led to the fact that medical organizations of the same profile and the same throughput capacity receive the same amount of funding, regardless of the quality of their medical care. In the OSHI system, financing of medical organizations depends, among other things, on the number of patients who are attracted by the quality and list of services provided.

2) Equalization in payments and the growth of informal payments

Unfortunately, regardless of the experience, knowledge and skills of the doctor, all specialists of the same profile, in the case of the same length of service, receive the same salary.

In this regard, most of the recognized doctors who are chosen by patients now move to private structures or open private offices where they can earn money in accordance with their professional skills.

3) Preservation of social paternalism

The guaranteed volume of free medical care gives rise to the conviction among the majority of the population that the state is responsible for their health. In practice, health depends as much on medicine as on lifestyle and environmental influences, genetics, etc.

All these problems together formed the basis of the existing critical background to the health care system in society.

This situation requires a radical change in the approaches to financing and organizing medical care, which is envisaged within the framework of the introduced system of compulsory social health insurance.

40

Which countries are an example for us in the implementation of medical insurance and will, as a result, we have the same medicine as in Germany or Korea?

Not only the experience of countries and trends in the development of the social insurance system in these countries, as well as their mistakes, were studied.

For example, in France, in the early years, the burden of paying contributions was distributed between employers and employees, when it became clear that almost 50% of all expenses go to the economically inactive population, the amount of contributions from the state budget was increased.

In Germany, there were more than a thousand health insurance funds that finance medical organizations. Such a number of cash registers prevented the redistribution of funds between the participants of the system, which have different levels of contributions, in the event of the onset of disease risks.

In this regard, Germany began to enlarge the sickness funds, as a result of which their number was reduced to 100, with a further tendency to create a single fund.

Since 2014, at the initiative of President Obama, instead of the funded system of medical insurance, which did not ensure the availability of medical care to all segments of the population due to the high cost of medical services, a universal system of public health insurance was introduced based on the Affordable Care Act, or, as it was called in people, Obamacare . A key element of US health care reform is the introduction of the obligation for US citizens to purchase health insurance if they are not insured. At the same time, subsidies are provided for the poor. The reform is also intended to improve the conditions of health insurance for citizens who already have a policy. 

Today in the world there are three systems of health insurance: public, private and public.

In the state model, medical services are provided at the expense of taxes and the state budget. The Ministry of Health is separate from the resource allocation agency.  

The advantages of this model are social orientation, equality of access, price control. Disadvantages - dependence on the budget, slow adaptation to the changing needs of the population, limited choice.

The private insurance model assumes a non-compulsory collection of revenues and excludes the accumulation of sufficient funds to cover the health needs of all. There are many separate private "systems".

The main advantage is a differentiated package of services depending on the desire and income of the citizen.

Cons: lack of price control, competition of medical organizations for non-medical factors, high costs of the economy on healthcare, lack of access to medical services in the absence of ability to pay.

Third, community model : coverage of health services provided by compulsory social contributions, collected and administered by the Fund, separated from the Ministry of Health 

Pros: social orientation, joint responsibility, increased competition and quality control, reduced informal payments

Cons: Risk of underfunding due to evasion of payment of contributions, an appropriate IT infrastructure is required.

Kazakhstan has chosen a public insurance system. The system operates on the principles of joint responsibility of the state, employer and citizens of the country.

41

Will there be any benefits in paying deductions for those working in hazardous conditions?

There are no benefits in paying deductions for those working in hazardous conditions. The law on compulsory social health insurance establishes uniform contributions for the entire working population. Contributions of employees to be paid to the fund are established in the amount of: from January 1, 2019 - 1 percent of the object of calculation of contributions; from January 1, 2020 - 2 percent of the object of calculating contributions. The object of calculation of contributions is the income of each employee.

42

Are all groups of people with disabilities included in the list of preferential categories of the population for compulsory health insurance?

Yes, disabled people of all three groups are included in 14 categories of socially unprotected categories of the population, for which the state pays contributions to the Social Health Insurance Fund.

43

Does the Medical Insurance Fund have an anti-crisis scenario for the formation of reserves in case of a worsening economic situation?

In the event of a worsening economic situation, the Fund will use:

- countercyclical measures, which provide for the transfer of contributions by the state for the economically inactive population from the average monthly salary in the economy for two years preceding the current financial year. In times of crisis, this will ensure a higher level of contributions from the budget than from employers;

- reserves for unforeseen expenses, formed in the amount of up to 3% of the assets of the Fund.

44

Are the funds of the Mandatory Medical Insurance Fund provided for protection from various threats, and first of all, inflation?

Firstly, unlike other social insurance systems that have “long money” and require safety, the funds are not accumulated in the Health Insurance Fund, but are directed to pay for services provided by medical organizations on a daily basis.

Secondly, the increase in the cost of medical services will be offset by contributions made from the income of the employed population, which already include inflation.

45

Can I track information on the services provided under the OSHI?

On the basis of the electronic health care system, each insured citizen will have access to a personal account through a login and password, where it will be possible to track information about the medical services provided, information about the course of treatment, diagnostics, doctor's appointments, etc. will be posted there.

46

To what extent will information on the fund's costs be transparent to the public?

The new model provides for a transparent system for collecting and distributing funds. The transparency of the FSMS will be carried out through:

Regular monitoring of collection of contributions and funds;

Regular monitoring of the provided medical services;

Submission of standard reports on the use of funds to the authorized bodies (MoH, MoF, Government, Accounts Committee);

Publication of the annual annual report to the public (short in newspapers, detailed on the website and in a separate media publication)

Maintaining the FSMS website, where the FSMS strategic documents (5-year development strategy, short-term development plan, annual plan) and financial statements are posted.

47

Will it be necessary to have an insurance (card) with you at all times or is an identity card sufficient?

The system of compulsory social health insurance does not operate the system with policies and contracts that is customary for voluntary insurance. To determine the status and receive insurance services, a person only needs his IIN.

48

Will the introduction of compulsory health insurance cause an increase in corruption by requiring payment from the citizens themselves?

One of the goals of introducing compulsory health insurance is precisely to reduce the volume of private spending on medical care. An insured citizen does not need to make any additional payments for the package of medical services that is guaranteed under compulsory medical insurance. Our contributions, deductions from the employer or the state for us are sent to the FSMS, which then, according to the approved tariffs, pays the medical organization upon confirmation of the quality and volume of the provided medical care. Recall that payments from the Fund for the provision of medical care in the compulsory health insurance system will begin to be made from January 1, 2018. Then the insured citizens will be able to receive all the medical assistance provided by the system.

49

I recently bought a hearing aid for my father. I would like to know - how is the amount of compensation determined for independently purchased technical means of rehabilitation within the framework of the compulsory health insurance?

The Foundation does not reimburse the expenses for independently purchased hardware.

fifty

Will dental services be included in the compulsory health insurance package? If yes, then when?

To date, dental services are not included in the planned list of services within the OSHI framework

Over time, as the service package expands, the possibility of including dentistry will be considered.

51

If doctors offer to buy medicines themselves due to their absence in the hospital, then in what case does the Fund return the money spent and are doctors obliged to inform the patient about this?

When concluding an agreement with the Fund, a medical organization undertakes to have material (medicines, food, etc.) and labor resources. The payment for inpatient treatment of the insured by the Fund is reimbursed in full.

The provision of medicines in the compulsory health insurance system during the provision of inpatient and inpatient substitution care is carried out in accordance with the pharmaceutical formulations approved by the head of the health organization in the manner established by the authorized body.

52

Will working pensioners pay contributions to the health insurance fund?

No, the state will pay contributions for pensioners.

If they are employed, the employer is exempt from paying contributions for him.

53

If during the last 3 years I have not applied for medical assistance, will the amount of my deductions accumulate and can they be withdrawn for other purposes?

No, the health insurance system is solidary, which means that it provides for a personified registration of participants and the redistribution of funds between the participants of the system when the risk of illness occurs.

54

Can we count on IVF under compulsory medical insurance? If so, where to start?

This procedure will be included in the health insurance package of the compulsory health insurance, so it can be done in the prescribed manner according to indications.

55

For example, if a person has an accident, is it necessary to find out if the victim has medical insurance to provide emergency assistance?

No, it is not necessary, since emergency assistance is provided to all citizens, regardless of participation in the compulsory health insurance.

56

If a person does not want to pay contributions to the FSMS. What to do in this case?

The health insurance system in Kazakhstan is mandatory. In this regard, the payment of contributions is mandatory. In case of non-payment, for employers and individual entrepreneurs, financial (accrual and collection of a penalty) and administrative penalties (warning, fines) are provided.

In respect of individuals who are not individual entrepreneurs, such measures are not provided. At the same time, non-payment entails a refusal to provide medical care, which is included in the compulsory health insurance package: outpatient and inpatient care. The draft law of the Republic of Kazakhstan, considered in the Parliament of the Republic of Kazakhstan, stipulates that in order to acquire the right to medical care in the compulsory health insurance system, it is necessary to pay for the unpaid period, but not more than 12 months.

57

In some countries, a family member can take advantage of another family member's insurance. Will our Law provide for such a possibility?

In the practice of medical insurance, including voluntary, there are approaches of group (or family) insurance. The compulsory social insurance model of Kazakhstan does not imply such principles. In our model, joint responsibility of the state, employer and citizen. The state bears the responsibility for the socially vulnerable segments of the population.

58

Will the payment of contributions to the FSMS be a citizen's duty or will it become his right? Will a working person be able to refuse to participate in the compulsory health insurance system and pay for medical care through the cashier of a medical institution?

The Law of the Republic of Kazakhstan dated November 16, 2015 No. 405-V ЗРК "On compulsory social health insurance" regulates public relations arising in the system of compulsory social health insurance in order to implement the constitutional right of citizens to health protection (hereinafter - the Law).

According to article 4 of the Law, one of the principles of compulsory social health insurance is the obligatory payment of contributions and (or) contributions.

In accordance with paragraph 6 of Article 14 of the Law, payers are obliged to timely and in full calculate (withhold) and transfer deductions and (or) contributions, as well as penalties for late and (or) incomplete payment of contributions and (or) contributions.  

At the same time, the bill plans to expand the circle of payers of contributions by citizens of the Republic of Kazakhstan who have left the Republic of Kazakhstan, with the exception of those who have left for permanent residence outside the Republic of Kazakhstan in the manner prescribed by law and citizens for whom deductions and (or) contributions are paid in the Republic of Kazakhstan (hereinafter referred to as citizens who have left the Republic of Kazakhstan).

Contribution payers are not foreigners and stateless persons, with the exception of persons permanently residing in the territory of the Republic of Kazakhstan and oralmans, unless otherwise provided by international treaties ratified by the Republic of Kazakhstan.

Considering the above, payment of contributions to the FSMS is the responsibility of payers, including citizens of Kazakhstan.

Receiving medical care through the cashier of a medical institution is possible in case of receiving paid medical services (Article 35 of the Code of the Republic of Kazakhstan dated September 18, 2009 "On people's health and the health care system").

59

Why are there no deductions and contributions for servicemen and employees of power structures?

The exemption of these persons from paying deductions and contributions is primarily due to the elimination of double funding. The presence of departmental medicine already presupposes expenditures on the part of the state for medical support of military personnel and employees of special state and law enforcement agencies. Payment for these persons of deductions and contributions from the state budget would be a double spending of funds for medical care

60

Self-employed (unproductive) will be able to make contributions to the OSHI Fund once a year the entire amount for 12 months or is it necessary to deduct monthly? Remote settlements will not always be able to travel to regional centers on time due to weather conditions.

The draft Law of the Republic of Kazakhstan "On Amendments and Additions to Certain Legislative Acts of the Republic of Kazakhstan on Health Issues" provides for the right to pay in advance. It could be 2, 3 or more months.

61

The state will make contributions to the CMC Fund for non-working persons caring for a disabled child under the age of 18. How and where will these persons be registered? Since at the moment information about this contingent is not available to the employment agencies and the State Center for Internal Affairs.

In accordance with the Law of the Republic of Kazakhstan "On State Benefits to Families with Children" dated June 28, 2005 N 63

There is a monthly state allowance assigned and paid to the mother or father, adoptive parent (adoptive child), guardian (trustee) raising a disabled child (disabled children). The records of these persons are kept in the databases of the Ministry of Labor and Social Protection of the Population of the Republic of Kazakhstan.

62

How and who will grant status to family members and dependents of military personnel? Will the state make contributions for these categories to the SMS Fund? For example, a soldier's spouse is a housewife, what is the status of self-employed (she herself pays 5% of the minimum wage) or should it be included in 14 categories for which the state pays?

The status of citizens is assigned depending on the presence (or absence) of income. As for the unemployed spouse, (unemployed) spouse of a serviceman, the draft Law of the Republic of Kazakhstan "On Amendments and Additions to Certain Legislative Acts of the Republic of Kazakhstan on Health Issues" proposes to give them the status of unemployed without presenting them with the requirements stipulated for the unemployed (registration, training , retraining, etc.). This norm was proposed for the purpose of social protection of family members of military personnel, employees of special state and law enforcement agencies, who, due to the peculiarities of their service, are forced to constantly change their place of residence, live in remote areas where there is no opportunity for employment, etc.

63

How will parents caring for disabled children over 18 years old be insured?

The draft Law of the Republic of Kazakhstan "On Amendments and Additions to Certain Legislative Acts of the Republic of Kazakhstan on Healthcare Issues" considered in the Parliament of the Republic of Kazakhstan for this category of persons provides for the obligation to pay monthly contributions to the compulsory health insurance in the amount of 5% of 1 minimum wage. With timely and full payment of contributions, these persons are entitled to the entire package of medical care in the compulsory health insurance system.

Payment of contributions and (or) deductions of these persons can be carried out at the expense of:

1. Wages for employment in accordance with applicable law as a social worker for the care of the disabled;

2. Wages for part-time employment or work at home;

3. State targeted social assistance for individuals (families) with a monthly average per capita income below the poverty line;

4. At the expense of the income of other family members and other persons

From health workers

64

How will the OSMS work?

All contributions and deductions made by the employee, employer, individual entrepreneurs and the state for the economically inactive population will go to the assets of the Social Health Insurance Fund in the National Bank of the Republic of Kazakhstan.

Control over admission to the Fund is assigned to the State Revenue Committee, and personalized accounting will be retained by the Government for Citizens State Corporation.

The fund will be the single strategic purchaser of medical services from medical organizations. The purchase will be carried out on a competitive basis. The competition will be held in two stages.

At the first stage, the resource provision (buildings, medical equipment, personnel) of the medical organization will be assessed for compliance with the minimum standards established by the state.

In case of a positive assessment, the medical organization is admitted to the second stage, where the assessment of the volume of services provided, the cost and their quality according to the established criteria will take place.

Thus, the best public and private clinics with appropriate resource provision and experienced specialists providing qualified assistance will have the opportunity to provide medical care.

65

How will healthcare professionals determine the status of the insured?

All medical organizations will have access to the Unified Register of Insured Citizens of the Republic of Kazakhstan.

When a citizen contacts a medical worker, it will be enough to enter his IIN and receive confirmation of his status as an insured.

If deductions are made, then the applicant has the right to use the full range of medical care provided by the compulsory health insurance system. If not, he will be provided with assistance within the framework of the state-guaranteed volume of medical care (GBMP).

66

What will medical organizations get from the implementation of compulsory health insurance?

Adequate financing for the volume of services provided;

Possibility of increasing salaries for medical personnel and introducing a performance-based remuneration system;

The possibility of updating medical equipment by including depreciation deductions in the tariff.

In general, the funds of the compulsory health insurance will be used to improve the quality of the entire health care system.

67

How will medical organizations provide medical care in the context of compulsory health insurance?

The fund will purchase medical services both within the guaranteed volume of medical care and compulsory health insurance on a competitive basis from public and private clinics.

The competition will be held in 2 stages.

At the first stage, each medical organization enters its technical, economic and medical data into the Unified Register of Service Providers.

In accordance with the submitted data, the Foundation assesses their compliance with the established minimum standards.

In case of a positive conclusion, the medical organization is admitted to the second stage of the competition.

At the second stage, the Fund assesses the volume of services provided, their cost and quality of services provided in previous years (established criteria).

If the resource provision of a medical organization meets the established minimum standards, and the services provided to the established quality criteria, then the medical organization will be selected as a potential service provider.

Medical care in the OSHI system is provided to consumers of medical services on the terms of the contract for the purchase of services, concluded on the basis of the procurement of services for the provision of medical care in the OSHI system, between the health entity and the Fund in accordance with the Law "On the OSHI".

68

What types of medical services will be provided under the conditions of compulsory health insurance?

There will be two packages of medical services.

The first is a state-guaranteed free package for all citizens of the country (GBMP). It includes:

• Treatment of socially significant diseases
• Vaccinations
• Ambulance
• Air ambulance
• until January 1, 2020 - outpatient polyclinic and emergency inpatient care.

The second package - a package of medical services provided under the conditions of compulsory health insurance, is intended for insured citizens and includes:

• Outpatient and polyclinic care:

- reception and consultation

- prevention

- diagnostics

- treatment

• Inpatient replacement care
• Inpatient assistance:

- treatment and rehabilitation

- palliative care and nursing care

• High-tech services
  • Provision of certain drugs

69

What is the procedure for paying medical organizations for services under the compulsory health insurance?

Payment for the services of healthcare entities for the provision of medical care in the compulsory health insurance system is carried out at the rates approved by the authorized body, on the basis of acts of services provided and taking into account:

1) the results of monitoring contractual obligations for the quality and volume of medical services;

2) the results of state control and supervision in the field of health care;

3) the exercise by citizens of the right to choose a health care subject;

Payment for services of healthcare entities is carried out at the expense of the assets of the Fund on the basis of the terms of the contract for the purchase of services.

70

Will the wages of medical workers rise?

The compulsory health insurance system makes it possible to increase the pay of medical workers.

The funds of the CSHI will be used to increase the ratio of doctors' salaries to the average salary in the economy

71

What is the mechanism for increasing the salaries of health workers? From what sources is this supposed to be done?

In the conditions of compulsory health insurance, each medical organization can gradually introduce a differentiated approach in matters of remuneration, independently form an effective model of material incentives for personnel.
This means that recognized professionals, experienced highly qualified doctors should receive higher salaries than they are now. The management of medical organizations must come to the understanding that the successful operation and financial well-being of a particular clinic will depend on the involvement of highly qualified specialists. This pay mechanism has long been used in the private medicine sector and has proven to be effective. It is no secret that in practice, most patients today choose reputable doctors for treatment and consultations, who, accordingly, should receive decent material support. Such levers of motivation for the work of health workers will be in the health insurance system, since the quality of medical services and the final result are the main goals of the compulsory health insurance.

72

How will the quality of medical services be assessed?

The quality of health care services will be assessed at different levels of health care delivery. Internal examination is carried out by the internal control service of medical institutions, and external examination will be carried out by experts of the FSMS by using information from health information systems that have a certain set of indicators of the fulfillment of obligations by a healthcare provider in accordance with the established volume and required quality. In case of defects, payment for medical services will not be made or will be partially paid.

Also, control will be carried out by an authorized state body with the involvement of independent experts.

At the same time, the satisfaction of the population with the quality of medical services will be assessed through the use of a mobile application, quality assessment terminals in medical institutions, and surveys.

Depending on the form of providing medical care, the Fund will develop indicators of direct and final results for each medical organization.

Based on the results of the quality assessment, it is planned to determine the supplier rating, which will be available to each patient on the official Internet resource of the Fund. Based on the rating, each patient will have the right to choose a medical institution to receive medical care .

73

How will transparency in the distribution of FSMS funds be ensured?

The transparency of the FSMS will be carried out through:

• regular monitoring of contributions and funds
• regular monitoring of provided medical services
• creation of Public Councils
• submission to the authorized bodies of standard reports on the use of funds (MHSD, MoF, Government, Accounts Committee)
• publishing an annual annual report to the public
• maintaining the FSMS website, where the strategic documents of the FSM are posted, information for the insured: general (rights, obligations, opportunities, news, conditions of provision, tariffs, etc.); individual through a personal account - reporting by the FSMS to the patient as a payer of contributions and a consumer of services, information to suppliers (legal regulations; procurement rules; tariffs; content of contracts with suppliers, including financial data; results of supplier control; different plans - procurement and control)
• results of various analyzes, reviews and studies in the field of health care
• publication of supplier ratings
• regular and targeted meetings with stakeholders (representatives of providers, patient organizations) to discuss issues of concern or planned innovations

74

Is it mandatory for medical organizations to have an information system in order to participate in the competition of the Medical Insurance Fund?

When providing medical care in the OSHI system, healthcare subjects are obliged to provide access to information systems and electronic information resources of the OSHI system.

75

Will there be public control over the activities of the FSMS?

One of the mechanisms for ensuring control already exists in the Law on Compulsory Social Health Insurance - this is the joint commission on the quality of medical services. This commission will become a dialogue platform of conciliation between the MHSD, FSMS, representatives of the public. Public control will be carried out through the obligatory introduction of representatives of associations of doctors, patients, representatives of NGOs into this commission.

The charter of the FSMS provides for the possibility of creating a Public Council on the functioning and development of the compulsory health insurance system, which may include representatives of government agencies, NGOs and citizens of the Republic of Kazakhstan. It is also possible to include a mechanism for public control over the work of the Medical Insurance Fund in the regulations on the activities of the Public Council, which is determined, in turn, by the regulations approved by the Board of Directors of the Fund.

76

What will healthcare workers get from the implementation of compulsory health insurance?

Gradually, health workers will receive the following benefits and advantages from the implementation of compulsory health insurance:

• performance-based pay;
• motivational package, including material incentives, social package, incentives, bonuses;
• the possibility of professional development at the expense of the employer:
• renewal of medical equipment;
• optimization of work processes and improvement of working conditions;
• on-the-job training;
• professional mobility;
• qualitative improvement of the system.

77

How will voluntary health insurance function in connection with the introduction of compulsory health insurance?

Voluntary health insurance (VHI) will allow to fully or partially cover the expenses of the insured person for medical services that are not provided for by the compulsory health insurance system.

The VHI policy allows individuals or employees of large companies to be examined in clinics of their choice and on conditions (services, no waiting lists, services not included in the CSHI - dentistry, etc.) at the expense of the insurance company. When issuing a VHI, a citizen himself chooses the volume of services included in the voluntary insurance policy.

78

Will the quality of medical care improve with the introduction of compulsory health insurance?

The quality of medical services with the introduction of compulsory health insurance will definitely increase. For this, a set of measures will be implemented:

- Creation of the Joint Commission for Quality;

- redistribution of functions in the field of quality management, including increased involvement of NGOs;

- strengthening the function of expertise of the services rendered by the Fund;

- providing conditions for the further development of competition among providers of medical services, which will naturally lead to an increase in quality;

- inclusion of quality indicators in contracts between the Fund and medical service providers and their linkage to the level of funding, etc.

79

Will the introduction of compulsory health insurance help solve the personnel problem?

The introduction of compulsory health insurance must be considered in conjunction with the implementation of other reforms, including the training of qualified personnel by medical universities and advanced training of practical medical workers.

The ministry and regional health departments will provide medical care, including the provision of medical personnel, equipping medical equipment with medical equipment, which will provide qualified medical care to the entire population.

Medical organizations, as a potential supplier, should provide all measures for the readiness of their organizations to participate in the competition for the provision of medical services under the compulsory health insurance in accordance with the established requirements.

80

Will the new tariff policy create conditions for self-sufficiency and further development of medical organizations?

Yes, since it is planned to gradually include the depreciation component in the tariffs. That will allow updating fixed assets and, with effective distribution of funds, introducing new technologies for diagnostics and treatment

81

Are our medical organizations in rural areas ready to implement the new system?

At the level of rural medicine, with the introduction of compulsory health insurance, no fundamental changes are expected. As part of the structural reforms, all rural medical organizations will be represented by one legal entity, which will be the provider of medical services for the FSMS. The outpatient and polyclinic part of rural medicine will be financed on the basis of the established CIT, inpatient - using the KGZ.

82

How will the admission ward of hospitals be funded upon transition to the compulsory health insurance system?

In the OSHI system, inpatient care will be provided by the referral of a PHC specialist or a medical organization within the framework of the planned number of hospitalizations determined by the authorized body, the Fund is obliged to ensure timely payment for inpatient care services of healthcare entities on the terms of a service purchase agreement .

83

Tell me, will funding for medical organizations remain at the level of local executive bodies, and in what areas?

At the level of local executive bodies, financing of capital expenditures of medical organizations, public health and some others that will not be included in the compulsory health insurance system and guaranteed health insurance through the FSMS will remain

84

How will equipment acquisition and overhaul costs be reimbursed?

According to the State Program for the Development of Healthcare of the Republic of Kazakhstan "Densaulyk" for 2016-2019, it is planned to gradually include the costs of updating fixed assets in the tariffs for medical services. Payment for equipment worth over 100 million tenge and overhaul will be carried out at the expense of local executive bodies.

85

Does the country have a single database of the entire population?

Yes, there is. This is the state database of individuals and legal entities, as well as the Register of the attached population. Based on the data from the above-mentioned databases, the Register of Insured Persons in the OSMS system will be formed.

86

Is it possible to develop private medicine with the introduction of compulsory health insurance?

For 2016, from the funds of the republican budget, contracts were concluded with 246 private medical organizations. We believe that with the introduction of compulsory health insurance, a greater number of private medical organizations will take part in the provision of medical services, taking into account the development of a competitive environment.

Procurement of medical care services from healthcare entities in the OSHI system is carried out by the Fund in the manner determined by the authorized body, based on the principles of equality of healthcare entities;

87

What is the international experience of compulsory health insurance?

Today in the world there are three systems of health insurance: public, private and public.

In the state model, medical services are provided at the expense of taxes and the state budget. The Ministry of Health is separate from the resource allocation agency.

The advantages of this model are social orientation, equality of access, price control. Disadvantages - dependence on the budget, slow adaptation to the changing needs of the population, limited choice.

The private insurance model assumes a non-compulsory collection of revenues and excludes the accumulation of sufficient funds to cover the health needs of all. There are many separate private "systems".

The main advantage is a differentiated package of services depending on the desire and income of the citizen.

Cons: lack of price control, competition of medical organizations for non-medical factors, high costs of the economy on healthcare, lack of access to medical services in the absence of ability to pay.

Third, community model: coverage of health services provided by compulsory social contributions, collected and administered by the Fund, separated from the Ministry of Health

Pros: social orientation, joint responsibility, increased competition and quality control, reduced informal payments

Cons: Risk of underfunding due to evasion of payment of contributions, an appropriate IT infrastructure is required.

Kazakhstan has chosen a public insurance system. The system operates on the principles of joint responsibility of the state, employer and citizens of the country.

88

At the moment, many state medical organizations are actively engaged in business: most medical services are provided on a paid basis, especially hospitals. Although these services are included in the list of guaranteed healthcare, there is no control, the population pays, the state, on the contrary, stimulates paid income in state enterprises. How will the situation change with the introduction of compulsory health insurance?

Services within the packages of the guaranteed volume of free medical care (guaranteed volume of medical care) and the package of medical care under the compulsory health insurance should not be provided on a paid basis both now and with the introduction of compulsory health insurance. Everything you need is guaranteed and will be provided. However, demand creates supply. When citizens see that they pay contributions specifically for health insurance, while the range and volume of medical services in the compulsory health insurance system expands, the consumption of paid services will decrease. Recall that in accordance with Article 7 of the Law "On Compulsory Health Insurance", the insurance package includes planned inpatient care, outpatient and polyclinic care, including outpatient drug provision, high-tech services.

The redistribution of types of medical care within the framework of the compulsory health insurance will be carried out from the guaranteed volume of medical care to the compulsory health insurance, taking into account a gradual increase in the size of contributions.

89

Will all medical organizations tomorrow be able to conclude a contract with the FSMS?

Nobody can give such a guarantee. For example, if there are three hospitals with cardiology departments in one city, then the Fund has the right to choose the medical organization that, firstly, will meet the minimum standards and requirements for the procurement of services, and, secondly, provide the highest quality and high-tech medical services, has in the presence of modern equipment, highly qualified specialists and creates the best conditions for patients.

Thus, the Fund will stimulate both the optimization of the network of healthcare facilities, depending on the actual demand for types of medical care in the region, and the optimization of business processes within medical organizations in order to reduce costs and increase their competitiveness.

The purchase of medical care services from healthcare entities in the OSHI system is carried out by the Fund in the manner determined by the authorized body, based on the principles:

1) the balance of the incomes of the compulsory health insurance system with the obligations to provide medical care;

2) ensuring the territorial availability of medical care in the compulsory health insurance system;

3) equality of subjects of health care;

4) fair competition;

5) the quality and efficiency of the provision of medical services.

90

What kind of medical care can people of homelessness expect?

If people of this category seek medical help, then in the absence of deductions from them to the Medical Insurance Fund, then they are entitled to receive medical services within the framework of the guaranteed volume of medical care.

91

How much will the pricing change for the NSR and VSMP?

Tariffs for EMS and HSR will also be improved on the basis of clinical-cost groups, taking into account international practices for calculating them and the actual costs of healthcare providers.

92

Does the Register of Attached Population (hereinafter - RPN) play a role if patients go to other areas?

In accordance with the current rules for attaching and detaching patients, patients can change attachment in the following cases:

- when changing the place of permanent or temporary residence, work or study outside of one administrative-territorial unit;

- in cases of reorganization or liquidation of the PHC organization;.

- no more than once a year with the free choice of a doctor and a medical organization by a citizen;

- during the campaign, held annually from September 15 to November 15 to attach the population to the PHC organization.

If the patient applies to other regions, but is attached in one region, only emergency assistance will be provided to him.

At the same time, it is planned to implement mutual settlements between medical organizations for the provision of medical care to an unassigned contingent.

93

How will medical organizations with the form of ownership of a state institution be financed and is there a need for a transition to an enterprise on the basis of the right of economic management (PHV)?

By the laws of the RK, state institutions that are not state bodies, in addition to performing managerial, socio-cultural or other functions of a non-commercial nature, may be granted the right to carry out income-generating activities (provision of paid services).

94

If local patients voluntarily choose the medical organizations of the city of Almaty, what will happen to the district hospitals?

Under the compulsory health insurance system, the existing mechanism of free choice of a medical organization and the principle of “money follows the patient” is preserved. In this case, those patients who will receive assistance in Almaty will be paid by the Fund to the medical organization that provided assistance. There are also mechanisms for increasing or decreasing the value of the contract, due to changes in the volume of services provided. District hospitals will receive payment only for those insured who received medical care at the institution.

95

How and by whom will medical equipment be procured and distributed?

With the introduction of compulsory health insurance, tariffs will be revised. The tariff will gradually include the costs of updating fixed assets, i.e. depreciation deductions. In addition, it provides for the rental of medical equipment from medical equipment suppliers.

96

How will the volume of medical care be planned in the conditions of compulsory health insurance?

The planning of the volume of medical services in the conditions of compulsory health insurance will be carried out at the level of local executive bodies in conjunction with the Fund, based on the needs of the population in certain types of medical assistance. At the same time, demographic forecasts and macroeconomic models will be used, the priorities of the strategic documents of the Republic of Kazakhstan and the financial capabilities of the Fund will be taken into account.

97

How will the cost of the insured event be reimbursed? By KZG or by actual cost?

It is planned to further improve the existing methods of payment for medical services in the conditions of compulsory health insurance, including the method of payment for inpatient services, taking into account the focus on creating a competitive environment for providers of medical services and ensuring the financial stability of the healthcare system as a whole.

At the outpatient level, a per capita financing system with an incentive component will be developed, the formation of combined tariffs for services will be studied to ensure the complexity and continuity of medical services in the interests of patients;

- At the stationary level, tariffs will also be improved based on clinical-cost groups, taking into account international practices for their calculation;

- Also, within the framework of the disease management concept being implemented, in some cases, tariffs will be considered with the integration of all levels of medical care: from primary health care to inpatient treatment and subsequent rehabilitation, especially in cases where expensive diagnostic and treatment technologies are used.

98

How will medical assistance be provided to foreigners working in the Republic of Kazakhstan, labor migrants?

According to clause 2 of article 2 of the Law of the Republic of Kazakhstan "On compulsory social health insurance", foreigners and stateless persons permanently residing in the territory of the Republic of Kazakhstan, as well as oralmans, enjoy the rights and bear responsibilities in the compulsory social health insurance system on an equal basis with citizens of the Republic of Kazakhstan, unless otherwise provided by this Law. Medical assistance is provided to labor migrants within the framework of interstate agreements. If there are no such agreements, then labor migrants will receive medical care under the VMI and for diseases that pose a danger to others on a free basis.

99

How will individual entrepreneurs pay contributions to the FSMS?

Individual entrepreneurs pay from July 1, 2017 - 5% of the size of 2 minimum wages (minimum wage).

According to forecasts, in 2018 the minimum wage will amount to 28,284 tenge, which means that the contributions of individual entrepreneurs will amount to 2,828 tenge per month. You can pay both monthly and in advance for a longer period.

Just like employers, individual entrepreneurs are familiar with the payment system, by analogy with pension contributions. It should be noted that these transfers can be made with or without opening an account, all of them are made through second-tier banks or Kazpost branches.

one hundred

What is included in the category of socially significant diseases and how will they be funded?

Socially significant diseases include: tuberculosis, disease caused by the human immunodeficiency virus and carriers of the human immunodeficiency virus, viral hepatitis B, C, malignant neoplasms, diabetes mellitus, mental and behavioral disorders, cerebral palsy, myocardial infarction (first six months) , rheumatism, systemic lesions of the connective tissue, hereditary-degenerative diseases of the central nervous system, demyelinating diseases of the central nervous system.

There is also a category of diseases that pose a danger to others. These include: disease caused by the human immunodeficiency virus and carriers of the human immunodeficiency virus, Crimean-Congo hemorrhagic fever, diphtheria, meningococcal infection, poliomyelitis, sexually transmitted infections, leprosy, malaria, anthrax (pulmonary form), tuberculosis, cholera , plague, typhoid fever, viral hepatitis, mental and behavioral disorders.

Citizens suffering from socially significant diseases receive medical assistance in medical organizations within the framework of the guaranteed volume of medical care.