Social Health Insurance Fund - Your health protection
OSMS is a complex reform involving medical and financial issues. That is why the Social Health Insurance Fund pays special attention not only to information, but also to the development of feedback channels to provide individual advice to each interested person on the quality and volume of medical services provided.
Information about the results of the work of the Branch of the Fund was provided by the director of the branch for the East Kazakhstan region of the NAO "FSMS" Galymzhan Abilov – «Experts of the monitoring department of the Branch constantly monitor the quality and volume of medical services provided, within the framework of the GOBMP and OSMS. According to the results of monitoring for 2020, more than 118 thousand defects were detected in medical organizations of the East Kazakhstan region. The main violations for 2020, detected during monitoring, are deviations from the standards of medical and diagnostic measures, poor-quality maintenance of medical documentation.»
This year, the Foundation plans to make changes to the quality monitoring system. Proactive monitoring will be implemented, which is aimed at identifying and preventing conditions and causes that lead to violations of the order of provision of medical services and the rights of patients.
Now, if a defect is detected, the supplier must eliminate the identified defects within 45 calendar days from the date of signing the conclusion.
defects and unfulfilled obligations. If the defects are not eliminated within the specified period, financial penalties will follow.
The Foundation notes that the innovation will increase the availability and quality of medical services and make more trusting relationships with suppliers.
"The branch of the fund is constantly working to protect the rights of consumers of medical services and explanatory work with the population: a single Call center 1406 is organized to consult the population on the issues of GOBMP and OSMS, payment methods and the presence of debt. In each regional branch of the Foundation, offices for the reception of citizens are organized. Managers of medical organizations should take advantage of this opportunity to eliminate defects and strengthen the work of the patient support service and internal quality assessment. Systematically analyze and conduct an examination of the quality of the work of secondary medical workers on the correctness of filling out medical documentation, as well as the completeness and timeliness of medical appointments," the head of the branch of the Federal Medical Service said.
Our experts will review each request and take action. For example, last year, the Fund's Branch received 17 written requests from individuals through the e-government PEP portal, 29,534 consultations through the Qoldau 24/7 mobile app. 509 complaints and 578 thanks were issued to medical organizations of East Kazakhstan region in the Aikey CRM portal. All complaints were considered by the employees of the Branch in a timely manner, with an operational solution. 316 applications for adjustment of insurance statuses for SMEs, 889 applications for assignment of temporary status were considered.
One of the key tasks of the Foundation is to protect the rights of the patient. In this regard, the fund's experts monitor the quality of medical care, as well as check the reasons for refusal to provide it individually for each case
The foundation is interested in protecting the rights of patients and encourages the public to report the facts of poor-quality provision of medical services, or about refusals to provide them through one of the available feedback channels – the Qoldau 24/7 mobile app, the telegram bot @SaqtandyryBot, the official website of the fms.kz and contact center 1406.
Summarizing the words of Galymzhan Abilov, Director of Filal for East Kazakhstan region of the FSMS, " Our goal is a competitive and transparent market for medical service providers, this is the only way to quality medicine." It can be added that the FSMS in everyone's life becomes not only a defender of our health and rights, but also a kind of link or bridge between medical institutions and the patient, for the latter to receive timely, high-quality and complete medical care within the framework of the OSMS.