the results of the implementation of the United National Health System
The President set the tasks that are aimed at achieving the goals of Kazakhstan nation health promotion since health is an important indicator of economic development of the country and the money spent on health care is "profitable" investments that bring huge economic benefits for the country's budget.
Comprehensive improvement of the health system that will lift it to a qualitatively new level of development through a radical change in the technology of patient oriented primary health care (hereinafter - PHC) is the main task of the health system given by the President in the framework of the State Program for the Health Development "Salamatty Kazakhstan for 2011-2015 "(hereinafter - State Program).
United National Health System (hereinafter - UNHS) which was integrated according to the instructions of the President in 2010 advocates in the context with its principles as the unique mechanism of implementation of tasks and upgrading health care. A policy of improving constituents of PHC sector with its adaptation to the principles of UNHS is implemented in the health system within the framework of the State program. Access to health care and improving the efficiency of services is provided to the population including rural residents. In this regard, the priorities are the development of social services, the development of transport medicine in the form of mobile medical complexes, as well as air ambulance and route medical aid stations.
The trend of an annual increase of funds allocated for the development of integrated primary health care sector is an event worthy of attention from the government and now it finds its development throughout the country. It would be impossible to fully assess the public policy aimed at strengthening the capacity of primary health care without a component of motivation of the sector employees. Stimulating component of the per capita standard (hereinafter - SCCS) covers every organization of primary health care and more than 35 thousand of health workers and 2.5 thousand of social workers. As a result of PHC sector performance evaluation average size of a quarterly surcharge amounted to physicians is 85 thousand tenge, 48 thousand tenge for nurses and 32 thousand Tenge for social workers.
A number of priorities and actions to improve the methodology of planning, payment, distribution of SCCS and effectiveness of screening programs by motivating health care workers and social workers of PHC are identified for 2013.
A pilot project on the introduction of integrated per capita standard was conducted in 15 primary health care organizations in order to improve financing of outpatient care in 2012 in accordance with the order of the MoH from June 14, 2012 №415 «On the pilot introduction of payment of outpatient care on integrated per capita tariff".
An analysis of the results of the pilot project showed the following:
- The relationship between understaffing of GPs and DCD funding was identified and confirmed, it has led to an increase of the GP’s in pilot organizations;
- The volume of actually consumed consultative and diagnostic services has reduced;
- The economy of means that were aimed at motivating health workers of PHC who impacted on the decline in DCD was received.
The positive results achieved within the framework of the pilot project enabled the introduction of a comprehensive per capita tariff for organizations providing PSH and declare the decision of the Government of the RK from December 7, 2009 №2030 «On Approval of the Rules of compensation of expenses to the organizations of health care at the expense of budgetary funds"
The positive results achieved within the framework of the pilot project allowed UNHS to adapt its principles in PHC sector and continues to develop the hospital sector within the framework of its competence. In order to create conditions providing the population with the available stationary and hospital-replacing help the amount of funds allocated from the republican budget increases every year with the property of the trend.
The implementation of the "free choice of hospital" principle has allowed the patient to participate in improving the quality of medical services and the formation of a competitive environment.
There is an annual positive growth trend of citizens who exercised their right to choose a hospital for planned hospitalization. As a result, in 2012 this number of residents in relation to 2010 increased by 2.5 times and among rural residents by 3 times. Number of dynamics of hospitalized by free choice in the NRI and SC increased by 2.2 times and among rural residents by 4 times.
Thus, in the reporting year, about 780 thousand people 46% of which were rural residents were hospitalized using their right to free choice of hospital. 92% of the citizens were treated in home regions and 2% went to other regions; 6% of the population received specialized medical care in the republican clinics. Of a total number of hospitalized people 93.9% were hospitalized within 10 days of waiting and only 6.1% of the citizens expected the date of hospitalization for more than 10 days.
There are positive trend indicators of hospital care in the republic in the Single Payer system for the 2012. The number of patients who received the hospital-replacing care during the reporting period increased by 34% compared with 2010.
Management in the organization of medical diagnostic aid develops in the context of UNHS. It is an independent and rational management of beds fund. So, 2717 beds were reduced on unclaimed profiles of medical services throughout the country in 2012. In the reporting year, the number of beds repurposed for more necessary profiles of medical care increased by 7.3% compared to 2011. As a result of optimizing the number of beds decreased by 1.1% at the end of 2012 in relation to the number of beds the same period of 2011.
Healthcare organizations continue to work on creating a model of "the motivated employee and the satisfied patient" relationship. This model is aimed at increasing the level of public satisfaction with the quality of medical services and physician’s interest in the final results of his work.
Motivation principles of medical staff were improved and amendments to the interim order of Minister of Health of the Republic of Kazakhstan dated November 10, 2009 № 689 "Rules of remuneration of health workers depending on the volume, quality of medical care and the branch system of encouragement" was approved in 2012.
By the end of 2012 the number of health care organizations that have implemented staff motivation has increased (in the reporting year - 65% in the past year - 31%). Differentiated payment for the final results of activities covered more than 34% of health care workers involved in the provision of GVFMC. As a result, the average size of differentiated monthly payments with respect to motivated persons of republic hospitals has amounted 30.1 thousand Tenge to physicians and 15.2 thousands for nurses.
As it is known, all the principles of UNHS are smoothly implemented only in terms of developed management of health care organizations that is likely to be achieved with the autonomous status of the provider. Now the total number of health enterprises with right of economic management is 54% of suppliers.
Training is one of the important elements of the implementation of an effective management system. So in the reporting year, more than 3,000 professionals of guiding rank were trained in planned order on issues in health care management. But this type of training is more just a theoretical nature. Therefore, to improve the efficiency of resource management a new form of learning within the project "Today the best is you, tomorrow - everyone" was introduced, "growth points" of the best medical institutions of the republic for the transfer of actual management technology in practice on management subjects are determined and prepared. These "points of growth" trained each project participant to effectively manage their income and expenses through the development of "Business Plans".
A system of payment for medical services by DRG is introduced since 2012 within the context of measures for ensuring attractive rates for health care organizations and administrative support for tariff is provided:
- Fare includes funds for training of health professionals - 1.1 billion Tenge;
- Tariffs on HRT increased to ¾ per case in terms of outpatient surgery;
- Rate of 1.3 is set to the tariff for HSMC.
Order of the Minister of Health on 30 December 2011 №936 «On approval of tariffs for medical organizations financed from the state budget for medical, communal and other expenses, the correction coefficients, coefficients of input intensities and additional compensation of employees of health organizations, medical costs for inpatient and hospital-replacing care" was designed to ensure the payment of hospital and inpatient care which improved during the reporting period. The system of payment by DRG in international practice shows itself as a financing tool, control for cost, efficiency and quality of medical care in hospitals.
A new information system “Electronic Register of cancer patients" based on web technology" was developed within improvements in financing system of oncological service. The goal is the automation of formation processes of the electronic register of cancer patients and compensation of oncological clinics expenses in delivery of health care to the specified category of patients with ensuring compliance of treatment quality to the international standards. The system covers all medical health organizations providing care to oncology patients within the GVFMC.
In 2012 healthcare organizations had the opportunity to purchase equipment with a cost of up to 50 million Tenge through leasing and compensation of leasing payments in the republican budget.
Favorable and equal financial conditions for both private and public health care providers established within the UNHS attracted the provision of GVFMC by nongovernmental Health Organizations and therefore, their share rose from 12% in 2010 to 15.36% in the reporting year.