Today the Minister of Healthcare and Social Development of Kazakhstan Tamara Duisenova held a meeting with Deputy Akim of regions, Astana and Almaty cities on the introduction of mandatory social medical insurance (further - MSMI). In the future, they will talk about basic principles of the MSMI akims of cities and districts, heads of territorial state bodies, which, in its turn will inform citizens. Thus, started the second stage of the informational-explanatory works, carried out by Ministry of Healthcare and Social Development of the RK (further – MHSD), which involves work with the wide population on the principle of "Region, district, village".
Tamara Duisenova speaking at a meeting emphasized that the implementation of the MSMI will help to build a financially-stable healthcare system of Kazakhstan on the example of the developed countries to improve the availability of medical care and expanding outpatient drug coverage, will provide joint and several liability of the state and citizens for their health. In addition, MSMI will facilitate the introduction of new technologies to improve the quality of medical services by promoting competition between their suppliers, wages and professional growth of medical workers.
Vice-Minister Yelzhan Birtanov told to the Deputy Akims on the distribution of functions between MHSD of RK, local Executive boards and social medical insurance Fund (further - SMIF).
So, in the system of MSMI, the Ministry will develop policies in the field of health; to determine the priorities and demands in medical services packages of guaranteed volume of free medical care (further – GVFMC) and MSMI; to approve the tariffs for the provision of medical services in the framework of GVFMC and MSMI; to exercise state control over observance of standards in the field of healthcare.
"On local executive boards entrusted functions to ensure the accessibility of medical services to all citizens, infrastructure development and improving the effectiveness of providers of medical services in the region, providing medical care in the region through system of healthcare organizations, participate in the planning of the requirement of medical services, providing the development of human resources of healthcare. Jointly with territorial departments of the Committee for quality control of medical and pharmaceutical activities at akimats will take part in the licensing of medical and pharmaceutical activity", - Yelzhan Birtanov said. SMIF will carry out the accumulation of deductions and contributions for MSMI; to create reserves and to place surplus funds in financial instruments via National Bank of Kazakhstan; to plan the cost of medical care in the system MSMI; to purchase medical services according to the demands of the population; to promote the efficiency and rationalization of the structures of healthcare delivery; to monitor the performance of providers of medical services contractual obligations for the quality and amount of medical care.
In turn Tamara Duisenova emphasized that one of the main tasks of local Executive boards are to ensure the readiness of regional medical organizations to participate in the MSMI, i.e., hospitals and polyclinics must meet the minimum standards for the selection SMIF providers of medical services.
As previously reported, the first phases of informational-explanatory works were held from June 9 to July 28 of this year for medical workers of the country. During this period, special mobile group, which consisted of prominent figures of the healthcare system and the heads of territorial departments of the Committee on payment for medical service of the MHSD of RK, the healthcare departments of regions, Astana and Almaty cities held more than 400 meetings and seminars for the medical community of the Republic? In total were covered over 38.3 thousand medical workers, including 3445 managers of 957 medical organizations.
We remind that in Kazakhstan will introduce a medical insurance system, tailored to international best practices, based on mutual responsibility of the state, the employer and each individual. At the same time the government will provide contributions for economically inactive population. Employers provide for employees. Employees and self-employed people registered in tax bodies – for themselves.
The state reserves the right to provide citizens with a guaranteed volume of free medical care (further – GVFMC): the provision of medical care in socially significant diseases, emergencies, emergency medical service, sanitary aviation and vaccination.
In order to ensure the universal right to health care by 2020 to uninsured citizens in the framework of GVFMC will be provided outpatient care with outpatient drug provision.
In the framework of the MSMI will be provided: outpatient care with outpatient drug provision to insured citizens, inpatient medical care, high-tech medical services, hospital-replacing technologies, long-term nursing care.
In addition, citizens, the participation in voluntary insurance, can receive medical services, unexpected system of MSMI, on the basis of contract concluded with private insurance companies.
The current legislation provides that employers and self-employed citizens will begin to make contributions to the social medical insurance Fund (further – SMIF) dated January 1, 2017, the state - from July 1, 2017.
The state contribution rate for special categories of citizens will be 7% of the average wage. The rate will gradually increase: 4% in 2017, 5% in 2018, 6% in 2023, from 2024 - 7%.
The overall rate of employers' contributions will amount to 5% of income, while contributions starting from 2% in 2017, 3% in 2018, 4% in 2019 and from 2020 - 5%.
The contribution rate self-employed people (individual entrepreneurs, private notaries, private bailiffs, lawyers, professional mediators, individuals who receive income under contracts of civil-legal character) will be 7% of income. At the same time 2% in 2017, 3% in 2018, 5% in 2019 and from 2020 - 7%.
Employees will begin to make deductions from 2019 - 1% of income, from 2020 - 2%.
From paying contributions to the social medical insurance Fund are exempted 15 categories of citizens, 12 of whom are socially vulnerable layers of the population, as well as military personnel, employees of special state and law enforcement boards. To socially vulnerable strata of the population include:
- mothers with many children, awarded pendants "Altyn Alka", "Kumis Alka" and got before the rank "Mother–heroine" and awarded the order of "Maternal glory" I and II degree;
- participants and invalids of the GPW;
- persons, registered as unemployed;
- persons, studying and living in residential institutions;
- persons enrolled in full-time education in the organizations of technical and professional, postsecondary, higher education, and postgraduate education in the form of residency;
- persons who are on leave in connection with childbirth, the child, adoption of newborn child, to care for a child under the age of 3 years;
- disabled pregnant women and invalid who actually raises a child up to the age of 3 years;
- persons, serving a sentence in prisons, with exception of minimum security institutions;
- persons, held in temporary detention facilities and pretrial detention centers.
It noted that the volume of provided medical care in the framework of the MSMI would not depend on the amount of the contribution in SMIF. It is sufficient that these payments made regularly.
In accordance with the already existing in the Kazakhstan practice, it proposed, that control of receipts in SMIF to consolidate the state revenue Committee of the Ministry of Finance of RK.
According to experts, in the result of introduction of MSMI significantly improve the level of medical care in the country, will also be opportunity to increase the salaries of doctors. The hospital will be able to purchase high quality equipment and expensive medicines. MSMI allow the person to be examined and if necessary, to receive treatment, not allocating cash from their budget.
Also at the meeting were discussed issues of social security of citizens, the implementation of the "Orleu" project and "Road map of employment 2020" program (further – "RME 2020").
Vice Minister Svetlana Zhakupova said that from July 1, 2017 will change the order of the appointment of basic pension (the size will depend on the length of participation in the pension system), and from January 1, 2018 introduces new accumulative component of the pension system by establishing additional 5% compulsory pension contributions of the employer.
Thus, the pension payments of citizens will consist of the following parts:
- basic pension payments appointed in accordance with the length of participation in the pension system;
- pension payments to the persons having working experience of minimum 6 months to January 1, 1998;
- pension payments from SNPF at the expense of individual 10% compulsory pension contributions of the employee, additional 5% compulsory pension contributions of the employer, 5% of mandatory professional pension contributions (employed in harmful (particularly harmful) working conditions) (from 2023);
- voluntary pension savings.
These measures will ensure that the pension provision of the citizens with international standards and recommendations of the International labour organization (size of pension should not be less than 40% of the salary).
However, from January 1, 2018, establishes a new procedure of targeted social care (further - TSC) to families with incomes below 50% of the subsistence minimum for each family member, with the condition of mandatory participation of able-bodied family members in active measures to promote employment, which will be granted in replacement of existing:
- special state allowances (further - SSA) large families;
- state child allowances till 18 years for low-income families;
- targeted social care to low-income households.
The new TSC will be classified into 2 types: unconditional and conditional cash assistance.
Unconditional cash assistance will be provided to those families in which no able-bodied members (e.g., families of disabled or elderly pensioners), or families of able-bodied members of which for objective reasons are unable to participate in measures promoting employment (for example, a single mother with children of preschool age). For these families, mandatory participation in employment measures for benefits is not required.
Conditional cash assistance will be given to families, having in its composition at least one able-bodied member, subject to the conclusion of the social contract and mandatory participation of all able-bodied family members in employment promotion measures.
"From 2014 the new approaches to social care have been approved in Akmola, East Kazakhstan and Zhambyl oblasts where it was implemented the pilot project "Orleu", providing conditional cash assistance to persons who have signed the social contract. From July 1, 2015 a similar regional pilot projects were launched in 38 districts and cities have participated 20,2 thousand persons. The project implementation contributed to the increase of per capita income of its participants more than 2 times; the involvement of about 90% of the working participants in employment promotion; reduction of recipients of address social care and state allowances to children up to 18 years in the whole country by 31.8% and 2.1%, respectively. This year a pilot project is being implemented in all regions of the country (132 city and district). For these purposes in the Republican budget provides 1.4 billion tenge. It is necessary to actively involve people in participating in the project "Orleu", because it is an effective tool for poverty reduction among population", - Svetlana Zhakupova said, referring to Deputy Akim.
She also noted that local Executive boards should provide access to the single volume of special social services to persons in difficult life situations.
In turn, Vice-Minister Birzhan Nurymbetov speaking about the implementation of "RME 2020", recommended local Executive boards to take strict control of tenders for the construction and repair of objects in the first direction of the program, ensuring employment through development of infrastructure and housing and communal services.
The Deputy Minister also advised the staff of managements of coordination of employment and social programs and employment center to intensify work on involvement of young people in "RME 2020" with using new tools:
- for not enrolled students, unemployed graduates and unemployed youth are provided training in computer literacy, entrepreneurship, English language (no employment obligations).
- for graduates of Universities and colleges, experiencing problems with the location of first employment, in the framework of the third direction of “RME 2020” will expand the component "Youth practice" salary increases from 38 to 53 thousand tenge.
- for students who failed to pass the threshold level will be provided training to work specifically at the request of employers, including training in another region with corresponding payment of the trip.
At the end of the meeting, Tamara Duisenova emphasized that local Executive boards should ensure the participation of unproductive self-employed people and individuals employed under "RME 2020", in the pension system, and in the future – in MSMI system.