At the site of NCE RK "Atameken" were discussed draft amendments to the law "On compulsory social health insurance"

The meeting was attended by Vice-Minister of Health and Social Development of the Republic of Kazakhstan Elzhan Birtanov, representatives of more than 70 large companies - the employers, the deputies of the Mazhilis of the Parliament, representatives of the expert community, the private health insurance companies.

The main question of the business community to the developers of the law: why does the significantly increased financial burden on the employer weakly correlate with the quality of the state of medicine in the circumstances of the complete absence of the right for the choice among entrepreneurs in terms of which system to use: mandatory or voluntary?

Deputy Chairman of NCE RK "Atameken" Yuliya Yakupbaeva called the main concerns of the business community: the poor quality of health services and, above all, family medicine, which entails an increased flow of complaints from the regions on the absence of pediatrics, queues in public health facilities, the lack of e-health, facts of hypo - and overdiagnosis.

The issue of professional medical examinations at the enterprises is also very acute. Prophylactic examinations are an important part of the health program and are required at the conclusion of collective agreements between employers and the workforce. The mechanism of mandatory health insurance system doesn’t include occupational health examination, assuming it is a direct responsibility of the employers.

According to Yuliya Yakupbaeva, questions of compliance with the rules of the collective agreement were raised last year, during the adoption of the basic law. And the Ministry of Health promised that after the list of services mandatory health insurance is completed and the cost of the package of services within mandatory health insurance will be clear, it will be possible to understand how to distinguish between services of voluntary medical insurance (VMI) and services of mandatory health insurance with benefit for workers. In fact, as shown by the proposed amendments, VMI is "left behind" in the system of social medicine.

A representative of the Association KAZENERGY Togzhan Kozhalieva explained that as part of the social package of the major oil companies family members of the company's employee are also attach to health care plan. To receive high-quality services, enterprise buy for employees voluntary health insurance policies. In addition, the largest mining companies have a medical unit, on which they spend annually on average up to 500 million tenge.

With the introduction of mandatory social health insurance, an employer will pay for the health care of employees contributions to the state fund.

Representatives of KAZENERGY on the example of one of the member companies of the association told what costs will incur employers. Approximate calculation of KAZENERGY shows that a company with a strength of 5 thousand people will pay for mandatory health insurance at a rate of 2% in 2017 713.4 million tenge, and in 2020, with growth rates of up to 5% - 1.7 billion tenge. Contributions per worker over the same period of time will increase each year from 128.4 thousand tenge to 321 thousand tenge. The difference is 4.3 fold. The quality of medical services still remains questionable.

At the same time, according to the calculations of KAZENERGY, an employer pays annually for VMI only 388.7 million tenge. 70 thousand tenge per employee for each year. And in order to optimize the expenses, of course, it is advantageous for an employer to work with theVMI system.

Employers are favor of introduction in the system of mandatory health insurance the principle of co-payment, which involves the provision of health care in private clinics by a policy of VMI, preserving the quality of medicine, and the payment for these services to compensate expenses of private clinics will be made by the Fund, that is, from the social insurance system.

Representatives of employers' asked to balance settlements to avoid additional payments from the payroll. And most importantly - to avoid social tension in the industrial oil production areas in the city of Zhanaozen, Aktau, Atyrau, where, according to a representative of KMG EP, in some areas, there is a lack of modern equipment and medical personnel, capable to provide quality medical care.

The representative of the Association of Insurers of Kazakhstan (AIK) Marina Shipovalova said that in 2015 insurance companies spent almost 20 billion tenge on 1.7 million insured customers, providing maximum service package.

According to M. Shipovalova, the insurance market has proposals for consideration within the framework of the legislative amendments. First proposal - to refer to deductions VMI premiums in calculating the corporate income tax of an employer. Currently, VMI products are paid by an employer, VMI is not purchased by individuals. Second proposal - to study the issue of combined funding of VMI and mandatory health insurance. Third proposal - it is necessary to write in detail the list of rendered services within mandatory health insurance package. While it is not determined, it will be difficult for an employer, an insurance company and the Ministry of Health to imagine what is the scope of the health care services in question, and how much they will cost.

Another important question inclusion foreign nationals, working in Kazakhstan, in mandatory health insurance. Contracts with a Kazakhstani employer should provide a benefit package with the obligatory presence of VMI policy. Foreigners are accustomed to good quality medicine, however, the law includes them in poor medical system.

For example, the amendments provide for the mandatory presence of foreigners in the system, "if the payments for them is carried out not less than 11 months in the last 12 calendar months". It turns out that a foreign specialist can get an access to health services only if he is in the system for 11 months. What should an expert do if he is in the country for less than 11 months? Is he deprived of the right for medical care? And expats are usually highly paid. "We believe that the issue of payment of fees for foreign citizens temporarily or permanently residing in the territory of the Republic of Kazakhstan, stateless persons, needs to be reconsidered. It is necessary either to abolish it, or to provide other conditions for participation of such people in the mandatory health insurance system. Many migrant workers are illegal in the country, and it is impossible to keep track of their payments for mandatory health insurance. In fact we get a law, which doesn’t work, or we do not understand how it will work", - says Marina Shipovalova.

Vice - Minister of Health and Social Development of the Republic of Kazakhstan Elzhan Birtanov commented on the proposals of entrepreneurs. Ministry of Health and Social Development support the proposal of entrepreneurs:

- Involvement of medical assistance companies as health care providers and entities of mandatory health insurance. This medical assistance companies must comply with the requirements established by the Rules of procurement of services from health care entities in the mandatory health insurance system;

- Automatic inclusion in the list of suppliers, of those who have the right to enter into an Agreement for the provision of medical care within mandatory health insurance and medical organizations regardless of form of ownership, which are certified by the National Accreditation Centre;

- Developments of the procedure for selection of service providers in an electronic tender. The Ministry decided to form an e-register of potential suppliers of the Fund of mandatory health insurance;

- The participation of the major employers in the Commission for the selection of health care providers.

The Chairman of the Pharmaceutical, Medical Industry Committee and medical services Dzhambulat Sarsenov highlighted the importance of these meetings in the framework of joint responsibility of the state, employers and citizens in ensuring the nation's health.

Meetings with the business community, the leadership of the Ministry of Health and Social Development will continue. They plan to discuss additional proposals on tariffs, development of voluntary medical insurance, pharmaceutical and other industries.