The problems and solutions of MSHI were discussed at "Atameken"

Today on 13^th of September 2017 at the site of the National Chamber was held an expanded meeting of the Committee of the pharmaceutical, medical industry and medical services of the Presidium of NCE RK "Atameken". The meeting was attended by the leadership of the Ministry of Health of the Republic of Kazakhstan, as well as employers from all regions.

Yuliya Yakupbaeva, Deputy Chairman of the Management Board of NCE RK “Atameken” noted that on 8^th of September was held a round table in Astana, during which the issue of introduction of MSHI was discussed with representatives of the Ministry of Health and the medical community.

"Today, employers and individual entrepreneurs are invited to discuss the implementation of the OSMS system on the other hand - from the payers of contributions and the recipients of services," Yulia Yakupbaeva stressed.

Dzhambulat Sarsenov, Chairman of the Committee for Pharmaceutical, Medical Industry and Medical Services of the Presidium of NCE, in his speech noted: "We are looking for possible ways to optimize the provisions of the Law on MSHI. Joint work with the Ministry of Health is very important for us, because it is connected with the high social importance of the implementation of MSHI in the Republic of Kazakhstan, affecting the interests of the whole business, the business community and all citizens".

In turn, Yuliya Yakupbaeva raised the issue of the health system's readiness for reform.

"The reform helped to solve problems that had not been paid attention before. Let's say, the question of involving the self-employed population in the development of the country's economy. We are in dialogue with the Ministry in order to optimize the work, improve the quality and transparency of MSHI system. With an annual increase in the financing of the health care system, the quality and accessibility of medical care remains insufficient. The introduction of health insurance for simply increasing health care resources will not have the desired effect. Therefore, the definition of total additional funding for health should be based on an assessment of the real needs for such financing. In order to implement an effective MSHI system, it is necessary to analyze the current system of financing of health care and its costs in order to identify the inefficient distribution and use of funds allocated to health care. The Chamber proposes to take the preparatory period to 2020 for a quality reform", - the speaker believes.

"Improvement of quality in the framework of MSHI is planned due to free choice of the doctor and free choice of the clinic. But in January a person will come to the same hospital and be in the same queue. Nothing will change", - she added. The position of the National Chamber of Entrepreneurs was supported by associations and entrepreneurs. Bibigul Malgadzharova, deputy executive director of the Republican Association of Mining and Metallurgical Enterprises, believes that preliminary work must be carried out before implementing something. "We support the position of the National Chamber on the need to postpone the implementation of MSHI until 2020 and suspend the payment of contributions for this period, and during this time to carry out preparatory work: to introduce an information system, an electronic health passport, to provide access to the Internet for all polyclinics", - Bigigul Magadzharova said.

"The Ministry of Health of the RK can’t show how the quality of medical services will improve. You come to the polyclinic, it takes more time to register you. You can get to the paid doctor at the reception in 5 minutes, and to the doctor within the framework of SGBP in 15 days ", - explained Bibigul Magadzharova. "Union of Farmers of Kazakhstan", Association of Security Companies, Association of Light Industry Enterprises, employers and entrepreneurs of Atyrau, Uralsk, Almaty, East Kazakhstan, North Kazakhstan, Kostanay region and other regions also expressed the opinion about the need to extend the implementation of MSHI system until 2020 year and the temporary suspension of the collection of money for this period.

There were also opinions that if they started collecting money, then we need to continue the reform and rectify the shortcomings along the way.

In addition, entrepreneurs commented on the unfairly high rate of contributions to the mandatory social health system for individuals receiving income under civil law contracts: 5%, and it was also proposed to set rates for individual entrepreneurs in the same amount as for physical bodies.

It was also noted that the introduction of a new MSHI system, which establishes the obligation of employers to make monthly compulsory contributions, will make it very difficult to purchase VHI services due to double expenses for health insurance services.

The chairman of the Social Health Insurance Fund Elena Bakhmutova noted that the law is already in force and payments are being made.

 "As long as the law exists, the collection continues. 7 billion 670 thousand tenge are on the account with the National Bank. They can be spent only on payment of medical services. We also need reserves for financial stability of the system. It is impossible to work without a "safety cushion". The information on the listed money will be available on the e-government website by IIN", - Elena Bakhmutova answered on the concerns of entrepreneurs regarding the safety of funds in the light of the negative past experience.

Minister of Health of the RK, after listening to the opinions of the leaders of the association, commented on the situation.

"Since 2015 we have many times gathered and discussed the development of health insurance. Every meeting is extremely important. We did two things - lowered the rates for employers, provided an opportunity for self-employed citizens to pay a minimum contribution and receive service s ", - Yelzhan Birtanov said.

He added that there are different opinions as to the period of implementation of MSHI.

"In accordance with the instruction of the Head of State, made on August 25 at a meeting on the activities of the National Commission for Modernization and on 4^th of September at a meeting of the two chambers of the Parliament, it is necessary to think and understand the basics so as not to stumble again, we will hold a number of meetings. We will also meet not only with business and doctors, but also with civil society. The proposal of the business community that it is necessary to postpone the implementation of MSHI is heard. But it is worth noting that the collection of contributions to create a "financial pillow" should continue", - the Minister of Health of the Republic of Kazakhstan said.

Elzhan Birtanov also said that the system needs more efficiency and in this connection the ministry together with NCE work a lot in terms of PPP development, reduction of the cost of medicines and medical equipment. The Ministry of Health supports the proposal of NCE RK to create a working group to optimize health care costs in order to monitor financial payments.

 "At the same time, all measures for the introduction of e-passport, corporate governance, improvement of tariff policy and, most importantly, digitalization will be implemented, as they are laid down by the State in Health Development Program of the Republic of Kazakhstan "Densaulyk"", - Elzhan Birtanov considers.

"We will work to clearly plan the action plan in the event of a transfer", - Dzhambulat Sarsenov summed up. It should be noted that international practice shows the need for a long preparatory and organizational period for the effective implementation of insurance medicine.