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Health insurance is for people’s benefit

This year, compulsory social health insurance (CSHI) is introduced in our country, and we are talking about it with CEO of Social Insurance Fund, Elena Bakhmutova.
- The first question: what is the essence of this health insurance system?

- The main principle of this system is the joint responsibility of the state and the population. This means that each participant makes insurance contribution corresponding to his income and social status and has equal right at that for a full range of medical services and remedies included in the CSHI package.

With the introduction and development of the compulsory social health insurance system in Kazakhstan the overall cost of healthcare will increase, while the citizens’ costs will reduce. It is especially important against the backdrop of the World Bank data, according to which at present in our country the citizens’ private expenses for medical care exceed 35%, while in OECD countries they hold at 20%.

The state makes contributions for socially vulnerable population categories, employers - for their employees, and the self-employed - for themselves. Participants in the system are not only all the citizens of Kazakhstan, but also repatriates and foreign nationals residing in our country.

The first contributions and deductions to the Social Health Insurance Fund start already in July 1, 2017. From this time on, employers and individual entrepreneurs will pay, in 2018, the state and the inactive population join in, and in 2019 - wage earners.

- What should one do now, before the launch of the system from July 1?

- First of all, you need to determine your social status in the CSHI system and check the attachment to the clinic. This is most important, since it is through the clinic that you access the healthcare system. This should be done before June 31.

The sizes of contributions differ, depending on the category.

First of all, the state pays for 14 preferential categories of the population. These include children, persons registered as unemployed, unemployed pregnant women, unemployed persons who actually raise children under 3 years old, persons on child birth and on newborn child adoption leave, non-working people taking care of a disabled child under the age of 18, recipients of pension payments, including people with disabilities and participants in the Great Patriotic War, people serving jail sentences, with the exception of the minimum security institutions, those contained in the detention centers, non-working oralmans, mothers with many children, Altyn alka, Kumis alka or Mother Heroine award holders. In this list are also disabled people, persons in full-time secondary, technical and vocational, post-secondary, higher and postgraduate education.

The state begins to pay contributions for the named categories from next year.

- How will the Fund collect and distribute the received incomes?

- Incomes will be coming from the state and from the population. In the first case, the money will go through the Finance Ministry, and then through the state corporation Government for Citizens in accordance with the list of insured citizens of preferential categories - to the asset account of the social Insurance Fund in the National Bank. Employers, individual entrepreneurs and inactive population make deductions and fees through second-tier banks, which are then transferred to the National Bank through the state corporation. These assets will be used to pay for medical services under the fund's contracts with suppliers, that is, medical organizations. Another player in the process is the State Revenue Committee of the Finance Ministry, which will administer and monitor the contributions, take action in case of non-payment.

- What kind of medical services will the insured citizens receive?

- They are entitled for a full amount of medical care and medicines provided by the CSHI package. It includes outpatient and in-patient care with remedies, rehabilitation treatment, high-tech care, palliative and nursing care.

More detailed lists of services and medicines of this package will be determined later by the relevant government regulations.

It is important to know that a person can receive medical services under CSHI within three months from the date of his last payment to the Social Insurance Fund. On the expiry of this period, to return to the system, he will need to pay fees for the missed period, but not more than for 12 months. In addition, before January 1, 2020, a transitional period is established, during which, if you contact a polyclinic in the absence of insurance, you can be served and receive outpatient and emergency inpatient care. However, free inpatient care for it will already be unavailable - it will be provided only to participants of the CSHI system.

At the same time, every Kazakhstani citizen, regardless of whether he paid contributions for compulsory insurance or not, and after January 1, 2020, will be able to receive a guaranteed amount of free medical care. This package includes preventive vaccinations, ambulance, emergency medical care, inpatient and inpatient-substitution medicare for socially significant diseases, as well as for diseases posing danger to others.


Author:
Irina Ignatova
18:33, 10 April 2017
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