It is planned that from next year the Social Health Insurance Fund will not conclude contracts with PHC providers who have less than 10 thousand attached population. This will allow more efficient distribution of funds among medical organizations, and at the same time protect the rights of patients to affordable, high-quality and timely medical care. The draft order with changes is undergoing public discussion. If they are approved, the norm will not bypass the existing suppliers. This was announced during a meeting with the medical community in the Turkestan region by the Chairman of the Board of the FSMS Sabit Akhmetov.
The number of medical organizations working with the Medical Insurance Fund is growing from year to year. This year, more than 1,900 providers signed contracts with the Fund, of which about 700 provide primary health care. At the same time, the largest number of polyclinics is in Almaty and the Turkestan region. The latter has 59 medical organizations.
Each is financed through a comprehensive per capita standard, which is paid by the Fund on a monthly basis for each attached. Thus, the larger the population of the polyclinic, the more funds it receives. It is more difficult financially for those medical organizations that have less than 10,000, or even 2,000 people attached to them. With a small budget, they incur significant expenses — they need to maintain the building, pay salaries, attract narrow specialists, pay utility bills, purchase equipment, medicines and medical products. Therefore, many medical organizations prefer to manage with one general practitioner and a nurse, transferring up to 90% of medical services for co-execution. As a result, the patient suffers, who has to visit different medical organizations in order to consult a specialist or undergo an examination. This violates the declared principle of access to medical care.
“People trust you with their health. Therefore, your task is to ensure the availability of medical services to the population and their quality, our task is to effectively distribute and pay for the services provided. Everyone should do their own thing and do it well. We are reviewing the procurement rules, and if the changes are adopted, then from next year, contracts with polyclinics that have less than 10 thousand attached population will not be concluded. Those with whom they are already concluded will be given time to consolidate and expand. If the polyclinic fails to recruit the required number of attached population, the contract will not be concluded with it,” commented Sabit Akhmetov during his speech.
According to the head of the Fund, a special role is played by the health departments in this matter, which control the situation in the region and are responsible for the availability of medical care, evenly distributing the population among polyclinics, helping with the purchase of medical equipment and attracting private investors to provide medical care, including within the framework of public private partnership. And given that the population of the Turkestan region has already exceeded 2 million inhabitants and there is a tendency to constant growth, this is a fairly attractive market for private investors.
“It doesn’t matter to us whether it will be a public or private medical organization. The Fund will conclude contracts with those polyclinics that have qualified doctors and appropriate material and technical equipment,” Sabit Akhmetov said.
As an example, he cited a number of modern private polyclinics in Karaganda and Astana, which managed to increase their population by several tens of thousands of people in 3-5 months and, accordingly, receive more funding from the Fund. There is a full range of narrow specialists, as well as full equipment (ultrasound machines, CT, MRI).
However, there are also bad examples of private clinics, the founders of which save on everything: there is no ventilation in the buildings, repairs are needed, etc. One head of the Fund noted for himself when visiting medical organizations in the Turkestan region and recommended that the management bring everything in line with the standards. If the situation is not corrected, such suppliers face termination of the contract.
The head of the health department of the Turkestan region, Askhan Baiduvaliev, in his speech emphasized that over 75% of the population of the region are residents of villages. To ensure their accessibility, the issue of consolidation of medical organizations is being addressed. In addition, many settlements will have access to all consultative and diagnostic assistance at the Sairam Central District Hospital, which is preparing to become an inter-district hospital and is already being equipped with all the necessary equipment.
During the meeting, he also raised problematic issues and asked to revise the rates for rehabilitation and ambulance, to develop a one-day surgery rate for patients from the regions so that they could remain under the supervision of doctors for some time after a minimally invasive operation to avoid complications.
The ambulance was not only voiced by the problems