Title: Kazakhstan Gears Up to Launch Social Health Insurance: Twenty Years Ago Yelzhan Birtanov Was a Physician Working in One of Kazakhstan's Hospitals, Today He Is Helping to Roll out Universal Coverage of Health Services in the Central Asian Country. He Talks to Vijay Shankar Balakrishnan
Abstract: Q: How did you become interested in care? A: My parents were physicians and I grew up in a medical atmosphere. While I studied medicine I also worked as a junior nurse in a hospital doing night shifts. Before graduating in 1994, I visited the University Medical Centre of Arizona University in Tucson, in the United States of America. I was impressed to see one of the most advanced health-care systems and was painfully aware of the stark differences between this and the care in my country at that time. Q: How well could the Kazakh people access care during the transition to the market economy after the end of the Soviet Union? A: The first years after independence in 1991 were the hardest. I was working in a hospital at the time and remember the shortages of medicines, medical supplies and devices. Patients often had to bring their own medicines, food and blankets to hospital and pay under the counter for services. Physicians' salaries were very low and much of the financial burden was on the patients. It was difficult for the government to maintain a network of primary care centres and hospitals providing care and to pay workers adequately because of our financial difficulties due to the abrupt transition to a market economy. Many nurses and doctors felt demoralized and left the health-care system. Q: The declaration of Health for all was adopted in Alma-Ata, the former Kazakh capital, in 1978 by WHO's Member States. Yet primary care was largely undeveloped in Kazakhstan and many other parts of the former Soviet Union before it broke up in 1991. How did the Kazakh system evolve after that? A: We tried different financing models before starting to roll out universal coverage of services from about 2001. The government wanted to provide all levels of care, from primary care, immunization, to secondary and tertiary care. But it was difficult and many services were not included. Under the first national programmes that were rolled out from 2005-10, we increased the number of general practitioners and primary care centres and introduced new healthcare services, such as check-ups for cardiovascular diseases at primary care level, and we increased efforts to encourage evidence-based practice among health-care providers. A unified information system was established in hospitals and clinics throughout the whole country. In the next national programme for the years 2011-2015, we expanded some services, such as screening for noncommunicable diseases, and we increased the number of general practitioners by 30%. Q; How did you finance these recent reforms? A: We introduced new payment methods and financial incentives, such as capitation at primary care level (a system whereby general practitioners are allocated a set sum for each head of population assigned to them) and diagnosis-related group payment methods for hospitals and clinics (a system for classifying health-care services for insurance reimbursement purposes). In 2014, we introduced the capitation payment method which allowed us to increase health-care financing at primary care level. Overall health-care spending has increased 1.5 times: from US$ 1.69 billion (562.8 billion tenge) in 2010 to US$ 2.61 in 2014. Q: In 2008, primary received only 16% of the national budget compared with 53.4% for inpatient care. How much has primary care provision increased in recent years? A: The demand for inpatient services has declined because many patients can now see a general practitioner. The average hospital stay is 27% shorter than it was in 2010 and the number of patients seen at primary care level has increased by 23.5% since 2010. The 2016-19 national programme, Densaulyk, which means health in Kazakh, also seeks to bolster primary care. The first goal is to implement public policy incentives to prevent and manage diseases at primary care level, the second is to achieve a more effective and financially stable health-care system and the third is to introduce mandatory social insurance next year. …
Publication Year: 2016
Publication Date: 2016-11-01
Language: en
Type: article
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Cited By Count: 3
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