About compulsory social health insurance

The system of compulsory social health insurance is a state system of social protection of interests in the sphere of health protection.

Compulsory social health insurance guarantees equal access to medical and medicinal care from the funds of the Social Health Insurance Fund to all insured citizens of Kazakhstan regardless of gender, age, social status, place of residence and income.

BASIC GOALS

Achieving social solidarity by strengthening one’s own health and sharing the burden of protecting public health
Ensuring the financial stability of the system by creating a system’s resilience to external factors and increasing costs, as well as transparency and fairness of the system
Increasing the efficiency of the system through ensuring high competence and competitiveness of the system, achieving the final results of accessibility, completeness and quality of services

PRINCIPLES

UNIVERSALITY

All permanent residents (universal coverage) must participate in the system and each of them must pay contributions (or the state pays for it)

SOCIAL JUSTICE

The contributions of the economically active population depend on the ability to pay; Income, and contributions for economically inactive pays the state budget from general taxes

SOLIDARITY

Each insured person has the right to medical care paid for by compulsory social health insurance, regardless of the amount of contributions paid

OBLIGATORY PAYMENTS

CONTRIBUTIONS OF THE STATE

The state will deduct 4% of the average monthly salary, preceding the two years of the current financial year, as of July 1, 2017, 5% from January 1, 2018, 6% from January 1, 2023 and from January 1, 2024 – 7%.

EMPLOYEES ‘COSTS

The employer will pay from his expenses paid to the employee in the form of income (wages), from 2 January 2017 – 2%, from January 1, 2018 – 3%, from January 1, 2019 – 4% and from January 1, 2020 – 5 %.

CONTRIBUTIONS OF EMPLOYEES

Employees’ contributions from the income (wages) accrued by employers will amount to 1% from January 1, 2019 and 2% from January 1, 2020

CONTRIBUTIONS OF SELF-EMPLOYED POPULATION

The calculation and payment of contributions of individual entrepreneurs, private notaries, private bailiffs, lawyers, professional mediators from 1 January 2017 – 2%, from January 1, 2018 – 3%, from January 1, 2019 – 5% and from January 1, 2020 – 7% will be implemented:

– for individual entrepreneurs applying the generally established taxation regime: from incomes received by them as a result of entrepreneurial activity taking into account the deductions

– for individual entrepreneurs applying a special tax regime for a small business entity: from the size of one minimum wage

– for private notaries, private bailiffs, lawyers, professional mediators: from all types of income

CATEGORY OF CITIZENS RELEASED FROM PAYMENT OF CONTRIBUTIONS

According to the law, 15 categories of citizens are exempted from paying contributions to the fund:

children;
Mothers with many children;
Participants and invalids of the Second World War;
Disabled people;
Persons registered as unemployed;
Persons studying and educating in boarding organizations;
Persons studying in full-time education;
Persons on leave in connection with the birth, adoption of the child;
Unemployed pregnant women, as well as non-working persons who actually raise a child before reaching the age of three;
Pensioners;
Military personnel;
Employees of special state bodies;
Law enforcement officers;
Persons serving sentences on the verdict of the court in the institutions of the penal-executive system;
Persons held in temporary detention facilities and pre-trial detention centers.

PROVISION OF HEALTH CARE TO FOREIGNERS

In the current situation in Kazakhstan, the guaranteed amount of free medical care is not provided:

Foreigners and members of their families permanently residing in Kazakhstan with a residence permit
Persons without citizenship
Foreigners temporarily residing in the Republic of Kazakhstan

Within the framework of compulsory social medical insurance, foreigners and stateless persons permanently residing in the territory of the Republic of Kazakhstan, as well as oralmans, enjoy the rights and bear responsibilities in the system of compulsory social health insurance on an equal basis with citizens of the Republic of Kazakhstan, unless otherwise provided by this Law.

Amendments to the law on compulsory social health insurance in the provision of medical care:

For non-working oralmans and their family members for one year at the expense of state contributions (since the status “oralman” is granted for 1 year, if he does not obtain citizenship during this period, he is considered as a “foreigner”;
Non-working aliens and members of their families permanently residing in the Republic of Kazakhstan on an equal basis with citizens of the Republic of Kazakhstan;
Working foreigners and members of their families on general grounds

MOVEMENT OF FUNDS

For the inactive population, the guaranteed amount of free medical care and transfers to the Fund (contributions to insurance for persons exempted from their payment) are paid by the state from the republican budget. The money is transferred monthly according to the plan of financing through the budget program of the Ministry of Health to the Social Health Insurance Fund.

In turn, the contributions of the active population (employers, employees, individual entrepreneurs, private notaries, lawyers, mediators, etc.) will be transferred to the Social Health Insurance Fund through the State Center for Pensions. This will ensure that income is recorded by analogy with the existing pension system and the State Social Insurance Fund, and will also save money for transferring contributions.

It is worth noting that the State Center for the payment of pensions will be the functions of verifying the individual identification numbers of participants, the return of erroneous payments, the transfer of information to the Tax Committee to reconcile work with non-payers and personal records.

The Social Health Insurance Fund will distribute the money as follows: the part will be sent to pay for services to healthcare entities, that is, to the medical organizations, and some will be sent to the National Bank, which will invest money and fully manage the assets.

CALCULATION OF ASSESSMENTS AND CONTRIBUTIONS

The employer deducts contributions for employees from the expenses paid to the employee in the form of income, that is, from the wage fund before the deduction of corporate income tax. Calculation and transfer of employee contributions / contributions are made by the employer on a monthly basis

Employees deduct contributions from income accrued by employers, that is, wages before deduction of individual income tax. Calculation and transfer of contributions of individuals are carried out monthly by tax agents with whom such contracts are concluded.

Individual entrepreneurs deduct contributions from the income they received as a result of doing business before deducting individual income tax. Calculation and payment of contributions of individual entrepreneurs are carried out by them independently by direct transfer of funds through the State Corporation to the account of the fund. In the case of an individual entrepreneur applying a special tax regime, the income is the amount of one minimum wage.

It should be noted that for all categories, the authorized body determines the revenues from which contributions and contributions are not paid,

Compensation for official business trips and the traveling nature of work,
Field allowance of workers,
Costs associated with the delivery of employees, to pay for training, benefits and compensation from the budget,
Allowance for vacation for health improvement, payments for payment of medical services, at the birth of a child, burial within the limits of 8 minimum salaries, scholarships, insurance premiums.

At the same time, the minimum size of the object of calculations and contributions can not be less than the minimum wage.

The monthly income accepted for the calculation of contributions / contributions should not exceed 15 times the minimum wage.

All contributions must be paid no later than the 25th day of the month of the next month of income payment.

MEDICAL SERVICES PACKAGES

1. Package of guaranteed volume of free medical care – including a state-guaranteed amount of medical assistance and financed from the national budget. It will be available to all citizens of Kazakhstan and oralmans. It includes:

Ambulance and sanitary aviation;
Medical care for socially-significant diseases and in emergency cases;
Preventive vaccinations;
Outpatient and outpatient care with outpatient drug support (for the unproductive self-employed population until 2020, that is, before the introduction of universal declaration).

2. The package of compulsory social health insurance – including the amount of medical assistance in excess of the guaranteed volume of free medical care, financed by compulsory insurance contributions from the state, employers and employees to the Fund for Mandatory Social Health Insurance. It can be received by persons who are participants in compulsory social health insurance. It includes:

Out-patient and out-patient care;
Stationary honey. Assistance (except for socially significant diseases);
Hospital-substituting care (except for socially significant diseases);
Regenerative treatment and honey. rehabilitation;
Palliative care and nursing care;
High-tech help.

ASSESSMENT OF QUALITY OF MEDICAL SERVICES

Who will improve the quality of the medical services provided?

The Joint Quality Commission will:

To improve the standards of medical education
To improve the clinical protocol
Improve medicines
To improve the standards of the system of quality control and accessibility of health services
Compliance with standards of quality and accessibility of health services

2. The Committee for the Control of Medical and Pharmaceutical Activities will carry out state control, including:

Monitoring compliance with health standards;
Checking for lethal cases;
Verification of complaints.

3. The health authorities will:

Standardize the network and services of the health system
To implement the standards of diagnosis and treatment
To encourage the accreditation of medical organizations in the national and international accreditation system
Reduce the number of justified complaints of the population and carry out sociological research on the population’s satisfaction with the quality of medical services
To ensure the effectiveness of external quality control and internal audit in medical organizations
To ensure continuous professional development of medical workers and the development of an independent assessment of the competence of health professionals

3. The Foundation will carry out an inspection on the basis of a signed agreement with the medical organization:

Examination of the volume and quality of the treated cases;
Examination of the reasonableness of prescribing medicinal products and medical products;
Monitoring indicators of the final result of the activities of suppliers.

Based on the results of the inspections, the Foundation will create a database of medical organizations that have positive and negative ratings.

EXPECTED RESULTS

Availability of quality medical care
A health system that can meet the needs of the population
Improve health, increase longevity
Expansion of ambulatory drug provision
Strengthening the quality control of medical services provided
Reducing the level of private spending (out of pocket) for health care