Experts from the Social Health Insurance Fund continue to monitor the quality and volume of services provided by providers within the framework of the state-guaranteed free volume of medical care (guaranteed by the state) and under the compulsory health insurance package.
By the end of July, more than 67 thousand various defects were revealed in the provision of medical care to the population, the amount of fines imposed for medical organizations amounted to more than 240 million tenge.
“It should be noted that payment for medical services to the population rendered by the Fund's suppliers under the packages of guaranteed medical care and compulsory medical insurance is made only after monitoring the quality and volume of these services. Services that were rendered in fact and are documented are paid for, in compliance with the standards and rules for the provision of medical care, as well as the recommendations of clinical protocols, ”the Fund noted.
The largest number of identified defects is associated with the provision of consultative and diagnostic services that are not included in the per capita standard, that is, each service is paid separately. More than 62 thousand such defects with a total value of 85.5 million tenge were recorded by experts of the Social Insurance Fund. Also, about 1.9 thousand defects were noted in the provision of outpatient care, 1.7 thousand facts in the provision of medical care in round-the-clock hospitals.
In July, the experts of the Foundation identified more than 2 thousand cases of actually not provided services, which were entered into information systems as received by patients. For the violations identified in such cases, medical organizations were fined 16.2 million tenge.
Among the regions, most often the facts of detecting defects are found in Kostanay, Almaty regions, Almaty city, the least defects were detected in Pavlodar, Zhambyl, Akmola regions.
“The quality of monitoring is significantly improved by combining data from various government databases and processing this data using IT tools. It also minimizes the human factor. Now the Fund is working on building end-to-end monitoring of the quality and volume of medical services in the IS by integrating data from various disparate ISs and registers on one site. This will make it possible to automate the monitoring process as much as possible, ”explains the department for monitoring the quality of medical care provided by the FSMS.
“Public control on the part of the population, on the one hand, helps the Foundation to reveal violations, on the other hand, disciplines the medical organizations themselves. Therefore, we urge Kazakhstanis to check their data in mobile applications and report in the event of discrepancies to the Fund or the Fund's branches, ”the Social Insurance Fund emphasizes.
To file a complaint or appeal, you need to call 1406 or through the Qoldau 24/7 mobile app.
