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Since the beginning of the year, the Social Health Insurance Fund has received more than 646 thousand applications from citizens

For 11 months of 2020, the Social Health Insurance Fund received more than 646 thousand applications from the population through various feedback channels, the most active were residents of Almaty, Nur-Sultan and Shymkent. Among the reasons for applying: obtaining the status of OSMS, lack of medicines, long waiting for consultative and diagnostic services, the quality of medical care in polyclinics and hospitals, non-compliance with medical ethics and deontology by employees of medical organizations, refusal of hospitalization, etc.

Most of the appeals, or 618 thousand, are of a consulting nature, 7314 are complaints, 2816 are thanks to medical organizations and doctors, 229 are suggestions for improving work.

The position of the unofficial leader among the feedback channels of the Social Health Insurance Fund was taken by the contact center 1406, which has received more than 563 thousand calls since the beginning of the year. The greatest load on operators fell on the summer period. Moreover, questions from subscribers concerned not only receiving medical care in an epidemiological situation, there were cases when those who applied complained about the lack of funds to buy food, problems in their personal lives.

Next is the Qoldau 24/7 mobile app, which has registered more than 72,000 messages from citizens since the beginning of the year. The telegram bot @saqtandyrybot received 2,489 requests.

The press service of the Social Health Insurance Fund has collected the most relevant questions from the population received by the FSMS since the beginning of the year.

- What should I do if I was given a referral for consulting and diagnostic services in one organization, but I want to get them in another?

- If, for example, a patient in a polyclinic was given a referral for tests in one laboratory, but he wants to pass them in another, because it is located closer to his home or work, he has the right to do so. After receiving the service, a co-execution agreement is automatically formed in the fund's payment system.

The main condition is that the medical organization must be in the FSMS Database and provide social health insurance services. This list of suppliers can be viewed on the foundation's website.

Recall that the consultative and diagnostic assistance includes receptions of narrow specialists (cardiologists, endocrinologists, ENT specialists, oculists, etc.), laboratory tests (biochemical blood analysis, enzyme immunoassay, antibody detection, etc.), diagnostic services (endoscopic examinations, electroencephalography, echocardiography, X-ray, ultrasound, etc.).

- Can labor migrants, foreign persons with a residence permit attach themselves to a polyclinic?

- Foreigners with a residence permit have the same rights as Kazakhstanis, so they can easily attach themselves to a polyclinic and receive assistance under the OSMS, provided that they regularly pay contributions and have the status of "insured".

Migrant workers must apply for a voluntary health insurance policy that will provide them with access to primary health care and specialized medical care. In its absence and the development of acute diseases that pose a danger to others, they can count on a guaranteed amount of free medical care.

- I was given a referral for a CT scan of the lungs, I called the organization with which my clinic cooperates, and I was told that I can pass the study only in a month and a half. What should I do in this situation?

- The algorithm of actions is as follows: you need to go back to the therapist and take a referral to another clinic. The patient can also independently find an organization where a particular examination is available in a shorter period of time, and report it to their doctor. It is worth noting that the clinic and the selected organization do not necessarily have to be bound by mutual obligations. If there is a referral from a PHC doctor to any medical organization with which the polyclinic does not even have a contract, the fact of performing the service is the basis for automatically forming a co-execution contract. It is important to remind that the clinic should be included in the FSMS Database and provide social health insurance services.

- Can I put my child braces for OSMS?

- The installation of braces is not provided according to the OSMS package, since the alignment of teeth is an aesthetic task and is carried out for a fee.

However, medical dental care for children under 18 years of age is provided within the framework of medical insurance. Children have access to services for anesthesia and tooth extraction, filling, treatment of pulpitis, periodontitis, complete functional restoration of the anatomical shape of the tooth in hypoplasia, fluorosis, plastic frenulum of the lips and tongue, radiography of the jaw and anesthesia.

Orthodontic services are also available for young patients, but only in the presence of congenital pathologies of the maxillofacial region.

- I am registered with asthma. Recently, I stopped giving out medicines that I previously received, citing the fact that I am not insured. How legitimate is this?

- Asthma refers to socially significant diseases that require dynamic monitoring. The patient must be provided with the necessary medicines, regardless of whether he is insured or not. You do not have the right to refuse medical care or medication that is included in the guaranteed amount of free medical care.

08.12.2020
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