Frequently Asked Questions

In accordance with the Work Plan for the formation of tariffs for medical services (a set of medical services) provided under GOBMP and (or) the MSHI system for 2024, approved by Order No. 359 of the Ministry of Health of the Republic of Kazakhstan dated June 4, 2024, a revision of tariffs for services provided in the emergency room (consultations by anesthesiologists-resuscitators, obstetricians-gynecologists, surgeons, ophthalmologists, neurosurgeons, administration of local anesthesia, novocaine blockade, intravenous anesthesia, etc.) is scheduled for the second half of 2024.

A penalty is applied for each violation at the rate of 0.05% of the total amount of the current service procurement contract. At the same time, the total penalty amount should not exceed 1% of the total contract value. For example, if the total contract amount is 50 million tenge, the penalty should not exceed 500 thousand tenge.

To submit an application for inclusion in the database, a medical organization must meet minimum requirements, such as having a license to practice medical activities, having specialists, medical equipment, and other requirements specified in paragraphs 6 and 7 of the Rules for Accounting Healthcare Entities.

Source: Order of the Ministry of Health of the Republic of Kazakhstan dated August 17, 2023, No. 145 "On Amending the Order of the Minister of Health of the Republic of Kazakhstan dated November 6, 2020, No. ҚР DSM-186/2020 'On Approval of the Rules for Accounting Healthcare Entities Providing Medical Care within the Framework of GOBMP and/or the MSMI System.'"

According to the Payment Rules, the linear scale is not applied to the following services:

• Emergency medical care,
• PHC,
• Screening of rural residents,
• Trauma centers,
• School medicine,
• Antenatal care and preventive examinations of target groups,
• Hemodialysis and peritoneal dialysis,
• Rural hospitals under the GOBMP,
• HTMP (high-tech medical services),
• Palliative care,
• Pathological diagnostics,
• Preparation of blood products,
• Treatment of patients with HIV infection, tuberculosis, oncology, oncohematology, mental, and infectious diseases,
• Regional and city-level maternity organizations for services provided in inpatient and outpatient settings,
• Inpatient facilities, including national healthcare organizations, providing services to children under 1 year old and maternity services with a combined share of 45% or more of treated cases involving children under 1 year old and maternity services.

Source: Order of the Ministry of Health of the Republic of Kazakhstan dated December 20, 2020, No. ҚР ДСМ-291/2020 "On the approval of payment rules for healthcare entities within the framework of the guaranteed volume of free medical care and (or) in the mandatory social medical insurance system."

Medical organizations (MOs) must conduct outreach activities regarding the available services under the MSMI system, its advantages and rights, as well as inform about the procedure for making MSMI contributions.

In the Republic of Kazakhstan, medicines are provided free of charge within the framework of the guaranteed volume of medical care and the compulsory social health insurance system.

Medicines within the framework of the guaranteed volume of medical care are issued to the population for medical reasons and categories of citizens, including preferential categories and patients with chronic and socially significant diseases.

To find out which medications you can get for your diagnosis for free, follow the link (link to the Medicines section)

In accordance with the Work Plan for the formation of tariffs for medical services (a set of medical services) provided under GOBMP and (or) the MSHI system for 2024, approved by Order No. 359 of the Ministry of Health of the Republic of Kazakhstan dated June 4, 2024, the revision and update of tariffs for medical services in the second half of 2024 is planned for the following priority areas: abdominal surgery, infections, neurology (adults), gastroenterology, cardiology, traumatology, nephrology, endocrinology, and oncohematology.

Services provided by co-executors are submitted for payment to the Fund on behalf of the providers. In accordance with the Rules for Monitoring (Order of the Ministry of Health of the Republic of Kazakhstan No. 321), current monitoring is conducted to assess the validity of the medical services in compliance with healthcare standards, regulations, and clinical protocols.

Throughout the current year, additional allocation of volumes and funds is carried out among suppliers included in the healthcare entities database in the following cases:
1) the presence of unallocated service volumes;
2) the availability of released service volumes;
3) changes in the medical services procurement plan within the current financial year.

Source: Order of the Ministry of Health of the Republic of Kazakhstan dated December 8, 2020, No. ҚР ДСМ-242/2020 "On the approval of the Rules for the procurement of services from healthcare entities for the provision of medical care within the framework of the GOBMP and (or) the MSMI system."

The amount of payment for the provision of medical care in secondary education organizations (excluding boarding schools) for the reporting period is determined by multiplying the per capita monthly norm for a student by the number of students assigned to the PHC subject based on the order of the Health Department.

Source: Order of the Ministry of Health of the Republic of Kazakhstan dated December 20, 2020, No. ҚР ДСМ-291/2020 "On the approval of payment rules for healthcare entities within the framework of the guaranteed volume of free medical care and (or) in the mandatory social medical insurance system."

We recommend checking the patient's MSMI contribution payment periods when issuing a referral for planned hospitalization. If the payment period has ended and there is a potential loss of status, it is advisable to explain to the patient the necessity of paying the contribution for the month corresponding to the discharge date.

In accordance with the Order of the Ministry of Health of the Republic of Kazakhstan dated October 30, 2020, No. ҚР ДСМ-170/2020 'On Approval of Tariffs for Medical Services Provided within the Framework of the Guaranteed Volume of Free Medical Care and the Mandatory Social Health Insurance System,' the per capita standard for one schoolchild per month for primary healthcare entities is 480.62 tenge.

Monitoring is carried out in relation to the main healthcare service provider, as it is the one that has concluded the co-execution agreement. Providers who are obliged to fulfill part of the services under the procurement contract enter into co-execution agreements with other co-executors, regardless of the location of their production bases or offices (branches).

The co-executor must meet the same requirements as the supplier and must be registered in the healthcare entities database. Co-executors are guided by the norms of the Procurement Rules (paragraphs 60, 61, 62, 63, 64).

Source: Order of the Ministry of Health of the Republic of Kazakhstan dated December 8, 2020, No. ҚР ДСМ-242/2020 "On the approval of the Rules for the procurement of services from healthcare entities for the provision of medical care within the framework of the GOBMP and (or) the MSMI system."

The payment rules are approved by the Ministry of Health of the Republic of Kazakhstan. If you have any suggestions, you can send them to the Ministry of Health of the Republic of Kazakhstan.

1. You need to attach to a polyclinic at your place of residence;

2. Register at the dispensary and be under the supervision of a district therapist or a specialized specialist;

- Get a free prescription, which indicates the prescription number and date of prescription of the medicine if the disease is included in the List for free provision.
((prescriptions are issued only by district doctors and specialized specialists of medical organizations);

3. With an identity card, get a prescription drug at a pharmacy at a medical organization.

Where to go if there are no prescribed medications?
You can contact the SK-Pharmacy Contact Center for free medication 1439 (from mobile and landline numbers). All calls are free.
You can also contact the Social Health Insurance Fund by phone number 1414 (from mobile and landline numbers) or file a complaint in the Qoldau 24/7 application, in the Telegram bot @SaqtandyryBot and on the website fms.kz

The medical care provided by a dentist belongs to the primary level. At this level, dentists can provide the following services: Oral hygiene training. Professional oral hygiene. Treatment of uncomplicated dental caries. Referral to secondary or tertiary care if indicated. In emergency cases — referral for hospitalization to provide specialized care in a hospital setting.

Source: Appendix 1 to the standard for the organization of dental care in the Republic of Kazakhstan, Order of the Ministry of Health of the Republic of Kazakhstan No. 31 dated February 24, 2023.

During the current year, additional allocation of volumes and funds is carried out among suppliers included in the database of healthcare entities in the following cases:
1) the presence of unallocated service volumes;
2) the availability of released service volumes;
3) changes in the medical services procurement plan within the current financial year.

Source: Order of the Ministry of Health of the Republic of Kazakhstan dated December 8, 2020, No. ҚР ДСМ-242/2020 "On the approval of the Rules for the procurement of services from healthcare entities for the provision of medical care within the framework of the GOBMP and (or) the MSMI system."

The choice of funding source is made automatically when creating a referral for hospitalization or a consultative-diagnostic service. Which package the service falls under is determined by the Government Decree of the Republic of Kazakhstan (GOBMP or MSMI). The mechanisms are implemented in the information systems of the Ministry of Health of the Republic of Kazakhstan. It is necessary to correctly code the disease or surgery.

Within the framework of GOBMP and MSHI, the following tests can be performed for allergic diseases:

• Determination of specific IgE to other allergens using ELISA;
• Skin tests with allergens;
• Skin tests with drugs;
• Provocative testing with allergens (conjunctival, endonasal, endobronchial, application, etc.);
• Allergometric titration (conjunctival, endonasal, endobronchial, application methods, etc.);
• Determination of total IgE in blood serum using an analyzer.

These tests are included in clinical protocols for allergy diagnosis.

Regarding the inclusion of specific tests in the list of GOBMP and MSHI services, we recommend contacting the Ministry of Health of the Republic of Kazakhstan.