Primary care in Kazakhstan Dr. Alexey Tsoy Vice-Minister of health - - PowerPoint PPT Presentation
OBSERVATORY VENICE SUMMER SCHOOL 2016 Primary care in Kazakhstan Dr. Alexey Tsoy Vice-Minister of health and social development, The Republic of Kazakhstan COUNTRY PROFILE Territory (total area) 2.7 mln sq. km Kazakhstan is a 9
Vice-Minister of health and social development, The Republic of Kazakhstan
COUNTRY PROFILE
Territory (total area) – 2.7 mln sq.
km
Kazakhstan is a 9th country by
territory size in the world
Population – 17.7 mln Population density - 6.3 per 1 sq.
km
Urban population – 10.1 mln
Rural population – 7.6 mln
Male – 8.5 mln
Female – 9.1 mln
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Policy priority
President of the Republic of Kazakhstan announced primary health care
development as a top priority in the health system development in our country;
New State Program on health care development 2016-2019 with aim to
strengthen the role of primary health care;
WHO EURO GDO on PHC was opened in Almaty (Kazakhstan) in 2015,
Position of primary care in the health care system (e.g. parallel
systems)
PHC is a priority, since the interaction of the patient and the doctor, as
the area of first contact between the person and the health care system should be the basis for the national health services in general.
Gate keeping
Currently 80% of all population is examined and treated at the level of
primary health care
134 countries adopted Alma-Ata Declaration, PHC defined as priority in the global health
Almaty (Kazakhstan) was made at 63 Session of WHO Regional Committee in Turkey
Members
primary health care in European Region and globally
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Payment system In the frame of health reforms in the country there were
introduced advanced methods of payment of medical services such as diagnosis-related groups (DRG), integrated capitation index, global budget); introduced differentiated payment system for medical workers;
Since 2014 the PHC is the fund holder and provides
comprehensive outpatient care to the population;
Since 2014 payment per integrated capitation index per
person was introduced, which consists two components:
ambulatory specialized care;
to achieve the final performance
Primary care expenditure as percentage of total Expenditures for primary health care is 36% in the
total cost of state guaranteed benefit package in the country (in the Strategic Development Plan of the Republic of Kazakhstan the goal is to achieve 60% to 2050).
Income of GPs in comparison of average hospital
specialist income
Income of GPs in comparison to hospitals
professionals income is higher for 10-15% .
Ratio of GPs’ salary to the average salary in the
economy is 1.03
Numbers of GPs in relation to population There is 2200 population per one GP
. Number of GPs
increased since 2013 from 30% to 49%.
Number of GPs as percentage of physician workforce The number of general practitioners as a percentage
Number of nurses in primary care Nurses are more than 22 thousand. The ratio of
general practitioners to the number of nurses in primary health care is 1:3.
Medical services on PHC level are provided to all addressed,
upon visiting the PHC organization;
Provided free of charge, urgently and in a planned manner; In addition, multidisciplinary team work in conjunction with the
medical staff to provide medical and social assistance to socially vulnerable categories of the population, including children, pregnant women, persons with disabilities, persons at risk, which includes people with chronic diseases, patients with social significant diseases . The members of the multidisciplinary team carried out a comprehensive social assessment of the family using social technologies and social intervention methods.
First contact care for whole population
The primary health care is provided due to standard of primary health care
urgent cases, it is also provided field visits (“visits of families”) if indicated.
Role in management and treatment of chronic disease
In order to improve the quality of life of patients with chronic non-
communicable diseases, since 2013 Kazakhstan has started to implement disease management programs based on partnerships between the specialist of primary care and the patient that helps prevent complications
among citizens for responsible attitude to their own health through their direct involvement to the disease management process.
Role in prevention and health promotion
Centers of family health with prevention and psycho-social care offices were organized, youth centers, elderly people clubs, anti-smoking centers, specialized "health schools" are opened and function. 5 priorities were defined for integrated management of diseases: acute myocardial infarction, stroke, cancer, trauma, maternal and infant mortality. The Coordination Council to carry out the work on the republic-wide was established.
Social-psychological services were established 650 psychologists
2060 social workers 8000 second and third nurses
Strengthening of diseases prevention 3587 healthy schools 252 health promotion centres 101 anti-smoking centres 87 youth centres
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Centre of Sanitary aviation 16 units 2.6 thousand departures 2.5 services 50 mobil medical facilities 1.6 mln people were tested during last 3 years 1.8 lab tests 984 thousand consultations 40 medical rescue saving points Expand net in 2016- 2020 1.5 thousand visits 2.7 thousand served 3 consultative- diagnostic trains 187 thousands during last 3 years 2.3 consultative diagnostic services provided
Continuity of health care provision to patients is based on the principles of direct contact and feedback between doctors of different specialties, as well as between all different levels of care, and is carried out by:
transferring active calls to outpatient clinics for patients served by ambulance service;
transferring of data on discharged patients, including children, from the hospitals to the outpatient clinics, for the active home visits by doctors (general practitioners);
interaction of primary care with women's consultations and obstetric clinics on family planning and women health issues;
transferring of information about newborns from maternity hospitals to
Call centers were organized, where professionals work with patient calls, provide information of interest, carried out records of the patients at the reception or calling a doctor to home visits, if necessary, connected to the doctor or the leadership of the organization.
e-health standards
systems
2014
processes in health system
for cloud technology development
2015
using paperless technologies
2016
passport for population
integration – 100%
2020
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Significant increasing of health expenditures in OECD countries Health will be main driver of government obligations
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1,8 1,3 2,7 2,1 3,1 2,5 1,7 1,9 1,2 3,1 1,2 1,3 1,6 3,7 3,8 3,3 2,7 9,7 0,7 2,5 1,4 2,7 3,1 3,7 5 4,8 5,6 4,1 6,5 7,8 7,7 6,7 7,1 7,9 8,6 8,2 Частные расходы, в % от ВВП Государственные расходы, в % от ВВП
4,6% 4,1% 6,7% 6,2% 6,2% 6,8% 6,7% 7,7% 7,2% 9,3% 9,1% 10,9% 10,4% 11,3% 11,2% 17,9%
3,8%
2,5%
Health expenditures, in % of GDP
(2011-2012, WB )
non- infection diseases
system resource using through new technologies implementation
Health expenditures are increasing due to above mentioned challenges
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ОЭСР РК
Increasing of volume and structure change of health financing
Proportion of health expenditures in Kazakhstan and other countries in 2013, % of GDP Health financing structure in Kazakhstan and OECD countries in 2013
Hospital care
34% 51%
Ambulatory/ PHC care Medication at ambulatory level Palliative and Daily hospital care Ambulance care
26% 16% 19% 22% 20% 4%
61% 46%
State/Public and insurance Personal/ private
2,5% 3,1% 3,7% 4,8% 4,1% 7,8% 7,6% 7,1% 7,9% 8,6% 8,2%
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