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 th 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 2
Governance of Primary Care 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, operations started in 2016 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
WHO Geographically Dispersed Office on primary health care in Kazakhstan 1978 - 134 countries adopted Alma-Ata Declaration, PHC defined as priority in the global health GDO creation – Decision on establishing of GDO on PHC in Almaty (Kazakhstan) was made at 63 Session of WHO Regional Committee in Turkey Thus, Almaty is now WHO capital on PHC for 53 State Members WHO GDO on PHC will lead development of innovations on primary health care in European Region and globally 4
Economic conditions of Primary Care Payment system I n 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: - Guaranteed part (90%) for the provision of primary and ambulatory specialized care; - Stimulation part (10%) for the motivation of PHC workers to achieve the final performance
Economic conditions of Primary Care (2) 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 GP s’ salary to the average salary in the economy is 1.03
Primary care workforce Numbers of GPs in relation to population There is 2200 population per one GP . Number of GPs - the percentage of physicians in primary care has increased since 2013 from 30% to 49%. Number of GPs as percentage of physician workforce The number of general practitioners as a percentage of physician workforce is 19.4%. 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.
Access to Primary Care services 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.
Comprehensiveness of Primary Care services First contact care for whole population The primary health care is provided due to standard of primary health care organization. In addition to scheduled visits and visits at home by call in 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 of chronic non-communicable diseases, reduce costs and create motivation 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.
Priorities in PHC development Social-psychological Strengthening of diseases services were established prevention 650 psychologists 3587 healthy schools 252 health promotion centres 2060 social workers 101 anti-smoking centres 8000 second and third nurses 87 youth centres 10
Transport medicine development 3 consultative- Centre of Sanitary 50 mobil 40 medical rescue diagnostic trains aviation medical saving points facilities 187 thousands 16 units Expand net in 2016- during last 3 years 1.6 mln people 2020 2.6 thousand were tested 2.3 consultative departures during last 3 1.5 thousand visits diagnostic services years provided 2.5 services 1.8 lab tests 2.7 thousand 984 thousand served consultations 11
Continuity and coordination of care 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 outpatient clinics for further active surveillance at home (patronage); 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 development 2020 2015 • Basic package of • Work with e-health • E-health • Automated business using standards passport for processes in health paperless population • Web-based IT system technologies systems • IT system • Creation conditions integration – for cloud technology 100% development 2016 2014 13
Global health challenges Increasing of non- infection diseases Health system resource using through new Health will be main driver of technologies Significant increasing of health government obligations expenditures in OECD countries implementation Increasing of number Health expenditures, in % of GDP 17,9% of elder population (2011-2012, WB ) 8,2 11,2% 11,3% 10,9% 10,4% 9,3% 9,1% 3,8% Health expenditures 7,7% 6,8% 7,2% 6,7% 6,7% 6,2% 6,2% 4,6% 4,1% 7,1 7,9 are increasing due to 6,7 8,6 2,5% 7,7 4,1 7,8 9,7 3,1 3,7 6,5 4,8 above mentioned 5 5,6 2,7 1,4 2,5 0,7 3,8 3,7 3,3 3,1 3,1 challenges 2,7 2,7 2,5 2,1 1,9 1,8 1,7 1,6 1,3 1,2 1,2 1,3 14 14 Частные расходы, в % от ВВП Государственные расходы, в % от ВВП
Situation in the country Increasing of volume and structure change of health financing Proportion of health expenditures in Health financing structure in Kazakhstan and Kazakhstan and other countries in 2013, OECD countries in 2013 % of GDP State/Public and Ambulance care 2,5% 4% insurance Palliative and 19% 3,1% Daily hospital Personal/ private care 20% 3,7% 46% Medication at 16% 61% ambulatory level 4,8% 22% 4,1% Ambulatory/ PHC 26% 7,8% care 7,6% 51% 7,1% Hospital care 34% 7,9% 8,6% 8,2% ОЭСР РК 15 15
THANK YOU! 16
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