As part of the President’s directive to improve the efficiency of the mandatory social health insurance system, the implementation of a Unified System for Medical Care Payment (USMCP) has commenced.
During a meeting chaired by the Presidential Aide Tamara Duisenova, the issues related to the implementation of this directive were discussed.
This new digital tool will ensure control over the quality and funding of medical services provided within the framework of the State Guaranteed Benefit Package (GOBMP) and Mandatory Social Health Insurance (MSHI).
In March of this year, a pilot implementation of the unified payment system began in medical organizations of the Akmola region. Starting July 1, the new system will be rolled out across all medical organizations in the country.
The new digital system will allow for:
- Transparency in the provision of medical services through personalized accounting and end-to-end monitoring of the validity of care provided;
- Elimination of unjustified expenditures and improved control over the quality of healthcare services;
- Automatic detection of errors and violations in medical care, including so-called “false claims”;
- Ensuring that payments for medical services are made exclusively for actually provided care.
It should be noted that this system is aimed at the effective use of financial resources, eliminating false reporting, and reducing corruption risks.
The automated quality control system will motivate healthcare organizations to be more responsive to patient needs.
The preliminary results of the pilot project in the Akmola region have already confirmed the effectiveness of the new system. In pilot mode, the system identified over 11,000 cases of medical care not meeting established standards, including cases of false claims.
Based on the identified violations, organizational and financial measures will be taken.
Thanks to this innovation, the financing of medical services will become more fair and efficient, and patients will be able to expect better and more timely treatment.
The meeting also addressed the readiness of medical organizations for system implementation, staff training, expert competencies, and the revision of tariffs for certain types of medical care. Stay updated with the latest news on our website https://ksph.edu.kz/ and in our Telegram channel: Mediclub
