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, over 646 thousand applications from the population were received through various feedback channels to the Social Health Insurance Fund, the most active were residents of Almaty, Nur-Sultan and Shymkent. Among the reasons for contacting: obtaining the status of compulsory health insurance, lack of medicines, long waiting for consultative and diagnostic services, the quality of medical care in polyclinics and hospitals, non-observance of medical ethics and deontology by employees of medical organizations, refusal of hospitalization, etc.
Most of the calls 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 1406 contact center, which since the beginning of the year received more than 563 thousand calls. The greatest load on operators fell in the summer period. Moreover, the questions from the subscribers concerned not only the receipt of medical care in an epidemiological situation, but there were also cases when those who applied complained about the lack of funds to buy food, problems in their personal lives.
Next comes the mobile application Qoldau 24/7, in which over 72 thousand messages from citizens have been registered since the beginning of the year. The telegram bot @SaqtandyryBot received 2,489 calls.
The press service of the Social Health Insurance Fund has collected the most pressing questions from the population that has been received by the SHIF since the beginning of the year.
– What if I was given a referral for consultative and diagnostic services in one organization, but I want to receive them in another?
– If, for example, a patient in a polyclinic was given a referral for tests to one laboratory, but he wants to have them in another sense it is located closer to his home or work, he has the right to do so. After receiving the service, a co-performance agreement is automatically generated in the fund’s payment system.
The main condition is that a medical organization should be a member of the FSMS Database and provide social health insurance services. This list of suppliers can be viewed on the fund’s website.
Recall that consultative and diagnostic assistance includes receptions of narrow specialists (cardiologists, endocrinologists, ENTs, oculists, etc.), laboratory tests (biochemical blood test, enzyme immunoassay, antibody determination, etc.), diagnostic services (endoscopic examinations, electroencephalography, echocardiography, X-ray, ultrasound, etc.).
– Can labor migrants, foreign persons with a residence permit be attached to the clinic?
– Foreigners with a residence permit have the same rights as Kazakhstanis, so they can freely attach to the clinic and receive assistance under the compulsory health insurance, provided that they regularly pay contributions and have the status of “insured”.
Labor migrants must take out 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 CT of the lungs, I called the organization with which my polyclinic cooperates, and they told me that I could undergo the study only in a month and a half. What to do in this situation?
– The algorithm of actions is as follows: it is necessary to return to the therapist and make a referral to another clinic. The patient can also independently find an organization where this or that examination is available in a shorter period of time, and inform his attending physician about it. It should be noted that the clinic and the chosen organization do not 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 an agreement, the fact that the service has been performed is the basis for the automatic formation of a co-performance agreement. It is important to remind that the clinic should be included in the FSMS Database and provide social health insurance services.
– Can I put braces on my child’s health insurance?
– Installation of braces is not provided under the OSMS package, since the alignment of the teeth is an aesthetic task and is paid for.
However, medical dental care for children under 18 is provided within the framework of medical insurance. Services for anesthesia and tooth extraction, filling application, treatment of pulpitis, periodontitis, full functional restoration of the anatomical shape of the tooth in hypoplasia, fluorosis, lip and tongue frenum plate, jaw X-ray, and anesthesia are available for children.
Orthodontic services are also available for young patients, but only in the presence of congenital pathologies of the maxillofacial region.