What medical care is provided to patients with socially significant diseases?
The Social Health Insurance Fund often receives questions from citizens with socially significant diseases. In this regard, the Foundation has prepared detailed explanations on the procedure for providing medical care to these patients.
What are socially significant diseases?
These are diseases that, due to their prevalence in society, cause the greatest mortality and disability in the population. Therefore, the health care system attaches great importance to their diagnosis and treatment. In Kazakhstan, the approved list of socially significant diseases (SPD) includes the following:
– Tuberculosis – Disease caused by the human immunodeficiency virus (HIV) – Chronic viral hepatitis and liver cirrhosis – Malignant neoplasms
– Diabetes – Mental, behavioral disorders (diseases)
– Cerebral palsy – Acute myocardial infarction (first 6 months)
– Rheumatism – Systemic lesions of connective tissue
– Degenerative diseases of the nervous system
– Demyelinating diseases of the central nervous system
– Orphan diseases.
What does medical care for citizens with SPZ include?
Medical assistance provided to citizens suffering from socially significant diseases includes medical services for diagnostics, treatment, and dynamic observation. It is important to understand that medical services are provided to patients with SPZ for the main disease within the framework of the guaranteed volume of medical care, that is, if they are diagnosed and they are registered at the dispensary for a socially significant disease in their polyclinic. Thus, in order to adjust the therapy or in case of an exacerbation of a chronic disease, medical services are provided in the guaranteed volume of medical care and are available to people who do not have insurance status in the compulsory health insurance system. However, for dispensary registration, diagnostic procedures and specialist consultations are required, which are included in the compulsory health insurance package. Based on this, the primary diagnosis to establish a socially significant disease, the diagnosis of other diseases, including those associated with an already confirmed socially significant disease, is carried out in the compulsory health insurance system, that is, to pass it, you must be insured.
What medical care is provided for patients with SPD?
Medical assistance to citizens suffering from socially significant diseases is provided in the following forms:
1) on an outpatient basis; 2) in stationary conditions; 3) in stationary-substituting conditions.
How is SPZ established for a patient?
If a local doctor (GP, therapist or pediatrician) observes signs of one of the socially significant diseases in a patient, then he refers him to the appropriate specialized specialist (narrow profile doctor, psychologist) for a consultation. At the same time, consultations of narrow specialists belong to the compulsory health insurance package, therefore, to receive this service, the status of an insured is required, with the exception of suspicions of tuberculosis and HIV infection, which are diagnosed in the guaranteed medical care and are available to uninsured patients. The doctor, if indicated, directs for diagnostics – this can be consultations of other specialized specialists, instrumental and laboratory studies. After confirming the diagnosis, the district doctor puts the patient on the dispensary, and he receives the necessary medical care. At the polyclinic level, citizens suffering from socially significant diseases can receive diagnostic services and outpatient treatment, they are provided with continuous dispensary observation. If indicated, the specialist can refer the patient to a medical organization with round-the-clock or daytime supervision.
Are SPZ Patients Eligible for Free Medicines?
Patients with certain socially significant diseases are provided with medicines and medical products within the guaranteed volume of medical care and in the compulsory health insurance system at the outpatient level, including: – tuberculosis; – HIV infection; – chronic viral hepatitis C, including the stage of liver cirrhosis; – viral hepatitis B; – diabetes mellitus; – oncological diseases; – ischemic heart disease; – prosthetics of the heart valve; – mental illness; – cerebral palsy; – reactive arthritis; – autoimmune diseases and immunodeficiency states; – polyarthritis nodosa; – Alzheimer’s disease; – Behcet’s disease; – Crohn’s disease; – mucopolysaccharidosis and some other orphan diseases. Patients are provided with medicines depending on the degree and stage of the disease. You can find out more about the free drugs relying on in the List of Medicines and Medical Devices, approved by order of the Minister of Health No. 666 of August 29, 2017.
Is it possible to undergo rehabilitation for patients with SPZ?
Patients suffering from socially significant diseases can undergo medical rehabilitation on a general basis according to the list of diseases subject to rehabilitation. To receive rehabilitation services or restorative treatment, you must contact your local doctor, who will send you for a consultation