The Health Minister announced significant changes to the OSMS system, effective December 21, 2024.
According to the minister, anything that falls outside this package must be covered by the health insurance system.
The draft law regulating these changes has already been posted on the open NPA portal.
"The duplication of services in two packages, the State Guaranteed Free Medical Care (GOBMP) and the Mandatory Social Health Insurance (OSMS), their lack of transparency, unclear boundaries, coupled with inconsistencies in financial provision, and ultimately complaints from healthcare consumers, necessitated fundamentally new mechanisms for their formation. To transition to a single-package funding model, a detailed plan was developed by specialists from the ministry and external experts, conducting a comprehensive analysis of all medical services and their costs. An important anchor for these transformations remains the maximum coverage by the system of Mandatory Social Health Insurance (OSMS) and ensuring access to medical care for all segments of the population," writes Akmaral Alnazarova.
She stated that in the insurance model, the government will continue to contribute for 15 categories of beneficiaries, including children, pregnant women, pensioners, students, unemployed individuals, persons with disabilities, and many other segments of the population.
"These socially vulnerable categories, which account for over 11.9 million Kazakhstanis, are protected by the state and will be guaranteed access to medical care at all levels, including primary medical and sanitary care (PMSP). Citizens of working age insured under the OSMS system, which amounts to 5 million people, will also retain full access to medical care," assured the Minister of Health.
Furthermore, according to the minister, over 1 million working-age citizens categorized as crisis (D) and emergency (E) levels of social well-being, meaning those with low income, will become insured under the OSMS system starting in 2026, thanks to local executive bodies, and will be able to receive additional medical assistance in the OSMS package without obstacles.
The remaining categories classified as A, B, C according to the digital family map of the Ministry of Labor and Social Protection of the Population (MTSZN), who have sufficient income, will need to insure themselves to receive planned medical assistance, while emergency services will be provided by the state.
As a result of including these categories of citizens in the OSMS system, the insurance coverage level among those with socially significant diseases will rise to 93%.
"Thus, we see that the measures taken will ensure maximum population coverage by insurance, and consequently, the availability of medical care. The unified package of basic state medical care will include all necessary services regardless of insurance status: emergency medical services, emergency inpatient care, diagnosis and treatment of socially significant diseases (including HIV, tuberculosis, oncological diseases), palliative care, and preventive screenings," explains Alnazarova.
The minister notes that this volume of services is sufficient and covers all necessary medical assistance for patients with acute and chronic illnesses.
A new development will be that starting in 2027, PMSP will also be included in the OSMS, creating a comprehensive Unified Package of Medical Care. This package will consist of 30% state funding and 70% from the OSMS system.