Unofficial translation
In accordance with Subparagraph 1) of Article 10 of the Law of the Republic of Kazakhstan dated November 16, 2015 “On Compulsory Social Health Insurance”, the Government of the Republic of Kazakhstan hereby DECREES AS FOLLOWS:
1. Approve the attached List of medical care in the system of Compulsory Social Health Insurance.
2. This Decree shall be enforced from January 1, 2020 and subject to official publication.
| The Prime Minister of the Republic of Kazakhstan | A. Mamin |
| Approved by the Decree of the Government of the Republic of Kazakhstan dated June 20, 2019 № 421 |
List of medical care in the system of Compulsory Social Health Insurance
Chapter 1. General Provisions
1. Medical care in the system of Compulsory Social Health Insurance (hereinafter referred to as the CSHI) - capacity of medical care provided to consumers of medical services from the assets of the Social Health Insurance Fund.
Foreigners and stateless persons permanently residing in the territory of the Republic of Kazakhstan, as well as oralmans enjoy the rights and obligations in the system of CSHI on an equal basis with citizens of the Republic of Kazakhstan, unless otherwise provided by the Law of the Republic of Kazakhstan “On Compulsory Social Health Insurance”.
Foreigners and members of their families temporarily staying in the Republic of Kazakhstan in accordance with the terms of an international treaty ratified by the Republic of Kazakhstan enjoy the rights and obligations in the system of CSHI on an equal basis with citizens of the Republic of Kazakhstan, unless otherwise provided by laws and international treaties.
Family members of foreigners shall be cohabiting spouse and children.
2. Medical care in system of CSHI shall be provided in the form of a complex of medical services, including medical care, aimed at maintaining and restoring the health of population.
3. The system of CSHI provides:
1) consultative and diagnostic assistance in the direction of a specialist in primary health care (hereinafter referred to as the PHC) and specialized specialists;
2) hospital-replacing care, with the exception of cases of treatment of diseases within the guaranteed capacity of free medical care (hereinafter referred to as the GCFMC), in the direction of the PHC specialist or medical organization;
3) planned inpatient care, with the exception of cases of treatment of diseases under the GCFMC, in the direction of the PHC specialist or medical organization within the planned number of hospitalizations;
4) medical rehabilitation and rehabilitation treatment in the direction of the PHC specialist or medical organization according to the list of diseases (conditions) approved by the authorized authority;
5) pathoanatomical diagnosis of diseases, not included in the GCFMC.
Chapter 2. List of medical care in the system of Compulsory Social Health Insurance
4. Consultative and diagnostic care in the direction of the PHC specialist and specialized professionals:
1) preventive medical examinations of children under the age of eighteen years and persons over eighteen years of age in the manner and at intervals approved by the authorized authority, in accordance with Paragraph 7 of Article 155 of the Code of the Republic of Kazakhstan "On People’s Health and the Health Care System" (hereinafter referred to as the Code);
2) reception and consultation by specialized professionals of persons with diseases that are not subject to dynamic monitoring under the GCFMC, including:
diagnostic services, including laboratory diagnostics, according to indications, in the direction of the specialist in the manner approved by the authorized authority;
use of high-tech medical services provided in the manner approved by the authorized authority in accordance with Paragraph 2 of Article 42 of the Code;
implementation by specialized professionals of medical manipulations and procedures in the manner approved by the authorized authority;
provision of inpatient care in accordance with Paragraph 5 of this List;
prescription of medicines and medical devices, including certain categories of citizens with certain diseases (conditions), provision of medicines on an outpatient basis in accordance with the List by the authorized authority, in accordance with Subparagraph 2) of Paragraph 1 of Article 88 of the Code;
examination of temporary incapacity for work, carried out in the manner approved by the authorized authority, in accordance with Paragraph 2 of Article 59 of the Code.
3) provision of emergency and planned dental care to certain categories of the population according to the List approved by the authorized body.
5. Inpatient care shall be provided, with the exception of cases of treatment of diseases under the GCFMC, in the direction of the PHC specialist or medical organization and includes:
1) inspection, consultation of specialized professionals;
2) diagnostic services, including laboratory diagnostics;
3) treatment of the disease that caused hospitalization and its complications, concomitant diseases that pose a threat to life, using drugs, medical devices, through medical procedures, procedures and surgical operations (with the exception of aesthetic plastic surgeries);
4) use of high-tech medical services provided in the manner approved by the authorized authority, in accordance with Paragraph 2 of Article 42 of the Code;
5) medical rehabilitation and rehabilitation treatment in the direction of the PHC specialist or medical organization according to the List of diseases (conditions) approved by the authorized authority;
6) the organization of a hospital at home in acute conditions and exacerbations of chronic diseases for persons with reduced mobility.
6. Planned inpatient care shall be provided, with the exception of cases of treatment of diseases under the GCFMC, in the direction of the PHC specialist or medical organization within the planned number of hospitalizations and includes:
1) examination, consultation of specialized professionals on medical indications, including using information and communication technologies;
2) diagnostic services, including laboratory diagnostics, for medical reasons;
3) treatment of the disease that caused hospitalization and its complications, concomitant diseases that pose a threat to life, using drugs, medical devices, through medical procedures, procedures and surgical operations (with the exception of aesthetic plastic surgeries);
4) provision of blood, its components in accordance with the nomenclature and in the order of their procurement, processing, storage, sale, as well as blood, its components, preparations in accordance with the procedure for their storage, transfusion, approved by the authorized authority, in accordance with Paragraph 5 of Article 162 of the Code;
5) use of high-tech medical services provided in the manner approved by the authorized authority, in accordance with Paragraph 2 of Article 42 of the Code;
6) medical rehabilitation and rehabilitation treatment in the direction of the PHC specialist or medical organization according to the List of diseases (conditions) approved by the authorized authority;
7) examination of temporary incapacity for work, carried out in the manner approved by the authorized authority, in accordance with Paragraph 2 of Article 59 of the Code;
8) medical nutrition provided in accordance with the natural standards for food approved by the Government of the Republic of Kazakhstan, in accordance with sub-paragraph two of Paragraph 2 of Article 69 of the Budget Code of the Republic of Kazakhstan;
9) providing the patient with a bed for the entire period of hospitalization, without providing additional services in the ward of hospital (TV, refrigerator, telephone, ordered meals, individual stay in the ward, with the exception of cases due to medical indications);
10) providing the opportunity to stay in medical organization of mother (father) or another person directly caring for a child under the age of three years, as well as for seriously ill older children who need additional care upon the conclusion of a doctor, with the issuance of a sheet on temporary disability;
11) providing the nursing mother of a child under the age of one year with free nutrition in a medical organization for the entire period of stay to care for a child;
12) creating the necessary conditions for games, recreation and educational work in children's inpatient medical organizations.
7. Medical rehabilitation and rehabilitation treatment in the direction of the PHC specialist or medical organization in the manner approved by the authorized authority.
8. Pathological diagnosis of diseases that are not included in the GCFMC.
9. The provision of medicines, medical devices, specialized medical products, immunobiological preparations in the provision of medical care in the system of GCFMC shall be carried out in the provision of:
1) inpatient and hospital-replacing care - in accordance with drug formulary of health organizations;
2) outpatient care - in accordance with the List of medicines and medical devices approved by the authorized authority for certain categories of citizens with certain diseases (conditions) in accordance with Subparagraph 2) of Paragraph 1 of Article 88 of the Code.
When providing medical care in the system of GCFMC, healthcare subjects shall use medicines, medical products, specialized medical products, immunobiological preparations registered in the Republic of Kazakhstan. Medicines must be included in the Kazakhstan national drug formulary.
It is allowed to use medicinal products and medical devices that are not registered in the Republic of Kazakhstan to provide medical care according to the vital indications of a particular patient or to provide medical care to a limited number of patients with rare and (or) especially severe pathology in the manner approved by the authorized authority in accordance with Subparagraph 32) of Paragraph 1 of Article 7 of the Code.
