Introduction of Complex Capitation
Standard Rate (CCSR) in outpatient care
organizations
Network public MOs, rendering OPP
Total 2292
Outpatient-polyclinic
organizations-674
Polyclinics-176
Dispensary
without beds
TB dispensary-13
Psychoneurologic-1
Medical exercise
dispensary-4
Cardiologic dispensary - 1
CPMSH -18
AIDS center-21
Outpatient polyclinic organizations
under hospital organizations-1618
polyclinics-361
CDC-11
Women’s health centres
under obstetric
organizations-26
Women’s health
clinic-5
Perinatal centres-16
Maternity hospitals-10
PD of dispensary with
beds -130
Dental
polyclinics-15
TB dispensary-51
Oncologic-17
Dermatovenerologic-20
Psychoneurologic-18
Endocrinological -1
Narcological -19
Cardiologic dispensary -4
For adults-4
For children -10
HEI andSRI-1
OC-409
CPMSH -15
OC-1086
МS, village firstaid station-4311
MW without
rooms-128
Network of МОs, rendering PHC, on the situation on January
1, 2013
Total- 2206
Outpatient-polyclinic organizations– 612
PD and OC
of hospital organizations – 1304
Municipal polyclinics
– 119
CDC – 3
PD of city hospitals– 20
Child polyclinics
– 14
CRP, RP, VP – 36
PD of CRH, RH, VH – 192
CPMSH – 17
OC – 409
CPMSH - 10
OC – 1082
Private OPO
1082
МS, village first-aid station
- 4311
MW without rooms – 128
Independent organizations,
rendering PHC
Total number of organizations 363
City184
Village179
MP 122
OC12
CPMSH 9
CDC 3
CP14
MH 24
VH 5
CRH133
RH 12
RP 29
Medical organizations, providing CDS
Total- 399
Outpatient-polyclinic organizations -174
Municipal polyclinics
- 124
RP - 25
Pediatric
polyclinics
- 14
CDC -11
Polyclinic departments (PD) of
hospital organizations - 225
PD of regional
hospitals - 12
PD of regional
pediatric hospitals - 16
PD of city
hospitals - 30
PD of CRH, RH - 158
PD of VH - 9
NETWORK OF ORGANIZATIONS, PROVIDING PHC. EXAMPLE OF ZHAMBYL REGION.
OPP ORGANIZATIONS INCLUDING
PHC OF ZHAMBYL REGION
CRH 10
MUNICIPAL
POLYCLINICS 9
REGIONAL
POLYCLINICS 10
OUTPATIENT
CLINIC111
DIAGNOSTIC
CENTER 1
VFAS 60
МS
117
MWWR
56
NETWORK OF ORGANIZATIONS, PROVIDING PHC. EXAMPLE OF KARAGANDA REGION
OPP ORGANIZATIONS INCLUDING
PHC OF ZHAMBYL REGION
MUNICIPAL
POLYCLINICS16
MH 7
CRH 9
REGIONAL
POLYCLINICS 9
OUTPATIENT
CLINICS 71
VFAS
51
МS 229
Tasks and objectives
Objective:
Improving availability and quality of primary medical and
sanitary care by introducing economic incentives
Tasks:
1. Stimulating preventing direction in work of PMSC organizations
2. Expanding the range of primary medical and sanitary help services
3. Provision of rational and effective usage of means dedicated for
outpatient-polyclinic and hospital care
4. Increasing payment of PMSC workers by introducing economic
incentive mechanisms
Stimulating preventing direction in work of PMSC
organizations




Covering not lesser than 70% of target group of assigned
population with screening assays
Increasing the number of diseases detected at early stage
Decreasing the number of chronic non-contagious
diseases and their complications by integrating the chronic
diseases management program
Systematic explanatory and promotion work with
population on disease preventing and forming healthy
lifestyle
Expanding the range of primary medical and sanitary care
services

1. Delegation of consultative and practical skills on most frequent
diseases from dedicated experts (subject matter experts) to the
specialists of PMSC :

cardiology– hypertension, CHD
endocrinology– hypothyroidism, diabetes
gastroenterology– ulcer, gastritis, duodenitis and hepatitis
ophthalmology – conjunctivitis
neurology – acute cerebrovascular disease, root disorders
pulmonology– pneumonia, COPD, bronchial asthma
obstetrics and gynecology – pregnancy follow-up

2. Expanding SMW powers and independence :
- independent admission of patients including case follow-up of dispensary patients;
- being able to use basic practical skills in surgery and obstetrics and gynecology;
- providing services for house-calls;
- prenatal nursing, postnatal nursing, nursing of healthy children younger that 1 year,
patients with chronic diseases;
- consulting on disease prevention and healthy lifestyle, social and psychological help
Provision of rational and effective usage of means dedicated
for outpatient-polyclinic and hospital care



Decreasing the number of unreasonable
hospitalizations to twenty-four hour hospitals
Decreasing CDS consumption
Decreasing the number of emergency calls in
PMSC organizations working hours
Increasing payment of PMSC workers by introducing
economic incentive mechanisms

Introduction of differentiated payment for
doctors’ and SMW work for:

expanding the list of consultative and diagnostic and practical skills
expanding prevention direction of work (covering not lesser than
70% of assigned population with preventive activities)
reaching basic indicators of productivity of PMSC activity


Primary medical and sanitary care
Article 45 of Code on Health and Healthcare System
Premedical, qualified medical care without twenty-four hour medical
observation, including complex of available medical services, provided
at the levels of person, family and society:
1) diagnostics and treatment of most common ailments, as well as of traumas,
poisonings and other emergencies;
2) sanitary and anti-epidemic (preventive) activities in sites of diseases;
3) hygienic education of population, family, maternity, paternity and child welfare
services;
4) explanatory work on safe water supply and nutrition
Capitation standard rate
for 2000-2200 population
assigned population
using PHC
Complex capitation
standard rate
assigned population
using PHC, primarily
with preventive
purposes
Existing functions of PHC:
• premedical, qualified medical care,
• examining patients for detecting
ailments at an early stage,
• appointment for hospitalization,
• chronically ill patients for preventive
medical examination,
•rehabilitation treatment,
•provision of medicines.
Expanding functions of
PHC:
• decreasing the number of common
chronic manageable diseases (CMD) at
PHC level
• systematic, explanatory, promotion
work with population on disease
prevention and forming healthy lifestyle
• transferring focus from ill patients onto
protection of healthy population
• delegation of powers from dedicated
expert to the specialists of PHC
• expanding SMW powers and
independence
• strengthening social orientation of PHC
Problems:
• lack of doctors
• lines in polyclinics
• poor quality of medical care
Solutions:
• making requirements for doctor and SMW
training stricter
• SMW status reinforcement
• extending the staff size of SMW and
keeping the relation between them in balance
• improving the level of doctor and SMW
training
• improving the level and the quality of care
workers’ and psychologists’ work
• increasing payments by integrating
differentiated payment for doctors’ and SMW
work for expanding their functions and
achieving targeted results
Pilot studies results
on the example of pilot MO – municipal polyclinic №8 of Аstana – general practitioners’ actual salary rose
2.2 times, therapists – 2.0 times and pediatrists – 1.6 times, nurses actual salary rose 2.3 times; therapist
nurses – 2.1 times; pediatrists nurses – 1.6 times
MP №8 General practice
Therapy
Salary
calculati
ons
Base
salary
Addition
al
salary
Total
Base
salary
Addition
al salary
Total
Base
salary
Addition
al salary
Total
Doctor
85000
102330
187330
80000
85850
165850
80000
52180
132180
Nurse
65000
87280
152280
60000
68680
128680
60000
37060
97060
Pediatrics
on the example of pilot MO – Taiynshyn CRH, NKR – general practitioners’ actual salary rose 2.9 times,
therapists – 2.5 times and pediatrists – 2.3 times, nurses actual salary rose 3 times; therapist nurses – 2.4
times; pediatrists nurses – 2.5 times (CCSR equals to 1221,12)
General practice
Therapy
Pediatrics
Salary
calculati
ons
Actual
(without
AGC)
With
AGC
(CCSR
=
1196,98)
With
AGC
(CCSR=
1221,12)
Actual
(without
AGC)
With
AGC
(CCSR =
1196,98)
With
AGC
(CCSR=
1221,12)
Actual
(without
AGC)
With
AGC
(CCSR =
1196,98)
With
AGC
(CCSR=
1221,12)
Doctor
110428
166122
328922
110428
143095
283328
110428
130461
258313
Nurse
70941
109775
217354
70941
87224
172704
70941
91468
181106
CCSR fund distribution (on the example of MP №8)
491890 tenge– one division’s
salary fund per month (1 doctor–
2-3 SMW), consists of:

215000 – base actual salary (as of
today on actual basis)

276890 – additional actual salary
(per 1 doctor and 2 SMW)
(+) For reaching lowest acceptable
level of indicators
(-) In case of not reaching or partially
reaching lowest acceptable level
of indicators, financial means are
redirected to divisions with better
results (of lowest acceptable level)

Additional salary fund – 276890 KZT 56%
Base salary fund – 215000 KZT 44%
дополнительн
ый фонд ЗП 276890 тг
56%
основной
фонд ЗП 215000 тг
44%
Expenses structure
(on the example of pilot organization –
municipal polyclinic №8, Astana)
Действующий ПН 624
КПН 900
0,0%
10,4%
0,0%
19,70%
21,2%
3,3%
34,20% Заработная плата
КДУ
Заработная плата
ПМСП
дополнительно
2,30%
1,10%
14,6%
Прочие товары
Прочие товары
8,40%
Коммунальные
услуги
Прочие услуги
0,00%
Админ.хоз.и др.зат.
лаборатория
34,30%
Заработная плата
КДУ
Заработная плата
ПМСП
дополнительно
Коммунальные
услуги
Прочие услуги
3,1%
2,1%
27,4%
5,2%
Админ.хоз и др затр.
Лаборатория
резерв
12,7%
Резерв
Relation between PHC/CDP
expenses on the example of pilot MO MP №8 of Astana
Действующий ПН 624
КПН 900
Additional 95 tenge per one assigned
person per month
12,6%
ПМСП
49%
45,7%
51%
ПМСП
КДП
Высвободившаяся сумма
КДП
41,7%
Differentiation of PHC and CDP services, included to
CCR (896 KZT)
PHC – 55 services
CDP – all the other services
including high-cost services
(596 KZT)
(300 KZT)
Doctor admissions
General clinic examinations
Biochemical examinations
ECG
Bacteriologic examinations
Immunoprophylaxis
Procedures and operations
Specialized doctors admissions
Extended biochemical examinations
Radiologic examinations
Ultrasound
Function studies
Procedures and operations
Primary surgical treatment of wounds, cast
application/removal
High-cost services (are limited by the local executive bodies) for certain population

classes
PCR, angiography, PET, CT, medicogenetic examinations and others in accordance with
the GVFMC
PHC volume within the GVFMC
Service name
For healthy persons
For patients with
acute forms of chronic
diseases
For children under 18
For pregnant women
Prevention
Carrying out activities on health protection and promotion, informing population on healthy lifestyle, healthy
nutrition, planning family
Teaching sanitary-hygienic skills of teeth and mucous tunic of mouth care
Preventive medical surveys of targeted population groups in accordance with the order set by the authorized
body
Doing preventive injections against infections and infestations, according to the
National Calendar of Immunization
Children, including
infants nursing
Nursing of the pregnant
Sanitary and anti-epidemic (preventive) activities in sites of contagious diseases
Teaching patients and their family members to self-control, self, and mutual care
Trainings in prophylactic rooms, health promotion schools.
Telephone consultation of people, taking part in ailments management
program (AMP)
Sociomedical and psychological services on prescription.
Primary prevention
Dispensary admission and case follow-up. Primary and secondary prevention
of illnesses for dispensary cases.
PHC volume within the GVFMC
Service name
For healthy persons
Diagnostics
Admission and
consultation
For patients with
acute forms of chronic
diseases
For children under 18
For pregnant women
Admission and service at home
Laboratory and diagnostic examinations with PHC specialist referral at hand
General blood and urine test
Vaginal smear
microscopy
Vaginal smear
microscopy and vagina
sanitation
Sputum analysis for TB detection (smear microscopy)
HIV-infection and Wassermann reaction blood sampling
Microreaction, statoscopy
Material sampling for microbiologic examinations
Biochemical examinations: blood clotting time, bleeding time, bile pigments
in urine, cholesterol, tryglycerides, blood sugar (express-methods with test
system usage )
Electrocardiogram
Fluorography
Treatment
Fluorography from 15
years
First aid when necessary
Medication treatment prescription: intravenous, intramuscular, hypodermic injection on prescription;
immobilization (application of gauze bandage casts, splints) on prescription
Paid medical services are rendered when PHC is done on patient’s initiative, as well as without PHC
specialists’ referrals, basing on the agreement, concluded between the patient and the healthcare subject
Expected results




Expanding PHC availability by private PHC
organizations network expansion, as well as on the
base of PPP
Increasing the number of finished cases of visits for
medical care at PHC level (not lesser than 70%)
Provision of PHC development priority
Transfer of focus from hospital care onto outpatient
services
Thank you for your attention!