Order 801 n dated 05.12. Nomenclature of positions for medical and pharmaceutical personnel and specialists with higher and secondary vocational education in healthcare institutions. I. Heads of healthcare institutions
Order of the Ministry of Health of the Russian Federation of December 5, 2014 N 801n
“On amendments to appendices No. 1 and No. 2 to the order of the Ministry of Health and social development Russian Federation dated April 12, 2011 N 302n “On approval of lists of harmful and (or) dangerous production factors and work, during which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting mandatory preliminary and periodic medical examinations (examinations) ) workers employed at hard work and at work with hazardous and (or) dangerous conditions labor"
In accordance with the Regulations on the Ministry of Health of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 19, 2012 N 608 (Collection of Legislation of the Russian Federation, 2012, N 26, Art. 3526; 2013, N 16, Art. 1970; N 20, Art. 2477; N 22, Art. 2812; N 33, Art. 4386; N 45, Art. 5822; 2014, N 12, Art. 1296; N 30, Art. 4307; N 37, Art. 4969), I order :
The List of harmful and (or) dangerous production factors, in the presence of which mandatory preliminary and periodic medical examinations (examinations) are carried out, has been adjusted.
According to the “industrial noise” factor, additional contraindications for employment include persistent (3 or more months) hearing loss (unilateral, bilateral sensorineural, mixed, conductive hearing loss) of any severity.
The amendments establish an exception in the form of lack of hearing, severe and significantly severe hearing impairment (deafness and III, IV degrees of hearing loss).
Due to the “infrasound” factor, audiometry was excluded from laboratory and functional studies.
Also, the necessary changes have been made to the List of works, during the performance of which mandatory preliminary and periodic medical examinations (examinations) of workers are carried out.
Order of the Ministry of Health of the Russian Federation dated December 5, 2014 N 801n “On amendments to Appendices No. 1 and N 2 to the order of the Ministry of Health and Social Development of the Russian Federation dated April 12, 2011 N 302n “On approval of lists of harmful and (or) dangerous production factors and work, during the performance of which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting mandatory preliminary and periodic medical examinations (examinations) of workers engaged in heavy work and work with harmful and (or) dangerous working conditions"
Registration N 35848
This order comes into force 10 days after the day of its official publication
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Order of the Ministry of Health of the Russian Federation dated December 5, 2014 No. 801n “On amendments to appendices No. 1 and No. 2 to Order of the Ministry of Health of the Russian Federation dated April 12, 2011 No. 302n (preliminary and periodic medical examinations)”
Clarifications have been made to the list of harmful and dangerous production factors and work, during which mandatory preliminary and periodic medical examinations are carried out, in particular, changes have been made to the wording of clause 3.5. Appendix No. 1 of the Order of the Ministry of Health and Social Development dated April 12, 2011 No. 302n “p. 3.5. Industrial noise in workplaces with harmful and (or) dangerous working conditions where there is technological equipment that is a source of noise."
According to the adopted changes, it is indicated, in particular, that in work related to management vehicles category “A”, re-examination must be carried out at least once a year. When driving vehicles of category “A1”, complete deafness is excluded from the list of additional medical contraindications for employment.
In some cases, it is specified what types of laboratory and functional studies are used in the diagnosis of specific disorders.
Registered with the Ministry of Justice of Russia on 02/03/2015 No. 35848.
Order No. 302n with amendments is attached.
www.sbras.nsc.ru
Order of the Ministry of Health and Social Development of the Russian Federation (Ministry of Health and Social Development of Russia) dated July 25, 2011 N 801n Moscow “On approval of the Nomenclature of positions of medical and pharmaceutical personnel and specialists with higher and secondary vocational education in healthcare institutions”
In accordance with subclause 5.2.100.91 of the Regulations on the Ministry of Health and Social Development of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 30, 2004 N 321 (Collected Legislation of the Russian Federation, 2004, N 28, Art. 2898; 2005, N 2, Article 162; 2006, N 19, Article 2080; 2008, N 11 (1 part), Article 1036; N 15, Article 1555; N 23, Article 2713; N 42, Article 4825; N46, Art. 5337; N 48, Art. 5618; 2009, N 2, Art. 244; N 3, Art. 378; N 6, Art. 738; N 12, Art. 1427, 1434; N 33, Art. 4083, 4088; N 43, Art. 5064; N 45, Art. 5350; 2010, N 4, Art. 394; N 11, Art. 1225; N 25, Art. 3167; N 26, Art. 3350; N 31, Art. 4251; N 35, Art. 4574; N 52 (part 1), Art. 7104; 2011, N 2, Art. 339; N 14, Art. 1935, 1944; N 16, Art. 2294), I order:
Approve the Nomenclature of positions for medical and pharmaceutical personnel and specialists with higher and secondary vocational education healthcare institutions according to the appendix.
Nomenclature of positions for medical and pharmaceutical personnel and specialists with higher and secondary vocational education in healthcare institutions
I. Heads of healthcare institutions
1. Chief physician (president, director, manager, chief, manager).
2. Director of a hospital (home) of nursing care, hospice.
3. Director (manager) of a pharmacy organization.
4. Head of the medical warehouse of the mobilization reserve.
5. Head of the dairy kitchen.
6. Deputy head (chief physician, director, manager, chief, manager).
7. Chief nurse, chief midwife, chief paramedic.
8. Head (chief physician, director, chief) of the federal budgetary institution of the Federal Service for Surveillance in the Field of Protection of Consumer Rights and Human Welfare and the Federal Medical and Biological Agency.
II. Heads of structural units (divisions, departments, laboratories, offices, teams, etc.)
III. Medical and pharmaceutical personnel
b) medical specialists, including:
aviation and space medicine doctor;
obstetrician-gynecologist of the workshop medical area;
clinical laboratory diagnostics doctor;
manual therapy doctor;
general practitioner (family doctor);
city (district) pediatrician;
diving medicine doctor;
rehabilitation medicine doctor;
child and adolescent hygiene doctor;
food hygiene doctor;
occupational health doctor;
doctor for hygienic education;
municipal hygiene doctor;
physical therapy doctor;
doctor for medical and social examination;
general hygiene doctor;
radiation hygiene doctor;
doctor for X-ray endovascular diagnostics and treatment;
doctor for sanitary and hygienic laboratory research;
sports medicine doctor;
emergency room doctor;
local children's psychiatrist;
district adolescent psychiatrist;
emergency physician;
local general practitioner of a workshop medical district;
ultrasound diagnostics doctor;
functional diagnostics doctor;
senior doctor of the emergency medical care station (department);
senior doctor of the emergency medical aid station (department) of mountain rescue units;
3. Nursing staff:
head of the medical and midwifery station - paramedic (midwife, nurse);
head of the health center - paramedic (nurse);
production manager of dental prosthetics institutions (departments, departments, laboratories);
senior nurse (midwife, paramedic, operating nurse, dental technician);
emergency medical technician;
paramedic-driver of ambulance;
medical laboratory assistant (medical laboratory technician);
paramedic for receiving emergency medical calls and transferring them to mobile emergency medical teams;
hygiene education instructor;
physical therapy instructor;
general practitioner (family doctor) nurse;
dietary nurse;
medical and social care nurse;
ward nurse (guard);
visiting nurse;
dressing room nurse;
cosmetology nurse;
massage nurse;
nurse for receiving emergency medical calls and transferring them to mobile emergency medical teams;
physical therapy nurse;
rehabilitation nurse;
admissions department nurse;
treatment room nurse;
sterilization nurse;
district nurse;
medical laboratory technician;
operating room nurse;
4. Nursing staff:
5. Junior medical staff:
junior nurse for patient care;
6. Junior pharmaceutical staff:
IV. Specialists with higher professional education
3. Software engineer technical means rehabilitation of disabled people.
4. Instructor-methodologist for physical therapy.
5. Consultant on professional rehabilitation of disabled people.
6. Medical psychologist.
7. Medical physicist.
8. Specialist in vocational guidance for people with disabilities.
9. Social work specialist.
10. Specialist in occupational physiology.
11. Ergonomics specialist.
12. Forensic expert (expert biochemist, expert geneticist, expert chemist).
13. Chemist-expert in healthcare institutions.
14. Expert physicist in monitoring sources of ionizing and non-ionizing radiation.
V. Specialists with secondary vocational education
1. Occupational therapy instructor.
2. Instructor industrial training workers of mass professions.
3. Social worker.
4. Technician for technical means of rehabilitation of disabled people.
1. The titles of the positions of deputy heads of a health care institution (chief physician, director, manager, chief, manager) are supplemented by the name of the section of work over which he supervises. For example, “deputy chief physician for medical affairs,” “deputy chief physician for nursing staff,” etc.
2. The title of a doctor’s position is formed taking into account the specialty for which the employee has appropriate training and the work for which is included in the scope of his duties. For example, “general practitioner.”
3. The titles of the positions of the heads of structural units (divisions, departments, laboratories, offices, squads, etc.) are supplemented by the name of the doctor’s position corresponding to the profile of the structural unit. For example, “the head of the surgical department is a surgeon.”
4. In a specialized healthcare institution or if there is a corresponding specialized unit in a healthcare institution, the title of the position “reception department doctor” is supplemented with the title of the position of a doctor of the corresponding specialty. For example, “emergency department doctor—emergency medical doctor.”
5. The titles of the positions “obstetrician”, “nurse”, “packer”, replaced by female persons, are named accordingly: “midwife”, “nurse”, “packer”; and the name of the position “nurse”, filled by male persons, is called “medical brother (nurse)”.
* The title of the position “laboratory doctor” is retained for specialists hired for this position before October 1, 1999.
Order of the Ministry of Health of Russia dated December 5, 2014 N 801n
ON AMENDMENTS TO APPENDICES N 1 AND N 2 TO THE ORDER OF THE MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION OF APRIL 12, 2011 N 302N “ON APPROVAL OF LISTS OF HARMFUL AND (OR) DANGEROUS PRODUCTION FACTORS AND RA BOT, WHEN IMPLEMENTED, MANDATORY PRELIMINARY AND PERIODIC MEDICAL EXAMINATIONS (SURVEYS), AND PROCEDURES FOR CONDUCTING MANDATORY PRELIMINARY AND PERIODIC MEDICAL EXAMINATIONS (SURVEYS) OF WORKERS WORKING IN HEAVY WORK AND IN WORK WITH HARMFUL AND (OR) DANGEROUS CONDITIONS LABOR"
Amend appendices No. 1 and No. 2 to the order of the Ministry of Health and Social Development of the Russian Federation dated April 12, 2011 No. 302n “On approval of lists of harmful and (or) hazardous production factors and work, during the performance of which mandatory preliminary and periodic medical examinations are carried out examinations (examinations), and the Procedure for conducting mandatory preliminary and periodic medical examinations (examinations) of workers engaged in heavy work and work with harmful and (or) dangerous working conditions" (registered by the Ministry of Justice of the Russian Federation on October 21, 2011, registration No. 22111) as amended by order of the Ministry of Health of the Russian Federation dated May 15, 2013 N 296n (registered by the Ministry of Justice of the Russian Federation on July 3, 2013, registration N 28970), according to the appendix.
Appendix to the order of the Ministry of Health of the Russian Federation dated December 5, 2014 N 801n
CHANGES TO APPENDICES N 1 AND N 2 TO THE ORDER OF THE MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION OF APRIL 12, 2011 N 302Н “ON APPROVAL OF LISTS OF HARMFUL AND (OR) DANGEROUS PRODUCTION FACTORS OV AND WORK, DURING WHICH PERFORMANCE, MANDATORY PRELIMINARY AND PERIODIC MEDICAL EXAMINATIONS (SURVEYS), AND PROCEDURES FOR CONDUCTING MANDATORY PRELIMINARY AND PERIODIC MEDICAL EXAMINATIONS (SURVEYS) OF WORKERS WORKING IN HEAVY WORK AND IN WORK WITH HARMFUL AND (OR) HAZARDS NEW WORKING CONDITIONS"
In Appendix No. 1:
a) in paragraph 3.4.2 in the column “Additional medical contraindications”, paragraph eight should be stated as follows:
“Persistent (3 or more months) hearing loss of any etiology, unilateral or bilateral (hearing acuity: whispered speech less than 5 m), with the exception of lack of hearing, severe and significantly pronounced hearing impairment (deafness and III, IV degree of hearing loss).” ;
b) in paragraph 3.5: the column “Name of harmful and (or) hazardous production factors” should be stated as follows:
“Industrial noise in workplaces with harmful and (or) dangerous working conditions where there is technological equipment that is a source of noise”;
The column “Additional medical contraindications” should be amended as follows:
“When hiring:
Persistent (3 or more months) hearing loss (unilateral, bilateral sensorineural, mixed, conductive hearing loss) of any severity, with the exception of lack of hearing, severe and significantly pronounced hearing impairment (deafness and III, IV degree of hearing loss).
Violations of the function of the vestibular apparatus of any etiology.
During periodic medical examinations:
depending on the degree of hearing loss according to the classification of quantitative hearing loss in workers exposed to noise:
mild degree of hearing loss (I degree of hearing loss) - in the presence of negative dynamics (over the course of a year) according to the study of hearing thresholds with pure tone threshold audiometry in an extended frequency range;
moderate degree of hearing loss (II degree of hearing loss) - in the presence of negative dynamics (over the course of a year) according to the study of hearing thresholds with pure tone threshold audiometry in an extended frequency range, as well as in the presence of concomitant pathology ( hypertonic disease 2 - 3 degrees, diseases of the central nervous system, vertebrobasilar insufficiency, ischemic disease hearts, peptic ulcer stomach, duodenum in the acute stage.";
c) in paragraph 3.7: in the column “Laboratory and functional studies”, delete the word “Audiometry”; The column “Additional medical contraindications” should be amended as follows: “Disorders of the vestibular apparatus of any etiology. Severe disorders of the autonomic nervous system."
2. In Appendix No. 2:
a) in paragraph 1 in the column “Additional medical contraindications”, subparagraph 6 should be stated as follows: “
“6) Persistent hearing loss (3 or more months) of any etiology, unilateral or bilateral (hearing acuity: whispered speech of at least 3 m), with the exception of lack of hearing, severe and significantly pronounced hearing impairment (deafness and III, IV degree of hearing loss) in persons who have undergone professional education, including training safe methods and methods of performing work";
b) in paragraph 2 in the column “Additional medical contraindications”, subparagraph 1 should be stated as follows:
“1) Persistent hearing loss (3 or more months) of any etiology, one- and two-sided (hearing acuity: whispered speech of at least 3 m) (except for computer repair and operation work), with the exception of lack of hearing, pronounced and significantly pronounced impairments hearing (deafness and III, IV degree of hearing loss) in persons who have undergone vocational training, including training in safe methods and techniques for performing work";
c) in paragraph 4:
in the column “Laboratory and functional studies”, delete the word “Audiometry”;
in the column “Additional medical contraindications”, subparagraph 2 shall be declared invalid;
d) in paragraph 10 in the column “Additional medical contraindications”, subparagraph 4 should be stated as follows:
“4) Persistent hearing loss (3 or more months) of any etiology, one- or two-sided (hearing acuity: whispered speech less than 3 m), with the exception of lack of hearing, pronounced and significantly pronounced hearing impairment (deafness and III, IV degree of hearing loss) from persons who have undergone vocational training, including training in safe methods and techniques for performing work”;
e) in paragraph 13 in the column “Additional medical contraindications”, subparagraph 15 should be stated as follows:
“15) Persistent hearing loss (3 or more months) of any etiology, unilateral or bilateral (hearing acuity: whispered speech of at least 3 m), with the exception of lack of hearing, severe and significantly pronounced hearing impairment (deafness and III, IV degree of hearing loss) ";
f) in paragraph 27.1 in the column “Additional medical contraindications”, subparagraph 21 should be stated as follows:
“21) Complete deafness in one ear (hearing acuity: spoken speech in the other ear less than 3 m, whispered speech less than 1 m, or spoken speech in each ear less than 2 m (in case of complete deafness, deaf-muteness, admission is carried out with re-examination at least 1 once a year), with the exception of lack of hearing, severe and significant hearing impairment (deafness and III, IV degree of hearing loss))”;
h) in clause 27.2 in the column “Additional medical contraindications”, subclause 2 is declared invalid.
Order of the Ministry of Health of the UK dated 09/06/2016 No. 01-05/801 “On introducing changes to the composition of the commission for reviewing documents on the provision of a one-time compensation payment to medical workers under the age of 50 years. »
MINISTRY OF HEALTH OF THE STAVROPOL REGION
ON AMENDING CHANGES IN THE COMPOSITION OF THE COMMISSION FOR REVIEWING DOCUMENTS ON PROVIDING A ONE-TIME COMPENSATION PAYMENT TO MEDICAL WORKERS UNDER THE AGE OF 50, WITH A HIGHER EDUCATION, ARRIVING IN 2016 TO WORK IN A RURAL CITY A SETTLEMENT IN THE STAVROPOL TERRITORY, OR A WORKING VILLAGE, OR AN URBAN-TYPE VILLAGE OR A MOVED TO WORK IN A RURAL SETTLEMENT OF THE STAVROPOL REGION, OR A WORKING VILLAGE, OR AN URBAN VILLAGE FROM ANOTHER SETTLEMENT, APPROVED BY ORDER OF THE MINISTRY OF HEALTH OF THE STAVROPOL REGION DATED MARCH 23, 2016 No. 01-05/130
Due to the redistribution job responsibilities in the department of personnel work and educational medical institutions Ministry of Health of the Stavropol Territory I order:
1. Include in the commission for reviewing documents on the provision of a one-time compensation payment to medical workers under the age of 50 years who have higher education who arrived in 2016 to work in a rural locality of the Stavropol Territory, or a working village, or an urban-type settlement, or who moved to work in a rural locality of the Stavropol Territory, or a working village, or an urban-type village from another locality, approved by order of the Ministry of Health Stavropol Territory dated March 23, 2016 No. 01-05/130 “On some measures to implement one-time compensation payments to certain categories of medical workers in 2016” the following changes:
1.1. Exclude A.V. Grin from the commission.
1.2. Include in the commission Valentina Sergeevna Vashchenko, a leading specialist in the department of personnel work and educational medical institutions of the Ministry of Health of the Stavropol Territory, as the secretary of the commission.
2. This order comes into force the next day after the day of its official publication.
3. I reserve control over the implementation of this order.
On approval of the Procedure for the formation of a federal data bank for the design of capital construction projects and the formation of a data bank for the most cost-effective reuse projects
In accordance with the Regulations on the Ministry of Regional Development of the Russian Federation, approved by Decree of the Government of the Russian Federation of January 26, 2005 No. 40 (Collected Legislation of the Russian Federation, 2005, No. 5, Art. 390; No. 13, Art. 1169; 2006, No. 6 , Art. 712; No. 18, Art. 2002; 2007, No. 45, Art. 5488; 2008, No. 22, Art. 2582; No. 42, Art. 4825; No. 46, Art. 5337; 2009, No. 3, Art. 378; No. 6, Art. 738; No. 14, Art. 1669; No. 38, Art. 4497; 2010, No. 9, Art. 960; No. 22, Art. 2776; No. 25, Art. 3190; No. 26, Article 3350; No. 28, Article 3702; No. 31, Article 4251), and paragraph 3 of the minutes of the meeting with the Deputy Chairman of the Government of the Russian Federation D.N. Kozak dated June 28, 2010 No. DK-P9-98pr, I order:
1. Approve the attached Procedure for the formation of a federal data bank for the design of capital construction projects and the formation of a data bank for the most cost-effective reuse projects.
2. Department of Architecture, Construction and Urban Development Policy (I.V. Ponomarev):
a) within three months, organize work on the formation of a federal data bank for the design of capital construction projects and the formation of a data bank of the most cost-effective reuse projects;
b) develop a form for a federal data bank for the design of capital construction projects and the formation of a data bank for the most cost-effective reuse projects.
Appendix to the order of the Ministry of Regional Development of the Russian Federation dated December 28, 2010 No. 801
formation of a federal data bank for the design of capital construction projects and formation of a data bank of the most cost-effective reuse projects
1. This Procedure for the formation of a federal data bank for the design of capital construction projects and the formation of a data bank of the most cost-effective reuse projects (hereinafter referred to as the Procedure) is intended for the collection of design documentation and the formation on its basis of a federal data bank for the design of capital construction and the formation of a bank of the most cost-effective projects re-application and consideration of projects in the field of capital construction (hereinafter referred to as Projects)
2. Projects are sent to the Ministry of Regional Development of the Russian Federation (hereinafter referred to as the Ministry of Regional Development of Russia) by design organizations subordinate to the Ministry of Regional Development of Russia and organizations for conducting state examination of design documentation and engineering survey results, as well as on an initiative basis - by federal government bodies, government bodies of constituent entities of the Russian Federation Federations, local governments, public associations, organizations and individuals.
3. Projects are submitted to the Ministry of Regional Development of Russia with the following materials attached:
applications in free form addressed to the Minister of Regional Development of the Russian Federation on the direction of the Project, signed by an authorized person;
passport of a capital construction project containing information of a technical and economic nature about the Project being directed; project documentation to the extent provided for by Decree of the Government of the Russian Federation dated February 16, 2008 No. 87 “On the composition of sections of project documentation and requirements for their content” (Collected Legislation (Collected Legislation of the Russian Federation, 2008, No. 8, Art. 744; 2009 , No. 21, Article 2576, No. 52, Article 6574; 2010, No. 16, Article 1920) on electronic media in one copy.
In accordance with Article 23 of the Code of the Republic of Kazakhstan dated September 18, 2009 “On the health of the people and the healthcare system”, I ORDER:
1. Include in the order of the Minister of Health of the Republic of Kazakhstan dated November 26, 2009 No. 801 “On approval of the Methodology for setting tariffs and planning costs for medical services provided within the framework of the guaranteed volume of free medical care” (registered in the Register of State Registration of Normative Legal Acts of the Republic of Kazakhstan No. 5946, published in the collection of acts of central executive and other central government bodies of the Republic of Kazakhstan No. 7, 2010), the following changes:
The methodology for setting tariffs and planning costs for medical services provided within the framework of the guaranteed volume of free medical care, approved by the said order, shall be stated in a new edition in accordance with the appendix to this order.
2. The Department of Strategic Development of the Ministry of Health of the Republic of Kazakhstan (Tokezhanov B.T.) shall ensure, in accordance with the procedure established by law, state registration of this order with the Ministry of Justice of the Republic of Kazakhstan.
3. The Legal Department of the Ministry of Health of the Republic of Kazakhstan shall ensure, in the manner prescribed by law, the official publication of this order after its state registration.
4. Control over the implementation of this order is entrusted to the Vice Minister of Health of the Republic of Kazakhstan A.D. Kurmangaliyeva.
5. This order comes into force after ten calendar days after the day of its first official publication.
And about. Minister E. Baizhunusov
Application
to the order of the acting Minister
health
Republic of Kazakhstan
dated March 1, 2011 No. 105
Approved
by order of the Minister of Health
Republic of Kazakhstan
dated November 26, 2009 No. 801
Methodology
formation of tariffs and cost planning
for medical services provided
within the guaranteed volume
free medical care
1. Basic provisions
1. This Methodology for setting tariffs and planning costs for medical services provided within the framework of the guaranteed volume of free medical care (hereinafter referred to as the Methodology) was developed in accordance with Article 23 of the Code of the Republic of Kazakhstan dated September 18, 2009 “On the health of the people and the healthcare system.”
2. This Methodology establishes a mechanism for determining tariffs for medical services provided within the framework of the guaranteed volume of free medical care in the following forms of medical care:
1) primary health care (hereinafter referred to as PHC);
2) consultative and diagnostic assistance;
3) emergency medical care, air ambulance;
4) inpatient care;
5) hospital-replacement care.
3. This Methodology uses the following concepts:
per capita standard - established norm costs, revised annually per person to provide a specific volume of medical services;
age-sex adjustment coefficient is a coefficient that takes into account differences in the level of consumption of medical care by different age-sex categories of the population;
Tariff - a list of tariffs for medical services provided;
tariff - the cost of providing medical care for one treated case in healthcare organizations providing inpatient and hospital-replacement care; for one call in organizations providing ambulance medical care, air ambulance;
the inpatient care tariff is an integral cost characteristic of medical and economic protocols for one treated case;
medical and economic protocols are groups of diseases that combine similar clinical conditions and treatment methods, characterized by stable combinations of disease codes and surgical interventions and having similar costs and cost characteristics of medical expenses with a detailed description of the included functional (according to structural divisions) and structural (by cost items) components;
maximum volumes of inpatient care - annual volumes of inpatient care determined by the authorized body in the field of healthcare in the context of regions, the cities of Astana and Almaty;
service cost ratio – reflects the ratio of the cost of a specific service to the average cost of all types of services;
The tarifficator’s base rate is the cost of an initial appointment with a general practitioner (general practitioner);
utility and other expenses (hereinafter referred to as CPR) are expenses that include utility and other expenses: heating, electricity, hot and cold water, costs for advanced training of medical workers, payment for banking services, communication services, purchase of office supplies, travel expenses, current repairs, renting premises for a hospital, purchasing household goods, soft equipment and other goods and services. Individual increasing coefficients are applied to the CPR.
2. Main stages of tariff calculation
4. The administrator of budget programs determines:
planned volume of consumption of medical services by forms of assistance for the planned period;
the necessary amount of resources to reimburse medical organizations for the provision of medical care. Planning of costs by type of assistance is carried out on the basis of current cost standards approved by the legislation of the Republic of Kazakhstan.
3. Formation of tariffs for medical services
5. For health care organizations providing primary health care, the tariff is a per capita standard for the territory served and (or) the location of citizens, taking into account the right of free choice medical organization, which is calculated by dividing the total amount of funds provided by the state budget by the number of the attached population in accordance with statistical data and the age-sex correction factor (Appendix 1).
6. The age-sex adjustment coefficient reflects the relative distribution by sex and age of budget funds intended for the provision of outpatient care.
7. For health care organizations providing consultative and diagnostic assistance, the tariff is the base tariff of the rater, which is determined by dividing the amount of funds for the provision of consultative and diagnostic assistance by the product of the average cost-intensity coefficient of the service and the planned amount of medical services provided in organizations providing consultative and diagnostic assistance .
8. The cost intensity coefficient is calculated as the ratio of the cost of a specific service to the cost of the base tariff.
9. Tariffs for calling emergency medical care and air ambulances are determined as the ratio of the amount of funds provided by the state budget to the number of calls. At the same time, the tariff for air ambulance consists of two components: the medical part, the transport component of the tariff.
10. Tariffs for healthcare organizations providing inpatient care are formed by summing up all actual expenses associated with the provision of medical services (salaries of healthcare organization employees, additional cash payments in accordance with Labor Code of the Republic of Kazakhstan, social contributions in accordance with the Tax Code of the Republic of Kazakhstan, purchase of medicines, products medical purposes and consumables, purchasing food for patients, as well as utility and other expenses, including costs for heating, electricity, hot and cold water, costs for advanced training of medical workers, payment for banking services, communication services, purchase of office supplies, travel expenses, current repairs, rental of premises for hospital placement, purchase medical equipment leasing, purchase of household goods, soft equipment and other goods and services).
11. The tariff for treated cases of inpatient replacement treatment is 1/4 of the fund wages, paid for treated cases of inpatient treatment.
Payment for utilities and other expenses when providing hospital-replacement treatment at home is not made.
Payment for utility and other expenses during treatment in a day hospital is made at the rate of 1/6 of the regional average tariff for utility and other expenses.
Payment of expenses for treated cases of hospital-substitution treatment for medicines, medical products and medical services is provided at actual costs, taking into account the results of quality control and volume of medical care provided.
Payment for the volume of specialized and highly specialized medical care provided in the form of consultative and diagnostic assistance is made at the base rate, determined by dividing the provided financial resources of the relevant budgets by the planned amount of medical services, taking into account cost-intensity coefficients.
3.1 Calculation of costs for updating fixed assets
12. The costs of planning the leasing payment for pilot healthcare organizations participating in the implementation project for the acquisition of medical equipment on lease are determined according to the formula:
Medicine expenses = About the actual funds of the stationary. x LP year / About the plan of funds static.
Where:
LP year – the annual amount of expenses for repayment of leasing payments of a pilot healthcare organization providing inpatient medical care, according to the financial leasing agreement;
About the factual means of the station. – the amount of funds actually received from the provision of inpatient care by a pilot healthcare organization participating in the purchase of medical equipment under leasing terms;
About the stationary funds plan. – the amount of funds planned to be received from the provision of inpatient care by a pilot healthcare organization participating in the purchase of medical equipment under leasing terms.
13. The annual expenses of a healthcare organization provided for the renewal of fixed assets through the acquisition of medical equipment on lease should not exceed the amount of the annual lease payment determined by the agreement between the lessor and the lessee.
14. Funds aimed at reimbursement of leasing payments are used only within the framework of financial leasing agreements concluded with an organization created by the Government of the Republic of Kazakhstan, the main activity of which is the organization and procurement of medical equipment for further transfer to healthcare organizations under financial leasing terms.
3.2 Calculation of costs for advanced training
15. Planning of expenses for advanced training of medical workers is carried out for pilot healthcare organizations of the Republic of Kazakhstan providing inpatient and hospital-replacement care (except infectious diseases, mental disorders and tuberculosis) according to the following indicators:
1) the number of medical workers of healthcare organizations of the Republic of Kazakhstan providing inpatient and hospital-replacement care (except for infectious diseases, mental disorders and tuberculosis) according to statistical forms;
2) the amount of funds planned for advanced training of medical and pharmaceutical workers in the planning year;
3) maximum volumes of inpatient care and limits of inpatient care (except for cases of treatment of infectious diseases, mental disorders and tuberculosis);
4) a conventional unit of measurement for inpatient and hospital-substituting care - the patient, which is used when calculating the improvement of the qualifications of medical workers.
16. Expenses for advanced training of medical workers of organizations providing inpatient and hospital-replacement care are determined sequentially according to the following formulas:
1) Step 1: = Kn, where,
N n – the number of medical workers in healthcare organizations for region “n”, providing inpatient and hospital-replacement care (except for infectious diseases, mental disorders and tuberculosis). Source of information – statistical forms.
N is the total number of medical services in state healthcare organizations of the Republic of Kazakhstan providing inpatient and hospital-replacement care (except for infectious diseases, mental disorders and tuberculosis). Source of information – statistical forms.
K n – the share of medical, region “n”, in health care organizations for region “n”, providing inpatient and hospital-replacement care (except for infectious diseases, mental disorders and tuberculosis);
2) Step 2: K n *M=M n , where,
K n – the share of medical workers, region “n”, in health care organizations for region “n”, providing inpatient and hospital-replacement care (except for infectious diseases, mental disorders and tuberculosis).
M – the total number of medical and pharmaceutical workers working in healthcare organizations of the Republic of Kazakhstan providing inpatient and hospital-replacement care (except for infectious diseases, mental disorders and tuberculosis), who must undergo advanced training in the plan year.
M n – the number of medical and pharmaceutical workers working in healthcare organizations in region “n”, providing inpatient and hospital-replacement care (except for infectious diseases, mental disorders and tuberculosis) who must undergo advanced training in the plan year;
3) Step 3: C*M n =S n, where,
C – the amount of funds provided in the budget for the planning year for advanced training of 1 cadet.
M n – the number of medical and pharmaceutical workers working in healthcare organizations in region “n”, providing inpatient and hospital-replacement care (except for infectious diseases, mental disorders and tuberculosis), who must undergo advanced training in the plan year.
S n – the amount of funds provided for in the budget for the planning year to finance expenses related to advanced training of medical and pharmaceutical workers for region “n”;
4) Step 4: = T n , where,
S n – the amount of funds provided in the budget for the planning year to finance expenses associated with advanced training of medical and pharmaceutical workers for region “n”.
L n – conditional maximum amount of assistance, which is determined by the formula: Z n +, where,
Z n – maximum volume of inpatient care (except for cases of infectious diseases, mental disorders and tuberculosis) for region “n”, approved by the authorized body in the field of healthcare.
X n – limits of inpatient care (except for cases of infectious diseases, mental disorders and tuberculosis) for region “n”, approved by the authorized body in the field of healthcare.
T n – the amount of funds paid per 1 maximum volume of inpatient care (except for cases of infectious diseases, mental disorders and tuberculosis) for region “n”;
5) Step 5: P n = , where,
P n – the amount of funds paid for 1 limit of inpatient care (except for cases of infectious diseases, mental disorders and tuberculosis) for region “n”.
T n – the amount of funds paid per 1 maximum volume of inpatient care (except for cases of infectious diseases, mental disorders and tuberculosis) for region “n”.
4. Planning costs for medical services
17. Planning of costs for medical services is carried out on the basis of analysis and assessment of the performance of the healthcare system as a whole and healthcare organizations according to the following indicators:
volume of medical care by type (over a 3-year period) for the region as a whole and for each healthcare organization separately;
the number of bed days in a hospital, the average length of stay in a bed, the operation of a bed in the context of healthcare organizations;
volumes of medical services provided from budget funds and other sources, including paid services;
number of working personnel, level of remuneration;
availability of equipment and their use, provision of soft equipment, etc., the degree of their wear;
condition of buildings and structures, the need for current and major repairs.
18. Based on the analysis, taking into account statistical data and industry directories (directory of medical services; directory of operations and manipulations; directory of medical and economic tariffs; list of medicines and medical products), approved by the authorized body in the field of health care, the following are determined:
1) the planned volume of medical care that should be provided at the level of primary health care organizations;
2) the planned number of emergency medical calls;
3) the planned number of specialized advisory and diagnostic services, including dental ones;
4) maximum volumes of inpatient care (hospitalization cases);
5) the planned number of treated cases of inpatient care;
6) the volume of medical care provided within the guaranteed volume of free medical care is regulated.
5. Formation of an additional component to the tariff
primary health care
19. The cost planning system for the provision of primary health care is aimed at performing the following tasks:
1) determination of the incentive component of the per capita standard for financing primary health care organizations for the results achieved, used for material incentives for medical workers;
2) advanced training of primary care medical workers;
3) improving the internal management system and employee motivation, which in turn will affect the improvement of the quality of services provided and the creation of a more efficient organizational structure PHC organizations.
20. The basic principles of building a per capita financing system with elements of payment based on performance are:
1) the relationship between the incentives and capabilities of primary health care organizations, aimed at results and process;
2) guaranteed payments to primary health care organizations to cover current costs within the framework of providing a guaranteed volume of medical care, as well as additional incentive payments for achieved (quality) work results;
3) coverage of all primary health care organizations operating on the principle of mixed admission or general medical practice;
4) the results of organizations’ activities (quality and efficiency) must be assessed through a system of specially established indicators that meet certain criteria. The assessment of indicators should be carried out periodically and based on the results of the assessment, payments should be accrued and made to organizations. The system of indicators and their assessment should be linked to the monitoring system of PHC activities and information systems.
21. An additional component to the tariff for the provision of primary health care is an additional component to the tariff of primary health care that takes into account the results of the activities of the primary health care organization.
22. Indicators reflecting priority areas for the development of primary health care and, accordingly, the activities of organizations through which administrative and budgetary programs (hereinafter referred to as the ABP) will assess the quality and effectiveness of the activities of primary health care organizations are established by the Ministry of Health of the Republic of Kazakhstan (hereinafter referred to as the Ministry).
23. The budget of primary health care organizations consists of a guaranteed part of financing, covering the current costs of providing a guaranteed volume of primary health care to the assigned population, and a variable incentive part, the size of which will depend on the results of work, assessed through a system of established indicators.
24. The development of a system for an additional component to the PHC tariff is based on the definition of rules and procedures for each of the following system parameters:
1) components of financing:
determination of the total amount of funding and its distribution into basic and incentive volumes, including costs for advanced training and labor incentives, taking into account differentiated pay;
2) performance indicators of primary health care providers for the incentive component:
establishing criteria for selecting indicators;
determining the optimal number of priority indicators;
establishing the frequency and rules for reviewing indicators;
3) assessment of indicators and determination of the amount of incentive payments for each primary care provider:
systematization of the collection and processing of necessary data on indicators;
determining the rules for assessing indicators and setting the amount of payments based on the assessment of indicators;
establishing the frequency of providing reports to primary health care providers based on the results of indicator assessments;
4) payments:
establishing the frequency of payments of the incentive component and priority areas for using funds;
5) management decision making (PHC and BPA).
25. Indicators for assessing the achieved results of the primary health care organization and determining the amount of payments for the incentive component are carried out quarterly (Appendix 2).
26. The system for assessing indicators is based on the assessment of comparative data from the present with previous years. This approach allows us to assess what the region's system as a whole is currently achieving, and what the contribution of each organization is. Based on the indicator assessment system, the size of incentive payments for primary health care organizations is determined in accordance with the achievement of certain values for the indicators.
27. Based on the assessment of indicators, quarterly reports are compiled and a conditional assessment of the activities of primary health care as a whole and a conditional ranking of primary health care organizations (relatively well and relatively poorly performing) is made. This information is used at the level of the Buyer and PHC Suppliers to make management decisions and helps determine priority areas for improvement of both individual PHC organizations and the system as a whole.
28. Health authorities of the regions, cities of Astana, Almaty carry out expert assessment existing levels of average values for each indicator and determine measures aimed at achieving optimal average values.
29. The commission for assessing results and calculating payments by administrators of budget programs finally approves the size of the incentive component for primary health care organizations for the reporting period (quarter).
30. Administrators of budget programs make incentive payments in accordance with the budget legislation of the Republic of Kazakhstan.
31. To achieve maximum management influence, it is recommended that incentive payments be directed to bonuses for employees of primary care organizations in accordance with the terms of the Labor Code and the collective agreement.
32. The introduction of a system of per capita financing of primary health care with an additional component to the tariff involves expanding the role and functions of organizations involved in this process.
33. The distribution of main functions and powers is as follows:
1) The Ministry carries out:
general management in the formation of a system of an additional component to the PHC tariff;
legal regulation: periodic improvement of the model of an additional component to the PHC tariff;
resolving issues within sectoral coordination;
2) administrators of budget programs carry out:
introduction of a system of an additional component to the PHC tariff at the regional level;
management and coordination of the activities of system participants at the regional level;
establishment of a Commission for assessing results and calculating payments;
introduction of uniform information systems;
implementation monitoring and system analysis;
preparing recommendations for improving the system and making proposals to the Ministry;
3) primary health care organizations carry out:
main activities within the framework of providing guaranteed volume of medical care;
implementation of information systems within the framework of a unified health information system;
making management decisions and improving the system for continuous improvement of the quality of medical services;
effective management and use of funds for guaranteed and incentive payments;
providing the necessary reporting;
4) commissions for assessing results and calculating payments carry out:
review and approval of the results of the monitoring and evaluation system of indicators;
calculation and approval of the amount of payments for the incentive component for each organization based on the assessment of indicators for the reporting period;
control over payments;
consideration of appeals from primary health care organizations on controversial issues.
34. The determination of the incentive component of the per capita standard of primary health care organizations is carried out according to the following processes:
1) determination of an integrated indicator of the indicator values of each primary health care organization in points;
2) determination of the amount of incentive bonus for each primary health care organization in tenge.
Process 1: Determination of an integrated indicator of the indicator values of each organization in points:
1) based on a specific indicator, the value of the previous and current reporting periods in the activities of the primary health care organization is determined - (Ip; Io);
2) the actual deviation of the indicator indicator for the current period from the indicator indicator for the previous period is determined:
FO = (Ip-It)/Ip,
if the indicator value is designed to decrease in dynamics,
if the indicator according to the standard should be increased compared to the previous one, the difference between the indicator value for the current period and its value for the previous period (It-Ip) is used in the numerator, the indicator value for the current period is used in the denominator;
3) the deviation of the indicator (DI) is determined in comparison with the deviation standard (ND) and taking into account the weight coefficient of each indicator (VC) (deviation norms - ND, weight coefficients (VC):
OI = FO-ON
4) the given indicator indicator for the current period is calculated as the sum of 1 and deviations compared to the standard for the current period, taking into account the indicator weight coefficient:
PPI = (1+OI/100)*VK
5) the described steps 1-4 are repeated for all indicators as a whole for the medical organization;
6) the values of the given indicator indicators for MO are summed up, thereby obtaining the total indicator of MO:
Process 2: Determining the amount of incentive bonus for each primary health care organization in tenge:
1) the values of the total indicators for all MOs are summed up:
2) the value of the norm of the remuneration rate (hereinafter referred to as the NRR) for the current period is calculated by dividing the planned amount of remuneration (F) for the current period by the sum of the values of the total indicators:
NSV = F/SSP
3) the amount of the incentive bonus for each MO is calculated by multiplying the value of the total indicator for each MO by the remuneration rate:
CH = SP*NSV
Annex 1
Sex and age correction factors
Age |
Men |
Women |
0-12 months |
4,82 |
5,52 |
12 months - 4 years |
1,45 |
1,65 |
5-9 years |
0,96 |
0,99 |
10-14 years |
0,94 |
0,92 |
15-19 years old |
1,02 |
0,83 |
20-29 years old |
0,53 |
1,20 |
30-39 years old |
0,413 |
1,21 |
40-49 years old |
0,53 |
1,20 |
50-59 years old |
0,48 |
1,11 |
60-69 years old |
0,84 |
2,19 |
70 and older |
1,11 |
1,48 |
Appendix 2
to the Tariff Formation Methodology
and planning costs for medical services,
provided within the guaranteed
volume of free medical care
Indicators for assessing achieved work results
PHC organizations
Name |
Calculation formula |
Coefficient |
|||
Dividend |
Divider |
||||
Proportion of cases |
Number of cases |
quantity |
At 100 ZhFV |
||
Cases of pregnancy with VFV |
Number of cases |
general |
At 100 ZhFV |
||
Teenage cases |
Number of cases |
general |
by 100 |
||
Cases completed |
Number of abortions |
Quantity |
by 100 |
||
Respect for the principle |
hospitalization cases |
general |
|||
Abortion rate by |
Total |
General |
|||
Infant mortality from 7 |
number of children's |
quantity |
by 100 |
||
Number of launched |
Number of launched |
quantity |
100% |
||
Quantity for the first time |
Quantity for the first time |
quantity |
100% |
||
Hospitalization rate |
Quantity |
Quantity |
100% |
||
Hospitalization rate |
Quantity |
Quantity |
100% |
||
Specific gravity |
Quantity |
Quantity |
100% |
||
Share of emergency |
Quantity |
Quantity |
100% |
||
5.5. |
Specific gravity of pregnant women |
Quantity |
Number of all |
100% |
|
Number of discrepancies |
Number of cases |
Quantity |
100% |
||
Reduction rate |
quantity |
Quantity |
100% |
||
Total |
Quantity |
quantity |
|||
9.*** |
Hospitalization rate |
Quantity |
Quantity |
100% |
|
Table continuation
Data source |
Threshold value |
Periodicity |
||
numerator |
denominator |
|||
Fact of death |
1. Statistical control data |
Ezhekvar- |
||
f. No. 066/у – (KKMFD |
f. No. 066/у (ICD-10: cl. O) |
Ezhekvar- |
||
f. No. 066/у – data on |
f. No. 066/у |
Decrease value |
Ezhekvar- |
|
f. No. 066/у – data on |
f. No. 066/у |
Ezhekvar- |
||
f. No. 066/у (ICD-10: O with |
f. No. 066/у (ICD-10: O with |
Decrease value |
Ezhekvar- |
|
f. No. 066/у (ICD-10: O 02-07) |
f. No. 066/у (ICD-10: childbirth) |
Decrease value |
Ezhekvar- |
|
1. The fact of death from f. |
1. Statistical office data |
Decrease value |
Ezhekvar- |
|
TubeRegister |
TubeRegister |
Decrease in the value of the indicator for the current period compared to the previous one by 5% |
Ezhekvar- |
|
OncoRegister |
OncoRegister |
Decrease in the value of the indicator for the current period compared to the previous one by 5% |
Ezhekvar- |
|
Hospitalization rate with complications of diseases managed at the primary health care level |
||||
f. No. 066/у (ICD-10: I10-I13, |
f. No. 066/у (ICD-10: |
Decrease value |
Ezhekvar- |
|
f. No. 066/у (E10 for |
f. No. 066/у (E10, E11) |
Decrease value |
Ezhekvar- |
|
f. No. 066/у (ICD-10: 45.0, |
f. No. 066/у (ICD-10: J45, |
Decrease value |
Ezhekvar- |
|
f. No. 066/у (ICD-10: J12-J16, |
f. No. 066/у (ICD-10: |
Decrease value |
Ezhekvar- |
|
f. No. 066/у (ICD-10: O15) |
f. No. 066/у (ICD-10: O) |
Decrease value |
Ezhekvar- |
|
F 066/u |
F 066/u |
Decrease value |
Ezhekvar- |
|
F 066/u |
F 066/u |
Decrease value |
Ezhekvar- |
|
SUKMU |
Decrease value |
Ezhekvar- |
||
9*** |
Ф066/у |
Ф066/у |
Decrease value |
Ezhekvar- |
* (Note to indicator 1.1.)
List of ICD 10 codes for diseases in which absolutely
pregnancy is contraindicated, taken into account when calculating this
indicator
ICD 10 code |
Name of diseases |
|
A15, A16, A17, A18, A19 |
all forms of active pulmonary and extrapulmonary |
|
S00-S97 |
current presence of a malignant neoplasm |
|
D60-D61 |
aplastic anemia |
|
D65, D68.2-9, D69.1, D69.6-9 |
often recurrent or severe purpura and |
|
F01-F03, F05.1, F06.0 |
organic, including symptomatic, mental |
|
F10.5-7, F11.5-7, F12.5-7, F13.5-7, F14.5-7, F15.5-7, F16.5-7, F17.5-7, F18. 5-7, F19.5-7 |
mental and behavioral disorders |
|
F20.0-2, F22 |
schizophrenia, schizotypal and delusional disorders |
|
F71-F73 |
mental retardation |
|
G40-G41 |
epilepsy with development of mental disorders |
|
B69 |
cysticercosis, hereditary neuromuscular diseases |
|
G30-G32 |
degenerative diseases of the central nervous system |
|
G12.2 |
motor neuron disease |
|
multiple sclerosis |
||
other demyelinating diseases |
||
G70, G73 |
myasthenia gravis and myasthenic syndromes |
|
G61.0, G61.8 |
acute (Guillain-Barre) and chronic inflammatory |
|
H46 |
Optic neuritis |
|
H47.0 |
ischemic bilateral neuropathy |
|
H36.0 |
recurrent hemophthalmos due to diabetic |
|
H35.0 |
recurrent hemophthalmos against the background of hypertension |
|
I01.0-2, I01.8-9 |
acute rheumatic fever |
|
I50.0-1, I50.9 |
congenital and acquired heart defects, |
|
I11.0, I12.0, I13.0-2, I13.9 |
hypertension, stage II-III. and malignant |
|
coronary heart disease, uncorrected |
||
I27.0 |
primary pulmonary hypertension with development |
|
I33.0, I33.9 |
acute and subacute endocarditis |
|
I40, I42, I46, I49, I50.0-1, I50.9 |
myocarditis, cardiomyopathies complicated by chronic |
|
I49, I46 |
life-threatening disorders heart rate |
|
I71.0-9 |
aneurysm and aortic dissection |
|
I01.0-2, I01.8, I01.9, I27.0 |
condition after mitral commissurotomy with |
|
J45, J96.1 |
bronchial asthma, severe course,
|
|
J43.1 |
bullous emphysema, grade III DN |
|
Q33.6 |
cystic pulmonary hypoplasia, common form, |
|
bronchiectasis of the lungs, stage III DN, |
||
J84.9 |
idiopathic fibrosing alveolitis, DN III |
|
K22.2 |
narrowing and stenosis of the esophagus, artificial esophagus |
|
K21 |
diseases of the esophagus - GERD, complicated by an ulcer, |
|
K31.2, K31.5 |
diseases of the stomach and duodenum - ulcerative |
|
K50.8 |
Crohn's disease in the acute stage (in remission) |
|
K71-2, K71.5, K71.7, K71.9, K74-6 |
spicy and chronic diseases liver in the stage |
|
K86.1, K86.6 |
chronic pancreatitis with severe impairment |
|
acute glomerulonephritis |
||
N08.3 |
diabetic nephropathy stage IV, V. |
** (Note for indicator 2)
List of ICD 10 codes for child mortality diagnoses (from 7
days up to 5 years) preventable at the primary health care level, taken into account when
calculation of this indicator
ICD 10 code |
Name of diseases |
|
A 02 |
Other salmonella infections |
|
A 03 |
Shigellosis |
|
A 04 |
Other bacterial intestinal infections |
|
A 08 |
Viral and other specified intestinal infections |
|
A 09 |
Diarrhea and gastroenteritis of suspected infectious origin |
|
J00 |
Acute nasopharyngitis |
|
J01 |
Acute sinusitis |
|
J02 |
Acute pharyngitis |
|
J03 |
Acute tosillitis |
|
J04 |
Acute laryngitis and tracheitis |
|
J05 |
Acute obstructive laryngitis and epiglotitis |
|
J06 |
Acute upper respiratory tract infections, multiple and |
|
J 12 |
Viral pneumonia, not elsewhere classified |
|
J 13 |
Pneumonia caused by Streptococcus pneumonie |
|
J 14 |
Pneumonia caused by Haemephulus influenzae |
|
J 15 |
Bacterial pneumonia, not elsewhere classified |
|
J 18 |
Pneumonia without specifying the pathogen |
|
J 20 |
Acute bronchitis |
|
J 21 |
Acute bronchiolitis |
|
J 22 |
Acute respiratory infection lower respiratory tract |
|
K59.1 |
Functional diarrhea |
*** (Note to indicator 9) List of ICD 10 codes for
diseases taken into account when calculating this indicator
ICD 10 code |
Name of diseases |
|
D 50 |
Iron-deficiency anemia |
|
E 10-E 14 |
Diabetes |
|
G 50 - G64; G 70 - G 73 |
Diseases of nerves, nerve roots and plexuses |
|
I 10 - I 13 |
Arterial hypertension |
|
I 20 |
Angina pectoris |
|
J 44 |
Other chronic obstructive pulmonary diseases |
|
M 15 – V 19 |
Arthrosis |
|
N 10, N 12, T 15 |
Tubulointerstitial kidney disease |
Order of the Minister of Health of the Republic of Kazakhstan No. 801 dated November 26, 2009
Registered with the Ministry of Justice of the Republic of Kazakhstan on November 30, 2009 No. 5946
On approval of the Methodology for setting tariffs for medical services provided within the framework of the guaranteed volume of free medical care financed from the republican budget
RCPI note!
For the procedure for putting the order into effect, see clause 5.
Footnote. Title as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017
In accordance with the Republic of Kazakhstan dated September 18, 2009 “On the health of the people and the healthcare system”, I ORDER:
1. Approve the attached Methodology for setting tariffs for medical services provided within the framework of the guaranteed volume of free medical care financed from the republican budget.
2. The Director of the Department of Organization of Medical Care of the Ministry of Health of the Republic of Kazakhstan (Aidarkhanov A.T.) shall ensure, in accordance with the procedure established by law, state registration of this order with the Ministry of Justice of the Republic of Kazakhstan.
3. The Department of Administrative and Legal Work of the Ministry of Health of the Republic of Kazakhstan (Bismildin F.B.) shall ensure, in the manner prescribed by law, the official publication of this order after its state registration.
4. Entrust control over the implementation of this order to Vice-Minister E.A. Birtanov.
5. This order comes into force ten calendar days after the day of its first official publication.
Methodology for setting tariffs for medical services provided within the framework of the guaranteed volume of free medical care financed from the republican budget
Footnote. Title as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 № 627
(the order of enforcement see clause 4).
Footnote. The methodology is as amended by the order of the Minister of Health of the Republic of Kazakhstan dated June 16, 2014 No. 321 (to be put into effect ten calendar days after the day of its first official publication).
Chapter 1. Basic provisions
Footnote. The title of Chapter 1 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement, see paragraph 4).
1. This Methodology for the formation of tariffs for medical services provided within the framework of the guaranteed volume of free medical care financed from the republican budget (hereinafter referred to as the Methodology) is uniform for healthcare entities of the Republic of Kazakhstan providing a guaranteed volume of free medical care (hereinafter referred to as the GVFMC) and determines mechanism for setting tariffs for medical services provided within the framework of the guaranteed volume of medical care, financed from the republican budget for the following forms of medical care:
2) inpatient care;
3) inpatient care;
4) emergency medical care;
5) air ambulance.
Footnote. Clause 1 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement, see clause 4).
2. This Methodology uses the following concepts:
1) comprehensive per capita standard for the provision of AMS (hereinafter referred to as the complex per capita standard of AMS) - the cost of a complex of outpatient and polyclinic services of the State Fund for Medical Care per one attached person registered in the portal "Register of Attached Population" (hereinafter - the portal "RPN") to the healthcare entity providing PHC, consisting of a guaranteed component of the comprehensive capitation standard of the AMS and an incentive component of the complex capitation standard;
2) the guaranteed component of the comprehensive per capita standard of the AMS - the estimated cost of the complex of outpatient and polyclinic services of the State Voluntary Medical Care in the forms of PHC and KDP according to the list of services determined by the authorized body in accordance with the Rules for reimbursement of costs to healthcare organizations from budgetary funds, approved by the order of the acting. Minister of Health and Social Development of the Republic of Kazakhstan dated July 28, 2015 No. 627 (registered in the Register of State Registration of Normative Legal Acts No. 11976) (hereinafter referred to as the Cost Reimbursement Rules) taking into account correction factors;
3) the basic complex per capita standard of the AMS - the estimated cost of a complex of outpatient and polyclinic services of the State Fund for Medical Care in the forms of PHC and KDP according to the list of services determined by the authorized body in accordance with the Cost Reimbursement Rules without taking into account correction factors;
4) comprehensive per capita standard for the provision of guaranteed volume of medical care services to the rural population (hereinafter referred to as the complex per capita standard for the rural population) - the cost of a set of guaranteed volume of medical care services according to the list of forms of medical care determined by the authorized body in accordance with the Rules for reimbursement of costs per one rural resident registered in the portal "RPN", to a healthcare entity of district significance or a village, consisting of a guaranteed component of a comprehensive per capita standard for the rural population and an incentive component of a complex per capita standard;
5) the guaranteed component of the comprehensive per capita standard for the rural population - the estimated cost of the complex of guaranteed volume of medical care services provided to the rural population, according to the list of forms of medical care determined by the authorized body in accordance with the Rules for reimbursement of costs, taking into account correction factors;
6) the cost of the base rate - the estimated cost of one unit of the guaranteed volume of medical care service;
7) administrator of the budget program (hereinafter - the administrator) - the Ministry of Health and Social Development of the Republic of Kazakhstan (hereinafter - the Ministry) or local public health authorities of the regions, the cities of Astana and Almaty (hereinafter - UZ);
8) authorized body in the field of healthcare (hereinafter referred to as the authorized body) - a state body exercising leadership in the field of protecting the health of citizens, medical and pharmaceutical science, medical and pharmaceutical education, circulation of medicines, medical products and medical equipment, quality control of medical services;
9) treated case - a complex of medical services provided to the patient in inpatient and (or) inpatient conditions from the moment of admission to discharge;
10) age-sex correction coefficient - a coefficient that takes into account differences in the level of consumption of medical care by different age-sex categories of the population;
11) stimulating component of the complex capitation standard (hereinafter referred to as the ICPN) - an stimulating component of the complex per capita standard, aimed at stimulating employees of a healthcare entity providing primary health care, based on the achieved end result indicators in the manner determined by the Rules for encouraging employees of healthcare organizations involved in the provision of a set of measures within the framework of the guaranteed volume of free medical care, approved by Order of the Minister of Health and Social Development of the Republic of Kazakhstan dated May 29, 2015 No. 429 (registered in the Register of State Registration of Normative Legal Acts No. 11526) (hereinafter referred to as Order No. 429);
12) complex tariff - the cost of a complex of medical services of the State Fund for Medical Care per one cancer patient registered in the electronic register of cancer patients, with the exception of patients with malignant neoplasms of lymphoid and hematopoietic tissue, approved by the administrator;
14) utility and other expenses (hereinafter - CPR) - expenses for heating, electricity, hot and cold water, banking services, communication services, purchase of office supplies, travel expenses, routine repairs, rent of premises, purchase of household goods, soft equipment and others goods and services;
15) medical-economic tariff - the average cost per treated case, formed on the basis of diagnostic and treatment protocols;
16) per capita standard for the provision of primary health care - the standard cost per person to provide guaranteed volume of medical care in the form of primary health care;
17) electronic register of cancer patients (hereinafter referred to as EROB) - a unified information system for electronic registration, accounting, processing and storage of data of patients with cancer, the data of which is used when placing the guaranteed volume of medical care and its payment;
18) tarifficator - an approved list of medical services indicating their cost in accordance with paragraph 5 of Article 35 of the Code of the Republic of Kazakhstan dated September 18, 2009 “On the health of the people and the healthcare system” (hereinafter referred to as the Health Code);
19) bed-day - a day spent by a patient in a hospital;
21) adjustment coefficients - coefficients applied by the administrator of budget programs for the purpose of adjusting the tariff in accordance with this Methodology;
22) cost-intensity coefficient - a coefficient that determines the degree of cost of the DRG to the cost of the base rate.
Footnote. Clause 2 as amended by the order of the Minister of Health and Social Development of the Republic of Kazakhstan dated August 31, 2016 No. 765 (shall be enforced upon the expiration of ten calendar days after the day of its first official publication); as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 № 627 (the order of enforcement see clause 4).
3. Excluded by order of the Minister of Health and Social Development of the Republic of Kazakhstan dated August 31, 2016 No. 765 (shall be enforced upon expiration of ten calendar days after the day of its first official publication).
Chapter 2. Formation of tariffs for medical services provided within the framework of the guaranteed volume of medical care, financed from the republican budget
Footnote. The title of Chapter 2 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement, see paragraph 4).
4. Tariffs for medical services of the guaranteed volume of medical care include costs associated with the provision of medical care within the framework of the guaranteed volume of medical care:
1) for remuneration of workers of a healthcare organization in accordance with the Labor Code of the Republic of Kazakhstan dated November 23, 2015 (hereinafter referred to as the Labor Code) in accordance with the Decree of the Government of the Republic of Kazakhstan dated December 31, 2015 No. 1193 “On the system of remuneration of civil servants, employees of organizations contained at the expense of the state budget, employees of state-owned enterprises" (hereinafter referred to as Resolution No. 1193), including additional cash payments to employees;
2) for taxes and other obligatory payments to the budget, including social tax, as well as obligatory professional pension contributions, social contributions, deductions and (or) contributions for obligatory social health insurance in accordance with the Code of the Republic of Kazakhstan dated December 10, 2008 “On Taxes” and other obligatory payments to the budget" (Tax Code), the Law of the Republic of Kazakhstan dated June 21, 2013 "On pension provision in the Republic of Kazakhstan", the Law of the Republic of Kazakhstan dated April 25, 2003 "On compulsory social insurance" and the Law of the Republic of Kazakhstan dated November 16 2015 “On compulsory social health insurance”;
3) for the purchase of medicines and medical products and consumables in accordance with diagnostic and treatment protocols and a drug formulary for the provision of medical services within the framework of the guaranteed volume of medical care;
4) for the purchase of food products for patients at the cost rate determined in accordance with Decree of the Government of the Republic of Kazakhstan dated January 26, 2002 No. 128 “On approval of natural food standards and minimum standards for equipping state healthcare organizations of the Republic with soft equipment” (hereinafter referred to as Resolution No. 128);
5) for the purchase of soft equipment and uniforms as needed, calculated in accordance with Resolution No. 128;
6) for advanced training and retraining of personnel;
7) to pay for utilities: heating, electricity, hot and cold water;
8) for other expenses, including communication services, including the Internet, travel expenses, routine repairs, rent of premises, purchase of office, household and fuel and lubricants, other goods and services, maintenance, payment for banking services;
9) capital expenses for the purchase of equipment worth less than five million tenge. At the same time, organizations providing guaranteed volume of medical care purchase equipment worth less than five million tenge if there are no accounts payable in the current financial year at the expense of existing savings.
When setting tariffs for medical services, the guaranteed volume of medical care does not include profitability and profit.
Footnote. Clause 4 as amended by the order of the Minister of Health and Social Development of the Republic of Kazakhstan dated August 31, 2016 No. 765 (shall be enforced upon the expiration of ten calendar days after the day of its first official publication); as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (the order of enforcement see clause 4).
5. Excluded by order of the Minister of Health and Social Development of the Republic of Kazakhstan dated August 31, 2016 No. 765 (shall be enforced upon expiration of ten calendar days after the day of its first official publication).
Paragraph 1. Outpatient care
Footnote. Paragraph 1 as amended by the acting order. Minister of Health and Social Development of the Republic of Kazakhstan dated July 29, 2015 No. 632 (shall be enforced after the day of its first official publication).
6. Calculation of tariffs for AMS is carried out:
for the provision of AMS, including medical care to students of secondary education organizations that are not related to boarding schools, according to a comprehensive per capita AMS standard in accordance with paragraphs 7-15 of this Methodology;
for the provision of primary health care according to the capitation standard for the provision of primary health care in accordance with paragraph 16 of this Methodology;
for the provision of advisory and diagnostic services in accordance with paragraphs 17-21 of this Methodology;
for the provision of services by a mobile medical complex (hereinafter referred to as the MMC) in accordance with paragraphs 21-1-21-3 of this Methodology.
Footnote. Clause 6 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement, see clause 4).
7. For urban health care entities that provide primary health care and have an attached population (hereinafter referred to as the primary health care entity) registered in the portal "RPN", the tariff for determining the amount of financing is the complex per capita standard AMS.
8. The complex per capita standard of the AMS is determined per month per attached person registered in the portal "RPN" and consists of a guaranteed component of the complex per capita standard of the AMS and the incentive component of the complex per capita standard.
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10. The incentive component of the comprehensive per capita standard includes costs for:
1) material incentives for employees of the primary health care subject for achieved indicators of the final result;
2) advanced training and retraining of employees of the primary health care entity, including travel expenses, which amount to at least 5% of the received amount of the accumulated income tax for the primary health care entity for the reporting period.
11. The list of employees of the primary health care subject who are eligible for incentives at the expense of SKPN funds is determined in accordance with Order No. 429.
12. The size of the amount of SCI for a primary health care subject depends on the level of achievement of the target value according to the indicators of the final result of the activity of the primary health care subject (hereinafter referred to as the final result indicator) and is calculated in the manner determined by paragraph 15 of this Methodology.
13. The calculation of the complex per capita AMS standard per resident per month for primary health care subjects is carried out according to the formula:
CPI for primary care = CPI gar.AP + S skpn, where:
CPI for primary health care - a comprehensive per capita standard for AMS per one attached person registered in the portal "RPN", per month;
S skpn - the amount of skpn per one attached person registered in the portal "RPN" to a primary health care subject, per month;
CPN gar.APP is a guaranteed component of the complex per capita standard APP per one attached person registered in the portal "RPN" to a primary care entity, per month, which is calculated using the formula:
CPN gar.APP = CPN base.PHC x PHC PHC + CPN base.PHC x (K dense region - 1) + CPN base.PHC x (K heating region - 1) + V eco.PHC / CH PHC / m + V school primary health care / Ch primary health care / m, where:
PHC PHC is the age-sex adjustment coefficient for the consumption of medical services by the population in the PHC subject, which is determined by the formula:
PHC PHC =
(H PHC k/n x PHC PHC(n)) / H PHC, where:
CH PHC - the number of the population attached to the PHC subject, registered in the portal "RPN";
CH PHC k/n - the number of the population attached to the PHC subject, registered in the portal "RPN" number k of the population falling into age and sex group number n;
PHC PHC(n) - sex and age correction factor according to Appendix 1 to this Methodology of sex and age group number n;
The population size and age-sex composition of the population assigned to a primary health care facility is determined based on population data from the RPN portal database based on the results of the free population attachment campaign or as of the last day of the month, which are used to calculate the amount of funding for the provision of health care services for the upcoming financial year. year or its adjustments during the current financial year by decision of the authorized body.
CPI base PHC - the basic comprehensive per capita AMS standard for one attached person registered in the portal "RPN", per month, determined without taking into account correction factors by the authorized body in accordance with paragraph 2 of Article 23 of the Health Code for PHC subjects for the coming financial year, which is determined by the formula:
CPI base.PHC = CPI base.APP(rk) - CPI base.APP(rk) x % KDP, where:
CPN base.APP(rk) - the basic complex per capita standard APP per one attached person registered in the portal "RPN", per month, determined without taking into account correction factors, which is determined by the authorized body and calculated by the formula:
PVK RK - the average age-sex adjustment coefficient for the consumption of medical services by the population at the country level, calculated on the basis of data from the portal "RPN" on the age-sex structure of the country's population;
CPI gar.APP(rk) - the average guaranteed component of the complex per capita standard APP per capita per month in the country for the coming financial year, excluding funds for paying premiums in environmental disaster zones and medical care for students of secondary education organizations that are not related to boarding schools, which is determined by the formula:
CPI gar.APP(rk) = (V APP(rk) - V skpn.rk - V eco.rk - V school.rk)/H rk /m, where:
V AMS(rk) - the planned annual amount of funding in the country for the provision of AMS to the population;
V SKPN.rk - the annual volume of funds allocated from the republican budget for SKPN in the republic;
V eco.rk - the annual amount of funds provided for payment of the premium for work in environmental disaster zones for regions, which is formed at the regional level in accordance with the laws of the Republic of Kazakhstan dated June 30, 1992 "On social protection citizens who suffered as a result of an environmental disaster in the Aral Sea region" (hereinafter referred to as the ZRK on the social protection of citizens of the Aral Sea region) and dated December 18, 1992 "On the social protection of citizens affected by nuclear tests at the Semipalatinsk nuclear test site" (hereinafter referred to as the ZRK on the social protection of citizens of the SNTP);
V school.rk - the annual amount of funds provided for the payment of costs within the allocated funds from the republican budget related to the activities of the medical center of the educational organization to provide medical care to students of secondary education organizations that are not related to boarding organizations, in accordance with the Standard for organizing the provision of primary care health care in the Republic of Kazakhstan, approved by order of the Minister of Health and Social Development of the Republic of Kazakhstan dated February 3, 2016 No. 85 (registered in the Register of State Registration of Normative Legal Acts of the Republic of Kazakhstan under No. 13392) (hereinafter referred to as Order No. 85);
Ch rk - the number of the attached population to all primary health care units of the country, registered in the portal "RPN" based on the results of the free population attachment campaign, or as of the date of the month, which is used to calculate funding;
m is the number of months in the financial year during which the AMS will be financed;
% CDP - the share of funds for the provision of advisory and diagnostic services within the framework of the Statewide Volume of Medical Care to the population assigned to primary health care subjects, the costs for which, according to the list of services determined in accordance with the Cost Reimbursement Rules, are not included in the comprehensive per capita AMS standard for primary health care subjects;
K density.rk - the average population density coefficient for the country;
K otopit.rk - the average coefficient for taking into account the duration of the heating season in the country;
K selsk.rk - the average coefficient for accounting for allowances for work in rural areas around the country;
V eco-primary health care - the annual amount of funds provided for the payment of an allowance for work in environmental disaster zones to a primary health care subject, which is formed at the regional level in accordance with the ZRK on the social protection of citizens of the Aral Sea region and the ZRK on the social protection of citizens of the SINP;
V school primary health care - the annual amount of funds provided for the payment of costs within the allocated funds from the republican budget related to the activities of the medical center of the educational organization to provide medical care to students of secondary education organizations that are not related to boarding organizations assigned to the primary health care subject, in accordance with order No. 85;
m - the number of months in the financial year during which the primary health care entity will be financed;
To dense region - population density coefficient for a given region (city of republican significance and capital) which is determined by the formula:
To dense region = 1 + V x P us RK/medium/Pnas region, where:
B is the weight with which the deviation of the population density of regions (cities of republican significance and the capital) from the average republican level or districts (cities of regional significance) from the average regional level is taken into account (according to the calculation of the Pearson linear correlation coefficient);
P us.RK/avg. - average population density for the Republic of Kazakhstan according to the data of the Statistics Committee of the Ministry of National Economy of the Republic of Kazakhstan (hereinafter referred to as the Statistics Committee) as of the period, which are used to calculate the amount of funding for the upcoming financial year;
P us.reg. - population density in the region (city of republican significance and capital) according to the data of the Statistics Committee as of the period, which are used to calculate the amount of funding for the upcoming financial year.
To heating area - coefficient for taking into account the duration of the heating season for the region (city of republican significance and the capital), which is determined by the formula:
D will heat. - the share of costs for the annual volume of heating in the total annual volume of current costs in the region (city of republican significance and the capital) based on data from healthcare entities providing outpatient care in the region (city of republican significance and the capital) for last year;
P region - the period of the heating season for the region (city of republican significance and the capital), determined on the basis of a decision of the local executive body of the region (city of republican significance and the capital), which is used to calculate the amount of funding for the upcoming financial year;
P rk/avg. - the period of the heating season on average for the Republic of Kazakhstan according to the data of the regions (city of republican significance and the capital), which are used to calculate the amount of financing for the upcoming financial year.
Footnote. Clause 13 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement, see clause 4).
14. Calculation of the volume of AMS financing according to the complex per capita AMS standard for a primary health care subject is carried out according to the formula:
V PHC = PHC x PHC PHC x m, where
V PHC - the amount of funding for the PHC subject for the upcoming financial year or reporting period;
CH PHC - the number of the population attached to the PHC subject, registered in the portal "RPN" based on the results of the campaign for free attachment of the population or as of the last day of the month of the reporting period, which is used to calculate the amount of funding for the upcoming financial year or reporting period;
PHC of primary health care - a comprehensive per capita standard of AMS per one attached person registered in the portal "RPN", per month, determined for the subject of primary health care;
m is the number of months in the period that are used to calculate the amount of financing.
The amount of funding for a primary health care subject according to the complex per capita AMS standard does not depend on the volume of services provided.
For a primary health care subject, the amount of SCI per capita is determined when determining the amount of financing for the coming financial year according to the planned level established for the republic, and when determining the amount of financing for the reporting period based on the actual result of the PPI.
15. The calculation of the SPC is carried out sequentially in the following order:
Step 1: Determination of the planned amount of SKNI per capita per month at the republican level is carried out according to the formula:
S skpn_rk = V skpn_rk / H us_rk / m year., where:
V SKPN_rk - the annual volume of funds allocated from the republican budget for SKPN in the republic;
H nas_rk - the population of the republic as of the date of the month, which is used to calculate funding for the upcoming financial year according to the Statistics Committee, subject to adjustment in accordance with the population data registered in the "RPN" portal, or according to the "RPN" portal;
m year - the number of months in the planned financial year in which the payment of SCI amounts will be made.
Step 2: determination of the planned annual volume of funding for the SPC in the region is carried out according to the formula:
V skpn reg. = H us.reg. * S skpn_rk * m year, where:
V skpn reg. - annual amount of funding for SKPN in the region;
H us.reg. - the number of attached population in the region, registered in the portal "RPN", used to calculate the budget in the current financial year;
S skpn_rk - the amount of skpn per 1 resident in the republic;
m year - the number of months in the planned financial year for calculating the SCI.
The amount of funding for the SKPN in the region per month is determined by dividing by the number of months in the planned financial year to calculate the SKPN, (V SKPN reg./month).
Step 3: determination of the planned annual volume of financing of the SPC for a primary health care subject is carried out according to the formula:
V skpn mo_plan = Ch primary care *S skpn_rk *K mo * m, where:
V skpn mo_plan - the planned annual volume of financing of the skpn of the primary health care subject;
Ch primary health care - the number of the population attached to the primary health care subject, registered in the portal "RPN" based on the results of the campaign for free attachment of the population or as of the date of the month, which is used to calculate the amount of funding for the coming financial year;
S skpn_rk - the planned amount of skpn per 1 resident in the republic;
K mo - the coefficient of compliance of a specific primary health care entity with the comprehensiveness of the provision of primary health care services within the framework of the guaranteed volume of free medical care, equal to 1.0;
m - the number of months in the planned financial year in which the payment of SPT amounts will be made.
The planned volume of financing of the SPC for a primary care subject per month is determined by dividing by the number of months in the planned financial year to calculate the SCS.
step 4: calculation of the amount of SCI for the achieved final result of the work of a primary health care subject up to the level of a primary health care subject for the reporting period is carried out in four stages:
Stage 1: assessment of the PHC subject’s achievement of the target value of the final result indicators for the reporting period (
Determination of the target value of indicators for assessing the achieved final results of the work of a primary health care subject (hereinafter referred to as the final result indicator) is carried out according to the formula:
C = I n - I n x N, where:
T is the target value of the final result indicator that must be achieved in the reporting period;
And n - the threshold value of the final result indicator, which was achieved in the last reporting period, is established by the authorized body in agreement with the regions and is calculated according to the calculation method according to the table of the maximum possible points for primary health care subjects in the context of profiles of territorial sections in accordance with Appendix 2 to this Methodology (hereinafter - Appendix 2);
N is the expected effect on improving the final result indicators based on the results of the reporting period, established by the authorized body in agreement with the regions. When setting N, the following must be considered:
1) if N sets a reduction in the threshold value of the outcome indicator, then N is applied in a positive value (N down);
2) if N sets the value of the outcome indicator to increase, then N is applied in negative value(N higher);
3) if the target value of the final result indicator must be achieved at a certain value, then C = N.
Determination of the current value of indicators for assessing the achieved final results of the work of a primary health care subject for the reporting period is carried out in the following order:
1) the formation of end result indicators in the information system “Additional component to the tariff of primary health care” (hereinafter referred to as DCPN) is carried out:
based on the databases of the portal "RPN", "Electronic Register of Cancer Patients" (hereinafter - IS "EROB"), "Quality Management System of Medical Services", "Electronic Register of Dispensary Patients" and (or) "National Register of Tuberculosis Patients" (hereinafter - database), as well as results state control in the field of provision of medical services, in accordance with the indicator for assessing the achieved results of the work of healthcare entities providing primary health care, in accordance with Appendix 3 to this Methodology (hereinafter referred to as Appendix 3);
monthly with daily updates of data from the database in an automated manner;
in full, corresponding to data from databases;
correctly, that is, the unloading was carried out in accordance with the requirements defined in Appendix 3 and the List of codes of the International Classification of Diseases, taken into account when calculating indicators for assessing the achieved results of the primary health care organization in accordance with Appendix 4 to this Methodology (hereinafter referred to as Appendix 4);
2) the calculation of the current value for the final result indicators (It) for the reporting period is carried out in an automated mode in the "DCPN" based on data downloaded from the database and is determined by the formula:
And t = K h / K z x N i, where:
Kh - aggregated quantitative data on the numerator for calculating a specific indicator of the final result for the reporting period in accordance with the requirements determined in accordance with Appendices 3 and 4 to this Methodology;
Кз - aggregated quantitative data by denominator for calculating a specific indicator of the final result for the reporting period in accordance with the requirements determined in accordance with Appendices 3 and 4 to this Methodology;
Ni is the value of the unit of calculation for a specific indicator of the final result, determined in accordance with Appendix 3 to this Methodology.
The exception is indicators with the expected effect of “absence”. For these indicators, the current value for the final result indicators (IT) for the reporting period is determined by the formula:
And t = K h, where:
And t is the current value for the final result indicators for the reporting period;
Kh - aggregated quantitative data on the numerator for calculating a specific indicator of the final result for the reporting period in accordance with the requirements determined in accordance with Appendices 3 and 4 to this Methodology.
The assessment of the achieved final results of the work of primary health care organizations in points is carried out sequentially in the following order for the reporting period:
1) the resulting indicator of the final result indicator (FRI) is calculated in points, which reflects the level of achievement of its target value in relation to the maximum score, according to the formula:
for the final result indicator for which the target value (V) is set at N lower:
PPI = C x I VK / I t, where
PPI - the given indicator of the final result indicator (hereinafter referred to as the actual score);
And t is the current value for the final result indicators for the reporting period;
And VC - the maximum score for a specific indicator of the final result;
T is the target value of the final result indicator that must be achieved in the reporting period.
for the final result indicator for which the target value (V) is set when N is increased:
PPI = I t x I VK / C, where
If the PPI exceeds the maximum value (I VK), then the PPI is set to its maximum value (I VK);
for the final result indicator for which the target value (V) is set to 0:
if And t = 0, then PPI is set to its maximum value (I VK);
if I t >0, then PPI is set to 0.
If for the final result indicators for which the target value (V) is set for N decreasing and N increasing, there is no data on the numerator and denominator, then the PPI should be set at its maximum value (I VK).
2) the level of contribution of an urban primary health care entity to achieving the target value according to the final result indicators for the reporting period is determined (T%) using the formula:
T score x 100, where:
T score - the sum of the maximum points for each outcome indicator that the PHC subject needed to score in the reporting period;
PPI is the sum of actual scores for each outcome indicator, accumulated during the reporting period for a specific primary health care subject.
Stage 2: the amount of financing of the SPC is calculated for a specific primary health care subject for the reporting period based on the actual result of the PPI using the formula:
V fact.skpn mo1 = H us. mo x S fact.skpn.rk/point x S PPI x K mo, where:
V fact./SKPN mo 1- actual volume of financing of the SKPN for the primary health care subject for the reporting period;
PPI - the sum of actual scores for each outcome indicator, formed during the reporting period for a specific primary health care subject according to the 1st stage of this step;
S fact.skpn.rk/point - the amount of SKPN established in the reporting period per 1 point for the country, which is determined by the formula:
S actual.skpn.rk/point = S skpn.rk / K max.score, where:
K max.score - the sum of points for all indicators indicated in the table in accordance with Appendix 2 to this Methodology;
K mo - the coefficient of compliance of a specific primary health care entity with the comprehensiveness of the provision of primary health care services within the framework of the guaranteed volume of free medical care for the reporting period is calculated based on data from the portal "RPN" using the formula:
K mo = (K y + K SMR + K social worker/psychologist)/3, where:
K y - coefficient of territorial areas, which is determined by the formula:
K y = (U ter x K ter + U ped x K ped + U vop x K vop)/(U mo x K max.point), where:
U ter - the number of therapeutic profile areas;
For peds - the number of pediatric sections;
For GPs - the number of general practitioner sites (hereinafter referred to as GPs);
Umo - the total number of sites for a given primary health care unit;
K max.score - the maximum sum of points for all indicators indicated in the table of maximum possible points for primary health care subjects in the context of profiles of territorial sections according to Appendix 2 to this Methodology;
K ter, K ped and K vop - the sum of points in the section of each profile, indicated in the table in accordance with Appendix 2 to this Methodology;
When determining the planned annual volume of funding for the SPC for all primary care entities, K y is set equal to 1.0.
K smr - the coefficient of provision of paramedical personnel is calculated using the formula:
K smr = (K fact./smr vop + K fact./smr ter + K fact./smr ped)/
(H us. fact./vop / H us. norms/vop + H us. fact./ter. / H us. norms/ter. +
H us.fact./ped. /H us. norms/ped.), where:
K fact./smr GP, K fact./smr ter, K fact./smr ped - the actual number of employed staff units of paramedical workers at the corresponding profile of the site according to the portal "RPN" as of the last date of the month in the reporting period;
H us.fact. (vop, ter, ped.) - the actual number of the population attached to the territorial site in accordance with the profile of the site, registered in the portal "RPN" in the reporting period as of the last date of the month;
H us.norm. (GP, ter., ped.) - the normative number of the attached population in the territorial area of the corresponding profile, approved by order of the Minister of Health of the Republic of Kazakhstan dated April 7, 2010 No. 238 “On approval of standard staffing levels and staffing standards for healthcare organizations” ( registered in the Register of State Registration of Normative Legal Acts under No. 6173) (hereinafter referred to as Order No. 238), and assigned to 1 position of nurse at the rate of 2 nurses per site.
When determining the planned annual volume of financing of the SPC for all primary health care entities, K smr is set equal to 1.0.
When determining the CMR for a specific PHC entity for the reporting period, the following is taken into account:
for all primary health care subjects, with the exception of district and village primary health care subjects, if the actual value exceeds 1.0, then the value is set to 1.0;
for primary health care subjects of district significance and villages, if the actual value exceeds 1.25, then the value is set to 1.25.
To social worker/psychologist - the coefficient of provision of social workers and psychologists is determined by the formula:
To social worker/psychologist = (To fact./social worker + To fact./psychologist)/
(To normal/social worker + To normal/psychologist), where:
K fact./social worker, K fact./psychologist - the actual number of staff positions of social workers and psychologists in a specific primary health care unit according to the portal "RPN" in the reporting period as of the last date of the month;
To norm./social worker , K norm./psychologist - the standard number of staff positions of social workers and psychologists, calculated for the actual number of the population attached to the primary health care subject is determined by the formula:
To norm./social worker = H us. mo /H us.norm./social worker, where:
H us. mo - the number of the population attached to the primary health care unit, registered in the portal "RPN" in the reporting period as of the last date of the month;
H us.norm./social worker - the normative number of the population attached to the primary health care subject for the establishment of one social worker position, approved by Order No. 238;
K normal/psychologist = H us. mo. /H us.norm./psychologist, where:
H us. mo - the number of the population attached to the primary health care organization, registered in the portal "RPN" in the reporting period as of the last date of the month;
H us.norm./psychologist - the normative number of the population attached to the primary health care subject for the establishment of one position of a psychologist, approved by Order No. 238.
When determining the planned annual volume of funding for the SCS for all primary health care subjects, K social worker/psychologist is set to 1.0.
When determining K social worker/psychologist for a specific PHC subject for the reporting period for all PHC subjects, the following is taken into account:
if the actual value exceeds 1.0, then the value is set to 1.0;
in the absence of social workers and psychologists, the value is set to 0.
If the level of contribution of the primary health care subject (C%):
up to 80% - the contribution to achieving the final result of the activity is assessed as partially achieved, then payment for the reporting period is carried out according to the actual amount of financing of the SKPN;
80% or more - the contribution to achieving the final result of the activity is assessed as achieved, then payment for the reporting period is made according to the actual amount of financing of the SKPN plus the amount from the additional incentive fund for achieving the final result of 80% or more, calculated in accordance with subparagraph 2) of the stage 3 provided there is no maternal mortality preventable at the PHC level. In the case of maternal mortality that is preventable at the primary health care level, payment to this primary health care entity is carried out according to the actual amount of financing of the Social Insurance Fund.
Stage 3: formation of a fund for additional incentives for primary care subjects for achieving the final result of 80% or more (hereinafter referred to as the fund) and the rules for its distribution;
1) the formation of the fund is carried out at the expense of funds received from primary health care entities in connection with the deviation in the reporting period of the planned amount of SPT from the actual amount of SPT according to the formula:
F = V plan.skpn mo - V actual.skpn mo 1, where:
F - the volume of funds from the fund for additional incentives for primary health care subjects for achieving the final result of 80% or more in the reporting period;
V plan.skpn mo - the planned volume of financing of the SKPN of the primary health care subject for the reporting period is determined by the formula:
V plan.skpn mo = H us. mo * S skpn.rk *K mo, where:
H us. mo - the number of the population attached to the primary health care unit, registered in the portal "RPN", in the reporting period as of the last date of the month;
S SKPN.rk - fixed value of SKPN per 1 resident, equal to 100 tenge;
K mo = equal to 1.0
V fact.skpn mo 1- actual volume of financing of the SKPn for the primary health care subject for the reporting period;
2) distribution of the fund’s funds among primary health care entities that have achieved the target value of the final result by 80% or more (hereinafter referred to as primary health care entities - leaders) is carried out in the following order:
The cost of 1 point for additional incentives for a primary health care subject - a leader is determined from the fund's funds using the formula:
S additional skpn_reg/point =
(H sat mo-80% x
PPI mo-80% x K mo-80%), where:
S additional skpn_reg/point. - an additional amount of SPC, established per 1 point for primary care subjects - leaders;
H us. mo-80% - the number of attached population of the primary health care subject - the leader, registered in the portal "RPN" in the reporting period as of the last date of the month;
PPI mo-80% - the sum of actual scores for each indicator of the final result of the primary health care subject - the leader for the reporting period;
Kmo-80% is the coefficient of comprehensiveness of medical services in the provision of guaranteed volume of medical care to the primary health care subject - the leader for the reporting period;
The amount of additional incentives from the fund for the primary health care subject - the leader is determined according to the formula:
Ф mo = (H sat. mo - 80% x
PPI mo-80% x K mo-80%) x S additional.skpn_reg/point, where:
F mo - the amount of additional incentives from the fund for the primary health care subject - the leader for achieving the final result of 80% or more.
If in the region the number of primary health care entities with a contribution level (C%) of 80% or more is from total number PHC subjects of the region:
20% or more - the formed fund is distributed in full among primary health care entities that have reached a contribution level (C%) of 80% or more, which have not registered a case of maternal mortality preventable at the primary health care level;
less than 20% - then payment of the amounts of SPT to PHC subjects is carried out in the following order:
for primary health care subjects with a contribution level (C%) of up to 80% - payment is made according to the actual amount of financing of the SKPN;
PHC subjects with a contribution level (C%) of 80% or more, provided there is no maternal mortality preventable at the PHC level, are paid according to the amount of the SKPN established in the reporting period per 1 point for the region (S fact.skpn_reg/point) increased by 25% within the amount of SST allocated for the region for the reporting period. In the case of maternal mortality that is preventable at the primary health care level, payment to this primary health care entity is carried out according to the actual amount of financing of the Social Insurance Fund.
The calculation of the cost of 1 point for the region (S fact.skpn_reg/point) with an increase of 25% is determined before the distribution of the sums of the sq. the amount of SPT from the fund after deducting the amount of SPT with an increase in the cost of 1 point by 25% for primary care entities with a contribution level of 80% or more is subject to return to the budget in the manner determined by budget legislation.
If the increase in the cost of 1 point is 25% higher than the amount of SPC provided for in the reporting period, then the increase in the cost of 1 point is calculated based on the remaining funds after distribution to primary care entities with a contribution level (C%) of up to 80%.
4th stage: calculation of the amount of SCI for the achieved final result of the work of the primary health care subject - the leader, taking into account additional incentives from the fund, is determined by the formula:
V fact.skpn mo 2 = V fact.skpn mo 1+ F mo, where:
V fact.skpn mo 2 - the amount of financing of the SKPn for the primary health care subject - the leader, taking into account additional incentives from the fund for the reporting period.
If the amount of financing of the SPC for the leading primary care subject, taking into account additional incentives from the fund for the reporting period (V actual SPC mo2) per 1 attached person of the population for the reporting period, amounted to more than 100 tenge, then payment of the amounts of the SPC to these entities Primary health care is carried out in the following order:
1) V fact.skpn mo 3 is determined by the following formula:
V fact.skpn mo3 = H us. mo - 80% x 100, where:
100 - the maximum amount of SPC per 1 attached person of the population for the reporting period, tenge;
2) the balance of funds is determined, subject to return to the budget in the manner determined by budget legislation, or subject to redistribution by decision of the authorized body, according to the following formula:
V remainder = V actual.skpn mo 2 - V actual.skpn mo 3
step 5: calculation of the amount of SCI for the achieved final result of the work of the primary health care subject to the level of the territorial section of the primary health care subject (hereinafter referred to as the section) for the reporting period is carried out in the following sequence:
1) determination of the amount of financial resources intended to stimulate the local service of the primary health care subject for the achieved final result of the work according to the formula:
V skpn academic service = V skpn mo - V higher sq. - V outside the uch. , Where:
V skpn mo - the volume of financial resources intended for skpn for a primary health care subject with a contribution level of up to 80% (V fact. skpn mo 1) or for a primary care subject - leader (V fact. skpn mo 2 or V fact. skpn mo 3) for the reporting period, calculated in accordance with step 7 of this Methodology;
V increased.kv - the amount of financial resources intended for SKPN, directed by the primary health care entity for advanced training and retraining of employees of this PHC entity, including travel expenses, but not less than 5% of the volume of financial resources intended for SKPN, for the primary health care entity (hereinafter referred to as - amount for advanced training);
V out of school - the amount of financial resources allocated for the SKPN to stimulate additional personnel (the head of an independent Family Health Center or a medical outpatient clinic, heads and senior nurses of general medical practice departments, heads and senior nurses of local service departments, workers (doctors and nurses) of the prevention department and socio-psychological assistance of the Family Health Center), but not more than 20% of the amount of the SKPN of the primary health care subject after deducting the amount for advanced training;
2) determination of the current value of indicators for assessing the achieved final results of the site’s work is carried out in accordance with the 1st stage of step 4 of this Methodology. In this case, the target value for indicators for assessing the achieved final results of work for the site is established as for the primary health care subject in accordance with step 4 of this Methodology;
3) the given indicator of the final result indicator is calculated in points for the site (PPI uch.) in accordance with the 1st stage of step 4 of this Methodology, with the exception of the indicator “Maternal mortality preventable at the primary health care level”. If one or more cases of maternal mortality are registered in the service area of a site, the PPI value is set as 0 for all indicators of this territorial site.
In the absence of registration of maternal mortality among the assigned population in the service area of the site, the PPI is set at its maximum value (I VC) according to the indicator “Maternal mortality preventable at the primary health care level”;
4) determination of the amount of financial resources intended to stimulate a specific site for the achieved final result of work in the reporting period according to the formula:
V skpn uch. = H us. uch. x S skpn_uch/point x
PPI student , Where:
V skpn uch. - the amount of financial resources allocated for the SKPN to stimulate workers providing services in the territorial area (general practitioners, local therapists and pediatricians, general practice and local service nurses, midwives providing medical services in the territorial area, social workers and psychologists );
H us.uch. - the number of the population attached to the site, registered in the portal "RPN" in the reporting period as of the last date of the month;
PPI uch - the sum of actual points for each indicator of the final result, formed during the reporting period for a specific section;
S skpn_uch/point - the amount of skpn established for the district service in the reporting period per 1 point, determined by the formula:
S skpn_uch/point = V skpn academic service /
(H us. uch. x
PPI uch.), where:
V skpn educational service - the amount of financial resources allocated for skpn, to stimulate the local service of the primary health care subject for the reporting period;
(H us.uch. x
PPI uch.) - the sum of the products of the number of the attached population registered in the portal "RPN" in the reporting period, and the sum of actual points for each indicator of the final result, formed during the reporting period, for a specific area.
step 6: calculation of the amount of SPT to the level of each primary care employee is carried out by the commission for assessing the results and calculating payments of SPT created by order of the first head of the primary care entity in accordance with Order No. 429.
Footnote. Clause 15 as amended by order of the Minister of Health and Social Development of the Republic of Kazakhstan dated August 31, 2016 No. 765 (shall come into force ten calendar days after the day of its first official publication); as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (the order of enforcement see clause 4).
16. Calculation of the per capita standard for PHC subjects for the provision of PHC is carried out in accordance with paragraph 13 in the structure of the guaranteed component of the complex per capita standard of the AMS and in accordance with paragraph 39 in the structure of the guaranteed component of the complex per capita standard for the rural population in the amount of funds determined for the provision of PHC to the population.
17. Payment for the provision of consultative and diagnostic services is carried out according to the tariff (average estimated cost) for the provision of one consultative and diagnostic service based on the method for determining direct and indirect (overhead) costs according to the tariff schedule.
18. Calculation of the tariff (average estimated cost) for the provision of one consultative and diagnostic service based on the method for determining direct and indirect (overhead) costs in accordance with the standard of service provision.
19. Calculation of the tariff (average estimated cost) for the provision of one consultative and diagnostic service based on the method of determining direct and indirect (overhead) costs is carried out using the following formula:
C kdu_i-P = P straight_i + P overhead_i, where:
С кду_i-Р - the average estimated cost of one consultative and diagnostic service, calculated without taking into account correction factors based on the method for determining direct and indirect (overhead) costs in accordance with the service provision standard;
i - type of consultative and diagnostic service according to the list according to the tarifficator for medical services;
P direct_i - the average estimated amount of direct costs for the provision of one consultative and diagnostic service, which includes the costs provided for in subparagraphs 1) and 2) for remuneration of the main medical workers of healthcare entities providing the i-th medical service, and paragraph 3) of paragraph 4 of this Methodology;
P overheads_i - the amount of overhead costs per one consultative and diagnostic service, which includes the costs provided for in subparagraphs 1) and 2) for payment of auxiliary (indirect) labor of employees of healthcare entities not directly involved in the provision of the i-th medical service, and subparagraphs 5)-8) paragraph 4 of these Rules, which are determined by the following formula:
P invoices_i = ZP i x k invoices, where:
ZP i - the average estimated amount of expenses for remuneration of the main medical workers of healthcare entities providing the i-th medical service, which is calculated in accordance with subparagraphs 1)-2) of paragraph 4 of these Rules;
k overhead - overhead coefficient, which is determined by the following formula:
k invoices = P invoices_mo / ZP mp, where:
P invoices_MO - the average estimated amount of overhead costs of healthcare entities providing outpatient care within the framework of the guaranteed volume of medical care, which includes the costs provided for in subparagraphs 5)-8) of paragraph 4 of these Rules;
Salary MP - the average estimated amount of expenses for remuneration of medical workers of healthcare entities, which is calculated in accordance with subparagraphs 1)-2) of paragraph 4 of these Rules;
20. Calculation of the average estimated cost of one consultative and diagnostic service, calculated taking into account correction factors, is carried out using the following formula:
C kdu _i- RR = C kdu _i- P _n + C kdu _i- P _n x (K 1 -1)+…+ C kdu_i-P_n x (K n -1)), where:
S kdu_i-РР - the average estimated cost of one consultative and diagnostic service of type n, calculated taking into account correction factors based on the method of determining direct and indirect (overhead) costs in accordance with the standard of service provision;
K 1 , K n - correction factors used by the administrator of budget programs in order to adjust the cost of advisory and diagnostic services, taking into account the costs of paying premiums for work in rural areas, for work in environmental disaster zones in accordance with the Law of the Republic of Kazakhstan on the social protection of citizens of the Aral Sea region and the Law of the Republic of Kazakhstan on social protection of citizens of the SINP, for the duration of the heating season and other coefficients approved by the administrator of budget programs.
21. Calculation of the amount of financing of a healthcare entity for the provision of consultative and diagnostic services within the framework of the guaranteed volume of medical care based on the average estimated cost of one consultative and diagnostic service, calculated on the basis of the method for determining direct and indirect (overhead) costs, is carried out using the following formula:
V kdu_i-P = H kdu_i-1 xC kdu_i-PP_1 + H kdu_i-n x C kdu_i-PP_n, where
V kdu_i-R - the amount of funding for reimbursement of expenses for the provision of advisory and diagnostic services within the framework of the Statewide Fund for Medical Care for the planned or reporting period;
Ch kdu_i-1, Ch kdu_i-n - the number of advisory and diagnostic services of type n for the planned or reporting period.
21-1. Payment for PMK services is carried out according to the tariff for PMK services per person.
Footnote. The order was supplemented with clause 21-1 in accordance with the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement, see clause 4).
21-2. The tariff for primary health care services per person is determined based on the average actual costs per person using the following formula:
T PMK = (V average actual costs - V eco.PMK)/H PMK, where:
T PMK - tariff for PMK services per person;
V average actual costs - the average volume of actual costs of a healthcare entity providing primary health care services, determined by the authorized body;
V eco.PMK - the annual amount of funds provided for the payment of the premium for work in environmental disaster zones, which is formed at the regional level in accordance with the ZRK on the social protection of citizens of the Aral Sea region and the ZRK on the social protection of citizens of the SINP;
H PMK - the number of people who received PMK services.
Footnote. The order was supplemented with clause 21-2 in accordance with the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement, see clause 4).
21-3. Calculation of the amount of financing of a healthcare entity for the provision of primary health care services is determined by the following formula:
V financial PMK = H PMK x T PMK x K eco. , Where:
V financial PMK - the amount of financing of the healthcare entity for the provision of PMK services;
Towards ecology - an adjustment factor applied by the administrator of budget programs in order to adjust the tariff for PMK services per person, taking into account the costs of paying the premium for work in environmental disaster zones in accordance with the LRK on the social protection of citizens of the Aral Sea region and the LRK on the social protection of citizens of the SINP, approved by the administrator of budget programs .
Footnote. The order was supplemented with clause 21-3 in accordance with the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement, see clause 4).
Paragraph 2. Inpatient and hospital-replacement care
22. Healthcare entities providing inpatient and hospital-replacement care use the following tariffs:
for one bed-day;
per case treated at the estimated average cost;
for one treated case at medical and economic rates;
for one treated case based on actual costs for the list of diseases, operations and manipulations determined by the authorized body;
for one treated case by clinical-cost groups, taking into account the cost-intensity coefficient (hereinafter referred to as the CCG).
23. The tariff for healthcare entities providing specialized medical care in the form of inpatient care, payment for which is carried out per bed-day, is determined by the following formula:
T k/day = V fin / Kl k/day, where:
T k/day - tariff for one bed-day for healthcare entities providing specialized medical care in the form of inpatient care;
V financial - the amount of funding for the next planning period for healthcare entities providing specialized medical care in the form of inpatient care, payment for which is carried out at a rate per bed-day;
C/day - the number of bed days for a given healthcare entity for the next planning period.
24. The tariff for one treated case at the estimated average cost for healthcare entities providing specialized medical care in the form of inpatient care is determined by the following formula:
T ps = V fin / Kl ps, where
T ps - tariff for one treated case at the estimated average cost for healthcare entities providing specialized medical care in the form of inpatient care;
V financial - the amount of funding for the next planning period for healthcare entities providing specialized medical care in the form of inpatient care, payment for which is carried out at a rate for one treated case at the estimated average cost;
Kl ps - the number of treated cases for a given healthcare entity for the next planning period.
25. The tariff for one treated case according to medical and economic tariffs for healthcare entities providing inpatient and (or) hospital-substituting medical care is calculated on the basis of diagnostic and treatment protocols.
26. The tariff for one treated case according to the DRG for healthcare entities providing inpatient and (or) hospital-substituting care is determined by the following formula:
S kzg = Bs kzg x KZ kzg i + Bs kzg x KZ kzg i x (Kn 1 -1) + Bs kzg x
KZ kzg i x (Kn 2 -1) +… + BS kzg x KZ kzg i x (Kn n -1), where:
With DRG - the cost of one treated case according to DRG;
i - type or group of KZG;
BS KZG - the cost of the base rate for KZG, approved by the authorized body;
KZ kzg i - coefficient of cost intensity of a certain type (i) KZG;
Kn 1, Kn 2, Kn n - correction factors (ecological coefficient, rural area coefficient, factor taking into account the duration of the heating season and other correction factors).
The adjustment factor for work in rural areas is assigned to healthcare entities to ensure increased wages of at least twenty-five percent of the salary of healthcare professionals working in rural areas compared to the salaries and tariff rates of specialists engaged in these types of activities in urban settings. in accordance with the Labor Code and Resolution No. 1193, which is calculated using the following formula:
K st = PC st x % salary, where:
K st - rural coefficient for healthcare professionals working in rural areas;
PCst - coefficient for healthcare professionals working in rural areas, provided for by the Labor Code and Resolution No. 1193;
%salary is the average share of wages in the total budget of healthcare entities providing medical services within the framework of the guaranteed volume of medical care in the corresponding region.
An environmental correction coefficient is assigned to healthcare entities to ensure additional payments to employees living in environmental disaster zones in accordance with the Law of the Republic of Kazakhstan on the social protection of citizens of the Aral Sea region, which is calculated using the following formula:
Ke prair = 1 + (PKe prair - 1) x %zp, where:
Ke prair - environmental coefficient for workers living in environmental disaster zones of the Aral Sea region;
PKe prar - coefficient for living in environmental disaster zones, provided for by the ZRK on the social protection of citizens of the Aral Sea region;
%salary is the average share of wages in the total budget of a healthcare entity providing medical services within the framework of the guaranteed volume of medical care in the territories of environmental disaster zones.
Workers living in the nuclear testing areas at the Semipalatinsk nuclear test site are provided with additional wages by zone in accordance with the Law of the Republic of Kazakhstan on the social protection of citizens of the STN, which is calculated using the following formula:
Ke sevenp = 1 + (Number of salary x N salary / salary avg x % salary), where:
Ke semip - environmental coefficient for workers living in the nuclear test areas at the Semipalatinsk nuclear test site;
Quantity of MCI - the number of monthly calculation indicators provided as a wage supplement for residents living in the nuclear testing areas at the Semipalatinsk nuclear test site;
N MCI - the amount of the monthly calculation indicator provided for the corresponding year by the Law on the State Budget for the corresponding years;
ZP av - average salary in the nuclear testing areas at the Semipalatinsk nuclear test site;
% salary - the share of wages in the total budget of a health care entity providing medical services within the framework of the guaranteed volume of medical care in the territories of nuclear testing zones at the Semipalatinsk nuclear test site.
The coefficient for taking into account the duration of the heating season for the region (city of republican significance and the capital) is determined by the following formula:
To heating area = 1 + D heat. x (P region - P RK/avg.)/P RK/avg. , Where
K heating region - coefficient taking into account the duration of the heating season for the region;
D heating - the share of costs for the annual volume of heating in the total annual volume of current costs in the region (city of republican significance and the capital) based on data from healthcare entities providing inpatient and (or) hospital-replacement care in the region (city of republican significance and the capital) over the past year ;
P region - the period of the heating season for the region (city of republican significance and the capital), determined on the basis of a decision of the local executive body of the region (city of republican significance and the capital), which is used to calculate the amount of funding for the upcoming financial year;
P RK/avg. - the period of the heating season on average for the Republic of Kazakhstan according to the data of the regions (city of republican significance and the capital), which are used to calculate the amount of financing for the upcoming financial year.
Footnote. Clause 26 as amended by the order of the Minister of Health and Social Development of the Republic of Kazakhstan dated August 31, 2016 No. 765 (shall be enforced upon the expiration of ten calendar days after the day of its first official publication).
27. Calculation of the amount of financing for healthcare entities providing inpatient and (or) hospital-substituting care, payment for which is carried out at the rate for one treated case according to the DRG, for the next planning period is determined by the formula:
V fin mo = Kl pr.case x Kz. sr kzg x Bs, where:
V financial - the amount of financing for the next planning period for a healthcare entity providing inpatient and (or) hospital-substituting medical care, payment for which is carried out at the rate for one treated case according to the DRG;
Kl pr. case - the number of treated cases for a given healthcare entity for the next planning period;
Kz. av kzg - the average cost intensity coefficient of the kzg for a given healthcare entity for the next planning period;
BS - the cost of the base rate for the planned period, approved by the authorized body.
28. Tariff for one treated case according to DRG day hospital is 1/4 of the tariff for one treated case according to the DRG of inpatient medical care.
29. The tariff for one treated case for the DRG of inpatient care at home is 1/6 of the tariff for one treated case for the DRG of inpatient medical care.
Paragraph 3. Medical care for cancer patients
30. Payment for medical services provided to cancer patients within the framework of the guaranteed volume of medical care is carried out at a comprehensive tariff per one cancer patient to healthcare entities, with the exception of:
provision of chemotherapy and targeted drugs, radiation therapy, which are financed based on actual costs;
republican healthcare organizations and patients with malignant neoplasms of lymphoid and hematopoietic tissue, which are paid for the provision of inpatient and hospital-substituting medical care at the rate for one treated case (hereinafter referred to as the healthcare entity providing medical services to cancer patients).
Footnote. Clause 30 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (the order of enforcement see clause 4).
31. Calculation of the complex tariff for one cancer patient per month, with the exception of patients with malignant neoplasms of lymphoid and hematopoietic tissue, registered in IS "EROB", for a healthcare entity providing medical services to cancer patients is carried out according to the formula:
Kt onco = (V financial.onco_year / H average list.onco_year) / m, where:
V financial oncology_year - the amount of funding for the provision of medical services to cancer patients for the upcoming financial year;
H average list.onco_year - annual average number of cancer patients, with the exception of patients with malignant neoplasms of lymphoid and hematopoietic tissue, which is calculated by the formula:
H average list.onko_year = (Chonko beginning + Chonko beginning x Tgrowth / 100) / 2, where:
Ch onko start. - the number of cancer patients, with the exception of patients with malignant neoplasms of lymphoid and hematopoietic tissue, registered in the IS "EROB" at the beginning of the financial year;
T growth is the average growth rate of cancer patients over the past three years, which is determined by the formula:
T gain = (H end (n1) / H end (n1) x 100 + H end (n2) / H end (n2) x 100 + H end (n3) / H end (n3) / H end (n2) x 100 + H end (n3) / H end (n2) n3) x 100) / 3, where:
Ch onko start. - the number of cancer patients, with the exception of patients with malignant neoplasms of lymphoid and hematopoietic tissue, registered in the IS "EROB" at the beginning of the year for the period (n1,2,3) of the last three years;
H onko end - the number of cancer patients, with the exception of patients with malignant neoplasms of lymphoid and hematopoietic tissue, registered in the IS "EROB" at the end of the year for the period (n1,2,3) of the last three years;
m is the number of months in the financial year during which funding will be provided for the provision of medical services to cancer patients.
Footnote. Clause 31 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement, see clause 4).
32. Calculation of the amount of financing for healthcare entities providing medical services to cancer patients, payment for which is carried out at a comprehensive tariff per one cancer patient for the reporting period is determined by the formula:
V fin.onko = H average list.onko x K fine, where:
H average list.onco - the average number of cancer patients, with the exception of patients with malignant neoplasms of lymphoid and hematopoietic tissue, for the reporting period is calculated by summing the number of cancer patients registered in IS "EROB" for each calendar day of the reporting period and dividing the resulting amount by the number of calendar days in the month of a given reporting period.
Footnote. Clause 32 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement, see clause 4).
Paragraph 4. Emergency medical care and air ambulance
33. Payment for emergency medical care provided is carried out at the rate for one emergency medical call, which is determined by the following formula:
T in = V fin / K ls, where:
T in - tariff for one emergency medical call;
V financial - the amount of funding for the next planning period for the provision of emergency medical care;
To pm - the number of emergency medical calls for the next planned period.
Footnote. Clause 33 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (the order of enforcement see clause 4).
34. Payment for medical services provided by air ambulance is carried out according to tariffs for transport and medical services.
The tariff for medical services of air ambulance is determined by the following formula:
T mu = V fin mp / Kl h, where:
T mu - tariff for one hour of medical air ambulance service;
V financial MP - the amount of funding for the next planning period for the provision of medical services by air ambulance;
Kl h - the number of planned hours for the provision of medical services.
The tariff for air ambulance transport services includes costs associated with the transportation of qualified specialists and (or) a patient various types transport and is determined by the average cost of proposals from potential suppliers.
Paragraph 5. Medical assistance to the rural population
35. For health care entities of district significance or a village that provide a range of services for the guaranteed volume of medical care according to the list of forms of medical care, determined in accordance with subparagraph 81) of paragraph 1 of Article 7 of the Health Code (hereinafter referred to as the village entity), the tariff for determining the amount of financing is a comprehensive per capita standard on the rural population.
Footnote. Clause 35 as amended by the acting order. Minister of Health and Social Development of the Republic of Kazakhstan dated July 29, 2015 No. 632 (shall be enforced after the day of its first official publication).
36. The comprehensive per capita standard for the rural population is determined for rural entities providing primary health care, based on one rural resident registered in the portal "RPN", per month and consists of a guaranteed component of the comprehensive per capita standard for the rural population and SKPN.
The comprehensive per capita standard for the rural population is determined for rural entities that do not provide primary health care, per one rural resident registered in the RPN portal for a given district or village, per month and consists of a guaranteed component of the comprehensive per capita standard for the rural population.
37. The guaranteed component of the comprehensive per capita standard for the rural population includes costs associated with the activities of a rural entity to provide a range of guaranteed volume of medical care services to the rural population by type of medical care, including pre-medical, qualified, specialized, medical and social, which are provided in the forms of primary health care, KDP, inpatient replacement and inpatient medical care, in accordance with paragraphs 4, 5 of this Methodology.
The size of the guaranteed component of the complex per capita standard for the rural population is established depending on the structure of rural subjects according to the forms of medical care (primary health care, clinical care, inpatient care, inpatient care) determined by the UK.
During the current financial year, the administrator of budget programs may revise the size of the guaranteed component of the comprehensive per capita standard for the rural population, its application and distribution during the period of validity of the GVFMC agreement.
Footnote. Clause 37 as amended by the acting order. Minister of Health and Social Development of the Republic of Kazakhstan dated July 29, 2015 № 632 (shall be put into effect after the day of its first official publication); as amended by order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 No. 627 (the order of enforcement see clause 4).
38. The incentive component of the complex per capita standard is determined in accordance with paragraphs 11 of this Methodology and calculated in accordance with paragraph 15 of this Methodology.
39. The calculation of the complex per capita standard for the rural population per month for rural subjects is carried out:
KPN village = KPN urban village + S skpn, where
CPI village - a comprehensive per capita standard for the rural population per attached person registered in the portal "RPN", per month;
S skpn - the amount of skpn per one attached person registered in the portal "RPN" to the subject of the village, per month;
CPI for rural villages is a guaranteed component of the complex per capita standard for the rural population per one attached person registered in the portal "RPN" to the subject of the village, per month, which is calculated using the formula:
CPI urban village = (CPN base PHC x PHC village + CPI base PHC x (K dense region -1) + CPI base PHC x (K heating region -1) + CPN base PHC x ( K rural region -1)) x K village subject + V eco-village / H village / m + (V sp/nwt_village /H village/m) x K village subject + V school village / H village / m, where :
CPI base PHC - the basic comprehensive per capita standard AMS per one attached person registered in the portal "RPN", per month, determined without taking into account correction factors by the authorized body on the basis of paragraph 2 of Article 23 of the Health Code, which is calculated according to the formula in accordance with paragraph 13 of this Techniques;
H village - the number of the population attached to a village entity that provides primary health care, registered in the portal "RPN" or the population of a village entity that does not provide primary health care, registered in the portal "RPN" for a given district or village (hereinafter - the number of population attached to a village entity );
PVK village - age-sex adjustment coefficient for consumption of primary health care by the population in a rural area, which is determined by the formula:
PVC village =
(H village k/n x PVK village (n))/ H village, where
H village k/n - the number of the population attached to the subject of the village, registered in the portal "RPN" number k population falling into age and sex group number n;
PVK village (n) - age-sex adjustment coefficient for the consumption of medical services by the population of age-sex group number n according to Appendix 1 to this Methodology.
The population size and age-sex composition of the population assigned to a rural entity are determined on the basis of population data from the database of the portal "RPN" based on the results of the free population assignment campaign or as of the last day of the month, which are used to calculate the amount of funding for the provision of a set of services for the guaranteed volume of medical care in rural areas to the population for the coming financial year or its adjustments during the current financial year by decision of the authorized body in the field of healthcare;
To dense region - population density coefficient for a given region, city of republican significance and capital, which is determined by a formula similar to paragraph 13 of this Methodology;
To heating area - coefficient for taking into account the duration of the heating season for the region (city of republican significance and the capital), which is determined by a formula similar to paragraph 13 of this Methodology;
To the rural region - coefficient for taking into account allowances for work in rural areas for regions, which is determined by the formula:
To the rural region = 1+0.25 x (H village / H region x BEFORE village), where
DO village - the share of labor costs based on the official salary in the total current costs of rural entities.
The coefficient for taking into account allowances for work in rural areas for a city of republican significance and the capital is 1.0;
K of a rural entity - an adjustment factor established for a rural entity in order to ensure sustainable functioning in cases of small population, large area with low density, and other territorial features determined by the administrator of budget programs. The calculation of the size of the correction factor and its approval is carried out by the administrator of budget programs;
V school village - the annual amount of funds provided for the village subject to pay costs within the allocated funds from the republican budget related to the activities of the medical center of the educational organization to provide medical care to students of secondary education organizations that are not related to boarding institutions assigned to the primary health care subject , in accordance with order No. 85;
V eco-village - the annual amount of funds provided for the payment of an allowance for work in environmental disaster zones to rural subjects, which is formed at the regional level in accordance with the ZRK on the social protection of citizens of the Aral Sea region and the ZRK on the social protection of citizens of the SINP;
V joint venture/nwt_village - annual amount of funds for a rural entity to provide inpatient and hospital-substituting medical care to the attached rural population, which is determined by the formula:
V sp/nwt_village = V sp/nwt_village/region. / PS sp/nwt_selo/reg. x PS sp/szt_selo, where:
V sp/nwt_village/region - the annual amount of funds in the region for the provision of specialized medical care to the rural population in the forms of inpatient and hospital-substituting medical care for the coming financial year;
PS sp/nwt_selo/reg. - the planned number of treated cases in the region for the coming financial year when providing specialized medical care to the rural population in the forms of inpatient and hospital-substituting medical care, which is defined as the sum of treated cases (PSsp/swt_village) for all rural entities;
PS sp/nwt_village - the planned number of treated cases for the rural subject for the coming financial year when providing specialized medical care to the attached rural population in the forms of inpatient and hospital-substituting medical care, which is determined by the formula:
Substation sp/north_village = Substation sp/rural + Substation sp/rural x %temp sp/rural + Substation nwt/village + Substation nwt/village x %tempe nwt/village, where:
PS village/village - the number of cases treated by a village subject over the past year, who received specialized medical care in the form of inpatient medical care among the attached rural population;
PS north-west telecom/village - the number of cases treated by a rural entity over the past year, who received specialized medical care in the form of hospital-replacement medical care among the attached rural population;
%rate of the joint venture/village, %rate of the northwestern telecom/village - the rate of growth or decline of inpatient and hospital-replacement medical care, respectively, planned for the coming financial year, expressed as a percentage;
m is the number of months in the financial year during which the rural entity will be financed.
Footnote. Clause 39 as amended by the acting order. Minister of Health and Social Development of the Republic of Kazakhstan dated July 29, 2015 No. 632 (shall be enforced after the day of its first official publication); as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (the order of enforcement see clause 4).
40. Calculation of the amount of funding for the provision of a range of services for the guaranteed volume of medical care to the rural population according to the complex per capita standard for the rural population for a rural entity is carried out according to the formula:
V financial village = H village x CPN village.x m, where
V financial village - the amount of funding for a rural entity providing primary health care for the upcoming financial year or reporting period;
K of a rural entity - an adjustment factor established for a rural entity in order to ensure sustainable functioning in cases of small population, large area with low density, and other territorial features determined by the administrator of budget programs. The calculation of the size of the correction factor and its approval is carried out by the administrator of budget programs.
The volume of financing of a rural entity according to the complex per capita standard for the rural population does not depend on the volume of services provided.
For a rural entity, the amount of SCI per capita is determined when determining the amount of financing for the coming financial year according to the planned level established for the republic, and when determining the amount of financing for the reporting period based on the actual result of the PPI
Chapter 3. Planning of costs for medical services provided within the framework of the guaranteed volume of medical care
Footnote. The title of Chapter 3 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement, see paragraph 4).
40. Planning of costs for the provision of medical services within the framework of the guaranteed volume of medical care by type of medical care is carried out by the administrator of budget programs on the basis of approved current cost standards, as well as analysis and assessment of the performance of the healthcare system as a whole and healthcare entities according to the following indicators:
volume of medical care by type (over a three-year period) for the region as a whole and for each healthcare entity separately;
the number of bed days in a hospital, the average length of stay in a bed, the operation of a bed in the context of healthcare entities;
number of working personnel, level of remuneration;
expenses for the purchase of medicines, medical products and consumables;
food expenses;
availability of equipment and their effective use, provision of soft equipment, etc.;
the condition of buildings and structures, the need for their ongoing repairs;
availability of space, availability of unused space;
utility costs: heating, electricity, hot and cold water;
expenses for advanced training and retraining of personnel;
other expenses: payment for banking services, communication services, travel expenses, routine repairs, rent of premises, purchase of office and household supplies, soft equipment, other goods and services.
41. The analysis should be based on statistical data, information systems data, as well as data from financial reports of healthcare entities, and information received from statistical and financial authorities.
Footnote. The upper right corner of Appendix 1 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement see clause 4).
Sex and age correction factors
Footnote. The upper right corner of Appendix 2 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated 08/21/2017 (for the order of enforcement see clause 4).
Table of maximum possible points for primary care subjects
in terms of profiles of territorial sections
|
№ |
Indicator name |
Total maximum score* |
General practice area |
Therapeutic |
Pediatric |
|
Maternal mortality preventable at the PHC level* |
|||||
|
Infant mortality |
|||||
|
In a timely manner |
|||||
|
Hospitalization rate of patients with complications of cardiovascular diseases (myocardial infarction, stroke) *** |
|||||
|
Justified complaints |
|||||
|
Total maximum score |
|||||
Note:
* The final maximum score for PHC subjects with only pediatric areas in their structure, and for PHC subjects with only therapeutic areas in their structure, is set at 20 points.
** The indicator “Child mortality from 7 days to 5 years, preventable at the PHC level” does not apply to PHC entities serving only the adult population, which have only therapeutic areas in their structure.
*** The indicator “Level of hospitalization of patients with complications of diseases of the cardiovascular system (myocardial infarction, stroke)” does not apply to primary health care entities serving only the child population under 18 years of age, which have only pediatric areas in their structure.
Footnote. The upper right corner of Appendix 3 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement see clause 4).
Indicators for assessing achieved work results
healthcare entities providing
primary health care
|
Name indicator |
Calculation method |
Data source |
Expected effect |
||||
|
Numerator |
Denominator |
multiply by |
numerator |
denominator |
|||
|
Maternal mortality preventable at the PHC level |
Number of cases of maternal death from preventable causes confirmed by experts among the attached population during the reporting period |
Portal "RPN": fact of death from form 2009-1/у “Maternal Mortality Record Card”, approved by Order of the Minister of Health of the Republic of Kazakhstan dated October 12, 2011 No. 698 “On monitoring of born, deceased children under 1 year of age, maternal mortality” (hereinafter referred to as Order No. 698) DKPN portal: The fact of death confirmed by the KKMFD on preventability at the PHC level |
absence |
||||
|
Child mortality from 7 days to 5 years, preventable at the PHC level |
Number of child deaths aged 7 days to 5 years preventable at the primary health care level among the attached population during the reporting period |
Portal "RPN": fact of death from form No. 2009/u "Registration card for a child born alive, stillborn, or deceased under the age of 1 year", approved by Order No. 698, extended to 5 years, for causes of death according to ICD-10 codes indicated in Table No. 1 of the Appendix 4 to the Methodology DKPN Portal: The fact of death, confirmed by the KKMFD about preventability at the PHC level |
absence |
||||
|
Timely diagnosed pulmonary tuberculosis |
The number of timely diagnosed forms of pulmonary tuberculosis in newly diagnosed patients with pulmonary tuberculosis among the assigned population during the reporting period |
Number of newly identified cases of pulmonary tuberculosis among the assigned population during the reporting period |
TB form 16/u “Map of monitoring the dispensary population”, approved by the order of the acting Minister of Health of the Republic of Kazakhstan dated November 23, 2010 No. 907 “On approval of forms of primary medical documentation of healthcare organizations”, cases of timely diagnosis of forms of tuberculosis according to ICD-10 codes and diagnosis codes according to the Register of Tuberculosis Patients, indicated in Table No. 2 of Appendix 4 to Methodology |
Portal "ERDB" (Electronic Register of Tuberculosis Patients): TB form 16/u “Map of monitoring the dispensary population”, approved by the order of the acting Minister of Health of the Republic of Kazakhstan dated November 23, 2010 No. 907 “On approval of forms of primary medical documentation of healthcare organizations”, all newly identified cases of tuberculosis according to ICD-10 codes and diagnosis codes according to the Register of Tuberculosis Patients, indicated in Table No. 2 of Appendix 3 to Methodology Portal "RPN": attached population |
promotion |
||
|
Newly identified cases of malignant neoplasm of visual localization stage 1-2 (breast cancer, cervical cancer, colorectal cancer, skin cancer, oropharyngeal cancer) |
The number of newly identified cases with a diagnosis of stage 1-2 visual malignancy among the attached population during the reporting period |
The number of all newly diagnosed cases with a diagnosis of malignant neoplasm of visual localization among the attached population during the reporting period |
form 030-6/у, approved by the order of the acting Minister of Health of the Republic of Kazakhstan dated November 23, 2010 No. 907, first identified cases of malignant neoplasm of visual localization of stages 1-2 according to ICD-10 codes indicated in Table No. 3 of Appendix 4 to the Methodology, Portal "RPN": attached population |
form 030-6/у, approved by the order of the acting Minister of Health of the Republic of Kazakhstan dated November 23, 2010 No. 907, all newly identified cases with a malignant neoplasm of visual localization according to ICD-10 codes indicated in Table No. 3 of Appendix 3 to the Methodology Portal "RPN": attached population |
promotion |
||
|
Hospitalization rate of patients with complications of cardiovascular diseases (myocardial infarction, stroke) |
The number of patients treated with complications of cardiovascular diseases (myocardial infarction, stroke) - in a 24-hour hospital from among the attached population during the reporting period |
Number of patients treated with diseases of the cardiovascular system from among the attached population during the reporting period |
form No. 066/у, approved by the order of the acting Minister of Health of the Republic of Kazakhstan dated November 23, 2010 No. 907, main diagnosis according to ICD-10 codes indicated in table No. 4 of Appendix 4 to the Methodology Portal "RPN": attached population |
form No. 066/у, approved by the order of the acting Minister of Health of the Republic of Kazakhstan dated November 23, 2010 No. 907, main diagnosis according to ICD-10 codes indicated in table No. 4 of Appendix 3 to the Methodology Portal "RPN": attached population |
decline |
||
|
Justified complaints |
The number of justified complaints among the attached population in relation to the activities of the primary health care facility during the reporting period |
Sukmu: cases of complaints from individuals, confirmed by the KKMFD on the validity of the complaint against the activities of the primary health care entity |
absence |
||||
Decoding abbreviations:
PHC - primary health care;
KKMFD - Committee for Control of Medical and Pharmaceutical Activities;
ICD-10 - International Classification of Diseases, 10th revision;
Portal "RPN" - portal "Register of Attached Population";
Portal "DCPN" - portal "Additional component to the PHC tariff";
Portal "ERDB" - portal "Electronic register of diagnostic patients";
SUKMU - quality management system for medical services;
EROB - electronic register of cancer patients.
Footnote. The upper right corner of Appendix 4 as amended by the order of the Minister of Health of the Republic of Kazakhstan dated August 21, 2017 (for the order of enforcement see clause 4).
Lists of International Classification of Diseases codes,
taken into account when calculating indicators, assessments of achieved
results of the primary organization's work
health care
Table No. 1. When calculating the indicator “Child mortality from 7 days to 5 years, preventable at the PHC level”, all cases of child mortality from 7 days to 5 years, preventable at the PHC level, confirmed by the KKMFD, are taken into account, with the exception of cases that arose in maternity hospitals, and the cases indicated in the table:
Table No. 2. List of ICD-10 codes and diagnosis codes according to the Register of Tuberculosis Patients for diseases taken into account when calculating the indicators “Timely diagnosed pulmonary tuberculosis” taken into account:
Codes 02, 04, 06, 12, 14, subject to filling out the column in the form TB 16/u “Map of observation of the dispensary contingent”, approved by the order of the acting. Minister of Health of the Republic of Kazakhstan dated November 23, 2010 No. 907 “On approval of forms of primary medical documentation of healthcare organizations” radiology diagnostics, the presence of a decay cavity at 0 months" - no.
2) in the denominator of this indicator:
|
No. |
Diagnosis code by |
Name of diseases |
ICD-10 code |
|
Primary tuberculosis complex with bacterial excretion |
|||
|
Primary tuberculosis complex without bacterial excretion |
|||
|
TB of intrathoracic lymph nodes with bacterial excretion |
|||
|
TB of intrathoracic lymph nodes without bacterial excretion |
|||
|
Disseminated acute pulmonary TB with bacterial excretion |
|||
|
Disseminated acute pulmonary TB without bacterial excretion |
|||
|
Disseminated subacute pulmonary TB with bacterial excretion |
|||
|
Disseminated subacute pulmonary TB without bacterial excretion |
|||
|
Disseminated chronic pulmonary TB with bacterial excretion |
|||
|
Disseminated chronic pulmonary TB without bacterial excretion |
|||
|
Focal pulmonary TB with bacterial excretion |
|||
|
Focal pulmonary TB without bacterial excretion |
|||
|
Infiltrative pulmonary TB with bacterial excretion |
|||
|
Infiltrative pulmonary TB without bacterial excretion |
|||
|
Caseous pneumonia with bacterial excretion |
|||
|
Caseous pneumonia without bacterial excretion |
|||
|
Pulmonary tuberculoma with bacterial excretion |
|||
|
Pulmonary tuberculoma without bacterial excretion |
|||
|
Cavernous pulmonary TB with bacterial excretion |
|||
|
Cavernous pulmonary TB without bacterial excretion |
|||
|
Fibrous-cavernous pulmonary TB with bacterial excretion |
|||
|
Fibrous-cavernous pulmonary TB without bacterial excretion |
|||
|
Cirrhotic pulmonary TB with bacterial excretion |
|||
|
Cirrhotic pulmonary TB without bacterial excretion |
|||
|
Miliary TB |
|||
|
Acute miliary TB of one specified location |
|||
|
Acute miliary TB of multiple localization |
|||
|
Acute miliary TB of unspecified localization |
|||
|
Other forms of miliary tuberculosis |
|||
|
Miliary TB of unspecified localization |
Table No. 3. List of topography of tumors of visual localization according to the codes of the International Classification of Topography and Morphology of Tumors (hereinafter referred to as ICD-O) for diseases taken into account when calculating the indicator “First identified cases with a diagnosis of malignant neoplasm of visual localization stage 1-2”:
1) the numerator of this indicator takes into account stages 1 and 2 this list ICD-10 codes;
2) the denominator of this indicator takes into account stages 1, 2, 3 and 4 of this list of ICD-10 codes
|
No. |
ICD-O code |
Name of diseases |
|
Lip, excluding lip skin (C44.0) |
||
|
Outside surface upper lip |
||
|
Outside surface lower lip |
||
|
Outer surface of the lip, NOS |
||
|
Mucous membrane of the upper lip |
||
|
Mucous membrane of the lower lip |
||
|
Mucous membrane of the lips, NOS |
||
|
Commissura lips |
||
|
Lip lesions extending beyond one localization |
||
|
Guba, NOS |
||
|
Base of tongue |
||
|
Other unrefined parts of the tongue |
||
|
Upper surface of the tongue |
||
|
Side surface |
||
|
Underside of the tongue |
||
|
Anterior 2/3 tongue, NOS |
||
|
Lesions of the tongue that extend beyond the specified localization |
||
|
Language, NOS |
||
|
Upper jaw gum |
||
|
Gum lower jaw |
||
|
Desna, NOS |
||
|
Floor of the mouth |
||
|
Anterior floor of the mouth |
||
|
Lateral floor of the mouth |
||
|
Damage to the floor of the mouth that extends beyond one location |
||
|
Floor of the mouth, NOS |
||
|
Solid sky |
||
|
Soft palate, bdu (excluding nasopharyngeal surface soft palate, s11.3) |
||
|
Damage to the palate extending beyond one localization |
||
|
Sky, NOS |
||
|
Other and unspecified parts of the oral cavity |
||
|
Buccal mucosa |
||
|
Vestibule of the mouth |
||
|
Retromolar region |
||
|
Involvement of other and unspecified parts of the oral cavity, extending beyond one localization |
||
|
Other and unspecified major salivary glands |
||
|
Submandibular gland |
||
|
Sublingual gland |
||
|
Damage to the major salivary glands that extends beyond one localization |
||
|
Big salivary gland, NOS |
||
|
Amygdala |
||
|
Tonsil fossa |
||
|
Almond arch |
||
|
Damage to the tonsil that extends beyond one or more localizations |
||
|
Amygdala, NOS |
||
|
Oropharynx |
||
|
Lateral wall of the oropharynx |
||
|
Back wall oropharynx |
||
|
Gill slit |
||
|
Oropharyngeal lesions extending beyond one location |
||
|
Oropharynx, NOS |
||
|
Rectum |
||
|
Anal canal |
||
|
Anus, NOS |
||
|
Anal canal |
||
|
Cloacogenic zone |
||
|
Damage to the rectum, anus and anal canal, extending beyond one localization |
||
|
Malignant melanoma skin |
||
|
Lip skin, NOS |
||
|
Outer ear |
||
|
Skin of other and unspecified parts of the face |
||
|
Skin of the scalp and neck |
||
|
Torso skin |
||
|
Skin of the upper limb and shoulder |
||
|
Skin of the lower limb and hip area |
||
|
Skin lesions extending beyond one localization |
||
|
Leather, NOS |
||
|
Kaposi's sarcoma of the skin |
||
|
Kaposi's sarcoma of soft tissue |
||
|
Breast |
||
|
Central part of the mammary gland |
||
|
Upper inner quadrant of the breast |
||
|
Inferior inner quadrant of the breast |
||
|
Upper outer quadrant of the breast |
||
|
Inferior outer quadrant of the breast |
||
|
Axillary lobe of the mammary gland |
||
|
Damage to the mammary gland that extends beyond one localization |
||
|
Breast, NOS |
||
|
labia majora |
||
|
Labia minora |
||
|
Lesion of the vulva extending beyond one localization |
||
|
Vulva, NOS |
||
|
Vagina |
||
|
Cervix |
||
|
Interior cervix |
||
|
Outer part of the cervix |
||
|
Damage to the cervix that extends beyond one location |
||
|
Cervix |
||
|
Penis |
||
|
glans penis |
||
|
Body of the penis |
||
|
Lesion of the penis that extends beyond one localization |
||
|
Penis, NOS |
||
|
Undescended testicle |
||
|
Descended testicle |
||
|
Testicle, NOS |
||
|
Scrotum, NOS |
||
|
Thyroid |
Table No. 4. List of ICD-10 codes for diseases taken into account when calculating the indicator “Hospitalization rate of patients with complications of cardiovascular diseases (myocardial infarction, stroke)”:
1) in the numerator of this indicator:
|
No. |
ICD-10 |
Name of diseases |
|
I20, I20.0-I20.9 |
Angina pectoris (angina pectoris) Unstable angina Angina with documented spasm Other forms of angina Angina pectoris, unspecified |
|
|
I21, I21.0-I21.4 |
Acute myocardial infarction Acute transmural infarction of the anterior myocardial wall Acute transmural infarction of the inferior wall of the myocardium Acute transmural myocardial infarction of other specified locations Acute transmural myocardial infarction of unspecified localization Acute subendocardial myocardial infarction |
|
|
I60, I60.0-I60.9 |
Subarachnoid hemorrhage Subarachnoid hemorrhage from carotid sinus and bifurcations Subarachnoid hemorrhage from the middle cerebral artery Subarachnoid hemorrhage from the anterior communicating artery Subarachnoid hemorrhage from the posterior communicating artery Subarachnoid hemorrhage from the basilar artery Subarachnoid hemorrhage from vertebral artery Subarachnoid hemorrhage from other intracranial arteries Subarachnoid hemorrhage from intracranial artery, unspecified Other subarachnoid hemorrhage Subarachnoid hemorrhage, unspecified |
|
|
I61, I61.0-I61.9 |
Intracerebral hemorrhage Intracerebral hemorrhage in the subcortical hemisphere Intracerebral hemorrhage in the cortical hemisphere Intracerebral hemorrhage in the hemisphere, unspecified Intracerebral hemorrhage in the brain stem Intracerebral hemorrhage in the cerebellum Intraventricular intracerebral hemorrhage Intracerebral hemorrhage of multiple localization Other intracerebral hemorrhage Unspecified intracerebral hemorrhage |
|
|
I62.0, I62.1, I62.9, I62, |
Other non-traumatic intracranial hemorrhage Subdural hemorrhage (acute) (non-traumatic) Non-traumatic extradural hemorrhage Intracranial hemorrhage (non-traumatic) unspecified |
|
|
I63, I63.0-I63.9 |
Brain infarction Cerebral infarction caused by thrombosis of precerebral arteries Cerebral infarction caused by precerebral artery embolism Cerebral infarction caused by unspecified occlusion or stenosis of precerebral arteries Cerebral infarction caused by thrombosis of cerebral arteries Cerebral infarction caused by cerebral artery embolism Cerebral infarction caused by unspecified blockage or stenosis of cerebral arteries Cerebral infarction caused by cerebral vein thrombosis, non-pyogenic Other cerebral infarction Cerebral infarction, unspecified |
2) in the denominator of this indicator: according to ICD-10 codes: I10-I79.8
I would like to say words of gratitude to those people who directly carried out this work - specialists D.A. Tolmachev, V.E. Andrusov and Deputy Head of the Department of the Ministry of Health of the Russian Federation N.A. Kostenko. The All-Russian Society of the Deaf expresses special gratitude for the support of our efforts in developing and adopting amendments to order No. 302n to Nikolai Arkadyevich Daikhes, chief freelance otorhinolaryngologist of the Ministry of Health of the Russian Federation, director of the Federal government agency"Scientific and Clinical Center of Otorhinolaryngology of the Federal Medical and Biological Agency of Russia." Everything was very difficult, but they understood how important it was for us and did everything possible to speed up the process of adopting this document. We bring to your attention the VOG's comments on the new order. Commentary on the order of the Ministry of Health of the Russian Federation dated December 5, 2014 No. 801n, registered with the Ministry of Justice of the Russian Federation on February 03, 2015 under registration No. 35848. The said order amended appendices No. 1 and No. 2 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n, in accordance with which a number of medical contraindications for persons with hearing impairment to the list of works are removed, namely: 1) Lack of hearing, pronounced and significantly pronounced hearing impairment (deafness and III, IV degree of hearing loss) are not contraindications for work with the following production factors: - General vibration (clause 3.4.2. Appendix No. 1 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n); - Industrial noise in workplaces with harmful and (or) dangerous working conditions, where there is technological equipment that is a source of noise (clause 3.5. Appendix No. 1 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n); - Infrasound (clause 3.7. Appendix No. 1 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n) - in clause 3.7. Infrasound excludes all medical contraindications associated with any hearing impairment; - Work performed using insulating materials individual funds protection and filtering gas masks with a full front part (clause 13. Appendix No. 2 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n); 2) Also, absence of hearing, severe and significant hearing impairment (deafness and III, IV degrees of hearing loss) in persons who have undergone vocational training, including training in safe methods and techniques for performing work - for the following jobs and professions are not medical contraindications: Work at heights, steeplejack work, as well as work on and maintenance of lifting structures (clause 1. Appendix No. 2 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n); - Maintenance and repair work on existing electrical installations with voltages of 42 V and above alternating current, 110 V and above direct current, as well as installation, adjustment work, testing and measurements in these electrical installations (clause 2. Appendix No. 2 to the order of the Ministry of Health and Social Development of Russia dated 12 April 2011 No. 302n); - Work in special geographic regions with a significant distance between the work sites and medical institutions providing specialized medical care (clause 2. Appendix No. 2 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n); - Work performed directly on mechanical equipment that has open moving (rotating) structural elements (lathes, milling and other machines, stamping presses, etc.) (clause 10. Appendix No. 2 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n) ; 3) Lack of hearing, severe and significant hearing impairment (deafness and III, IV degree of hearing loss) are not contraindications for work on driving land vehicles of categories A, A1, B, B1, BE. In this case, the examination must be completed once a year.
I would like to say words of gratitude to those people who directly carried out this work - specialists D.A. Tolmachev, V.E. Andrusov and Deputy Head of the Department of the Ministry of Health of the Russian Federation N.A. Kostenko. The All-Russian Society of the Deaf expresses special gratitude for the support of our efforts in developing and adopting amendments to order No. 302n to Nikolai Arkadyevich Daikhes, chief freelance otorhinolaryngologist of the Ministry of Health of the Russian Federation, director of the federal state institution “Scientific and Clinical Center of Otorhinolaryngology of the FMBA of Russia.” Everything was very difficult, but they understood how important it was for us and did everything possible to speed up the process of adopting this document. We bring to your attention the VOG's comments on the new order. Commentary on the order of the Ministry of Health of the Russian Federation dated December 5, 2014 No. 801n, registered with the Ministry of Justice of the Russian Federation on February 03, 2015 under registration No. 35848. The said order amended appendices No. 1 and No. 2 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n, in accordance with which a number of medical contraindications for persons with hearing impairment to the list of works are removed, namely: 1) Lack of hearing, pronounced and significantly pronounced hearing impairment (deafness and III, IV degree of hearing loss) are not contraindications for work with the following production factors: - General vibration (clause 3.4.2. Appendix No. 1 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n); - Industrial noise in workplaces with harmful and (or) dangerous working conditions, where there is technological equipment that is a source of noise (clause 3.5. Appendix No. 1 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n); - Infrasound (clause 3.7. Appendix No. 1 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n) - in clause 3.7. Infrasound excludes all medical contraindications associated with any hearing impairment; - Work performed using insulating personal protective equipment and filtering gas masks with a full face part (clause 13. Appendix No. 2 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n); 2) Also, absence of hearing, severe and significant hearing impairment (deafness and III, IV degrees of hearing loss) in persons who have undergone vocational training, including training in safe methods and techniques for performing work - for the following jobs and professions are not medical contraindications: Work at heights, steeplejack work, as well as work on and maintenance of lifting structures (clause 1. Appendix No. 2 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n); - Maintenance and repair work on existing electrical installations with voltages of 42 V and above alternating current, 110 V and above direct current, as well as installation, adjustment work, testing and measurements in these electrical installations (clause 2. Appendix No. 2 to the order of the Ministry of Health and Social Development of Russia dated 12 April 2011 No. 302n); - Work in special geographic regions with a significant distance between the work sites and medical institutions providing specialized medical care (clause 2. Appendix No. 2 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n); - Work performed directly on mechanical equipment that has open moving (rotating) structural elements (lathes, milling and other machines, stamping presses, etc.) (clause 10. Appendix No. 2 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n) ; 3) Lack of hearing, severe and significant hearing impairment (deafness and III, IV degree of hearing loss) are not contraindications for work on driving land vehicles of categories A, A1, B, B1, BE. In this case, the examination must be completed once a year.