Description
In Kyrgyzstan, there is a State Guaranteed Benefits Program (the SGBP) which ensures access to health services additionally to a number of other state programs and mechanisms aimed at provision of available and good-quality health services.
However, many of these programs are not fully implemented and integrated in the health care system. Besides, access to the guaranteed primary health care (PHC) services varies greatly depending on the place of residence, that is, in terms of the service volume, resources and geographic accessibility.
Key research objectives were to review the delivery of basic services for selected conditions within the SGBP and identify the main barriers that cause inadequate access to the guaranteed services.
Methodology: The study was designed as a rapid assessment which involved conducting qualitative interviews with key informants and exploring patients' views on the availability of services at the PHC level.
Results
Family doctors are mainly focused on providing services for patients who refer to them due to incidence and acute conditions; insufficient attention is paid to prevention and education. There is a tendency for patients to increasingly refer to narrow specialists.
PHC facilities do not fully provide services in accordance with the SGBP standards due to the limited range of diagnostic and treatment services available in primary care. Geographical factors, such as living in remote villages, lack of pharmacies, and shortage of family doctors, aggravate the problem of access to health services for the population.
The existing PHC financing mechanisms aim to cover a wide range of services and cover as many people as possible, while almost half of the 4.5 million insured people are in the beneficial category and do not pay insurance premiums.
Thus, there is a gap between these ambitions and available resources. As a result, patients forgo health care or pay high prices for services in the private health sector, resulting in financial hardship for low-income households.
Conclusions
Kyrgyzstan needs to invest more and better in primary health care. This country can implement a primary health care financing model that will reduce household costs and protect low-income families from financial hardship. To improve PHC service delivery, ambitious changes are needed which will require political and public support. Some of the proposed measures will require advocacy and communication activities:
- Review the package of PHC services in the SGBP from the perspective of universal coverage and equal access of the population, regardless of the availability of beneficial categories and insurance status.
- Specify services in the SGBP for priority diseases, and agree upon the list of free laboratory diagnostic services with approved clinical protocols.
- Revise the system of co-payment and exemption from insurance payments.
- Prices for medicines should be regulated by the Government.
- Allocate additional resources for health sector.
Despite the challenges, these measures are necessary to provide financial protection to low-income families and improve the efficiency of health spending.
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