CC BY
8Received by the Editor 26.11.2020 г.
IRSTI 76.01.800+76.75
UDC614.2
BARRIERS TO OBTAINING HEALTH CARE FOR UNEMPLOYED YOUTH UNDER THE COMPULSORY HEALTH INSURANCE SYSTEM
S. Duisekova1, A. Turgambayeva1, Rimantas Stukas2
1NcJSC «Astana medical university», Nur-Sultan city, Kazakhstan
2Institute of public health faculty of Medicine of Vilnius university, Vilnius city, Lithuania
The purpose of the study was to assess the availability of medical care for unemployed young people within the framework of compulsory health insurance.
Materials and methods: We analyzed statistical data, carried out a content analysis of scientific publications on a given topic.
Results and conclusions According to the data obtained, we saw the following situation: young unemployed people who are not registered in employment centers must contribute their own funds to an insurance policy to receive medical services, and since most do not make this payment, this is a barrier to receiving medical care.
Conclusion: Young people are the key to the future nation, while, due to modern phenomena, they are a vulnerable group of the population. During the COVID-19 pandemic, youth unemployment rose by 0,1%. Young people who have lost their jobs have limitations in receiving medical and social assistance, which ultimately increases the incidence among this age group.
Keywords: youth unemployment, unemployed youth, compulsory health insurance, accessibility of medical care.
БАРЬЕРЫ ПОЛУЧЕНИЯ МЕДИЦИНСКОЙ ПОМОЩИ ДЛЯ БЕЗРАБОТНОЙ МОЛОДЕЖИ ВРАМКАХ ОСМС
С. А. Дуйсекова1, А.К. Тургамбаева1, Rimantas Stukas2
1НАО «Медицинский университет Астана», Нур-Султан, Казахстан
2Институт общественного здоровья Медицинского факультета Вильнюсского университета, Вильнюс, Литва
Целью исследования было оценить доступность медицинской помощи безработным молодым людям в рамках обязательного медицинского страхования.
Материалы и методы: был проведен анализ статистических данных, проведен контент-анализ научных публикаций по заданной теме.
Результаты. Согласно полученных данных, мы увидели следующую ситуацию, молодые безработные люди, не зарегистрированные в центрах занятости должны вносить собственные средства на страховой полис для получения медицинских услуг, а так как большинство не производит этой оплаты, это является барьером для получения медицинской помощи.
Заключение: молодые люди являются залогом будущей нации, при этом в силу современных явлений являются уязвимой группой населения. В период пандемии COVID-19 молодежная безработица выросла на 0,1%. Молодые люди, потерявшие работы имеют ограничения в получении медико-социальной помощи, что в итоге увеличивает заболеваемость среди данной возрастной группы.
Ключевые слова: молодежная безработица, безработная молодежь, ОСМС, доступность медицинской помощи.
М1НДЕТТ1 МЕДИЦИНАЛЫЦ САЦТАНДЫРУ ЖYЙЕСI БОЙЫНША Ж¥МЫССЫЗ ЖАСТАРГА МЕДИЦИНАЛЬЩ К0МЕК АЛУДЬЩ КЕДЕРГ1ЛЕР1
С.Б. Дуйсекова1, А.К. Тургамбаева1, Rimantas Stukas2
1«Астана медицина университет!» КеАК, Нур-Султан к;., ^азакстан
2Вильнюс университетшщ медициналык денсаулы; сактау институты, Вильнюс каласы, Литва
Зерттеудщ максаты мщдетп медициналык сактандыру шецберiнде жумыссыз жастарга медициналык кемектщ кол жепмдшпн багалау болды.
Материалдар мен тэсшдер: бiз статистикалык деректердi талдадык, берiлген такырып бойынша гылыми жарияланымдарга контент-талдау жасадык.
hath^rop meh k()|)i>mi>iii.u>i. i:ip. AnbrnraH ManiMerrep 6oHbrnma 6i3 Keneci ^argangbi KepgiK: ^MbicneH KaMry opra^HRrapHHga ripKenMereH ®¥Mbiccbi3 ®ac agaMgap Meg^HHanbiK; ^M3Mer any YmiH caKraHgbipy nonHcrne e3 Kapa^arrapbm canybi KepeK, ®9He Kenminiri 6^n reneMgi ^acaMaraHgMRraH, 6^n Meg^HHanbiK; KeMeK anyra Kegepri 6onbm ra6binagbi.
^oputmmgu: ^acrap 6onamaK ^nrrbiH KinTi 6onbm ra6binagbi, an Ka3ipri K^binbiCTapra 6annaHbiCTbi onap xanbiRTbiH ocan to6m 6onbm Ta6binagbi. COVID-19 naHgeMHacbi Ke3iHge ^acTap apacbrngarbi ®¥Mbiccbi3gbiK; 0,1% ecTi. ^^MwcHHaH anbipbinraH ^aCTapgbiR Meg^HHanbiK; ®9He aneyMerriK KeMeK anyga meKTeynepi 6ap, 6^n caftbm KenreHge ocbi ®ac To6bHga aypymaHgbiRTbi aprrbipagbi.
tyflimgi ce3.ep: ^aCTap ®¥Mbiccbi3gbirbi, ®^MHCCH3 ^aCTap, MiHgerri Meg^HHanbiK; caKraHgbipy, Meg^HHanbiK; KeMeKriH Ron ^eriMginiri.
Relevance
As is commonly believed, young people are the future of our country, and how they will be happy, healthy, and able to work from working age, so in the future this will affect the economy and development of the state as a whole. According to modern realities, young people of the current generation are more likely to change jobs, in search of more prestigious and interesting work, moreover, with the development of requirements for qualification requirements for positions, a decrease in the number of jobs in rural areas, social barriers to job acquisition are acquired [1]. In addition to all of the above, now the whole world and our country is experiencing the consequences of the COVID-19 pandemic, where job loss remains one of the most pronounced, problematic phenomena, in particular among young people [2,3].According to the data of the National Bureau of Statistics of the Republic of Kazakhstan, the level of youth unemployment increased during the COVID-19 pandemic, since the main area that was affected during the pandemic is small and medium- sized businesses, leisure enterprises, catering services, where most of the workforce is aged 25 29 years.Since 2020, Kazakhstan has switched to compulsory health insurance, which has the potential to improve access to health care and protect people from the financial risks of disease. Health insurance coverage in Kazakhstan includes contributions from the state for 14 groups of the population, including the unemployed registered in employment centers, but according to the national bureau of statistics, only 50% of the total number of unemployed people are registered in the database and have benefits from the state [4]. Thus, young unemployed people who do not have the official status of "unemployed" have barriers to obtaining medical care and are forced to either pay an insurance premium on their own, or go to private medical centers, which is especially problematic in rural areas where the standard of living is lower. than in the city and paid services are not fully developed [5,6]. According to researchers from the Washington Institute for Health Metrics and
Evaluation, unemployment increases the likelihood of health decline from 22% to 67%. Family income reduces the likelihood of ill health by 16% to 28% for each additional percentage point of income. As a member of a family with a difficult financial situation, the chances of perceiving one's health as poor are increased by 70-140% [7].
Purpose of the study
Assess the availability of medical care for unemployed youth aged 18-29 during the COVID-19 pandemic and taking into account the introduced compulsory health insurance.
Materials and research methods
We conducted a review and study of international studies on the availability of health care for unemployed youth within the framework of health insurance using the keywords "youth unemployment, unemployed youth, compulsory health insurance, access to health care". We studied publications from such international platforms as: PubMed 15 publications, EMBASE-4 publications, Global Health - 2 publications, IBSS - 1, WHO library database (WHOLIS) - 1, IDEAS, Econlit, ELDIS, IndMED-3. The exclusion criteria were publications that were more than ten years old and included unemployed people over 29 years old.
In addition, we searched research reference lists and searched for citations through the Web of Science to find other potentially relevant studies.
We studied and analyzed data from the official websites on youth unemployment in Kazakhstan (https://stat.gov.kz/), for insured young unemployed people (https://fms.kz/). Interviewing of
employees of amusement centers, city polyclinics, unemployed youth was carried out.
Research results and discussion
When studying the regulatory framework for health insurance, state contributions for compulsory social health insurance are paid for 14 categories of the population (changes from 07.07.2020), including for non- working persons registered as unemployed, non-working pregnant women, non-working persons raising children up to 3 years old or caring for a disabled child, non-working oralmans, non-working recipients of state targeted assistance. From this list it follows that unemployed, who lost their jobs during the state of emergency must pay their own contribution, which is an additional burden in such a period and costs 1 MCI per month (2 651 tenge for the city and 1 326 for the village). According to a survey of unemployed young people, they do not apply to employment centers because there is no desire to wait for the procedure to be completed and also because of temporary work. Another category of persons who are in a vulnerable zone are correspondence students who are not covered by the state and do not work because they have not completed their education. Young people are not ready to pay the insurance premium on their own, because they think that they may not need medical assistance, in case of emergency, they can go to an ambulance. This, in the opinion of medical workers, reduces the coverage of screenings and examinations, which are included in the compulsory health insurance package. Young people are not ready to pay the insurance premium on their own, because they think that they may not need medical assistance, in case of emergency, they can go to an ambulance. This, in the opinion of medical workers, reduces the coverage of screenings and examinations, which are included in the compulsory health insurance package. Young people are not ready to pay the insurance premium on their own, because they think that they may not need medical assistance, in case of emergency, they can go to an ambulance. This, in the opinion of medical workers, reduces the coverage of screenings and examinations, which are included in the compulsory health insurance package.
The data of the Committee on Statistics of the Ministry of National Economy were studied and analyzed, which notes that the level of youth unemployment as of the third quarter of 2020 increased and amounted to 3,8%, which is due to the situation after the imposed strict quarantine. The largest growth of young unemployed people is in the cities of Almaty, Shymkent, Nur-Sultan, Turkestan, Almaty and Karaganda regions. Figure shows the ratio of general and youth unemployment.
6,
5,
4,
3, 0
1, 0
Figure - The level of general unemployment among youth in the Republic of Kazakhstan.
According to the forecast of the international labor organization, the growth of youth unemployment in Kazakhstan and in the world in 2020 -2021 will grow to 5%, and the same among men and women.An interview was also conducted with the employees of the employment center on the subject of what measures are being taken within the framework of the roadmap for employment of the population in the direction of youth practice, as a result of the survey it was revealed that the program was suspended and impossible to implement during the quarantine period and restrictive measures related to the epidemiological situation in the country.
5- 5.
■Уровень безработицы, в
■ Уровень молодежной безработицы
И Чй ЛОтЛ Q
201 201 201 201
2019 202
Conclusions
1. Hammered unemployed people are not able to pay for insurance, since, for example, to receive one- time medical assistance, you need to pay for all previous months from January 1, 2020.
2. It is necessary to increase information training of young people with an emphasis on the prevention of healthy lifestyles through the media, social networks and more.
Quarantine and the restrictive measures introduced during his time dramatically affected the social sphere of life of young people, in particular, it affected employment and access to medical care. At the moment, anti- crisis measures are being worked out to stabilize youth employment. However, there is a risk of a re-wave of diseases and the possible introduction of harsh measures, which will also increase unemployment. Given these risks, there is a need to consider providing health care for young people who have lost their jobs during the pandemic and are not registered with employment centers.
List of references
1. Bismarck and the Long Road to Universal Health Coverage https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149836/.
2. Report of the Kazakhstan Institute for Strategic Studies under the President of the Republic of Kazakhstan "Unemployment in Kazakhstan and foreign countries, response to the crisis". - Nur-Sultan, 2020. - 3 p.
3. Law of the Republic of Kazakhstan dated. - November 16,2015. - No. 405-V 3PK "On compulsory social health insurance".
4. Demand for Self-Employed Health Insurance https://www. ncbi.nlm.nih. gov/pmc/articles/PMC526859 7/.
5. Strategies for expanding health insurance coverage in vulnerable populations.https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC4455226.
6. Institute for Health Metrics and Evaluation (HMIH) Global Health Financing 2016: Development Aid, Public and Private Health Spending Towards Universal Health Coverage. IHME; Seattle, Washington: 2017.
7. Institute for Health Metrics and Evaluation (HMIH) Global Health Financing 2016// Development Aid, Public and Private Health Spending Towards Universal Health Coverage. IHME; Seattle. - Washington, 2017.
Corresponding author: Duisekova S.B. - PhD doctoral student of the 2nd year of the Department of Public Health and Management of the NJSC "Astana Medical University", [email protected]
