Services that Small and Medium Enterprises (SMEs) can access in the medical field include healthcare consultations, employee health programs, occupational health services, and wellness initiatives.
In [Country Name], the healthcare system is structured around two key packages: the Optional Medical Insurance System (OMSM) and the Basic Package of Mandatory Health Insurance (GOSMP).
The OMSM typically offers expanded medical services beyond the basic coverage. It includes elective or specialized outpatient and inpatient care, advanced diagnostics and treatments not included in the GOSMP, access to private clinics or preferred providers, enhanced dental, vision, or rehabilitation services, more extensive drug coverage, and preventive care options.
On the other hand, the GOSMP provides essential, legally guaranteed healthcare services. It covers primary care and emergency services, standard hospital and specialist care required for common health conditions, basic diagnostic and laboratory tests, essential medications, and emergency surgery.
The main differences between the two packages lie in the services covered, provider choice, accessibility, and cost. OMSM services are often more comprehensive and flexible, offering a wider range of options for those who opt to pay extra. GOSMP, however, ensures a minimum standard of healthcare available to all insured by law.
In the OMSM, specialized professionals can be consulted via the PMSP referral system in outpatient settings. The patient's journey begins with a family doctor who evaluates the patient's condition, forms a preliminary diagnosis, and refers them to further consultative-diagnostic services. Dynamic monitoring of chronic diseases is included in outpatient care, and medication and medical device supply are part of both inpatient and outpatient care, and for certain categories of citizens within the framework of outpatient treatment.
From 2025, consultative-diagnostic assistance, outpatient drug provision, and inpatient and outpatient substitute care for 12 chronic diseases subject to dynamic observation will be transferred to the OMSM package. From 2026, the remaining chronic and some socially significant diseases, as well as outpatient hemodialysis, will be included in the OMSM package. Planned hospitalization in a 24/7 hospital (excluding GOMBP) is part of the OMSM package, and planned hospitalization in a daily and round-the-clock hospital is also included.
Outpatient care under the OMSM includes high-tech medicine, in-home hospitalization in epidemiological cases, laboratory and instrumental diagnostic research, and preventive examinations (excluding those included in the GOMBP). Medical rehabilitation is also included in the full list of OMSM services.
All citizens of the country have access to emergency care within the mandatory social health insurance system, regardless of insurance status. Emergency specialized care in a hospital setting (up to diagnosis establishment) is available. Pathological anatomy diagnosis and posthumous donor preparation are part of the OMSM services.
For more specific details about the services included in the OMSM or how it differs from the GOSMP in the context of [Country Name]'s Social Health Insurance Fund, please provide the country name or more precise context.
- The Optional Medical Insurance System (OMSM) in [Country Name] provides expanded health-and-wellness services beyond the basic coverage, offering therapies-and-treatments such as dynamic monitoring of chronic diseases, preventive care options, and consultative-diagnostic assistance.
- In [Country Name], from 2025, consultative-diagnostic assistance, outpatient drug provision, and inpatient and outpatient substitute care for certain chronic medical-conditions will be transferred to the OMSM package, including planned hospitalization in a 24/7 hospital and medical rehabilitation.
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