TBY talks to Elzhan A. Birtanov, CEO of National Medical Holding (NMH), on the evolution of the healthcare sector, the effects of new reforms, the benefits of the national healthcare system, and the growth of the private sector.
TBY How would you describe the activity in the healthcare sector in Kazakhstan during the company’s evolution?
YERZHAN BIRTANOV Twenty years ago we were facing the huge challenge of almost not having a national healthcare system. We did have well-developed social infrastructure, but the system was managed from Moscow. We faced a strategic planning vacuum. We had our own health ministry, but it executed a centrally planned agenda. In the past 20 years we have attempted various reforms and had different experiences. In the mid-1990s, we introduced a health insurance system, which was not very successful, so we switched to a budget-based system. Currently, preventive medicine, primary care, emergency medical services, research, and medical education are all funded by the government. The government is the main driver of social development, but this is not necessarily good, because in order to develop infrastructure, meet rapidly changing global challenges, and meet the public’s needs, healthcare providers should be more flexible. In 20 years since independence, we have continued to develop our healthcare infrastructure. More than 400 healthcare facilities have been built across the country in the past five or six years. We have established a central regulation system and financing system. The recent healthcare reforms were launched in 2010 through the creation of the unified national healthcare system; all healthcare funds were centralized and patients can now choose any hospital in the country after consulting with their primary healthcare providers. Currently, regional hospitals are developing rapidly, relieving some pressure on the hospitals in Astana and Almaty. We give a high priority to primary care, because good primary care reduces the pressure on secondary and tertiary care providers. We have begun to increase our per capita spending across many regions of Kazakhstan. The Ministry of Health is providing incentives to providers based on performance, in order to keep primary healthcare providers practicing in rural areas.
What are some highlights from the NMH’s recent past? How would you evaluate the Holding’s significance for the country’s healthcare sector?
Managing a hospital involves managing several thousand different business processes, which requires a diverse skill set. A hospital manager can no longer be just a physician. We are trying to change our management system to one where hospital directors are interested not only in running a hospital, but in having a unified policy for patient satisfaction, which we give them as a strategic plan. Each hospital has a strategic plan and all six have implemented them to achieve strategic goals. It is not about changing only the management, but also the mentality of the staff, and gaining competence in diverse areas such as health economics, patients’ rights, and informatics. We are spending a lot of money on the education and retraining of our staff.
How has your cooperation with Nazarbayev University assisted your operations?
Since 2010, National Medical Holding is a 100% subsidiary company of Nazarbayev University. Previously we saw ourselves as a new group of innovatively managed hospitals with an advanced technological base, trying to distribute that innovation throughout the healthcare system of the country. Now we see ourselves as part of an academic healthcare system. We are training new doctors and conducting research. The big issue is to integrate clinical practice, medical education, and research in our centers. The concept of an integrated academic healthcare system implies that one physician will provide care, train students, and conduct research on a usual basis. Our challenge is to catch up with best international academic medical practices that are the results of hundreds of years of experience in a short time using sound strategic tools.
How do state and private healthcare services balance each other in Kazakhstan? What steps can be taken to facilitate the growth of private healthcare services in the country?
Government cannot be the sole investor in social infrastructure. Demand is growing fast, and because of high costs the government cannot support the entire process. At some point the private sector needs to take over to meet increasing demand, and keep up with the latest technologies. The government is trying to encourage private investment activity in this field, and we are already seeing more activity on the part of foreign investors. We will be partnering with private sector companies more and more in the future, as long as they bring good results. Some intermediary services such as private labs and ultrasound centers represent opportunities for investment; also, small private medical centers and clinics are opening, providing a limited range of services. In the future, it is possible that mergers will occur in this area, and through consolidation we will see bigger private actors in the sector.
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