TAKE CARE

Kazakhstan 2018 | HEALTH & EDUCATION | REVIEW: HEALTH

Kazakhstan's healthcare system suffered a significant decline in the years following the fall of the Soviet Union. Economic collapse led to lack of human and capital investment as public funding fell to new lows. In the years since the turn to the 21st century, Kazakhstan's health outcomes have improved as the nation's economic fortunes have lifted.

Kazakhstan's healthcare system suffered a significant decline in the years following the fall of the Soviet Union. Economic collapse led to lack of human and capital investment as public funding fell to new lows. In the years since the turn to the 21st century, Kazakhstan's health outcomes have improved as the nation's economic fortunes have lifted. Baseline statistics like life expectancy and infant mortality are still below EU averages but have been trending up over the past decade, and access to healthcare has widened as the government has increased funding and sought new international partnerships. Kazakhstan is in the midst of an ambitious healthcare reform effort that aims to increase funding, improve the quality of care, and introduce a new universal coverage system for Kazakhstani citizens.

Kazakhstan's health outcomes are below regional neighbors across the board. Life expectancy, for example, was at 68 years in 2012, well below the WHO regional average of 76 and the World Bank's income group average of 74. Likewise, its infant mortality rate of 19.6 deaths per 1,000 live births ranked 82nd globally, and its maternal mortality and under-five mortality rates, while down significantly from the early 1990s, remained slightly above the WHO regional averages. At the core of all this are Kazakhstan's levels of healthcare spending, which have remained far below OECD averages. Though classified by the World Bank as an upper-middle income country with a 2017 GDP per capita of USD27,100, good for 77th in the world, Kazakhstan's healthcare spending is far below comparable countries. In 2014, healthcare expenditures equaled just 4.4% of GDP, 158th in the world. That came about thanks to per-capita healthcare expenditure of just USD538 per person, nowhere near the EU average of USD3,612 and the OECD average of 4,739.

This lack of funding is the largest issue facing the Kazakhstani healthcare system, but reforms are in progress to increase spending and bring new services to the population. In 2016, the government passed legislation implementing a new universal health coverage law. The law establishes a single-payer National Insurance Fund that is expected to become the primary funding mechanism for the nation's healthcare system. Funding for the program would come from a mix of federal, employer, and employee contribution; the legislation calls for employers to contribute 2% of payroll in 2017, with this ultimately rising to 5% in 2020. Employees will contribute 1% of their pay beginning in 2019, with this ultimately rising to 2% in 2020; this would not apply to certain categories including the disabled and the elderly.

Beyond increasing funding, the creation of a national single-payer healthcare fund is also about shifting the burden of healthcare and building a more sustainable system. Previously, hospitals shouldered a disproportionate share of the country's healthcare burden because of the lack of adequate primary and preventative care facilities. Kazakhstan wants to use the new wave of funding from employer contributions to develop a more robust network of primary care centers better equipped to meet the specific needs of their communities. In the past, Kazakhstan's health system was highly centralized, with funding distributed between states. As the nation has grown, however, this has proved to be an inefficient model that has resulted in large gaps in quality between regions. By giving primary care centers better funding and more autonomy, Kazakhstan is confident that it can improve health outcomes.

Kazakhstan also has plans to increase foreign private investment in the healthcare sector, with the long-term goals of improving the quality of care and becoming a destination for medical tourists across Central Asia. The National Insurance Fund is expected to increase spending to the private sector from its current level of 10 to 50% by 2025, and the upcoming surge in modernization, expansion, and construction projects has already begun to draw the attention of international investors. Kazakhstan's Ministry of Health is working to form new partnerships with European medical schools and medical supply companies to increase the healthcare sector's capability with new technologies to meet global standards, and the government is focused on streamlining the regulatory environment to facilitate inflows of much-needed FDI.