Fiscal issues of social health insurance implementation in Kazakhstan

Abstract

The aim of implementing new social health insurance system in Kazakhstan is increasing the expenses for one household and decrease the out-of-pocket payments. The importance of out-of-pocket payments is part of the financing system of health care in all countries. However, catastrophically high private spending can lead to financial instability of the entire health system, and national economy as a whole. High level of private service costs health suggests that the population prefers pay for medical services at their own expense. And this means that allocated public funds are not enough effectively used, there is still a shortage accessibility of health services. Also unregulated high health care prices are often an obstacle to access to necessary medical care, and also contributes to growth of pocket payments, causing financial problems protection of the population. The research methods of dissertation are system analysis, statistical analysis, quantitative analysis, forecasting and PEST analysis. iiiThe first stage was implemented by analyzing all existing approaches to determining the meaning of social health insurance, defining criteria, considering types and factors of health insurance, out-of-pocket payments, healthcare system of Kazakhstan; The second stage included the diagnostic work and control of statistical information regarding expenses of households on medical care, analyzing of report of Republic center of healthcare development about national accounts of healthcare for 2010-2018 years. All the information regarding government spending and out- of-pocket payments of households were taken from this report. Information about compulsory social health insurance payers, socially vulnerable population of the Republic of Kazakhstan were found on the the official site of Compulsory health insurance Fund, expenditures of Fund’s assets, Statistic committee of Republic of Kazakhstan, Taldau.stat.gov.kz, the official site of Ministry of Healthcare of Republic of Kazakhstan, OECD reports. The problem in this dissertation was identified by using statistical data of out-of-pocket payments, which increases year by year. As the hypothesis of work is implementation of social health insurance decreases the out-of-pocket payments, in the results were made forecast of contributions to compulsory social health insurance, out-of-pocket payments percentage, and the impact of implementing CSHI to the level of out-of-pocket payments. ivIn the last stage, using the higher tariffs assumption there were made recommended forecasting , as a result in 2023 the percentage of out-of-pocket payments will reach to 20.4%. Recommended tariffs to reach the level of percentage recommended by WHO: government contributions for 15 preferential category – 10%, employer deductions – 10%, employee contributions - 5%, and individual entrepreneurs contribution – 8%.