In Kazakhstan, over nine months of strengthened control in the mandatory social health insurance (MSHI) system, financial losses of 234 billion tenge were prevented. This was reported by Qazaqyia.kz citing Kursiv Media.
As part of criminal cases, more than 79 billion tenge illegally paid to medical service providers is also being returned. This was reported by the Ministry of Finance.
After the Social Health Insurance Fund was transferred to the ministry's jurisdiction, the priority became cutting off funding leaks and ensuring targeted use of money. According to the agency, the identified leak channels have been closed, and the saved and returned funds were directed to paying for medical care.
To prevent unjustified payments, new tools are being used, including artificial intelligence-based antifraud. They allow detecting signs of violations before money is transferred.
The Ministry of Finance reported an increase in funding limits for medical organizations. Hospitals have gained the ability to pay for services based on the fact of care provided. There is also a phased move away from restrictions on volumes of care through the use of a linear scale.
According to the agency's assessment, these changes expand the possibilities for providing planned care and help reduce hospitals' accounts payable.
The Fund also moved from accounting for the total amount of debt to analyzing the causes of its occurrence in each problem clinic. There are 68 medical organizations in the country with overdue accounts payable. For each of them, together with local executive bodies, a financial recovery plan was developed.
By the end of 2026, overdue debt is projected to be reduced from 17 billion to 10 billion tenge. To achieve this, they plan to increase clinic revenues and adjust the volumes of funded care where unmet need for treatment is confirmed.
The ministry expects that as results are consolidated, patients will be able to receive necessary care faster.
According to the Ministry of Finance, the tasks of the first stage set by the head of state have been fulfilled. Work on preventing violations and returning funds continues.
The next stage envisages the introduction of insurance mechanisms: assessment of expected need for treatment and the cost of obligations, planning their coverage and forming reserves. Payment methods must take into account the complexity of the case and the treatment result.
Financing is planned to be built around the entire patient journey — from diagnosis to treatment, rehabilitation and follow-up. Payment mechanisms must support continuity between medical organizations, timely treatment and prevention of complications.
The Ministry of Finance intends to evaluate the result of further changes by the accessibility of necessary care and the sustainability of its financing.
Earlier, Kursiv wrote that in January Olzhas Bektenov instructed to transfer the Social Health Insurance Fund to the Ministry of Finance after systemic violations were identified, including fictitious appointments, services to deceased patients and double financing. Already by the end of the first half of the year, the antifraud system prevented unjustified payments of more than 4 billion tenge before money was transferred to medical organizations.