[et_pb_section fb_built=”1″ admin_label=”!! PLEASE DO NOT EDIT !!!” _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}”][et_pb_row use_custom_gutter=”on” gutter_width=”1″ admin_label=”!!! PLEASE DO NOT EDIT !!!” _builder_version=”4.20.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}”][ba_gradient_heading title=”From Soviet-era central planning to the post-Soviet social health insurance umbrella” html_tag=”h3″ primary_color=”#455A64″ secondary_color=”#455A64″ admin_label=”HEADING (50-60 characters)” _builder_version=”4.21.0″ _module_preset=”default” title_font=”||||||||” title_font_size=”32px” title_line_height=”1em” custom_padding=”||10px||false|false” global_colors_info=”{}”][\/ba_gradient_heading][et_pb_text admin_label=”TEXT – BLOCK 10 – author” _builder_version=”4.21.0″ _module_preset=”default” text_font_size=”15px” custom_margin=”||30px||false|false” custom_padding=”20px|25px|20px|25px|false|false” custom_css_main_element=”background:#DCE5EA;” global_colors_info=”{}”]<\/p>\n
About the author: <\/strong>Ainur Aiypkhanova, MHA, worked as the <\/em>general director of the <\/em>Republican Center for Healthcare Development<\/em> from 2016 through 2019. The <\/em>health policy institute <\/em>is part <\/em>of the Ministry of Healthcare in Kazakhstan. She was charged with prep<\/em>a<\/em>r<\/em>ing<\/em> the introduction<\/em> of social health insurance in Kazakhstan<\/em>, <\/em>a major reform<\/em>. She was involved in policymaking at the national level and provided leadership for the teams that conducted reform preparations<\/em>.<\/em> In 2019 Ainur became <\/em>the <\/em>director of the <\/em>Department of Strategy and International Cooperation <\/em>of the Ministry of Healthcare <\/em>and was responsible for planning<\/em> and monitoring strategic plans<\/em>. Ainur <\/em>has <\/em>worked with the P4H <\/em>N<\/em>etwork since 2017 to <\/em>promote <\/em>collaborations<\/em> on health financing and social health protection among<\/em>\u00a0<\/em>countries<\/em> in Central Asia<\/em> and Easter<\/em>n<\/em> Europe<\/em>.<\/em><\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 1 ” _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n The unifying feature of the post-Soviet countries was the centrally planned, single-payer, and wholly publicly\u00a0financed health system model named after its author Semashko. The so-called Semashko model, implemented across the fifteen USSR member nations decades before their independence, was based on state\u00a0budget transfers exclusively and universal access to care. A strong emphasis was placed on primary health care, supported by a\u00a0network of hospitals that had clear territorial service areas and a defined scope of services. With independence, each post-Soviet country exercised freedom in defining reform goals\u00a0and choosing reform tactics.\u00a0While the countries shared a uniform past before their independence, they took diverging paths afterwards. Seeing how each country addressed challenges and analyzing the policy and reform lessons they learned make for an exciting look into the past and into the years ahead.<\/p>\n [\/et_pb_text][et_pb_image src=”https:\/\/p4h.world\/app\/uploads\/2023\/09\/Ever-growing-health-expenditure_map_Sep2023.jpg” title_text=”Maps-08 (2).png” admin_label=” IMAGE – 650x320px ” _builder_version=”4.21.0″ _module_preset=”default” custom_margin=”||10px||false|false” global_colors_info=”{}”][\/et_pb_image][et_pb_text admin_label=”TEXT – BLOCK 3″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n Now, after three decades of sovereignty, most of the post-Soviet countries have adopted or are initiating\u00a0a mandatory social health insurance (SHI) model, a form of contributory health financing arrangement. Two of the three Baltic States (Estonia<\/strong>, Lithuania<\/strong>) and five members of the Commonwealth of Independent States (CIS) (Azerbaijan, Kazakhstan, Kyrgyzstan, <\/strong>Moldova,<\/strong> Russia<\/strong>) have implemented a mandatory SHI model, with three other CIS members (Armenia, Tajikistan, Uzbekistan<\/strong>) currently piloting or planning to introduce SHI. Mongolia<\/strong>,<\/strong>\u00a0a Central Asian country that followed a similar route in the past, \u00a0adopted the SHI Law in 1993 and began fully implementing it in 1994. Turkmenistan<\/strong> introduced state-regulated voluntary health insurance\u00a0in 1996, a\u00a0contributory health insurance scheme with premiums\u00a0calculated as fixed percentages of salary or other income\u00a0that are collected in a state fund the government\u00a0oversees. Four of the fifteen post-Soviet countries have not implemented\u00a0mandatory SHI (Belarus, Georgia, Latvia, Ukraine<\/strong>).\u00a0<\/p>\n [\/et_pb_text][et_pb_text quote_border_color=”#EA3A32″ admin_label=”PULL QUOTE (250-300 ch.)” _builder_version=”4.21.0″ _module_preset=”default” quote_font=”Oswald|||on|||||” quote_text_color=”#5EAABC” quote_font_size=”26px” quote_line_height=”1.3em” global_colors_info=”{}”]<\/p>\n The arguments in favour of compulsory social health insurance, often voiced in a national political dialogue\u00a0among CIS countries that adopted SHI, were several and interrelated.<\/p>\n<\/blockquote>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 4 ” _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 5″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n In Kazakhstan,\u00a0another powerful argument in support of SHI reform included increased health funding in the context where the formal sector dominated. Employers and employees started contributing to health care with the launch of SHI in 2020. As a result,\u00a0Kazakhstan saw a doubling of total health expenditure as measured in local currency in 2019-2020, increasing the share of GDP spent on health care from 2.79% to 3.79% in the first year of SHI. Furthermore, out-of-pocket spending fell by a quarter from 34% in 2019 to 27% in 2020. While spending related to the COVID-19 pandemic contributed to these numbers, that alone cannot explain the improvements.<\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 6″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n The argument that SHI would boost funding for health was well demonstrated within one year after launch of the national SHI scheme in Kazakhstan. However, that kind of success may not last long or be achieved at all. This blogpost series was inspired by the author\u2019s realization\u00a0that early euphoria from good initial outcomes may fade as\u00a0diminishing returns and outcomes\u00a0of the new system become apparent. At the same time, I suggest that given the post-Soviet\u00a0background, movement towards a contributory system was the most suitable course of action in years after independence for reasons explained in this and the second post of this blog series.<\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 7″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n The above-mentioned arguments in favour of SHI are advocated publicly by reform stakeholders such as ministries of health, health insurance agencies, and parliament members in countries that have adopted SHI.\u00a0<\/p>\n [\/et_pb_text][et_pb_text quote_border_color=”#EA3A32″ admin_label=”PULL QUOTE (250-300 ch.)” _builder_version=”4.21.0″ _module_preset=”default” quote_font=”Oswald|||on|||||” quote_text_color=”#5EAABC” quote_font_size=”26px” quote_line_height=”1.3em” global_colors_info=”{}”]<\/p>\n Reminding the public of the benefits of the SHI model helps maintain\u00a0trust\u00a0<\/strong>in the contributory health insurance system.<\/p>\n<\/blockquote>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 7″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n This is why countries that have implemented SHI periodically revisit its pros and cons. For example, Kazakhstan switched to SHI in 2020, and the debate about the choice of SHI took up the national policy stage in 2022 and again in 2023.<\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 8″ _builder_version=”4.21.0″ _module_preset=”default” custom_margin=”||30px||false|false” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n But there is one significant benefit of SHI reforms in the post-Soviet countries that is overlooked in the public dialogue. While\u00a0any health financing model has its drawbacks and strengths, most post-Soviet countries that implemented the compulsory SHI model\u00a0embarked on a series of related reforms<\/strong>.<\/strong> These interrelated reforms\u00a0were clustered under the larger umbrella term SHI for simplicity and included a fresh look into many dimensions of a health system, such as governance, quality improvement and payment innovations, digitalization, streamlined intersectoral work, health care delivery, much needed strengthening of primary health care, formal sector expansion and tax reforms. Therefore, SHI in post-Soviet countries entailed a\u00a0collection of reforms, not a mere change of a health financing model.<\/p>\n [\/et_pb_text][et_pb_text admin_label=”image CAPTION” _builder_version=”4.21.0″ _module_preset=”default” text_font_size=”13px” custom_margin=”||20px||false|false” custom_padding=”||||false|false” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n Featured image on top:<\/strong> Health Minister Yelzhan Birtanov and key policymakers in Kazakhstan communicate benefits of SHI reform to the media and the public in 2019, prior to the nationwide launch in 2020. Source: Ortcom<\/a><\/em><\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 9 – teaser” _builder_version=”4.21.0″ _module_preset=”default” text_font_size=”13px” custom_margin=”20px||||false|false” custom_padding=”||||false|false” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n\n
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