Costs borne by the populace
In the bustling city of Astana, significant changes are on the horizon for the healthcare system. The Akimat of Astana has announced that the Compulsory Social Health Insurance (CSHI) package will be expanded in 2025–2026 to include additional services and categories of care.
The total plan for medical care in 2025 is 2.96 trillion tenge, with over 1.3 trillion tenge allocated for medical services under CSHI. This expansion will see a variety of services moving from the Guaranteed Volume of Free Medical Care (GVFMC) into the insured package, with increases in contributions to fund the expansion.
One of the key additions to the CSHI package is the inclusion of outpatient drug provision, planned stationary and ambulatory care for 12 chronic diseases under dynamic observation. From 2026, the rest of the chronic and some socially significant diseases, as well as outpatient hemodialysis, will be included in the CSHI package.
Specialized care in hospital conditions, including diagnostic and therapeutic measures in the reception department of a 24-hour hospital, is included in CSHI. This also encompasses emergency surgery and specialized, including high-tech, medical care in planned form in hospital conditions. Planned hospitalization in both day and round-the-clock hospitals for treatment or surgeries, including high-tech ones, is included in CSHI.
The patient's journey in CSHI begins with a family doctor who assesses the patient's condition, forms a preliminary diagnosis, and refers them for further consultative-diagnostic services. This includes consultations with specialist doctors such as cardiologists, endocrinologists, and ophthalmologists.
Laboratory tests, instrumental diagnostics (CT, MRI, ultrasound, X-ray, etc.) are included in CSHI. The package also covers pathological anatomical diagnosis and the preparation of a post-mortem donor. Specialized, including high-tech, medical care in home-like conditions is available under CSHI, as well as home hospital services for certain diseases.
It's important to note that all citizens have access to the basic package of guaranteed free medical care (GFMC). However, without insurance, one can call an ambulance, visit a family doctor, receive emergency care for injuries, burns, poisoning, and acute conditions.
The city administration states that the amount of contributions paid to the Compulsory Social Health Insurance will increase to finance the expanded package. Diabetes-related services (previously provided under GVFMC) are being transferred into the Mandatory/Compulsory Social Health Insurance package. Authorities emphasized that this transfer does not require extra payments beyond standard insurance contributions.
For those uninsured and unable to pay, local budgets may provide support. The Ministry of Healthcare and related bodies carried out analysis before the transfer and indicated most diabetes patients are already insured.
These changes are part of a broader plan to improve the healthcare system in Astana, ensuring that residents have access to the best possible medical care. The exact services being added and the planned contribution rates for 2025–2026 can be found on the official Astana administration page (in Kazakh/Russian). Published timelines and the proposed legal/regulatory steps required for the transfer from GVFMC to CSHI are yet to be announced.
- In the expanded Compulsory Social Health Insurance (CSHI) package, various services focused on health-and-wellness, such as outpatient drug provision and stationary care for medical-conditions under dynamic observation, will be included from 2025–2026.
- The CSHI package also accounts for fitness-and-exercise by covering specialized, including high-tech, medical care in home-like conditions and home hospital services for certain diseases.
- One of the therapeutic-treatments included in CSHI is laboratory tests, instrumental diagnostics, and specialized medical care during emergency situations.
- Nutrition plays a role in CSHI as it covers services like pathological anatomical diagnosis and the preparation of a post-mortem donor.
- To fund these additions to the CSHI package, there will be an increase in insurance contributions, but the authorities have emphasized that diabetes-related services, now being transferred from the Guaranteed Volume of Free Medical Care (GVFMC), do not require extra payments beyond standard insurance contributions.
