In 2003, the total per capita expenditure on health care³¹ was Intl $315 (3.5% of GDP).³² Among the Commonwealth of Independent States, this figure falls within a spending range of Intl $ 71 in Tajikistan (4.4 % of GDP) and Intl $570 in Belarus (6.4% of GDP). At 3.5%, the smallest spending as a percentage of GDP is in Kazakhstan (Tables 5 and 6).

After independence in 1991, there was initially little change to the health care system. Pilot projects in health care reform focussed on restructuring primary care, insurance funding, new provider payment mechanisms and user fees. In 1995 a new compulsory health insurance scheme was announced, but following some experimentation with this, a government-run Medical Services Payment Centre was established in December 1998, which effectively ensured that the system reverted from being insurance-based to being taxation-based. The 14 oblast and 14 city health departments are the key bodies in health care administration. Privatisation of health care facilities has not proceeded rapidly and there is some confusion over which organisations are ‘for profit’ or ‘non profit’.³³

Kazakhstan is not aware of the Council of Europe (2003) report on palliative care (Recommendation 24 of the Committee of Ministers to member states on the organisation of palliative care).³⁴

The WHO overall health system performance score places Kazakhstan 62/191 countries. This composite measure of overall health system attainment³⁵ is based on a country’s goals relating to health, responsiveness, and fairness in financing. The measure varies widely across countries and is highly correlated with general levels of human development as captured in the human development index.