Kyrgyzstan Medical Insurance
The Kyrgyz Republic is one of six independent Turkic states located in Central Asia. It is landlocked, and is bordered by Kazakhstan, Uzbekistan, Tajikstan, and China. With over 80 different ethnic groups mostly from Turkish and Slavic origins, Kyrgyzstan is a country where visitors can still see many traditions and lifestyles of a semi-nomadic people still preserved. Mountainous ranges cover 80 percent of Kyrgyzstan’s 199,900 sq. km.; the other 20 percent is made up of valleys and basins. This unique terrain has given rise to a small tourism industry based on trekking, camping, horse riding, and skiing. With a lack of road infrastructure, traveling in Kyrgyzstan is difficult, which is why horses are still a much-used mode of transportation.
Since its independence from the former Soviet Union in 1991, Kyrgyzstan has been a place of economic and political instability. Despite significant foreign aid from the International Monetary Fund (IMF), the World Bank, and the Asian Development Bank, Kyrgyzstan still remains the second poorest country in Central Asia. In 2010, civil protests against corruption and rising living expenses led to the fleeing and resignation of President Bakiyev. In addition to these economic and political troubles, Kyrgyzstan’s health care system is likewise having trouble providing adequate care and coverage to its citizens. Before its independence, the Soviet Union’s Ministry of Health had offered a system of free universal health care. This provided sufficient health care personnel, medical infrastructure, and equipment to cover the medical needs of the Kyrgyz populace. However, with the dissolution of the former Soviet Union, the health sector has gradually deteriorated. Equipment, medical supplies, and pharmaceuticals have progressively become older and many have fallen into disrepair without proper maintenance. Medical staff are also no longer adequately trained. Despite these grim realities, Kyrgyzstan still enjoys better health care than most countries with a similar per capita income, which has led to an influx of refugees, the majority of which are from Tajikstan, Afghanistan, and Chechnya. The migration of these foreign nationals has placed an additional burden for the Kyrgyzstan health care system to bear.
In 1996, with support from the World Health Organization (WHO), the Kyrgyzstan government reformed the national health care system with the establishment of the Manas Taalimi Health Care Reform Program. This program’s focus is to provide medical assistance at the primary care level through general practitioners, implement new financing methods, and to improve the overall quality of healthcare within the country. Prior to Manas, many patients had to make out-of-pocket and under-the-table payments to health providers. To stem this, Manas aimed to transform the Kyrgyzstan national health care system into one of a public heath insurance scheme. Under this system, funds for the health sector would come from a general tax on both employers and employees. Unemployed citizens’ health services would be funded by state contributions. Despite the implementation of Manas, there are still significant out-of-pocket payments. In 2001, 22 percent of patients paid for outpatient care and 87 percent paid for hospital care. Also, the state budget and government expenditures only make up 48.7 percent of health financing, while private spending accounted for 51.3 percent.
In 1997, following the Manas program, the Mandatory Health Insurance Fund (MHIF) was established to make payment methods more efficient. 2001 saw the advent of a new system of payment methods that revolved around the “single payer” concept. The MHIF is responsible for gathering funds locally and being the single purchaser of health care services for all of its population. The MHIF is mandatory and citizens cannot choose to opt out. The MHIF is also responsible for maintaining and improving the quality of care. It originally began in only one district, but by 2004, the whole country was under the new system. Since then, out-of-pocket payments were further reduced. In addition to taxes and government funding, other sources of funding include humanitarian aid, grants, and foreign aid. In 1998-2000, foreign aid made up 10% of health expenditures.
Alternative health insurance and services are also available in Kyrgyzstan. There are seven ministries and five large state-owned joint stock organizations that receive partial funding from the government. Private services are also available. As of 2003, there were 254 licensed private practices. There are also many private pharmacies that may carry more supplies and medicine than the government-funded ones. There are often overlaps between the government sponsored programs and private health facilities because private ones are able to bid for contracts and partake in state-sponsored programs. Similarly, private providers may also purchase services from public facilities. Although barely in existence in the early 90’s, the private health sector has grown significantly in the past two decades, which has been important in supplementing the out-of-date public facilities. By the early 2000s, while public spending on the health sector has decreased, the ratio of health care personnel to population has risen. Nongovernmental organizations (NGOs) also play a role in the health sector of Kyrgyzstan, but mostly in organizing and assisting the development of future policies and strategies. Many NGOs have formed associations for nurses, family doctors, hospitals, pharmacists, and many more other health professions.
Although the Kyrgyzstan government is trying to decentralize the management of its health sector, it is still currently organized in a hierarchical model. The Supreme Council of Kyrgyzstan and the prime minister develop policies, regulations, and laws. The Ministry of Health then manages the implementation of these. The ministry oversees all government-owned health care services providers and makes sure that they work in accordance with the orders of the Supreme Council. Each facility operates with its own administrations, but must file an annual report to the Ministry of Health, which, in turn, makes an annual report to the Supreme Council.
As of 2003, there were 8 large regional hospitals, 45 territorial hospitals, 14 city territorial hospitals, 31 rural district hospitals, 668 family group practices, 20 specialized hospitals, 22 dispensaries, 1,073 other various health facilities, and 12,902 doctors that operate as a part of the Ministry of Health. Other government sponsored agencies and private providers also add to this number. Despite the number of facilities that Kyrgyzstan has, many of these are very out-of-date, with many rural ones not even having basic necessities such as electricity and running water. In addition, one of the biggest problems facing Kyrgyzstan’s health care system is the lack of medicine and vaccines. Kyrgyzstan does not produce any pharmaceuticals; supplies such as insulin, narcotics, antiseptics, and antihistamines are very rare. Even if they are available, they may be several times more expensive than prices in the western world. One of the major reasons for this is the lack of faith in the local currency. Most former Soviet republics only trade for medical supplies in US dollars, which may not be available. Many medical supplies are accessible through the black market. However, the quality and availability is inconsistent and highly questionable. There have been many cases of accidental deaths from tainted or fake medicine. The lack of medicine has also made epidemics more likely to occur. Without vaccines to control or curb the outbreak of diseases such as measles and diphtheria, there is no telling when an epidemic can occur. Some hospitals have even been known to require patients to provide for their own medicine and supplies for surgeries or other major procedures.
While expatriates in Kyrgyzstan can access adequate medical services, the general level of healthcare within the country is poor. Travelers are strongly urged to consider an international health insurance policy before arriving in Kyrgyzstan. Visitors and expatriates can use the local medical facilities. However, an immediate cash payment in a secure currency will sometimes be required. With the shortage of medicine, vaccines, and medical supplies, it is important to remember to always carry your own medical supplies and medicine. In the event of a serious accident or illness, especially in the rural parts of the country, local medical services may not be capable of providing care other than immediate emergency services. For more severe accidents and illnesses, an emergency evacuation may be required, which can be highly expensive. As such, it is recommended that any Kyrgyzstan health insurance policy purchased by individuals traveling to the country have a comprehensive emergency evacuation benefit.
Vaccinations for Hepatitis B and E, rabies, tuberculosis, brucellosis, and meningitis should be obtained before entering the country. They are not mandatory, but may be much more difficult to obtain once in the country and are thus, highly recommended. Furthermore, travelers are also advised to bring vitamin supplements because it may be difficult to obtain proper nutrition in certain parts of Kyrgyzstan.
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