This presentation was made by Ali Nurgozhayev, Kazakhstan, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016

1. National Health Accounts
in Kazakhstan
usefulness in operational issues
and preparation of reforms

2. 2004
2011
2014
2015
2016
2
HISTORY
1. Institutionalisation on the
base of the National Center
for Healthcare Development;
2. Support of the Oxford Policy
Management under the WB
project: new approach based
on the centralized stable and
regular information sources;
3. Start of the annual
production
Implementation
of the SHA-2011
 Revision of the 2010+ tables
in accordance with SHA-2011;
 Participation to the activities
held by OECD
KAZ NHA Review by
OECD
Ali Nurgozhayev, Tallin, 1-2 Dec 2016
Beginning of the NHA development in the RK under support of the WB:
 Data source analysis;
 Studying business processes;
 Developing the concept of NHA based on the data collection from each health provider

3. 3
INSTITUTIONALISATION
Ministry of Finance
Budget expenditures MOH
Detalization of
allocations and
statistics
National Bank
Voluntary Insurance
Statistics Committee (Ministry of Economy)
• Statistical form on volumes of medical services;
• Statistical form on income and expenditure of health facilities;
• Statistical form on pharmaceuticals – wholesale and retail volumes;
• Household income and expenditure Survey
Center of Economic
Research
(National Center for
Healthcare
Development)
NHA production Publication
Ali Nurgozhayev, Tallin, 1-2 Dec 2016

4. 4
CURRENT STATE
• 5 tables including capital expenditure
(FSxHF, HFxHC, HFxHP, HPxHC,
HFxHK);
• Productivity indicators (macro and
sectoral levels)
• Disaggregation by region
Ali Nurgozhayev, Tallin, 1-2 Dec 2016

5. 5
KEY FIGURES: THE* as % of GDP
Ali Nurgozhayev, Tallin, 1-2 Dec 2016
16.9
11.5
11.2
11.1
11.0
10.8
10.6
10.4
10.4
10.1
9.9
9.8
9.6
9.4
9.4
9.3
9.1
9.0
9.0
8.9
8.9
8.8
8.4
8.2
7.7
7.5
7.4
7.2
7.2
7.0
7.0
6.3
6.3
5.9
5.8
5.6
5.2
3.3
UnitedStates
Switzerland
Japan
Germany
France
Netherlands
Denmark
Belgium
Austria
Canada
Norway
UnitedKingdom
Finland
NewZealand
Ireland
Australia
Italy
Spain
Sweden
OECDaverage
Portugal
Iceland
Slovenia
Greece
Chile
CzechRepublic
Israel
Korea
Luxembourg
Hungary
SlovakRepublic
Poland
Estonia
Russia
Mexico
Latvia
Turkey
Kazakhstan
* current expenditure
Sources: 1. stats.oecd.org; 2. KAZ NHA 2015

6. 6
KEY FIGURES: PRIVATE SPENDING as % of THE*
Ali Nurgozhayev, Tallin, 1-2 Dec 2016
* current expenditure
50.6
48.5
44.4
44.0
39.6
39.4
39.3
37.5
34.0
33.3
33.0
32.1
30.8
30.1
29.2
28.4
27.8
27.1
24.5
24.5
24.5
23.9
22.8
22.5
21.4
21.0
20.3
19.4
19.3
18.2
16.3
16.0
15.8
15.4
15.1
15.0
14.8
UnitedStates
Mexico
Korea
Kazakhstan
Latvia
Greece
Chile
Israel
Portugal
Australia
Hungary
Switzerland
Ireland
Spain
Canada
Poland
Slovenia
OECD35
Italy
Finland
Estonia
Austria
Turkey
Belgium
France
UnitedKingdom
NewZealand
SlovakRepublic
Netherlands
Iceland
Sweden
Luxembourg
Denmark
CzechRepublic
Japan
Germany
Norway
Sources: 1. stats.oecd.org; 2. KAZ NHA 2015

7. KAZ NHA REVIEW BY OECD (2016)
Doubts on some parts of
methodology after
moving to the SHA-2011
(OOP, Memorandum
Items, etc.)
REVIEW BY OECD
under the Country Program:
• More than 100 technical recommendations;
• Recalculated 2014 data (delta = 4.5%);
• Clear direction for further development (e.g.
disease/sex accounts)
Need to make NHA
results “legal” for
Government
(more trust to increase
its usage)
Ali Nurgozhayev, Tallin, 1-2 Dec 2016 7

8. Monitoring of UHC:
regular review of the productivity indicators allows to determine potential
issues in coverage
Example:
Indicator: Number of surgical interventions at inpatient level per 1 mln. LCU
Issue: Decreases since 2012
Interpretation A: in 2012, DRGs were introduced, so observed effect is
explained by enhanced structure of inpatient cases (simple cases are filtered)
Interpretation B: effect is caused by real decrease in hospital productivity
Findings: after diving into issue, the impact of both factors was found, and
MOH accepted the elaboration of measures for deepened monitoring and
enhancement of hospital productivity.
NHA CONTRIBUTION: OPERATIONAL ISSUES (a)
Ali Nurgozhayev, Tallin, 1-2 Dec 2016 8

9. Monitoring of regional differences:
allows to perform targeted work on inequalities
Example:
Issue: number of significant inequalities was found since the disaggregation
was implemented first time in 2014
Measures package A: measures to reduce inequalities in allocation of public
finances
Measures package B: measures targeted at the areas where OOP spending
is of a critical level and significance
Both of these are now at the Government’s consideration
NHA CONTRIBUTION: OPERATIONAL ISSUES (b)
Ali Nurgozhayev, Tallin, 1-2 Dec 2016 9

10. NHA CONTRIBUTION: OPERATIONAL ISSUES (b)
Ali Nurgozhayev, Tallin, 1-2 Dec 2016 10
33.6
35.6
43.3
45.6
46.2
50.0
52.9
53.0
54.3
54.4
54.6
57.3
57.7
58.7
64.3
88.5
192.2
Алматинская область
ЮКО
Жамбылская область
Костанайская область
Актюбинская область
Акмолинская область
ВКО
Карагандинская область
Атырауская область
СКО
ЗКО
РК
Кызылординская область
Мангистауская область
Павлодарская область
гАлматы
гАстана
93.0
89.5
88.4
87.9
86.6
84.4
84.0
80.5
77.4
77.2
70.0
68.9
66.9
61.0
58.6
56.5
4.4
6.9
9.3
9.7
8.2
13.1
11.9
14.4
18.5
19.1
25.0
27.1
29.5
36.3
36.5
29.6
0% 20% 40% 60% 80% 100%
Алматинская область
ЮКО
Жамбылская область
СКО
Костанайская область
Кызылординская…
Акмолинская область
ЗКО
Карагандинская область
ВКО
Актюбинская область
Павлодарская область
Атырауская область
Мангистауская область
гАстана
гАлматы
Current per capita spending by region, thsd. LCU
Structure of current spending by region,
excl. drugs, %
public population enterprises

11. Monitoring of the shift to the Social Health Insurance
Issue: Kazakhstan is moving from budget model towards
SHI in 2018
Its supposed to use all the NHA means for careful and
deepened monitoring of the changes in coverage and
funds distribution during the process
NHA CONTRIBUTION: OPERATIONAL ISSUES (c)
Ali Nurgozhayev, Tallin, 1-2 Dec 2016 11

12. In this regard, timeliness of NHA is quite important
TODAY
For the moment, due to availability of a number of
statistical data sources, the Final KAZ NHA Report is
published only by the end of year
TOMORROW
However, as key data (budget execution, preliminary
estimates on GDP / households consumption / etc.) is
available by February, for 2017 we’re going to release the
Express Report by March (with estimates of 2016
spending).
This is expected to fully cover budget expenditure and
provide key estimations on private spending
NHA CONTRIBUTION: OPERATIONAL ISSUES (d)
Ali Nurgozhayev, Tallin, 1-2 Dec 2016 12

13. NHA CONTRIBUTION: PREPARATION OF REFORMS
Ali Nurgozhayev, Tallin, 1-2 Dec 2016 13
Preparation of the shift to the Social Health Insurance
Issue: Need to assess possible increase of the demand
for health services, perspectives of Voluntary Insurance
operators, etc.
NHA data on private expenditure is used for that

14. THANK YOU FOR ATTENTION
Ali Nurgozhayev, Tallin, 1-2 Dec 2016 14