The document discusses performance budgeting in Kazakhstan's health system. It begins by defining performance budgeting as linking budget formation and execution to achieving strategic goals and objectives. It then outlines Kazakhstan's history of implementing performance budgeting since 2007. Key aspects discussed include the country's state planning system, budget management cycle, health care financing structure, and strategic documents like the healthcare development program and ministry of health strategic plan that guide performance budgeting implementation. Performance indicators, reimbursement mechanisms, and examples of cases subject to payment withdrawal are also summarized.

1. Performance
budgeting in health in
Kazakhstan
Zarina Temekova

2. Performance budgeting (PB)
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Formation and execution of the budget in order to achieve specific results in
accordance with the strategic directions, goals and objectives of state policy
(clear relationship between results and budget expenditures)
Old system:
 the budget programs are not well
aligned with program objectives;
 the use of budget funds “at any cost”;
 emphasis on compliance with rules,
regulations and instructions;
 budget programs are aimed at
ensuring the activities of state bodies,
institutions and enterprises
PB:
 budget programs are interlinked with
strategic development goals;
 budgetary resources are allocated to
achieving results;
 focus on feasibility and cost effectiveness
through self-reliance;
 budget programs are aimed at providing
services to the population, business and
government bodies to each other
Main differences:

3. The history of the implementation of performance
budgeting in Kazakhstan
In the annual Address to the nation "New Kazakhstan in the new
world" (2007), the Head of the state Nursultan Nazarbayev
highlighted the important direction of the Government's work on
building a new model of public administration on the principles of
corporate governance, efficiency, transparency and accountability
to society.
2007 – the Concept of implementation of the system of state
planning based on results was approved.
2008 – new Budget code of the Republic of Kazakhstan was adopted.
2009 – the System of state planning in the Republic of Kazakhstan
was approved.
2013 – the Concept of the new budget policy of the Republic of
Kazakhstan was approved.
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4. DOCUMENTS OF STATE PLANNING SYSTEM
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Strategy 2050;
State programs and
strategic documents
Forecast of socio-economic
development
(for 5 years)
Strategic Plan of state body
(for 5 years)
Republican budget,
Local budget
(for 3 years)
Operational plan of the state body
(for 1 year)
Development Programs
(for 5 years)

5. Budget management cycle
Strategic planning and budget
preparation.
To help set the macro-fiscal
framework and inform budget
negotiations, taking account of
national plans, policies and
sector strategies. Budget approval.
To identify expected results
from proposed appropriations
to aid the legislature’s review
of the proposed budget.
Budget execution.
To help managers manage
and monitor performance
during the year.
Reporting.
For reporting performance
against plan, alongside financial
information, in budget reports
and ministry annual reports
and others
Monitoring and evaluation.
As part of the formal
monitoring, review and
evaluation process.
Audit.
To ensure accountability through
financial and performance audits

6. Structure of the health care financing system of
Kazakhstan
Control
The Ministry of health, Departments of health, Department for
sanitary-epidemiological supervision, Committee of protection of
public health
Tariff system.
Outpatient Tarifficator,
capitation, DRG
Legal regulation
The budget code of the Republic of
Kazakhstan, the Code «On public health and
the health system», the State program of
health development "Densaulyk" 2016-2019,
the Strategic plan of the Ministry of health
Local budget
The provision of guaranteed free
medical care, purchase of vaccines,
medical drugs, production of
blood, etc.)
Republican budget
Expenditures in the field of health and in
accordance with the budget code
Budget expenditures
Extra-budgetary sources
Voluntary health insurance funds, provision of medical services on a
paid basis, other sources
Healthcare
financing
system

7. Financial resources
of the health care system are directed to:
1) payment for health care providers within the guaranteed volume of free medical
care;
2) material and technical equipment of health care organizations;
3) purchase of medicines, orphan drugs, blood and its components, vaccines and
other immunobiological drugs, and also medical products and medical equipment;
4) elimination of cases and epidemics of infectious diseases;
5) training, advanced training and retraining of personnel in the field of health;
6) development and implementation of medical science achievements;
7) other expenses not prohibited by the legislation of the Republic of Kazakhstan.

8. State Program of Healthcare development
“Densaulyk” (2016-2019)
• Increase in life expectancy (years)
• Reduction of maternal mortality (per 100,000 live births)
• Reduction of infant mortality (per 1,000 live births)
• Reduction of total mortality (per 1000 population)
• Reduction of tuberculosis incidence (per 100 thousand population)
• Retention of HIV prevalence in the age group of 15-49 years in the
range of 0.2 - 0.6%
• Increase in the proportion of malignant neoplasms detected at stage
I-II to 55.1% by 2019
• Increase in the proportion of 5-year survival rate of patients with
malignant neoplasms to 50.6% by 2019

9. Strategic plan of the Ministry of health of the Republic of Kazakhstan for
2017 - 2021
Health goals:
by 2020, the life expectancy of the population will increase to 73
years;
maternal mortality will decrease by 3 times;
infant mortality will decrease by 2 times;
total mortality will decrease by 30 %;
the incidence of tuberculosis will decrease by 20 %.
Strategic objectives for improving the provision of health services:
 by 2020 - the level of spending on PHC will increase up to 40 % of the total funds
allocated to the guaranteed volume of free medical care;
 the main indicators of health care organizations providing inpatient care (bed
turnover, average length of stay, etc.) will meet international standards of
efficiency;
 100% coverage of children under 16 years of age with the full range of medical
services;
Strategic objectives to improve the availability and quality of
medicines:
 By 2020 an effective system for providing medicines and medical
products within the framework of the guaranteed volume of free
medical care will be introduced.

10. Strategic directions of the ministry of health
Strategic direction 1.
Public health promotion
Strategic direction 2.
Improving the efficiency of the health
care system
Goals of the Ministry of Health
Goal 1.1
Public health
protection
Goal 1.2
Improving access to
care
Goal 2.1
Improving the
healthcare
management and
financing
Goal 2.2
Development of
human resources
and science in
healthcare system

11. Indicators of Strategic direction 1.
Public health promotion
Performance indicator
Increase in life Expectancy at birth
Retention prevalence of HIV infection in the
age group of 15-49 years in the range of 0.2-
0.6%
Reducing the incidence Of tuberculosis
Improving the position of the GCI on all health
sub-factors
Retention of the indicator of morbidity of the
population with infectious and parasitic
diseases at the level of no more than 315,9
Performance indicator
Reduced Overall mortalitypopulations
The decline in Infant mortality
Reducing Maternal mortality
Reduction of Mortality from diseases of the
circulatory system
Reduction of Mortality from malignant diseases
Reducing the Level of inpatient care
consumption
Increase in the Share of private providers of
medical services within the guaranteed volume
of free medical care
Goal 1.1
Public health protection
Goal 1.2
Improving access to care

12. Indicators of Strategic direction 2.
Improving the efficiency of the health care system
Performance indicator
Proportion of population with e-health
passports – 100%
Share of the population for which the Fund
of mandatory social health insurance
received payments and contributions –
100%
The share of PHC financing in the
framework of the guaranteed volume of
free medical care
Performance indicator
reducing the shortage of medical personnel
increase in the proportion of graduates meeting
the need for secondary health workers
increase in the Share of doctors who have
undergone advanced training and retraining at
home and abroad from the total number of
doctors of public health organizations
increase in the Share of developments of
domestic researchers in the total volume of new
medical technologies annually introduced into the
health care system of the Republic of Kazakhstan
Goal 2.2
Development of human resources and
science in healthcare system
Goal 2.1
Improving the healthcare management
and financing

13. № PERFORMANCE INDICATOR GENERAL
PRACTITIONER
PHYSICIAN PEDIATRICIAN Expected
effect
1 Maternal mortality, preventable at PHC level 4,00 4,00 absence
2 Infant mortality from 7 days to 5 years,
preventable at PHC level
4,00 4,00 absence
3 Proportion of children under 5 years hospitalized
with complicated acute respiratory infections
4,00 reduction
4 Coverage of nursing visits to newborns in the first
3 days after discharge from the hospital
4,00 100%
5 Timely diagnosed pulmonary tuberculosis 4,00 4,00 4,00 increase
6 First identified cases of visual localization of stage
0-1 malignancy, with the exception of malignant
neoplasms of the breast and cervix. First detected
cases: breast cancer 0-2 a (t0-T2N0M0), cervical
cancer 1-2 a (T1-T2N0M0)
4,00 4,00 4,00 increase
7 The level of hospitalization of patients with
complications of diseases of the cardiovascular
system (myocardial infarction, stroke)
4,00 4,00 reduction
8 Complaints 4,00 4,00 4,00 absence
Total maximum score 24,00 20,00 24,00

14. The mechanism of reimbursement of medical
organizations
2. Payment according to
the established tariffs
3. Quality and volume control (random
unscheduled inspections) for compliance with the
standards and declared volumes of medical care
under the contract
4. Formation of the
inspection report
5. Defect
detection
6. Adjustment of the sums of
budgetary funds for the contract
for the provision of guaranteed
free medical care
1. Free choice of medical
organization

15. The examples of cases to be withdrawn and not
to be paid
PRIMARY HEALTH CARE Withdrawal amount
Control of preventive, therapeutic and diagnostic measures 4-25 of capitation tariff
Monitoring of children under 1 year of age 4 of capitation tariff
Monitoring of pregnant women 8 -15 of capitation
tariff
Monitoring of adolescents 15 of capitation tariff
Consultative and diagnostic assistance 4-20 of capitation tariff
INPATIENT CARE
Cases of hospitalization without medical indications 100%
Cases of complications resulting from treatment 30%
Cases with the outcome of the disease "deterioration" 30%
Cases with the outcome of the disease "without change" 20%

16. Thank you for your attention!