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CARK MCH Forum VII Annual Meeting National Health Expenditures in the Kyrgyz Republic

Dr. Gulnara Oskonbaeva, Head of Financial and National Policy Department at the Ministry of Health, discusses the indicators of the health care system in the Kyrgyz Republic from 1991-2002. The strengths and weaknesses of the system are examined, including infrastructure and equipment, qualified personnel, equal access to health services, and a free health care system. The presentation also highlights the health care reforms implemented, such as the establishment of the Mandatory Health Insurance Fund.

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CARK MCH Forum VII Annual Meeting National Health Expenditures in the Kyrgyz Republic

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  1. CARK MCH Forum VII Annual MeetingNational Health Expenditures in the Kyrgyz Republic Dr. Gulnara Oskonbaeva Head of financial and national policy department, Ministry of Health

  2. Indicators of health care system 1991 1992 1993 1994 1995 1996 1998 1999 2000 2001 2002 1997 68.8 68.3 67.3 65.9 66.6 66.7 66.7 67.1 68.7 68.5 68.6 68.6 Life expectancy Mortality rate 6.9 7.2 8.3 8.2 7.6 7.4 7.4 6.8 6.9 6.6 6.6 7.7 7.1 women 6.4 6.7 7.6 7.5 6.9 6.8 6.8 6.2 6.2 6.1 6.1 men 7.6 7.8 8.5 9.1 9.0 8.3 8.3 8.1 7.4 7.7 7.7 7.6 infants 29.7 31.5 31.9 29.1 28.1 25.9 28.2 26.2 22.7 22.6 21.7 21.2 mothers 76.4 70.1 80.1 80.1 67.4 65.0 76.4 54.7 45.9 46.5 49.9 53.5

  3. Infrastructure and equipment; qualified personnel; equal access to health services; free health care system; high indicators of health sector compare to medium level of income. redundancy of personnel; excessive number of hospitals; inadequate methods of treatment; weak prophylactic and medical-sanitary care; imbalance of system of health services provision; poor coordination and doubling of services. Health Care System:Strengths and Weaknesses

  4. Health Care Reforms: «Single Payer» Establishment of the Mandatory Health Insurance Fund • Accumulates budgets at oblast level; • Cross subsidies shift around oblast and between budget financing and tax allocations of health personnel; • Needs and availability of resources are taken into consideration in resources allocation process; • Administrative expenses for health management sector are reducing.

  5. Health Care Reforms: «Single Payer» Transfer to financing according to effective indicators • Denial from financing upon number of beds and availability of personnel; • Per capita funding methodology for primary health care; • Payment per case treated in hospitals; • Standards of expenditures for treatment per user based on selective checkup; • Mechanism of co-payment by user has been introduced.

  6. Health Care Reforms: «Single Payer» First results • Reduction of informal payments practice in health institutions; • Increase of effectiveness in financing for health sector; • Cutting down of personnel in health institutions; • Increase of expenditures per health services user.

  7. Financial sources of health care system • national budget; • categorical grants for oblasts; • own means of local authorities; • mandatory health insurance; • co-payment and informal payments from users; • programme of state investments financing from external sources.

  8. Financial Sources of Health Care System

  9. Health Expenditures (in % to GDP)

  10. Inter-budget relations in financing in health system 1995 1996 1997 1998 1999 2000 2001 National budget 23.8 28.3 33.9 31.8 32.2 33.3 31.6 Local budget 76.2 71.7 66.1 68.2 67.8 66.7 68.4 Categorical grants 31.1 31.4 31.0 31.8 24.2 • Role of local authorities; • Role of Ministry of Health; • Role of categorical grants. Local means 76.2 71.7 35.0 36.7 36.8 42.5 36.6

  11. Breakdown of Expenditures of health sector:by programs

  12. Breakdown of Expenditures in health care system: by budget line 1995 1996 1997 1998 1999 2000 2001 2002 Total expenditures 91.0 90.9 91.7 93.7 94.9 94.1 94.6 96.2 Salary 56.3 51.6 52.3 51.8 56.4 50.5 52.5 52.4 0.2 0.2 0.2 0.3 0.3 0.4 0.2 0.3 Daily Subsistence Allowances Medical supplies, stationaries 8.4 9.8 12.7 12.0 12.0 9.3 9.4 10.3 Nutritional supplies 8.3 9.0 8.3 10.0 8.5 9.0 9.1 8.8 Utilities 12.4 15.5 13.7 15.4 14.0 21.3 20.2 21.0 Transportation expenses 2.5 2.0 1.8 1.8 2.0 2.2 1.9 2.0 Other expenditures 3.1 2.9 2.9 2.7 2.0 1.8 1.4 1.3 Total capital expenditures 9.0 9.1 8.3 6.3 5.1 5.9 5.4 3.8 Purchase of equipment 2.1 2.1 2.0 1.7 1.5 1.5 0.9 1.7 Major repairs 2.5 2.2 2.8 2.9 2.0 2.9 2.4 2.1 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Total budget expenditures

  13. Breakdown of Expenditures of health care system: Mother and child protection (Bishkek city) 2000 2001 2002 Republican health institutions totally 258140 260277.5 100 % 271018 100 % 100 % 10630.4 6501.1 7827.9 Republican Children’s hospital 4.1 % 2.4 % 3.0 % 5935.4 6837.9 7456.8 2.3 % 2.5 % 2.9 % Institute of Obstetrics and Pediatrics 2411.6 2480.7 1682 Center of Human Reproduction 0.7 % 0.9 % 0.9 % 1565.9 1909.1 Chui-Tokmok Baby House 0.6 % 0.7 % 0.7 % 1993.6

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