UHC Forward: Towards Universal Health Coverage

The reforms restructured the health delivery system to form a completely new PHC sector and introduced retraining mechanisms for physicians in order to establish a cadre of autonomous primary care providers across the country. From 2000 to 2003 alone, the share of primary care expenditures in total health spending increased from 17% to 31%.

Enrollees are free to choose a family group practice for their primary care and they can switch once per year during the annual registration period. In large urban settings, practices that offer higher quality services will attract a larger number of patients, leading to higher capitation payments for the practice. Rural areas, however, have too few providers in order to create this type of quality incentive.

After the primary care reforms created the undergraduate, postgraduate, and continuing education curricula, the number of primary care physicians rose significantly from 5.8 per 1,000 population in 2001 to 8.2 per 1,000 population in 2005. Furthermore, by the end of 2004, 75 percent of primary care physicians and nurses had been retrained as family physicians and family medicine nurses.

Kyrgyzstan has three types of primary care providers. First, the core of the old rural health system, Feldsher-Obstetric Ambulatory Points (FAPs) are facilities in the most remote reaches of the country that offer basic services such as neonatal care, immunizations, and health education. As of 2006 there were 875 FAPs across Kyrgyzstan, each serving between 500 and 2,000 people. Second, Family Group Practices (FGPs) are the major providers of primary care in Kyrgyzstan. FGPs are normally made up of three to five doctors. They can be freestanding and autonomous entities or units within large hospital polyclinics. Finally, Family Medicine Centers (FMCs) are large outpatient facilities staffed by varying numbers of specialists, often 10 to 20 health care professionals in addition to their affiliated FGPs. Their service offerings range from primary care to specialized care, including instrumental diagnostics. In 2006, approximately 93% of FAPs and 96% of FGPs were part of Family Medicine Centers.

Secondary care is provided by hospitals at the oblast level (generally one oblast merged hospital in each oblast), and by territorial hospitals in rayons and cities (51 hospitals nationally). The main difference between these two types of hospitals lies in the variety and complexity of conditions that they can handle. Tertiary care that provides highly specialized services is conducted in eight central-level hospitals. In terms of legal organization, most health care organizations tend to be public. The exceptions are optic, dental, urologic, and gynecological services, which tend to be private facilities and are mostly concentrated in the capital city of Bishkek.

Health care delivery relies heavily on the private sector. Only about 10% of hospitals are public, while 90% of total health care resources are provided for-profit by the private sectorKorean patients with health insurance are able to go to any doctor or medical institution that they choose without being denied, except specialized general hospitals. If a patient wants to go to a secondary or tertiary care hospital, they must present a referral slip issued by the original medical practitioner. The exceptions to this include: childbirth, emergency medical care, dental care, rehabilitation, family medicine, and hemophiliac disease. Higher co-payments are requested for those patients without a referral letter.

The Medical Law stipulates that only authorized and licensed healthcare professionals can provide health services. The Ministry of Health and Welfare (MoHW) licenses only doctors, dentists, nurses, oriental medical doctors, and midwives, while nurse’s aides, acupuncturists, and massage therapists are licensed as quasi-medical professionals. As of 2007, there were 91,400 physicians, 23,114 dentists, 16,663 oriental medical doctors, 57,176 pharmacists, 8,587 midwives, and 235,687 nurses. However, wide disparities exist between urban and rural areas; about 90% of physicians are concentrated in urban areas.

Health care delivery relies heavily on the private sector. Only about 10% of hospitals are public, while 90% of total health care resources are provided (de facto for-profit) by the private sector. The 10% of the public service system are composed of community public health centers known as Bogeunso, the National Medical Center, and provincial hospitals. There has been less of a push from the public sector to formulate policy alternatives to the private sector–dominated delivery system.