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Joint Learning Network for Universal Health Coverage

The Joint Learning Network for Universal Health Coverage systematically documents the reforms of its member countries and other countries that have expanded health coverage through demand-side financing. The case studies contained in these pages are brief, comparative and modular in nature, describing the key highlights and technical features of each program.


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Program Primary source of funding Secondary source of funding Contributing Populations Types of Contributions Funding
Kyrgyz Republic: Mandatory Health Insurance Fund (MHIF)
  • Payroll Tax
  • General government revenues
  • Formal Sector
  • Government Employees
  • Informal Sector
  • Co-payments

Premiums for the Mandatory Health Insurance Fund (MHIF) are paid by different entities depending on the status of the enrollee. The payroll tax is set at 2% for those employed and is payable by employers. Farmers pay 5% of their land tax as their contribution to the health fund. Finally, pensioners and the unemployed have their contribution paid for by the pension and unemployment insurance funds. This contribution equals 1.5 times the minimum wage. The MHIF is the sole purchasing agency for health services within the Kyrgyz health system.

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Premiums for the Mandatory Health Insurance Fund (MHIF) are paid by different entities depending on the status of the enrollee. The payroll tax is set at 2% for those employed and is payable by employers. Farmers pay 5% of their land tax as their contribution to the health fund. Finally, pensioners and the unemployed have their contribution paid for by the pension and unemployment insurance funds. This contribution equals 1.5 times the minimum wage. The MHIF is the sole purchasing agency for health services within the Kyrgyz health system.

Table 2: Population coverage and funding sources

Population groupPayroll tax rate, base and sourceComment
Employed population groups
Employees in formal sector2% payroll contribution by employerThere is an upper limit on contribution payments: earnings exceeding 120-times the monthly minimum wage are not subject to payroll tax payments (i.e., earnings portions above 12,000 soms)
Civil servants and public enterprises2% payroll contribution by employer
Self-employed2% of total enterprise income
Private farmers5% of land tax (only after 2001)
Non-employed population groups
Pensioners1.5x minimum wage from pension fun to MHIF
Registered unemployed1.5x minimum wage from unemployment fund
Children under 16 and students under 18Republican budget
Persons receiving social benefitsRepublican budget

Source: Jakab, M.

Copayments are regulated in the State Guaranteed Benefits Package (SGBP). The SGBP was the primary instrument used to address the problem of informal payments. Copayments were introduced in two oblasts starting in 2001 and were henceforth expanded gradually to the entire country through 2004, when all oblasts conformed to the same system. The destination of the copayment revenues is regulated; 20% can go toward complementing personnel salaries and 80% must go towards inputs such as medicines, supplies, and food. The majority of copayments are used for the purchase of medicines and supplies, functioning as additional revenue for hospitals to fund their variable costs. Copayments vary with insurance status, exemption status, case type (delivery, surgery, medicine), and referral status.

Populations with high expected use of the health care system qualify for two copayment exemptions. The first is based on social characteristics and was intended to target vulnerable groups such as war veterans, the elderly, and the disabled. The second is based on groups with certain medical conditions with high externalities such as tuberculosis, AIDS, syphilis, and polio. Both of these groups are exempt from any fees. Hospitals are also required to set aside 10% of all copayment funds in order to cover services for the very poor that are uninsured. This process was initiated voluntarily by health providers to support the most vulnerable populations.