As part of the implementation of the instructions of the Head of State to strengthen budget discipline, the Government is carrying out systematic work.

On 18 December 2025, Prime Minister Olzhas Bektenov instructed the Ministry of Finance to conduct an analysis of the activities of the Social Health Insurance Fund (SHIF) in order to improve the efficiency of budget spending.

Following the analysis, Minister of Finance Madi Takiyev reported that despite the growth in budget expenditures (in 2026, spending for these purposes will amount to 2.4 trillion tenge, which is 1 trillion tenge more than in 2020), the effectiveness of the Fund is not increasing. At the same time, the accumulated investment income since 2020 amounted to 588 billion tenge, including 195.9 billion tenge in 2025 alone. According to the analysis, a significant portion of the funds is accumulated in the Fund’s assets and is not directed toward the provision of medical services.

An IT audit of medical service delivery information systems conducted by the Ministry of Finance revealed a number of systemic violations:

• inflation of services through fictitious patients (with an attached population of 1,000 people, in reality about 500 apply for services, yet payment is made for the entire contingent);

• provision of medical services that are not characteristic of the patients;

• double financing of the same services from SHIF funds and voluntary medical insurance provided by employers;

• provision of an abnormally high number of medical services within extremely short timeframes;

• provision of services to deceased citizens;

• prescribing more than one thousand medications per day to children, and others.

Minister of Finance Madi Takiyev cited specific figures and examples:

1. A doctor at a private clinic received 1,442 patients in one day, with an average norm of up to 24 patients per day (15 minutes per patient with a 6-hour working day). At the same clinic, another doctor received 4,832 patients in one month (Astana);

2. 1,713 treated cases per month by a single specialist, with 300–400 examinations per day on certain days (Astana);

3. 3,640 cases of medical services provided to 996 deceased patients, including cases where a patient was recorded as having received services in 2025 despite having died in 2023 (2.5 years after death);

4. 769,446 screening cases that did not correspond to the patient’s gender, totaling 1.8 billion tenge. Thus, 768,827 men underwent screening for female diseases (cervical cancer), and 619 men underwent mammography. In one district hospital alone, 11,123 such cases were identified (Almaty Region);

5. 68,717 cases of systematic overstatement of prescribed medicines for children. For the drug Dimexide, 126,000 entries were recorded for two children — 63,000 write-offs per child (Zhetysu Region);

6. 2,872 cases of medication write-offs for one patient within a single day. In a children’s hospital, 179 such cases were identified: 88,000 units were written off, while patients stayed in inpatient care for no more than one day (Astana), and others.

The analysis also revealed two widespread cases of double financing. The first involves private medical organizations receiving payment simultaneously through voluntary medical insurance from employers and from SHIF funds. The second involves the same patient being registered in two medical organizations at the same time on the same dates.

In addition, tax authorities conducted desk audits of the heads of medical organizations, analyzing their income and acquisitions. It was found that 1,465 executives in 2024–2025 acquired more than 5,000 real estate properties, while 912 individuals acquired 1,416 vehicles. Some heads of private clinics acquired between 52 and 124 real estate properties and 14 to 24 vehicles each over a two-year period.

Furthermore, fragmentation of information systems between the Fund and the Ministry of Healthcare, as well as of the regulatory framework, was noted. The absence of a unified database for patients and medical organizations has led to a situation where the current regulatory framework is largely tied to the functions of individual organizations (SHIF, SK “Pharmacy”), rather than to the final outcome — the provision of medical care to the population.

After the initial confirmation of the material and technical base, equipment, and staffing requirements of medical organizations, subsequent oversight is effectively not carried out. Preventive control mechanisms have not been established, which prevents timely prevention of misuse of funds from the Guaranteed Volume of Free Medical Care (GVFMC) and SHIF by medical organizations.

There are no incentives for savings: instruments for returning saved funds to the budget are not предусмотрены. As a result, motivation is formed not toward efficiency, but toward spending allocated funds.

Certain problems were also identified in tariff formation. The system applies more than 3,000 tariffs, which significantly complicates administration and control over the provision of medical services.

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Following the results, Prime Minister Olzhas Bektenov instructed:

• the Ministry of Finance to transfer all announced facts and materials to law enforcement agencies for procedural decisions;

• to transfer the Social Health Insurance Fund under the authority of the Ministry of Finance to ensure control over all financial flows;

• to ensure full digitalization of healthcare system business processes based on the systems of the Ministry of Finance;

• to halt unjustified financing by revising the parameters of the SHIF investment strategy for asset placement and generation of investment income.

#Olzhas Bektenov #Finance #Healthcare #President's instruction

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