In the first half of 2026, unjustified payments totalling more than 4 billion tenge were prevented in the compulsory social health insurance (CSHI) system. Anti-fraud mechanisms identified defects before funds were transferred to medical organisations.
HOW CONTROL OVER CSHI HAS CHANGED
According to the press service of the Government, in February 2026, the implementation of the CSHI system reform began, aimed at improving financial discipline and changing the management model.
One of the key changes was the shift from subsequent control to preventing unjustified payments before they are made. Whereas previously payments were checked after the money had been transferred, the system now identifies defects at the stage preceding payment.
HOW THE QALQAN DIGITAL PLATFORM WORKS
In parallel with the CSHI reform, the Qalqan digital platform is being introduced, through which the processes of financing, checking and paying for medical care are being integrated.
Currently, in a pilot trial based at 207 clinics in Astana, payment is being made through the platform for 20 of the 92 types of medical care, with a further 60 types undergoing testing.
The move to the digital framework is linked to a new control model in which defects are identified before funds are transferred, rather than after payment.
HOW PATIENTS ARE INVOLVED IN CONTROL
Digitalisation also affects patients. Today, the fact of a visit to a medical organisation can be confirmed via a QR code in eGov Mobile.
The next stage is set to be an electronic financial passport for patients, which should contain information about the medical care provided to them and paid for on their behalf.
WHAT THE FIRST STAGE OF THE REFORM SHOWED
As reported by the Government, the first stage of reforming the CSHI system, focused on financial discipline, transparency and manageability, has now been completed.
In the second half of 2026, the Social Health Insurance Fund (SHIF) will move to scaling up the mechanisms of the new model. At the same time, it is proposed that the effectiveness of the changes be assessed by the concrete outcome for the patient and the doctor.
CONTEXT
The problem of CSHI financing in Kazakhstan developed against the backdrop of identified violations in the payment of medical services and questions over the effectiveness of control over SHIF funds. In 2024, the Supreme Audit Chamber reported violations worth billions of tenge following an audit of the Fund's activities, and the SHIF itself later stated that there was a liquidity shortfall. In subsequent years, violations were also identified at the level of individual medical organisations, including fictitiously documented services, double payment and other violations in the use of CSHI funds.
In 2026, following an analysis of the SHIF's activities, a decision was made to transfer the Fund to the remit of the Ministry of Finance, and President Kassym-Jomart Tokayev stated that the violations identified in CSHI were systemic in nature. At the same time, law enforcement agencies continued their investigations into cases involving the possible unlawful receipt of health insurance funds.
