Abstract
The compulsory social health insurance system introduced in Kazakhstan in 2020 plays a central role in ensuring the financial sustainability and accessibility of healthcare. Upcoming reforms, including the implementation of the Unified Package of Health Services in 2025–2027, require stable population coverage. However, recent data indicate declining enrollment, raising concerns about equity, financial protection, and the system’s long-term viability. The objective of this study was to assess population coverage dynamics under the compulsory social health insurance system from 2020 to 2025, identify regional differences, and evaluate implications for forthcoming healthcare financing reforms. A retrospective analysis of national and regional coverage indicators was conducted using descriptive statistics, absolute and relative change calculations, and annual growth rates. Interregional variability was assessed through dispersion measures, with comparative analysis between regions and cities of national significance. National coverage declined from 84.6% in 2020 to 81.9% in 2025, demonstrating a fluctuating but overall downward trajectory. All regions reported declines of -2 to -11 percentage points, with the sharpest decreases in Akmola Oblast and Shymkent. Persistent regional heterogeneity was observed, with gaps exceeding 12 percentage points. Urban centers consistently demonstrated lower coverage than regions. The study revealed a persistent downward trend in compulsory social health insurance coverage, significant regional disparities, and increasing interregional variability, which may call into question the effectiveness of the future Unified Package of Health Services. Strengthening mechanisms will be crucial to ensuring the sustainability and equity of Kazakhstan's compulsory social health insurance system.