Аннотация
Between 2019 and 2024, Kazakhstan recorded a significant decrease in the number of foreign patients receiving inpatient care: from 10 thousand to 2 thousand individuals, representing a reduction of approximately 81%. At the same time, the financial cost of treating a single patient rose sharply -the average cost increased more than 2,4 times, reaching 330 thousand tenge in 2024 compared to 137 thousand tenge in 2019, with an average annual growth rate of 19,2%.The predominance of emergency hospitalizations persists and continues to intensify each year. In 2019, 9,8 thousand out of 10 thousand treated patients (94,8%) were admitted on an emergency basis, whileby 2024 this share had reached 1,9 thousand out of 2 thousand patients (97,8%). The trend shows a steady increase: 95,1% in 2020, 96,1% in 2021, 97,1% in 2022, and 98,4% in 2023.A notable disparity exists in the funding structure. Within the Guaranteed Volume of Free Medical Care, the proportion of emergency hospitalizations remains consistently high (99,0–99,4% during 2020–2024), whereas in the Mandatory Social Health Insurance system the share of emergency cases increased from 12,8% in 2020 to 31,5% in 2024. This indicates a growing share of complex and high-cost medical interventions.In 2024, the majority of patients were women (59,6%), with an average age of 36. The most common causes of hospitalization were emergency obstetric-gynecological conditions and pneumonia. Additionally, 12 cases of high-tech medical care were provided at a total cost of 48,3 million tenge, with the average cost per case amounting to 4,03 million tenge -significantly increasing the financial burden on the budget.What is the problem? Despite the decline in the number of foreign patients, the healthcare system continues to experience a substantial and increasingly complex load. Rising treatment costs, the predominance of severe emergency cases, and insufficient control over the reasons for hospitalization pose risks to the financial sustainability of both the Guaranteed Volume of Free Medical Care and the Mandatory Social Health Insurance system. Several key problems can be identified:1.Increasing financial pressure on the state budget.Although the number of foreign patients has decreased, expenditures on their treatment continue to rise, especially in cases requiring high-cost interventions such as high-tech medical care, obstetric services, and surgical procedures.2.Weak control over access to medical services.Foreign patients often receive emergency care without subsequent compensation of costs, particularly when they lack mandatory social health insurance or contracts with the Social Health Insurance Fund.3.Unclear categorization of patient groups.Existing statistics do not always allow clear differentiation between medical tourists, foreign nationals, labor migrants, and regular tourists, complicating planning and analysis.4.Absence of effective cost-recovery mechanisms. Unlike many other countries, Kazakhstan lacks functional tools to recoup expenses borne by the budget for treating foreign citizens.Thus, the healthcare system faces growing financial strain, a high share of complex and costly cases, weak oversight of legal status and grounds for hospitalization, and the absence of effective reimbursement mechanisms. This makes the provision of medical care to foreigners financially unsustainable and necessitates a revision of existing approaches.Policy options–Introduce mandatory insurance requirements and co-financing mechanisms for foreign citizens;–Strengthen interagency control over the legal status of foreigners and the grounds for their hospitalization;–Develop and implement a differentiated model governing foreign citizens’ access to medical care.Vision for implementing policy optionsEach of the proposed approaches can significantly enhance transparency, governance, and financial sustainability in providing medical care to foreign citizens. A balanced combination of mechanisms -from insurance obligations to interagency oversight and differentiated access -will help reduce unjustified budget expenditures, ensure fair distribution of responsibility, and maintain the priority of accessible emergency care. A comprehensive implementation of these measures would contribute to establishing a more efficient and sustainable regulatory framework.Keywords: foreign patients, emergency care, financial burden, mandatory social health insurance, access control, insurance, regulation.