With economic decline in Kazakstan in the 1990s, state health sector spending fell dramatically. Although insurance has made up some of the shortfall, rural healthcare provision has suffered disproportionately from the transition. Resources are now spread extremely thinly between facilities and there is an urgent need to rationalise over-capacity. Services are duplicated and poorly co-ordinated between hospitals. Overall occupancy is variable.
Low occupancy is reflected in costs, meaning that smaller units are the most expensive to run.
The financing system based on bed and staff numbers encourages hospitals to retain patients and discourages innovative treatment. Standards of care are outdated and based on targets for interventions in hospital rather than other indicators of success. Primary services are seen as inferior and doctors believe that home care is inadequate. As a result, outpatient care is, in effect, replaced by inpatient treatment. Lack of resources, such as medicines, also results in longer inpatient care.