Kazakhstan has invested heavily in healthcare reform over the past decade. PHIG examines what the region’s largest health system offers as a benchmark — and what Georgia can learn from its trajectory.
“Kazakhstan’s health system transformation is the most ambitious in the post-Soviet space. Whether it delivers commensurate health outcomes will determine whether the model is exportable.”
WHO Regional Office for Europe. Kazakhstan Health System Review. Copenhagen: WHO/Europe; 2023.[1]
Introduction
Kazakhstan, with a population of approximately 19 million and significant hydrocarbon wealth, has invested more per capita in health system transformation than any other former Soviet republic over the past decade, with health expenditure per capita reaching USD 1,247 (PPP) in 2024 — above Georgia’s USD 1,284 but with a considerably larger public sector share.[2] Its 2020 State Health Programme introduced mandatory social health insurance, electronic health records, and a Primary Health Care (PHC) reform drawing explicitly on Estonian and UK models.
PHIG analyses Kazakhstan’s experience as a benchmark for the South Caucasus and Central Asian region, identifying transferable lessons and important caveats.
| Indicator | Kazakhstan | Georgia | Kyrgyzstan | Azerbaijan | WHO Eur. Avg |
|---|---|---|---|---|---|
| Health exp. per capita USD PPP | 1,247 | 1,284 | 248 | 692 | 2,847 |
| Govt. share of health spending (%) | 58% | 52% | 52% | 37% | 71% |
| Social health insurance (% CHE) | 21% | 0% | 0% | 0% | 35% |
| Life expectancy (years) | 73.4 | 73.8 | 73.1 | 74.2 | 77.5 |
| CVD mortality (per 100,000) | 390 | 412 | 420 | 401 | 172 |
| UHC service coverage index | 69 | 67 | 62 | 61 | N/A |
| Physician density (per 1,000) | 4.1 | 5.1 | 2.2 | 4.0 | 3.8 |
Sources: WHO European Health Information Gateway 2024; WHO Global Health Expenditure Database 2024.[1,2]
Kazakhstan’s PHC Reform: Lessons
Kazakhstan’s PHC reform introduced capitation-based payment for registered patients, electronic referral gating, and a ‘Family Medicine’ model replacing Soviet-era polyclinics. The 2023 WHO evaluation found that GP registration reached 94% of the population, but GP-to-specialist referral rates remained high (42% of GP consultations resulted in specialist referral, compared to 15% in the UK), suggesting that the functional gatekeeping role was not yet consolidated.[1,3]
Figure 1. PHC vs. Specialist Utilisation: Kazakhstan vs. Peers 2024 (consultations per capita)
Sources: WHO European Health Information Gateway 2024; NHS England 2024.[1,2,3]
| Reform Element | Kazakhstan Outcome | Georgia Context | Transferability |
|---|---|---|---|
| Capitation payment for GPs | 94% population registered | Partial capitation exists | High — build on existing |
| Electronic referral gatekeeping | 42% GP→specialist rate (high) | No electronic gatekeeping | High — Georgia EHR needed |
| Family medicine model | Deployed; consolidating | Partially present; fragmented | Medium — need faculty dev. |
| Social health insurance | 21% CHE; growing | 0% — tax funded only | High priority — long lead time |
| QI linkage to payment | Piloted 2023; limited data | Not implemented | Medium — data capacity first |
| Rural PHC investment | Mobile clinic programme | Ongoing but underfunded | High — scale needed |
Sources: WHO 2023; PHIG 2025.[1,5]
Figure 2. Life Expectancy vs. Health Expenditure: South Caucasus and Central Asia 2024
Sources: WHO GHED 2024; WHO European Health Information Gateway 2024.[1,2]
Conclusion
Kazakhstan’s health system experience is instructive for Georgia in three specific areas: the introduction of social health insurance, the electronic health record and referral infrastructure, and the PHC capitation model. All three are transferable to the Georgian context, with appropriate adaptation for scale and administrative capacity. What Kazakhstan’s experience also demonstrates is that health spending and health outcomes do not move in lockstep — Kazakhstan spends comparably to Georgia but achieves slightly lower life expectancy, reflecting the difficulty of converting investment into outcomes without simultaneously addressing alcohol consumption, dietary patterns, and occupational health risk factors prevalent across the region.
References
- WHO Regional Office for Europe. Kazakhstan: Health System Review 2023. Health Systems in Transition Series. Copenhagen: WHO/Europe; 2023.
- WHO Global Health Expenditure Database 2024. Available from: https://apps.who.int/nha/database
- NHS England. GP Referral Data 2023/24. London: NHS England; 2024.
- Katsaga A, Kulzhanov M, Karanikolos M, Rechel B. Kazakhstan: Health System Review. Health Syst Transit. 2012;14(4):1–154.
- PHIG. Central Asia Health System Benchmarking Report. Tbilisi: PHIG; 2025.
Public Health Institute of Georgia
