Keyword: Insurance

ABSTRACT: This article presents a comprehensive analysis of the health system of the Republic of Kazakhstan, its current state, key achievements and remaining challenges. Using the Harvard “Five Control Knobs” analytical framework (financing, payment, organization, regulation and behavior), as well as analysis of the dynamics of the main medical and demographic indicators and human resources for 2017-2023, the article seeks to fill the gap in the systemic understanding of the effectiveness of the ongoing reforms and their impact on the health of the population. Particular attention is paid to the relationship between the various components of the system and the identification of priority areas for further improvement.
Our findings indicate a moderate improvement in population health, with average life expectancy increasing from 72.9 to 75.1 years and overall mortality returning to pre-pandemic levels. However, noncommunicable diseases continue to account for approximately 84% of all deaths. Total health expenditure remained low at 3.8% of GDP in 2023, while out-of-pocket spending accounted for 27.7% of current health expenditure, reflecting persistent gaps in financial protection. Although the introduction of mandatory social health insurance has expanded pooled financing, significant weaknesses persist in provider incentive structures, workforce distribution, and regulatory enforcement.
Overall, the results suggest that while gradual progress has been achieved, chronic underfunding, system fragmentation, and governance challenges continue to constrain equity and efficiency, underscoring the need for coordinated, evidence-based reforms.

ABSTRACT: Japan's healthcare system recognized for its achievements in universal healthcare coverage, for one of the highest life expectancies, and for low infant mortality rate. These impressive results achieved after decades of thoughtful policy making process and financial investments into the equitable access. In addition to that Japan has a long history of strong public health traditions and sophisticated insurance model. On the other hand, despite these achievements, the healthcare system recently faces growing pressure which may impact its sustainability and fairness.  One of the challenges is rapid aging of population.  In combination with persistently low fertility, these challenges are reshaping the demand for healthcare and long-term care services. Moreover, financial pressure in increasing with health-related and social security expenditures consume a growing share of the national budget. A shrinking number of workforces, unequal healthcare provider distribution, and fragmentation across nearly 3,000 health private insurers create additional inefficiencies and threaten equitable access of the population to healthcare services, especially in the rural areas. In addition, the healthcare system is under strain from rising number of multimorbidity and increasing mental health issues among young population. Advance in technological progress creates opportunities but at the same time requires substantial adaptation.