More than 3 million residents of Kazakhstan remain outside the compulsory social health insurance (CSHI) system, despite increased funding for the Social Health Insurance Fund (SHIF).
The Supreme Audit Chamber (SAC) also revealed underpayments by the state for preferential categories of citizens, instances of double funding for medical services, and insufficient transparency in the spending of fund resources.
WHAT THE AUDIT REVEALED
According to BES.media, the audit of the implementation of the republican budget for 2025 separately assessed the activities of the SHIF.
The budget of the Ministry of Healthcare in 2025 amounted to 2.55 trillion tenge, of which 2.27 trillion tenge (approximately 90%) was transferred to the SHIF. At the same time, 125.1 billion tenge remained unspent. The SAC noted that this was due to the state's incomplete payment of contributions for preferential categories of citizens because of a lack of funds in the control account of the republican budget's cash holdings.
The state's debt to the SHIF amounted to 212.4 billion tenge at the end of 2024 and 124.5 billion tenge at the end of 2025. Auditors note that the fund compensates for the shortfall using its own assets.
WHAT VIOLATIONS THE AUDITORS FOUND
During the audit for the period 2022–2023, cases of double funding for inpatient medical care were identified. The same services were paid for both under the guaranteed volume of free medical care (GVFMC) and as paid services. The total amount of such funding was 4.2 billion tenge.
Furthermore, auditors found an overstatement of the volume of outpatient care by 28 billion tenge.
Materials showing signs of administrative offences have been forwarded to the relevant authorities to initiate administrative proceedings.
The SAC also stated that 1.3 billion tenge, allocated for equipping medical organisations, was transferred by the SHIF to pay for GVFMC services. According to the auditors' assessment, this constitutes misuse of funds allocated for the implementation of the national project.
HOW SHIF FUNDING HAS CHANGED
From 2020 to 2025, approximately 18.8 trillion tenge was received into SHIF accounts. Of this, 8.7 trillion tenge came from the republican budget, and another 10.1 trillion tenge came from non-budgetary sources.
In 2025, the fund's receipts amounted to 1.85 trillion tenge, which is 110.8 billion tenge more compared to the previous year. The main sources of non-budgetary income were employer contributions, contributions from system participants, and state contributions.
WHY MILLIONS OF CITIZENS REMAIN OUTSIDE THE SYSTEM
Despite the increase in funding volume, the planned targets for population coverage by the CSHI system have not been met for several consecutive years.
According to the SAC, the coverage rate was:
- 2021 — 82.61% against a plan of 86%;
- 2022 — 82.4% against a plan of 87%;
- 2023 — 87.4% against a plan of 88%;
- 2024 — 87.8% against a plan of 89%.
As a result, as noted in the report, more than 3 million people remain outside the compulsory social health insurance system.
CONTEXT AND SIGNIFICANCE
The SHIF is one of the largest non-budgetary funds in Kazakhstan. In 2025, it accounted for 1.5 trillion tenge, or 51.3% of all receipts of the four non-budgetary funds included in the report on the implementation of the consolidated and republican budgets.
It is also noted that no state body has complete information on the number of non-budgetary funds in the country.
