KAZAKHSTAN
Accessibility
Affordability
Access to treatment • Access to care has been reported as an issue. However, it is not clear whether this is due to a lack of healthcare professionals or the requirement that prescriptions be renewed monthly.6,7 o Task shifting for type 2 diabetes care was adopted in 2012 and diabetes training programmes for GPs are being implemented.6 • Some inequalities remain between regions in terms of the number of endocrinologists and pharmacies.3 Stock and shortages • Supply has improved but occasional shortages persist due to delays in distribution or insufficient supplies.3,6
Looking ahead Multiple reforms are underway regarding the benefit package for diabetes medicines and medication and their supply. 3,6,8,10
• Most people living with diabetes in Kazakhstan pay an out-of-pocket contribution to the cost of their treatment to complete the state’s care package (additional consumables, the oral medications that are not covered). • An estimate for annual out-of-pocket diabetes expenditure could not be obtained. However, the 2012 study mentioned above puts average annual out-of-pocket expenditure for diabetes medicines and medical devices at KZT 26,515 (USD 176).9 • The available information suggests that the price of medicines is high, including those paid at procurement.4,11 Furthermore, prices are not regulated.4 There is no promotion of non-branded products. As a result, the more expensive branded products are most often prescribed.6,4,11
Financial coverage Diabetes is considered a socially significant disease; people with the disease are entitled to free healthcare and outpatient medications.3,4 Insulin and medical devices for people on insulin are funded by the central government; oral medications are funded through regional budgets. Thus the coverage for oral medicines may vary between regions.1,7 A new reimbursement model began implementation in 2012 aimed at increasing the list of oral medications and the share of their costs covered by public budgets.8 Insulin
Free1,5,6,7,9
Anti-diabetes medication
Free/partially covered/not covered at all – depending on the medication5,6
Medication for hypoglycaemia
Only people on insulin receive these for free Otherwise, not covered – 100% paid for by the person with diabetes 6
Pens and related supplies
Free1,5,6,7 – with a limit of one new pen every 50-75 cartridges and 100 needles per year9
Syringes and related supplies
Free1,5,6,7,9
Pumps and related supplies
Only children under 15 receive these free Otherwise, not covered- 100% paid for by the person with diabetes 6
Blood glucose test strips and meters
Only people on insulin receive these for free – with a limit of 300 test strips per year Otherwise, not covered – 100% paid for by the person with diabetes 1,6,7,9
Ketone test strips
Only people on insulin receive these for free Otherwise, not covered – 100% paid for by the person with diabetes 5,6
Please note that the information provided above only present a summary of the reimbursement system and may not apply to individual cases.
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References 1 EURADIA, FEND, IDF, & PCDE. (2011) 2 Global health observatory data repository. (2013). 3 Katsaga, A. et al. (2012) 4 HAI Global. (2005a) 5 IDF-Europe Access survey (2013) 6 Diabetes Association of the Republic of Kazakhstan (personal communication) (2013) 7 Andriciuc, C. (2007a) 8 Skonieczna, A. (2013). 9 Kissimova-Skarbek, K. (2012) 10 Procurement of medicines. (2013). 11 International expert (personal communication) (2013)