Mandatory Health Insurance as an Unfair Monopoly: The Case for Voluntary Insurance and Competition Among Clinics

I have many friends, acquaintances and relatives who are doctors, and looking at how they live, you realize that we are certainly doing something wrong in our healthcare system. Of course, one advantage is that healthcare in Kazakhstan is very accessible, whereas in developed countries it is anything but cheap. It is hard for me to judge whose system is better, but ours clearly has many shortcomings.

Formally, we have no free healthcare, because a mandatory health insurance system was created (something between insurance and free medicine), which covers our costs, and which employers in turn pay as a share of the payroll.

This is precisely where the key problem lies: we have a monopoly on insurance, and everyone perceives this payment as a tax, since it is compulsory. And that is the main flaw of the system: it is highly unfair in terms of contributions, and it has no alternative. Let me try to explain the problem.

First, the more you earn, the more you pay, yet people with high incomes prefer to go to private clinics or use voluntary health insurance, and many do not even know what they are entitled to under the Social Health Insurance Fund (SHIF) coverage.

Second, all those who receive their wages in envelopes, declaring only the minimum wage, are in effect receiving medical services at the expense of those who pay taxes without hiding their real incomes. In my opinion, that is unfair.

Third, the absence of competition deprives the SHIF of any incentive to optimize its spending and to work on reducing the contributions collected from the population.

Fourth, all hospitals depend on the Fund, which creates a bottleneck and subjectivism, and this stifles hospitals' development and deprives them of the chance to grow.

Of course, the state should ensure a guaranteed volume of medical care for the population, but I think the current system needs to be reformed and more freedom given to voluntary health insurance (VHI). For example, employers could be given a choice: to provide coverage through VHI or to make payments through MHI. Those covered by VHI would not fall under the SHIF system, but their costs would be covered by insurance companies. This would create greater competition among insurers and revive the market, and, most importantly, hospitals would begin to earn revenue without a bottleneck, receiving payments from insurers. This would give an impetus to the development of medicine in the country, and top doctors would be able to earn decent money.

A top surgeon in the United States will most likely be a dollar millionaire, while here a top surgeon will be in debt to a bank for household appliances or a car.

I am not a great specialist in this field, but I know for certain that the work of doctors in our country is the most undervalued.