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Kyrgyzstan
Health Care System
Kyrgyzstan inherited the Soviet system of free universal health
care, which in Kyrgyzstan's case generally provided sufficient
numbers of doctors, nurses, and doctor's assistants, as well as
medical clinics and hospitals. However, since 1991 citizens often
have received inadequate care because medical personnel are not
well trained; pharmaceuticals, medical supplies, and equipment
are insufficient; and facilities are generally inadequate and
unsanitary.
In 1991 Kyrgyzstan had 15,354 doctors, or 34.2 per 10,000 people.
Paramedical workers totaled 42,448, or 94.6 per 10,000 people.
Some 588 outpatient clinics were in operation, averaging 139 hours
of patient visits per eight-hour shift. In addition, 246 general
and twenty specialized hospitals were in operation; nearly one-third
of all hospitals were located in Osh Province (which also had
about one-third of the country's total population). By contrast,
the capital city, Bishkek, had the fewest hospital facilities
per capita of all regions, providing 1.55 general hospitals per
100,000 population. Like other Central Asian countries, Kyrgyzstan
has continued the Soviet practice of state enterprises having
their own clinics and sanatoriums. With the dissolution of the
Soviet Union, Kyrgyzstan's residents lost the right to free treatment
in the hospitals of other former republics, making unavailable
many types of specialized treatment that the Soviet system had
apportioned among adjacent republics.
Very few truly private health facilities have developed in the
early post-Soviet period, and those that exist face very high
licensing fees. Although it is illegal for state employees in
the health field to diversify their activity into private practice,
by 1993 many health workers were accepting unreported payments
for providing additional treatment. In 1992 the maximum salary
of a medical specialist such as a surgeon was only about 18 percent
higher than the maximum salary of a technician or laboratory worker.
Under such conditions, the rising cost of living in 1992 and 1993
forced many doctors to leave medicine for higher salaries in other
professions.
Kyrgyzstan produces no vaccines of its own and almost no medicines
or other pharmaceuticals. Drug availability is substantially higher
at regional facilities than at smaller ones, but items such as
antihistamines, insulin, antiseptics, vaccines, and some narcotics
are either extremely scarce or extremely expensive. The other
former Soviet republics now demand payment in United States dollars,
which Kyrgyzstan does not have, for medical supplies. Because
of the scarcity of vaccines, there is a greatly increased likelihood
of epidemics of diseases such as diphtheria and measles. An outbreak
of measles in Bishkek in early 1993 was said to be just below
epidemic level. It has become common practice in hospitals and
clinics to require patients to provide their own medicines for
operations and other medical procedures. Because virtually the
only available medicines are those for sale in the public bazaars,
quality is questionable, and accidental poisonings caused by misuse
and spoilage have been reported.
Kyrgyzstan's post-Soviet financial crisis has reduced government
support of the Soviet-era health system, forcing government planners
to formulate an ambitious health care delivery reform program.
The center of the program is a transformation of the national
health system into a system of public health insurance, in which
compulsory employer fees and a health insurance tax on employees
would support care for employees, and state contributions would
support care for unemployed citizens. All employed citizens would
be required to carry health insurance. All care providers would
switch from the salary basis of the old system to a fee-for-service
payment system. Because the banking, record-keeping, and tax systems
of the country are not ready to support such a nationwide program,
however, installation has lagged far behind the original timetable,
which called for a pilot program in Bishkek in 1993.
Data as of March 1996
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