Toward a More Pro-Poor and Explicit Health Benefit Package in the Kyrgyz Republic : A Critical Review of the Stated Guaranteed Benefit Package and Options for Its Revision
The Kyrgyz Republic has made significantsteps in reforming the health system through successiveNational Health Programs implemented over the last 20 years.One of the major achievements of such reforms were theestablishment of a single-payer national health insuranceand a basic benefit package. The State Guaranteed BenefitPackage (SGBP) provides free basic health services at theprimary care level for the whole population, and inpatientcare with nominal co-payments or no fee for certain groups.Even though the principles of the SGBP contain elements ofinternational good practice, the SGBP has hardly changedsince it was stablished. At the same time, many changes havetaken place within and outside the health system, exertingmounting pressure for the SGBP to adapt to the new diseaseburden and meet population’s expectations within the contextof budget constraints. The current paper provides a criticalassessment of the Kyrgyz Republic’s basic health benefitpackage. It reveals several issues in the actual benefitsdelivered to the population as opposed to the generouspromise of the statutory package. Some important limitationsinclude lack of clarity, persistent funding gap, largenumber of fee exemption categories given the resourceconstraints and at the same time lack of an effectivemechanism to protect the poor. Most importantly, there is nosystematic arrangement in place to ensure a regularevidence-based process of the benefit package revision. Thepaper proposes several measures that could guide the processof SGBP revision, considering the Kyrgyz context andbuilding on international experiences. It is expected thatinformation from the paper will be useful not only for theKyrgyz stakeholders but also other countries in making thebenefit package an effective instrument for achievinguniversal health coverage.
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