The Kazakh government has restructured the management of the Social Medical Insurance Fund (SMIF), transferring oversight of its operations to the Ministry of Finance. The decision was formalized by Prime Minister Olzhas Bektenov following a comprehensive audit of the fund’s financial activities conducted over the past month.
The SMIF serves as the principal operator of Kazakhstan’s Compulsory Social Medical Insurance (CSMI) system. It collects contributions from employees, employers, and the state, then allocates these funds to medical institutions based on the volume of services rendered.
However, the fund’s operations have faced sustained public and parliamentary criticism. In January 2025, members of parliament declared that the SMIF had lost the public’s trust and called for tighter oversight of its expenditures.
Delayed Audit and Financial Irregularities
Despite growing concerns, a large-scale audit had long been postponed. It was not until December 2025 that the Prime Minister tasked the Ministry of Finance with analyzing the fund’s financial flows.
Finance Minister Madi Takiev presented the audit’s findings last week. According to the government press service, the results raised serious concerns about the overall effectiveness of the country’s healthcare financing model.
Despite a steady rise in expenditures, the Ministry of Finance found that SMIF’s efficiency had not improved. Since 2020, the fund’s investment income totaled $1.1 billion, including $383 million in 2025 alone. A significant portion of these funds, however, was not allocated toward medical services, and instead accumulated in the fund’s reserves.
Overbilling and Digital System Failures
An IT audit of the healthcare information system revealed extensive violations in service reporting. These included billing for fictitious patients, services provided without medical necessity, and instances of double financing. Numerous cases documented implausibly high volumes of procedures performed within short timeframes.
Several high-profile anomalies stood out. In some reports, medical services were recorded for individuals who were deceased at the time. In another case, minors were allegedly prescribed more than a thousand medications in a single day.
Tax authorities also conducted a desk audit of the directors of medical institutions, comparing declared incomes with actual property holdings.
Transition to Centralized Oversight
In response to the audit, Bektenov ordered that all materials be forwarded to law enforcement agencies for further investigation.
This marks the effective dismantling of SMIF’s former autonomous governance model in favor of centralized control by the Ministry of Finance.
The move comes amid rising fiscal pressure on the healthcare system. In 2026, the government will continue to fund medical insurance premiums for socially vulnerable groups. As previously reported by The Times of Central Asia, the state will finance insurance coverage for over one million unemployed citizens.
