카자흐스탄 의무의료보험제도 도입 과정 연구

The Introduction of Compulsory Medical Insurance in Kazakhstan: Applying Kingdon’s Multiple Streams Framework

In November 2015, Kazakhstan introduced the “Compulsory Social Health Insurance System (the System) in the social insurance format,” first among the Central Asian countries, including Russia. By introducing the system, the country shifted from the previous government-led medical insurance system that had originated from the era of the former Soviet Union to that in the “social insurance format.” Under the new system, every citizen pays health insurance premiums and bears the collective responsibility for public health. The process of introducing the System was quite abrupt, which was possible because Kazakhstan is an authoritative nation where the president of the country exerts enormous power. In this regard, this study alters and modifies Kingdon's multiple streams framework model, which is useful for analyzing such an abrupt process of policy change by period, and applies the revised version as the analysis framework. The analysis period was classified into three periods based on the national mood, the presence and direction of policies, etc. In addition, the intensity of the three streams(problems, politics and policies), and the extent of the policy entrepreneur’s role were set as the specific components of the analytical framework. As a result of the analysis, the policy change succeeds in the third period(Jan. 2014-Jan.2020). The results confirmed that when the aforementioned model is applied, policy entrepreneurs played the most important role in the policy change process in Kazakhstan for the introduction of the compulsory social health insurance system. Nazarbayev, a policy entrepreneur, first recognized the necessity of improving the public health budget indicators, which had been deteriorating since 2010, from the perspective of the flow of policy problems. Based on his realization, Nazarbayev tried to strengthen the country's financial soundness by resolving the identified policy problems and further, he intended to achieve the advancement and modernization of the country. Aggressive and enthusiastic efforts and firm and decisive willingness of the policy entrepreneur finally led to the successful policy change. Consequently, the System was established and implemented nationwide in Kazakhstan from January 2020, starting with partial implementation in July 2017.