Improving Access to MRIs in Northern Kazakhstan

Access to quality healthcare remains a critical challenge facing communities in northern Kazakhstan. In the city of Petropavl, a dearth of qualified personnel combined with frequent downtime of medical equipment in the local state-run hospital means patients in critical need of services face long wait times, and often go without.

Petropavl is home to four magnetic resonance imaging (MRI) machines, serving a population of over 200,000 people. Just one of these devices is housed in the local public hospital; the remaining three belong to private clinics, which also receive state funds. More than 57 million KZT (133,000 USD) is spent annually on their maintenance. Patient access to the machines, however, remains limited.

“My neurologist ordered me an MRI at the regional hospital. But the queue for a scan stretched several months. I couldn’t get an appointment until late May, by which point my referral was no longer valid. How can that be?” lamented one patient. “I could go to a clinic, but do I have to then pay out-of-pocket for the scan? This should be included under national health coverage, but it’s not.” With an Innovative Solutions Grant under USAID’s Social Innovation in Central Asia Program, local civic organizations Tugan Zher and the First Anti-Corruption Media Center decided to investigate. The project team sent undercover patients to local medical facilities in search of care.

One patient attempted to make an appointment for an abdominal scan at the local hospital. The scan would be covered under national health guidelines. The patient requested an appointment in April 2021, to no avail. According to hospital staff, the wait list for the month of May was closed, and the hospital was not yet scheduling patients for June. The patient’s only alternative was to seek a scan at a local clinic, where he would be required to pay out-of-pocket. This experience was common throughout the city.

“Our study revealed hospital MRI queues numbering almost 800 patients each month. If a person was given a referral for an MRI scan, it would take more than three months to see a hospital specialist using national health coverage,” says Ruslan Asaubayev, First Anti-Corruption Media Center head. “But most revealing was that if a patient agreed to a scan on a paid basis at a private clinic, that timeline would shrink to a matter of days.”

Under Kazakhstani law, private clinics that receive state funding must accept national health coverage. For a single MRI scan, clinics earn just under 10,000 KZT (23 USD) within the national health plan. However, by denying patients coverage, and instead accepting only private payment, clinics can reap an average 18,000 KZT (42 USD) per scan.

The study revealed that private clinics were regularly denying service under national health mandates and instead only accepting cash payments. With the regional hospital overburdened and private clinics capitalizing on bloated wait times, regional health outcomes suffered. “This is a direct violation of patient rights,” says Asaubayev. “The patient contributes to the national health fund and has every right to receive services on time and free of charge, whether at the regional hospital or at private clinics. These MRI machines cost taxpayers millions each year and must be accessible to all.”

In response, Tugan Zher and the First Anti-Corruption Media Center convened local healthcare stakeholders, including representatives from national and municipal health ministries, the national medical insurance fund and the medical community. Together, the committee drew up a new protocol, which encourages physicians to refer patients to private clinics to reduce wait times and requires private clinics to accept national health coverage.

The project team also engaged local journalists to draw attention to this issue, and to encourage patients to exercise their right to health coverage at private clinics. As a result of their efforts, wait times for MRIs in Petropavl have fallen from 90 days to only 12 days. Patients can now access critical care efficiently and economically, thereby improving health outcomes and public trust in the medical system across the region. “The queue is already dissolving,” says local resident Lyuba Panko, who received an MRI in June, just days after requesting an appointment. A month prior, she had been told to wait till September. “This is an immense relief for patients and for the regional hospital.”