Factors influencing the competitiveness of healthcare organizations in the Republic of Kazakhstan: evidence from the Karaganda region

INTRODUCTION

The development of compulsory social health insurance, digital health tools and private provision has changed the competitive environment of Kazakhstan’s healthcare system. At the regional level, competitiveness affects not only the financial position of providers but also accessibility, quality, workforce stability, innovation and patient trust. The Karaganda Region is a suitable empirical setting because it combines large urban hospitals, primary healthcare organizations, geographically dispersed populations and an expanding private sector. The aim was to identify and systematize the factors influencing the competitiveness of public and private healthcare organizations in the Karaganda Region. The study focused on organizational capabilities and patient-reported barriers that can be influenced through strategic management.

MATERIALS AND METHODS

A cross-sectional mixed analytical study was conducted during 2024–2026 in Karaganda, Temirtau and Balkhash. The organizational sample comprised 16 healthcare providers: seven multidisciplinary hospitals, six primary healthcare organizations and three private clinics. The institutional component included 45 managers and healthcare organizers. The consumer component included 384 patients. The patient sample consisted of 296 women (77.1%) and 88 men (22.9%). The age distribution was: under 18 years, 9 respondents (2.3%); 19–40 years, 249 (64.8%); 41–60 years, 95 (24.7%); and over 60 years, 31 (8.1%). The imbalance in sex and age composition was considered when interpreting the findings. Ninety-six respondents (25.0%) reported employment in the public sector, while 288 (75.0%) belonged to other social categories.

Data sources included organizational statistical, managerial and financial information, patient questionnaires and expert assessments. System, comparative, institutional, statistical and economic analyses were combined with survey methods, expert evaluation, benchmarking, SWOT and PEST analysis, and elements of multicriteria assessment. Indicators were organized into six domains and normalized on a 0–1 scale for comparative interpretation. Descriptive statistics were calculated as absolute values and percentages. The design was diagnostic and did not infer causality from cross-sectional associations.

RESULTS

Regional configuration of competition

Public organizations retained the central role in emergency care, childbirth, specialized inpatient services and broad population coverage. Their competitive strengths were the breadth of services, established infrastructure, multidisciplinary teams and the ability to treat complex cases. At the same time, rigid administrative processes, workforce shortages in selected specialties, waiting times and uneven digital maturity constrained responsiveness. Private providers strengthened the regional competitive environment through outpatient consultations, diagnostics, laboratory services, CT/MRI, rehabilitation and service differentiation. Their relative advantages included shorter decision chains, flexible scheduling, customer-oriented communication and faster adaptation of the service portfolio. Their limitations included narrower clinical scope, selective geographic concentration and dependence on patients’ ability to pay or on purchasing arrangements.

Patient choice, access and financial burden

Among 384 respondents, 264 (68.8%) reported choosing a public healthcare organization and 120 (31.2%) a private organization. This distribution confirms the continuing dominant role of the public sector while also demonstrating a substantial market position for private providers. Choice should not be interpreted as an isolated preference: it reflects service availability, referral routes, insurance coverage, location, price and perceived quality.

A total of 236 respondents (61.5%) reported waiting at least one week to receive a service. This makes waiting-time management a direct competitiveness factor: delays affect continuity, trust, perceived accessibility and the likelihood of seeking an alternative provider. Meanwhile, 344 respondents (89.6%) reported out-of-pocket expenditure. The high share indicates that patient attraction cannot be separated from financial affordability and transparency. Expansion of commercial services without cost justification and patient protection may increase revenue in the short term but weaken equitable access and trust.

Integrated factor profile

The results support a six-domain factor structure. Quality and safety form the non-negotiable foundation of competitiveness. Resource efficiency determines whether infrastructure and equipment translate into timely services. Strategic management aligns the service portfolio with regional needs and financing conditions. Workforce capacity affects service availability and continuity. Digital maturity supports scheduling, information continuity, monitoring and management decisions. Patient orientation converts clinical and organizational capabilities into a comprehensible and trusted patient journey.

The factors have a cumulative character. For example, a digital appointment platform does not reduce waiting times if staff schedules, referral processes and capacity allocation remain unchanged. Similarly, modern equipment does not generate competitive advantage when personnel are unavailable or utilization is poorly managed. Sustainable improvement therefore requires coordinated interventions rather than isolated investments.

DISCUSSION

The evidence reveals different, complementary competitive profiles. Public organizations derive advantage from scale, mandate and clinical breadth; private organizations derive advantage from flexibility, responsiveness and differentiated service. A valid regional strategy should not force both sectors into an identical commercial model. Instead, common minimum criteria—quality, safety, transparency and patient value—should be combined with type-specific benchmarks.

Patient data identify three actionable priorities: access, waiting time and financial burden. These results are consistent with the view that healthcare competitiveness extends beyond profitability. A provider that expands paid services while failing to improve accessibility, communication or clinical processes may achieve commercial growth without building sustainable competitiveness. Conversely, a public provider can strengthen its competitive position through process redesign, patient feedback, digital coordination and more transparent service navigation even when its social mandate limits market selectivity.

The study has limitations. The patient sample was dominated by women and adults aged 19–40, and the broad “other” social-status category limited subgroup analysis. Cross-sectional data do not establish causal relationships. Provider-level integral scores should be validated with comparable clinical and financial measures before public ranking. Nevertheless, triangulation of organizational, expert and patient perspectives provides a useful regional diagnostic picture.

CONCLUSION

Competitiveness of healthcare organizations in the Karaganda Region is determined by the interaction of strategic management, quality and safety, resource efficiency, workforce capacity, digital maturity and patient orientation. Public providers have advantages in scale, infrastructure and coverage; private providers demonstrate flexibility and service responsiveness. Patient-reported waiting and out-of-pocket expenditure show that accessibility and financial protection remain central competitive factors. Regional policy and organizational strategies should use an integrated indicator system, type-specific benchmarking and coordinated improvement of processes, workforce, digital tools and patient experience.

DECLARATIONS

Funding: No external funding. Conflict of interest: The author declares no conflict of interest. Author contribution: The author designed the study, analysed the data and prepared the manuscript. Ethical information: Survey participation was voluntary and results are reported in aggregate form.