Financing of medical care providers within CSHI (compulsory social health insurance) and GVFMC (guaranteed volume of free medical care) is carried out retrospectively (payment for each service), that is, payment at the time or after the provision of medical services. In parallel with the insufficient allocation of funds to the health care of the Republic of Kazakhstan, the use of the "payment for each service" model has caused a number of problems: reduced interest of medical organizations in carrying out appropriate preventive measures, rational use of resources, and lack of motivation for effective work of medical workers. To solve similar problems in the 1990s, an idea to introduce incentive payments for health care providers was proposed. “Pay-for performance” model uses the idea of incentive payments, but it is not used in the healthcare system of the Republic of Kazakhstan.

The "pay-for-performance" or "value-based-purchasing" model of healthcare financing is a relatively new system for paying doctors or financing medical organizations based on their performance. The main idea is the presence of direct or indirect incentives, and they are achieved by funding based on the results of evaluating the effectiveness and quality of medical activities. The theory behind the "pay-for-performance" model is exclusively economic - high-quality medical services should be provided using minimal costs. And from the facts, the main problems of the model arise: a weak evidence base of effectiveness in improving the delivery of medical care or improving health indicators, and ignoring important aspects of medicine, such as patient confidence in doctors and the "doctor-patient"attitude. Despite this, a number of countries are implementing programs based on the model and taking full advantage of it.

The advantages of the model include the flexibility of the system, since it is based not on the health indicators of the population, but on more specific variables (the number of blood pressure measurements, consultation on a healthy lifestyle, etc.). Flexibility consists in the ability to implement the system in less effective areas of health care. In addition, the collection of specific data (in some cases) has led to rapid adoption of it, implementation of quality improvement tools, accountability and management. The "pay-for-performance" model helps to improve the production system: it helps to define the main goals, improve the system of purchasing services, and measure productivity.

The results of using this model differ from country to country. Let's look at them on the example of primary health care (PHC) and general practitioners.

1. Australia. PHC in Australia is provided by private general practitioners. Due to the lack of elaboration of the remuneration system, PHC provided little prevention of chronic diseases. Behind the subsequent reform was the idea of incentive payments (GPs who did not receive remuneration from the “pay for every service” system), aimed at reducing short doctor visits and ensuring quality consultations. Further, the results of the program were checked by the number of services rendered. As a result of the reform, the results did not show significant improvements, possibly due to poor design of the data collection system. But this is because of correct program planning and analysis of results.

2. France. France's health service problems were its fragmentation (non-coordinated work of service providers), inconsistent delivery of medical care, and weak preventive measures. Incentives were measured by a point system and included 29 variables in four areas: preventive measures, treatment of chronic diseases, cost-effective prescribing, and organization of practice. According to the results of independent research, positive results of the reforms were revealed: improving the work of general practitioners aimed at preventing diabetes, diseases associated with high cholesterol and heart disease in people over 65 years of age. However, these results cannot be generalized to other areas of medicine.

Thus, "pay-for-performance" as a tool for determining the structural elements of a medical organization's function and collecting data is worthy of attention. After all, the model creates awareness of the importance of a proper strategy for purchasing medical services, and its relationship to the goals of the medical organization in particular and the health of the country as a whole. Is it worth implementing this model in the healthcare system of the Republic of Kazakhstan? The question remains open, as this requires careful analysis and control of each process. But it is impossible to ignore the advantages and results of the experience of foreign countries, so it is recommended to consider this model to solve problems in the health system.