Specialists will now be able to refer patients for additional tests and consultations directly, while clinics will be required to publish doctor schedules two months in advance. Tengrinews.kz outlines the other changes introduced by the updated regulations.
Why the order was amended
The order in question, titled "On Approval of the Rules for Providing Specialized Medical Care in Outpatient Settings," defines the consultative and diagnostic services available to Kazakhstanis at the PHC (primary health care) level—essentially, in public clinics.
Originally adopted in 2022, the order was recently amended with changes taking effect on January 1, 2026. Certain provisions of the document have now been further supplemented.
Asel Khasenova, Director of the Department at the Salidat Kairbekova National Scientific Center for Health Development (NSCHD) of the Ministry of Health, explains that after the document came into force, experts realized certain norms required clarification.
"We have now detailed who is responsible for what more precisely to eliminate any grounds for misinterpretation or discrepancies in the future," she commented.
We take a closer look at what is changing starting today and how it will impact both doctors and patients.
Specialists to order additional examinations directly
Asel Khasenova notes that profile specialists—such as cardiologists, urologists, gynecologists, and others—technically already had the authority to refer patients for additional tests and consultations with colleagues in other fields.
However, while this provision existed in previous orders, it was not considered mandatory and was not always implemented in practice.
What will change in practice now?
Suppose a person has heart issues, is registered with a cardiologist, and attends regular appointments.
"What complications does a cardiologist look for? Circulatory system issues can lead to stroke or negatively affect blood vessels and vision. Now, if a doctor sees a patient and determines they need a consultation with an ophthalmologist, neurologist, or angiosurgeon, they can refer the patient directly. The same applies to diagnostic tests, such as ultrasounds or lab work. Previously, patients had to book another appointment with their GP just to get these referrals after seeing the cardiologist. That is no longer necessary."
A specialist can independently issue referrals for lab tests or refer a patient to colleagues, though to no more than three specialists at a time.
This rule is linked to another significant change.
"We are introducing the concept of a 'completed case' and 'outcomes' into practice, which the doctor must record in the medical information systems," Khasenova noted.
Patient "statuses": How they affect treatment
The order states:
"In the event of an incomplete case during the provision of specialized care, the outcome 'continues to be ill' shall be entered into the Medical Information Systems (MIS)."
This applies when a specialist—such as a cardiologist, ophthalmologist, or endocrinologist—decides that a patient requires further treatment, testing, or consultation.
The doctor marks the "continues to be ill" column in the system, which then allows the doctor to personally schedule the patient for a follow-up appointment..
Asel Khasenova explains that this capability was previously unavailable, and patients generally had to return to their general practitioner to get a referral for a follow-up visit with the specialist.
Another innovation: at the end of an appointment, the doctor must indicate a patient's "status" in the MIS. Officially, this is called the "outcome":
- "Healthy" — in the absence of complaints or pathology.
- "Recovery" — upon full cure with no need for further examination or treatment.
- "Improvement" — when there is positive progress in the patient's condition.
- "No change" — when the patient's condition is stable, with no signs of deterioration or improvement.
- "Deterioration" — when there is negative progress in the patient's condition.
- "Death" — in the event of a fatal outcome.
"We need this information for internal statistics — it does not affect patients or the work of doctors in any way. We will be able to analyze it to identify problems and, if necessary, correct them," the expert explains.
All six outcomes, except for "continues to be ill," are considered completed cases.
"Only in the event that a doctor prescribes treatment and marks 'continues to be ill' in the system does he have the opportunity to independently schedule a follow-up appointment," the speaker explains.
Doctor appointment schedules for two months ahead
It is important to note another point here: to make it easier for patients to choose a convenient time, clinics will be required to publish doctor appointment schedules at least 60 calendar days in advance and update them whenever the schedule changes. Previously, doctor appointments were generally available for only 7–10 days ahead.
"A person would come to see a gastroenterologist — the doctor would conduct an examination, prescribe treatment, and a follow-up visit, say, in a month. But the gastroenterologist himself could not immediately book the person because appointments were only open 7–10 days in advance. Therefore, the patient had to go back to the GP. This should now become easier," the expert believes.
Khasenova also draws attention to the fact that the workflow algorithm in medical information systems (MIS) has changed:
"Until recently, a doctor was forced to complete seven steps to enter all patient data into the MIS during an appointment. Now, it is enough for a local doctor to correctly specify the ICD code (the disease code according to the International Classification of Diseases — editor's note), after which the information system will automatically determine the source of funding for the service."
According to the expert, this should ultimately simplify the work of doctors, allowing them to devote more time to patients.
Tests and ultrasounds only according to clinical protocols
Asel Khasenova points out another important addition: the document states that doctors must prescribe consultative and diagnostic services only within the framework of clinical protocols for each disease.
"The order now strengthens the monitoring of compliance with clinical protocols. Previously, a patient could come with a stack of prescriptions from any other doctor (or even from someone who is not actually a medic but takes the liberty of treating and giving prescriptions) and demand to be referred for tests or an ultrasound," the doctor comments.
As the expert explains, the restrictions do not apply to the number of services that can be prescribed to a patient.
"However, a local doctor must issue referrals for ultrasounds, specialist consultations, or tests only by following clinical protocols for each disease. This could be a confirmed diagnosis or a suspected one," Khasenova says.
She provides an example.
Suppose a patient has chronic gastritis. The doctor should prescribe only those examinations defined for the diagnosis of this disease and nothing more.
Or if a person went to a private gastroenterologist who prescribed tests — it doesn't matter: if they are not included in the clinical protocols, the local doctor cannot issue a referral for them.
"The doctor, using their knowledge and an objective examination, makes a diagnosis and then proceeds within its framework. Clinical protocols are publicly available, and anyone can look them up."
Time standards for appointments and services
Furthermore, the order establishes time standards for performing medical services.
One of the appendices to the document specifies how many minutes a specialist should spend on an appointment, an ultrasound procedure, conducting tests, and so on.
"In some clinics, services have been put almost on an assembly line. You haven't even had time to get up from the couch in the ultrasound room before the next person walks in. Everything is done in a hurry — this ultimately affects the quality of diagnosis and treatment. Now, time standards have been defined. For instance, 20 minutes are allocated for one ultrasound procedure. This includes the patient interview, the examination itself, sanitizing the couch, and so on," says Asel Khasenova.
Standards have been set for all services. For example, consultations with a pediatrician, general practitioner, surgeon, obstetrician-gynecologist, pulmonologist, cardiologist, and most other doctors should last 20 minutes.
But there are exceptions:
- psychologist — 30 minutes;
- dental surgeon — 40 minutes.
If necessary, an initial appointment with any of the aforementioned specialists can take up to half an hour.
Almost all types of ultrasounds last 20 minutes. But again, there are exceptions. For example, an obstetric ultrasound in the first trimester is 40 minutes, for multiple pregnancies — 60 minutes, and an eye ultrasound — 30 minutes.
Most of these provisions will take effect on August 3, 2026.
