Date of Award


Degree Type

Open Access Dissertation

Degree Name

Political Science, PhD


School of Politics and Economics

Advisor/Supervisor/Committee Chair

Benoy Jacob

Dissertation or Thesis Committee Member

Arthur Denzau

Dissertation or Thesis Committee Member

Branco Ponomariov

Terms of Use & License Information

Terms of Use for work posted in Scholarship@Claremont.

Rights Information

© 2011 Dariga Chukmaitova


case study, health care, Kazakhstan, public vs private sector, sector-switching, transition economies

Subject Categories

Health and Medical Administration | Health Policy | Public Policy


The dissertation examines the economic and behavioral factors influencing 'sector-switching' in Kazakhstan's health care industry. Sector-switching involves doctors moving from the national to the private system, which is not well established, thereby raising questions about why the switch occurs. It addresses the question: why health care professionals in Kazakhstan switch from the public sector to similar jobs in the private or nonprofit sectors? This study addresses a key issue in public management (sector switching) and also offers insights into the dynamics of the transition from a centralized economy to a market economy. As such, its findings have `real-world' applications beyond the particular case being studied i.e. Kazakhstan. This study is based on two simple claims. First, fundamental to the reforms that characterize transitional economies is effectively moving public sector employees to a nascent private sector. Second, such switches are unique because the risks related to transitioning to the private sector are different in transitional economies than in established market economies. Thus, the study considers: the degree to which economic and behavioral factors interact with different perceptions of sectoral risk, and subsequently shape the decision to move from the public sector to the private sector; in particular in Kazakhstan's health industry. The data supporting this study come from a survey covering approximately 1,000 health care professionals (practicing physicians working in both the public and private health care sectors) from nine regions of Kazakhstan. The data includes information about individual incentives physicians have for switching sections and their perceptions of perceived risks and uncertainties given the economic transition currently underway in Kazakhstan. The findings of the research suggest the strong support for the proposed hypotheses and have revealed some of the dynamics of sector switching behavior and the characteristics of "sector switchers" in Kazakhstan. The results demonstrate that physicians' overall job dissatisfaction, relative salary compared to physicians in a different sector, their risk-taking behavior, the national health care system's deterioration compared to previous years, as well as problems with providing medical services in the country affect physicians in making their decision to change their employment sector.