they also raise the question of whether access is commensurate with need data on discharge diagnoses based on icd codes as well as surgical diagnoses based on icd codes suggest that most hospitals remain focused on delivering core services of limited complexity a significant proportion of which would be more likely be provided in lower level facilities in oecd countries obstetric services also largely dominate the picture of hospital activity in kazakhstan most of these services should indeed be hospital based but their prominence suggests that the activity in kazakh hospitals is neither very complex nor very diverse