Hospital Sector Reform in Uzbekistan : A Policy Note
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World Bank, Washington, DC
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Since the mid-1990s, Uzbekistan has
undergone reforms in the health sector focused on
restructuring of primary health care in Uzbekistan as well
as the establishment of an emergency medical care network.
Reform and development initiatives in at secondary and
tertiary care level have been limited to gradual downsizing
of sub-national hospitals, with the exception of the
emergency medical care network, and expansion of Republican
specialized tertiary centers. Recent years have seen
increases in out-of-pocket payments (both official and
informal) for hospital and other health services, which now
present a barrier to accessing health services and
pharmaceuticals for some patients. The Ministry of Health
(MOH) is implementing a program of development of new
standards for diagnostic/curative services at each level of
care that are intended to modernize practice and increase
quality and efficiency. Twenty disease areas have been
covered to date. Standards for equipment requirements at
each level are also being defined. The Ministry now faces
the challenge of developing a strategy to changing clinical
and managerial practice in hospitals to bring them into line
with the new standards. Uzbekistan has a large and
fragmented network of hospitals and specialist clinics,
characterized by multiple vertical programs and many
single-specialty facilities. There is lack of clarity
regarding the specific roles and linkages between the
numerous hospitals and specialized care facilities. The
Government has pursued a policy of increases in official
user fees or "self-financing", alongside
offsetting reductions in budget provision for non-salary
operating costs in Republican hospitals and many Oblast
hospitals in recent years. City and oblast hospitals have
self-financing beds. User fees are projected to amount to an
average of 18 percent of revenue in 2008 for oblast
hospitals (compared to an average of 1.4 percent in 2000).
Republican Specialist Centers (tertiary level hospitals) now
obtain up to around 65 percent of revenue from user fees,
and have a target of 80 percent. By contrast, rayon
hospitals collect little user revenue (projected to be a
little under 1percent in 2008, a level that is approximately
unchanged since 2000). Budget funds for oblast hospital now
cover little more than the costs of staff salaries and
benefits, following budget reductions that offset increases
in user fees.
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