Uzbekistan

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7.4%CHE/GDP

65.3%OOP/CHE

7.1%GGHE-D/GGE

80BGDP (USD)

34.9MPopulation

During the Soviet era, health services in Uzbekistan were publicly funded, and universal access to care was declared for all people, regardless of their social status and income. Since Uzbekistan’s transition to a market economy, the health system has steadily experienced underfunding. This has undermined health service infrastructure and increased out-of-pocket (OOP) payments. From 2000 through 2020, current health expenditure (CHE) in Uzbekistan averaged 5 % of GDP, which is lower than in most other countries of the Commonwealth of Independent States (CIS) ^[1]. Although government spending on health (domestic general government health expenditure) continuously grew from 2000 through 2020, its share of CHE has been below 50% in 2000-2020, except one year in 2014 when it reached 52% ^[1]. Conversely, OOP payments exceeded 50%of health spending in most years since 2000, reaching 53% in 2020 ^[1]. This trend highlighted the need for financial protection and access to services^[2].

Uzbekistan experienced a dynamic economic growth after its 2016 presidential elections. And reforms in social sectors complemented the growth, improving health financing, equal access to health care, financial security, and fair distribution of resources ^[3]. The 2018 Presidential Decree No. 5590 approved the Concept of Health System Development in the Republic of Uzbekistan for 2019–2025 that determined mandatory health insurance (‎MHI)‎ as the approach to advance universal health coverage in Uzbekistan^[4]. The World Health Organization performed a feasibility study in which several scenarios for revenue streams were assessed^[5].

Benefits of a phased approach: early lessons and expectations

Introduction of MHI was planned in three phases, beginning in 2021, and incorporates an expanded package of benefits: Phase I, a pilot, was conducted in Syrdarya region (2021–2022); Phase II is the expansion of MHI to 50% of the country in 2023–2024); Phase III is planned for national implementation in 2025.

The MHI reform is supported with strategies enabling a more efficient and patient-centered health system than in the preceding period. The reform has attracted investments to strengthen primary health care and service coverage. One of the strategies is a gradual adoption of telemedicine and eHealth through electronic polyclinics. Another part of the reform is the outpatient medicine reimbursement programme, which allows patients to obtain free-of-charge medicines from private pharmacies through an electronic prescription a family doctor writes.

References

[1] Global Health Expenditure Database. Geneva: World Health Organization. Accessed 11 February 2022.

[2] European Observatory on Health Systems and Policies, WHO Europe (2021). “Health systems in action: Uzbekistan”. Accessed 23 January 2022.

[3] P4H Network (2022). “Country Briefs: Social Health Protection and Health Financing Reforms”. Briefing Note for Uzbekistan prepared by the International Labour Organization. Accessed 23 January 20

[4] Presidential Decree No. 5590 on Comprehensive Measures for Improvement of the Healthcare System of the Republic of Uzbekistan (2018). Accessed 7 April 2022..

[5] P4H Network (2021). Feasibility study is published about the introduction of mandatory health insurance in Uzbekistan. Accessed January 23, 2022.

[6] P4H Network (2022). Information systems will simplify the work of the Health Insurance Fund. Accessed January 24, 2022.