Health systems in transition : Uzbekistan

party payer reimbursement system for inpatient care, and as they have only 
limited pharmaceutical coverage, perverse incentives are in place for the use 
of formally free emergency services in lieu of hospital-based specialty services. 
These incentives lead to a redirection of patients from other levels of care to the 
emergency services. This not only results in efficiency losses but is also likely 
to limit access for those in real need of emergency care.

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Health systems in transition
  
Uzbekistan
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Furthermore, nominally free services in both primary and emergency care 
might often require informal payments, which are likely to diminish the extent 
of financial protection envisaged by reform initiatives. The practice of informal 
payments is reported to be more common in hospital than in primary care 
(World Bank, 2009). 
Over the last decade, efforts to strengthen financial protection were 
primarily directed at improving the infrastructure of facilities that provide the 
care included in the basic benefits package. These efforts involved investments 
in primary care facilities nationwide, in ambulance and emergency care, 
and in paediatric facilities at the regional and national level (see Chapter 6). 
Infrastructure investments mostly consisted of construction works and the 
procurement of medical equipment. They were expected to increase financial 
protection through improving the quality of services. However, reliable data on 
the impact of these investments on financial protection are lacking. 
Funding mechanisms for specialized care reflect government efforts to shift 
costs to non-budgetary sources. State coverage for secondary and tertiary care 
has been limited to predefined population groups and conditions, which are not 
necessarily linked to the poverty status of individuals. In the absence of third-