Health systems in transition : Uzbekistan

party pooling schemes, most of the revenue in tertiary care facilities comes 
from direct payments, thus passing the entire costs to those who are ill. The 
burden is especially high for poor groups of the population who are not included 
in the benefits package. Requests for informal payments further disadvantage 
the poor; even when they receive care, the quality of the care received may be 
lower if they cannot afford to pay the requested informal payments. 
7.2.2 Equity in financing
A tax-based public system is at the core of the current health system in 
Uzbekistan. The private sector only accounts for a small share of delivered 
health services. This overall tax-based framework contributes to improved 
equity in financing, whereby those with higher incomes pay more, irrespective 
of the actual use of services. 
However, two important elements of the current system should be noted. In 
Uzbekistan, as in many other post-Soviet countries, the informal sector makes 
up a significant share of the economy (Bendini, 2013; World Bank, 2013). This 
means that not all income is taxed and, thus, not all individuals contribute to 
the system in proportion to their income. 

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The other element relates to the limited scope of the benefits package and the 
importance of private out-of-pocket payments. The benefits package is mostly 
limited to primary care, ambulance and emergency services, paediatric services 
and services for a selected group of conditions (see Chapter 3). Other services 
in the public sector, particularly at the levels of secondary and tertiary care, 
are increasingly being shifted towards official fee-for-service arrangements. 
Although specialized facilities provide services free of charge for specified 
groups of population (see Chapter 3), these free services only make up a 
small proportion of the total care provided. This set-up results in inequities in 
financing the services outside the benefits package. Furthermore, the common 
practice of informal payments further contributes to regressive vertical equity 
in financing, as does the fee-for-service based private industry.