Health systems in transition : Uzbekistan

7. 3 User experience and equity of access to 
health services
7.3.1 User experience
In many respects, health services do not differ from many other services 
provided in the market. In the marketplace, goods and services need to cater to 
three key domains in order to succeed: they should do what they are supposed 
to do well; they should be safe and reliable; and they should deliver good 
user experiences (Bate & Robert, 2006). In Uzbekistan, health care delivery 
frameworks mainly focus on the first two elements and often neglect attempts 
to improve user experience. There are checks and balances in place that take 
account of user perspectives (that is, frameworks for filing complaints), but 
they are often retrospective in nature and focus on individual cases, not on 
improvements to the overall system. 
Clearly, effectiveness and safety are paramount concerns in health care. 
However, there is also a strong business case for improving user experience. 
One important economic aspect is related to opportunity costs. Many health 
care providers in the public sector lack frameworks for appointment scheduling. 
This leads to long waiting times and multiple return visits. Many providers also 
do not have frameworks for evaluating and improving work processes, resulting 
in poor user experiences and efficiency losses due to poor workflow designs. 
Although there are one-off provider-led initiatives to improve user 
experience, system-wide efforts are still lacking. Reliable system-wide data on 
user experiences are also non-existent. However, findings from other former 

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Health systems in transition
  
Uzbekistan
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Soviet countries suggest low patient satisfaction rates. In a survey conducted 
in 2010 in nine post-Soviet countries, about 40% of patients on average were 
satisfied with the respective health system (Footman et al., 2013). 
One possible explanation for the low priority placed on user experience in 
the Uzbek health system lies in the fact that business models and ideas of new 
public management are rarely applied in the health sector. Health services are 
run primarily by physicians and health management training in the country 
does not have a strong business component. 
The situation is slightly different in the private sector, where the experience 
of users has received more attention. However, in the last few years, the 
government has taken measures to restrict the private sector’s scope of 
activities. For instance, inpatient surgical procedures need to be primarily 
performed in the public sector. Performing them in the private sector requires 
special permits, which are rarely, if ever, granted. As a result, some public 
facilities have become de facto monopoly providers in tertiary care services. 
This situation does not provide incentives to be responsive to patient needs and 
improve patient experiences.