Health systems in transition : Uzbekistan

7.5.2 Technical efficiency
Technical efficiency means making the best use of available resources (Duran 
et al., 2012). Two initiatives implemented after independence are likely to have 
resulted in increased technical efficiency of inpatient care in the public sector: 
the introduction of formal user charges and the development and implementation 
of new treatment protocols. User charges have led to a significant decline of 
demand, although this might also be due to inability to pay. New protocols 
have reduced the number of hospital days for inpatient stays. At the same time, 
shifting secondary and tertiary care providers in the public sector towards 
self-financing is bound to have reduced technical efficiency, as higher bed 
occupancy rates lead to higher revenues for providers. How technical efficiency 
has evolved in primary care remains unclear, due to new financing mechanisms 
based on capitation (which might have improved efficiency) and complex 
interrelationships between primary care settings and district treasury offices 
(Expert-Fikri, 2011). Profit-making entities are likely to have higher technical 
efficiency than non-profit-making providers (Jha et al., 2009). 
Hospitals in most former Soviet countries are now paid on the basis of global 
budgets or cases treated (Fuenzalida-Puelma et al., 2010). In Uzbekistan, there 
are ongoing pilots to test new hospital financing mechanisms, including those 
based on diagnosis-related groups (DRGs). 

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Uzbekistan
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Recent government efforts to streamline health facilities at the district level 
should help to improve technical efficiency. There are multiple secondary 
care facilities at the regional level that provide the same type of services (see 
Chapter 5). Additional efforts to optimize providers and care pathways at the 
regional and national level could yield further efficiency gains.