Health systems in transition : Uzbekistan

3.4 Informal payments
Although there is only limited hard evidence, anecdotally informal payments 
were already a feature of health care during the Soviet era. With the break-up 
of the Soviet Union, they have become more common throughout the region 
(Belli, Gotsadze & Shahriari, 2004). 
In Uzbekistan, informal payments can be defined as payments that go 
unregistered. Informal private practice by publicly employed physicians is a 
major reason for informal payments, supplementing the low official income 
of health professionals. In a household survey conducted in 2007, 42% of 
respondents reported to have made some kind of informal payment for health 
services. This included voluntary gifts (in kind or cash) or payments without a 
receipt (World Bank, 2009). 

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Health systems in transition
  
Uzbekistan
53
Informal payments impede the utilization of health services, in particular 
for the poor. As they are more prevalent in secondary and tertiary care, poorer 
segments of the population face particular obstacles in accessing these levels 
of care. In addition, the existence of informal and formal payments can result 
in a poverty trap for those with serious illnesses. The likelihood of falling 
into impoverishment is quite high for those facing serious health problems in 
Uzbekistan (World Bank, 2003). 
The introduction of official user fees, the greater flexibility in the use of 
funds and the shift towards self-financing were expected to formalize and reduce 
the share of informal payments. The Ministry of Health has also endeavoured 
to address the general lack of awareness about new policies related to benefits, 
rights and obligations by drawing up a protocol that obliges all health care 
providers to inform patients on posters displayed in health care facilities about 
the benefits package and prices for chargeable services. However, it is unclear 
whether these policies and mechanisms have reduced informal payments. There 
are incentives for patients to receive informal services, since the overall fee 
negotiated directly between the patient and the provider could be lower than 
official charges (World Bank, 2003, 2009).