Health systems in transition : Uzbekistan

3.7 Payment mechanisms
3.7.1 Paying for health services
Payment mechanisms for health services in the public sector can be differentiated 
according to the types of care provided:
•
  prospective global budgets based on per capita payments for primary care 
in rural areas;
•
  prospective global budgets based on past expenditures and inputs for 
primary care in urban areas, specialized outpatient and inpatient care, 
and public health services in the sanitary-epidemiological system.
The introduction of capitation-based payments has been a major move away 
from the inherited Soviet financing framework. Primary care units in rural areas 
are now included in a nationwide capitation-based payment system. Financing 
of primary care in urban areas is to be shifted to a capitation basis by 2015. Per 
capita payments are paid for the covered population, with adjustments for age 
and gender. Importantly, under the new arrangements, these per capita rates 
are calculated at the 
viloyat
 level, which helps to spread risks more evenly and 
to level off the impact of geographical income differentials on health financing 
in primary care. The payment system does not differentiate between different 
health services and includes all expenses related to the running of primary 
care practices. The received funds can be spent according to the four budget 
lines set by government protocols (see above). Per capita rates are set annually 
by the 
viloyat
 government and depend on the size of the 
viloyat
 health budget. 
No protocols exist that define the share of primary care funding in the overall 
health budgets. 
The second health financing mechanism is based on past expenditures 
and the inputs involved in health care delivery. The inputs that are used for 
the calculation of budgets are the number of beds in inpatient care and the 

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Health systems in transition
  
Uzbekistan
55
number of patient visits in outpatient care (urban primary care and specialized 
outpatient care providers). In the calculation of budgets, these inputs are linked 
to predefined ratios of staff to inputs. In the sanitary-epidemiological system, 
inputs are defined in terms of staff. Other budget items are mostly based on 
past expenditures, such as expenses for maintenance. 
The financing mechanism initiated at selected providers of tertiary and 
specialized care is similar to “full-cost” reimbursement. The government 
annually allocates funds for each of these providers. The providers are then 
expected to justify allocation of these funds by providing free services to 
eligible individuals.