Health systems in transition : Uzbekistan

7.2 Financial protection and equity in health financing
7.2.1 Financial protection
Ill health can become a significant financial burden to individuals and 
households due to the medical costs and loss of earnings associated with it. 
During the Soviet period, the government provided strong financial protection 
from ill health. Virtually all aspects of care were provided free of charge at 
the point of use. Although informal payments existed, they rarely had a major 
impact on financial protection. The public system of social support compensated 
those unable to work due to illness at rates close to the individual’s normal 
salary until their return to work. 
After the break-up of the Soviet Union and the resulting economic difficulties, 
Uzbekistan had little choice but to ration benefits in all social areas, including 
health services and social support for those with illnesses. The decision was 
made to limit financial protection from ill health to selected areas, such as 
primary and emergency care. 

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Health systems in transition
  
Uzbekistan
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Primary health care facilities in the public sector are expected to 
provide universal and free coverage for the assigned population. However, 
comprehensive pharmaceutical coverage for outpatient care is not part of the 
guaranteed package of primary care, except for small predefined groups of 
the population and certain clinical conditions (see Chapter 3). Third-party 
pooling schemes insuring against the expenses associated with outpatient 
pharmaceuticals do not exist in Uzbekistan. The resulting lack of coverage 
for outpatient pharmaceuticals is likely to reduce the utilization of nominally 
free primary care services. Full pharmaceutical coverage would be an 
expensive undertaking. In 2013, total government funding for health was 
a little over US$ 1.5 billion (at official currency exchange rates), while the 
country’s pharmaceutical market was predicted to amount to US$ 600 million 
in the same year (Chemrar, 2013; Ministry of Finance, 2014). Many other 
countries of the former Soviet Union also require direct patient payments for 
outpatient pharmaceuticals (Rechel et al., 2013; Richardson, Sautenkova & 
Bolokhovets, 2014). 
Emergency care is formally free and accessible for all, and an extensive 
network of emergency facilities exists. Although no data are readily available 
on the amount of public funding earmarked for the delivery of emergency care, 
anecdotal evidence suggests that emergency care facilities are comparatively 
well equipped. Pharmaceutical procurement for the emergency care network is 
considered to be far superior to that of other primary and secondary facilities 
in the public sector that are charged with providing the guaranteed benefits 
package. However, pharmaceuticals not available at the facility will need to be 
provided by patients. 
The implementation of formally “free emergency treatment for all” seems 
to have resulted in some undesirable effects. As secondary and tertiary care 
generally require formal out-of-pocket payments, since there is no third-