Health systems in transition : Uzbekistan

Financing
Uzbekistan spends a comparatively low share of its gross domestic product 
(GDP) on health, amounting to an estimated 5.9% in 2012. This was below 
the average of the WHO European Region of 8.3%, but slightly above the 
average for the central Asian republics of 5.2%. While the share of public 
sector expenditure has increased in recent years, private expenditure remains 
substantial. In 2012, public sources (mostly raised through taxes) accounted 
for 53.1% of total health expenditure, while 46.9% came from private sources, 
mostly in the form of out-of-pocket expenditure. Voluntary health insurance 
does not play a major role. 
The basic benefits package guaranteed by the government includes primary 
care, emergency care, care for “socially significant and hazardous” conditions 
(in particular major communicable diseases, plus some noncommunicable 
conditions such as poor mental health and cancer), and specialized (secondary 
and tertiary) care for groups of the population classified by the government as 
vulnerable. It thus excludes secondary and tertiary care for significant parts 

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Health systems in transition
  
Uzbekistan
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of the population. Pharmaceuticals for inpatient care that forms part of the 
basic benefits package are included in the package. Outpatient pharmaceuticals 
are not covered, except for 13 population categories, including veterans of the 
Second World War, HIV/AIDS patients, patients with diabetes or cancer, and 
single pensioners registered by support agencies. 
Payments for health services are both formal and informal. Formal payments 
have been increasingly introduced and now account for a major share of revenue, 
in particular for health facilities that are expected to finance themselves largely 
through user fees rather than allocations from the state budget. This approach is 
being increasingly encouraged for secondary and tertiary care facilities. There 
is also anecdotal and survey evidence of informal payments, in particular for 
secondary and tertiary care. Other sources of funds include technical assistance 
programmes by multilateral and bilateral agencies. 
The government pools and allocates public funding for health care. There is 
a distinct divide between national (republican) and subnational (
viloyat
, 
tuman 
or city) governments with regard to health financing. The national government 
is responsible for the financing of specialized medical centres, research 
institutes, emergency care centres and national-level hospitals. Regional and 
local governments are responsible for expenditures related to other hospitals, 
primary care units, sanitary-epidemiological units and ambulance services. 
Primary care in rural areas is now financed on a capitation basis and primary 
care in urban areas is expected to follow by 2015. Specialized outpatient and 
inpatient care is financed on the basis of past expenditures and inputs, as well 
as, increasingly, “self-financing”. 
Health workers in the public sector are salaried employees and paid according 
to strict state guidelines. However, there are efforts to increase the flexibility of 
health care providers in reimbursing health professionals. Salaries of physicians 
in the public sector ranged from US$ 300 to US$ 600 per month in 2014 and 
salaries of nurses are even lower. These salary levels are considered insufficient 
to cover the cost of living (although some providers on “self-financing” schemes 
are able to pay substantially better salaries).