Health systems in transition : Uzbekistan

participants of the “labour front” in 1941–1945, participants and people 
who have incurred disabilities in the Second World War, people with 
disabilities incurred when dealing with the consequences of the Chernobyl 
nuclear power plant accident, participants in international wars (such as 
the war in Afghanistan during the Soviet period), and retired military 
personnel who served in posts related to nuclear technology.
Health services
A set of initiatives has permitted direct formal payments to health care providers. 
The 1998 
Presidential Decree
 outlined a timeframe for replacing government 
funding with other sources of revenue for various types of health care providers 
in the public sector. In the absence of a third-party payer system, direct patient 
payments have become a major formal source of revenue. According to data 
from the Ministry of Health, the ratio of revenues from formally paid services 
in the public sector has grown gradually in recent years. 
In recent years, the government has encouraged selected tertiary care 
facilities to shift their revenue collection towards user fees rather than 
allocations from the state budget. In the Uzbek context, these health facilities 
are described as “self-financing”. Most public facilities on the “self-financing” 
scheme heavily rely on user fees and direct formal payments. Between 2012 
and 2015, 46 secondary and tertiary care facilities are anticipated to move 
towards full “self-financing”, and another 57 are expected to start charging 
formal fees (President of Uzbekistan, 2011a). Patients utilizing public health 

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Health systems in transition
  
Uzbekistan
48
care institutions included in the “self-financing” scheme have to pay the price 
charged by the institution. The price-setting process is regulated and user 
charges have defined ceilings. 
Cost-sharing
Cost-sharing (such as through co-payments) is almost non-existent in the 
Uzbek health system. Anecdotally, various forms of cost-sharing are being 
introduced in the VHI sector, although no reliable data on the forms and the 
extent of cost-sharing in this sector are available. However, in hospitals, limited 
cost-sharing arrangements are in place, such as for food, communal expenses, 
or lacking pharmaceuticals (see Chapter 5).