Health systems in transition : Uzbekistan

5.2.1 Referral processes
Although public primary care providers are expected in the current reform 
context to provide high quality and accessible primary care to the population, 
they face a number of challenges. Existing financial and structural arrangements 
do not place primary care at the centre of the Uzbek health system. Clear 
criteria for referrals to each level of care are often lacking and patients’ 
pathways are often not regulated. As secondary and tertiary care are outside 
the state-guaranteed medical package for significant parts of the population 

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Health systems in transition
  
Uzbekistan
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(see Chapter 2 for exceptions), this presents another reason for the weak link 
between primary and other forms of care. GPs also lack financial incentives to 
take on a gatekeeper role. Patients can easily refer themselves to any secondary 
or tertiary institution. The private industry is even less regulated in terms of 
referral processes. Patients can easily opt for private providers anywhere in the 
continuum of care without any referral. 
With the introduction of new market elements into inpatient care, such as 
through the “self-financing” scheme and greater use of contracts (see Chapter 3), 
the link between primary care and inpatient care has been further loosened. 
A number of initiatives were developed by the government to improve access 
to inpatient care for selected groups of the population. According to a newly 
designed system, the Ministry of Health issues permits to selected patient 
groups (people with disabilities, orphans and veterans) to utilize secondary and 
tertiary care services (President of Uzbekistan, 1998). These permits reimburse 
health care providers for the expenses incurred in the diagnosis and treatment of 
patients, within the limits of funding earmarked for this purpose. The funding 
of permits is determined by the government on an annual basis (Cabinet of 
Ministers, 2003). Patients who fall into the defined population groups have 
to apply to the Ministry of Health or to 
viloyat
 health authorities to obtain the 
permits, although no data are available on the number of applications or permits.