title: Uzbekistan: health system review.
abstract: Uzbekistan is a central Asian country that became independent in 1991 with the break-up of the Soviet Union. Since then, it has embarked on several major health reforms covering health care provision, governance and financing, with the aim of improving efficiency while ensuring equitable access. Primary care in rural areas has been changed to a two-tiered system, while specialized polyclinics in urban areas are being transformed into general polyclinics covering all groups of the urban population. Secondary care is financed on the basis of past expenditure and inputs (and increasingly self-financing through user fees), while financing of primary care is increasingly based on capitation. There are also efforts to improve allocative efficiency, with a slowly increasing share of resources devoted to the reformed primary health care system. Health care provision has largely remained in public ownership but nearly half of total health care expenditure comes from private sources, mostly in the form of out-of-pocket expenditure. There is a basic benefits package, which includes primary care, emergency care and care for certain disease and population categories. Yet secondary care and outpatient pharmaceuticals are not included in the benefits package for most of the population, and the reliance on private health expenditure results in inequities and catastrophic expenditure for households. While the share of public expenditure is slowly increasing, financial protection thus remains an area of concern. Quality of care is another area that is receiving increasing attention.
authors.affiliation: Consultant on health services and systems.
authors.forename: Mohir
authors.initials: M
authors.lastname: Ahmedov
authors.affiliation: School of Public Health, Tashkent Medical Academy.
authors.forename: Ravshan
authors.initials: R
authors.lastname: Azimov
authors.affiliation: Institute of Health and Medical Statistics under the Ministry of Health of Uzbekistan.
authors.forename: Zulkhumor
authors.initials: Z
authors.lastname: Mutalova
authors.affiliation: WHO Regional Office for Europe.
authors.forename: Shahin
authors.initials: S
authors.lastname: Huseynov
authors.affiliation: WHO Country Office in Uzbekistan.
authors.forename: Elena
authors.initials: E
authors.lastname: Tsoyi
authors.affiliation: European Observatory on Health Systems and Policies.
authors.forename: Bernd
authors.initials: B
authors.lastname: Rechel
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000266:history / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D003710:Demography; D005069:Evaluation Studies as Topic; D033161:Government Regulation; D018166:Health Care Reform; D061889:Healthcare Financing; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D011787:Quality of Health Care; D014610:Uzbekistan