Ahmedov, Mohir, et al. "Uzbekistan: Heath System Review". Health Systems in Transition, vol.9, no.3 (2007): 1-210.

Ahmedov, Mohir, et al. "Uzbekistan: Heath System Review". Health Systems in Transition, vol.9, no.3 (2007): 1-210.

• This report by the European Observatory on Health Systems and Policies created in partnership w/ the WHO Regional Office for Europe, The Veneto Region of Italy, Belgium, Finland, Greece, Norway, Slovenia, Spain, and Sweden, the European Investment Bank, the Open Society Institute, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene and Tropical Medicine, with special assistance from the Republic of Uzbekistan, is extremely comprehensive and covers in minute detail the entirety of the system of health care provision in Uzbekistan.
• This is quite simply, the quintessential text on the health care system of Uzbekistan. Any information about aspect of the health care system, from coverage to funding to provision to issues to contemporary reform programs, is available in this report. It is such a detailed and succinct report of the health system that I will not be discussing any individual facts from the report as essentially be a transcription. Instead, I will describe the topic of each chapter and additionally include some key charts about funding and administration. Only specific conclusions and recommendations will be individually addressed.
• The introduction from page 1 to page 18 discusses the social, political, and demographic context of the Uzbekistani health system. This chapter discusses the sociodemography of Uzbekistan (1-2), the basic economic situation (3), the contemporary political system (4-6), and the health status of the Uzbekistani population (8-16). The section on health status explores the healthiness of the population based on general indicates, rates of communicable and noncommunicable diseases -- with special emphasis on HIV/AIDS and TB -- mortality rates, dental hygiene, vaccination rates, neonatal health, maternal health, alcohol consumption, and access to sanitary facilities.
• Chapter 2 from page 19 to page 35 explores the organizational structure of the Uzbekistani health care system beginning with an overview of the Ministry of Health structure from the national to the tuman level (19-20). The historical background for the system's development from the pre-colonial through the Soviet system and the types of early reforms to create the contemporary Uzbekistani health system are discussed (21-24). An overview of the organizational system from the perspective of management is provided, including descriptions of key agencies and stake-holders at the national, viloyat, and tuman level (25-30). The limited scope of decentralization of administration is discussed (31). Patient rights and empowerment within the system is also covered, including freedom of information, compensation, and legal protections (32-35).
• Chapter 3 discusses the financing of the Uzbekistani health system from page 37 to page 69. Total health expenditures are provided, including information on specific areas of fundings and trends within that funding in service and administrative level of allocation (39-45). The chapter discusses the population coverage with details about the basic services provided (45-50), the sources of funds and means of collecting revenue in public and private health care providers including both state, formal, and informal payments (50-58), and agencies and mechanisms responsible for pooling and distributing funds for health care including information on new mechanisms for increasing finance control at a hospital level (58-63). The chapter also covers the relations between purchasers -- usually the state -- and health care providers (63-64), and mechanisms for payment covering both treatments and medical personnel (65-69).
• Chapter 4 explores the planning and regulation of the health care system from page 71 to page 86. The chapter contains information on the regulation of the health care system and health care providers at a national, regional, and local level including information on efforts to reform the system towards increased decentralization of financial resources (72-79), and concerning the use of health care technology and information systems within the Uzbekistani health care system, with additional emphasis on the management of research and development programs (79-86).
• Chapter 5 examines the physical and human resources of the Uzbekistani health system from page 87 to page 114. This chapter records the health technology infrastructure and physical resources of the health care system with particular emphasis on information technology, bed numbers, medical equipment, and pharmaceutical products (87-97), and the training of health care personnel including information on contemporary personnel availability (97-100), and methods of registration and training for health care personnel (101-114), with specific information provided on public health specialists (104), physicians (106), nurses and midwives (109), dentists, and pharmacists (110). The chapter also discusses the perceived relative importance of certain health care specializations within the system (113-114).
• Chapter 6 deals with the system for the provision of health care services within the Republic of Uzbekistan from page 115 to page 150. This chapter discusses public health services in Uzbekistan in both sanitation and education (115-119), the scope, quality, coverage, and pathways for accessing primary care services (120-127), the quality and pathways for accessing specialized ambulatory and inpatient care (127-131), the provision of free emergency care (131-133), the regulation and distribution of pharmaceutical products (133-137), the provision of rehabilitory care (137-138), the legal framework, workforce composition and pathways for the provision of mental health care (138-141), the quality, scope, coverage, and pathways for accessing dental health care including public, private, and preventive measures (141-145), the use of alternative medicine (145), the health care provided by specific public services such as the military, MXX, or large state-owned corporations (146), and the programs and framework specific to the provision of health care targeting maternal and child health (146-150).
• Chapter 7 discusses the principle reforms and reform initiatives in the Uzbekistani health care system from page 151 to page 175. This chapter explores the legal and structural framework for reform within the scope of four laws and presidential decrees from 1996 to 2003 with focus on current laws (152-155), and the detailed aspects of the reform programs carried-out under the 'Health I' and 'Health II' loans from the World Bank and Asian Development Bank (155-174). The exact direction of funding in each program is explored in depth, while reforms in secondary and tertiary care are separately discussed later on (173-175).
• The principle health care reforms in Uzbekistan target five main areas: improving child and maternal health, promoting further privatization, improving the quality of health care services, containing health care costs by lowering public expenditure, and health care decentralization (151-152).
• Chapter 8 -- page 177 to page 188 -- is an assessment of the Uzbekistani health system with regards to access, coverage, effectiveness, and equity of distribution. The system is analyzed first in terms of the stated objectives of the government, although these are lacking in clarity (177-178). In terms of access to health services, there is rough geographic equality largely due to the new varying-size SVP system being put in place w/ funding based on capitation (178-180), while access to health care is restricted based on finances as groups outside of special categories seeking services outside of conditions of national importance face restrictive out-of-pocket payments for health care w/o any cost-pooling mechanisms; even access to primary care is limited by informal costs and bribes within the health care system (180-182). Allocative efficiency remains low as health outcomes are not directly linked to care and emergency services take a brunt of patients better dealt w/ at other levels, still the system has redressed the main issues of Soviet health care with a refocusing on primary care and outpatient services (184-188).
• The poor are not specifically targeted for programs to subsidize health care costs, although many fall within categories eligible for free health care services. The equal costs -- or lack thereof -- between rich and poor, however, means the system is still fairly regressive and leaves some w/o coverage due to lack of income (182).
• The quality of health care in Uzbekistan remains low according to anecdotal information, largely b/c there are few factors and distributions tied to health care outcomes, leading to lack of incentives to provide quality health services (183-184).
• The conclusions of this review of the Uzbekistani health system are available from page 189 to page 191.
• The health care reforms undertaken by the government seem to have accomplished the primary goals of the reform process, in that the creation of a package of universal primary care and emergency services has kept high coverage rates while increasing efficiency and lowering health care costs, however the new costs of secondary and tertiary care for those outside of specific conditional groups has limited access to other services and put additional pressure on free emergency services in a way that inefficiently utilizes current resources (189).
• Most measures designed to increase incentives for service quality have ended up increasing quantity of services alone due to Soviet-era statistical models. Actual increases in quality are prevented by lack of access to medical information for self-education, as most medical professions are not fluent in English or German that journal are printed in, and most universities with English-speaking students cannot afford subscriptions to the relevant publications (190).
• The primary area of necessary reform continues to be additional decentralization of management structures backed up by increased expertise and information. Putting hospitals more in control of financing will increase efficiency, but only when coupled with the professionalization of hospital administration and a better results-driven system of information collection (191).