Out-of-Pocket Health Care Expenditures in Uzbekistan: Progress and Reform Priorities

Abstract

Over the past twenty years, Uzbekistan’s health system changed drastically from the inherited Soviet health system. This research aims to examine the main aspects of the Uzbek health financing system and policy process that led to out-of-pocket (OOP) health care expenditures by using a mixed-method case study approach. Qualitative findings reveal that the covered basic benefit package is limited. Health care evaluation methods and accessible information on health quality are lacking. This leads to inefficient use of resources and a risk of using unnecessary or low-quality health services. Quantitative findings reveal that especially the chronically ill have high OOP. Furthermore, alcohol use, health status of the household head, money saved in the past and place of residence proved to be significant factors. This research showed that the limited benefit package, lacking evaluation methods, and inaccessible information on health care led to high OOP. Policies remain inefficient at addressing OOP due to limited civilian participation, lack of data, and limited evidence-based decision making. This research suggests that the benefit package should be expanded to cover the chronically ill.