Tashkent, Uzbekistan (UzDaily.com) -- Accelerated economic growth since mid 2000th allowed to considerably increase public expenditures in health care, the Center for Economic Research (CER) said in a publication “Health reform in Uzbekistan: longer terms and challenges”

The publication said still there is a growing concern that in the longer run government alone would hardly be able to meet the growing need of the sector. It is expected that the total health-care expenditures would grow 3.8 times by 2020 over 2010, and 8.7 times by 2030.

This will result in the increase of the share of health-care expenditures in GDP from to 5.5% in 2010 to 9.8% in 2020 and 10.7% in 2030.

Three main factors would contribute to this рigh rate of economic growth and increasing disposable incomes with households. It is estimated that by 2020 GDP will be 2.2 times higher in constant prices than in 2010, and by 2030 4.5 times higher. Due to high elasticity of demand for health services, health-care spending over this period will increase by a factor of 2.7 and 5.6, respectively.

Modern medical technologies and newer therapies will inevitably increase health-care expenditures by 84% in 2020 over 2010 and by 230% in 2030.

Changes in demographic pattern (the process of population aging) will lead to health-care spending increases of 28% by 2020 compared with 2010 and 77% by 2030.

The CER said that one of the main determinants of the health financing option is the stage of country’s economic development. In less developed countries the healthcare is considered to be a luxury, thus for these countries more likely that healthcare financing to be dominated by out-of-pocket payment.

Developed or socially enlightened nations usually provide universal coverage as a guarantee for most if not all citizens. Sweden, Norway, Canada and Australia offer tax-based or strictly demarcated or allocated social insurance for health. This mechanism pits well these countries due to the high tax rates (overall taxes close to 50% or more of earned incomes) and the broad tax base (more than 70 % of the working populations of these countries are taxpayers).

These enable governments to implement collection mechanisms such as dedicated health insurance on a more inclusive and comprehensive risk pooling (community-rated) manner. Achieving the goal of universal coverage implies that governments, policymakers and the public are enlightened enough to agree to and allocate sufficient tax revenues toward health care, as well as to agree to some form of cost-sharing and risk-pooling. They must thus, also agree to the imposition of mutually-acceptable or negotiated social health insurance schemes to cover all the residents within their borders. Within the framework of the system the following issues should be covered:

• Identification of the extent of the population covered (e.g. who is covered) and the extent of health service coverage (e.g. what is covered). This must clearly fit within the context of affordability and means.
• Establishment of a system of state guarantees of free medical care. Provision by the governments sufficiently robust systems of emergency and safety net services allows to socially vulnerable groups partake of the health services.
• It further infers that the country’s tax collection practices are mature, socially redistributive and reasonably equitable, so that the majority of the population can be adequately covered.

In the model of compulsory health insurance (CHI) health-care financing comes from insurance premiums, which are accumulated in a national medical insurance fund. The sources for the Fund are contributions from employers and employees that are allocated in certain proportions from the payroll of economic entities and employees’ salaries. The medical insurance of the nonworking population is funded by budget appropriations. One major criticism about the CHI model is that healthcare spending per capita tends to rise more than tax-based health systems, although achieving less coverage.

The private sector model of health care like all business or commercial enterprises fosters escalating costs, albeit towards distributing the healthcare cost to those who could afford to contribute or pay more for themselves. Thus the private health care has to be developed as a complement to public health care in meeting the demand of high-income groups and the middle class for medical services not covered by government guarantees or the health insurance package. This will stimulate an improvement in the quality of medical services, the introduction of new, more efficient and advanced technologies and innovations in health care.

Thus, while there is obvious need for thinking about the vision of longer term health reform in Uzbekistan, just applying of some ready-cut models would hardly work. As it was mention by Dr. Margaret Chan, the WHO Director-General “no single mix of policy options will work well in every setting… Health systems are complex adaptive systems, and their different components can interact in unexpected ways. Trade-offs is inevitable, and decisions will need to strike the right balance between the proportion of the population covered, the range of services included, and the costs to be covered.”

Reforming something so fundamental as health care would require in depth analysis and assessments, extensive consultations, systematic pilot projects, which might be instrumental to determine the effective strategy for health financing and avoid any disruptions, and ultimately ensuring sustainability and secure access for all to appropriate promotive, curative and rehabilitative health services at affordable costs to all strata of population.