Uzbekistan Fully Transitions to State Medical Insurance: Payment and Primary Care Reform

Uzbekistan has officially completed a major phase of its healthcare reform: as of October 1, 2026, the state medical insurance system has been fully rolled out across all regions of the country. This material is for informational purposes, and the analysis is conducted from the perspective of actuarial calculations and financial risk management in healthcare.

Reform Chronology and Digitalization

The transition to the new model was carried out in phases. In preparation for the reform, over 230 trillion soums have been directed into Uzbekistan's medical sector in recent years. More than 1,400 medical facilities were constructed or reconstructed. A key infrastructure element is the unified electronic information system DMED, which already contains medical profiles for over 36 million citizens. Digitalization has reduced ambulance response times from 25–30 to 10–15 minutes and ensured transparent patient flow management.

Actuarial Analysis: New Financing Mechanisms

The main change lies in abandoning line-item budgeting (funding beds and staff) and shifting to payments for actually rendered services within the state-guaranteed package. From an actuarial standpoint, this fundamentally alters the risk structure. Financing is now distributed through three key mechanisms:

1. Capitation Rate: allocation of funds for each registered citizen, adjusted for age and gender. This requires precise demographic modeling to prevent primary care budget deficits.

2. Global Budget: a fixed volume of funds for specialized services (oncology, emergency care, blood centers, psychiatry). This method is applied where risks are unpredictable or require tight centralized control.

3. Payment per Treated Case: inpatient care is paid based on treatment outcomes. This encourages clinics to optimize hospitalization periods but carries the risk of "upcoding" (artificial inflation of diagnosis severity), requiring strict actuarial data auditing.

Reaction Chronicle and Operational Risks

The implementation of the system triggered wide public resonance. In particular, rumors emerged about the termination of free oncological care for Tashkent residents. The Republican Oncology Center promptly refuted this, explaining that only the patient routing had changed. Free access to high-tech care is now available strictly via electronic referrals in the DMED system, issued by a family doctor after basic screening.

Sayyora Shoeva, head of the information service of the State Medical Insurance Fund, emphasized: "The Fund reimburses medical organizations for the costs of providing services included in the state-guaranteed package. Thus, funds are not simply allocated to a medical institution but are directed based on the actually provided medical services and their volume."

The Oncology Center noted that previously, patients were often referred without preliminary diagnostics, causing expensive fund resources to be spent on basic tests rather than high-tech treatment. The new electronic referral mechanism is designed to eliminate these inefficiencies.

Regional Context and Conclusions

For Central Asian countries, including Kazakhstan, Uzbekistan's experience is of great interest. Unlike the Kazakh CSHI model, which is based on insurance contributions from employers and citizens, Uzbekistan is implementing state medical insurance funded primarily from the state budget through a single strategic purchaser—the State Medical Insurance Fund.

Actuarial Conclusion: The success of the reform critically depends on the quality of data in the DMED system. To ensure long-term financial sustainability, the State Medical Insurance Fund will need to build actuarial models for disease forecasting, calculate precise weight coefficients for treated cases, and implement risk-adjustment systems for capitation tariffs. Without this, there is a risk of rapid budget limit exhaustion.

Source: UzDaily.uz, 2026-10-09. Also reported by: Yangi O‘zbekiston, 2026-10-09.