Tuberculosis (TB) funding in Uzbekistan has perverse incentives. Under the current system, hospital funding is based on the number of occupied beds. This funding system promotes unnecessary and prolonged patient hospitalizations, leading to the inefficient allocation of resources. But now Uzbekistan is taking steps to reform its health financing system to enhance the efficiency and quality of healthcare services. The government issued a Presidential Decree in January 2023 to develop a financing mechanism using diagnostic-related groups (DRGs) for case-based payment in TB hospitals. This means that hospitals will now receive funding based on the number of patients treated, rather than the number of occupied beds.
Building on the TB momentum, the Abt Global-led U.S. Agency for International Development’s (USAID) TB Free Uzbekistan activity collaborated with the Ministry of Health of Uzbekistan, State Health Insurance Fund, and National TB Program to facilitate a Technical Working Group (TWG). This TWG developed analytical tables with important information about TB hospitalization, such as how many people were hospitalized, how long patients stayed, and how much it cost. Abt’s TB Free Uzbekistan specialists analyzed data from 14,998 patients in 13 TB hospitals, which represented a quarter of all TB clinics in Uzbekistan. This study was the first of its kind in Uzbekistan and gave valuable insights into the structure and cost of TB treatment and highlighted the urgent need for a new funding system.
TB Free Uzbekistan’s analytical findings and innovative approaches quickly gained the attention of Uzbekistan’s Ministry of Health. As a result, DRGs were accepted, and the Ministry of Health approved a new funding system and further implementation. “Thanks to support from USAID, Uzbekistan has gained unique experience in developing a DRG financing model for specialized care providers, aligning with international practice,” said Zokhid Ermatov, executive director of the State Health Insurance Fund.
The technical support and analysis Abt provided has become invaluable in helping the government make effective decisions about budgeting for TB care. This successful development of DRGs in Uzbekistan's TB services is a significant milestone in the country's health reform efforts, highlighting the impact of collaboration among international organizations, governmental bodies, and healthcare professionals.
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