From Budget Allocation to Strategic Purchasing: Integrating State Health Insurance with Program Budgeting in Uzbekistan
Year: 2026
Type: article
Abstract: Uzbekistan’s health financing reforms are increasingly shifting public resources from the maintenance of institutions toward the purchase of defined health services. This article examines how the State Health Insurance Fund can become the operational bridge between program budgeting and strategic purchasing. Drawing on budget parameters for 2017-2026 and the institutional arrangements, the analysis shows that in 2026 local budgets account for 77.3% of total healthcare expenditure, while UZS 34,067.0 billion, or 90.3% of local health spending, is directed through the State Health Insurance Fund. This structural shift creates a unique opportunity to connect the guaranteed benefits package, provider contracts, service units, risk-adjusted tariffs, quality requirements, KPIs and subsequent budget decisions. The paper proposes a six-part integration mechanism: financially costing the guaranteed package; converting services into program units; contracting providers for volume and quality; integrating electronic claims and clinical data; evaluating purchasing performance; and feeding evaluation results back into budget allocations. It argues that insurance-based purchasing should not be treated as a parallel financing reform but as the transaction layer of a closed program-budgeting cycle. The framework also identifies implementation risks related to data quality, tariff design, provider incentives, regional equity and the premature use of complex payment systems.
Institution: Tashkent International University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7218336607