Unless you are dying from a heart attack or serious injury, it is up to you to decide whether to check into a hospital or not. My Tashkent-based friend who had double pneumonia recently refused to stay in a hospital after seeing a hospital room full of cockroaches. The doctors asked her to sign a refusal paper and let her go.
A patient with double pneumonia has to stay in bed all the time in order to avoid serious complications, including death. But my friend’s doctor asked her to come to the hospital every day (!) for IVs and injections. She went to her local clinic for two days and spent 2.5 hours in queues each time, although she paid extra to every single medical staffer and asked them not to make her wait. Finally, after agreeing to pay more, she hired a nurse to come to her house for all the medical procedures.
“I bought half of the medicine the doctors prescribed. It already cost me half a million [Uzbek soums]. I am not even talking about bribes. And now, I have to wait until my next salary to buy the other half,” she told me over the phone when I called her to wish a quick recovery.
The situation in private clinics or in “paid” wards of hospitals is not different. Here, a patient also buys everything – from medicine to food – although the hospital rooms may be nicer. Doctors often get commissions from pharmaceutical companies for prescribing certain types of drugs. And it is the same doctors who work in public hospitals and private ones. They share their time between public and private clinics. They like high rates and nice offices and equipment in private clinics, but cling to their public jobs for more security in terms of stable salaries, future retirement payments, and a steady flow of patients, something that many private clinics still lack. Besides, according to www.minzdrav.uz, the official site of the Healthcare Ministry, there are 2926 private clinics in Uzbekistan – a low number for a country of 30 million.
There has been no public debate about healthcare reform in Uzbekistan. Officials and doctors often cite the 1998 presidential decree “On the state program for reforming the healthcare system of Uzbekistan.” It focused mostly on the distribution of state funds for the healthcare system and creation of private clinics, including provisioning equipment to clinics and hospitals. It also aimed at strengthening the professional level of medical staff and included some reforms in the medical education system. However, none of the government decisions envisions either universal healthcare or creating private insurance companies.
It is not clear how the situation will develop in the future. The doctors are very unlikely to push for more reforms as they seem to benefit from the status quo.
A doctor in Tashkent makes USD 600 and above every month, both in official salary and unofficial payments for the provided services. Needless to say, none of them pay taxes from unofficial payments, i.e. bribes. A good surgeon can make as much as a few thousand dollars a month. (Well-known surgeons often own other business as well, including restaurants and beauty salons). The professions of doctor and nurse are among the most prestigious for school graduates. It is hard to enroll in medical universities and colleges. One has to be either super-brilliant to pass the entrance tests or have acquaintances who help with enrollment in exchange for a financial reward. The bribes range from USD 12,000 to USD 25,000. It takes at least seven years to graduate with a medical degree, and even more if one wants to pursue a master’s degree. The graduates find themselves in a highly competitive market where jobs are hard to find. In spite of these, the number of medical school applicants has been on the rise.
Doctors with many years of experience also have to go through various tests and exams to prove their professionalism as defined by categories. The purpose of the exams is that some medical staff aim to maintain their current category while others strive to get a higher one – which will mean an additional UZS 150-250 thousand in their monthly salaries.
The country has been getting foreign aid to reform its healthcare system. From UNICEF to WHO to UNDP to the World Bank, international organizations help conduct immunization campaigns, advise on healthcare reforms, equip medical centers, treat patients with tuberculosis and HIV/AIDS, and provide women with contraceptives. However, the campaigns are often reactive. The international organizations’ activities are defined by the Uzbek authorities. Officials in Tashkent are prone to showing their ability to handle healthcare and medical issues independently, rather than admitting and accepting foreign help.
Meanwhile, a wealthy few head to foreign countries for medical treatment, drawing on their own savings and often those of their close relatives, whereas the majority poor can only hope not to get sick. They have nobody to rely on except for God.