New Healthcare System Still Open to Abuse

People in pilot regions across Tajikistan will now have to officially pay for medical treatment, but NBCentralAsia experts say that although the standard of healthcare will rise with the extra funds, patients are still not protected from having to pay bribes.



A state programme setting out new rules for healthcare has been launched in four pilot districts - Spitamen, Rasht, Dangara and Tursunzade - according to the Avesta news agency. Under the new system, the patient pays some of the cost of healthcare – 30 per cent if they are referred by their general practitioner and 70 per cent if they seek hospital treatment on their own.



Tajikistan is one of the few post Soviet countries where healthcare is still officially free of charge. In reality, though, it is very costly, as patients have to cover all their medical expenses including dressings and medicines, and paying medical staff bribes to perform their work.



“The budget for healthcare institutions doesn’t cover all the costs, so people have to make informal payments,” said Safar Sayfiddinov, head of the health ministry’s department for medical services.



The new system is based on a unified system of fees, set according to the actual cost of treatment.



Sayfiddinov says the new system will not increase the financial burden on patients since they are already having to pay at least as much, though unofficially.



Free healthcare will continue for people with illnesses such as tuberculosis, diabetes and schizophrenia and for those who have had heart attacks.



Salohiddin Miraliev, head of planning, coordination and reform at the health ministry, said that instead of going on bribes, patients’ money will be spent on improving medical services, equipping hospitals and clinics and making medicine more avaliable.



“The fixed price list for medical services will be significantly lower than the illegal tariffs imposed by medical staff at the moment,” he said.



Miraliev adds that this programme differs significantly from a failed attempt to achieve something similar two years ago. This programme came into effect in August 2005, but was suspended within two months after people complained that they were being charged twice with payments to doctors on top of the official fee to medical institutions.



At the time, many experts argued that the authorities had been too hasty in pushing through a poorly-coordinated set of changes, so a more cautious approach is being taken this time around.



The improved programme has been pondered over by various relevant ministries and agencies, and will be introduced gradually in pilot areas. If that experiment proves successful, it will be extended to 11 more administrative districts.



Firuz Saidov, an independent expert on social affairs, welcomed the programme and the fixed price charges it imposes, but warned that it still fails to define clearly how patients can avoid paying for services twice over. There is no guarantee that doctors will not charge an extra fee, he said.



(News Briefing Central Asia draws comment and analysis from a broad range of political observers across the region.)