Uzbek Doctors to be Barred from Private Practice

Uzbek Doctors to be Barred from Private Practice

Wednesday, 14 October, 2009
The Uzbek authorities are planning to close private medical clinics in hope that state healthcare will improve. NBCentral Asia observers are concerned that the move will deprive doctors of an important source of extra income.

President Islam Karimov is currently reviewing a law which parliament passed in late September curtailing private healthcare. Once the law comes into force, only state hospitals and clinics will be allowed to operate.

The private medical sector was sanctioned by a 1996 law, but existed even before that. There are now more than 4,000 licensed health centres offering a range of services from diagnosis and therapy to dentistry and cosmetic surgery.

The parliamentarians who drafted the new bill say their aim is to improve care in the state sector and protect people from “unprofessional” private practitioners.

However, analysts say private doctors are generally highly professional and have opted out of the state system because of the poor remuneration.

“The quality of medical services in private clinics can be said to be higher than it is at state medical facilities,” said Ravshan Nazarov, an expert in Tashkent.

A doctor in a state hospital currently earns an average of 90 US dollars a month, while a nurse gets about 70 dollars.

“In private clinics, one can earn ten or 20 times more,” said Farhod, a 43-year-old dentist in Tashkent.

Wages in the private sector depend on the number of patients doctors see and the amount of services they provide.

A consultation costs up to 20 dollars, tests 10 or 15 dollars, dental treatment 25 or 30 dollars per tooth, and a course of treatment as an in-patient 350 to 650 dollars.

The consensus among experts and medical personnel is that the authorities want to force some of the best doctors back into the state system.

But Dilmurad Kholmatov, an analyst in Tashkent, warns that the strategy may not work, and doctors “will become part of the grey economy, either seeing patients at home, or [privately] at state hospitals with the complicity of their superiors”.

Other commentators are concerned that removing the competitive private sector will lead to higher prices being charged by state clinics.

An electrocardiogram, X-ray test or fluorography at the Tashkent Medical Academy’s clinic currently costs between 1.3 and 3.3 dollars, while ten days in hospital costs 155 dollars.

By taking this sector in their hands, the government is trying to solve the problem of the underfunded healthcare at the expense of paid medical services.

The state system is chronically under-funded, and repairs to clinics are often paid for by doctors, while medical equipment from the Soviet period is still in use.

“The technology at our clinic became obsolete long ago,” said Rayhon, chief doctor at a clinic in Andijan in eastern Uzbekistan. “The regional health department stopped making promises a long time ago. They tell us to continue using the existing equipment and not to grumble about it.”

(NBCentralAsia is an IWPR-funded project to create a multilingual news analysis and comment service for Central Asia, drawing on the expertise of a broad range of political observers across the region. The project ran from August 2006 to September 2007, covering all five regional states. With new funding, the service has resumed, covering Uzbekistan and Turkmenistan.)

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