Feasibility study for the introduction of mandatory health insurance in Uzbekistan (2021)

Uzbekistan has decided to introduce mandatory health insurance (MHI) to move towards universal health coverage. This feasibility study assesses the impact of potential revenue sources to expand the fiscal space for health under MHI. Using population, employment and economic data, it projects three scenarios of the potential public revenue mix for health.

Scenario 1 projects that in 2025, 620 000 som per capita will be available for health from general taxation. Scenario 2 projects revenues from general taxation combined with a 2% payroll tax to add 35 000 som per capita (5.4% of total public funding for health). Scenario 3 doubles the payroll tax to 4% and adds 52 000 som per capita (7.7% of total public funding for health).

It concludes that general taxation offers the most effective way to support progress towards universal health coverage, and a payroll tax would generate limited additional resources, be inconsistent with the objectives of the 2019 income tax and social security contribution reform, and risk harming the labour market. Instead, Uzbekistan can seek complementary revenue streams from alternatives (e.g. sin taxes), and further expand fiscal space for health through focusing on efficiency gains in the service delivery system.