HEALTH INSURANCE REFORM AND FINANCIAL SUSTAINABILITY: INSTITUTIONAL CHALLENGES AND POLICY PERSPECTIVES IN UZBEKISTAN

The introduction of state health insurance systems constitutes a fundamental pillar of health sector reform in emerging economies, aiming to ensure universal health coverage, financial protection, and equitable access to essential services. Uzbekistan has embarked on an ambitious reform path to establish a mandatory state health insurance system as part of broader public sector modernization. This study analyzes the financial, institutional, and governance challenges associated with the design and implementation of health insurance reforms in Uzbekistan. Using national health expenditure data, fiscal indicators, and comparative policy analysis, the research evaluates the sustainability of financing mechanisms, administrative capacity, and institutional integration. The findings reveal that while Uzbekistan has achieved notable progress in healthcare funding expansion and service coverage, persistent challenges remain related to fiscal sustainability, risk pooling, and administrative fragmentation. The study proposes a comprehensive institutional framework to enhance long-term viability, emphasizing fiscal diversification, digital integration, and governance reform. The results provide empirical insights for policymakers and contribute to the academic literature on health system transformation in transition economies.