Payment Models, Cost Transparency And Performance Measurement Of Healthcare Providers: International Benchmarking And An Adaptation Framework For Uzbekistan

Background: how providers are paid determines what they measure about their own efficiency. Objective: to compare payment models, cost-data infrastructure, performance-measurement tools and composite indices in seven countries and to derive a framework for adapting them to Uzbekistan. Methods: comparative case analysis of Germany, the United Kingdom, the United States, Japan, the Republic of Korea, Kazakhstan and Russia, supplemented by public–private partnership (PPP) experience of the United Kingdom and Turkey, using 2023 financing and resource indicators. Results: Uzbekistan has 4.89 hospital beds and 11.08 nurses per 1,000 population (OECD average: 4.20 beds), yet spends only PPP USD 749 per capita, of which 35.4% is public and 64.1% out-of-pocket. Four common principles were identified: standardised service units, mandatory and open cost data, a small outcome-linked share of payment (1–2%), and uniform rules irrespective of ownership. Tools implementable within existing statistics (unit cost, cost recovery ratio, DEA benchmarking, equity indices) were separated from those requiring new data infrastructure (DRG payment, payment for outcomes). Conclusion: for resource-rich but cash-poor systems, efficiency measurement should precede and prepare payment reform.