Abstract

General Background: In recent years, non-state medical institutions have become integral to healthcare delivery systems in Uzbekistan, spurred by national reforms aimed at improving service accessibility and diversity. Specific Background: Despite their growing presence, concerns persist regarding the consistency and safety of services in the non-state sector. Knowledge Gap: Limited empirical data exist comparing the quality of care in public and private health institutions, especially within transitional economies such as Uzbekistan. Aims: This study aims to assess and compare the quality of inpatient and outpatient care between a private clinic (TJS-MED) and a public healthcare facility (Vabkent District Medical Association) in Bukhara region using defined quality indicators. Results: Findings revealed that while the private clinic excelled in service speed and patient comfort, it exhibited notable deficiencies in clinical-pathological diagnostic consistency and fulfillment of medical conditions. Overall, the quality coverage score was 86%, deemed “excellent,” though gaps in physician qualifications and technological application were identified. Novelty: The study introduces a structured indicator-based assessment tool tailored to the Uzbek healthcare context, allowing quantifiable comparisons across sectors. Implications: The results advocate for enhanced regulatory oversight, standardized clinical protocols, and investment in medical personnel training to ensure quality equity across healthcare providers.

Highlight : 

• Quality Variability – Non-state clinics often offer faster service but show inconsistency in clinical standards and staff qualifications.

• Evaluation Tools – A mixed-methods approach using surveys, records, and expert interviews helps assess quality indicators effectively.

• Policy Implication – There is an urgent need for regulatory reforms and standardized clinical guidelines to ensure patient safety.

Keywords : Non-State Medical Institutions, Medical Care Quality, Healthcare Indicators, Patient Satisfaction, Regulatory Oversight

Introduction

Public health holds significant economic and political importance, as the availability and quality of medical services play a vital role in ensuring the well-being of the population. In recent years, Uzbekistan has undertaken substantial reforms aimed at improving the accessibility and quality of healthcare. As part of these reforms, the development of the private medical sector has gained special attention. Recognized as a key component of the national healthcare system, the non-state sector not only enhances the diversity of services but also contributes to reducing the burden on public institutions. The government has created favorable conditions for the growth of private medical institutions, promoting competition, innovation, and responsiveness to patient needs [1].

Despite this positive progress, there is an ongoing discussion regarding the consistency, reliability, and safety of medical services provided by non-state institutions. While private clinics often offer faster service, better infrastructure, and increased patient comfort, concerns remain about disparities in clinical standards, staff qualifications, and regulatory compliance. Theories of healthcare quality, such as Donabedian’s model (structure, process, and outcome), are especially relevant in analyzing the performance of non-state medical institutions. However, few empirical studies in the context of Uzbekistan have systematically assessed how these facilities compare to their public counterparts in terms of service quality and patient outcomes, highlighting a significant knowledge gap in the literature [2].

Previous research in other countries suggests that non-state medical providers can achieve high efficiency and patient satisfaction when properly regulated and integrated into the broader healthcare system. However, in transitional economies like Uzbekistan, evidence remains scarce. This study aims to address this gap by applying a mixed-methods approach to assess the quality of care in private and public medical institutions. Specifically, it compares a private clinic (“TJS-MED” in Peshku district) and a public healthcare facility (Vabkent District Medical Association) in Bukhara region. The analysis incorporates quantitative data from patient records and surveys, alongside qualitative insights from expert interviews [3].

The study expects to find differences in accessibility, service delivery speed, patient satisfaction, and adherence to clinical guidelines. It also aims to identify systemic challenges such as inconsistent regulation and variation in healthcare personnel training, which may influence overall quality. By analyzing these factors through both statistical and socio-hygienic lenses, the research seeks to develop a well-rounded view of the current healthcare landscape in non-state institutions [4].

The results are expected to provide practical recommendations for improving healthcare governance, with implications for policymakers aiming to ensure equitable and high-quality medical services across all sectors. Strengthening oversight, standardizing clinical protocols, and enhancing staff qualifications are among the anticipated suggestions. This study contributes valuable empirical evidence to the ongoing discourse on the role of the private sector in national health systems and offers a basis for informed policy reforms in Uzbekistan’s healthcare sector [5].

Metodology

The methodology of this study was designed to comprehensively assess the quality of medical services provided in both non-state and public healthcare institutions within the Bukhara region. For this purpose, two healthcare facilities were selected as the main sites of investigation: the private clinic “TJS-MED” located in the Peshku district and the Vabkent District Medical Association, representing the public healthcare sector [6].

The study focused on a total of 100 patients, with 50 individuals from each institution who received treatment primarily in the therapeutic departments. A combination of statistical, socio-hygienic, and analytical research methods was employed to gather and interpret data. Patient satisfaction surveys were conducted to evaluate perceptions of service quality, accessibility, and the effectiveness of care. In addition, expert interviews with healthcare professionals were carried out to gain deeper insight into institutional practices, staffing levels, and adherence to clinical protocols [7].

Medical records from both facilities were reviewed to assess compliance with treatment standards, documentation practices, and the availability of necessary resources. Data collected were subjected to comparative analysis to identify differences in patient outcomes, service delivery, and institutional efficiency [8].

The integration of both qualitative and quantitative methods allowed for a more nuanced understanding of how healthcare quality differs between non-state and public sectors. This methodological approach provided a solid foundation for evaluating key performance indicators and identifying systemic gaps that could affect patient safety and satisfaction, thereby supporting the study’s overall objective of informing improvements in healthcare governance and service standardization [9].

Results and Discussion

The study of the state of the quality of medical care in medical institutions of the non-state health care sector confirmed that the quality of medical care in most institutions does not meet the requirements. One of the main reasons for this is insufficient qualification of doctors [10].

This was confirmed by the results of the survey conducted to determine the level of satisfaction of the population with medical care. A total of 68.7% of respondents said they were satisfied with medical care 26.8% were not satisfied and 4.5% refused to answer. Many complained of dissatisfaction with office services, of which 15.2% complained of poor quality of ultrasound, 12.7% of X-rays, 10.5% of laboratory and 9.2% of receptionists. As a solution to these problems, it was proposed to improve the qualifications of doctors in non-state medical institutions by reducing modern technologies and techniques [11].

In order to determine the quality of medical care in medical institutions of the non-state health sector in Bukhara province, preliminary surveys of a number of private clinics were conducted. In particular, in the private clinic “TJS-MED” of Peshku district the indicators of the quality of medical care were studied by survey method. At the same time, in order to effectively implement the definition of the quality of medical care, the task of comparative study of the quality of medical care in medical institutions of the public health sector was set [12].

Vabkent District Medical Association (DMA) was also selected for this purpose. During the study of the thesis, a comparative study of the quality of medical care in the cardiology department of the district medical association in relation to the private clinic “TJS-MED” was conducted. In addition, the indicators of the quality of medical care for inpatients treated in Vabkent DMA were determined [13].

Quality indicators are defined to study the quality of medical care in medical institutions of the non-state health care sector. Quality indicators are divided by inpatient and outpatient types of medical care into two categories:

1. Ks - indicators characterizing the quality of hospital care.

2. Ka - indicators characterizing the quality of outpatient care.

To study these indicators, questionnaires were developed by categories. Using the developed questionnaires as an example, the quality indicators of medical care in the private clinic “TJS-MED” in Peshku district were studied [14].

The study of quality indicators was preliminary, so it was conducted by questionnaire method. When studying the indicators “filling in the table” in the columns “Yes” (“Ks” or “Ka” respectively) and in the absence of indicators “No” (again “Ks” or “Ka” respectively) values were entered. The indicators were given values of 1, 0 if the indicators were not studied, 1/1 (0.5) if the indicators were partially studied and 0/0 (0.5) if there was no data for the indicators (Tables 2,3). For values of 0.5 (1/1 or 0/0), explanations are given in the respective columns. The coverage of the study of the quality of medical care in medical institutions of the non-state health care sector is defined in percentages:

Figure 1.

The coverage of the study was found to be complete with a score of 86% - “excellent” and the indicators were recommended for use in further studies. This study of quality indicators was used to conduct a detailed study and evaluate the quality of health care delivery in the selected private clinic. The therapeutic department of the private clinic “TJS-MED” of Peshku district was selected to assess the quality of medical care in medical institutions of the non-state health sector [15].

Tuberculosis therapy department in Vabkent district of Bukhara region was selected for comparative analysis. When assessing the quality of medical care, these indicators were taken as services provided by the institution. Given that these indicators are significantly influenced by the material and technical base of the institution, they were also taken as indicators to be assessed [16].

Thus, we divide the quality indicators to be evaluated in further studies into 3 groups:

1. Indicators of the quality of the medical institution's activity.

2. Indicators of the quality of services provided by the medical institution.

3. Patients' opinion as a factor in improving the quality of medical care.

The table presents an assessment of 16 quality indicators of inpatient pediatric care at the private clinic "TJS-MED." Fourteen indicators were positively met, reflecting strengths in diagnostics, treatment, and patient satisfaction, while two indicators clinical-pathological diagnostic consistency and medical condition fulfillment require further improvement despite being studied (Table 1).

Conclusion.

Abroad, enough scientific research has been conducted and practical results have been obtained to study, evaluate and improve the quality of medical care in medical organizations of the non-state health care sector. Therefore, it is necessary to widely use their experience in the development of the sector. To assess the quality of medical care in medical organizations of the non-state sector of health care, it is advisable to identify and study quality indicators in advance, including in the comparative aspect, and to implement this work in the public health sector as well. The data are confirmed by preliminary studies conducted in the private clinic “TJS-MED” of Peshku district and in medical institutions of Vabkent district medical association.

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