The key facts

  • The Oncology Center switched to electronic referrals via DMED; free care, according to the Center, was never suspended
  • Patients report delays in processing referrals, queues, and unclear procedures
  • Medical Insurance Fund: payment is made after treatment; the procedure does not imply delays in care

What changed in the referral procedure

Gazeta.uz received appeals from oncology patients in Tashkent who reported that obtaining a benefit referral (order) for treatment at the Republican Oncology and Radiology Center had become more complicated. According to them, the new system has not been fully debugged, which causes delays. In early October, messages appeared on social media about the suspension of free care at the Center; the Center denied this, explaining that only the referral procedure had changed: previously, residents of the capital went to the city branch with a paper referral, but now, as in other regions of Uzbekistan, patients are referred via an electronic referral through the DMED system (the state digital medical ecosystem).

The patient's new route

According to the Center's description, the patient first goes to a family polyclinic, where they undergo a blood test, X-ray, and ultrasound free of charge. Then comes an examination by the district (city) oncologist and clarifying tests. An electronic referral is issued through DMED. If the Center confirms it, the patient is provided free of charge with an examination, CT and contrast-enhanced MRI, PET-CT, histological and immunohistochemical studies, as well as free treatment — chemotherapy, radiation therapy, and surgical care. The Center cited as the reason for the changes that previously most patients were referred only with Form 027 without the necessary examinations done locally: the Center's polyclinic was operating under excessive load, and primary examinations were paid for from State Medical Insurance Fund resources intended for high-tech care. It was also difficult to determine whether patients from Tashkent needed treatment at the regional or republican level.

What patients said

Lola Kh., a patient with stage III triple-negative breast cancer, described the repeat-patient route "polyclinic — Oncology Center — polyclinic — back to the Center for chemotherapy" as prone to failures. According to her account, the district oncologist said he sees patients "only by consultation," then for about three hours she and a general practitioner tried to process the benefit referral until an employee of the district health department processed everything in 10 minutes. Her referral, she said, has been awaiting the Center's approval for the fourth day now. She emphasized that she is not against digitalization, but the new system must be debugged and staff trained in practice. Anvar M. reported that family polyclinics, in his words, cannot perform the laboratory indicators needed for a chemotherapy decision (urea, creatinine, ALT, AST, and others), which is why patients have to take tests at private clinics or with a one-day delay; the document package, he claims, is sent to the district health department knowingly incomplete, and the Center's internal commission cannot cope with the flow of requests. According to him, patients spend two or three days on queues and repeat tests, and, exhausted by this, agree to paid hospitalization. Muira Z. (Munira Z.) said her treatment was approved, but the Center demanded payment from the state insurance, whereas the Fund's call center, in her words, said the Center must admit her for treatment and send a report after treatment, after which the expenses would be paid: "After all, we don't know in advance how much it will cost." The Center, she said, stated that it could not hospitalize her without payment from the insurance.

The Medical Insurance Fund's response

The State Medical Insurance Fund responded to the publication with a statement: "Oncology patients must be provided with the necessary medical care in a timely manner. The electronic referral system was introduced not to complicate the treatment process, but to ensure the established procedure for organizing medical services, record-keeping, and transparency of their financing." The Fund emphasized that it pays medical organizations for services actually provided (after the completion of treatment) on the basis of medical documentation, the terms of the contract, and approved base prices, and that "the established financing procedure does not imply delays in treatment or denial of necessary medical care to a patient." According to Gazeta.uz, the Oncology Center and the Ministry of Health of Uzbekistan, at the time of the Fund's response being published, had made no statements regarding the material.