INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 02,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 1379
THE ROLE OF MEDICAL CLUSTERS IN REFORMING THE
HEALTHCARE SYSTEM
Ramz Muhammadiev
Applicant, (PhD), Associate Professor.
+99894-660-48-07
Nigorakhon Murotova
Applicant, (PhD), National Medical Center
+99893-505-31-03,
Abstract:
This article discusses consistent reforms in the healthcare system through the creation
of modern medical clusters, the purpose of which is to provide specialized medical services to
patients, increase the quantity and quality of innovative services and their convenience for the
population. Important tasks are considered to be the effective use of state budget funds and state-
owned objects.
Keywords:
financing, medical cluster, private sector, management, healthcare.
Introduction.
In the world, effective, fair and sustainable financing of health care is a matter of constant
attention, which serves to determine priorities and main directions of financing the state social
protection system. In addition, among the main tasks facing the state and society is improving
the quality of medical services and ensuring equal, convenient and affordable access to medical
services for all segments of the population.
To improve the efficiency of financing and ensure the quality of medical services, first of
all, it is necessary to attract funds from insurance systems and the private sector in addition to
funds allocated from the state budget, develop public and private partnerships, equip medical
institutions with modern equipment and inventory, systematically and continuously improve the
qualifications of doctors, and to improve the efficiency of the allocated funds, a serious approach
to the creation and digitalization of medical information systems is required.
The main conditions for the creation of medical clusters are providing them with modern
equipment necessary for the provision of specialized, prompt and innovative medical services, as
well as the availability of qualified practical personnel. Also, all types of medical services are
provided under one roof, which saves time, money and other resources. The legal basis for the
creation of medical clusters in Uzbekistan are the Decrees of the President of the Republic of
Uzbekistan No. PF-5590 of December 7, 2018 [1], No. PK-4890 of November 12, 2020 [2] and
Resolution of the Cabinet of Ministers No. 318 of May 20, 2021 [3], defining the main tasks and
areas of activity of medical clusters.
According to these documents, using international experience, the quality and efficiency
of medical services are improved in the regions, international standards are introduced in
diagnostics and provision of highly qualified medical consulting care, as well as training,
retraining and advanced training of medical and pharmaceutical personnel. The tasks of the
clusters include conducting scientific research, creating favorable conditions for training highly
specialized doctors, implementing a pilot project for the introduction of state medical insurance
INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 02,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 1380
mechanisms and developing scientifically based conclusions on the introduction of insurance
mechanisms in practice.
Also conducting scientific research, creating favorable conditions for training doctors of
narrow specialties, active participation in the implementation of a pilot project for the
introduction of state health insurance mechanisms and the development of scientifically based
conclusions on the introduction of insurance mechanisms, providing patients with highly
qualified specialized inpatient care in accordance with clinical standards approved by the
Ministry of Health, providing advisory and organizational and methodological support to
specialists of district (city) medical associations.
In addition, medical organizations conduct an examination of the quality of treatment and
preventive processes, analyze cases of general morbidity and mortality, eliminate factors leading
to loss of ability to work and disability. Targeted programs for the development of medical care
on a contractual basis are developed and implemented.
Analysis of literature on the topic.
The problem of creating clusters has been studied by scientists both foreign Portan M. [4],
Tsikhan T. [5], Altenburg T. [6], Granovetter M. [7], Emelyanov S. [8], Mochalnikov V. [9], and
domestic Rasulov T. [10], Urdushev H., Eshankulov S. [11], Ochilov I. [12] with an emphasis on
the formation of their structure, the use of existing technologies, maintaining statistics,
accounting for income and expenses, planning costs and achieving economic efficiency.
Although these studies have played an important role in forming the theoretical
foundations of economic efficiency in the country's economic life and production system,
scientific research on social protection of the population, the advantages of medical clusters, the
targeted use of funds through their organization, saving funds by distributing the necessary funds
to regions with a high incidence rate, and achieving economic efficiency in the fight against
unexpected infectious diseases has not been carried out.
The economic aspect of creating medical clusters in the healthcare system is to improve
the availability and convenience of medical services, improve their quality, effectively use
budget funds and centralize medical services, optimize duplicate functions and areas of activity
to save money and direct it to the treatment of patients. Also, the introduction of a self-control
mechanism in the healthcare sector contributes to achieving positive results.
Research Methodology
The methodological basis of the study is the goals and objectives provided for in the field
of sustainable development for the period up to 2030, through the creation of a network of
medical clusters, centralization of medical services, improving their quality, training personnel
and providing them with decent wages, with the transition to the principle of distributing funds
according to the patient's condition. In the process of scientific research, methods of grouping
and comparison, analysis and synthesis, a systems approach to the relationship between
economic phenomena and the object of study were used.
Analysis and results.
From the standpoint of international practice, the organization of dwarf multidisciplinary
specialized centers is considered irrational from both organizational and economic points of view,
since high-tech expensive equipment, highly qualified expensive specialists, as well as a unique
and expensive building will stand idle. For this reason, the absolute majority of hospitals in
countries with a developed health care system are multidisciplinary and, as a rule, large - more
than 500 beds. Of course, it is possible to bring the functionality of the existing 155 regional and
INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 02,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 1381
23 republican specialized centers to international standards, but this will require a lot of money
and time. And it is unreasonable to do this!
It would be more rational to build one medical cluster in each regional center with 1000-
1200 beds in large regions and 700-800 beds in small regions and use them effectively.
As a result of our analysis, we studied the existing opportunities and sources for
organizing a medical cluster, which were discussed above, and the following calculations were
formed. In Tashkent, 620.0 billion soums (50 million US dollars) were spent on the construction
of the National Medical Center with 460 beds, and an additional 200.0 billion soums (15 million
US dollars) were spent on modern medical equipment. Thus, about 800.0 billion soums ( 65-70
million US dollars) will be required to build a modern building (medical cluster) with 500 beds
in the regions .
The total amount spent on average per 1 place is 1.8 billion soums (140.4 thousand
dollars). It is clear that for the construction of a modern building (medical cluster) with an
average of 500 beds in the regions, about 800.0 billion soums (65-70 million dollars ) will be
required. If we are talking about the necessary large medical cluster, then the funds will increase
again and will amount to an average of about 1.5-1.6 trillion soums (120-130 million USD). If
similar medical clusters are planned to be created in 14 regions, funds in the amount of 21-22
trillion soums (1.7-1.8 billion USD) will be required.
When studying the issue of covering the costs associated with the creation of medical
clusters at the expense of our own capabilities, the following was established: the number of
specialized medical centers in the regions is 155 - they are located in 11 state institutions in each
region. Based on location (geolocation) and convenience, on average, each building and
infrastructure is estimated at approximately 30-40 billion soums. On average, the cost of 155
objects is 4.6-6.2 trillion soums (or $360-490 million).
In addition, these 155 specialized medical centers spend an average of 3-8 billion soums
annually on the maintenance of their buildings and facilities. This shows that from 450 billion
soums to 1.2 trillion soums (or $ 36-97 million) are spent annually.
Since the heating and cooling systems of buildings and structures are not adapted to the
modern low-energy type, 2-5 billion soums are spent on each institution, which amounts to 310
billion to 775 billion soums (or 24-61 million US dollars) annually.
At the same time , due to the lack of necessary medical equipment and qualified
personnel in 155 specialized medical centers, the population and patients in need of medical care
migrate and choose other medical institutions, and ultimately, in specialized medical centers, on
average, up to 100 billion soums (or 7-8 million $) leads to a decrease in income.
Similarly, because each of the 155 specialized medical centers in the regions operates as a
separate legal entity, each facility employs, on average, more than 80 full-time support and
administrative staff, totaling more than 13,000 people. On average, up to 1.8 trillion soums (or
$140 million) are spent on wages and equivalent payments and deductions from wages per year,
with the main funds in the system being spent on management and departmental work, and not
on providing medical services to patients.
On funds allocated from the State budget for the healthcare sector in 2016-2024, as well as
their ratio to the population and patients
INTELLIGENCE
in billion soums
INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 02,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 1382
Indicato
rs' Name
Year
2016
Year
2017
Year
2018
Year
2019
Year
2020
Year
2021
Year
2022
Year
2023
Year
2024
GDP
Volume
1993
25
2491
31
406 64
8,5
511 83
8,1
580
203,2
738 42
5,2
888 34
1,7
1 066 56
9,0
1 301 75
8,8
Total
Governm
ent
Budget
Expendit
ures
3971
4
4934
3,6
79 736,
1
118 00
8,7
144 14
3,0
188 25
7,1
236 69
2,0
281 097,
4
312 920,
7
Total
Healthcar
e Sector
Expendit
ures
4883 7097 9 696,6 14 781,
6
20 752,
9
24 834,
6
26 493,
8
31 196,4 33 480,1
Share of
Healthcar
e
Expendit
ures
in
GDP
2,4% 2,8% 2,4%
2,9%
3,6%
3,4%
3,0 %
2,9 %
2,6 %
Share of
Healthcar
e
Expendit
ures
in
Governm
ent
Budget
Expendit
ures
12,3
%
14,4
%
12,2% 12,5 % 14,4% 13,2% 11,2% 11,1 %
10,7 %
Number
of
Permane
ntly
Registere
d
Individua
ls
(in
units)
31 57
5 332
32 38
8 561
32 956
099
33 255
538
34 558
900
35 271
296
36 024
947
36 799
771
37 535
605
Total
Morbidit
y
(in
27 54
2 558
27 14
4 368
27 807
028
25 359
730
23 593
967
23 384
819
23 891
583
19 266
460
18 312
460
INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 02,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 1383
units)
Morbidit
y Rate as
a
Percentag
e of the
Populatio
n
87 % 84%
84 %
76%
68%
66%
66%
52 %
49 %
Governm
ent
Budget
Expendit
ures per
Capita
(Amount
per
Person)
in UZS
1 257
754
1 523
488
2 419
464
3 548
543
4 170
937
5 337
402
6 570
225
7
638
564
8
336
637
Healthcar
e
Expendit
ures per
Patient
(Amount
per One
Patient)
in UZS
177
289
261
454
348
710
582
877
879
585
1 061
997
1 108
918
1
619
208
1
828
269
As can be seen from the table, although healthcare spending in 2020 amounted to 3.6% of
GDP, it declined in subsequent years and dropped to 2.6% in 2024. The funds allocated to
healthcare in 2017 and 2020 were high. However, this share has decreased in recent years. The
funds allocated per capita have been steadily increasing and reached 8.3 million soums in 2024.
The funds allocated per patient have increased 10-fold over 10 years. This indicates an increase
in demand for medical services and an increase in funds.
There is a decrease in the share of the
state budget in the healthcare sector, which indicates the need to introduce more effective
financing mechanisms.
The creation of modern medical clusters and their integration with district and city
medical institutions will allow the elimination of health management bodies, centralization of the
management of medical institutions and the use of the saved 100 billion soums (7-8 million US
dollars) to improve the quality of medical services. The focus of the medical system and, as a
result, savings of up to 100 billion soums (7-8 million US dollars) allows the funds to be directed
towards improving the quality of medical services.
INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 02,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 1384
The analysis shows that the share of healthcare expenditure in GDP has fluctuated
between 2.4% and 3.6% for many years. The peak was reached in 2020 (3.6%), which may be
due to the impact of the pandemic. The share of medicine in state budget expenditure in 2017
and 2020 reached 14.4%, then decreased. Although the state budget and funds allocated to the
population are growing, the share of GDP is decreasing. Healthcare expenditure is declining as a
share of GDP, which leads to a decrease in the sector's impact on the economy. It is necessary to
improve the efficiency of funds allocated to healthcare.
Conclusions and suggestions.
Access to qualified medical care is one of the constitutional rights of every person, and
ensuring public health should remain the main task of the state. The development of the medical
system, improving the quality of medical services and bringing specialized medical care closer to
the population should become the main goal.
The best option is to carry out high-tech operations performed in the capital at the
regional and district level and to establish services in the area where the population lives. As a
result, most citizens living in remote areas will save time and money spent on traveling hundreds
of kilometers to the capital for treatment.
Based on the above, in order to provide patients with innovative medical services of
specialized quality through the organization of modern type medical clusters, as well as the
efficient use of state budget funds and state-owned objects, the following is proposed.
1.
Attracting international credit funds for the creation of modern medical clusters and
the implementation of construction and repair work using these funds.
2.
By selling vacant buildings after new facilities are put into operation, we can partially
repay international loans.
3.
The remaining loan funds will be distributed according to the schedule for the creation
of new medical clusters.
List of references:
1. Decree of the President of the Republic of Uzbekistan dated 07.12.2018 No. UP-5590 “On
comprehensive measures for the radical improvement of the healthcare system of the
Republic of Uzbekistan
2. Resolution of the President of the Republic of Uzbekistan dated 12.11.2020 No. PP-4890
“On measures to introduce a new model for organizing the healthcare system and
mechanisms of state health insurance in the Syrdarya region”.
3. Resolution of the Cabinet of Ministers of the Republic of Uzbekistan dated 05.20.2021 No.
318 “On measures to create a new model for improving the healthcare system in the
Syrdarya region - the Gulistan medical cluster”
4. Porter M. Clusters and the new economics of competition. // Harvard Business Review.
Nov/Dec, 1998, vol.76, issue 6. -P. 77.
5. Tsikhan T.V. Cluster theory of economic development. // “Theory and practice of
management”, 2003, No. 5.
6. Altenburg T., Meyer-Shtamer J. How to promote clusters: policy experiences from Latin
America. // World Development, 1999, 27 (9).
7. Granovetter M. The success of an innovation cluster is based on openness, flexibility and
freedom. // The New Times, 2010, April 6.
8. Yemelyanov S. Strategy for the development of science and technology in the USA in the
INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE
ISSN: 2692-5206, Impact Factor: 12,23
American Academic publishers, volume 05, issue 02,2025
Journal:
https://www.academicpublishers.org/journals/index.php/ijai
page 1385
21st century. // Problems of the theory and practice of management. 2002..№ 1. P. 19-24.
9. Mochalnikov V.N. Sectoral features of clustering of the economy/Questions of Economics
and Law. 2014. No. 7. -P. 74-82
10. Rasulov, T.S., Makhmasobirova N. The experience of the United States of America in the
formation of innovative clusters. - Tashkent: Economy and Finance., 2017,7.
11. Urdushev Kh., Eshankulov S., Mavlyanov M. Clusters as an integrated structure. - Tashkent:
Аgrobiotexnologiya va veterinariya tibbiyoti ilmiy jurnalining maxsus soni/2023.
12. Ochilov I.S. Issues of financial analysis of clusters, services and food security.-Problems
and scientific solutions/2023 Australia, Melbourne. researchgate.net.
