Multi–Channel Financing, Service Costing and the Financial Result in Public Hospitals: Evidence from a Seven–Year Reporting Archive

Public medical organisations in Uzbekistan now draw roughly half their resources from sources other than the budget, yet their accounting is organised on a model built for full budget financing. This paper traces the consequences of that mismatch through three connected questions: how multi-channel financing reshapes the organisation of accounting, whether the cost of a medical service can be computed from the resulting records, and what the reported financial result actually measures. We use the complete 2019–2025 statutory reporting archive of four public medical organisations, with the haematology centre serving as the object for which service-volume data exist. Four results are reported. Four independent financial flows operate in parallel, each with its own treasury personal account and its own reporting form, and no consolidating form exists; the number of accounts in use varied between one and four across the period and the budget account code changed twice. The three-stage model of cost formation lacks its middle stage entirely: directly attributable expenditure amounts to 11.3 per cent of the total in 2024, and the remaining 88.7 per cent cannot be allocated because no cost-centre cross-section is recorded anywhere. Applying partial identification, the cost of a bed-day is bounded between 67 and 598 thousand UZS in 2024, an 8.9-fold interval that narrows to 512–571 thousand only once four assumptions are stated openly; the sensitivity coefficient with respect to the measurement base reaches 4.33. Finally, the financial result on budget funds is shown to be an identity: it equals the difference between cash and actual expenditure to the last decimal in all seven years and conveys no independent information. Once capital consumption enters the calculation, the result changes sign in four years out of five.