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Health insurance system in Mongolia

Health insurance system in Mongolia. Ch. Oyun, MD, MPH. Context. Introduction of the health insurance system Health insurance fund - revenue for health sector financing The current situation and concerns Payment methods Challenges and potential areas of improvement.

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Health insurance system in Mongolia

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  1. Health insurance system in Mongolia Ch. Oyun, MD, MPH

  2. Context • Introduction of the health insurance system • Health insurance fund - revenue for health sector financing • The current situation and concerns • Payment methods • Challenges and potential areas of improvement

  3. Health insurance systemintroduced • 1990-transition from a centrally planned economy to a market economy • The underlying reasons were the need - to increase revenue - to introduce market incentives - to raise public responsibility • Citizen’s health insurance law passed on July 8, 1993 and enforced on Jan 1, 1994

  4. Cont.. • Social health insurance system- solidarity • One of the five social insurance schemes

  5. The health insurance fund • Employers • Employees • Those in the informal sector • State subsidized groups

  6. Health insurance coverage • Compulsory for the total population (75%) • Voluntary for foreigners

  7. Percentage and amount of insurance premium as well as collection procedures • Employers - not exceed 6 percent of their salary and other similar income • Those in the informal sector pay approx 5USD per year • The state shall be responsible for the insurance premiums of vulnerable groups & pay approx 3USD per year

  8. Benefit packages of HI • In-patient care services • Out-patient care services • Pharmaceutical drugs prescribed by FGP from the list of essential drugs are discounted by 50-75% • Sanatoriums

  9. Benefit packages of HI Health insurance care services are provided by licensed and accredited health facilities under all forms of ownership

  10. Health insurance care services • Therapeutic • Neurological • Eye, ear, skin and muscles • Non-emergency injuries • Surgical

  11. Copayment • 10% at the aimag/district hospitals as well as regional diagnostic and treatment centers • 15% at the tertiary level hospitals respective of the variable inpatient costs

  12. Policy framework of health insurance • Health insurance policy is the responsibility of the MOSWL and MOH • Legislation and programs are enforced by the SSIGO, the governmental implementation agency under the MOSWL • Social Insurance National Council reports to the Parliament & authorizes revenue & expenditures from the HI fund

  13. State Social Insurance general Office (SSIGO) • Vertical management system • 31 branches in total • 1065 employees,100 of which deal w/health insurance • Social insurance inspectors in every soum (365)

  14. What HI has brought? • One of the key financial sources of health care and services • 25% of the total health care expenditure • Prospective payment with adjustment at the end • Insurers contract with health agencies

  15. Challenges and potential areas of improvement COVERAGE: • Informal sector’s enrollment • Reaching out to those who are in the informal sector is cumbersome • Gaps in contribution rates • Participation of the State and individuals

  16. Cont.. THE PROVIDER’S PAYMENT SYSTEM: • Moral hazard towards more inpatient care • The poor quality of health care and services • No systematic data for evaluation

  17. Conclusion • To introduce performance based incentives • To incorporate provider’s payment methods with the quality of services • To strengthen health insurance w/universal coverage • To enhance organizational capacity

  18. Thank you for your attention

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