1 health insurance system in mongolia ch. oyun, md, mph
TRANSCRIPT
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Health insurance system in Mongolia
Ch. Oyun, MD, MPH
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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 introduced
• 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
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Cont..
•Social health insurance system- solidarity
•One of the five social insurance schemes
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The health insurance fund
•Employers•Employees•Those in the informal sector
•State subsidized groups
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Health insurance coverage
•Compulsory for the total population (75%)
•Voluntary for foreigners
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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
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Revenue of HIF, 2006
12% - State subsidized
groups
83.9% - Employers & employees
4.1% -unemployed, herders & students
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HEALTH INSURANCE FUND EXPENDITURE, 2006
4%2%2%
9.0% for private
sector's care
13.0% for out-patient
care 70% for in-patient
care
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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
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Benefit packages of HI
Health insurance care services are provided by licensed and accredited health facilities under all forms of ownership
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Health insurance care services
–Therapeutic –Neurological –Eye, ear, skin and muscles–Non-emergency injuries–Surgical
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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
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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
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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)
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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
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Challenges and potential areas of
improvementCOVERAGE:
• 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
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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
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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
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Thank you for your attention