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

2. 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. 3 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

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

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

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

7. 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

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10. 10 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

11. 11 Benefit packages of HI Health insurance care services are provided by licensed and accredited health facilities under all forms of ownership

12. 12 Health insurance care services –Therapeutic –Neurological –Eye, ear, skin and muscles –Non-emergency injuries –Surgical

13. 13 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

14. 14 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

15. 15 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)

16. 16 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

17. 17 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

18. 18 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

19. 19 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

20. 20 Thank you for your attention