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    Who is bearing the financial burden of non-communicable diseases in Mongolia?

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    Author
    Dugee, O; Palam, E; Dorjsuren, B; Mahal, A
    Date
    2018-06-01
    Source Title
    Journal of Global Health
    Publisher
    UNIV EDINBURGH, GLOBAL HEALTH SOC
    University of Melbourne Author/s
    Mahal, Ajay
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Dugee, O., Palam, E., Dorjsuren, B. & Mahal, A. (2018). Who is bearing the financial burden of non-communicable diseases in Mongolia?. JOURNAL OF GLOBAL HEALTH, 8 (1), https://doi.org/10.7189/jogh.08.010415.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/254662
    DOI
    10.7189/jogh.08.010415
    Abstract
    Background: Non-communicable diseases (NCDs) pose a formidable health and development challenge for low- and middle-income countries (LMICs). However, translating this challenge into resource allocation is seriously constrained by a lack of country specific evidence on NCD financing and its distributional implications. This study estimated expenditures associated with NCDs in Mongolia and their distributions across socioeconomic groups, focusing especially on private out-of-pocket (OOP) spending on the major NCDs. Methods: Secondary data analysis of multiple data sources on NCD related health service use and expenditures including detailed administrative data, World Health Organization STEPwise approach to Surveillance (STEPs) survey for Mongolia, and household surveys. Sample-weighted estimates of OOP expenditures for NCDs were constructed using STEPs data. OOP payments per discharge and per outpatient visit were estimated by condition and type of service provider, and survey data on utilization, after adjusting for utilization in administrative records. Results: NCDs in Mongolia accounted for more than one-third of total health expenditures in 2013. A significant fraction of this expenditure was borne by households in the form of OOP spending. CVD-related health spending is the major driver of NCD-spending in Mongolia, accounting for about 24.2% of total health expenditure. OOP health payments, largely driven by outpatient diagnostics and drugs, were incurred disproportionately by the better-off, seeking more specialist services and better quality private care. Conclusion: A high share of OOP spending for NCDs in Mongolia, which ostensibly enjoys universal health coverage, provides a cautionary tale for LMICs in a similar situation. Improvement in the quality of services at the primary care level and rural health care facilities, where the poor mainly attend, is desirable together with an effective exemption policy for user fees at higher level hospitals.

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