Assessment of Systems for Paying Health Care Providers in Mongolia

Achieving access to basic health services for the entire population without risk of financial hardship or impoverishment from out-of-pocket expenditures (“universal health coverage” or UHC) is a challenge that continues to confront most low- and middle-income countries. As coverage expands in these countries, issues of financial sustainability, efficiency, and quality of care quickly rise to the surface. Strategic health purchasing is an important lever to efficiently manage funds for UHC through the definition of what is purchased (which services and benefits the covered population is entitled to receive), from whom services are purchase (which providers are contracted to deliver the covered services), and how and how much the providers are paid.

In the early 1990s, after 70 years of a socialist system, Mongolia transitioned to a market economy and embarked on reform across all sectors, including health. Since that time, the health system has gradually moved from a centralized “Semashko-style” model to somewhat more decentralized financing and service delivery, with a growing role for private sector providers and private out-of-pocket financing. The main challenge to the system has been to maintain the universal coverage of the socialist period in the face of drastically reduced public funding, while introducing incentives for greater efficiency and improved quality of care. 

Tis assessment was conducted to help inform the design and implementation of Mongolia’s provider payment systems going forward. After providing a brief overview of Mongolia’s health financing and service delivery system, this report describes the provider payment assessment and summarizes the main findings. It discusses the positive aspects and shortcomings of the current mix of payment systems and compares the design and implementation with international good practices. The chapter concludes by providing a roadmap for refining and realigning Mongolia’s provider payment system going forward.

The Mongolia Provider Payment Assessment was carried out jointly by the Ministry of Health, the Joint Learning Network, the World Bank and the World Health Organization (WHO). The assessment was led by Cheryl Cashin under the task team leadership of Aparnaa Somanathan. The assessment was carried out under an overall program of analytical work on Service Delivery under Decentralization in Mongolia led by Elena Glinsakaya and Philip O’Keefe. 

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