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Assessment of Systems for Paying Health Care Providers in Mongolia



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Implications for Equity, Efficiency and Universal Health Coverage

Ulaanbaatar, Mongolia, August 25, 2015 – 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 purchased (which providers are contracted to deliver the covered services), and how and how much the providers are paid.

Health care provider payment systems—the way providers are paid to deliver the covered package of services—are an important part of strategic purchasing to balance system revenues and costs in a way that creates incentives for providers to improve quality and deliver services more efficiently. This ultimately makes it possible to expand coverage within limited funds. In practice, however, provider payment systems are often under-utilized as an effective tool to achieve UHC goals.

As part of plans to revise the Law on Health Insurance, the Mongolian Ministry of Health (MOH) commissioned an in-depth assessment of its current provider payment systems to inform a roadmap with steps to strengthen the health purchasing function under the new law.

The 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.

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