Development of Social Health Insurance in Mongolia: Successes, Challenges and Lessons

Publication Date: Apr 2005
Published by: Oxford, U.K: Blackwell Publishing Ltd.
Document Type: Journal Article (PDF)

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Is a prepaid health insurance mechanism based on risk sharing and fund pooling feasible in low-income countries?

This paper talks of the phase after social health insurance scheme was introduced in Mangolia in 1994. It explains:

• The process of developing the social health insurance scheme,
• Its successes, challenges and lessons.

The paper argues that developing such scheme was not very easy in Mangolia as the population had received free medical care for more than seven decades. However, more than 95% of the population was covered under the scheme within the first two years.

As per the paper, the factors which contributed to the successful implementation of the insurance scheme are:

• General awareness of the necessity of fundamental reform towards democracy and a market economy with adequate social protection;
• Political commitment and economic support provided in the form of subsidy to the health insurance premiums of the low-income and vulnerable population.

It then outlines the challenges faced in maintaining the universal coverage as:

• Difficulties in maintaining good-quality services when budgetary financing was under-estimated, reduced or delayed;
• The little financial incentive for healthcare providers to contain health expenditure, in the new financing arrangement, contributing to rapid health cost inflation;
• Decrease in population coverage due to limited capacities of the insurance administrative office to process information on the persons insured, lack of client-oriented arrangements for the collection of premiums, inability or unwillingness to pay premiums on the part of certain population groups etc.

The paper lists down following points as lessons learned from the implementation of health insurance scheme: