Non-communicable diseases (NCDs) pose a formidable health and development challenge for low-and middle-income countries. 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 direct out-of-pocket (OOP) spending on the major NCDs.
How much Mongolia spends on NCD?
In 2013, Mongolia spent 34.1% of total health expenditure on health services for 4 major NCDs (cancer, cardiovascular diseases, diabetes, chronic obstructive pulmonary diseases including asthma).
What type of services are provided?
About 40.0% of NCD spending was on inpatient care, 45.6% on outpatient care and diagnostics, 14.0% for drugs and the remainder, only 0.4% for health promotion and surveillance.
How much people pay from their pocket?
Direct OOPs accounted for 49.0% of NCD inpatient care, 82.2% for outpatient care and diagnosis and 85.6% for the drugs prescribed by ambulatory care service providers.
Who pays most?
OOP expenses are largely being incurred by the better off.
Is there an equity concern?
Public sector allocations for outpatient care disproportionately reach better-off groups. Public subsidies per capita for NCDs were highest in the capital city, whereas OOP health spending per capita was highest in remote Northwestern Mongolia. This potentially indicates inadequate public sector services for populations with NCDs in remote areas of Mongolia. However, public funds for inpatient care for the major NCDs are relatively equitably distributed by socioeconomic status because of exemptions for the poor and retirees from co-payments in higher level hospitals and free admissions in primary level rural hospitals.
What are the main messages?
The Mongolian people pay from their pocket for NCD related services and treatments. They are driven mainly by outpatient care, including outpatient, diagnostics and drugs that make households financially vulnerable to NCDs. Social health protection mechanisms substantially limit the exposure of the poor to financial implications of NCDs, although Mongolia is considered a country with extensive population health coverage through a combination of social health insurance and subsidized public provision. Increasing reliance on co-payments for public services, unregulated growth in private providers and informal payments undermine the national health policy aimed at universal health coverage. Improvements are needed in service organization and the quality at the primary care level and rural health care facilities, where the poor mainly attend, along with an effective exemption policy at higher level hospitals. Health promotion and disease prevention programs need greater attention and investments.