Development of social health insurance in Mongolia: Successes, challenges and lessons
Development of social health insurance in Mongolia: Successes, challenges and lessons
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DOI：
10.1111/j.1468-246x.2005.00224.x
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发表时间：
2005-10-01
影响因子：
1.2
通讯作者：
Ron, Aviva
中科院分区：
文献类型：
--
作者：
Bayarsaikhan, Dorjsuren;Kwon, Soonman;Ron, Aviva
本文考察了蒙古国发展社会医疗保险的历程、成功之处、面临的挑战和经验教训。蒙古政府于1994年引入了社会健康保险，这是所有公共和私营部门雇员以及低收入和弱势群体的强制性保险。该计划还为处于工作年龄的失业人员提供自愿保险。由于政府为弱势群体提供了高水平的补贴，大约95%的人口在头两年内得到了医疗保险。保险福利最初涵盖了几乎所有的住院服务，除了一些特定的慢性病和传染病的治疗，这些疾病是由政府直接资助的。该计划不仅取得了许多成功，而且在保持全民覆盖方面也面临着挑战。新的融资安排几乎没有为医疗保健提供者提供多少财政激励，以遏制医疗支出，从而导致医疗成本迅速上涨。除了改革提供者的支付系统外，越来越多的人需要将福利扩大到门诊护理。蒙古强制医疗保险的发展表明，鉴于对弱势群体的政治承诺和政府财政支持，基于风险分担和资金汇集的预付费医疗保险机制在低收入国家是可行的。
This paper examines the process of developing social health insurance in Mongolia, and its successes, challenges and lessons. The government of Mongolia introduced social health insurance in 1994, which is compulsory for all public and private sector employees and low-income and vulnerable population groups. The scheme also provided voluntary insurance for unemployed people of working age. About 95 per cent of the population was covered by health insurance within the first two years thanks to a high level of government subsidy for vulnerable population groups. The insurance benefit initially covered nearly all inpatient services except the treatment of some specified chronic and infectious diseases, which were directly funded by the government. The scheme not only had many successes but also faced challenges in maintaining universal coverage. The new financing arrangement has provided little financial incentive for healthcare providers to contain health expenditure, contributing to rapid health cost inflation. In addition to reforming the payment system for providers, there has been an increasing need to expand benefits into ambulatory care. The development of compulsory health insurance in Mongolia shows that a prepaid health insurance mechanism based on risk sharing and fund pooling is feasible in low-income countries given political commitment and government financial support for vulnerable population groups.