Transcript ЭРҮҮЛ МЭНДИЙН САЛБАРЫН САНХҮҮЖИЛТ

FINANCIAL OPTIONS FOR TB
CONTROL IN MONGOLIA
Dr D. Narangerel, Director of Public Health Division, MoH
The 9th Technical Advisory Group and National TB Programme
Managers meeting for TB control in the Western Pacific Region
Manila, Philippines
9-12 December 2014
CONTENT
Demographic, economic and health
indicators
 Overview of health service delivery
 Health financing system

◦ Legal and policy framework
◦ Current health financing

Financing of TB control in Mongolia
DEMONGRAPHIC AND HEALTH
INDICATORS
INDICATORS
Population size
Gross domestic product
(GDP) per capita (USD)
% of population living under
poverty line
MONGOLIA
SOURCE
2,9 million Health indicators 2013, MOH
4,056 USD (2013) World bank
27% (2013) World Bank, National
Statistical Office of Mongolia
Maternal mortality (modelled
estimate, per 100,000 live
births)
68 (2013) WHO Global Health Statistics,
2014
Under 5 mortality (per 1000
live births)
28 (2012) WHO Global Health Statistics,
2014
Life expectancy (male/female)
64/72 (2012) WHO Global Health Statistics,
2014
STRUCTURE OF HEALTH
SERVICE DELIVERY



Primary level
◦ FGPs in urban areas and soum (village)/intersoum hospitals,
bag feldshers in rural areas
Secondary level
◦ Ulaanbaatar (capital) city health department – 9 district
health centers and hospitals, private sector
◦ 21 Provincial health departments – provincial hospitals and
ambulatories, private sector
Tertiary level
◦ Specialized centers/ hospitals, private sector in urban areas
◦ Regional diagnostic and treatment centers in rural areas
HEALTH FINANCING SYSTEM
Legal and policy framework
◦ Budget Law
◦ Health law
◦ Law on citizens’ social health insurance
◦ Law on social insurance
◦ Law on special foundation
◦ Government and ministerial orders,
resolutions, guidelines
HEALTH FINANCING SYSTEM

Two main sources of financing:
◦ Social health insurance
◦ State budget
2.3% 0.6%
22%
State budget
Social health insurance
75.1%
Revenue from main and
supportive services
External funding
Health expenditure as % of GDP
600
4
560.6
3.5
3.3
500
3.1
3.1
455.6
520.6
3.5
3
3
2.9
400
2.8
2.5
321.2
300
2
Health expenditure as % of GDP
250.3
211.5
1.5
206.4
200
1
100
0.5
0
0
2008
2009
2010
Total health expenditure
2011
2012
2013
2014
HEALTH FINANCING SYSTEM

Health insurance benefits cover mainly:
◦ Curative care at secondary and tertiary level hospitals
◦ Limited outpatient services and outpatient drugs

State budget:
◦ primary health care services in family group practices
(FGPs), soum hospitals
◦ specific services at secondary care level in provincial
and city district public hospitals and health centres
◦ specialized public hospitals at tertiary care level in
Ulaanbaatar (capital)
HEALTH FINANCING SYSTEM
Health services and treatment of
diseases financed by state budget
Health services and treatment
of diseases funded through
health insurance
Consultation, diagnostics and treatments
related to pregnancy and childbirth until the end
of the postnatal period
Inpatient and outpatient services at
secondary and tertiary care levels
Medical services for children provided by
public hospitals
Day care at secondary care level.
Treatment of tuberculosis, cancer,
HIV/AIDS and mental illness
Rehabilitation services for patients
admitted to sanatoria.
Epidemiological and sanitation measures
for communicable diseases, including
disinfection and routine immunization
Traditional inpatient treatment.
Long-term care for patients admitted to
sanatoria and rehabilitation centres.
FINANCING OF TB CONTROL




TB services are free
60% of funding from state budget, 40% from GF
and WHO in 2014
Government gradually increases its financial
commitment to TB control (90% of first-line
drugs, drugs for management of side effects, 50%
of laboratory reagents and diagnostics, inpatient
and outpatient care, health workforce)
GF: 100% MDR-TB, 50% of laboratory reagents,
patient support (lunch DOT and home DOT,
transportation cost), capacity building, infection
control, TA, M&E)
HEALTH SECTOR REFORM

Revision of Health Law and Law on social health
insurance law are in the process
◦ TB financing options have been discussed
 Keep financing for TB control from state budget
 High TB burden and ongoing transmission of
TB in the community
 70% of TB cases are poor people living under
poverty line
 High risk groups for TB are not insured, no
residential registration
 Health insurance system is not optimal, needs
improvements
CHALLENGES
Sustainability of TB control after end of the
GF support
 Continue keeping TB control in high political
agenda
 More work is needed to strengthen
collaboration with non-health sector (Min. of
Population Development and Social Welfare,
Min. of Justice, Min. of Education, Min. of
Defense)
 Lack human resources

Thank you for your attention