health insurance coverage in mongolia: challenges … · •the mongol daatgal company carried out...
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HEALTH INSURANCE
COVERAGE IN MONGOLIA:
CHALLENGES AND
OPPORTUNITIES
HEALTH INSURANCE DEPARTMENT
2014.04.17
1
Content
Mongolian health insurance system
Types of health insurance, premium rate, fund income and expenditure
Insurance coverage, compensation and legal regulation
Further task
1
2
3
4
• Made amendment in 1994, 1997, 1998 , 2003 and 2006
• Revised in 2002 онд
• Revised law draft was submitted to the parliament by the Government in 2013
At first, Law on Citizens’ Health Insurance was passed in 1993
Law on citizens’ health insurance
1994 year
• The Mongol Daatgal Company carried out operation of citizens’ health insurance
From January 01, 1996
• The Health insurance service was transferred to organization of social insurance by Order No.195 of Government in 1995
1
Reduce the state budget loading
To include people to insurance, set up
the fund and to purchase health aid
and service on behalf of the people
from the fund
1
2
Based on friendship principle (wealthy
people support vulnerable group and
healthy people support diseased
people )
3
Principle of the health insurance
Financing of health sector
State budget
Health insurance fund
Income from pay service
Foreign loan and non-refundable
subsidy
•People employed and people with financial capability
• Young •Healthy
Diseased Elder
Risky group
Financial inability
Organization structure and number of staff
1994
Mongol
Daatagal
2008 1996 2006 2011
General
Authority for
Social Insurance
General
Authority for
Social Insurance
General
Authority for
Social Insurance
General
Authority for
Social Insurance
3 орон тоо
Department
of Health
Insurance
Inspection
and
Financing
Department
of Health
Insurance
Inspection
and
Financing
Departmen
t of Health
Insurance
8 орон тоо
5 орон тоо
Inspection
and Financing
Department
of Health
Insurance
Office of
Health
Insurance
14 орон тоо
34 орон тоо
Health
Insurance
2013 2011
ОН At General
Authority for
Social Insurance
Office of
Health
Insurance at
General
Authority for
Social
Insurance has
4 departments
• Policy planning
department
• Finance and
Accounting
Department
•Quality
Department for
Aids and Service
•Department of
Inspection
Health insurance premium
All Mongolian citizen are
responsible to purchase
health insurance
service Employed
Unemployed
Herder
Child
Elder
Student
Disabled people
Solder
Prisoner
.
Types of health insurance
Compulsory
Non-compulsory
Each Mongolian
citizen is responsible
to purchase
compulsory insurance
service in according to
Law on Citizen’s
Health Insurance
Foreign people
and non-citizens
can purchase the
health insurance
service
2
Type of Insured
Premium rate Health insurance
premium paid by
Staffs of the enterprise and organization Monthly fixed salary of 4%,
2% by employer and 2% insured
By Directors of private company and self-employers Total income of 1 % based on income statement
submitted to Department of Taxation in
accordance with Order No.87 of the General
Authority of Social Insurance
Part-time students of university, colleges and vocational education &
technical training centers
670 /a month/
8040 /a year/
Yourself
Unemployed people or herders
-youth under16 years old /for pupils of general educational schools under
18 years old/
- Without income except the pension benefit
-Citizens specified in Article 12, Law on Social Welfare
-Full-time student of university and colleges
-parents caring their child
From state budget
Foreign people and non-Mongolian citizens Minimum wage rate
of 6%
11520/138240
Yourself
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Premium /Governmental 2013/423/
Constitution of fund income
Premium paid by insured;
Premium paid by employer;
Premium paid by Human
Development Fund; Penalty for
premium term
exceeding;
Bank saving Interest of
free balance of the Fund;
Constitution of Fund
income
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The Fund Expenditure
Expense for state service of
the health insurance;
Expense of drug price discount ;
Operation expense of health
insurance ;
Membership expense of
council of health insurance;
Bonus expense
The Fund
expenditure
Payment methods for financing aids and service
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Until 2006.07.01
• Pre-payment method for estimating one insured
Until 2006.07.01-
2010
• The value is approximately 18 diagnosing groups,
2010
• By 115 group depending on diagnose and by value weight
3
Health insurance aids and service type
1 • Hospital treatment aids and service
2 • A day treatment aids and service
3 • Ambulatory treatment service
4 • Diagnosing and test
5 • Traditional treatment
6 • Rehabilitation nursing treatment service
7 • Easy treatment
8 • Necessary drug discount
8 • Bonus and benefit service and aids
The insured
Nursing service
Drug price discount
hospital service and aid
The Insured has
right to receive
state service
with amount of
1328000MNT
from Health
Insurance Fund
Health organizations with health
insurance agreement which carry out
operation in territory of Mongolia
insured herder, student unemployed other income
71
.9
2.4
10
.9
5.3
98.3
2.4
10
.9
4.9
14
0.7
3.0
10
.9
9.6
162
.5
2.2
12
.2
6.3
Income of Health Insurance Fund /2013 year/
/by type of insured, billion MNT/
2010 year 2011 year
2012 year 2013 year
90.1
121.6
166.5
183,1
2,3
31
.3
2,7
93
.2
2,5
93
.6
2,8
64
.5
82.6%
98.6 %
90.4 %
97.7
2010 year 2011 year 2012 year 2013 year
number of insured /thousand people/
Percent of insured
Insured of Health Insurance
/2013 year/
State hospital Parmacy Private hospital
& nursing
center
nursing and
caring center
64
.3
2.0
9.8
2.1
69
.9
3.0
11.9
2.4
89
.8
4.9
15.8
3.9
89
.6
9.7
17
.1
4.3
Expenditure of Health Insurance
Fund in 2013
/billion MNT/ 2010 year
2011 year
2012 year
2013 year
78.1
87.2
114.4
120,8
80
,3
2657,5
114,4
4126,5
120,8
3843,2 3198,7
87,2
EXPENDITURE OF HEALTH INSURANCE
FUND, STATE SERVICE AND NUMBER
OF INSURED
/billion MNT, thousand people/
FURTHER TENDENCY Goal
Make system to deliver state god
quality health service without
financial difficult to each citizen
who is insured at health insurance,
if necessary
Principle
To receive health service and aid on the basis of their
necessity
Transparency and meet with social partnership and
negotiation
to purchase efficiency state service centered to custom with good quality
and protect probable financial risk
Official regulation
Friendship principle
Objectives
Income of the health insurance and rate of insured
Increase scope of health insurance, and to ensure stability of Health Insurance Fund
Governance
Introduce good governance principle, increase satisfaction of insured
Unit of health insurance aid and service
To provide health demand of population completely and define optimally
Purchase qualified state service
Improve effective strategic procurement and quality assurance
E-program
Introduce e-card
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General Authority for Social Insurance Baga Toiruu 13-1 RD, 4th Khoroo, Chingeltei district, Ulaanbaatar 211238 Tel/Fax: 328030-/407, 408, 501/; 329392, www.ndaatgal.mn
Thank you
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