HEALTH INSURANCE COVERAGE IN MONGOLIA: CHALLENGES AND OPPORTUNITIES HEALTH INSURANCE DEPARTMENT

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1 HEALTH INSURANCE COVERAGE IN MONGOLIA: CHALLENGES AND OPPORTUNITIES HEALTH INSURANCE DEPARTMENT

2 Content 1 Mongolian health insurance system 2 Types of health insurance, premium rate, fund income and expenditure 3 Insurance coverage, compensation and legal regulation 4 Further task

3 1 Law on citizens health insurance At first, Law on Citizens Health Insurance was passed in year The Mongol Daatgal Company carried out operation of citizens health insurance 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 From January 01, 1996 The Health insurance service was transferred to organization of social insurance by Order No.195 of Government in 1995

Revised in 2002 онд Revised law draft was submitted to the parliament by the Government in 2013 From January 01, 1996

4 Principle of the health insurance State budget 1 Reduce the state budget loading Foreign loan and non-refundable subsidy Financing of health sector Health insurance fund 2 To include people to insurance, set up the fund and to purchase health aid and service on behalf of the people from the fund Healthy Income from pay service Diseased Elder Young 3 Based on friendship principle (wealthy people support vulnerable group and healthy people support diseased people ) People employed and people with financial capability Financial inability Risky group

the people from the fund Healthy Income from pay service Diseased Elder Young 3 Based on friendship principle (wealthy people support

1994 Mongol Daatagal Organization structure and number of staff Health Insurance Department of Health Insurance 3 орон тоо 1996 2006 2008 2011 General Authority for Social Insurance Inspection and

5 1994 Mongol Daatagal Organization structure and number of staff Health Insurance Department of Health Insurance 3 орон тоо General Authority for Social Insurance Inspection and Financing Department of Health Insurance 5 орон тоо General Authority for Social Insurance Inspection and Financing Departmen t of Health Insurance 8 орон тоо General Authority for Social Insurance Inspection and Financing Department of Health Insurance 14 орон тоо General Authority for Social Insurance Office of Health Insurance 34 орон тоо 2013 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 2011 ОН Department for Aids and Service Department of Inspection

Inspection and Financing Department of Health Insurance 14 орон тоо General Authority for Social Insurance Office of Health Insurance 34 орон тоо 2013 At General Authority for Social Insurance Office

6 2 Health insurance premium Types of health insurance. Compulsory Each Mongolian citizen is responsible to purchase compulsory insurance service in according to Law on Citizen s Health Insurance Herder Child Elder Student Disabled people Non-compulsory Foreign people and non-citizens can purchase the health insurance service Unemployed Employed All Mongolian citizen are responsible to purchase health insurance service Solder Prisoner

Law on Citizen s Health Insurance Herder Child Elder Student Disabled people Non-compulsory Foreign people

7 Premium /Governmental 2013/423/ 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 Part-time students of university, colleges and vocational education & technical training centers 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 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 670 /a month/ 8040 /a year/ Yourself From state budget Foreign people and non-mongolian citizens Minimum wage rate of 6% 11520/ Yourself 7

/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

8 Constitution of Fund income Premium paid by employer; Premium paid by Human Development Fund; Penalty for premium term exceeding; Premium paid by insured; Constitution of fund income Bank saving Interest of free balance of the Fund;

premium term exceeding; Premium paid by insured;

9 The Fund expenditure Expense for state service of the health insurance; Bonus expense Expense of drug price discount ; The Fund Expenditure Membership expense of council of health insurance; Operation expense of health insurance ; 9

discount ; The Fund Expenditure Membership expense of

10 3 Payment methods for financing aids and service Until Pre-payment method for estimating one insured Until The value is approximately 18 diagnosing groups, 2010 By 115 group depending on diagnose and by value weight 10

11 Health insurance aids and service type 1 Hospital treatment aids and service 2 A day treatment aids and service Ambulatory treatment service Diagnosing and test Traditional treatment Rehabilitation nursing treatment service Easy treatment Necessary drug discount Bonus and benefit service and aids

Diagnosing and test Traditional treatment Rehabilitation nursing treatment

Health Insurance Fund Nursing service Health organizations with

12 The insured Drug price discount hospital service and aid The Insured has right to receive state service with amount of MNT from Health Insurance Fund Nursing service Health organizations with health insurance agreement which carry out operation in territory of Mongolia

13 , , , , Income of Health Insurance Fund /2013 year/ /by type of insured, billion MNT/ 2010 year 2011 year 2012 year 2013 year Insured of Health Insurance /2013 year/ number of insured /thousand people/ Percent of insured 98.6 % , % 82.6% insured herder, student unemployed other income 2010 year 2011 year 2012 year 2013 year

2013 year Insured of Health Insurance /2013 year/ number of insured /thousand people/ Percent of insured 98.

2.0 3.0 4.9 2.1 2.4 3.9 4.3 9.7 9.8 11.9 15.8 17.1 80,3 64.3 69.9 87,2 114,4 89.8 89.6 120,8 Expenditure of Health Insurance Fund in 2013 /billion MNT/ 2010 year 2011 year 2012 year 2013 year 114.

14 , ,2 114, ,8 Expenditure of Health Insurance Fund in 2013 /billion MNT/ 2010 year 2011 year 2012 year 2013 year ,8 EXPENDITURE OF HEALTH INSURANCE FUND, STATE SERVICE AND NUMBER OF INSURED /billion MNT, thousand people/ ,7 4126,5 3843,2 2657,5 State hospital Parmacy Private hospital & nursing center nursing and caring center

114.4 120,8 EXPENDITURE OF HEALTH INSURANCE FUND, STATE SERVICE AND NUMBER OF INSURED /billion MNT,

15 4 Goal Make system to deliver state god quality health service without financial difficult to each citizen who is insured at health insurance, if necessary FURTHER TENDENCY 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 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 Official regulation Purchase qualified state service Improve effective strategic procurement and quality assurance Friendship principle E-program Introduce e-card 15

protect probable financial risk 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

16 Thank you General Authority for Social Insurance Baga Toiruu 13-1 RD, 4 th Khoroo, Chingeltei district, Ulaanbaatar Tel/Fax: /407, 408, 501/; , 16

MonGolia - Security for your life

Øâåéöàðèéí õºãæëèéí àãåíòëàã Social Insurance General Office Social insurance MonGolia - Security for your life ulaanbaatar 2015 Social insurance - Security for your life WWW.SaM.Mn WWW.nDaatGal.Mn Ulaanbaatar