Our society needs to have an informed discussion on which parts of our healthcare system are corrupt, in what layers, and why. For this purpose, the DeFacto Institute organized its TV debate on 1 December. The debate was kicked off with a presentation of results from an independent survey ‘Corruption situation in the public health sector of Mongolia’ commissioned by the Asia Foundation in 2014.
The survey covered 18 hospitals in Ulaanbaatar, 200 doctors and nurses who worked there for no less than one year, and 200 clients who have received their healthcare services for no less than two weeks. Fifty-five per cent of all clients said that they gave money and gifts in some form to doctors and nurses. It was either the clients (23 per cent) themselves or their families (32 per cent) who provided the gifts.
The Ministry of Health and the Ministry of Labor and Social Welfare had agreed to have their specialists take part in the TV debate. However, they bailed out at the last minute, just before the debate began. This is a clear example of how the authoritites, government, and its employees neglect their duty to provide information to the public. Given our governments nowadays last a year and a half, we are seeing more incapable, bureaucratic people who cannot do their job well and always try to avoid accountability.
Nevertheless, other participants – O. Batbayar, Executive Director of Transparency International Mongolia, and J. Amarsanaa, Advisor to the President and Doctor of Medicine – were respectful of their commitments and had an active participation in the debate. Due to the sudden absence of government representatives, the three of us had a discussion rather than a debate, which is summarized below.
Funding in healthcare
When increasing the allocated spending for healthcare, we need to improve its effectiveness, mechanism for oversight, and expand the role of civil society. Otherwise, the money will just leak away without any substantial impact.
Anomaly in medications and treatment
Ulaanbaatar currently has pharmacies everywhere. These pharmacies do not ask for prescriptions when providing pills and medications, which has resulted in people consuming medicine like food. One third of all medications and medical equipment in Mongolia is counterfeit. A WHO study reveals that nearly 30 per cent of all medications sold in our country are unregistered and low-quality. Mongolia has now become one of the countries with the most inappropriate use of medicines.
As of October this year, the government has spent 26.3 billion MNT to subsidize medications sold at pharmacies. Fifteen per cent of the health insurance fund went into these subsidies. The WHO has also reported that Mongolia is one of the ten countries that charge the highest prices for medications.
People pay for health insurance on a regular basis through their employer. An average of 50,000 MNT is also paid when receiving healthcare services. On top of that, you will need to give a gift to doctors and nurses. Mongolians are struggling financially when they become ill because medications are too expensive and of low quality.
The Asia Foundation study on health sector corruption has revealed that doctors, nurses, and other hospital employees do commit bribery, but the underlying cause is that they are underpaid when there is low availability of healthcare services.
Mongolia has the infrastructure to provide healthcare services to everyone. Having a three-layered public hospital system and private hospitals is advantageous when it comes to healthcare. Although the growing number of private institutions helps alleviate pressure on public hospitals, we need to improve the oversight on healthcare spending that is coming from the health insurance fund, and enhance the role of civil society. This involvement from civil society is absolutely called for, given the health insurance fund is now moving to the Ministry of Health, which basically means the service provider is going to be paying itself.
Public oversight
Public oversight is something that we must do for the sake of our own health, but we are not doing it well today. If people do not monitor how the money they pay for health insurance is being spent and ensure complete transparency of information, we will not be able to solve any problem in the health sector.
If the government opens an easy-to-access online platform to let everyone know where their money is going, it will be an important step to improve the public oversight mechanism.
Introducing private institutions into the public healthcare services and insurance would allow for improved public oversight on how the funds are being spent. Also, making that information available on public media would enhance the efficiency of our healthcare system.
Trans. by B.Amar
2017.12.06