Mongolia spent three per cent of its GDP on healthcare in 2017. Our country currently has a population of 3.1 million with an average age of 70 (75 in females and 66 in males). Sevently per cent of our population live in urban settlements while 30 per cent live in rural areas.
Mongolia is the country with the least population density in the world, which makes it an extremely challenging task to provide healthcare services to its people. According to a 2016 report from the Center for Public Health, Mongolia has 3,500 healthcare institutions (13 central hospitals and specialized centers, 5 regional diagnostic and treatment centers, 16 aimag hospitals, 12 capital city district hospitals and health centers, 6 rural central hospitals, 39 inter-soum hospitals, 273 soum health centers, 220 household health centers, 234 private hospitals with beds, and 1,076 private hospitals without beds) that employ 48,173 healthcare professionals. There are 309 people per general practitioner, and 268 per nurse. The doctor-to-nurse ratio has now reached 1:1.2.
Mongolia is ranked higher among developing countries by its availability of doctors, nurses, and hospital beds. However, the issues pertain to quality, not quantity. There is a lot to be done to improve the quality of healthcare services.
Due to the underwhelming quality of healthcare services, the number of Mongolians who traveled abroad to get medical treatment increased every year until 2014, when a decreasing trend was observed. A 2015 study from Mongolbank suggest that approximately 50,000 people cross the border to receive medical services every year, which means Mongolia loses 70-130 million USD per year in imports of medical services and treatment.
Analysing the cause, structure, and trend of Mongolia’s imports of medical treatment and taking adequate mitigation measures would not only save money out of people’s pockets but also make a substantial difference in improving in-country healthcare services.
TRIPS THAT SEEK TREATMENT
Mongolians continue to travel abroad on medical trips (medical tourism) in order to receive healthcare services for diseases and medical conditions both treatable and non-treatable in Mongolia.
In 1990, the list of diseases and disorders that weren’t able to be treated in Mongolia had 40 items while this number had decreased to 26 in 2017. The remaining 26 diseases and disorders are usually rare conditions treated surgically using the most advanced technology, equipment, and skills.
The overall reasons why Mongolia imports medical treatment and services include 1) tests, diagnosis, and treatment that are simply not done in Mongolia regardless of whether the disease is in the ‘non-treatable’ list, 2) diagnosis and treatment that require more advanced technology and equipment, 3) medical services that require a long waiting time despite being treatable in-country, 4) loss of faith in domestic healthcare institutions due to inaccurate diagnosis and differing views, and 5) preference to enjoy more comfort when receiving medical services.
If we look more deeply into the types of medical service and treatment people are choosing to receive abroad, despite their availability in Mongolia, we have the following list:
- Liver and kidney transplant. Although this can be done at Hospital no.1 and the National Cancer Center of Mongolia, the queue is often too long and there is a bigger risk of incompatible organs.
- Brain surgery. This is available at Hospital no.3, but the queue is long and post-surgery treatment and supervision are weak. However, the hospital offers closed surgery on coronary artery conditions in diagnosis and treatment.
- Heart defect surgery. This is available at Hospital no.3, but the queue is long and there is a limited pool of skilled professionals. The surgery is mainly conducted as open surgery. The hospital has started offering treatment for hearth rhythm problems.
- Surgery for injuries and joints. Both public and private hospitals, including the National Trauma and Orthopedic Research Center, Hospital no.2, Intermed, Grandmed, and Mungunguur, have started doing this surgery. However, there are complaints about their service.
- Rehabilitation services. People usually choose to travel abroad for highly specialized medical advice, more advanced equipment, a better environment and comfort, and quality of medications.
- Cosmetic surgery. People usually choose to go to Korea for cosmetic surgery to receive services from highly specialized medical institutions. The services offered in Mongolia are underdeveloped and have complaints about quality.
- Delivery. Those who are financially comfortable often travel to South Korea or the United States for better reliability. This outflow has eased somewhat after Intermed opened its doors.
- Cancer surgeries. The National Cancer Center of Mongolia bears the biggest burden, which makes the queue long and environment less than ideal. This center used to be the only place where chemotherapy was offered. Currently Intermed also offers chemotherapy along with surgery.
- Preventative check up. People used to travel abroad for better comfort and reliability. However, private hospitals such as Intermed, UB Songdo, and Grandmed, have reduced this outflow.
- Early detection of foetal abnormalities. Mongolia has a small number of professionals in this area. Due to insufficient capability in software and hardware, the National Maternal and Child Health Center does early stage tests only. Intermed is doing diagnosis at all stages, including early, mid, and late stages.
- MRI and CT scans for children under sedation. This used to be unavailable in Mongolia, but Intermed offers the service now.
- Eye surgeries. People usually choose to go to India or Russia because the cost is not that different and they consider that the technology and quality of care are better than what is offered in Mongolia.
These are the reasons why many Mongolians choose to go to China, South Korea, India, Thailand, Singapore, Taiwan, the United States, Japan, Russia, and other countries to receive medical treatment and services. Large Indian hospitals have already established representative offices in Ulaanbaatar and expanded into the countryside starting from 2017.
HEALTHCARE COSTS
A 2014 report from the World Bank states that an average Mongolian spends 200 USD a year on health-related costs, including health education, medical services, medications, and doing sports.These statistics put us 134th out of 216 countries – a similar rank as Turkmenistan, Ukraine, Angola, Egypt, Morocco, Bolivia, and Fiji. The annual cost per person increases to 420 USD in China, 893 USD in Russia, and 9,402 USD in the United States.
Mongolians go to the hospital relatively more often – 5.5 visits per person on average (4.7 times to public hospitals, and 0.7 times to private hospitals). Interestingly, some people don’t go to the hospital while some others visit them too often.
If you look at the issue from the market perspective, Mongolians are not valuing their health much and don’t want to invest an adequate sum into it, in addition to being relatively weak in financial capabilities. Therefore, public and private schools don’t earn much, have a low level of competitiveness and don’t pay their employees much.
Mongolia has many hospitals, and the quality of services vary a lot. We need to improve our health insurance. The insurance cost of spending one night in a public hospital is calculated at 35,000 MNT, which includes medication, treatment, and meals. This sum halves when it comes to private institutions. In order to keep their costs under this range, hospitals save money from medication, one-time use materials, and employee salaries. As a result, the quality grows weaker.
In this fashion, our hospitals have spent 20 years adjusting their medical services and treatment to financials, not patients. As a consequence, our entire healthcare system now has limited capability and people have lost faith, which makes them go abroad if they can pay for it.
STEPS TO REDUCE IMPORTING MEDICAL TREATMENT AND SERVICES
The competition between public and private healthcare institutions has improved the quality of medical services. Also, it is good to see that private hospitals now tend to specialize in a particular area. Nevertheless, our healthcare industry still needs a lot of investment.
We need to improve the capacity of our health insurance system, increase the funding pool, better calculate costs, and allow people to receive compensation regardless of being treated at public or private institutions.
It is time to set common standards, policy, and regulations to improve quality of services, ensure implementation, organize training, tidy up medical statistics and databases, and establish common terms for hospital infrastructure and equipment in public and private hospitals.
We need to become capable of producing good quality medication. Until then we could offer softer conditions on import of medications regulated in the United States and in Europe. In this way we can simplify the process that currently wastes too much time and paperwork.
The work of healthcare professionals should be better appreciated and valued. Instead of encouraging people to go on medical tourism, we need to bring skilled professionals from abroad and learn their know-how.
Finally, we can collect data by offering to pay a small amount, perhaps five per cent, of costs people are covering when they go abroad to receive medical services. It is time to collect that data and analyze it to come up with the right solutions.
2018.05.16
Trans. by B.Amar