The healthcare system of Mongolia has undergone many transitions and changes since its establishment in 1921. The first healthcare system promised health services free of charge to the population of Mongolia under the first constitution of the People’s Republic of Mongolia. At this time, this promise was a bit ambitious because the country was not yet organised enough to handle such a daunting task. In order to keep true to its promise, Mongolia formed the Department of People’s Health Protection in 1925. This later expanded into the Ministry of Health in 1930. From 1941 to 1990, with subsidies from the former Soviet Union, the Mongolia transformed into a socialist system. During this period, there were vast improvements in the Mongolian health sector that can be seen in the increases in life expectancies, increases in infrastructural resources, and social services. However, the Mongolian healthcare system disintegrated along with the dissolution of the former Soviet Union. Without subsidies, the Mongolian health sector fell apart. Since 1991, the Mongolian healthcare system has been slowly transitioning from a centrally-planned economy to a market-oriented economy, and its health sector has followed suit.
Since 1994, Mongolia has had a compulsory health insurance scheme, which requires employees and employers to contribute equal amounts. Insurance for children, seniors, and the disabled is covered by the government. In 2006, the Health Sector Strategic Master Plan was implemented. This is a policy platform designed to be in effect from 2006-2015 that hopes to increase life expectancy, reduce infant, child, and maternal mortality rates, improve nutritional status, improve basic sanitation services, increase the percentage of the population that has access to clean drinking water, decentralise healthcare services, and includes numerous other healthcare goals.
Mongolia has seen great positive changes in its healthcare system, and with a growing economy, this trend is predicted to continue. The government is presently spending 3.5% of the country’s GDP on the health industry. They are trying to expand this to 6% over the next two years. Currently foreign aid makes up about 30% of the healthcare budget. There are hopes that by 2020, which is the year that economists have predicted will be when Mongolia will have one of the fastest growing economies in the world; it can become less reliant or even completely independent of foreign aid. However, one of the challenges that impede Mongolia from improving the health of its citizens is the disparity between the rural and urban areas and the rich and the poor. This is evident in the quality and accessibility to health and social services in rural areas. With the culture and lifestyle of the Mongolian population, it is often difficult for the government to create infrastructure that can service the nomadic or semi-nomadic groups. To tackle this problem, the Mongolian government is trying to create an e-health system so that regions can be linked through an integrated database.
The Mongolian healthcare system is administered centrally. The Ministry of Health and the prime minister are responsible for developing healthcare policies, regulations, and strategies. The Ministry of Health is then responsible for the implementation and assessment of these orders. These responsibilities are also delegated to the heads of each province, which are often made up of several districts. The capital city Ulan Bator is unique in that it is made up of nine urban local governments.
Healthcare services are divided into three tiers. At the primary level are family group practices (FGP), which were established by the Health Sector Development Program (HSDP), a program financed by the Asian Development Bank (ADB). FGPs are mainly found in the urban areas. Rural areas tend to have more facilities that belong in the secondary level, which is made up of district hospitals. These health centres can be quite large and offer a wide range of services. However, district hospitals may not be able to offer complicated medical procedures. At the tertiary level are the major hospitals and specialised facilities. These include centres for cancer, maternity care, psychiatric care, infectious diseases and many more. These centres do offer a higher level of care, but still remain poorly equipped relative to western standards. Patients with more serious injuries or illnesses may have to be evacuated to Beijing or Seoul. Again, the major problem with the healthcare system is not with the hospitals themselves, but with the infrastructure. In such a vast country, road maintenance is difficult. There are often bad roads or no roads at all, so citizens may have to travel very far to get treatment or diagnosis, which often mean that people are diagnosed too late. For example, over 83% of diagnosis of cancer is at the very late stages, which makes mortality rates very high. In addition to the Mongolian facilities, there is also one tertiary Korean hospital. The facilities and services are much more advanced than the local government’s facilities. However, services here are quite expensive and payment may be asked for immediately.
Including both public and private facilities, there are approximately 15 tertiary hospitals, 32 general hospitals, 13 district hospitals, 334 sub-district hospitals, 178 family group practices, 12 health centres, 13 centres for infectious diseases, 446 private hospitals, 35 emergency medical service centres, 26 blood transfusion stations, and 319 pharmacies. Furthermore, there are 6,162 doctors and 13,815 health workers working in the Mongolian health sector. These facilities are open to all expatriates and tourists. However, both public and private centres will ask for a cash payment at the time that service is provided.
Healthcare is improving in Mongolia, but most of this development is in Ulan Bator and other major urban areas. Rural areas still remain in dire need of access to medical treatment. In addition, the healthcare facilities in urban areas are still below that of Western Europe and North American standards. Visitors are strongly advised to purchase an international health insurance before they arrive as serious injuries or illnesses may require evacuation to Korea or China.