Reform of the citizens' health insurance system
Project description
Title: Reform of the citizens' health insurance system
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Country: Mongolia
Lead executing agency: Ministry of Population Development and Social Protection (MoPDSP)
Overall term: 2011 to 2013
Context
The number of people covered by Mongolia’s social health insurance system – the so-called citizens' health insurance – has been declining for several years. Inherent weaknesses in the system mean that, in order to receive adequate treatment from doctors and hospitals, insured persons are having to make ever more supplementary payments from their own pockets. The financial risks associated with sickness are therefore rising, and the acceptance of the citizens' health insurance system is being eroded. This development is threatening an important institution of social protection at a time when Mongolia's economy is undergoing structural changes and its society is becoming increasingly fragmented.
Objective
There is a sustained improvement in the functional capacities of the institutions associated with citizens' health insurance.
Approach
The project is working with the Social Insurance General Office to further its organisational development, and to build capacities in the administration of the citizens’ health insurance system. It is also supporting the development of a quality assurance system for the services provided through the insurance.
Policy advice provided by the project is facilitating further reforms to improve the legal and institutional framework for the citizens’ insurance system. The project also promotes an open dialogue on the reform process, involving the Government and social partners (employers and employees), and it provides technical advice to help relevant civil society organisations to represent their interests competently and effectively.
Results achieved so far
The foundation has been put in place for bringing sustainable improvements to the functionality of the social health insurance institution. This was achieved through capacity building and the further development of existing competences. The approval of a medium-term business development plan for the institution was an important milestone. This is the first development-strategy document in the history of health insurance in Mongolia.
By successfully implementing the activities that were planned as part of the project, the institution has strengthened its position within the Social Insurance General Office and the Ministry of Population Development and Social Protection. Today the institution is a semi-autonomous agency.
With respect to the improvement of health care services, a significant contribution has been made to increased knowledge and changed attitudes among health insurance inspectors. In addition, an efficient quality management system has been established through a gradual programme of improvement, as well as the renewal and adjustment of the contracts with health care providers and the introduction of modern monitoring and management instruments.
The project has empowered its social partners and secured their inclusion in the change process. This in turn has strengthened the social consensus and cooperation in areas relevant to the further development of social health insurance. Social dialogue has become an integral part of the activities of the trade union, the employers' association and the government agencies in charge of health insurance.
The project’s achievements have contributed significantly to the sensitisation of the public and the stakeholders. It has increased people’s awareness of the relevance of social health insurance, as well as the willingness of decision makers to implement fundamental processes of change. This can be seen, for example, in the development of a long-term policy paper and a draft law that will make the initiated process of reforming the social health insurance system legally binding.