Mongolia : Improving Health Care Financing for Universal Health Coverage

Sovereign Project | 51386-001

The proposed knowledge and support technical assistance (TA) will support development of more efficient health insurance system in Mongolia through assessment, development of more effective model, policy reforms, and institutional development. This is to shift state funding from financing budget lines (input-based) to purchasing services (output-based), to allow for more equitable health care system and achieve universal health coverage under the Sustainable Development Goals. The TA will lay the foundation of the strategic purchaser, which will be consolidated by the Multitranche Financing Facility (MFF): Improving Access to Health Services for Disadvantaged Groups, which is still in process and is expected to be approved by 2019.

Project Details

Project Name Improving Health Care Financing for Universal Health Coverage
Project Number 51386-001
Country / Economy Mongolia
Project Status Closed
Project Type / Modality of Assistance Technical Assistance
Source of Funding / Amount
TA 9701-MON: Improving Heath Care Financing for Universal Health Coverage
Japan Fund for Prosperous and Resilient Asia and the Pacific US$ 1.00 million
TA 9701-MON: Improving Health Care Financing for Universal Health Coverage (Supplementary)
Technical Assistance Special Fund US$ 135,000.00
Operational Priorities OP1: Addressing remaining poverty and reducing inequalities
OP2: Accelerating progress in gender equality
OP6: Strengthening governance and institutional capacity
Sector / Subsector

Health / Health care finance

Gender Some gender elements
Description The proposed knowledge and support technical assistance (TA) will support development of more efficient health insurance system in Mongolia through assessment, development of more effective model, policy reforms, and institutional development. This is to shift state funding from financing budget lines (input-based) to purchasing services (output-based), to allow for more equitable health care system and achieve universal health coverage under the Sustainable Development Goals. The TA will lay the foundation of the strategic purchaser, which will be consolidated by the Multitranche Financing Facility (MFF): Improving Access to Health Services for Disadvantaged Groups, which is still in process and is expected to be approved by 2019.
Project Rationale and Linkage to Country/Regional Strategy

The purchasing capacity of HIOs has improved over the last decade with support from ADB. However, key operational systems needed for effective purchasing of health services, such as the capacity to (i) provide quality of cost services; (ii) monitor the quality of service provision through an effective information technology-based system; (iii) review claims efficiently; and (iv) contract providers, are not optimal resulting in limited purchasing capacity. The lack of autonomy of the HIOs, combined with insufficient quantity and quality of staff (e.g., to review claim and ensure proper quality monitoring) and deficient purchasing procedures need improvements.

State funds budgeting, allocation, and control are entirely budget line item-based leading to complete passive purchasing of health services. This is mostly based on historical budgets poorly linked to actual cost and volume of services and inefficient resources allocation. The lack of coherence between Ministry of Health (MOH) policies and state funds budgeting and allocation reinforces the passive nature of services purchased with state funds and does not provide incentives for health providers to deliver more rational care (e.g., penalizing the excess use of antibiotics by withholding payments). The performance assessment system for budget managers and providers established for over a decade is not effective, i.e., results of assessments have no real effect on resource allocation.

Out-of-pocket expenses in the health sector are very high caused by weak purchasing practices; excessive admissions; over prescription of drugs (cost of drugs is poorly reimbursed except for in patients); unregulated setting of tariffs (fees) leading to abuse; ceilings imposed by health insurance on reimbursement of diagnostic tests; and gaps in benefit packages (e.g., high cost services). State budget and health insurance funding have increased substantially and nominally over the last decade but government health spending as a proportion of total public spending and as a proportion of gross domestic product have dropped. Overall, high out-of-pocket expenses coupled with inefficient resource allocations in the sector result in limited financial protection for Mongolians against ill-health despite very high health insurance coverage (95%).

Impact

Health status of Mongolians improved

Project Outcome
Description of Outcome

Strategic purchaser model approved and initiated

Progress Toward Outcome The TA became effective on 10 January 2019. The TA implementation is on track after delays due to change of implementation arrangements to better align the TA with government regulations, strengthen sustainability, and synergize with the outputs of related projects.
Implementation Progress
Description of Project Outputs

Strategic purchasing model defined

Government and health care provider capacity and capability for strategic purchasing implementation strengthened

Institutionalization of the strategic purchaser initiated

Status of Implementation Progress (Outputs, Activities, and Issues) All national consultants have been mobilized. All output targets have been achieved 100%. Some of them achieved more than planned. For the first output, strategic purchaser model has been approved by the decisions of the Cabinet, Minister of Health and NHIC. As the HIGO is a government implementing agency the strategy and structure should be approved by the Minister of Health. As an insurance agency, NHIC also needs to approve the structure of the HIGO, which is overlapping. For the second output, the TA conducted an exten-sive capacity building activities in strategic purchasing for all key ministries and agencies and all levels of public and private providers. For the third output, the TA made significant efforts to strengthen the strategic purchasing capacity of the HIGO: i) developed key decisions to be made by the purchasing organization; ii) developed practical guidelines and tools to be used internally by the purchasing organization; and iii) conducted various in class trainings and on the job facilitation and guidance.
Geographical Location Nation-wide
Summary of Environmental and Social Aspects
Environmental Aspects
Involuntary Resettlement
Indigenous Peoples
Stakeholder Communication, Participation, and Consultation
During Project Design
During Project Implementation
Business Opportunities
Consulting Services A consulting firm will be engaged to provide a total of 21 person-months of international and 60 person-months of national consultants' inputs.
Responsible ADB Officer Habib, Najibullah
Responsible ADB Department East Asia Department
Responsible ADB Division Urban and Social Sectors Division, EARD
Executing Agencies
Ministry of Finance (formerly Ministry of Finance and Economy)
Ministry of Health (formerly Ministry of Health and Sports)
Timetable
Concept Clearance 06 Sep 2018
Fact Finding 21 Aug 2018 to 23 Aug 2018
MRM -
Approval 24 Dec 2018
Last Review Mission -
Last PDS Update 29 Sep 2022

TA 9701-MON

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
24 Dec 2018 10 Jan 2019 10 Jan 2019 30 Nov 2020 30 Apr 2022 14 Nov 2022
Financing Plan/TA Utilization Cumulative Disbursements
ADB Cofinancing Counterpart Total Date Amount
Gov Beneficiaries Project Sponsor Others
135,000.00 1,000,000.00 0.00 0.00 0.00 0.00 1,135,000.00 06 Dec 2022 1,027,000.06

Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.

The Access to Information Policy (AIP) recognizes that transparency and accountability are essential to development effectiveness. It establishes the disclosure requirements for documents and information ADB produces or requires to be produced.

The Accountability Mechanism provides a forum where people adversely affected by ADB-assisted projects can voice and seek solutions to their problems and report alleged noncompliance of ADB's operational policies and procedures.

In preparing any country program or strategy, financing any project, or by making any designation of, or reference to, a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.

Title Document Type Document Date
Improving Health Care Financing for Universal Health Coverage: Technical Assistance Report Technical Assistance Reports Dec 2018

Safeguard Documents See also: Safeguards
Safeguard documents provided at the time of project/facility approval may also be found in the list of linked documents provided with the Report and Recommendation of the President.

None currently available.


Evaluation Documents See also: Independent Evaluation

None currently available.


Related Publications

None currently available.


The Access to Information Policy (AIP) establishes the disclosure requirements for documents and information ADB produces or requires to be produced in its operations to facilitate stakeholder participation in ADB's decision-making. For more information, refer to the Safeguard Policy Statement, Operations Manual F1, and Operations Manual L3.

Requests for information may also be directed to the InfoUnit.

Tenders

Tender Title Type Status Posting Date Deadline
Health Service Quality Monitoring Specialist (National) Individual - Consulting Closed
Legal Expert (National) Individual - Consulting Closed
Information and Technology Specialist (National) Individual - Consulting Closed
Health Service Quality Monitoring Specialist (National) Individual - Consulting Closed
Costing and Payment Mechanism Specialist (National) Individual - Consulting Closed
Strategic Purchasing Expert and Team Leader (National) Individual - Consulting Closed
Software Developer/Programmer (National) Individual - Consulting Closed
Benefit Package Specialist (National) Individual - Consulting Closed
Strategic Purchasing Expert (International) Individual - Consulting Closed
Consulting Firm for Improving Health Care Financing for Universal Health Coverage (51386-001) Firm - Consulting Closed
Project Finance and Administrative Officer Individual - Consulting Closed
Project Coordinator Individual - Consulting Closed

Contracts Awarded

No contracts awarded for this project were found

Procurement Plan

None currently available.