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Mongolia: Improving Health Care Financing for Universal Health Coverage

Sovereign (Public) Project | 51386-001 Status: Active

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 Officer
Habib, Najibullah East Asia Department Request for information
Country
  • Mongolia
Sector
  • Health
 
Project Name Improving Health Care Financing for Universal Health Coverage
Project Number 51386-001
Country Mongolia
Project Status Active
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 Poverty Reduction US$ 1.00 million
Strategic Agendas Inclusive economic growth
Drivers of Change Gender Equity and Mainstreaming
Governance and capacity development
Knowledge solutions
Partnerships
Sector / Subsector

Health / Health care finance - Health insurance and subsidized health programs - Health sector development and reform

Public sector management / Social protection initiatives

Gender Equity and Mainstreaming 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.
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)
S.Danzangiin Gudamj 5/1, Zasgiin Gazriin
II Bair, Ulaanbaatar 15160 Mongolia
Ministry of Health (formerly Ministry of Health and Sports)
1st Floor, Government Building VIII
Olympic Street 2, Ulaanbaatar
Mongolia
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 30 Mar 2020

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 Nov 2021 -
Financing Plan/TA Utilization Cumulative Disbursements
ADB Cofinancing Counterpart Total Date Amount
Gov Beneficiaries Project Sponsor Others
0.00 1,000,000.00 0.00 0.00 0.00 0.00 1,000,000.00 24 Dec 2018 291,526.52

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.

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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

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Related Publications

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Tenders

Tender Title Type Status Posting Date Deadline
Health Service Quality Monitoring Specialist (National) Individual - Consulting Closed 28 Jan 2020 30 Jan 2020
Health Service Quality Monitoring Specialist (National) Individual - Consulting Closed 11 Dec 2019 17 Dec 2019
Strategic Purchasing Expert and Team Leader (National) Individual - Consulting Closed 11 Dec 2019 17 Dec 2019
Software Developer/Programmer (National) Individual - Consulting Closed 11 Dec 2019 17 Dec 2019
Legal Expert (National) Individual - Consulting Closed 11 Dec 2019 17 Dec 2019
Costing and Payment Mechanism Specialist (National) Individual - Consulting Closed 11 Dec 2019 17 Dec 2019
Benefit Package Specialist (National) Individual - Consulting Closed 11 Dec 2019 17 Dec 2019
Information and Technology Specialist (National) Individual - Consulting Closed 11 Dec 2019 17 Dec 2019
Strategic Purchasing Expert (International) Individual - Consulting Closed 05 Dec 2019 11 Dec 2019
Consulting Firm for Improving Health Care Financing for Universal Health Coverage (51386-001) Firm - Consulting Closed 25 Jul 2019 13 Aug 2019
Project Coordinator Individual - Consulting Closed 26 Apr 2019 02 May 2019
Project Finance and Administrative Officer Individual - Consulting Closed 26 Apr 2019 02 May 2019

Contracts Awarded

No contracts awarded for this project were found

Procurement Plan

None currently available.