Tsevelvaanchig Uranchimeg, Gouda Hebe, Baker Peter, Hill Peter S
Health Policy Plan. 2017 May 1;32(4):476-486. doi: 10.1093/heapol/czw157.
The collapse of the Soviet Union in 1990 severely impacted the health sector in Mongolia. Limited public funding for the post-Soviet model public system and a rapid growth of poorly regulated private providers have been pressing issues for a government seeking to re-establish universal health coverage. However, the evidence available on the role of private providers that would inform sector management is very limited. This study analyses the current contribution of private hospitals in Mongolia for the improvement of accessibility of health care and efficiency.
We used mixed research methods. A descriptive analysis of nationally representative hospital admission records from 2013 was followed by semi-structured interviews that were carried out with purposively selected key informants (N = 45), representing the main actors in Mongolia's mixed health system.
Private-for-profit hospitals are concentrated in urban areas, where their financial model is most viable. The result is the duplication of private and public inpatient services, both in terms of their geographical location and the range of services delivered. The combination of persistent inpatient-oriented care and perverse financial incentives that privilege admission over outpatient management, have created unnecessary health costs. The engagement of the private sector to improve population health outcomes is constrained by a series of issues of governance, regulation and financing and the failure of the state to manage the private sector as an integral part of its health system planning.
DISCUSSIONS/CONCLUSION: For a mixed system like in Mongolia, a comprehensive policy and plan which defines the complementary role of private providers to optimize private public service mix is critical in the early stages of the private sector development. It further supports the importance of a system perspective that combines regulation and incentives in consistent policy, rather than an isolated approach to provide regulation.
1990年苏联解体对蒙古的卫生部门造成了严重影响。后苏联模式公共系统的公共资金有限，且监管不力的私立医疗服务提供者迅速增加，这一直是寻求重新建立全民医保的政府面临的紧迫问题。然而，关于私立医疗服务提供者在部门管理方面作用的现有证据非常有限。本研究分析了蒙古私立医院目前在改善医疗服务可及性和效率方面的贡献。
我们采用了混合研究方法。首先对2013年具有全国代表性的医院入院记录进行描述性分析，随后对有目的地挑选出的关键信息提供者（N = 45）进行了半结构化访谈，这些信息提供者代表了蒙古混合卫生系统中的主要参与者。
营利性私立医院集中在城市地区，其财务模式在这些地区最具可行性。结果是私立和公立住院服务在地理位置和提供的服务范围上都存在重复。持续以住院治疗为导向的护理与鼓励住院而非门诊管理的不当财务激励措施相结合，造成了不必要的医疗成本。私营部门在改善人群健康结果方面的参与受到一系列治理、监管和融资问题的限制，而且国家未能将私营部门作为其卫生系统规划的一个组成部分进行管理。
讨论/结论：对于像蒙古这样的混合系统而言，在私营部门发展的早期阶段，制定一项全面的政策和计划来界定私立医疗服务提供者的补充作用，以优化公私服务组合至关重要。这进一步支持了从系统角度出发的重要性，即在一致的政策中结合监管和激励措施，而不是采取孤立的监管方法。
