Tsevelvaanchig Uranchimeg, Narula Indermohan S, Gouda Hebe, Hill Peter S
School of Public Health, University of Queensland, Herston, Queensland, Australia.
Department of Health Policy and Management, Health Policy Research Center, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
Int J Health Plann Manage. 2018 Jan;33(1):185-201. doi: 10.1002/hpm.2417. Epub 2017 May 29.
Regulating the behavior of private providers in the context of mixed health systems has become increasingly important and challenging in many developing countries moving towards universal health coverage including Mongolia. This study examines the current regulatory architecture for private healthcare in Mongolia exploring its role for improving accessibility, affordability, and quality of private care and identifies gaps in policy design and implementation.
Qualitative research methods were used including documentary review, analysis, and in-depth interviews with 45 representatives of key actors involved in and affected by regulations in Mongolia's mixed health system, along with long-term participant observation.
There has been extensive legal documentation developed regulating private healthcare, with specific organizations assigned to conduct health regulations and inspections. However, the regulatory architecture for healthcare in Mongolia is not optimally designed to improve affordability and quality of private care. This is not limited only to private care: important regulatory functions targeted to quality of care do not exist at the national level. The imprecise content and details of regulations in laws inviting increased political interference, governance issues, unclear roles, and responsibilities of different government regulatory bodies have contributed to failures in implementation of existing regulations.
在包括蒙古在内的许多朝着全民健康覆盖迈进的发展中国家，在混合卫生系统背景下规范私立医疗服务提供者的行为变得越来越重要且具有挑战性。本研究考察了蒙古私立医疗保健的现行监管架构，探讨其在提高私立医疗服务的可及性、可负担性和质量方面的作用，并找出政策设计和实施中的差距。
采用了定性研究方法，包括文献回顾、分析，对蒙古混合卫生系统中参与监管并受其影响的45名关键行为者代表进行深入访谈，以及长期参与观察。
已经制定了大量规范私立医疗保健的法律文件，并指定了特定组织来进行卫生监管和检查。然而，蒙古的医疗保健监管架构在设计上并非最优，无法提高私立医疗服务的可负担性和质量。这不仅限于私立医疗服务：针对医疗质量的重要监管职能在国家层面并不存在。法律中法规内容和细节不精确，导致政治干预增加、治理问题、不同政府监管机构的角色和职责不明确，这些都导致了现有法规实施的失败。
