Exploring the efficiency of primary health care provision in rural and sparsely populated areas: a case study from Mongolia.

Mongolia is facing serious challenges in the health sector and the macro-economic sphere that have important implications for health financing and the completion of universal health coverage. In this context, improving the efficiency of primary health care facilities is a critical issue. We study the efficiency of Soum Health Centres (SHCs) that provide primary care in rural Mongolia. Based on activity and resources data collected for all SHCs of Mongolia in 2017 and 2018 we estimate bias-adjusted efficiency scores. A double bootstrap truncated regression procedure is then used to study the factors associated with SHCs' efficiency. On average, SHCs could potentially engage in the same activity while reducing overall resource use by ∼23%. A comparatively higher population density and dependency ratio in the districts where they are located tend to favour SHCs' efficiency. Conversely, the higher the poverty rate in the soum, the lower the efficiency. We find a positive association between SHCs' efficiency and the proportion of doctors in the health workforce. The human resources allocation process and the capitation formula currently used to pay SHCs should be adjusted based on the size and socioeconomic/demographic characteristics of the population living in the catchment area of SHCs.