2015年-世界发展银行全球_Assessment_of_Systems_for_Paying_Health_Care_Providers_in_Mongolia___Implications_for_Equity_Efficiency_and_Universal_Health_Coverage_47页_2mb

Summary of the Assessment of Systems for Paying Health Care Providers in Mongolia

Core Content

This document presents an assessment of Mongolia's health care provider payment systems, focusing on their implications for equity, efficiency, and the achievement of universal health coverage (UHC). It outlines the current mix of payment methods, their design and implementation, and their effects on the health system. The study was conducted using the JLN Provider Payment Diagnostic and Assessment Guide, which evaluates how different payment systems influence health outcomes and resource allocation.

Main Payment Methods in Mongolia

Mongolia employs three main types of provider payment systems:

1. Line Item Budgets: Used by most public providers, these are based on historical spending and input-based allocation. They are the dominant method for public facilities.
2. DRG-Based Payments: Applied to inpatient services, particularly by hospitals, with a set of 115 diagnosis-related groups.
3. Fee-for-Service: A smaller portion of revenue, primarily used by private providers, where clients pay directly for services.

Payment System Mix by Provider Type

Key Features of the Payment System

• Global Revenue Caps: All providers face a cap on total revenue, which is set based on historical data or projected needs. Excess revenue from one source is offset by reductions in others.
• Input-Based Budgeting: The majority of public funding is managed through input-based line item budgets, which are rigid and limit flexibility in service delivery.
• Capitation Payments: Family health centers and some soum health centers are paid through capitation, which is based on population catchment.
• Decentralization: The Integrated Budget Law (IBL) has shifted some budgeting authority to subnational levels, allowing aimag and Capital City governors more control over health budgets.
• Strategic Purchasing: The Ministry of Health (MOH) aims to use strategic purchasing to better allocate resources to priority services and populations.

Positive and Negative Consequences

• Positive:

  • Global revenue caps help control costs.
  • Capitation and DRG-based systems offer some incentive for efficiency and quality.
  • Decentralization allows for more tailored budgeting at the local level.

• Negative:

  • Input-based line item budgets create inefficiencies and misalignment with service needs.
  • Providers report difficulties in managing surpluses or deficits.
  • The lack of flexibility in budgeting leads to under-resourcing and service delivery challenges.
  • The Budget Law restricts the use of output-oriented payment systems, limiting their potential to improve efficiency and quality.

Challenges and Limitations

• The current payment systems are largely input-based, which hinders the ability to create incentives for quality and efficiency.
• The global revenue cap system is perceived as somewhat arbitrary and inflexible.
• The IBL has introduced some decentralization, but it is constrained by the Budget Law, limiting its effectiveness.
• There is a lack of clarity on the rationale behind revenue caps, leading to confusion and inefficiencies.

Policy Implications and Roadmap

• The assessment highlights the need for a more flexible and output-oriented payment system to improve efficiency and quality of care.
• Strengthening strategic purchasing and aligning payment methods with health system objectives is essential.
• The JLN Guide recommends a roadmap for refining and realigning provider payment systems, including the use of better data and more transparent budgeting processes.
• The roadmap emphasizes the importance of stakeholder engagement and consensus-building to ensure the implementation of improved payment mechanisms.

Conclusion

The current payment systems in Mongolia are a mix of line item budgets, DRG-based payments, and fee-for-service. While they provide some financial control and stability, they are largely inefficient and do not support the necessary incentives for quality and efficiency. The IBL has introduced some decentralization, but the constraints imposed by the Budget Law limit its effectiveness. The study recommends a transition towards more output-oriented payment systems to better support UHC and the overall health system objectives.