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Economic impacts of chronic conditions in a country with high levels of population health coverage: lessons from Mongolia
Author(s) -
Dugee Otgontuya,
Sugar Bolormaa,
Dorjsuren Bayarsaikhan,
Mahal Ajay
Publication year - 2019
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13231
Subject(s) - socioeconomic status , poverty , environmental health , population , medicine , health care , household income , socioeconomics , business , geography , economic growth , economics , archaeology
Objective To analyse the impact of non‐communicable diseases (NCDs) on household out‐of‐pocket (OOP) expenses, catastrophic health payments and medical impoverishment in Mongolia, a middle‐income country with a high population health insurance coverage rate. Methods Secondary data analysis of the Mongolian Household Socioeconomic Survey with 12 840 households, including information on standard of living, OOP spending, and health conditions of household members. Measures of catastrophic spending and medical impoverishment were constructed for Mongolia. The association of medical impoverishment and catastrophic spending with a range of socioeconomic and demographic covariates and health conditions was assessed using multiple regression models. Results OOP health spending contributed to an 8% increase in the incidence of poverty in Mongolia. The impoverishment associated with medical expenses is concentrated in the poorer quintiles, indicating some deepening of poverty among the already poor. Households with a member affected by NCDs and with multiple morbidities were more likely to experience catastrophic spending and medical impoverishment than those with infectious diseases. The main drivers of the financial distress were expenditures incurred for outpatient services, including for diagnostics and drugs. Conclusion Despite high rates of population health insurance coverage, health expenditures have substantial impoverishing effects in Mongolia, with the impacts being greater among households containing individuals with chronic conditions. Addressing the goal of universal health coverage (UHC) in Mongolia needs attention to the depth of coverage, especially for expenditures on outpatient care and medicines, and targeting the poor effectively.