Ulaanbaatar MONGOLIA

2016.04.21

1ST ANNUAL BUSINESS

COUNCIL MONGOLIA

SUMMIT

PRIVATE HEALTH INSURANCE: COULD BE A

LEVERAGE TO IMPROVE HEALTHCARE SYSTEM

IN MONGOLIA?

1

Dr. Usukhbayar Ariunbold, M.D., M.Sc. Health Insurance Director, Mandal General Insurance

CURRENT HEALTH INDICATORS IN

MONGOLIA

PROBLEMS AND MISSING POINTS IN

HEALTHCARE SYSTEM

WHAT CAN BE IDEAL SOLUTION TO THE

PROBLEM?

BENEFITS AND OUTCOMES

АГУУЛГАCONTENTS

2

I. CURRENT HEALTH INDICATORS – MONGOLIA

25468

Human resources:

39 diagnoses are incurable in Mongolia

Clinical diagnoses:

Health environmental factors:

Private expenditure

42%

Other indications:

Total population 3 051 325/ under 15 age 27.5% / over 60 age 5.8%

Number of medical facilities:

- Nationwide 1500- Private 1030 - Pharmacies 855- Hospital beds

19,582 - Social health

insurance 270B Medical professionals

2.7 physician

3.5 nurse

Per 1000 population

Male Female

6572

Life expectancy: 67

3

Improved sanitation 64%(U), 29% (R)

Improved drinking

water 100%(U), 53% (R)

- Air pollution - Food borne illness - Poor access to

water- Sanitation- Chemical safety

II. PROBLEMS AND MISSING POINTS IN HEALTHCARE SYSTEM

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• More than 40’000 patients/ annually

• More than 100 Million USD/ annually

• Healthcare expenditure - 3.5% of GDP

• (2-5 times lower, excluding out-of-pocket)

• Mismanagement in public sector

• No matter how much they earn,

people do not have additional

financial support for their health

• More than 50% of families become

poor after paying serious medical

problems

• Social health insurance up to 2M locally

• Literally no protection for serious

medical conditions for population

• Less attention for preventive medicine

• Risk on lifestyles, food, drinking,

smoking, behavioral

LOWER GDP ON HEALTH CARE SYSTEM

HIGH LEVEL OF OUTBOUND MEDICAL TOURISM: NO OPTION TO GET ADDITIONAL PROTECTION

INCAPABLE SOCIAL HEALTH INSURANCE SYSTEM

LESS DEVELOPED PUBLIC HEALTH EDUCATION

II. PROBLEMS AND MISSING POINTS IN HEALTHCARE SYSTEM

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• Health service focuses more on treatment,

less on service (patient experience)

• Less integration of private and public

partnership

• Less encourage from state health insurance

to public hospital

• High risk of investment for private sector

• Less monitoring on quality control in public

hospitals

• People spend 42% of out of pocket

expenditure from total

• Expensive treatments 100%

• Health related financial catastrophe

• Patient/ insured have unequal

knowledge of medical service

• Bureaucracy in medical service,

particularly among public hospitals

PRIVATE AND PUBLIC HOSPITALS

UNSATISFIED HEALTHCARE SERVICE HIGH OUT OF POCKET EXPENSES

INEQUALITIES IN THE DISTRIBUTION OF HEALTH AND HEALTH CARE KNOWLEDGE

III. WHAT CAN BE IDEAL SOLUTION TO THE PROBLEM?

Bringing international standard with long term healthcare sector development in Mongolia

INNOVATIVE HEALTH SERVICE PRODUCT UPDATED CUSTOMER SERVICE CONNECTED INFRASTRUCTURE

A. INNOVATIVE PRODUCT: JARGALAN HEALTH INSURANCE

Market Leading Health Insurance Product :

7

Co-Insurance 70:30

Leading private & Public hospital

networks

Chronic condition

benefit

Dedicated customer

service

Tailored insurance benefits

Serious health condition coverage

Discounts: family, corporate

Payment option: Reinsurer: LAMP Group

Inpatient service benefits Outpatient service benefits

Pregnancy service benefits Private room service benefits

INNOVATIVE PRODUCT: JARGALAN HEALTH INSURANCE

JARGALAN HEALTH INSURANCE GOLD PACKAGE

- Up to 50’000’000 MNT per year- Full electivity - Co-Insurance - Serious health conditions (Organ

transplantation)- IP + OP + PREG + PRIV- Monthly payment ≈ 40’000MNT - Network hospitals + All public

Hospitals

- Up to 50’000’000 MNT + 250’000$ per year- Full electivity - Co-Insurance - Mongolia + China (Mainland) + Thailand- Serious health conditions (Organ transplantation)- IP + OP + PREG + PRIV + Traveler's PA - IP cash benefit + Accompanying member cash

allowance- Monthly payment ≈ 76’000MNT - Mongolian+ Asian Network Hospitals + All public

Hospitals

JARGALAN HEALTH INSURANCE PLATINUM PACKAGE

B. UPDATED CUSTOMER SERVICE

Medical expert team on Health Insurance :

Hospital based Claim reception Medical phone line assistance Short reimbursement period International medical assistance Health insurance operation unit in

Mongolia Mapped customer experience journey Online service assistance Corporate agent support Improved hospital service

C. CONNECTED INFRASTRUCTURE: HOSPITALS

• Intermed (IMC)

• GrandMed

• Mungun Guur

• Gurvan Gal

• Ulaanbaatar

SongDo

• University

General Hospital

• Achtan Elite

• UB Med

1. Tertiary level hospitals

2. Second level hospitals

3. National Cancer Centre

4. Non-Communicable disease

hospital

5. Family Hospitals

6. Rural hospitals

7. All maternity hospitals

8. State traumatology centre

PUBLIC HOSPITALS :PRIVATE NETWORK HOSPITALS:

Network hospitals:

• Leading 10 private hospitals in Mongolia

• Direct Billing

• Reduced service fee

• Customer service

• Int’l standard on medical service

• All public hospitals (Reimbursement)

• Asian Class A level international hospitals

IV. BENEFITS AND OUTCOMES

SOCIAL IMPACT NATIONAL LEVEL HEALTH CARE SYSTEM LEVEL IMPACT FOR PEOPLE

IV. BENEFITS AND OUTCOMES

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NATIONAL LEVEL SOCIAL IMPACT

• Retain outbound cash flow from Mongolia

• Reduced number of Incurable disease list (39)

• Private health insurance reduces Out of pocket

expense, but from insurance

• Increase voice of healthcare via private sector

cooperation

• People will have choice for

healthcare awareness

• Prevent financial catastrophe caused

by health condition

• Additional strong support for social

health insurance system – synergism • Cooperation with public organizations: PHI

• Disseminate health education through strengthened

channels (private companies, hospitals)

INCREASED GDP ON HEALTH CARE SYSTEM

REDUCED OUTBOUND MEDICAL TOURISM: OPTION TO GET INT’L STANDARD SERVICE

MORE PROTECTION FOR THOSE WHO NEEDED :

STRENGTHENED HEALTH INSURANCE SYSTEMIMPROVED AWARENESS FOR THEIR HEALTH

IV. BENEFITS AND OUTCOMES

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HEALTH CARE SYSTEM LEVEL IMPACT FOR PEOPLE

• Healthcare customer service development

from customers, private sector viewpoint

• On going support for hospitals to reduce

customer service failure via monitoring,

customer feedback

• Sustainable revenue for private hospitals

• Additional revenue for paid services in

public hospitals

• Inbound cash flow for Mongolian hospitals

• Allows to get international standard health

insurance locally without FINANCIAL

PRESSURE

• Reduced out of pocket expenses

• Protected from major intervention cost

• Patient/ insured will be informed/

advised by professional team

• Gets health care information, learn

about future preventable diseases

ALTERNATIVE FUNDING SUPPORT FOR PRIVATE AND PUBLIC HOSPITALS

HEALTHCARE SERVICE DEVELOPMENT REDUCED OUT OF POCKET EXPENSES

INEQUALITIES IN THE DISTRIBUTION OF HEALTH AND HEALTH CARE KNOWLEDGE

V. ACKNOWLEDGEMENT

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1ST ANNUAL BUSINESS COUNCIL

MONGOLIA SUMMIT

15

Thank you for your attention!

The greatest wealth is health.

Virgil

Dr. Usukhbayar Ariunbold,

M.D., M.Sc.

Health Insurance Director,

Mandal General Insurance

Usukhbayar.a@mandal.mn

976-70117017

976-99109720