Free and universal, but unequal utilization of primary health care in the rural and urban areas of Mongolia

International Journal for Equity in Health

Research

Enkhjargal Batbaatar¹  Javkhlanbayar Dorjdagva²  Bayarsaikhan Dorjsuren³  Burenjargal Batmunkh⁴  Mikael Svensson⁵  Jussi Kauhanen⁶ 

[1] Department of Health Policy and Management, School of Public Health, Mongolian National University of Medical Sciences, Zorig street, 14210, Ulaanbaatar, Mongolia;Department of Health Policy and Management, School of Public Health, Mongolian National University of Medical Sciences, Zorig street, 14210, Ulaanbaatar, Mongolia;Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland;Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland;Department of Physiology, School of Pharmacy and Bio Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia;Health Metrics Unit, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland;

关键词: Primary health care;    Inequality;    Horizontal inequity;    Urban and rural disparity;    Mongolia;   

DOI  :  10.1186/s12939-017-0572-4

 received in 2016-11-09, accepted in 2017-05-02,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe entire population of Mongolia has free access to primary health care, which is fully funded by the government. It is provided by family health centers in urban settings. In rural areas, it is included in outpatient and inpatient services offered by rural soum (district) health centers. However, primary health care utilization differs across population groups. The aim of this study was to evaluate income-related inequality in primary health care utilization in the urban and rural areas of Mongolia.MethodsData from the Household Socio-Economic Survey 2012 were used in this study. The Erreygers concentration index was employed to assess inequality in primary health care utilization in both urban and rural areas. The indirect standardization method was applied to measure the degree of horizontal inequity.ResultsThe concentration index for primary health care at family health centers in urban areas was significantly negative (−0.0069), indicating that utilization was concentrated among the poor. The concentration index for inpatient care utilization at the soum health centers was significantly positive (0.0127), indicating that, in rural areas, higher income groups were more likely to use inpatient services at the soum health centers.ConclusionsIncome-related inequality in primary health care utilization exists in Mongolia and the pattern differs across geographical areas. Significant pro-poor inequality observed in urban family health centers indicates that their more effective gatekeeping role is necessary. Eliminating financial and non-financial access barriers for the poor and higher need groups in rural areas would make a key contribution to reducing pro-rich inequality in inpatient care utilization at soum health centers.

【 授权许可】

CC BY   
© The Author(s). 2017

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