Private health insurance could help improve Mongolia's healthcare system by addressing current problems. The system faces low spending, high out-of-pocket costs, and an incapable public insurance program. This leads to many seeking treatment abroad. A new "Jargalan Health Insurance" program is proposed with innovative products, improved customer service, and connected hospital networks. It could retain healthcare spending domestically, reduce the number of untreated conditions, and protect people from financial hardship due to medical costs. Both the national healthcare system and individuals would benefit from alternative funding, improved access to care, and reduced out-of-pocket expenses.

1. 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

2. 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

3. 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
65
72
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

4. II. PROBLEMS AND MISSING POINTS IN HEALTHCARE SYSTEM
4
• 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

5. II. PROBLEMS AND MISSING POINTS IN HEALTHCARE SYSTEM
5
• 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. IV. BENEFITS AND OUTCOMES
SOCIAL IMPACTNATIONAL LEVEL HEALTH CARE SYSTEM LEVEL IMPACT FOR PEOPLE

12. IV. BENEFITS AND OUTCOMES
12
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 SYSTEM
IMPROVED AWARENESS FOR THEIR HEALTH

13. IV. BENEFITS AND OUTCOMES
13
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

14. V. ACKNOWLEDGEMENT
14
1ST ANNUAL BUSINESS COUNCIL
MONGOLIA SUMMIT

15. 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