Abstract
BackgroundAlthough health strategies and policies have addressed equitable distribution of health care in Mongolia, few studies have been conducted on this topic. Rapid socio-economic changes have recently occurred; however, there is no evidence as to how horizontal inequity has changed. The aim of this paper is to evaluate income related-inequalities in health care utilizations and their changes between 2007/2008 and 2012 in Mongolia.MethodsThe data used in this study was taken from the nationwide cross-sectional data sets, the Household Socio-Economic Survey, collected in 2007/2008 and 2012 by the National Statistical Office of Mongolia. We employed the Erreygers’ concentration index to measure inequality in health service utilization. Horizontal inequity was estimated by a difference between actual and predicted use of health services using the indirect standardization method.ResultsThe results show that the concentration indices for tertiary level, private outpatient and inpatient services were significantly positive, the contrary for family group practice/soum hospital outpatient services, in both years. After controlling for need, pro-rich inequity (p < 0.01) was observed in the tertiary level, private outpatient, and general inpatient, services in both years. Pro-poor inequity (p < 0.01) existed in family group practice/soum hospital outpatient services in both years. Degrees of inequity in tertiary level hospital and private hospital outpatient services became more pro-rich, whereas in family group practice/soum hospital outpatient services became more pro-poor from 2007/2008 to 2012. Pro-rich inequity in inpatient services remained the same from 2007/2008 to 2012.ConclusionsEquitable distribution of health care has been well documented in health strategies and policies; however, the degree of inequity in delivery of health services has a tendency to increase in Mongolia. Therefore, there is a need to consider implementation issues of the strategies and refocus on policy prioritizations. It is necessary to strengthen primary health care services, particularly by diminishing obstacles for lower income and higher need groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-015-0185-8) contains supplementary material, which is available to authorized users.
Highlights
Health strategies and policies have addressed equitable distribution of health care in Mongolia, few studies have been conducted on this topic
Vertical equity is convenient to be measured when funding e.g. progressivity in financial contribution is the center of concern, while horizontal equity is measured in terms of access to health services based on a key aim of ensuring equitable services for those who have same needs [12]
Secondary and tertiary level health care use in outpatient visits were observed across the study years, albeit statistically insignificant
Summary
Health strategies and policies have addressed equitable distribution of health care in Mongolia, few studies have been conducted on this topic. The aim of this paper is to evaluate income related-inequalities in health care utilizations and their changes between 2007/2008 and 2012 in Mongolia. There is considerable evidence on Income-related inequality occurs when there are differences in the use of health care services across different income groups. Equitable distribution of health care has two dimensions, horizontal equity and vertical equity. Vertical equity is difficult in measuring and interpreting, in countries where there are barriers of access to health services [11]. Vertical equity is convenient to be measured when funding e.g. progressivity in financial contribution is the center of concern, while horizontal equity is measured in terms of access to health services based on a key aim of ensuring equitable services for those who have same needs [12]
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