The recent changes in the health insurance system have confused citizens and they cannot easily find an explanation of the new rules. N.Oyungerel of the Ministry of Health answers our questions on the issue.

What are the new areas now covered by health insurance?

From this year, the health insurance fund will pay for diagnostic tests and some hospital treatment as many times as necessary, in both Ulaanbaatar and in provinces and some soums. The insurance will also cover nursing costs, also for terminal illnesses, dental problems, and basic health care during pregnancy. These new areas brought under the purview of insurance will be of great help to many. Of special importance is that money is now made available for incurable conditions, as the earlier practice was that once doctors decided a patient’s condition was untreatable, he was discharged from hospital and left to the care of non-professional people. Now they will be entitled to professional care until they die. At the moment, cancer patients are not included among them, but we hope to do something for them soon.

What new things have you initiated in diagnostics?

Our aim is to popularize preventive diagnostics. On proper medical advice, anybody can get a diagnostic test that costs up to MNT30,000 at 2nd and 3rd step hospitals, but not in  soum and family hospitals. Any expenses above that will have to be borne by the individual. A medical prescription, however, is essential to claim the benefit. We wish to bring down the number of in patients and so insurance payment for out patients has been raised from MNT45,000 to MNT114,000. The insured expense limit at traditional hospitals has been raised from MNT50,000 to MNT80,000.

Besides, while previously insurance would pay up to MNT226,000 for 22 kinds of diagnostic groups, now the limit is MNT536,000 covering  107 diagnostic groups.

Will treatment in private hospitals be paid for?

One or two hospitals in the provinces and some 70 private hospitals will be eligible.

What about soum and family hospitals?

They are already totally free for anybody with insurance. We want health insurance to cover 2nd and 3rd step hospitals and those in middle soums.

Will there be any reward for people who pay premium but do not need to avail themselves of any benefit?

By definition, insurance is a matter of risk. We must not think of the benefit to only ourselves. What we pay helps our relatives and friends too. But we plan to introduce some benefits. Anybody who has paid for three years and not made any claims will get a free preventive diagnostic test soon. By the way, insurance paid for MNT56 billion worth health services last year but this year the target is MNT76 billion. Both the capacity and scope will expand.