Healthcare: QUALITY OR QUANTITY?
For public health care, as well as other important fields in human development, the question is: Is it more important to have quality or quantity? World's governments interrogate themselves if it is better to guarantee a higher quality medical services or assuring that a larger portion of the public receives it. Health care has been a critical issue in politics and economy, as well as for people.
Mongolia and the USA represent a perfect example of both sides. The first is trying to give access to healthcare to almost all of its citizens, while the latter has a system that spends the greater percentage of public money for quality services.
The Mongolian goverment invests 5.4 percent (400 billion MNT) of its revenue to public health care, having increased it in recent years, according to the World Health Organization. It means around 1.4 million MNT is allocated for each citizen, according to the Institute for Health Metrics and Evaluation data. The government is willing to keep raising it in order to provide better health services. Economists predict that by the year 2020, Mongolia will have amassed substantial economic growth. By then, the administration's goal will be to become independent from foreign aid, which accounts for 30 percent of Mongolia’s budget designated for health care.
But what about health quality and coverage? Obviously, in the countryside, it's much more difficult to guarantee a good health care system, because of the vast Mongolian territory and the massive distances between rural areas and medical centers. This is a problem that needs to be addressed. The project "Third Health Sector Development" of the Asian Development Bank wants to develop hospitals in Central Mongolia with better equipment, new facilities and training for doctors. With regard to coverage, the Human Development Fund in 2011 provided subsidies for uninsured people, increasing the percentage of the insured population from 74 percent to 98.6 percent in the last 15 years.
In contrast to Mongolia, the most debated health care system in the world continues to be the American one. Recently, US President Donald Trump failed to replace Obamacare with his version of healthcare which reportedly reduced coverage drastically. Compared to Mongolia’s health care system coverage, the differences are huge. In the US, around eight percent of the population has no public medical insurance (1.4 percent in Mongolia). As said before, the US government invests more than any other country in health care per capita: about 22 million MNT according to the Institute for Health Metrics and Evaluation.
Mongolia wants to guarantee an accessible and equitable service open to every citizen, and the government has divided medical services in three parts: primary health care (delivered by family health centers, soum health centers and intersoum hospitals); secondary health care (provided by district and aimag general hospitals, rural general hospitals and private clinics); and tertiary health care (provided by multispecialized central hospitals and specialized centers in Ulaanbaatar).
“This system made Mongolian health care unique,” explained Michael C. Walker, a professor at the University of Florida. “It was at one time a quality system which provided good, although not the most technically advanced, comprehensive care for the citizens of the nation and foreigners alike.”
Even if the government is trying to provide medical services to the broadest range of people, Walker said the problem is that "there is a shortage of qualified doctors, nurses, and other care-givers in all state hospitals and clinics.” In fact, according to a report published by the scientific magazine The Lancet, Mongolia’s hospital care is lacking for some illnesses, such as neonatal disorders, ischaemic heart disease, cerebrovascular disease and peptic ulcer disease.
Another big difference between Mongolia and the USA’s health systems is economics. In Mongolia, the aim is not to turn hospitals into a profitable business. Government insurance, available for the whole population, is supposed to cover 90 percent of hospital costs.
Across the Pacific Ocean, it is very different. A free assistance program called Medicaid is guaranteed only for people under the poverty line. For other citizens, prices can be really high. “It is not just that US healthcare is expensive, with price tags often far higher than those in other developed countries… Americans face astronomical prices that quite simply defy the laws of economics and of decency and common sense,” stated CNN journalist Elisabeth Rosenthal.
What Trump wants to do is remove the obligation for individuals to subscribe to a health care program, which is obligatory. Moreover, his intention is to abolish medical payment obligations for workers of firms with more than 50 employees. The problem, according to several politicians, is that there wouldn't be funds to guarantee help to the ones who can only rely on Medicaid.
In that case, the difference between Mongolia and the US health care systems would be even bigger. While Mongolia is increasing its social welfare and fighting illnesses, in the US, the ethical doubts about the government's actions on medical issues are unending. But the question still remains: quality or quantity?