ENHANCING THE USE OF HEALTH INSURANCE TAX
In Mongolia, 808 pharmacies are selling 817 drugs with discounts of 40 to 80 percent, made possible by the Health Insurance Fund (HIF).
Of these pharmacies, 324 of them are in Ulaanbaatar, and they receive subsidies from the HIF on the 25th of each month. Depending on the capacity of the pharmacy, they receive one to ten million MNT a month.
Unfortunately, when an individual goes to one of these pharmacies to buy discounted medication, sometimes the pharmacy says that the discount isn't available because the subsidy for that medication has already been spent.
Very few people are able to purchase discounted medication. We want to know who is benefiting from discounts and which pharmacies are selling discounted medication to people who qualify for them.
A nurse working for a Monos pharmacy in Bayanzurkh Disctrict said that seniors crowd the pharmacy on the first two or three days of each month to purchase discounted medication, and that within the first three days of each month, the pharmacy’s HIF subsidized medication is gone.
Pensioners and pregnant and nursing women really need discounted medication from pharmacies, but they need to go to their local clinic first to get a doctor's prescription allowing them to buy discounted medication.
After getting a prescription, you have to go to a pharmacy early in the month to buy your medication at a discount. Getting back home without any medication at all is common, even when you go on the first of the month.
When you visit a pharmacy to buy discounted medication, the pharmacist usually says that the pharmacy doesn’t have the drug in stock, or that the pharmacy has not received its HIF subsidy yet, or has already spent it. The pharmacist may suggest that you return within the first two days of the following month.
A doctor's prescription is valid for only 30 days, so you have to go back to your local clinic to ask a doctor for a new prescription if a pharmacy turns you away, but sometimes doctors will not give you a new prescription because doctors have quotas for prescriptions for discounted medication.
This situation at pharmacies results in people giving up trying to take advantage of discounts on medicine. When participating in meetings, speaking about campaigns, and appearing on TV programs, health officials and the Minister of Health claim that people are receiving low cost and free drugs, but in reality, the implementation of the discount and distribution program is very poor.
Most people who are regularly employed pay a health insurance tax of nearly 20,000 MNT a month, but many people cannot benefit from health insurance due to long lines at public hospitals and our unhealthy health insurance system.
Some people stockpile discounted medication available on the first or second day of the month by getting their friends who are doctors to include a number of drugs on their prescriptions, and resources at pharmacies are quickly depleted.
To stop some people from cheating, certificated pharmacies need to adopt an online database that tells a pharmacist how many drugs a person has received in one month.
There are 808 pharmacies that are certificated by the state to receive monthly subsidies from the HIF, and they receive a total of 41 billion MNT a year. Reducing the number of pharmacies that are able to provide people with discounted medication and more effectively maintaining the distribution of monthly HIF subsidies would be helpful in providing more people with better service and more access to discounts.
It is important that a few quality pharmacies provide low and middle-income people, as well as pregnant and nursing women, who can’t access private hospitals and can’t afford expensive medication with access to low cost, high quality pharmaceutical services.