Factors associated with catastrophic health expenditure and impoverishment in Mongolia in 2021

Abstract

Background: Globally, almost a billion people allocated 10% of their household budget on health, and half a billion people were impoverished due to paying for health out of their pocket in 2017 (WHO, 2021a). Health costs paid directly by individuals, known as out-of-pocket (OOP) expenses, affect the financial resources of households, and it is crucial to avoid exceeding a certain amount of their budget when it comes to spending on health. Mongolia, a country with a lower-middle-income status and extensive social health insurance coverage, has witnessed a significant increase in OOP health spending over the past decade. In 2018, around 7.2% of the population allocated more than 10% of their household budget towards healthcare (WHO, 2022). Objectives: The objective of this study is to quantify the incidence and financial hardship caused by catastrophic health expenses in Mongolia throughout the year 2021, as well as to determine the factors associated with it. Methods: This study is a retrospective cross-sectional analysis that examines the factors associated with catastrophic health expenditure (CHE) and destitution in Mongolia in 2021. Two distinct methodologies were utilized in this investigation to compute the incidence rate of CHE: OOP payments made directly by individuals that surpass 10% of the total amount spent by the household (Wagstaff & van Doorslaer, 2003), households that spend more than 40% of their nonfood spending on OOP payments (Ke Xu et al., 2003). Multivariate logistic regression model was used to evaluate the likelihood of incurring CHE on the socio-economic determinants of CHE. Results: At the threshold is 10% of the total household consumption, 13.8% of households at the threshold of 40% of capacity to pay 5.3% of households experienced CHE in Mongolia. Around 110,000 people were impoverished due to paying for health in 2021 in Mongolia. Households who have elderly members, household heads who are single, who are economically inactive, household members who sought inpatient and outpatient care were more likely to incur CHE at both thresholds. Conclusion: Despite the mandated status of national health insurance in Mongolia and the government's efforts to protect citizens from financial hardship during the last decade, it still falls short in terms of providing adequate financial protection and achieving universal health care. The government needs to implement consistent policies in protecting the population from financial burden.