Introduction
In today’s world, public health systems have become a key element in ensuring well-being and improving the quality of life. Each country needs to develop and implement an effective health system appropriate to its population’s characteristics and needs. Two Asian countries, Mongolia and China, are examples of different approaches to organizing health systems. Mongolia and China are two neighboring countries located in Asia, and each has approaches to providing health care to its population. Although both countries have a long medical practice history, they have faced different healthcare challenges and formed unique public healthcare system models.
This paper will review and compare the main characteristics of Mongolia and China’s public healthcare systems to identify and analyze the similarities and differences in their approaches. Moreover, the study will focus on the strategies and measures that both countries are taking to ensure the health and well-being of their citizens. By comparing the public health systems of Mongolia and China, the study will shed light on the challenges and achievements they face in the health sector, contributing to a more reasonable understanding of optimal models and strategies in this critical area.
Characterizing the Health Systems of Mongolia and China
Before proceeding to a direct comparison, it is first necessary to briefly characterize the health systems of each country. Mongolian medicine has a long history, dating back over three thousand years. It is not very well known in the Western world and is an Asian medical tradition heavily influenced by Tibetan Buddhism, which has dominated the state’s regions for centuries (Jigjidsuren et al., 2019). Despite this, the people’s government has taken special care to protect workers’ health from its earliest days.
The young republic inherited from feudal Mongolia a widespread incidence of infectious and social diseases, extreme insanitation, hunger, and high mortality. There was no single medical institution in the country; Lamaist medicine, witch doctors, and lama healers completely dominated. The republic’s government set the task of urgent liquidation of medical ignorance inherited from the past (Kim et al., 2023). Their medical treatment system was developed by Mongols following their way of life and had significant differences from the medicine of neighboring countries, the same as China.
China is entering a new era of economic development. Decades of rapid growth have flowed into slower but more sustainable quality processes. The healthcare system is undergoing significant changes driven by ongoing reforms and the rapid introduction of innovative technologies. The country’s policies are becoming more open, and new players are entering the medical industry. China’s healthcare sector remains one of the fastest-growing markets in the world. Since 2015, annual healthcare spending has increased by 9-9.5%, mainly due to government reforms (Li et al., 2020). Regarding the absolute size of the industry, China is catching up with Japan and second only to the U.S.
An analysis of the characteristics of the health care system in Mongolia and China makes it clear that each of these countries has its unique characteristics and approaches to organizing medical care for its population. Mongolia is noted for its long-standing traditional medicine, strongly based on natural methods and oriented toward locals, but with limited access for foreigners.
Standing on the path of economic development, China is innovating and reforming, making its healthcare system more accessible and efficient for the general population, showing a high growth rate in this area. It is necessary to analyze and compare the healthcare systems of Mongolia and China further to identify additional aspects. Among these are their specificity, accessibility, financing, and areas of medical innovation and achievement.
Traditional Medicine
Both China and Mongolia share a tendency to utilize folk medicine. Despite the progress in world medicine, the inhabitants of China and Mongolia often resort to traditional treatment methods. Traditional Chinese medicine still enjoys great popularity among the population and professional doctors despite the skepticism of the Western medical community.
The journal Quality of Primary Health Care in China even published an article that stated that Chinese laws promoting traditional medicine are a step backward. According to the publication, only full-fledged clinical trials can lead to real progress in the fight against the disease (Li et al., 2020). Unsurprisingly, many residents turned to traditional medicine during the coronavirus epidemic in Wuhan. Even official recommendations for treating the virus included several traditional Chinese remedies and Western drugs.
Such remedies may be effective in some cases. Still, the international scientific community agrees that using traditional medicine instead of the latest scientific advances may reduce the effectiveness of the healthcare system. It should be noted, however, that despite its reliance on tradition, China has made significant advances in basic medicine. Regarding the number of citations of scientific papers in medicine, China has risen from 22nd place in 2000 to second place in the world in 2019 (Li et al., 2020). Thus, it is important to note that Chinese medicine is gradually developing without omitting actual treatment methods.
Traditional medicine plays an important role in Mongolia’s overall healthcare system. For over three thousand years, Mongolian medicine has developed its unique methodology, strongly based on using herbs, minerals, and other natural components to treat diseases (Jigjidsuren et al., 2019). Traditional Mongolian medicine influences the lifestyle and cultural aspects of the national community. It becomes the cause of many dangers, particularly the lack of qualifications of specialists.
Most doctors of Mongolian medicine have only completed 45 months of training (Kim et al., 2023). Then, they are immediately authorized to treat people, which is very dangerous for patients who often seek help in desperate situations. However, despite the trust in traditional medicine, the country recognizes and actively develops modern medicine and scientific research in this field.
A general tendency to favor folk healing methods unites Mongolia and China. It may be due to cultural, historical, and geographical factors that have shaped the peculiarities of approaches to health care in both countries. However, it should be remembered that using traditional medicine instead of modern methods may have risks. Although some traditional remedies may be effective, it is important to base the fight against serious diseases and epidemics on scientific research and clinical trials to maximize the effectiveness of the healthcare system.
Inequalities at the Regional Level
Inequality of access to health care in different parts of the country is another feature that characterizes both countries. At the head of China’s health care system is the National Health Commission, a ministerial-level institution under the State Council of the People’s Republic of China. (Song et al., 2019) The Commission administers the overall healthcare system and guarantees access to health insurance for all citizens. For example, it carries out its activities by providing additional subsidies to poor regions.
At the same time, the quality of medical care can vary greatly. Some hospitals, such as the largest in Beijing or Shanghai, are run directly by the national ministry, but regional or local governments fund the rest (Song et al., 2019). For this reason, hospitals in megacities are much better equipped than those in poorer western regions.
Although public hospitals remain key to health care delivery, the profile of health care providers is gradually becoming much more diverse and complex. Besides allowing private hospitals to open, the government allows doctors and nurses to practice in multiple locations (Song et al., 2019). Public hospitals are forced to increase their efficiency due to changing profit models. They are forming alliances and partnerships to save money. For example, the recent nationwide reform of second-tier hospitals aims to prevent unnecessary duplication of resources and over-expansion. The gist is that there can only be two community hospitals in a province, and all others must change ownership and downgrade (Song et al., 2019). It is, therefore, not surprising that many second-tier hospitals seek to differentiate themselves by offering higher value-added services such as minimally invasive surgeries or rehabilitation programs.
At the same time, many positive changes have resulted from the reform of the healthcare industry in Mongolia. Unfortunately, transitioning from a socialist economy to a market economy has created many problems in providing medicines. In particular, there is currently no adequate drug supply policy for rural areas, where a significant proportion (more than 43%) of the population (Jigjidsuren et al., 2019). As a result of market transformations, there are three and a half times more pharmacies in urban areas, while in rural areas, their number, on the contrary, has decreased.
Over the past five years, the availability of medicines to rural residents has decreased. Private entrepreneurs tend to do business where population density and turnover are higher, while in remote rural areas, it is not profitable to sell medicines. The high level of economic inequality in Mongolia affects access to health care. Low-income people struggle to access quality health care due to limited financial resources (Tsogbadrakh et al., 2022). It may lead some people to postpone visiting doctors or not getting the necessary medications, which may worsen their health status.
In China and Mongolia, unequal access to the health care system between different parts of the country is an important feature. Although the health care system covers all citizens in China, the quality of care can vary greatly between different regions. Hospitals in large cities such as Beijing and Shanghai are better equipped and provide higher services than health facilities in poorer western regions. This is due to differences in the financing and management of health facilities.
On the other hand, in Mongolia, the transition from a socialist economy to a market economy has been accompanied by some problems in the provision of medicines in rural areas. The availability of medicines for villagers has decreased as many entrepreneurs prefer to do business in urban areas with higher turnover. It makes it more difficult to obtain necessary medicines in remote rural areas.
Insurance
The insurance systems in China and Mongolia differ significantly despite the territorial proximity of the countries. In China, it was only in 2016 that a unified insurance system for all residents – rural and urban began to be created (Li et al., 2020). However, Chinese state insurance does not cover important medicines and procedures.
According to the World Bank, in recent years, no more than 40% of total medical expenses in China have been personal expenses of citizens (Yip et al., 2019). This means that the Chinese pay every third of yuan in medical bills from their own pockets without the help of the state or insurance companies. Moreover, insurance regulations are extremely inefficient: state insurance usually covers inpatient care but not outpatient care. Due to this, doctors hospitalize patients even when unnecessary, and the hospitalization rate per thousand people in China is one of the highest in the world.
At the same time, private health insurance is gaining popularity: demand from private enterprises and individuals with higher incomes is growing. China’s private health insurance market is just emerging. The industry estimates a projected growth rate of 25-30% for the next five years (Li et al., 2020). Supportive government policies are key, as private insurance will ease the industry’s financial burden, help retain key personnel, and increase competition.
Mongolia has a compulsory and voluntary health insurance system designed to provide the population access to health services and protection against high medical costs. This system was introduced to improve the quality and accessibility of healthcare in the country. Compulsory health insurance includes compulsory accident and sickness insurance (Kim et al., 2023). Employees and organizations must pay an insurance premium, a certain percentage of their salary, or other income.
The Government of Mongolia determines the annual insurance premium. Organizations and institutions where Mongolian citizens are employed pay a minimum of 50% of the premium, and the employees themselves pay the rest (Jigjidsuren et al., 2019). It helps to spread the cost of insurance between employers and employees, easing the financial burden of the population and increasing the affordability of insurance. Compulsory insurance provides access to outpatient and inpatient services in medical facilities that are licensed and accredited. It ensures that medical services are provided by qualified and certified personnel and that patients receive quality treatment and care.
Voluntary health insurance provides additional options for the public, allowing them to expand their coverage of medical services or receive additional benefits. It provides an opportunity to insure against additional risks or provide insurance for family members (Kim et al., 2023). Thus, Mongolia’s compulsory and voluntary health insurance system plays an important role in ensuring the population’s accessibility and quality of health care. It helps to distribute healthcare costs equitably and provides financial protection against high medical costs for many people in the country. At the same time, China’s insurance system is still poorly established and is characterized by many difficulties.
Development and Innovation
Despite certain problems, the quality of medicine in China remains high. At the same time, China is getting richer: the number of households that can afford large out-of-pocket healthcare expenses is becoming significant. In 2019, 75 million urban households in China earned more than the U.S. average (Yip et al., 2019). The growing number of affluent and ultra-wealthy people is driving the adoption of high-quality healthcare products and services in China. Private hospitals are also entering the Chinese market to provide high-level services to the wealthy so that they are treated in their home country rather than abroad.
The state supports domestic players, creating all conditions for them to thrive. For example, the medical equipment industry has been identified as a priority, with procurement policies favoring local companies (Yip et al., 2019). Several strong domestic pharmaceutical companies have been established and supported. Emphasis has been placed on developing biological medicine and high-performance medical devices. The National Development and Reform Commission (NDRC) has abolished government-set drug prices (Li et al., 2020). While this encourages market competition, cheaper domestic brands will have an advantage. Many provinces have adjusted bidding or procurement processes to favor cheaper domestic brands or introduce more complex procedures for hospitals to purchase international brands.
Furthermore, the government and manufacturers promote screening programs for key chronic diseases. There is a growing demand for health and wellness products. Higher-income consumers are shifting from critical care to preventive diagnostics and health care. At the same time, in Mongolia, healthcare quality is mostly good in public hospitals and large clinics in the capital city of Ulaanbaatar (Kim et al., 2023).
However, in some cases, patients may seek treatment abroad, especially for complex medical problems. Currently, Mongolia’s healthcare system is a collection of more than four thousand medical institutions, a quarter of which are private. In total, they employ more than 50 thousand people (Tsogbadrakh et al., 2022). These figures seem quite impressive considering the country’s small population. Regarding hospital beds and the number of medical personnel per capita, Mongolia is the leader among developing countries.
However, quantity is not always a sign of quality. Not all Mongolian hospitals are equipped with modern technology, and staff are not always qualified. Public institutions face a lack of funding. Moreover, not all hospitals provide the necessary list of services. This is due to the lack of narrow specialists who seek employment abroad, most often in South Korea or China (Tsogbadrakh et al., 2022). Recently, there have been positive dynamics in the development of Mongolian medicine. The state pays attention to the low salaries of specialists and the meager material base. They are also working on attracting investments from abroad. At the same time, the growing quality of private clinics forces the state clinics to compete with them, which serves as an incentive for them.
Conclusion
In conclusion, a comparison of Mongolia’s and China’s public healthcare systems shows that both countries have unique characteristics and challenges in this area. Mongolia has a fairly well-developed healthcare system, with good-quality services in public hospitals and large clinics in Ulaanbaatar. However, limited healthcare access in remote and rural areas is a significant challenge. There are also some shortcomings in drug supply and healthcare financing.
Comparing the situation in China, the country has made significant progress in developing medical infrastructure and quality medical services. High levels of insurance, availability of services, and various medical offerings, including private hospitals and health tech, make China’s healthcare system one of the most diverse and fastest growing in the world. Both countries also tend to utilize folk therapies and support the development of traditional medicine. However, China is also actively integrating the latest technologies and innovations into healthcare, demonstrating its commitment to modernity and system improvement.
Despite the achievements, both countries face challenges, such as unequal access to health care in different regions and segments of the population. It is important to note that for further development of health care, it is necessary to pay special attention to rural areas and ensure equal opportunities for all country residents. Overall, a comparison of the healthcare system in Mongolia and China shows that each country has unique approaches and challenges. Still, both strive to enhance healthcare services and access to healthcare for their populations. It is significant to continue to improve and invest in health care to ensure the health and well-being of all citizens in both countries.
References
Jigjidsuren, A., Byambaa, T., Altangerel, E., Batbaatar, S., Saw, Y. M., Kariya, T., & Hamajima, N. (2019). Free and universal access to primary healthcare in Mongolia: the service availability and readiness assessment. BMC Health Services Research, 19, 1-12. Web.
Kim, J., Rapuri, S., Chuluunbaatar, E., Sumiyasuren, E., Lkhagvasuren, B., Budhathoki, N. R., & Laituri, M. (2023). Developing and evaluating transit-based healthcare accessibility in a low-and middle-income country: A case study in Ulaanbaatar, Mongolia. Habitat International, 131, 729. Web.
Li, X., Krumholz, H. M., Yip, W., Cheng, K. K., De Maeseneer, J., Meng, Q., & Hu, S. (2020). Quality of primary health care in China: Challenges and recommendations. The Lancet, 395(10239), 1802-1812. Web.
Song, S., Yuan, B., Zhang, L., Cheng, G., Zhu, W., Hou, Z., & Meng, Q. (2019). Increased inequalities in health resource and access to health care in rural China. International Journal of Environmental Research and Public Health, 16(1), 49. Web.
Tsogbadrakh, B., Yanjmaa, E., Badamdorj, O., Choijiljav, D., Gendenjamts, E., Ayush, O. E., & Stark, A. (2022). Frontline Mongolian healthcare professionals and adverse mental health conditions during the peak of COVID-19 pandemic. Frontiers in Psychology, 13, 800-809. Web.
Yip, W., Fu, H., Chen, A. T., Zhai, T., Jian, W., Xu, R., & Chen, W. (2019). 10 years of health-care reform in China: Progress and gaps in universal health coverage. The Lancet, 394(10204), 1192-1204. Web.