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Free and universal, but unequal utilization of primary health care in the rural and urban areas of Mongolia

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Date
2017
Author
Dorjdagva Javkhlanbayar
Batbaatar Enkhjargal
Svensson Mikael
Dorjsuren Bayarsaikhan
Batmunkh Burenjargal
Kauhanen Jussi
Unique identifier
10.1186/s12939-017-0572-4
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Citation
Dorjdagva Javkhlanbayar. Batbaatar Enkhjargal. Svensson Mikael. Dorjsuren Bayarsaikhan. Batmunkh Burenjargal. Kauhanen Jussi. (2017). Free and universal, but unequal utilization of primary health care in the rural and urban areas of Mongolia.  International Journal for Equity in Health, 16, 73. 10.1186/s12939-017-0572-4.
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CC BY http://creativecommons.org/licenses/by/4.0/
Abstract

Background
The entire population of Mongolia has free access to primary health care, which is fully funded by the government. It is provided by family health centers in urban settings. In rural areas, it is included in outpatient and inpatient services offered by rural soum (district) health centers. However, primary health care utilization differs across population groups. The aim of this study was to evaluate income-related inequality in primary health care utilization in the urban and rural areas of Mongolia.

Methods
Data from the Household Socio-Economic Survey 2012 were used in this study. The Erreygers concentration index was employed to assess inequality in primary health care utilization in both urban and rural areas. The indirect standardization method was applied to measure the degree of horizontal inequity.

Results
The concentration index for primary health care at family health centers in urban areas was significantly negative (−0.0069), indicating that utilization was concentrated among the poor. The concentration index for inpatient care utilization at the soum health centers was significantly positive (0.0127), indicating that, in rural areas, higher income groups were more likely to use inpatient services at the soum health centers.

Conclusions
Income-related inequality in primary health care utilization exists in Mongolia and the pattern differs across geographical areas. Significant pro-poor inequality observed in urban family health centers indicates that their more effective gatekeeping role is necessary. Eliminating financial and non-financial access barriers for the poor and higher need groups in rural areas would make a key contribution to reducing pro-rich inequality in inpatient care utilization at soum health centers.

Subjects
Primary health care   Inequality   Horizontal inequity   Urban and rural disparity   Mongolia   
URI
https://erepo.uef.fi/handle/123456789/5023
Link to the original item
http://dx.doi.org/10.1186/s12939-017-0572-4
Publisher
Springer Nature
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  • Terveystieteiden tiedekunta
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