Privatising general practice in Mongolia: a trial of needs-adjusted capitation.
Mongolia's family doctors have long been salaried government employees. The crisis caused by the break-up of the Soviet Bloc required the government to seek a balance between command and market economies, and this influenced the decision to introduce capitated private practice for family doctor services on a trial basis. This article explains why and how a risk-adjusted capitation model was developed by a blend of empirical analysis and expert judgement, which comprises ten classes of clients defined by age-sex and poverty groupings. Payment relativities across the classes were set in proportion to a desirable (or target) number of contacts per year. Separate processes were used to set the targets for patient-initiated and active (health promotion and illness prevention) contacts. The model is intended to lead to greater equity of service access and provision. It should also encourage a greater concern for health outcomes, sensitivity to clients' views, and operational efficiency.
Hindle
D
D
School of Health Services Management, University of New South Wales.
O'Rourke
M
M
Batsuury
R
R
Orgil
B
B
D000367:Age Factors; D002204:Capitation Fee; D005194:Family Practice / Q000191:economics*; D017048:Health Care Costs; D019981:Health Care Sector / Q000639:trends; D006801:Humans; D017059:Models, Econometric; D008986:Mongolia; D020380:Needs Assessment / Q000145:classification* / Q000191:economics; D010865:Pilot Projects; D011203:Poverty; D011332:Privatization / Q000191:economics*; D011907:Rate Setting and Review / Q000379:methods; D020379:Risk Adjustment; D012737:Sex Factors