title: Income-related inequalities in health care utilization in Mongolia, 2007/2008-2012.
abstract: BACKGROUND
  Although health strategies and policies have addressed equitable distribution of health care in Mongolia, few studies have been conducted on this topic. Rapid socio-economic changes have recently occurred; however, there is no evidence as to how horizontal inequity has changed. The aim of this paper is to evaluate income related-inequalities in health care utilizations and their changes between 2007/2008 and 2012 in Mongolia.
  
  
  METHODS
  The data used in this study was taken from the nationwide cross-sectional data sets, the Household Socio-Economic Survey, collected in 2007/2008 and 2012 by the National Statistical Office of Mongolia. We employed the Erreygers' concentration index to measure inequality in health service utilization. Horizontal inequity was estimated by a difference between actual and predicted use of health services using the indirect standardization method.
  
  
  RESULTS
  The results show that the concentration indices for tertiary level, private outpatient and inpatient services were significantly positive, the contrary for family group practice/soum hospital outpatient services, in both years. After controlling for need, pro-rich inequity (p < 0.01) was observed in the tertiary level, private outpatient, and general inpatient, services in both years. Pro-poor inequity (p < 0.01) existed in family group practice/soum hospital outpatient services in both years. Degrees of inequity in tertiary level hospital and private hospital outpatient services became more pro-rich, whereas in family group practice/soum hospital outpatient services became more pro-poor from 2007/2008 to 2012. Pro-rich inequity in inpatient services remained the same from 2007/2008 to 2012.
  
  
  CONCLUSIONS
  Equitable distribution of health care has been well documented in health strategies and policies; however, the degree of inequity in delivery of health services has a tendency to increase in Mongolia. Therefore, there is a need to consider implementation issues of the strategies and refocus on policy prioritizations. It is necessary to strengthen primary health care services, particularly by diminishing obstacles for lower income and higher need groups.
authors.affiliation: Department of Health Policy and Management, School of Public Health, Mongolian National University of Medical Sciences, Zorig street, Ulaanbaatar, 14210, Mongolia. javkhlanbayar.d@gmail.com.|Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland. javkhlanbayar.d@gmail.com.
authors.forename: Javkhlanbayar
authors.initials: J
authors.lastname: Dorjdagva
authors.affiliation: Department of Health Policy and Management, School of Public Health, Mongolian National University of Medical Sciences, Zorig street, Ulaanbaatar, 14210, Mongolia. eni1mn@yahoo.com.|Faculty of Economics and Business Sciences, University of Sannio, Benevento, Italy. eni1mn@yahoo.com.
authors.forename: Enkhjargal
authors.initials: E
authors.lastname: Batbaatar
authors.affiliation: Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland. BayarsaikhanD@who.int.
authors.forename: Bayarsaikhan
authors.initials: B
authors.lastname: Dorjsuren
authors.affiliation: Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland. jussi.kauhanen@uef.fi.
authors.forename: Jussi
authors.initials: J
authors.lastname: Kauhanen
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008986:Mongolia; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty / Q000191:economics* / Q000706:statistics & numerical data; D011247:Pregnancy