Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument

Abstract

Background Mongolia has made significant progress towards achieving Universal Health Coverage (UHC), but there are still challenges ahead with population ageing and non-communicable diseases (NCDs). The purpose of this study was to investigate patterns and determinants of outpatient and inpatient health service use amongst older people in Mongolia. Methods Data were collected using a questionnaire developed for the World Health Organization’s Study on global AGEing and adult health (WHO SAGE). There were 478 participants from rural areas and 497 participants from Ulaanbaatar (further divided into 255 ger/yurt district and 242 apartment district residents). Multivariable logistic regression analyses were used to investigate determinants of outpatient and inpatient health service use with reported adjusted Odds Ratios (AORs) and 95 % Confidence Intervals (CIs). Results Participants were aged 60 to 93 years. About 55 % of respondents used outpatient services in the past 12 months and 51 % used inpatient services in the past three years. Hypertension was the most common reason for health service use. Rural residents had longer travel times and were more likely to incur out-of-pocket expenditure (OOP). Multivariable logistic regression revealed that women were more likely to use outpatient services (AOR 1.88; 1.34-2.63). Compared to apartment residents in urban areas, ger residents in urban areas were less likely to use outpatient services (AOR 0.54; 0.36-0.83). There was no statistically significant differences in inpatient service by location. Increasing numbers of chronic conditions (1 and 2+ compared to none) were associated with both outpatient (AORs 2.59 and 2.78) and inpatient (AORs 1.97 and 3.01) service use. Conclusions This study highlights the needs to address disparities in outpatient service use for rural and urban ger populations. Compared with other WHO-SAGE countries, older Mongolians have relatively higher use of inpatient health care services. With a high prevalence of hypertension and an ageing population, efforts to achieve UHC would benefit from reorienting care services towards prevention and primary care management of NCDs to reduce the costs from hospital-based care.

Epidemiology of pneumonia in hospitalized adults ≥18 years old in four districts of Ulaanbaatar, Mongolia, 2015–2019

“…25,26 Despite typically having greater health needs, lower income individuals are more likely to use primary or public secondary care services, whereas higher income individuals are more likely to use secondary or tertiary services regardless of health needs and underestimating the true burden of community-acquired pneumonia. 25,27 We found seasonal variations in clinical pneumonia hospitalizations, with the highest incidence rates occurring during the winter months. These results were expected, as pneumonia is considered highly seasonal in Mongolia, where winter temperatures can reach as low as À40°C.…”

“… 24 , 25 Our study found that patients who received antibiotics within 48 hours prior to hospital admission had lower odds of severe pneumonia, indicating that healthcare utilization practices and delay in seeking care may contribute to adverse health outcomes. 24 , 26 , 27 While nearly all Mongolians have social health insurance and reform efforts have been made to provide equitable access healthcare, financial barriers persist. 25 , 26 Despite typically having greater health needs, lower income individuals are more likely to use primary or public secondary care services, whereas higher income individuals are more likely to use secondary or tertiary services regardless of health needs and underestimating the true burden of community-acquired pneumonia.…”

“… 25 , 26 Despite typically having greater health needs, lower income individuals are more likely to use primary or public secondary care services, whereas higher income individuals are more likely to use secondary or tertiary services regardless of health needs and underestimating the true burden of community-acquired pneumonia. 25 , 27 …”

“… 13 , 38 Men are also less likely to use outpatient services and may delay seeking care for communicable diseases or other health conditions considered less urgent. 24 , 27 Consequently, Mongolia has one of the largest life expectancy gaps between males and females globally, with women expected to outlive men by almost a decade. 35 Risk factor data collected as part of the prospective surveillance study will provide additional insights into the burden of disease in men.…”

“…Furthermore, higher income individuals typically overutilize inpatient services, whereas lower income individuals underutilize inpatient services due to financial constraints. 25 , 26 , 27 As a result, different thresholds for hospitalization among different income groups could contribute to an underestimate of the case-fatality rate.…”