Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia

BACKGROUND: Many low- and middle-income countries with a social health insurance system face challenges on their road towards universal health coverage (UHC), especially for people in the informal sector and vulnerable population groups or the informally employed. One way to address this is to subsidize their contributions through general government revenue transfers to the health insurance fund. This paper provides an overview of such health financing arrangements in Asian low- and middle-income countries. The purpose is to assess the institutional design features of government subsidized health insurance type arrangements for vulnerable and informally employed population groups and to explore how these features contribute to UHC progress. METHODS: This regional study is based on a literature search to collect country information on the specific institutional design features of such subsidization arrangements and data related to UHC progress indicators, i.e. population coverage, financial protection and access to care. The institutional design analysis focuses on eligibility rules, targeting and enrolment procedures; financing arrangements; the pooling architecture; and benefit entitlements. RESULTS: Such financing arrangements currently exist in 8 countries with a total of 14 subsidization schemes. The most frequent groups covered are the poor, older persons and children. Membership in these arrangements is mostly mandatory as is full subsidization. An integrated pool for both the subsidized and the contributors exists in half of the countries, which is one of the most decisive features for equitable access and financial protection. Nonetheless, in most schemes, utilization rates of the subsidized are higher compared to the uninsured, but still lower compared to insured formal sector employees. Total population coverage rates, as well as a higher share of the subsidized in the total insured population are related with broader eligibility criteria. CONCLUSIONS: Overall, government subsidized health insurance type arrangements can be effective mechanism to help countries progress towards UHC, yet there is potential to improve on institutional design features as well as implementation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12939-016-0436-3) contains supplementary material, which is available to authorized users

The adoption of roles by primary care providers during implementation of the new chronic disease guidelines in urban Mongolia: a qualitative study

(1) BACKGROUND: In 2011, new chronic disease guidelines were introduced across Mongolia. No formal advice was provided regarding role delineation. This study aimed to analyse the roles that different primary care providers adopted, and the variations in these, in the implementation of the guidelines in urban Mongolia; (2) METHODS: Ten group interviews with nurses and ten individual interviews each with practice doctors and practice directors were conducted. Data was analysed using a thematic approach based on the identified themes relevant to role delineation; (3) RESULTS: There was some variability and flexibility in role delineation. Factors involving teamwork, task rotation and practice flexibility facilitated well the guideline implementation. However, factors including expectations and decision making, nursing shortage, and training gaps adversely influenced in the roles and responsibilities. Some role confusion and dissatisfaction was identified, often associated with a lack of training or staff turnover; (4) CONCLUSIONS: Findings suggest that adequate ongoing training is required to maximize the range of roles particular provider types, especially primary care nurses, are competent to perform. Ensuring that role delineation is specified in guidelines could remove confusion and enhance implementation of such guidelines

GPR measurements to assess the Emeelt active fault's characteristics in a highly smooth topographic context, Mongolia

International audienceTo estimate the seismic hazard, the geometry (dip, length and orientation) and the dynamics (type of displacements and amplitude) of the faults in the area of interest need to be understood. In this paper, in addition to geomorphologic observations, we present the results of two ground penetrating radar (GPR) campaigns conducted in 2010 and 2011 along the Emeelt fault in the vicinity of Ulaanbaatar, capital of Mongolia, located in an intracontinental region with low deformation rate that induces long recurrence time between large earthquakes. As the geomorphology induced by the fault activity has been highly smoothed by erosion processes since the last event, the fault location and geometry is difficult to determine precisely. However, by using GPR first, a non-destructive and fast investigation, the fault and the sedimentary deposits near the surface can be characterized and the results can be used for the choice of trench location. GPR was performed with a 50 MHz antenna over 2-D lines and with a 500 MHz antenna for pseudo-3-D surveys. The 500 MHz GPR profiles show a good consistency with the trench observations, dug next to the pseudo-3-D surveys. The 3-D 500 MHz GPR imaging of a palaeochannel crossed by the fault allowed us to estimate its lateral displacement to be about 2 m. This is consistent with a right lateral strike-slip displacement induced by an earthquake around magnitude 7 or several around magnitude 6. The 2-D 50 MHz profiles, recorded perpendicular to the fault, show a strong reflection dipping to the NE, which corresponds to the fault plane. Those profiles provided complementary information on the fault such as its location at shallow depth, its dip angle (from 23 • to 35 •) and define its lateral extension. Central Asia is known for its high level of seismic hazards, especially Mongolia, which has been one of the most seismically active intracontinental regions in the world with four large earthquakes (magnitude around 8) along its active faults in the western part of the country during the last century (Khilko et al. 1985). The deformation in Mongolia is located between compressive structures related to the collision and penetration of the Indian plate into the Eurasian plate and extensive structures in the north of the country related with the Baykal rift (Tapponnier & Molnar 1979; Baljinnyam et al. 1993; Schlupp 1996; Bayasgalan & Jackson 1999). The seismic activity observed in the vicinity of Ulaanbaatar (UB), capital of Mongolia, is relatively low compared to the activity observed in western Mongolia. Nevertheless, since 2005, the seismic activity around UB not only has increased, but is also organized (see Fig. 1) at the west of UB along two perpendicular directions, which determine two active faults: Emeelt fault, discovered in 2008 (NNW-SSE direction, 25-km-long minimum and situated about 10 km W of UB) and Hustai fault (WSW–ENE direction, 80 km long, with its NE tip at less than 20 km west of UB); their length and morphology indicate that they can produce earthquakes of magnitude 6.5–7.5 (Schlupp et al. 2012). Most of the Mongolian population (1.2 million over 3 million) is concentrated at UB, which is the main political and economical centre of the country. Hence, the study of seismic hazard and the estimation of the probability of future destructive earthquakes are of primary importance for the country (Dugarmaa et al. 2006). Since the last large earthquake, the faults geomorphology has been highly smoothed by erosional processes and the exact location of the fault plane surface rupture is thus hidden within a several metre wide strip. The GPR method has been proven to give good and useful results to characterize faults by identifying offsets of radar reflections (Malik et al. 2007; Christie et al. 2009; Yalçiner et al. 2013) an

Torus palatinus and torus mandibularis in skeletal remains from Xiongnu and Medieval period

Oral tori are bony growth present in the oral cavity and are not considered as pathological lesions. Smaller tori do not cause any problems, but larger sized tori can result in significant problems. The aim of this study was to determine the prevalence of torus palatinus (TP) and torus mandibularis (TM) in the two historical periods Xiongnu and Medieval period. A total of 90 skeletal remains were examined from both the Xiongnu (n=53; 25 male, 23 female, 5 child) and the Medieval periods (n=37; 13 male, 19 female, 5 child), which stored at the Human Bone Collection of the Institute of Archaeology, MAS. A total of 8 Xiongnu individuals (15%) and 5 Medieval period individuals (13.5%) presented with TM, while 5 Xiongnu (9.4%) and 2 Medieval period individuals (5.4%) had TP. In both historical periods, TP and TM were more common in the 20-39 age group and more frequent in males than females. The correlation between the torus palatinus and the torus mandibularis is statistically significant at 0.01 level. The results of the present study demonstrate that the prevalence of tori in the studied Xiongnu and Medieval populations is low. There is a tendency for the prevalence of tori to increase with age, although this is not a statistically significant trend. Хүннү болон Дундад зууны үеийн хүний ясан дээрх эрүү ба тагнайн торус Хураангуй: Амны хөндийн торус нь амны хөндийд ажиглагддаг ясны ургалт бөгөөд энэ нь өвчлөлд ордоггүй байна. Жижиг хэмжээтэй торус нь тухайн хүний амьдралын чанарт нөлөөлдөггүй ба харин томоохон хэмжээтэй торус нь хэл ярианы хөгжилд нөлөөлөх зэргээр өдөр тутмын амьдралд хүндрэл учруулах боломжтой. Энэхүү судалгааны зорилго нь Хүннүгийн болон Дундад зууны үе дэх тагнайн торус болон эрүүний торусын тархалтыг тодорхойлох явдал юм. Уг судалгаанд ШУА-ийн Археологийн хүрээлэнгийн хүний ясны сан хөмрөгт хадгалагдаж буй Хүннү (n=53; 25 эрэгтэй, 23 эмэгтэй, 5 хүүхэд) болон Дундад зууны үеийн (n=37; 13 эрэгтэй, 19 эмэгтэй, 5 хүүхэд) нийт 90 палеоантропологийн хэрэглэгдэхүүнийг хамрууллаа. Судалгааны үр дүнд Хүннүгийн 8 бодгаль (15%), Дундад зууны үеийн 5 бодгаль (13.5%) нь эрүүний торусын эмгэгтэй байсан бол Хүннүгийн 5 бодгаль (9.4%), дундад зууны үеийн 2 бодгаль (5.4%) нь тагнайн торустай байжээ. Судлагдсан түүхэн үеүдэд тагнайн торус болон эрүүний торус 20-39 насны бүлгийнхэнд түгээмэл тохиолдож байгаа бөгөөд хүйсийн хувьд эмэгтэйчүүдээс илүү эрчүүдийн дунд илүү ажиглагдаж байна. Тагнайн торус болон эрүүний торус хоорондын хамаарал статистикийн хувьд 0.01 түвшинд байна. Энэхүү судалгааны үр дүнд судлагдсан Хүннү болон Дундад зууны үеийн хүн амд торусын тархалт бага байгааг харуулж байна. Торусын тархалт нас ахих тусам нэмэгдэх хандлагатай байдаг ч энэ нь статистикийн хувьд ач холбогдолтой хандлага биш юм. Түлхүүр үг. Тагнайн торус, эрүүний торус, Хүннү, Дундад зууны ү

THE ROLE OF MONGOLIAN SPECIAL OPERATIONS FORCES IN TERRITORIAL DEFENSE

The recent Russo-Ukrainian conflict insists that Mongolia focus more on enhancing its security and implementing effective defense systems tailored to the unique features of the country—an emerging nation with a small population over a large area. In 2018, Mongolia adopted the “Territorial defense” law to improve the formation of defense capabilities. However, Mongolia’s Soviet-era conscription-based military mobilization limits its present utility in terms of organization, adequate training, and sufficient size to compete against larger neighbors that present threats to its territorial sovereignty. The program needs improvement on implementation and organizational structure to prepare the territorial defense system to enhance the security of Mongolia in support of a more comprehensive approach. This thesis is intended to research how the Mongolian Special Operations Forces is uniquely positioned to help improve the existing territorial defense capacity. During the research, lessons learned from the combined efforts of armed civilians and the small Ukrainian professional forces to resist the overwhelming Russian forces demonstrate strategic value to Mongolia on the effectiveness that a properly trained and resourced Territorial Defense Force has on national deterrence. This thesis will demonstrate the value of Mongolian Special Forces in training territorial defense forces and how this capacity creates the necessary conditions for the utilization of local defense forces.Ded Huranda, Mongolian Armed ForcesApproved for public release. Distribution is unlimited

The Effect of Copper Price Shock on the Relationship between Government Revenue and Expenditure: Testing the Fiscal Stability Law of Mongolia

This study empirically investigates the relationship between government revenue, government expenditure and the copper price in Mongolia, a resource abundant country. Using quarterly data of government revenue, expenditure and international copper price from 2000 to 2015, the results of auto regression (VAR) show that there is a strong causality from revenue to expenditure, while increase in expenditure, most likely, is not accompanied by rises in revenue. This result is consistent with the revenue-spent hypothesis. Moreover, the result also indicates that copper price shock increases revenue, but decreases expenditure. This finding supports the assumption that the Mongolian government follows its Fiscal Stability Law, a strategy that intends to maintain the stability and sustainability of the government budget

The Mongols and the Armenians (1220-1335)

In the thirteenth century, the Armenians of Greater Armenia and of the Armenian Kingdom in Cilicia were invaded by Mongol nomads of the Inner Asian steppe. The ensuing Mongol-Armenian relations were varied. The Greater Armenians became subjects of the Mongol Empire, whereas the Cilician Armenians, by entering into vassalage, became allies and furthered the Mongol conquests. In order to enhance our understanding of this turning point in medieval history, the effects of long distance military raids, missions, diplomacy, collaboration, administrative assistance and confrontation as well as the reasons for invading Greater Armenia and motives for establishing an alliance, are considered

The Effect of Copper Price Shock on the Relationship between Government Revenue and Expenditure: Testing the Fiscal Stability Law of Mongolia

This study empirically investigates the relationship between government revenue, government expenditure and the copper price in Mongolia, a resource abundant country. Using quarterly data of government revenue, expenditure and international copper price from 2000 to 2015, the results of auto regression (VAR) show that there is a strong causality from revenue to expenditure, while increase in expenditure, most likely, is not accompanied by rises in revenue. This result is consistent with the revenue-spent hypothesis. Moreover, the result also indicates that copper price shock increases revenue, but decreases expenditure. This finding supports the assumption that the Mongolian government follows its Fiscal Stability Law, a strategy that intends to maintain the stability and sustainability of the government budget