The First Central Hospital of Mongolia is set to celebrate its 100th anniversary next year. Established on October 25, 1925, as the People’s Hospital, it began operations with 15 beds, staffed by three Mongolian doctors and one Russian doctor. As the hospital approaches its centenary, we spoke with its current Director, B.Khishigjargal, about the hospital’s healthcare services and its evolution over the years. He is one of the members of the Stem Cell Transplantation Team which was honored with the State Prize last year. B.Khishigjargal has worked at the hospital’s Hematology and Bone Marrow Transplantation Department since 2006.
How has the hospital expanded and developed over the years?
The history of modern healthcare in Mongolia began with the establishment of the First Central Hospital. Next year, we will celebrate its 100th anniversary. Over this century, the hospital has undergone significant transformation, development, and advancement. All of the major achievements in medical science, the introduction of new technologies, innovations, and discoveries in Mongolia are closely linked with our hospital. The foundation of modern medical science in Mongolia was laid with the help of specialists from the Soviet Union, who trained and assisted our doctors and staff. Over time, the various departments and units of the then-single central hospital naturally evolved and branched out. For instance, the Second Central Hospital, Third Central Hospital, National Trauma and Orthopedic Research Center, National Cancer Center, National Center for Communicable Diseases, National Center for Maternal and Child Health, National Center of Mental Health, and the Mongolian National University of Medical Sciences all originated from the hospital. Currently, our hospital operates with more than 1,000 doctors and staff, providing care with a capacity of 540 beds, including 24 intensive care beds.
Due to the overwhelming demand and long waiting times at state-run hospitals, many citizens turn to private healthcare services. What measures is the hospital taking to provide more efficient care to patients?
Mongolia’s healthcare system operates on a tiered structure, ranging from soum and district health centers to provincial hospitals and specialized tertiary care facilities. However, patients often bypass lower-tier facilities and seek care directly at specialized hospitals after first consulting with their local health center. While the law does grant citizens the freedom to choose their healthcare provider, we cannot turn away patients who come to our hospital. It is our responsibility to provide prompt and efficient care.
Given that our hospital offers a wide range of specialized services that are not available elsewhere, it naturally attracts a large number of patients. To alleviate the burden on our outpatient services, we have increased the number of high-demand departments and expanded our service windows to operate simultaneously. For example, we now offer MRI and CT scans on weekends to reduce waiting times for these highly sought-after diagnostic services. However, our operations are constrained by a limited budget, which means we must tailor our services accordingly.
There is growing concern about a widespread shortage of human resources in the healthcare sector. How do you ensure the retention and stability of your medical staff?
Human resource management is crucial in the field of medical science. In the past, our healthcare system operated in a planned, centralized manner similar to a planned economy. However, since March 1, 2021, the healthcare sector transitioned to performance-based financing. Coincidentally, I was appointed as the Director of the hospital on that very day. Previously, the hospital’s operations were entirely dependent on state funding. Now, the funding and autonomy of state hospitals depend on their performance and efficiency.
At that time, our hospital’s annual budget was around 40 billion MNT. Last year, it increased to approximately 85 billion MNT, reflecting the improved performance of our hospital. This shift represents a move toward a more effective system, though there have been successes and challenges along the way. I believe in making decisions through teamwork and collective discussion rather than acting alone.
We have focused on policies to increase our staff’s salaries. Since 2021, we have raised salaries every year, with a 20 percent increase in 2021 and up to a 50 percent increase in 2022. Last year, we also provided bonuses from the revenue generated through performance-based financing.
One of the major challenges we face is the growing issue of burnout among doctors and nurses due to heavy workloads. In particular, the shortage of nurses has become a critical issue. Many nurses leave the profession to work in other fields, so we have prioritized our human resources policies to address this. In some departments, we have even increased nurses’ salaries to be higher than those of doctors to retain them.
How many more nurses are needed?
Currently, our hospital needs approximately 30 more nurses. While we have been hiring graduates to work at our hospital, the shortage remains a significant issue. Some staff members commute from the outskirts of the city or even further. To address this challenge, we selected 30 nurses and specialized professionals, each receiving 30 million MNT. I believed that if we could maintain good financial performance under the new system, we could continue to address our staff’s social needs. However, the limited resources of the Health Insurance Fund have led to a competitive environment among hospitals to secure higher reimbursements. Due to budgetary constraints and subsequent reductions, we are unable to replicate the profitability we experienced in 2022.
The frequent changes in resolutions and decisions by the National Council for Health Insurance have negatively impacted the stability of operations at state hospitals. For instance, there have been reports that the shift of high-cost services into package deals and subsequent reductions in funding have led to financial losses. Is this an issue at your hospital as well?
Compared to last year, our revenue from outpatient services has decreased. We are currently operating with monthly losses of 300 million to 400 million MNT. This situation is partly due to the Health Insurance Fund financing a wide range of services at private hospitals. For example, some clinics generate income by conducting CT and MRI scans for patients. To address these issues, the Health Insurance Fund has now bundled services, including consultations, tests, and high-cost diagnostics, into packages. Several types of bundled service packages have been introduced.
The council implements its resolutions and decisions immediately, which has caused significant challenges. There is no trial period or opportunity for improvement. During seasonal peaks, there are times when resources fall short.
Organ transplantation is a hallmark of the First Central Hospital. It has been reported that funding has been allocated in the national budget for building a new organ and tissue transplantation center. Can you provide more information on this?
Currently, we have performed liver transplants on 265 patients, kidney transplants on approximately 360 individuals, and hematopoietic stem cell transplants on 32 people. We are not only increasing the number of procedures but also performing more complex surgeries. For instance, we have successfully introduced surgeries that were previously not performed in Mongolia and continuously improve our services. Initially, we conducted transplants between patients with fully compatible conditions. Now, we handle more complex cases involving mismatches in blood types or bile ducts, requiring advanced surgical techniques. We are also performing transplants for children and have cases where a single donor liver is divided between two recipients. While we discuss liver and kidney transplants broadly, we also conduct many intricate and high-risk surgeries.
The existing building for the organ and tissue transplantation center, constructed in 2009, was deemed unsuitable and demolished, leading to a new design project. The Ministry of Health issued an international tender, and a South Korean company was selected to design a modern medical facility. Over the years, various hospital directors have advocated for the new center and presented proposals to relevant agencies. Despite the delays caused by the pandemic and economic challenges, the budget for this project was finally approved this year. We hope to have a modern organ and tissue transplantation center by 2026. Although we are successfully performing liver and kidney transplants, the demand remains high. Transplant surgeries involve simultaneous operations for both donors and recipients and can extend beyond 24 hours. In addition, routine surgeries are performed daily. Therefore, we plan to conduct one kidney and one liver transplant per week. With the new center, we will be able to serve many more patients.
Is the hospital able to implement the latest advancements in organ transplantation technology and treatments? Are there any shortages in manpower or resources?
In Mongolia, financial support for introducing new techniques and technologies is not typically included in the budget. We can only contract for services and assistance within the scope of what we are currently equipped to provide. This means we do not receive funding for services not covered in our contract. For example, they may require us to demonstrate that we have provided a certain number of treatments, say 50 cases, before they consider providing funding for new technologies.
We believe that revenue from special taxes, such as those on alcohol and tobacco, should be allocated to healthcare, particularly for funding new technologies. There is also an ongoing discussion about supporting new technologies and training staff through directives from the Minister of Health related to treating conditions that are currently beyond our capabilities in Mongolia. We are hopeful that these issues will be gradually addressed in the future.
In what directives is the hospital focusing on treating currently untreatable diseases in Mongolia?
There are 26 diseases considered untreatable in Mongolia. Over the past two years, our doctors have started treating two types of these diseases. We have implemented stem cell transplants from donors to patients, and we have introduced a new treatment for severe heart blockages. Although there is a significant need for these treatments, the funding has not yet been secured. According to the Minister of Health’s directive, we are also preparing a team to treat Meniere’s disease and will send them abroad for training.
How many patients get medical care annually? What are the main services provided?
Approximately 3,000 people are seen at our outpatient department daily, and in some cases, this number can reach 6,000. However, there is a limit to the number of patients a single doctor can see. Under the new health insurance regulations, doctors are allowed to spend only 10 minutes per patient. Considering this, each department and unit provides assistance and services to over 1,000 patients daily. The core of our services is centered in the general surgery department. We also offer comprehensive care for stomach, liver, gallbladder, and kidney diseases, as well as treatments for a wide range of conditions including lung, heart, and vascular issues.
What are your thoughts on increasing the funding for the Health Insurance Fund?
In developing countries, health insurance premiums for subscribers can be quite high. In countries with advanced health systems, a significant portion of GDP is allocated to healthcare. To ensure adequate funding for health insurance, it is essential to secure funding from the national budget, increase subscriber premiums, and maintain co-payments for each service. For example, there are numerous services where the government covers 100 percent of the costs. Since these services are free, some individuals may neglect their follow-up care or fail to return for monitoring. As the number of people with chronic or long-term illnesses increases, government funding requirements also rise.
On the other hand, there are cases where individuals who have paid into health insurance for many years do not see the benefits. If state-owned hospitals provided quality services without delays, would citizens still prefer private facilities?
Patients need to choose their level of care appropriately. Often, people bypass primary and district health centers to access services directly from tertiary hospitals, increasing the burden on these facilities. State hospitals also need to focus on efficient management to provide prompt services. The challenges faced by state hospitals are largely due to excessive patient load. As a result, individuals may spend several days traveling to receive comprehensive care from doctors.
1.1 million out of 1.4 million citizens who got an early diagnosis test, found to have some form of disease. Given this situation, is the healthcare system in Mongolia moving in the right direction?
The high prevalence of diseases among the population indicates issues within the healthcare sector’s structure and organization. There should be a greater focus on public health. Preventative measures and policies to avoid illnesses have been neglected. As a result, there is a rise in the number of patients, which increases the burden on healthcare facilities. Last year was a year of promoting public health. Promoting healthy eating, adopting a healthy lifestyle, engaging in physical activities, and avoiding harmful habits from a young age will help reduce illness rates. However, results will not be immediate. Consistent policies and efforts are required to see results. Air pollution, traffic congestion, and social stress contribute to health issues, with stress being a major underlying factor for many diseases.
It is often criticized that Mongolia’s healthcare sector lags 20-30 years behind global standards. Do you agree with this assessment?
It’s challenging to state that we are 20-30 years behind. While some advanced technologies that are just being introduced in developed countries are already being implemented here, there are areas where we are lagging. To align more closely with global standards, medical professionals and specialists need to read extensively, study, and work on implementing new technologies. This requires not just sporadic efforts but sustained investment of time, effort, and resources to fully integrate and localize new methods.
I believe the country should invest more in scientific research. Developed countries often have research and academic centers within hospitals, funded through government projects, scholarships, and grants, which supports the introduction of new technologies. This creates a self-sustaining financial mechanism. Mongolia needs to focus on health research and government investment to advance medical science at the levels of cells, tissues, molecules, and genes. Modern medical advancements are increasingly focused on genetics, and we need to enhance this area.
Currently, there are no research laboratories in state hospitals. The medical faculty primarily conducts public health research rather than clinical research. Third-tier hospitals should collaborate with research institutes and adopt new technologies to accelerate the development of the medical field.
How is it planned to mark the 100th anniversary of the hospital?
Merely celebrating as a pioneer or leader is no longer relevant in modern times. In recent years, other hospitals, especially private ones, have developed rapidly. There is a need to compete, learn from each other, and evolve together. It is essential not only to update the hospital’s infrastructure and equipment but also to ensure that the benefits of development reach the public. We are focused on providing patients with less hassle and efficient services.
Rather than just celebrating the anniversary with awards and medals, we see it as an opportunity to promote the hospital, improve our services, and enhance our ability to serve the public promptly. Therefore, we are planning 100 creative initiatives for the anniversary. Several working groups have been formed to organize activities such as international academic conferences, sports events, and various patient-oriented initiatives.
