Kidney transplantation fee must be raised in Mongolia
By Caroline Song
In an interview conducted by the UB POST of Mongolia, the State Honored Doctor and Professor of Chronic Kidney Disease Clinic D.Nyamsuren, who is currently the head of the Kidney Transplant Center team at the National Central Hospital in Mongolia, addresses the concern of kidney transplant fees. Currently, a kidney transplant at the National Central Hospital costs 12 million Mongolian Tughrik (MNT), which is roughly $7,000 US dollars. Out of the 12 million MNT, the Ministry of Health covers 8 million MNT and the rest is to be covered by the patient. D. Nyamsuren claims that the true cost of a kidney transplant is not 12 million MNT, but closer to 27.5 million MNT. This means that the hospital is covering the residual cost. The 27.5 figure is still a conservative estimate and only includes the necessary medication, equipment, materials, immunosuppressant and postoperative treatment expenses, but does not include a fixed costs of rent, doctors’ fees, nurses and caregivers, and building expenses. However, a sudden increase in the fee would change the current 4 million MNT for the patient’s out of pocket expense to 19.5 million MNT. In US figures, that means an increase from about $2,300 to $11,000, nearly a five-fold increase. While this expense is much higher, D. Nyamsuren hopes that insurance companies would be able to provide a 50%-60% return to the patient.
The increase in fee, he believes, will aid in developing the health sector. Since 1970, the health sector has seen little advance over the years. In order for development to occur, it would require changing the system to follow more western standards where insurance companies help pay a percentage. Yet, Mongolia is trying to move to a system where medical examinations, treatments, and health services are provided for free instead of for a fee. D. Nyamsuren believes this is wrong and could cripple the health system.
In Mongolia, kidney disease is ranked third as the most common disease. Right now, around 300 people are on dialysis waiting for a transplant. According to the Law on Donation, which was approved on January 22, 2000 and later revised on May 22, 2012, approved of cadaveric donations. Despite the mandate, donations are low, partially because of a nationwide infection on Shpritsnii Shar from 1970-1990; a large number of the population has Liver B or C infections rendering them poor candidates for donation. There is also a religious belief hindering deceased donations. Despite the troubles, the National Central Hospital is seeing advancements in their kidney transplant procedures and performed their first successful adult donor to child transplant in 2006 and are scheduled for three more in the coming months.
In order to address the lack of kidney surgeons in outlying provinces, the Minister of Health is promising the distribution of doctors for kidney surgery within 21 provinces and district hospitals. Mongolia is comprised of 21 provinces and this mandate would provide relief for the National Central Hospital, which is currently the only hospital providing kidney surgery. The hospital will also provide about four to six months of training for kidney surgeons.
