Free and universal, but unequal utilization of primary health care in the rural and urban areas of Mongolia

Background: The entire population of Mongolia has free access to primary health care, which is fully funded by the government. It is provided by family health centers in urban settings. In rural areas, it is included in outpatient and inpatient services offered by rural soum (district) health centers. However, primary health care utilization differs across population groups. The aim of this study was to evaluate income-related inequality in primary health care utilization in the urban and rural areas of Mongolia. Methods: Data from the Household Socio-Economic Survey 2012 were used in this study. The Erreygers concentration index was employed to assess inequality in primary health care utilization in both urban and rural areas. The indirect standardization method was applied to measure the degree of horizontal inequity. Results: The concentration index for primary health care at family health centers in urban areas was significantly negative (-0.0069), indicating that utilization was concentrated among the poor. The concentration index for inpatient care utilization at the soum health centers was significantly positive (0.0127), indicating that, in rural areas, higher income groups were more likely to use inpatient services at the soum health centers. Conclusions: Income-related inequality in primary health care utilization exists in Mongolia and the pattern differs across geographical areas. Significant pro-poor inequality observed in urban family health centers indicates that their more effective gatekeeping role is necessary. Eliminating financial and non-financial access barriers for the poor and higher need groups in rural areas would make a key contribution to reducing pro-rich inequality in inpatient care utilization at soum health centers.