Market Fetishism and Attenuated Primary Care: Producing Poor Medicine for Poor People in Post-Socialist Mongolia

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Market Fetishism and Attenuated Primary Care
Producing Poor Medicine for Poor People in
Post-Socialist Mongolia

• Craig R. Janes, Ph.D.
• Professor of Anthropology Health and Behavioral
  Sciences, University of Colorado
• 2001-2002 Fulbright New Century Scholar
• Thanks to Oyuntsetseg Chuluundorj, Casey
  Hilliard, Khulan Janchiv, Kimberly Rak

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Study Question

• Are principles of health equity consistent with
  the main elements of the global health reform
  agenda?

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Principles of Health Equity

• Fair mobilization of resources
• Fair distribution according to need
• Social vs. cost-utility approaches
• Fair protection from the consequences of
  catastrophic sickness
• Balanced approach needed

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Research Context

• Why Mongolia?
• Economic transition and impact on social services
• Health reform
• Essential primary care delivered through
  network of private family group practices
• Health insurance

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Research Design and Methods

• Multiple-method and multiple-sited study
• Core strategy cluster-type random sample of 91
  low-income urban and rural households,
  representing health experience of 475 individuals

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Summary of Findings

• Health insurance system exclusive and
  unsustainable
• Family group practices limited in kind and
  quality of care
• No access to essential drugs or diagnostic tools
• Funding problems
• Consequences for low-income Mongolians
• Reduced levels of access to care in the secondary
  and tertiary sectors
• Serious consequences in terms of delaying care
  and impoverishment

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Concluding Points

• Health equity as a product of local-global
  processes
• Ambiguous role of state in post-socialist
  contexts
• Lack of serious political interest in social
  justice and equity among
• The discourse on equity among members of the
  donor community
• Uncritical market ideology
• Attenuated primary care and fragmentation of the
  health sector