Ts.Tumur-Ochir: Privatization of state hospitals will open greater opportunities

Trans. by B.DULGUUN

The sole referral center for cardiovascular and neurological treatment in Mongolia is the State Central Third Hospital. It has introduced several new technologies for medical treatment and services this year, including cardiac resynchronization therapy CRT, which was introduced in September for treating chronic heart failure.
Doctors and surgeons from the hospital have successfully completed difficult surgeries for the first time in Mongolia. They transplanted three heart valves simultaneously in June, completed varicose vein surgeries that operate inside blood vessels in August, and treated a patient with resistant hypertension and renal artery disease by removing the diseased inner lining of the artery.
The State Central Third Hospital can hospitalize up to 430 people and has over 720 staff. Approximately 18,000 to 19,000 people receive outpatient services, which don’t require patients to stay overnight at the hospital, and around 20,000 people are admitted to the hospital annually.
The following is an interview with Director of the State Central Third Hospital Ts.Tumur-Ochir about the hospital.

State hospitals completed a number of projects and programs with investment from the government and private sector. Were these projects effective?

The Heart Attack and Stroke Project was carried out with support from the Millennium Challenge Account in Mongolia and the World Health Organization from 2010 to 2013. As a result, a department for acute cerebral stroke and heart attack was established with 20 beds. The department is fully equipped with computer-assisted diagnostics and angiography laboratory. The workload increased rapidly after this department was opened.
Around 600 people were treated after stokes at this department in the first half of 2015. The number of people getting a heart attack is increasing every day. A total of 14 billion MNT was invested into our hospital. Besides renewing technology and equipment, we had doctors trained overseas for short and long periods.
The State Central Third Hospital cooperates with university hospitals of over 20 countries, including the USA, France, Taiwan, Russia, Japan, Singapore and South Korea. Most recently, we signed an agreement with the National Heart Center Singapore. The Singapore Brain Spine Nerves Center also proposed to collaborate.
Luxembourg’s Cardiovascular and Vein Center project is being implemented for the 13th year in Mongolia. This is definitely one of the most consistent and well-enforced health projects. We used to experience blackouts during brain and heart surgeries. Through this project, a backup 700 kW generator was installed at our hospital. This generator is capable of supplying power to seven to eight soums. All cardiac departments in Mongolia were connected electronically within the frameworks of the Cardiovascular and Vein Center project.
The project team is focusing on improving functional capacity for cardiac surgery. Foreign experts visited twice this year and did surgeries on 10 people with congenital and acquired heart defects on each visit. Luxembourg’s project is targeted at adults. Luxembourg is running surgical training to improve skills of Mongolian surgeons. More than 30 patients have been fully treated through this project. Now, expensive heart surgeries are performed for free on both children and adults.

What kind of technological innovation was brought in this year?

Our hospital is concentrating on providing high-quality treatment and diagnosis to the public this year. We performed varicose vein surgery, which is currently impossible to treat in Mongolia, on eight to nine patients and completed difficult heart surgeries on infants with assistance from Seoul National University Hospital and South Korea’s Raphael Clinic.
These surgeries costs 30,000 to 40,000 USD each. Most of the costs for heart, brain and varicose vein surgeries and diagnosis have been covered by the Health Insurance since July 1, 2014.
Majority of Mongolian patients travelling abroad for treatment and diagnosis suffer from arrhythmia (irregular heartbeat). The surgery for this disease costs 40,000 to 45,000 USD in China.
More than 40 percent of patients who were treated abroad in 2014 received support from the Ministry of Health and Sports, but this year, the Ministry is supporting 58 percent of patients. We recently received equipment required for arrhythmia treatment, worth 1.05 billion MNT. Now, we’re working to provide trainings for specialists. Mongolia will be able to cure arrhythmia domestically in 2016. An objective was set to limit the number of people travelling abroad for medical treatment for this reason.
The Diabetics Center opened on November 13, 2015, with a 5,000 USD donation from a Danish company, Novo Nordisk. The number of people diagnosed with diabetes is increasing among the population in relation to the increase of carbohydrate content in daily-used food products. This disease can strongly impact the heart, nerves and other organs when it aggravates and even lead to blindness, limb amputation, stokes and heart attack. This center was established to improve social health activities.

Doctors came last month from South Korea’s Sejong General Hospital and Seoul National University Children’s Hospital, but they had their injections and tools for surgeries confiscated at customs. Were they able to retrieve these items?

They still haven’t been able to get them back. We recently met with the Chief of Investment and Debt Management Division of the Ministry of Finance and delivered an official request for exemption from customs taxes and VAT. He said he’d respond to it in the near future. Our surgeons performed surgeries on nine babies with congenital heart diseases from October 2 to 10.
The team from South Korea came to operate on 10 children, but the number of children in urgent need of surgery increased during examination. Yet, medicine and injections required for the surgeries of 10 children are still being kept at customs.
Approximately 8.2 million MNT was spent on the medication and injection of a single child. These expensive medications can expire or become unusable if stored for too long at customs without a proper storage regime.

A recent survey showed that around 200 to 300 children go abroad for heart surgery every year. The National Center for Maternal and Children’s Health (NCMCH) keeps approximately 1,400 children under its supervision, but it doesn’t have a cardiac surgery department. Is the relation between the State Central Third Hospital and NCMCH improving?

Our hospital cooperates with cardiac surgeons’ teams from the USA, Japan and South Korea. As the population grows, the number of children born with heart defects tend to increase. The NCMCH sends children in urgent need of surgery to our hospital.
According to international standards, a surgery is required immediately after any kind of risk is detected during angiography, a medical imaging technique used to visualize the inside of blood vessels and organs of the body. Even so, [the State Central Third Hospital and NCMCH]are still unable to cooperate well at the policy level.

Many Mongolian patients are developing disabilities after a stroke or heart attack. Is rehabilitation therapy poor in Mongolia?

We do therapy for full recovery. People who have suffered a stroke do not have to lose the ability to work if they are treated in a timely manner. Clinical guidelines for strokes and heart attacks have been developed at a national level. Every hospital is actively following these guidelines.
Considerable amount of time is lost while taking patients to hospitals. Not being able to notice symptoms of strokes and heart attacks or provide first aid is aggravating the conditions of patients. This increases the chances of patients losing the ability to work. We provide traditional rehabilitation therapy. Physical, occupational and speech therapists are trained for a whole year. An expert is necessary for each stage as rehabilitation takes a lot of time.

How much is the annual expenditure? Are there any out of use equipment at your hospital due to low budget?

The state allots 18 to 19 billion MNT annually. Around 2.9 billion MNT is spent on medicine and tools. The stroke and heart attack department hasn’t received government funding since 2013. Our hospital has been operating it through its own resources.
The apparatus for retinal surgery hasn’t been used for a year because we haven’t got the necessary medicine nor reagents. At the beginning of the year, a new technology was introduced and cornea surgery was performed for the first time in Mongolia. But this technology hasn’t been used since. A specialist was trained in India. He has worked for two years at Bolor Med Hospital. We plan to do this surgery continuously starting next year.

Privatization of state hospitals became a controversial topic recently. Have hospitals discussed this among themselves? What do you think about the privatization of state hospitals?

Eight members of Parliament, including S.Odontuya, D.Battsogt and L.Enkh-Amgalan, are developing a draft bill on management of medical care and services. It’s being discussed right now. MP S.Odontuya told hospitals to send proposals for the bill. Our hospital discussed and send a reply.
Some hospital administrations seem to prefer keeping their governance and finance separated from the state. We do too. Hospitals might become independent from the state if this bill is approved. Though only within the scope of administration and organization. Each hospital will get a board that appoints hospital directors. Basically, hospitals will manage their own budget but remain as state properties.
State hospitals aren’t developing because operations are adjusted to their limited budgets. There’s so much to do at the policy level but every year, we end up doing only routine maintenance. Management can improve within a short period, new technologies and equipment can be introduced to hospitals, and the quality of treatment and diagnostics can improve if hospitals become independent from the state. It’ll also give opportunities to resolve social insurance issues of staff members.

Source: Unuudur

Short URL: http://ubpost.mongolnews.mn/?p=17073

Posted by on Nov 25 2015. Filed under Prime Interview. You can follow any responses to this entry through the RSS 2.0. You can skip to the end and leave a response. Pinging is currently not allowed.

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