In Mongolia, the story of everyday life is not one of thriving, but of enduring. For decades, citizens have faced a harsh paradox. Despite paying into the country’s social insurance system, they often fail to receive the health care and basic services promised to them. Across sectors, from government offices to hospitals, work is entangled in bureaucracy, favoritism and corruption. To get anything done, connections are essential. Even in hospitals, patients must call in favors, or discreetly hand over a few money to secure proper care. Every month, Mongolian workers see a portion of their salaries deducted for mandatory health insurance. In theory, this system is meant to embody solidarity, pooling contributions to protect citizens against financial risks during illness. In reality, the benefits rarely materialize.
“There is little difference between those who have paid their health insurance and those who haven’t,” frustrated citizens say. Many now pay into the system unwillingly, not out of faith, but because the deductions are automatic. This has eroded public trust. While other nations with mandatory health insurance, such as Japan and most European countries, provide citizens with timely, affordable and reliable services, Mongolia’s system falls short.
Japan, often cited as a model, requires all citizens to carry health insurance. There, insurance covers 70 percent of medical costs, with the patient covering the rest. Europeans enjoy similarly robust protections. In contrast, the US reliance on private insurance means uninsured citizens face devastating bills, yet even there, the difference between being insured and uninsured is clear. In Mongolia, by comparison, paying into health insurance offers little tangible advantage. Citizens still queue, plead and pay informally to receive care that should already be guaranteed. Beyond health care, the pattern repeats across public life. From education to workplace rights, Mongolians often find themselves navigating systems that seem designed to obstruct rather than support. For many, life feels less about enjoying the benefits of citizenship than about sheer survival.
Take the case of a woman who went to the First Central Hospital seeking treatment. Instead of care, she was told the earliest doctor’s appointment was in a month’s time. For someone sick, even a day of waiting can worsen a condition, a month can turn an illness into a fatal crisis. In the country’s largest state hospitals, the wait is often worse: two or three months to see a doctor is not unusual. This is not an isolated frustration. Many Mongolians spend 10, even 20 years working in state organizations, with health and social insurance contributions deducted from every paycheck. Yet when they finally seek medical help, they are brushed aside with the now-familiar words, “There is no time. The funds have run out.” Faced with this neglect, citizens are forced to turn to expensive private hospitals. The contrast is stark, the state system promises solidarity but delivers scarcity, while the private sector thrives on those left behind.
For instance, last year, a single citizen managed to receive a discounted 202 million MNT from the Health Insurance Fund, which is proof that the system holds resources. But why should only one person access this “pie”, while millions of others pay in for decades without a meaningful return? Medicines and vaccines are often out of stock, doctors are unavailable, and services are delayed until patients are at death’s door. The bitter reality is that insurance contributions, extracted monthly without consent, rarely translate into the protection they were meant to guarantee. Instead, the gap between what citizens pay and what they receive continues to widen, fueling a sense of betrayal.
The Minister of Health has announced that the health insurance fund has been depleted, state hospitals are running out of medicines and vaccines, and it is no longer possible to receive patients. It has been exactly 100 days since J.Chinburen, who eagerly sought the ministerial post, took office, but so far nothing has been done to improve the sector. Instead, he has replaced the head of the National Health Insurance Center and now has turned his attention to the General Department of Health Insurance. He has informed the Prime Minister that he will not cooperate with the department’s Director S.Enkhbold, who was appointed by the previous minister. Yet, despite his role in bankrupting the insurance fund, S.Enkhbold cannot be dismissed. In the meantime, citizens are left to suffer the consequences, denied even the right to be hospitalized.
The General Department of Health Insurance began 2025 with no debt, but by the end of the first eight months it had accumulated arrears of 142 billion MNT. Those who have not been paid are now refusing to supply medicines and vaccines to state hospitals, and citizens are already feeling the pain. Insulin injections for diabetics have been interrupted, expensive treatments halted, and family hospitals are unable to perform even basic blood and urine tests due to shortages of reagents.
At the same time, the Health Insurance Fund has continued to channel money into private hospitals. In the first eight months of this year, financing for private facilities already exceeded 160 billion MNT, which is the amount intended to last for the entire year. The Ministry tried to provide an additional 40 billion MNT in both September and October, but by then the fund had already been emptied. While the government blames the depletion on earlier spending, the outcome is the same: public hospitals are collapsing while private hospitals benefit from the flow of public money.
Private hospitals in Mongolia, which have absorbed vast sums of money through the health insurance system, rarely deliver the benefits citizens are entitled to. The phrase “health insurance funding has run out” has become a convenient excuse, repeated so often it now sounds almost “beautiful” in its familiarity. In reality, patients seeking care under health insurance find that many private facilities refuse to provide even a single diagnostic test.
Few private hospitals, for example, offer MRI or CT scans through health insurance. Because these services are costly, when citizens request them at the discounted insurance rate, they face waiting lists stretching three to four months. Yet the same scans can be obtained immediately, at any hour of the night, if patients pay in cash. This stark two-tier system, where access depends on money rather than medical need, has left citizens exhausted and embittered.
The consequences are severe in a country already facing one of the world’s highest rates of cancer incidence and mortality. Doctors and experts often warn that patients arrive too late, seeking help only in the advanced stages of disease. But citizens say the system itself is to blame. Preventive care is almost nonexistent. Hospitals often dismiss patients with early symptoms, telling them their illness is “not severe”, only to treat them later when it has already progressed to a critical stage. Oncology hospitals have even halted bone marrow transplant surgeries due to lack of funding, depriving patients of life-saving options.
The situation is no better in general state hospitals. Reports are constant that major facilities are charging for care that should be covered. ENT surgeries, once part of insurance coverage, now require direct payment. In fact, funding for entire categories of diseases and disorders has been withdrawn. The General Department of Health Insurance has even introduced a quota system for planned surgeries. Patients whose operations fall outside the limit must pay for them on their own, regardless of their financial situation. For many, this means abandoning treatment altogether, allowing their conditions to worsen, and in some cases, leading to preventable deaths.
The most tragic aspect is the treatment of chronic diseases. These conditions, which should be managed and prevented long before they escalate, have instead been pushed into the category of services that face new restrictions. Elderly people and those with long-term illnesses are finding it increasingly difficult to secure hospital care under health insurance. By denying coverage for the very diseases that require consistent attention, the system has turned its back on those who need it most.
Everyone knows that the budget of the health insurance fund is limited. But if the money that citizens pay every month were properly managed and distributed fairly, the fund would not be depleted, and hospitals would not be left without basic supplies. Instead, citizens watch in dismay as leaders more concerned with personal interests squander resources that should have been used to safeguard their health.
The Minister of Health has echoed the same tone of indifference once voiced by the Minister of Education, who blamed the growth of the population for shortages in schools and kindergartens. Now the health minister claims that rising numbers of people with chronic diseases are overwhelming the system and stretching the budget beyond its limits. The message is the same: blame lies not with the government, but with the people.
This logic places the burden of failure on citizens themselves. It is their fault, officials imply, that they have grown ill. Their fault for paying insurance premiums on time from wages earned with sweat and sacrifice. Their fault for relying on a system that only seems to function at the very brink of death. When citizens are forced to raise donations to send loved ones abroad for treatment, officials say nothing. When taxpayers cannot benefit from the services they have already paid for, the silence is deafening.
Meanwhile, corruption scandals and evidence of mismanagement continue to surface within government ministries and agencies. Funds are misused, contracts are tainted by bribery, and the health insurance fund is treated like a leaky vessel. Yet those responsible face little accountability. Leaders escape blame while ordinary people are left to bear the cost in their bodies, their families, and their lives.
In this environment, health insurance has become a hollow promise, a system that extracts money from citizens but returns little in moments of need. For Mongolians, the bitter truth remains: they have done their part, paying faithfully every month, while those in power squander their trust.
What is happening in Mongolia today is more than a crisis of health insurance; it is a crisis of values. A nation that once promised equality and solidarity has allowed those ideals to rot under the weight of corruption and neglect. The insurance fund should have been the safety net that protected every citizen, rich or poor, young or old. Instead, it has become a sieve, draining away public resources while leaving the people exposed.
The tragedy is not only in the empty hospitals or the long queues, but in the erosion of trust between the state and its citizens. People have grown tired of being told to be patient while officials fight over positions and power. They have grown tired of being told that shortages are their fault, that their illnesses are the result of their own weakness, that the system is collapsing because they have lived too long or fallen too sick. When leaders treat their people as burdens instead of as the very purpose of government, they betray the foundation of democracy itself.
The Health Insurance Fund should never have been reduced to a political battleground or a private purse. It should have been guarded with the highest level of responsibility, because it holds not only money but lives. The future of Mongolian society depends on whether it can rebuild this trust, whether the government can place people above profit, fairness above favoritism, and service above self-interest. For the ordinary citizen, the demand is simple but profound: to be treated not as a statistic, not as an afterthought, and not as a source of revenue, but as a human being whose health and dignity matter. Until that demand is met, Mongolians will continue to pay for an insurance system that insures nothing, and to live in a country where survival is possible, but living is not.

Published Date:2025-09-22