Relationship between Doctor and Patient in Mongolia

Since 1990 Mongolia has been in a state of transition from a communist system to a market economy, with consequent rising unemployment and poverty: 35.6% of the population are classified as ‘very poor’. The other side of the coin is a small number of ‘rich people’ with easy access to a growing number of private clinics, especially in the capital, Ulan Bator. During the communist period everybody had free access to health care facilities, but they had no freedom of choice. There were large primary care clinics and no competition between doctors. People didn't take much care of their health because medical care was free, so it was not important to invest in a good relationship between doctor and patient. Today, 234 family clinics have been established and there are about 950 family physicians. Patients in the city receive their primary health care from the family clinics while rural patients attend a medical station with between one and three doctors, a couple of nurses, laboratory assistants and ancillary personnel. Family doctors are responsible for the health of a family. Patients can select their family doctor themselves and receive care 24 hours a day, seven days a week. The recent development of primary health care has given the family physician the possibility to decide independently on referrals and treatments. Today family doctors are closer to clients and to the family. Primary health care is improving and, in the city, competition exists between family clinics and doctors. People prefer to stay registered with one doctor because of an increase in care offered to the chronically sick and the elderly. Why, however, do most people prefer to consult hospital specialists? This is probably determined by history. First, medical care was free; second, primary health care was unsatisfactory; third, most people have a low standard of living. In previous years the health care system was evaluated according to the number of doctors and beds per patient, whereas nowadays it is evaluated according to quality of service, average age of registered patients, mother and infant mortality and the effectiveness of health economy. The health care system is evolving in a more patient-oriented direction. Doctors have to pay special attention to the growing poverty, which generates infectious diseases, and knowledge problems. The new medical curriculum follows the changes in society.