Cost Containment in Comparative Health Systems: A Comparative Descriptive Analysis and Document Review of the United States, Germany, Japan, South Korea, and Mongolia

Abstract

Containing healthcare costs while preserving quality and access remains a central challenge in health policy. Rising expenditures –  driven by population ageing, technological change, wage growth, and expanded coverage – pose increasing risks to fiscal sustainability. In Mongolia, ongoing health financing reforms highlight the need for clearer evidence on effective and context-appropriate cost-containment strategies. Objective: This study compares cost-containment strategies across the health systems of the United States, Germany, Japan, South Korea, and Mongolia, and identifies specific policy options tailored to Mongolia. Methods: A sequential explanatory comparative design was applied. Quantitative analysis used the most recent available data (2019-2024) from OECD Health at a Glance 2025, the World Bank, WHO Global Health Expenditure Database, and national Health Accounts to compare expenditure patterns and system indicators. This was followed by a structured document review and thematic policy analysis of national policies, institutional reports, and peer-reviewed literature. A deductive-inductive coding framework identified key cost-containment mechanisms and their empirically documented outcomes. Results: Health expenditure as a share of GDP ranged from 17.2% in the United States to 8.4% in South Korea, with substantial variation in per capita spending. Countries with stronger centralized price regulation, coordinated purchasing, and pharmaceutical cost control, particularly Japan and South Korea, achieved more effective cost containment while maintaining favorable health outcomes. Germany demonstrated stable expenditure growth through negotiated pricing and corporatist governance. In contrast, the United States exhibited high expenditure with limited cost control. Mongolia showed constrained strategic purchasing capacity, limited provider incentives, and hospital-centered resource allocation. Conclusion: Effective cost containment depends on payment design, purchasing capacity, and regulatory coherence. For Mongolia, evidence supports adopting a blended payment model combining expanded DRG-based hospital payments with capitation-based primary care financing and 20-30% performance incentives, alongside increasing primary care expenditure to 30-35% of total health spending and strengthening pharmaceutical pricing and regulatory mechanisms.