Khaing Inn Kynn, Malik Amonov, Oo Myo, Hamajima Nobuyuki
Young Leaders' Program of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan ; Department of Biostatistics, University of Public Health, Yangon, Myanmar.
Young Leaders' Program of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya J Med Sci. 2015 Feb;77(1-2):203-12.
Myanmar has a high proportion of out-of-pocket (OOP) health care expenditures with limited cost-sharing mechanisms. In Myanmar, there were limited data on the frequency of catastrophic health expenditure (CHE) due to OOP payments, as well as on the factors associated with CHE. This study aimed to investigate health care expenditure, the frequency of CHE, and the factors influencing CHE among households in Magway, Myanmar. A cross-sectional household survey was conducted in 2012 for 700 households (350 in urban areas and 350 in rural areas) in Magway. CHE was defined as a condition wherein the total amount of household health care expenditure was 40% or more of non-food expenditure in the past year. Multiple logistic regression analysis was applied to estimate odds ratios (ORs) and 95% confident intervals (CIs) of CHE. In the previous year, 28.3% of 350 urban households and 51.4% of 350 rural households utilized outpatient services. Households with at least one member admitted to a medical facility were 10.0% and 12.9%, respectively. Those with CHE were 25.2% in the urban areas and 22.7% in the rural areas. The adjusted OR of CHE was 7.79 (95% CI 3.73-16.26) for hospitalization and 1.08 (95% CI 0.36-3.23) for outpatient care, relative to no services used. These findings indicated that nearly one fourth of households in Magway faced CHE due to inpatient care. A safety-net mechanism to protect households from CHE in Myanmar seems essential.
缅甸自费医疗支出占比很高,且成本分摊机制有限。在缅甸,因自费支付导致的灾难性医疗支出(CHE)发生频率以及与CHE相关的因素方面的数据有限。本研究旨在调查缅甸马圭地区家庭的医疗保健支出、CHE发生频率以及影响CHE的因素。2012年对马圭地区700户家庭(350户城市家庭和350户农村家庭)进行了横断面家庭调查。CHE被定义为家庭医疗保健支出总额在过去一年中占非食品支出40%或更多的情况。应用多重逻辑回归分析来估计CHE的比值比(OR)和95%置信区间(CI)。上一年,350户城市家庭中有28.3%、350户农村家庭中有51.4%使用了门诊服务。至少有一名家庭成员入住医疗机构的家庭分别为10.0%和12.9%。城市地区CHE家庭占25.2%,农村地区占22.7%。与未使用任何服务相比,住院治疗的CHE调整后OR为7.79(95%CI 3.73 - 16.26),门诊治疗为1.08(95%CI 0.36 - 3.23)。这些结果表明,马圭地区近四分之一的家庭因住院治疗面临CHE。在缅甸,建立保护家庭免受CHE影响的安全网机制似乎至关重要。