Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
Water, Research and Training Center (WRTC), Yangon, Myanmar.
Int J Equity Health. 2019 Jul 30;18(1):118. doi: 10.1186/s12939-019-1018-y.
Around the world, millions of people are impoverished due to health care spending. The highest catastrophic health expenditures are found in countries in transition. Our study analyzes the extent of financial protection by estimating the incidence of catastrophic health care expenditure in Myanmar and its association with sociodemographic factors.
We performed a secondary analysis of data from the household surveys conducted by the Livelihoods and Food Security Trust Fund (LIFT) in 2013 and 2015 in Myanmar. To estimate the magnitude of catastrophic health care expenditure, we applied the definition of catastrophic payment proposed by the World Health Organization (WHO); a household's out-of-pocket payment for health care is considered catastrophic if it exceeds 40% of the household capacity to pay. We also examined the changes in catastrophic payments at three different threshold levels (20, 30, 40%) with one equation allowing for a negative capacity to pay (modified WHO approach) and another equation with adjusted negative capacity to pay (standard WHO approach).
In 2013, the incidence of catastrophic expenditure was 21, 13, 7% (standard WHO approach) and 48, 43, 41% (modified WHO approach) at the 20, 30, 40% threshold level respectively, while in 2015, these estimates were 18, 8, 6% (standard WHO approach) and 47, 41, 39% (modified WHO approach) respectively. Geographical location, gender of the household head, total number of household members, number of children under 5, and number of disabled persons in the household were statistically significantly associated with catastrophic health care expenditures in both studied years 2013 and 2015. Education of household head was statistically significantly associated with catastrophic health expenditure in 2013. We found that the incidence of catastrophic expenditures varied by the approach used to estimate expenditures.
Although the level of catastrophic health care expenditure varies depending on the approach and threshold used, the problem of catastrophic expenditures in Myanmar cannot be denied. The government of Myanmar needs to scale up the current Social Security Scheme (SSS) or establish a new financial protection mechanism for the population. Vulnerable groups, such as households with a household head with a low-level of education, households with children under the age of 5 years or disabled persons, and low-income households should be prioritized by policymakers to improve access to essential health care.
在全球范围内，数以百万计的人因医疗支出而陷入贫困。在转型期国家，灾难性卫生支出最高。我们的研究通过估计缅甸灾难性医疗支出的发生率及其与社会人口因素的关联，分析了医疗保障的程度。
我们对缅甸生计和粮食安全信托基金（LIFT）于 2013 年和 2015 年进行的家庭调查数据进行了二次分析。为了估计灾难性医疗支出的程度，我们应用了世界卫生组织（WHO）提出的灾难性支付定义；如果一个家庭的医疗保健自付费用超过家庭支付能力的 40%，则认为该家庭的医疗保健支出是灾难性的。我们还检查了在三个不同阈值水平（20%、30%、40%）下灾难性支付的变化，一个方程允许存在负支付能力（修改后的 WHO 方法），另一个方程则使用调整后的负支付能力（标准的 WHO 方法）。
2013 年，按标准 WHO 方法，在 20%、30%、40%的阈值水平下，灾难性支出发生率分别为 21%、13%、7%，而在修改后的 WHO 方法下，这一比例分别为 48%、43%、41%；2015 年，按标准 WHO 方法，这一比例分别为 18%、8%、6%，而在修改后的 WHO 方法下，这一比例分别为 47%、41%、39%。地理位置、户主性别、家庭人口总数、5 岁以下儿童人数和家庭残疾人数与 2013 年和 2015 年的灾难性医疗支出均有统计学显著关联。户主的教育程度与 2013 年的灾难性医疗支出有统计学显著关联。我们发现，支出估计方法的不同会导致灾难性支出的发生率发生变化。
尽管灾难性医疗支出的水平取决于所使用的方法和阈值，但缅甸灾难性支出的问题不容忽视。缅甸政府需要扩大现有的社会保障计划（SSS）或为民众建立新的财务保障机制。政策制定者应优先考虑弱势群体，如教育程度低的户主家庭、有 5 岁以下儿童或残疾人的家庭以及低收入家庭，以改善获得基本医疗保健的机会。
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