Department of Health Policy, London School of Economics and Political Science, London, United Kingdom.
PLoS Med. 2021 Oct 15;18(10):e1003811. doi: 10.1371/journal.pmed.1003811. eCollection 2021 Oct.
Universal health coverage (UHC) encompasses 2 main components: access to essential healthcare services and protection from financial hardship when using healthcare. This study examines Myanmar's efforts to achieve UHC on a national and subnational level. It is a primer of studying the concept of UHC on a subnational level, and it also establishes a baseline for assessing future progress toward reaching UHC in Myanmar.
The study uses the Demographic and Health Survey (2015) and the Myanmar Living Conditions Survey (MLCS; 2017) and adapts a previously developed UHC index to provide insights into the main barriers preventing the country's progress toward UHC. We find a negative correlation between the UHC index and the state/region poverty levels. The equity of access analysis reveals significant pro-rich inequity in access to all essential healthcare services. Socioeconomic status and limited availability of healthcare infrastructure are the main driving forces behind the unequal access to interventions that are crucial to achieving UHC by 2030. Finally, financial risk protection analysis shows that the poor are less likely to use healthcare services, and, once they do, they are at a greater risk of suffering financial catastrophe. Limitations of this study revolve around its correlational, rather than causal, nature.
We suggest a 2-pronged approach to help Myanmar achieve UHC: Government and state authorities should reduce the financial burden of seeking healthcare, and, coupled with this, significant investment in and expansion of health infrastructure and the health workforce should be made, particularly in the poorer and more remote states.
全民健康覆盖（UHC）包含两个主要组成部分：获得基本医疗保健服务以及在使用医疗保健时免受经济困难的影响。本研究考察了缅甸在国家和次国家层面实现全民健康覆盖的努力。它是在次国家层面研究全民健康覆盖概念的入门，也为评估缅甸未来实现全民健康覆盖的进展建立了基准。
本研究使用了 2015 年的人口与健康调查（DHS）和 2017 年的缅甸生活条件调查（MLCS），并采用了之前开发的全民健康覆盖指数，以深入了解阻碍该国向全民健康覆盖迈进的主要障碍。我们发现全民健康覆盖指数与州/地区贫困水平呈负相关。获取途径的公平性分析表明，在获取所有基本医疗保健服务方面存在显著的偏向富人的不公平现象。社会经济地位和医疗基础设施的有限可用性是导致 2030 年实现全民健康覆盖的关键干预措施获取不平等的主要驱动因素。最后，财务风险保护分析表明，穷人更不可能使用医疗保健服务，而且一旦使用，他们遭受财务灾难的风险更大。本研究的局限性在于其相关性而非因果性。
我们建议采取双管齐下的方法来帮助缅甸实现全民健康覆盖：政府和州当局应减轻寻求医疗保健的经济负担，同时应进行大量投资并扩大卫生基础设施和卫生人力，特别是在较贫穷和较偏远的州。
