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. 2019 Apr 27;19(1):258.
doi: 10.1186/s12913-019-4071-8.

Patterns of health care use and out-of-pocket payments among general population and social security beneficiaries in Myanmar

Chaw-Yin Myint  1   2 , Milena Pavlova  3 , Wim Groot  3   4
Affiliations

Patterns of health care use and out-of-pocket payments among general population and social security beneficiaries in Myanmar

Chaw-Yin Myint et al. BMC Health Serv Res. .

Abstract

Background: As a consequence of the low government expenditure and limited access to health insurance offered by the Social Security Scheme (SSS), out-of-pocket payments (OOPPs) have become the main source of payment for health care in Myanmar. This study aims to provide evidence on the patterns of health care use and OOPPs by the general population and SSS beneficiaries in Myanmar.

Method: Face-to-face interviews were conducted among two samples drawn independently of each other. The first sample, the general population sample of persons not insured by SSS, was drawn from the general population in the Yangon Region. The second sample, the SSS sample, was drawn from those possessing SSS insurance. The data were analyzed per sample. Mann-Whitney U tests were applied to compare ordinal variables and independent sample t-tests were applied to compare continuous variables between the two samples. Two-step cluster analysis was applied to identify clusters of respondents with similar patterns of health care use and OOPPs. After the clustering procedure, we used regression analysis to examine the association between socio-demographic characteristics and cluster membership (patterns of health care use and OOPPs) for the two samples separately.

Results: Only 23% of those who belonged to the SSS sample and sought health care during the past 12 months, report receiving health care from a SSS clinic during the last episode of illness. Close distance is the main reason for choosing a specific health facility in both samples. OOPPs for health care and pharmaceuticals, used during the last episode of illness are significantly higher in the general population sample. The regression analysis shows that the pattern of health care use is significantly associated with household income. In addition, respondents in the general population sample with a higher income pay higher amounts for their last health care used and were significantly more likely to have to borrow money or sell assets as a coping strategy to cover the payments.

Conclusion: Significantly higher OOPPs in the general population sample highlight the need of financial protection among this group. Myanmar needs to extend social protection for both coverage breadths and coverage depth.

Keywords: Myanmar; Out of pocket payment; Social security scheme; Type of health care facility; Utilization of health care.

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Conflict of interest statement

Ethics approval and consent to participate

The Ethics Review Committee on Medical Research Involving Human Subjects, Department of Medical Research, Ministry of Health and Sport (MOHS), Myanmar, approved to conduct the current survey under the theme of “A Universal Health Insurance Scheme in Myanmar” with reference letter no.106/ethics 2015. The written informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors have no financial, personal or other relationships with other people or organizations that could inappropriately influence to this study. Milena Pavlova, co-author of this paper, is a Section Editor for BMC Health Services Research.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Model summary and cluster quality of cluster analysis I for general population
Fig. 2
Fig. 2
Model summary and cluster quality of cluster analysis I for SSS population
See this image and copyright information in PMC

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