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Policy, Perception and Health Care Utilization in Myanmar

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Author(s): Soe Moe | Daw Khin Saw Naing

Journal: International Journal of Collaborative Research on Internal Medicine & Public Health
ISSN 1840-4529

Volume: 3;
Issue: 3;
Start page: 239;
Date: 2011;
Original page

Keywords: Policy | health expenditure | health care utilization | patient perception | surgical cases

ABSTRACT
Background: Health Care financing is one of the challenges in health sector globally, and Myanmar isnot an exception. Myanmar provided free health care to all citizens till 1993. As health care cost escalatedin line with technological advancements and newer treatment options, Myanmar envisaged a policy toencourage alternative health care financing by promoting the role of co-operatives, joint ventures, privatesectors and non-governmental organizations in delivery of health care. Thus a community cost-sharingsystem was introduced in all government hospitals and health clinics since 1993. Government hospitalsopened Private wards. Private clinics were developed and upgraded to private hospitals. Clients shared thecost of medicines at government health care facilities, although consultation and accommodation is free.In private sector, clients pay all health care expenses out-of pocket. Formal health insurance is not welldeveloped in Myanmar and Social Security is the only available Scheme. However coverage of thatscheme is limited to some Ministries and enterprise. In this context how people make a choice amongpublic and private sector and how they manage to share the cost of health care is important to see theconsequences of cost sharing policy implementation from patient’s perspectives. .Aim & Objectives: To explore the client perspectives of “individual financing” at private hospital andgovernment hospital under community cost-sharing scheme.Methods/Study Design: A cross sectional study was done in a government hospital, namely YangonGeneral Hospital (YGH) and one private hospital in Yangon, Myanmar. Study population was allsurgical cases undergoing operation in study hospitals during the study period of 3 months. As YGH has3 surgical wards, one of them was randomly selected. Researcher visited selected surgical ward fromYGH and surgical ward of one well known private hospital everyday during 3 months of study period.Newly admitted surgical patients were approached and explained about the research and informed writtenconsent was taken. The interviews of the consented patient were done by the researcher. Altogether 83surgical cases, 35 from private and 48 from government hospital, were interviewed. Among the 48patients in YGH only 4 patients sought private ward. Data collection tool was a pretested pre-codedquestionnaires developed for this purpose. Structured as well as open ended questions were included inthe questionnaires. Quantitative analyses were done for the structured questions and qualitative analysiswas made for the open ended questions. Chi square test was applied to see the statistical differences insocio demographic characteristics of two hospitals. P value of 0.05 was set at 95% confident level.Inclusion criteriaSurgical (both minor and major) patients age 18 and above, both gender, either planned or emergencycases admitted to the hospitals under study.Exclusion Criteria• Patients who were operated outside the study hospitals and being transferred in to the studyhospitals• Cases who were transferred out from the study hospital before completion of treatment• Patients who declined to give consent to be interviewedResults/Findings: High family income group were 7 times more likely to use the private hospitalcompare to low family income group. It was statistically significant (P=0.00008). However, no significantdifference was found in other socio demographic characteristics of private hospital users and governmenthospital users. Median Monthly family income of patients was highest in the private ward of governmenthospital. Patients chose private hospital because of better accommodation, shorter waiting time, minimumrestriction of visiting hours and perceived lack of free services at government hospital. Users of publichospital gave reasons that they were already familiar with the government hospital and they were awarethat services in private hospital were expensive. Relatively larger number of human resources for healthcare and availability of private ward in government hospital were among the reasons provided by thepublic hospital users. Out-of pocket expenditure was reportedly adjusted with family’s monthly incomeand support from non-family members. Some secured the payment with borrowed money or selling ofpersonal assets.Study Limitations: Being a cross sectional study, comparison among private and public hospital couldnot be strongly supported by statistical significance. This study did not extend to the details of individualfinancing mechanism such as interest rate for borrowing money, what is the long term impact of sellingpossession on family.Conclusion: The private sector was sought by the rich but the richer preferred the private ward fromgovernment hospitals. Patients’ perceived quality of care played a role in health care utilization inMyanmar. Nearly half of the YGH users borrowed or sold possessions to cope with the out-of-pocketexpenditure.
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