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Myanmar Universal Health Coverage

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on 20 May 2014

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Transcript of Myanmar Universal Health Coverage

Home Country Profile
Universal Health Coverage: Why?
Thailand's '30 Baht Universal Health Coverage'
Key social & economic perspectives
MINGALAR Universal Health Coverage
UHC is "the most powerful unifying single concept that public health has to offer, because you can realize the dream and the aspiration of health for every person irrespective of what class you belong to, whether you are a woman or whether you are poor"
- Dr. Margaret Chan, Director General of WHO
MINGALAR Universal Health Coverage
Why and How?
Insik Kong, Mohammad Amin Khaliqi
Thein Than Htay

Social burden of Diseases
Social deprivation
Underlying reasons
Promote equity to health care services
: Outpatients 2.45(2003) -> 3.22(2010),
Inpatients 0.094(2003) -> 0.194(2010)
High participation rate by the poor
Increase economic efficiency by spending 3.5% of GDP
Government subsidies plus partial contribution by purchaser
Catastrophic health expenditure fell to 3.2% in 2002, 2.6% in 2004 and finally to 1.9% in 2006
Political perspectives
Motivation/Willingness of policy makers
Short-term implementation period
Purchaser-provider split
Financial resources: Mixed tax-based funds, social insurance and international support
Participation: Mandatory or voluntary
Coverage : Basic service package to extended services
Providing Actors: Single payer or multiple payers
Provider payment: Fee-for-service with global budget and capitation
Root causes
Poor housing
Poor health knowledge
Facts (which never lie)
1/3 of population lives below poverty line

Infant mortality rate - 42 deaths/1000 livebirths
Under-5 mortality rate - 55 deaths/ 1000 livebirths
Maternal mortality rate - 219 deaths/100,000 population
Adult (15-60) mortality rate - 219 deaths/1000 population
WHO's 10 facts on UHC
1. Universal Coverage ensures that all people can use health services without financial hardship
2. All people should have access to the health services they need
3. Out-of-pocket payments push 100 million people into poverty every year
4. The most effective way to provide universal coverage is to share the costs across the population
5. All countries are continually seeking more funds for health care
6. In 2010, 79 countries devoted less than 10% of government expenditure to health
7. Countries are finding innovative ways to raise revenue for health
8. Only 8 of the world’s 49 poorest countries have any chance of financing a set of basic services with their own domestic resources by 2015
9. Globally, 20–40% of resources spent on health are wasted
10. All countries can do more in order to move towards universal coverage
Literature reviews on UHC
“everyone has the right to a standard of living adequate for health, including medical care, and the right to security in the event of sickness or disability” – UDHR
“...an access to key promotive, preventive, curative and rehabilitate health interventions for all at an affordable cost, thereby achieving equity in access” – United Nations
“Health for all” – Alma Alta Declaration
"We also recognize the importance of UHC to enhancing health, social cohesion, and sustainable human and economic development"
- Ban Ki Mun, UN General Secretory
introduced in 2001, implemented in 2002, aim to ensure equitable health care access for all
Purchaser pay 30 Baht (approx. $1) per visit
Exemption for children under 12 years, senior citizens, very poor people
Cover from basic primary health care to comprehensive health packages
Irrational decision making
Limited health expenditure
– 0.5% of GDP
Lack of international support
Poor National investment
Comprehensive dimensions of the policy
Inequity between the poor and the rich
Military regime – 1964-2010
Political driven ‘Social Security Scheme’
Closed economy and monopoly
To address social problems after democratization:
Increasing health care budget to quadruple in 2012
Raising minimal wages of governmental staffs
Strengthening health infrastructures with the help of international organizations
Capacity building – human resources empowerment
Promoting public awareness for taxes
Reforming existing ‘Social Security Scheme’
Myanmar current policy environment
Reducing out-of-pocket money
Enhancing the poor's
accessibility to healthcare
Increasing equity
Increasing national productivity
Insufficient human resource
Aging infrastructure
Lack of technology
Public-private partnership
Trust building
International collaboration
Achieve MDGs
2015 general election
2015 general election/Coup
Economic crisis
Aging population
Policy Analysis
Funding: 2% of annual GDP plus international aid

Implementation period: 2014-2034 (20 years)

Coverage: 60% of total population (both formal & informal sector)

Scheme: 1,000 Kyat (approx.1 $) per visit, Out-of-Pocket money(gap fees)

Services: first five year 2014-2019 - Primary health care
second phase 2020-2025 - Primary health care plus extended health packages

Exemption: the very poor, the disabled and the maternity and infant
MINGALAR Universal Health Coverage
Chongsuvivatwong, V, Phua, KH, Yap, MT, Pocock, NS, Hashim, JH, Chhem, R, Wilopo, SA & Lopes, AD 2011, ‘Health and health-care systems in southeast Asia: diversity and transitions’, The Lancet, vol. 377, no. 9763, pp. 429-437.
Editorial 2012, ‘The struggle for universal health coverage’, The Lancet, vol. 380, no. 9845, p. 859.
Evans DB, Marten R and Etienne C 2012, ‘Universal health coverage is a development issue’, The Lancet, vol. 380, no. 9845, p. 864.
Holmes D 2012, ‘Margaret Chan: committed to universal health coverage’, The Lancet, vol. 380, no. 9845, p. 387.
Hughes, D & Leethondgdee, S 2007, ‘Universal coverage in the land of smiles: lessons from Thailand’s 30 Baht health reforms’, Health Affairs, vol. 26, no. 4, pp. 999-1008.
Prakongsai P, Limwattananon S and Tangcharoensathien V 2009, ‘The equity impact of the universal coverage policy: lessons from Thailand’, Advances in health economics and health services research, vol. 21, pp. 57-81.
Sachs JD 2012, ‘Achieving universal health coverage in low-income settings’, Lancet, vol. 380, no. 9845, pp. 944-947.
Towse, A, Mills, A & Tangcharoensathien, V 2004, ‘Learning from Thailand’s health reforms’, British Medical Journal, vol. 328, no. 7431, pp. 103-105.
World Health Organization 2012, ‘10 facts on universal health coverage’, World Health Organisation, viewed on 2 May 2013, <http://www.who.int/features/factfiles/universal_health_coverage/facts/en/index.html>.
__ 2011, ‘Health system financing country profile: Myanmar’, World Health Organisation, viewed on 29 April 2013, <http://apps.who.int/nha/database/StandardReport.aspx?ID=REPORT_COUNTRY_PROFILE>.
__ 2011, ‘Health system financing country profile: Thailand’, World Health Organisation, viewed on 29 April 2013, <http://apps.who.int/nha/database/StandardReport.aspx?ID=REPORT_COUNTRY_PROFILE>.
Expected Achievement
Equity and Efficiency to health services for all
Reduced mortality and morbidity
Healthy society leads to a healthy economy
High Morbidity & Mortality
Big gap between
the rich and the poor
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