Progress towards universal health coverage in Myanmar: a national and subnational assessment
Progress towards universal health coverage in Myanmar: a national and subnational assessment
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DOI：
10.1016/s2214-109x(18)30318-8
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发表时间：
2018-09-01
影响因子：
34.3
通讯作者：
Shibuya, Kenji
中科院分区：
文献类型：
--
作者：
Han, Su Myat;Rahman, Md Mizanur;Shibuya, Kenji
实现全民健康覆盖是全球卫生工作的优先事项。缅甸政府已承诺到2030年实现全民健康覆盖，但迄今尚未评估进展情况。我们的目的是估计国家和国家以下的卫生服务覆盖率和金融风险protection.Methods我们使用全国代表性的数据，从缅甸人口和健康调查（2016年）和综合家庭生活状况评估（2010年），检查26个卫生服务指标，并探讨了灾难性的卫生支付和自付费用造成的贫困的发生率。我们使用logistic回归模型的不平等，和风险因素，全民健康保险的指标。结果全国范围内，卫生服务指标的覆盖范围从18.4%（95%CI 14.9-21.9）到96.2%（95.9-96.5）。大多数保健服务指标的覆盖率低于80%的全民健康覆盖目标。14.6%（95%置信区间13.9-15.3）使用卫生服务的家庭面临灾难性的卫生保健费用。2.0%（95%可信区间1.7-2.3）的非贫困家庭因自费支付医疗费用而变穷。保健服务覆盖面和金融风险保护因地区而有很大差异。尽管最富有的五分之一人口比最贫穷的五分之一人口更容易获得医疗服务，但由于医疗保健费用的支付，他们发生财务灾难的几率也更高。在研究所包括的指标中，按财富五分位数计算，适当卫生设施、室内不使用固体燃料、至少四次产前保健访问、母亲产后护理、熟练助产和住院分娩的覆盖率最不公平。解释由于医疗服务覆盖率低、财务风险高、医疗保健服务覆盖率低、医疗保健服务覆盖率低、以及获得医疗服务的不平等。应优先考虑为弱势群体提供卫生服务和财务风险保护。版权所有（C）2018作者。爱思唯尔有限公司出版
Background Attainment of universal health coverage is a global health priority. The Myanmar Government has committed to attainment of universal health coverage by 2030, but progress so far has not been assessed. We aimed to estimate national and subnational health service coverage and financial risk protection.Methods We used nationally representative data from the Myanmar Demographic and Health Survey (2016) and the Integrated Household Living Condition Assessment (2010) to examine 26 health service indicators and explored the incidence of catastrophic health payment and impoverishment caused by out-of-pocket payments. We used logistic regression models of inequalities in, and risk factors for, indicators of universal health coverage.Findings Nationally, the coverage of health service indicators ranged from 18.4% (95% CI 14.9-21.9) to 96.2% (95.9-96.5). Coverage of most health services indicators was below the universal health coverage target of 80%. 14.6% (95% CI 13.9-15.3) of households that used health services faced catastrophic health-care payments. 2.0% (95% CI 1.7-2.3) of non-poor households became poor because of out-of-pocket payments for health. Health service coverage and financial risk protection varied substantially by region. Although the richest quintiles had better access to health services than the poorest quintiles, they also had a higher incidence of financial catastrophe as a result of payments for health care. Of the indicators included in the study, coverage of adequate sanitation, no indoor use of solid fuels, at least four antenatal care visits, postnatal care for mothers, skilled birth attendance, and institutional delivery were the most inequitable by wealth quintile.Interpretation Attainment of universal health coverage in Myanmar in the immediate future will be very challenging as a result of the low health service coverage, high financial risk, and inequalities in access to care. Health service coverage and financial risk protection for vulnerable, disadvantaged populations should be prioritised. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.