A new hope: from neglect of the health sector to aspirations for Universal Health Coverage in Myanmar
A new hope: from neglect of the health sector to aspirations for Universal Health Coverage in Myanmar
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DOI：
10.1093/heapol/czy110
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发表时间：
2019-10-01
影响因子：
3.2
通讯作者：
Royono, Rivandra
中科院分区：
文献类型：
--
作者：
Ergo, Alex;Htoo, Thant Sin;Royono, Rivandra
自1975年以来，缅甸卫生部门的公共支出水平一直很低。再加上该国历史上的政治和经济孤立、经济管理不善和多次国内武装冲突，这些有限的资源导致即使是最基本的服务覆盖率都很低，卫生结果也很差，差距很大。它们还导致自付医疗费用占卫生总支出的比例在世界上名列前茅。缅甸政府现已确认其致力于实现全民健康覆盖。这一承诺体现在《2017-2021年国家卫生规划》中。根据对2015年缅甸贫困和生活条件调查数据的分析，并使用该国修订后的方法来估计贫困，本文探讨了缅甸过度依赖自付资金作为卫生资金主要来源的一些后果。2015年，缅甸约有48.1万户家庭经历了灾难性的医疗支出。在这一群体中，有18.5万户生活在国家贫困线以下。经历了灾难性医疗支出的家庭平均花费了他们总医疗支出能力的54.7%。在2015年前往医疗机构就医的所有缅甸家庭中，约28%的家庭获得了贷款，约13%的家庭出售了资产以支付医疗支出。同年，约有170万人因医疗支出而降至国家贫困线以下。然后，本文讨论了正在进行的改革如何有助于缓解与寻求护理有关的经济困难。缅甸目前有改革卫生系统的政治意愿，有利的宏观经济环境，以及相对有限的既得利益，缅甸有机会在实现普遍保健制度方面取得重大进展。要使改革走上正轨，需要持续的高层政治支持和强有力的领导。
Myanmar's health sector has received low levels of public spending since 1975. Combined with the country's historic political and economic isolation, poor economic management and multiple internal armed conflicts, these limited resources have translated into low coverage of even the most basic services and into poor health outcomes with wide disparities. They have also resulted in out-of-pocket payments for health as a proportion of total health spending being among the highest in the world. The Government of Myanmar has now affirmed its commitment to moving toward Universal Health Coverage. This commitment is reflected in the National Health Plan 2017-2021. Drawing upon analysis of data from the Myanmar Poverty and Living Conditions Survey 2015 and using the country's revised methodology to estimate poverty, this paper explores some of the consequences of Myanmar's excessive reliance on out-of-pocket funding as the main source of health financing. Around 481 000 households in Myanmar experienced catastrophic health spending in 2015. Of this group, 185 000 households lived below the national poverty line. Households that experienced catastrophic health spending spent, on average, 54.7% of their total capacity to pay on health. Of all Myanmar households that went to a health facility in 2015, similar to 28% took loans and similar to 13% sold their assets to cover health spending. In that same year, similar to 1.7 million people fell below the national poverty line due to health spending. The paper then discusses how ongoing reforms could help alleviate the financial hardship associated with care-seeking. With current political will to reform the health system, a conducive macro-economic environment, and the relatively limited vested interests, Myanmar has a window of opportunity to achieve significant progress towards UHC. Continued high-level political support and strong leadership will be needed to keep reforms on track.