The World Bank, which is assisting the government with its plans, describes universal coverage as ensuring all people obtain the health services they need without suffering financial hardship when paying for them.
U Htay Win, director general of the Health Planning Department, said the Ministry of Health expects it will take 20 years – and a massive injection of state and private funding – to replace the decades-old cost-sharing system with universal health coverage.
“Universal Health Coverage is a very complicated project and we need to balance the organisation of health insurance, welfare health organisations and the public,” he told The Myanmar Times in a recent interview.
After decades of underinvestment in health, the challenges for introducing universal health coverage are enormous. Many remote populations are entirely cut off from health services; rates of tuberculosis, malaria, and maternal and child mortality are among the highest in Asia. The high and varied burden, combined with a 20-year decline in social sector spending, presents formidable health policy challenges, particularly for extending services to hard-to-reach populations in conflict zones, in mountainous states and among the burgeoning class of urban poor, analysts say.
But providing healthcare coverage for Southeast Asia’s largest country will require more than just careful planning. It will require money – and tough decisions about where this money should come from, said Dr Hnin Hnin Pyne from the World Bank.
“It is a social and political decision,” Dr Hnin Hnin Pyne said of deciding on how to implement universal coverage.
In contrast to the government, NLD health policy adviser Dr Kyaw Zaw said the opposition party would make universal coverage a priority and introduce it within 10 years if elected, while over the same period increasing total health expenditure more than seven-fold.
“We want to implement the project within a short time by increasing the government budget for public health,” Dr Kyaw Zaw said. “In Myanmar most people are unable to access acceptable health services from the government and they can’t afford to pay for treatment.
“If the NLD wins the election, they have a plan to increase the government budget [so that] health expenditure is 15 percent of [gross domestic product],” he said, adding that this would be paid for through higher taxes on alcohol and cigarettes.
Total health expenditure – the amount expended by both the government and individuals – currently represents 2pc of GDP, U Htay Win said. The government is aiming to incrementally increase this to 5pc – a figure suggested by the World Health Organisation (WHO) – by raising state spending, which in 2012-13 was K386.66 billion; around 0.76pc of GDP and 3.14pc of the total budget. Spending increased more than 29pc in 2013-14, to K499.31 billion.
However, there are limits as to how fast both state and private health expenditure can be scaled up, U Htay Win said.
“We are a developing [country] so we cannot support free treatment for all people and people cannot afford to spend a lot of money for health treatment.”
The funding shortfall would be made up by levying private health insurance premiums on high-income earners, he said. But developing this form of private health insurance so that it covers the entire country could take at least 20 years, he added.
Working with the support of the World Bank and WHO, which are providing technical assistance, the government has earmarked maternal and neo-natal services as the priority services to be delivered first under the universal coverage program.
Choosing priority services requires an honest assessment of what is needed and what can be delivered first through the existing public and private health care establishments, taking into account their human resources and infrastructure, Dr Hnin Hnin Pyne said.
While neighbouring Thailand introduced a relatively large universal care package of services over about 10 years from 1992, Dr Hnin Hnin Pyne said it did so from much higher level of initial spending.
Its total national expenditure on health was estimated at 4.3pc of GDP in 2009 and today Thailand spends about US$174 per capita on health, compared to $2 in Myanmar, she said.
In Myanmar, patients end up paying more than 65pc of their healthcare bills out of their own pocket – a payment system that leaves healthcare seekers highly vulnerable to impoverishment or ruin.
This can lead people to forgo treatment – an unhealthy statistic almost impossible to capture.
A functioning universal health care program provides affordable treatment at a cost that is not impoverishing or ruinous, said Dr Sundarajan S Goplan, health adviser to the World Health Organization in Myanmar, said.
“This means that if [someone] is on the poverty borderline, they do not fall into poverty due to health expenditure,” Dr Goplan said, “and that if someone is already impoverished they do not incur catastrophic spending on health that is [economically] ruinous.”
source: The Myanmar Times
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