scholarly journals A new hope: from neglect of the health sector to aspirations for Universal Health Coverage in Myanmar

2019 ◽  
Vol 34 (Supplement_1) ◽  
pp. i38-i46
Author(s):  
Alex Ergo ◽  
Thant Sin Htoo ◽  
Reena Badiani-Magnusson ◽  
Rivandra Royono
Keyword(s):  
Universal Health Coverage ◽  
Health Sector ◽  
Health Spending ◽  
Poverty Line ◽  
Political Support ◽  
Care Seeking ◽  
Health Coverage ◽  
Catastrophic Health Spending ◽  
Out Of Pocket Payments ◽  
Universal Health

Abstract 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, ∼28% took loans and ∼13% sold their assets to cover health spending. In that same year, ∼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.

scholarly journals Financial risk protection of Thailand’s Universal Health Coverage: results from series of national household surveys between 1996 and 2015

2020 ◽  
Author(s):  
Viroj Tangcharoensathien ◽  
Kanjana Tisayaticom ◽  
Rapeepong Suphanchaimat ◽  
Vuthiphan Vongmongkol ◽  
Shaheda Viriyathorn ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Financial Risk ◽  
Health Spending ◽  
Poverty Line ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Catastrophic Health Spending ◽  
Out Of Pocket Payments ◽  
Risk Protection ◽  
Universal Health

Abstract Background: Thailand, an upper-middle income country, has demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country achieved full population coverage and a high level of financial risk protection since 2002, through implementing three public health insurance schemes. UHC has two explicit goals of improved access to health services and financial protection where use of these services does not create financial hardship. Prior studies in Thailand do not however provide evidence of long-term UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002.Methods: We used data from a fifteen-year series of annual national household socioeconomic surveys between 1996 and 2015, which were conducted by the National Statistical Office. The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payments for health by households exceeding 10% and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by the additional number of non-poor households falling below the national and international poverty lines after making health payments. Results: Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when the 25% threshold was applied from 1.8% to 0.4% during the same period. The incidence of impoverishment against the national poverty line reduced considerably from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was applied, the incidence of impoverishment was 1.4% and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low. Conclusion: The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design of Thailand’s UHC, which provides a comprehensive benefits package and zero co-payment at point of services. The well-founded healthcare delivery system and favourable benefit package concertedly support the achievement of UHC goals of access and financial risk protection.

scholarly journals Financial risk protection of Thailand’s Universal Health Coverage: results from series of national household surveys between 1996 and 2015

2020 ◽  
Author(s):  
Viroj Tangcharoensathien ◽  
Kanjana Tisayaticom ◽  
Rapeepong Suphanchaimat ◽  
Vuthiphan Vongmongkol ◽  
Shaheda Viriyathorn ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Financial Risk ◽  
Health Spending ◽  
Poverty Line ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Catastrophic Health Spending ◽  
Out Of Pocket Payments ◽  
Risk Protection ◽  
Universal Health

Abstract Background: Thailand, an upper-middle income country, has demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country achieved full population coverage and a high level of financial risk protection since 2002, through implementing three public health insurance schemes. UHC has two explicit goals of improved access to health services and financial protection where use of these services does not create financial hardship. Prior studies in Thailand do not however provide evidence of long-term UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002.Methods: We used data from a fifteen-year series of annual national household socioeconomic surveys between 1996 and 2015, which were conducted by the National Statistical Office. The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payments for health by households exceeding 10% and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by the additional number of non-poor households falling below the national and international poverty lines after making health payments. Results: Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when the 25% threshold was applied from 1.8% to 0.4% during the same period. The incidence of impoverishment against the national poverty line reduced considerably from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was applied, the incidence of impoverishment was 1.4% and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low. Conclusion: The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design of Thailand’s UHC, which provides a comprehensive benefits package and zero co-payment at point of services. The well-founded healthcare delivery system and favourable benefit package concertedly support the achievement of UHC goals of access and financial risk protection.

scholarly journals Financial risk protection of Thailand’s universal health coverage: results from series of national household surveys between 1996 and 2015

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Viroj Tangcharoensathien ◽  
Kanjana Tisayaticom ◽  
Rapeepong Suphanchaimat ◽  
Vuthiphan Vongmongkol ◽  
Shaheda Viriyathorn ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Financial Risk ◽  
Health Spending ◽  
Poverty Line ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Catastrophic Health Spending ◽  
Risk Protection ◽  
Universal Health ◽  
Benefits Package

Abstract Background Thailand, an upper-middle income country, has demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country achieved full population coverage and a high level of financial risk protection since 2002, through implementing three public health insurance schemes. UHC has two explicit goals of improved access to health services and financial protection where use of these services does not create financial hardship. Prior studies in Thailand do not provide evidence of long-term UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002. Methods We used data from a 15-year series of annual national household socioeconomic surveys (SES) between 1996 and 2015, which were conducted by the National Statistic Office (NSO). The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payment (OOP) for health by households exceeding 10 and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by the additional number of non-poor households falling below the national and international poverty lines after making health payments. Results Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when the 25% threshold was applied from 1.8 to 0.4% during the same period. The incidence of impoverishment against the national poverty line reduced considerably from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was applied, the incidence of impoverishment was 1.4 and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low. Conclusion The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design of Thailand’s UHC, which provides a comprehensive benefits package and zero co-payment at point of services. The well-founded healthcare delivery system and favourable benefits package concertedly support the achievement of UHC goals of access and financial risk protection.

scholarly journals Financial Risk Protection of Thailand Universal Health Coverage: results from series of national household surveys between 1996 and 2015.

2020 ◽  
Author(s):  
Viroj Tangcharoensathien ◽  
Kanjana Tisayaticom ◽  
Rapeepong Suphanchaimat ◽  
Vuthiphan Vongmongkol ◽  
Shaheda Viriyathorn ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Financial Risk ◽  
Critical Role ◽  
Health Spending ◽  
Poverty Line ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Catastrophic Health Spending ◽  
Risk Protection ◽  
Universal Health

Abstract Background Thailand, an upper-middle country, had demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country has achieved UHC since 2002 when the whole population was covered by the three public health insurance schemes. Prior studies do not provide long series of UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002.Methods We used data from a fifteen-year series of annual national household socioeconomic surveys between 1996 and 2015, which were conducted by the National Statistical Office. The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payment for health by households exceeding 10% and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by additional number of non-poor households falling below the national and international poverty lines after health payment.Results Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when 25% threshold was applied (from 1.8% to 0.4% in the same period). The incidence of impoverishment against national poverty line reduced considerably, from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was used, the incidence of impoverishment was 1.4% and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low.Conclusion The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design on the Thai UHC that provides comprehensive benefit package, zero co-payment at point of services. The well-founded healthcare delivery systems also play critical role in supporting and sustaining the function of the UHC.

scholarly journals A Hybrid Decision-Making Approach for the Service and Financial-Based Measurement of Universal Health Coverage for the E7 Economies

2019 ◽  
Vol 16 (18) ◽  
pp. 3295 ◽  
Author(s):  
Xiaofeng Shi ◽  
Jianying Li ◽  
Fei Wang ◽  
Hasan Dinçer ◽  
Serhat Yüksel
Keyword(s):  
Decision Making ◽  
Universal Health Coverage ◽  
Health Spending ◽  
Poverty Line ◽  
Negative Influence ◽  
World Health ◽  
Annual Growth Rate ◽  
Health Coverage ◽  
Fuzzy Dematel ◽  
Universal Health

The aim of this study is to measure universal health coverage in Emerging 7 (E7) economies. Within this framework, five different dimensions and 14 different criteria are selected by considering the explanations of World Health Organization and United Nations regarding universal health coverage. While weighting the dimensions and criteria, the Decision-making Trial and Evaluation Laboratory (DEMATEL) is considered with the triangular fuzzy numbers. Additionally, Multi-Objective Optimization on the basis of Ratio Analysis (MOORA) approach is used to rank E7 economies regarding Universal Health Coverage (UHC) performance. The novelty of this study is that both service and financial based factors are taken into consideration at the same time. Additionally, fuzzy DEMATEL and MOORA methodologies are firstly used in this study with respect to the evaluation of universal health coverage. The findings show that catastrophic out of pocket health spending, pushed below an international poverty line and annual growth rate of real Gross Domestic Product (GDP) per capita are the most significant criteria for universal health coverage performance. Moreover, it is also concluded that Russia is the country that has the highest universal health coverage performance whereas China, India and Brazil are in the last ranks. It can be understood that macroeconomic conditions play a very significant role on the performance of universal health coverage. Hence, economic conditions should be improved in these countries to have better universal health coverage performance. Furthermore, it is necessary to establish programs that provide exemptions or lower out-of-pocket expenditures which will not prevent the use of health services. This situation can protect people against the financial risks related to health expenditures. In addition to them, it is also obvious that high population has also negative influence on the countries such as, China and India. It indicates that it would be appropriate for these countries to make population planning for this purpose.

The Path Toward Universal Health Coverage

2016 ◽  
Vol 47 (2) ◽  
pp. 352-373 ◽  
Author(s):  
Rami Yassoub ◽  
Mohamad Alameddine ◽  
Shadi Saleh
Keyword(s):  
Universal Health Coverage ◽  
Social Protection ◽  
Stakeholder Analysis ◽  
Health Sector ◽  
World Health ◽  
Health Coverage ◽  
Implementation Framework ◽  
Middle Income ◽  
Out Of Pocket Payments ◽  
Universal Health

Lebanon is a middle-income country with a market-maximized healthcare system that provides limited social protection for its citizens. Estimates reveal that half of the population lacks sufficient health coverage and resorts to out-of-pocket payments. This study triangulated data from a comprehensive review of health packages of countries similar to Lebanon, the Ministry of Public Health statistics, and services suggested by the World Health Organization for inclusion in a health benefits package (HBP). To determine the acceptability and viability of implementing the HBP, a stakeholder analysis was conducted to identify the knowledge, positions, and available resources for the package. The results revealed that the private health sector, having the most resources, is least in favor of implementing the package, whereas the political and civil society sectors support implementation. The main divergence in opinions among stakeholders was on the abolishment of out-of-pocket payments, mainly attributed to the potential abuse of the HBP’s services by users. The study’s findings encourage health decision makers to capitalize on the current political readiness by proposing the HBP for implementation in the path toward universal health coverage. This requires a consultative process, involving all stakeholders, in devising the strategy and implementation framework of a HBP.

scholarly journals Assessment of Health Budgetary Allocation and Expenditure Toward Achieving Universal Health Coverage in Nigeria

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Yusuff Adebayo Adebisi ◽  
Joshua Ottah Umah ◽  
Omotayo Carolyn Olaoye ◽  
Aishat Jumoke Alaran ◽  
Ayomide Busayo Sina-Odunsi ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Capital Expenditure ◽  
Care Delivery ◽  
Health Sector ◽  
Health Coverage ◽  
Quality Health Care ◽  
Healthcare Budget ◽  
Out Of Pocket Payments ◽  
Universal Health ◽  
Budgetary Allocation

Context: The implementation of the Universal Health Coverage (UHC) promotes access to quality health care delivery through cost-effective initiatives to ensure good health and wellbeing without discrimination. This study examines government finance, budgetary allocation, and expenditure as key health development indicators towards achieving the UHC in Nigeria. Evidence Acquisition: Data analyzed in the study were gotten from journal articles, reports and other secondary sources. Searches were conducted in PubMed, Google Scholar, and WHO Library Database with pre-determined search terms. Further publications were identified through snowballing of citations and references. We reviewed only papers written in English with no date restrictions placed on searches. Results: Within the period of analysis, the annual national health budgetary allocation in Nigeria has been below the 2001 Abuja declaration of allocating 15% of the national budget to health. Our analysis also revealed that if the Abuja declaration was implemented, additional allocations of NGN 4.99 trillion should have been injected into the health sector between 2014 and 2020. In addition, Nigeria also lags behind relative to some other low-and middle-income countries in terms of government expenditure to the health sector in achieving the UHC. Conclusions: The inadequate budgetary allocation in Nigeria to healthcare has significantly influenced recurrent and capital health expenditure. It is worthy to note that the insufficient allocation will continue to significantly affect capital expenditure which is a large determinant of the development of any health system. With the current state of healthcare budget allocation in Nigeria, efforts need to be intensified to ensure the achievement of UHC. In the face of achieving UHC, reviewing the system of healthcare financing and ensuring prudent allocation of resources while shifting the focus from out-of-pocket payments for health is essential. We also recommend increase in political commitment towards improving the health of the populace so as to ensure health systems goals of efficiency, equity, quality of care, sustainability, financial risk protection for all citizens are achievable.

scholarly journals Financing Healthcare in Central and Eastern European Countries: How Far Are We from Universal Health Coverage?

2021 ◽  
Vol 18 (4) ◽  
pp. 1382
Author(s):  
Marzena Tambor ◽  
Jacek Klich ◽  
Alicja Domagała
Keyword(s):  
Universal Health Coverage ◽  
European Countries ◽  
Eastern European ◽  
Health Coverage ◽  
Benefit Package ◽  
Significant Downward Trend ◽  
Out Of Pocket Payments ◽  
Eastern European Countries ◽  
Universal Health

After the fall of communism, the healthcare systems of Central and Eastern European countries underwent enormous transformation, resulting in departure from publicly financed healthcare. This had significant adverse effects on equity in healthcare, which are still evident. In this paper, we analyzed the role of government and households in financing healthcare in eight countries (EU-8): Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia. A desk research method was applied to collect quantitative data on healthcare expenditures and qualitative data on gaps in universal health coverage. A linear regression analysis was used to analyze a trend in health expenditure over the years 2000–2018. Our results indicate that a high reliance on out-of-pocket payments persists in many EU-8 countries, and only a few countries have shown a significant downward trend over time. The gaps in universal coverage in the EU-8 countries are due to explicit rationing (a limited benefit package, patient cost sharing) and implicit mechanisms (wait times). There is need to increase the role of public financing in CEE countries through budget prioritization, reducing patient co-payments for medical products and medicines, and extending the benefit package for these goods, as well as improving the quality of care.

scholarly journals The Legislative Role of Universal Health Coverage Achievement in Kolaka Regency

2020 ◽  
Vol 8 (T2) ◽  
pp. 41-46
Author(s):  
Rahmat Anzari ◽  
Sukri Palutturi ◽  
Aminuddin Syam
Keyword(s):  
Universal Health Coverage ◽  
Health Sector ◽  
Health Coverage ◽  
Data Validity ◽  
District Government ◽  
Document Review ◽  
Fully Functioning ◽  
Depth Interviews ◽  
Universal Health

BACKGROUND: The legislative role intended in accordance with the mandate of law number 17 of 2014 concerning the MPR, DPR, DPD, and DPRD in article 365 mentions three functions of the DPRD, namely, legislation, budgeting, and supervision. AIM: This study aimed to determine the legislative role in the achievement of Universal Health Coverage (UHC) in Kolaka Regency. METOHDS: This research method uses a qualitative with four informants selected by accidental sampling. Data obtained through in-depth interviews, observation, and document review. Data triangulation analysis is used to obtain data validity. RESULTS: The results showed that the role of the legislature in the legislative function had not been carried out properly because there were no regional regulations issued by the district government of Kolaka who supports the achievement of UHC and will only conduct academic studies related to JKN, the budgeting function has been carried out well because of Commission III of the District Parliament of Kolaka has provided full support regarding budgeting in the health sector and the oversight function is also well implemented. Parliamentary budget oversight in Kolaka is carried out 3 times a year/per quarter by the DPRD in collaboration with the inspectorate, BPK and APIP by comparing planning with reality on the ground. It was concluded that the legislative role in the achievement of UHC in Kolaka was not fully functioning properly. CONCLUSION: It is expected to immediately formulate and issue regional regulations that support the implementation of the JKN program as a manifestation of the achievement of UHC in Kolaka and involve academic experts in UHC/JKN in formulating the regional regulation.

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