IDEAS home Printed from https://ideas.repec.org/a/plo/pmed00/1003811.html
   My bibliography  Save this article

Evaluation of progress toward universal health coverage in Myanmar: A national and subnational analysis

Author

Listed:
  • Zlatko Nikoloski
  • Alistair McGuire
  • Elias Mossialos

Abstract

Background: Universal health coverage (UHC) encompasses 2 main components: access to essential healthcare services and protection from financial hardship when using healthcare. This study examines Myanmar’s efforts to achieve UHC on a national and subnational level. It is a primer of studying the concept of UHC on a subnational level, and it also establishes a baseline for assessing future progress toward reaching UHC in Myanmar. Methods and findings: The study uses the Demographic and Health Survey (2015) and the Myanmar Living Conditions Survey (MLCS; 2017) and adapts a previously developed UHC index to provide insights into the main barriers preventing the country’s progress toward UHC. We find a negative correlation between the UHC index and the state/region poverty levels. The equity of access analysis reveals significant pro-rich inequity in access to all essential healthcare services. Socioeconomic status and limited availability of healthcare infrastructure are the main driving forces behind the unequal access to interventions that are crucial to achieving UHC by 2030. Finally, financial risk protection analysis shows that the poor are less likely to use healthcare services, and, once they do, they are at a greater risk of suffering financial catastrophe. Limitations of this study revolve around its correlational, rather than causal, nature. Conclusions: We suggest a 2-pronged approach to help Myanmar achieve UHC: Government and state authorities should reduce the financial burden of seeking healthcare, and, coupled with this, significant investment in and expansion of health infrastructure and the health workforce should be made, particularly in the poorer and more remote states. Zlatko Nikoloski and colleagues provide analytical insight into Myanmar’s efforts to achieve universal health coverage on a national and sub-national level.Why was this study done?: What did the researchers do and find?: What do these findings mean?:

Suggested Citation

  • Zlatko Nikoloski & Alistair McGuire & Elias Mossialos, 2021. "Evaluation of progress toward universal health coverage in Myanmar: A national and subnational analysis," PLOS Medicine, Public Library of Science, vol. 18(10), pages 1-18, October.
  • Handle: RePEc:plo:pmed00:1003811
    DOI: 10.1371/journal.pmed.1003811
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003811
    Download Restriction: no

    File URL: https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1003811&type=printable
    Download Restriction: no

    File URL: https://libkey.io/10.1371/journal.pmed.1003811?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896.
    2. Wagstaff,Adam & Eozenou,Patrick Hoang-Vu & Smitz,Marc-Francois, 2019. "Out-of-Pocket Expenditures on Health : A Global Stocktake," Policy Research Working Paper Series 8808, The World Bank.
    3. Martin Ravallion, 2012. "Mashup Indices of Development," The World Bank Research Observer, World Bank, vol. 27(1), pages 1-32, February.
    4. Brown, Sarah & Hole, Arne Risa & Kilic, Dilek, 2014. "Out-of-pocket health care expenditure in Turkey: Analysis of the 2003–2008 Household Budget Surveys," Economic Modelling, Elsevier, vol. 41(C), pages 211-218.
    5. Zhang, Anwen & Nikoloski, Zlatko & Mossialos, Elias, 2017. "Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly," Social Science & Medicine, Elsevier, vol. 190(C), pages 11-19.
    6. Sartori, Anne E., 2003. "An Estimator for Some Binary-Outcome Selection Models Without Exclusion Restrictions," Political Analysis, Cambridge University Press, vol. 11(2), pages 111-138, April.
    7. Adam Wagstaff & Daniel Cotlear & Patrick Hoang-Vu Eozenou & Leander R. Buisman, 2016. "Measuring progress towards universal health coverage: with an application to 24 developing countries," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 32(1), pages 147-189.
    8. ERREYGERS, Guido, 2006. "Beyond the Health Concentration Index: An Atkinson alternative for the measurement of the socioeconomic inequality of health," Working Papers 2006029, University of Antwerp, Faculty of Business and Economics.
    9. Adam Wagstaff, 2005. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 429-432, April.
    10. Owen O'Donnell & Eddy van Doorslaer & Ravi P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Deni Harbianto & Charu C. Garg & Piya Hanvoravongchai & Mohammed N. Huq & Anup Karan & Gabriel M., 2007. "The Incidence of Public Spending on Healthcare: Comparative Evidence from Asia," The World Bank Economic Review, World Bank, vol. 21(1), pages 93-123.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Kyriopoulos, Ilias & Nikoloski, Zlatko & Mossialos, Elias, 2021. "Financial protection in health among the middle-aged and elderly: Evidence from the Greek economic recession," Health Policy, Elsevier, vol. 125(9), pages 1256-1266.
    2. Andrew J. Mirelman & Miqdad Asaria & Bryony Dawkins & Susan Griffin & Richard Cookson & Peter Berman, 2020. "Fairer Decisions, Better Health for All: Health Equity and Cost-Effectiveness Analysis," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 4, pages 99-132, World Scientific Publishing Co. Pte. Ltd..
    3. Erreygers, Guido, 2009. "Correcting the Concentration Index," Journal of Health Economics, Elsevier, vol. 28(2), pages 504-515, March.
    4. Mohammad Monirul Hasan & Jalal Uddin & Mohammad Habibullah Pulok & Nabila Zaman & Mohammad Hajizadeh, 2020. "Socioeconomic Inequalities in Child Malnutrition in Bangladesh: Do They Differ by Region?," IJERPH, MDPI, vol. 17(3), pages 1-14, February.
    5. Mohammed Khaled Al-Hanawi & Rubayyat Hashmi & Sarh Almubark & Ameerah M. N. Qattan & Mohammad Habibullah Pulok, 2020. "Socioeconomic Inequalities in Uptake of Breast Cancer Screening among Saudi Women: A Cross-Sectional Analysis of a National Survey," IJERPH, MDPI, vol. 17(6), pages 1-13, March.
    6. Pulok, Mohammad Habibullah & Sabah, Md Nasim-Us Sabah & Uddin, Jalal & Enemark, Ulrika, 2015. "Progress in utilization of antenatal and delivery care services in Bangladesh: Where does the equity gap lie?," MPRA Paper 63496, University Library of Munich, Germany.
    7. Ziebarth, Nicolas, 2010. "Measurement of health, health inequality, and reporting heterogeneity," Social Science & Medicine, Elsevier, vol. 71(1), pages 116-124, July.
    8. Erreygers, Guido & Van Ourti, Tom, 2011. "Measuring socioeconomic inequality in health, health care and health financing by means of rank-dependent indices: A recipe for good practice," Journal of Health Economics, Elsevier, vol. 30(4), pages 685-694, July.
    9. Yerramilli, Pooja & Fernández, Óscar & Thomson, Sarah, 2018. "Financial protection in Europe: a systematic review of the literature and mapping of data availability," Health Policy, Elsevier, vol. 122(5), pages 493-508.
    10. Peter Konings & Sam Harper & John Lynch & Ahmad Hosseinpoor & Dirk Berkvens & Vincent Lorant & Andrea Geckova & Niko Speybroeck, 2010. "Analysis of socioeconomic health inequalities using the concentration index," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 55(1), pages 71-74, February.
    11. H. Eme Ichoku & William Fonta & Michael Thiede, 2011. "Socioeconomic gradients in self-rated health: a developing country case study of Enugu State, Nigeria," Economic Change and Restructuring, Springer, vol. 44(3), pages 179-202, August.
    12. Zhong, Hai, 2009. "A multivariate analysis of the distribution of individual's welfare in China: What is the role of health?," Journal of Health Economics, Elsevier, vol. 28(6), pages 1062-1070, December.
    13. Aristides dos Santos, Anderson Moreira & Perelman, Julian & Jacinto, Paulo de Andrade & Tejada, Cesar Augusto Oviedo & Barros, Aluísio J.D. & Bertoldi, Andréa D. & Matijasevich, Alicia & Santos, Iná S, 2019. "Income-related inequality and inequity in children’s health care: A longitudinal analysis using data from Brazil," Social Science & Medicine, Elsevier, vol. 224(C), pages 127-137.
    14. Olufunke A. Alaba & Charles Hongoro & Aquina Thulare & Akim Tafadzwa Lukwa, 2021. "Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa," IJERPH, MDPI, vol. 18(13), pages 1-18, July.
    15. Van de Poel, Ellen & Van Doorslaer, Eddy & O’Donnell, Owen, 2012. "Measurement of inequity in health care with heterogeneous response of use to need," Journal of Health Economics, Elsevier, vol. 31(4), pages 676-689.
    16. Marion Devaux, 2015. "Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 21-33, January.
    17. Pulok, Mohammad Habibullah & van Gool, Kees & Hall, Jane, 2020. "Inequity in physician visits: the case of the unregulated fee market in Australia," Social Science & Medicine, Elsevier, vol. 255(C).
    18. Olufunke Alaba & Lumbwe Chola, 2014. "Socioeconomic Inequalities in Adult Obesity Prevalence in South Africa: A Decomposition Analysis," IJERPH, MDPI, vol. 11(3), pages 1-20, March.
    19. dos Santos, Anderson Moreira Aristides & Triaca, Lívia Madeira & Tejada, Cesar Augusto Oviedo, 2021. "Evolution of inequalities in health care use among older people in Brazil: Evidence for the period 1998–2019," The Journal of the Economics of Ageing, Elsevier, vol. 20(C).
    20. Kehinde O. Omotoso & Steven F. Koch, 2017. "Social Determinants of Health Inequalities in South Africa: A Decomposition Analysis," Working Papers 201716, University of Pretoria, Department of Economics.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pmed00:1003811. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosmedicine (email available below). General contact details of provider: https://journals.plos.org/plosmedicine/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.