Patterns of health care use and out-of-pocket payments among general population and social security beneficiaries in Myanmar

Background: As a consequence of the low government expenditure and limited access to health insurance offered by the Social Security Scheme (SSS), out-of-pocket payments (OOPPs) have become the main source of payment for health care in Myanmar. This study aims to provide evidence on the patterns of health care use and OOPPs by the general population and SSS beneficiaries in Myanmar. Method: Face-to-face interviews were conducted among two samples drawn independently of each other. The first sample, the general population sample of persons not insured by SSS, was drawn from the general population in the Yangon Region. The second sample, the SSS sample, was drawn from those possessing SSS insurance. The data were analyzed per sample. Mann-Whitney U tests were applied to compare ordinal variables and independent sample t-tests were applied to compare continuous variables between the two samples. Two-step cluster analysis was applied to identify clusters of respondents with similar patterns of health care use and OOPPs. After the clustering procedure, we used regression analysis to examine the association between socio-demographic characteristics and cluster membership (patterns of health care use and OOPPs) for the two samples separately. Results: Only 23% of those who belonged to the SSS sample and sought health care during the past 12 months, report receiving health care from a SSS clinic during the last episode of illness. Close distance is the main reason for choosing a specific health facility in both samples. OOPPs for health care and pharmaceuticals, used during the last episode of illness are significantly higher in the general population sample. The regression analysis shows that the pattern of health care use is significantly associated with household income. In addition, respondents in the general population sample with a higher income pay higher amounts for their last health care used and were significantly more likely to have to borrow money or sell assets as a coping strategy to cover the payments. Conclusion: Significantly higher OOPPs in the general population sample highlight the need of financial protection among this group. Myanmar needs to extend social protection for both coverage breadths and coverage depth