Jutatip Sillabutra

Household Catastrophic Health Expenditures in Selected Townships of Lower Myanmar

Objective: To measure the extent of household catastrophic health expenditures in both urban and rural areas of ten selected townships in Yangon Division of Lower Myanmar. Methods: The descriptive study for household catastrophic health expenditures was conducted by the Department of Preventive and Social Medicine during 2010. The minimum standard approach was used to determine the catastrophic health expenditures. The incidence and intensity of catastrophic health care payments in terms of 3 defined threshold levels were determined and the impact of catastrophic health care payment matters more for poor or rich households by calculating concentration indices was presented. Finding: 43% of households had catastrophic health expenditures that were entirely out of pocket. All these expenditures related to costs of treatment for one or more of their household members. The incidences of catastrophic health care payments was 9.4%, 5.6% and 4.2% of the sample for 10%, 20% and 30% catastrophic threshold levels respectively. The intensities were 5.9%, 5.1% and 4.6% at 10%, 20% and 30% threshold levels, respectively. It was more significant in urban areas where the intensities were 8%, 7.3% and 6.8%.Mean Positive Gaps (MPG) were extra-ordinarily high and results as 62.8%, 92.5% and 112% in 10%, 20% and 30% catastrophic threshold levels respectively. The concentration indices and rank-weighted versions of incidence and intensity of household catastrophic health care payments highlights the extent of household catastrophic health care payments burdens on whether poor households or rich households and resulted as more concentrated among the poor households. Therefore it can be concluded that there is a greater tendency for the worse-off to exceed the payment threshold and that poor households pay more for health care.Recommendation: In conclusion, the attempts to develop at the national level and the regional level, will need economic, institutional, administrative and reforms, human resource development and poverty reduction programs, to name a few. The incidence of catastrophic health expenditures and the clearly voiced need for health care of good quality provide good ground for innovations; the communities seem to be, “ready,” for trying out something new and are quite willing to give full support. In order to reduce the financial burden of health care services both in urban and rural areas, should be made more affordable especially for poor households. Affordability can be increased by minimizing the expenses of commuting from rural to urban for basic minimum health services. This can be achieved by increasing the coverage and promoting the quality of health care services available from rural health centers and sub centers.