Govt, NLD at odds over health coverage upgrade
UNIVERSAL health coverage appears set to become a political issue in the 2015 election, with the government and the National League for Democracy in agreement on the need to introduce af-fordable coverage for all – but at odds on how and over what period to do it.The World Bank, which is assist-ing the government with its plans, de-scribes 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 in-surance, welfare health organisations and the public,” he told
The Myanmar Times
in a recent interview. After decades of underinvestment in health, the challenges for introduc-ing universal health coverage are enor-mous. Many remote populations are entirely cut oﬀ from health services; rates of tuberculosis, malaria, and ma-ternal and child mortality are among the highest in Asia. The high and varied burden, combined with a 20-year de-cline in social-sector spending, presents formidable health policy challenges, particularly for extending services to hard-to-reach populations, analysts say.But providing healthcare coverage for Southeast Asia’s largest country will require more than just careful plan-ning. 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 uni- versal 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 treat-ment.“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 taxes on alcohol and cigarettes. Total health expenditure – the amount expended by both the govern-ment and individuals – currently repre-sents 2pc of GDP, U Htay Win said. The government is aiming to incrementally increase this to 5pc – a ﬁgure suggest-ed by the World Health Organization (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 ex-penditure 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 treat-ment.”The funding shortfall would be made up by levying private health in-surance 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 the 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 need-ed and what can be delivered ﬁrst through the existing public and private healthcare establishments, taking into account their human resources and in-frastructure, Dr Hnin Hnin Pyne said. While neighbouring Thailand intro-duced 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 treat-ment – 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 Or-ganization 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.”
SHWE YEE SAW MYINTBRIDGET DI CERTO
NLD says it will implement universal health coverage within 10 years if elected, while government – assisted by the World Bank and the WHO – has set a 20-year timeframe
A male patient sits with a relative at Bogale township hospital in Ayeyarwady Region.
Photo: Kaung Htet
Increase in the state health budget in 2013-14, to K499.31 billion
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