Htoo Wai Aung
Objective: In Myanmar, Social Security Scheme had been implemented since 1956. Social security law was reoriented in 2012 to promote the insurance coverage, and extend the health services including the purchaser-provider split system which is steered by social security board. The study explored the awareness, attitude toward, health seeking behavior, and utilization of health services under the scheme among insured persons, and find out the barriers to access by qualitative approach.
Methods: Community based cross-sectional descriptive study was conducted among 270 employees from 6 factories in three townships of Yangon region by using pre-structured questionnaires. Multistage sampling method was used. Health seeking behavior was explored by Andersen’s model of healthcare utilization. Utilization rates were calculated by USAID Measure formula using secondary data sources. Focus group discussions and key informant interviews applied to explore the barriers.
Results: The utilization rate in 2017 was 3214/10000 population per year among insured persons in the study three townships. Nearly all participants knew that they had the right to free medical care at SSB health services. Among them, 54.4% of the participants had awareness score more than mean score, 12 in maximum of 19. The awareness level was significantly associated with educational and occupational statuses, and service years. In term of utilization, 48.5% had utilized, and it was significantly related with awareness level and some socioeconomic conditions. The participants preferred the other health facilities than the SSB health services. The health seeking behavior was associated with awareness level, perceived severity of illness, and some socioeconomic factors. The higher awareness group, female group, low income group and the group who perceived that their illnesses were severe were more preferred the SSB health services. The main reasons for not utilizing were perceived severity of illness and inconvenient opening hours. The qualitative findings stated that the main barriers were long waiting time, inconvenient opening hours, and inadequate health facilities.
Conclusion: The study indicated that the insured employees perceived that Social Security Scheme is effective for them and helpful when they need. However, it needs to extend the opening hours, expanding the SSB clinics, and promoting the public-private partnership system to increase the utilization of health services under the scheme.
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