Perceptions on community cost sharing scheme in selected township hospitals in Myanmar

Abstract

The Community Cost Sharing scheme has been implemented in Myanmar for more than 18 years, since its first implementation in 1993 and this study attempted to explore on the current practices and focused on the perceptions of not only the health providers and health consumers but the poor of the community. Qualitative methods such as in depth interview and focus group discussions were carried out at two township hospitals and in two village communities. The study revealed a number of problems faced by both health providers and consumers. The user fees charged in CCS acted as a barrier to those seeking health and also at the same time pushing those receiving health into impoverishment due to high out-of-pocket expenditure. Mainly pharmaceuticals are the reason for high out of pocket payment. Selling assets and borrowing at high interest rates were revealed as coping mechanisms. Community participation and awareness were lacking and people did not know of their right to receive exemption. There was no clear exemption policy being practiced and majority of the patients only received partial exemption. The revenue generated from CCS could only make a meager contribution towards upgrading the quality of services and for the cost of giving exemption. The study show that implementation of CCS in Myanmar, is not achieving its objective of cost recovery and at the same time poor are being affected by user fees and suggests for the need to explore a health financing system which would be more equitable and give more social protection.