JANUARY 3, 2025
Out-of-pocket payment and catastrophic health expenditure of tuberculosis patients in accessing care at public-private mix clinics in Myanmar, 2022
Background
The financial burden of tuberculosis (TB) can hinder patients and their families, creating obstacles throughout the care cascade, despite TB prevention and control being provided free of charge. In Myanmar, patients can visit private providers operating under public-private mix (PPM) schemes, where TB services (diagnosis and treatment) are typically offered at no cost. The study focused on quantifying the financial burden faced by TB patients seeking care from Myanmar’s PPM providers.
Methods
This study surveyed 695 adults being treated for TB (including standard TB and cases needing retreatment) from private healthcare providers in four areas in Myanmar with high TB rates. The survey was done by phone in May and June 2022. Researchers looked at all the costs patients and their families had to pay before and after treatment. If a family spent more than 20% of what they could afford on TB care, it was considered a financial burden, based on guidelines from the World Health Organization. Costs were recorded in Myanmar Kyats (MMK) and converted to US dollars (1 USD = 1850 MMK as of July 20, 2022). The study also analyzed what factors made families more likely to face this financial burden.
Results
Patients visited clinics a median of 7 times during TB treatment, with the total cost averaging 53.4 USD, including medical, testing, and other expenses. About 34.5% of patients faced severe financial hardship, spending more than 20% of their income on treatment, especially those who were hospitalized, lived outside Yangon, or used coping strategies. Families with higher monthly incomes (over 162 USD) were less likely to experience this financial burden.
Conclusions
TB patients and their households in Myanmar faced risk of catastrophic costs, even when treated in the private sector with free diagnostic charges and anti-TB medicine. The study highlighted the need for additional strategies or policies to make TB care affordable and mitigate the financial burden of TB-affected households.
