Come July, Burma to begin rolling out health insurance

Working in the American health care sector has intensified my fascination with the health care landscape, the complex interplays between patient and provider, government and business sector, and the competing motivators of money versus care.

And the bottom line is that the wellbeing of individuals, communities, and populations is at stake. Yet most people overlook what underpins these medical transactions: insurance policies and legislation.

So the Finance Ministry’s announcement that health insurance is coming to Burma let me feeling like this was a bit premature.

Starting July 1, 12 Burmese insurance companies, including the publicly-run Myanma Insurance, will be offering health insurance on a one-year trial. The announcement was made by the Ministry of Finance.

This comes after a recent announcement by the nation’s Insurance Business Supervisory Board that foreign insurance companies will be allowed to operate on Burmese soil, most notably, directly, or through joint ventures with local firms.

Some notable highlights from the announcement:

  • Eligible coverage is limited to people ages 6-65.
  • Annual premiums are set at 50,000 kyats per person.
  • Consumers can purchase insurance in “units” up to 5 units.
  • Each unit will cover expenses of up to $15,000 kyat/day for 30 days (e.g. hospitalization).
  • Under limited circumstances, death will be compensated, up to 1 million kyats.
  • Exclusions on said coverage include:chronic conditions like HIV/AIDS and deaths resulting from war; pregnancy-related issues (child delivery, pregnancy-onset illnesses, abortions, in vitro fertilization treatment); mental health issues; dental care; eye or cosmetic surgery, heart disease, lung disease, injuries resulting from protest, and expenses from foreign travel.
  • The insurance plans will be reimbursed after care is rendered.
  • Premiums are not refundable.
  • Insurers may deny coverage to consumers depending on pre-existing conditions.

The American way?

I was a bit taken aback by the deputy finance minister’s comments comparing the American and British health insurance schemes:

“Britain’s [health insurance] is more successful than the USA though it spends less than America,” he said. “Britain’s [health] insurance sectors stands at the top of the world’s list. Even in the US, where its health insurance system has been practised for a century, it hasn’t made good progress – though President Obama has focused on it.”

The UK uses a publicly-funded health care system, the National Health Service (NHS), where employees and employers are mandated to pay into the system (via National Insurance). Britain’s system consistently ranks highly on various health care metrics.

On the other hand, Burma seems to be treading in the direction of the U.S., where much policymaking has been driven by the insurance companies, leading to an ever fragmented market that simply does not work. For the illusion of consumer choice, Americans have given up tremendous efficiencies that could be realized through consolidation.

Back in September 2013, Myanmar Times reported that foreign experts in the form of “international insurance professionals”  were being consulted on the health insurance scheme. Currently, about 80% of health care is controlled by the private sector.

Steps toward universal coverage: Myanmar caseAn outline of plans to expand health coverage in a 2012 MOH report (source)

Health policy should in fact, be driven by the Ministry of Health and Parliament, not the Ministry of Finance and Revenue. As a note, the Ministry of Health is aiming to achieve universal health coverage by 2030.

Without any details, the system seems to misalign incentives with treatment (with little accountability on the part of providers to actually tend to their patients) and would exclude large segments of the population from coverage. Thoughts?

Sources

  1. “Government approves plan for health insurance” (Myanmar Times)
  2. “ကျန်းမာရေး အာမခံ ဇူလိုင် ၁ ရက် စတင်မည်၊ အာမခံဝယ်ထားသော်လည်း သတ်မှတ်ချက်များနှင့် ငြိစွန်းလျှင် အာမခံကြေးရမည်မဟုတ်” (မဇ္ဈိမ)
  3. “Private Health Insurance Gets Government Green Light” (The Irrawaddy)
  4. “Insurance firms could work together” (Eleven News)

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