Healthcare Provider Payments: Acceptance and Preferences of Myanmar General Practitioners
Kyu, Ei Mon Thinn
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Progress towards universal health coverage (UHC) has been uneven globally due to weaknesses in health financing. Experiences in managing the COVID-19 pandemic and its need for increased healthcare resources have highlighted the frailties in health financing, particularly strategic purchasing. The pandemic has also provided an opportunity to critically reconsider current UHC approaches, which need to be more resilient and sustainable. These adjustments include applying robust payment methods in the private health sector to optimise health resources during a public health crisis or other emergencies. Myanmar, a low-to-middle-income country in Southeast Asia, requires robust provider payment mechanisms to achieve UHC by 2030. This research sought to examine Myanmar general practitioners’ (GPs) acceptance of and preferences for healthcare payment methods. Previous literature is biased to the Global North, with limited reference to Southeast Asia, and an absence of research focused on provider perceptions, attitudes, and beliefs prior to the introduction of nationwide strategic purchasing payment mechanisms. These research gaps created an opportunity to explore the relationships between GPs’ socio-demographic characteristics and clinic services profile and their acceptance of, and preferences for, specific payment methods. A cross-sectional study, recruiting 622 participants with a convenience sampling method was used. A Qualtrics online survey was disseminated to Myanmar GPs through Facebook Ads Manager, the primary investigator’s networks, and other third-party organisations. The research showed that performance-based payment was the most acceptable and most preferred payment method, followed by fee-for-service. Salary payments were reported as the least acceptable and least preferred payment type, while findings on capitation were not definitive. The study’s findings also showed that gender, advanced postgraduate qualifications, and overseas experience of GPs predicted the acceptability of specific payment methods. In addition, the GPs whose clinics were in peri-urban or rural settings were less likely to accept performance-based payment. Of the attributes investigated for GP clinic services, the number of health services offered, clinic opening hours, and daily consultation load were associated with the acceptability of and preferences for three payment options: capitation, salary, and performance-based payment. Due to existing knowledge gaps and the bias of literature, the results of this research were not always comparable to findings from earlier studies. The rising burden of non-communicable diseases and the skewness of age and gender distribution in the sample may be possible explanations for these unexpected findings. The results also signalled the critical role of third-party organisations in the delivery of primary health services when government-funded healthcare is disrupted due to multiple simultaneous shocks. Despite the potential for this research to inform strategic purchasing arrangements in Myanmar, the scope for applying these findings as initially intended is not realistic in the immediate future. In this context, the study’s results provide valuable insights into the possible role of alternative provider payment architectures, especially during public health crises and emergencies.