Unmet Healthcare Needs and Their Determining Factors: Addressing Inequalities in Access to Healthcare in Myanmar

Main Article Content

Chit Su Tinn
Seung Chun Paek
Natthani Meemon


Myanmar aims to achieve universal health coverage by 2030 through the 2017–2021 National Health Plan while providing nearly cost-free healthcare services at public facilities. Nonetheless, concerns regarding healthcare access persist. This study examined healthcare access in Myanmar by identifying the prevalence, determinants, and reasons behind unmet healthcare needs (UHN), which occur when an individual needs healthcare but cannot access it. Descriptive statistical analysis and binary logistic regression were employed using data obtained from 318 residents of Tat Kon Township, Nay Pyi Taw. Among the participants, 23.6% experienced UHN. Specifically, individuals with low income, daily-waged workers, rural residents, younger individuals, and females reported high UHN. The primary reason was the unavailability of healthcare facilities (46.7%), followed by competing personal priorities (19%) and treatment or transportation costs (14%). The government could consider expanding public healthcare infrastructure and implementing a nationwide health insurance system. Continuing the geographic expansion of health services to address the needs of rural residents and extending service hours to accommodate individuals engaged in daily-waged or full-time employment are recommended. These efforts could be complemented by improving public transportation infrastructure, promoting income security, and supporting gender equity to facilitate access to healthcare services.

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Tinn, C. S., Paek, S. C. ., & Meemon, N. (2024). Unmet Healthcare Needs and Their Determining Factors: Addressing Inequalities in Access to Healthcare in Myanmar. Journal of Population and Social Studies [JPSS], 32, 591–608. Retrieved from https://so03.tci-thaijo.org/index.php/jpss/article/view/269670
Research Articles
Author Biography

Chit Su Tinn, Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Thailand

Corresponding author


• Aday, L. A., & Anderson, R. M. (1974). A framework for the study of access to medical care. Health Services Research, 9(3), 208–220. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071804/

• Åhs, A., Burell, G., & Westerling, R. (2010). Care or not care—that is the question: Predictors of healthcare utilisation in relation to employment status. International Journal of Behavioral Medicine, 19(1), 29–38. https://doi.org/10.1007/s12529-010-9129-2

• Allin, S., Grignon, M., & Le Grand, J. (2010). Subjective unmet need and utilization of health care services in Canada: What are the equity implications? Social Science & Medicine, 70(3), 465–472. https://doi.org/10.1016/j.socscimed.2009.10.027

• Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly. Health and Society, 51(1), 95–124. https://doi.org/10.2307/3349613

• Asian Development Bank. (2012, August). Myanmar in Transition: Opportunities and Challenges. https://www.adb.org/sites/default/files/publication/29942/myanmar-transition.pdf

• Asian Development Bank. (2016). Myanmar Transport Sector Policy Note: Rural Roads And Access. https://www.adb.org/sites/default/files/publication/189079/mya-rural-roads.pdf

• Bhattacherjee, A. (Ed.). (2014). Myanmar in Transition: Ethnic Conflicts, External Interests and Political Changes. Institute of Peace and Conflict Studies. http://www.jstor.org/stable/resrep09401

• Bryant, T., Leaver, C., & Dunn, J. R. (2009). Unmet healthcare need, gender, and health inequalities in Canada. Health Policy, 91(1), 24–32. https://doi.org/10.1016/j.healthpol.2008.11.002

• Carr, W., & Wolfe, S. (1976). Unmet needs as sociomedical indicators. International Journal of Health Services, 6(3), 417–430. https://doi.org/10.2190/MCG0-UH8D-0AG8-VFNU

• Chen, J., & Hou, F. (2002). Unmet needs for health care. Health Reports, 13(2), 23–24. https://pubmed.ncbi.nlm.nih.gov/12743954/

• Choi, Y., Nam, K., & Kim, C.-Y. (2019). Association between convenience of transportation and unmet healthcare needs of rural elderly in Korea. Journal of Preventive Medicine and Public Health, 52(6), 355–365. https://doi.org/10.3961/jpmph.19.172

• Chung, W. (2022). Changes in barriers that cause unmet healthcare needs in the life cycle of adulthood and their policy implications: A Need-Selection Model analysis of the Korea Health Panel Survey data. Healthcare, 10(11), Article 2243. https://doi.org/10.3390/healthcare10112243

• Dorjdagva, J., Batbaatar, E., Svensson, M., Bayarsaikhan, D., Batmunkh, B., & Kauhanen, J. (2017). Free and universal, but unequal utilization of primary health care in the rural and urban areas of Mongolia. International Journal for Equity in Health, 16(1), Article 73. https://doi.org/10.1186/s12939-017-0572-4

• Giang, K. B., & Allebeck, P. (2003). Self-reported illness and use of health services in a rural district of Vietnam: Findings from an epidemiological field laboratory. Scandinavian Journal of Public Health, 31(62_suppl), 52–58. https://doi.org/10.1080/14034950310015112

• Government of Republic of the Union of Myanmar. (2018). Geography. Myanmar National Portal. https://myanmar.gov.mm/geography#:~:text=The%20total%20area%20of%20the,dominant%20topographical%20features%20of%20Myanmar

• Grundy, J., Annear, P. L., Ahmed, S., & Biggs, B. (2014). Adapting to social and political transitions: The influence of history on health policy formation in the Republic of the Union of Myanmar (Burma). Social Science & Medicine, 107, 179–188. https://doi.org/10.1016/j.socscimed.2014.01.015

• Han, S. M., Rahman, M., Rahman, S., Swe, K. T., Palmer, M., Sakamoto, H., Nomura, S., & Shibuya, K. (2018). Progress towards universal health coverage in Myanmar: A national and subnational assessment. The Lancet Global Health, 6(9), e989–e997. https://doi.org/10.1016/s2214-109x(18)30318-8

• Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). John Wiley & Sons, Inc.

• Hwang, J. (2018). Understanding reasons for unmet health care needs in Korea: What are health policy implications? BMC Health Services Research, 18(1), Article 557. https://doi.org/10.1186/s12913-018-3369-2

• Iimi, A. (2021, July). Estimating the impact of improved roads on access to health care: Evidence from Mozambique. Policy Research Working Papers. The World Bank Group. https://doi.org/10.1596/1813-9450-9726

• Jung, B., & Ha, I.-H. (2021). Determining the reasons for unmet healthcare needs in South Korea: A secondary data analysis. Health and Quality of Life Outcomes, 19(1), Article 99. https://doi.org/10.1186/s12955-021-01737-5

• Kasman, N. M., & Badley, E. M. (2004). Beyond access: Who reports that health care is not being received when needed in a publicly-funded health care system? Canadian Journal of Public Health, 95(4), 304–308. https://doi.org/10.1007/bf03405137

• Kim, J. Y., Kim, D. I., Park, H. Y., Pak, Y., Tran, P. N. H., Thai, T. T., Thuy, M. T. T., & Van Dung, D. (2020). Unmet healthcare needs and associated factors in rural and suburban Vietnam: A cross-sectional study. International Journal of Environmental Research and Public Health, 17(17), Article 6320. https://doi.org/10.3390/ijerph17176320

• Kirdruang, P. (2011). Essays in Economics of public health insurance in developing countries: Evidence from Thailand and Vietnam [Doctoral dissertation, University of Minnesota]. University Digital Conservancy. https://hdl.handle.net/11299/119863

• Knodel, J., & Teerawichitchainan, B. (2017). Aging in Myanmar. The Gerontologist, 57(4), 599–605. https://doi.org/10.1093/geront/gnw211

• Krishnaswamy, S., Subramaniam, K., Low, W. Y., Aziz, J. A., Indran, T., Ramachandran, P. V., Hamid, A. R. A., & Patel, V. (2009). Factors contributing to utilization of health care services in Malaysia: A population-based study. Asia Pacific Journal of Public Health, 21(4), 442–450. https://doi.org/10.1177/1010539509345862

• Kullanit, A., & Taneepanichskul, N. (2017). Transportation barriers on healthcare utilization among elderly population living in Mahasarakham province, Thailand. Journal of Health Research, 31(Suppl. 2), S233–S238. https://doi.org/10.14456/jhr.2017.89

• Lachin, J. M. (2005). Sample size determination. In P. Armitage & T. Colton (Eds.), Encyclopedia of Biostatistics. John Wiley & Sons, Ltd. https://doi.org/10.1002/0470011815.b2a15138

• Latt, N. N., Myat, C. S., Htun, N. M. M., Saw, Y. M., Myint, M. N. H. A., Aoki, F., Reyer, J. A., Yamamoto, E., Yoshida, Y., & Hamajima, N. (2016). Healthcare in Myanmar. Nagoya Journal of Medical Science, 78(2), 123–134. https://www.med.nagoya-u.ac.jp/medlib/nagoya_j_med_sci/782/01_NyiNyiLatt.pdf

• Lee, S.-Y., Kim, C.-W., Kang, J.-H., & Seo, N.-K. (2015). Unmet healthcare needs depending on employment status. Health Policy, 119(7), 899–906. https://doi.org/10.1016/j.healthpol.2014.09.007

• Lu, J. R., & Chiang, T. (2018). Developing an adequate supply of health services: Taiwan’s path to universal health coverage. Social Science & Medicine, 198, 7–13. https://doi.org/10.1016/j.socscimed.2017.12.017

• Marrone, S. (2007). Understanding barriers to health care: A review of disparities in health care services among indigenous populations. International Journal of Circumpolar Health, 66(3), 188–198. https://doi.org/10.3402/ijch.v66i3.18254

• Meemon, N., & Paek, S. C. (2018). Health-seeking behavior of the uninsured before and after the Universal Coverage Scheme in Thailand. Asia-Pacific Social Science Review, 18(1), 1–14. https://repository.li.mahidol.ac.th/handle/123456789/44946

• Meemon, N., & Paek, S. C. (2019). Factors associated with unmet need for healthcare among older adults in Thailand. Asia-Pacific Social Science Review, 19(2), 180–191. https://www.dlsu.edu.ph/wp-content/uploads/pdf/research/journals/apssr/2019-June-vol19-2/14-factors-associated-with-unmet-need-for-healthcare-among-older-adults-in-thailand.pdf

• Meemon, N., & Paek, S. C. (2020). Universal coverage scheme in Thailand: Analysis of factors associated with and reasons for underutilization. Asia-Pacific Social Science Review, 20(2), 1–13. https://www.dlsu.edu.ph/wp-content/uploads/pdf/research/journals/apssr/2020-June-vol20-2/2-universal-coverage-scheme-in-thailand-analysis-of-factors-associated-with-and-reasons-for-underutilization.pdf

• Ministry of Health [Myanmar]. (2016). National Health Plan (2017–2021). https://mohs.gov.mm/Main/content/publication/national-health-plan-2017-2021-eng

• Ministry of Health [Myanmar]. (2021, September). Public Health Statistics 2017–2019. Health Information Division Department of Public Health Ministry of Health. https://mohs.gov.mm/ckfinder/connector?command=Proxy&lang=en&type=Main&currentFolder=%2FNews%2FNews_2021%2FOct_2021(B)%2F&hash=a6a1c319429b7abc0a8e21dc137ab33930842cf5&fileName=Public%20Health%20Statistics%20Report%202017-2019%20(22%20Sep%202021).pdf

• Ministry of Labour, Immigration and Population [Myanmar]. (2017, March). The 2014 Myanmar Population and Housing Census: Thematic Report on Population Projections for the Union of Myanmar, States/Regions, Rural and Urban Areas, 2014 – 2050: Census Report Volume 4-F. https://myanmar.unfpa.org/sites/default/files/pub-pdf/4F_Population%20Projections.pdf

• Ministry of Labour, Immigration and Population [Myanmar]. (2020, December). The 2019 Inter-censal Survey: The Union Report. https://dop.gov.mm/sites/dop.gov.mm/files/publication_docs/ics_report_eng_7012021.pdf

• Mitrašević, M., Radovanović, S., Radević, S., Maričić, M., Mačužić, I. Ž., & Kanjevac, T. (2020). The unmet healthcare needs: Evidence from Serbia. Iranian Journal of Public Health, 49(9), 1650–1658. https://doi.org/10.18502/ijph.v49i9.4081

• Moturi, A. K., Alegana, V. A., Mumo, E., Snow, R. W., Okiro, E. A., & Macharia, P. M. (2022). Geographic accessibility to public and private health facilities in Kenya in 2021: An updated geocoded inventory and spatial analysis. Frontiers in Public Health, 10, Article 1002975. https://doi.org/10.3389/fpubh.2022.1002975

• Myint, C. Y., Pavlova, M., & Groot, W. (2019). Patterns of health care use and out-of-pocket payments among general population and social security beneficiaries in Myanmar. BMC Health Services Research, 19(1), Article 258. https://doi.org/10.1186/s12913-019-4071-8

• National Population and Family Planning Board (BKKBN), Statistics Indonesia (BPS), Ministry of Health (Kemenkes), & ICF. (2018, September). Indonesia Demographic and Health Survey 2017. https://dhsprogram.com/pubs/pdf/FR342/FR342.pdf

• Nikoloski, Z., McGuire, A., & Mossialos, E. (2021). Evaluation of progress toward universal health coverage in Myanmar: A national and subnational analysis. PLOS Medicine, 18(10), Article e1003811. https://doi.org/10.1371/journal.pmed.1003811

• Nisak, B. A. (2021). Determinants of unmet needs in married women in Indonesia (Indonesian DHS Analysis 2017). Jurnal Biometrika Dan Kependudukan (Journal of Biometrics and Population), 10(1), 1–10. https://doi.org/10.20473/jbk.v10i1.2021.1-10

• Organization for Economic Cooperation and Development (OECD). (2020). Unmet needs for health care. https://www.oecd-ilibrary.org/sites/13aff239-en/index.html?itemId=/content/component/13aff239-en

• Paek, S. C., Meemon, N., & Wan, T. T. H. (2016). Thailand’s universal coverage scheme and its impact on health-seeking behavior. SpringerPlus, 5(1), Article 1952. https://doi.org/10.1186/s40064-016-3665-4

• Papanikolaou, V., & Zygiaris, S. (2012). Service quality perceptions in primary health care centres in Greece. Health Expectations, 17(2), 197–207. https://doi.org/10.1111/j.1369-7625.2011.00747.x

• Pappa, E., Kontodimopoulos, N., Papadopoulos, A., Tountas, Y., & Niakas, D. (2013). Investigating unmet health needs in primary health care services in a representative sample of the Greek population. International Journal of Environmental Research and Public Health, 10(5), 2017–2027. https://doi.org/10.3390/ijerph10052017

• Quashie, N. T., & Pothisiri, W. (2019). Rural-urban gaps in health care utilization among older Thais: The role of family support. Archives of Gerontology and Geriatrics, 81, 201–208. https://doi.org/10.1016/j.archger.2018.12.011

• Read, J. G., & Smith, P. B. (2017). Gender and national origin differences in healthcare utilization among U.S. Immigrants from Mexico, China, and India. Ethnicity and Health, 23(8), 867–883. https://doi.org/10.1080/13557858.2017.1297776

• Salary Explorer. (2021). Average salary in Myanmar 2021. http://www.salaryexplorer.com/salary-survey.php?loc=148&loctype=1

• Sanmartin, C., Houle, C., Tremblay, S., & Berthelot, J.-M. (2002). Changes in unmet healthcare needs. Health Reports, 13(3), 15–21. https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2001003/article/6101-eng.pdf?st=7Y1VdzId

• Saw, Y. M., Than, T. M., Thaung, Y., Aung, S., Shiao, L. W.-S., Win, E. M., Khaing, M., Tun, N. A., Iriyama, S., Win, H. H., Sakisaka, K., Jimba, M., Hamajima, N., & Saw, T. N. (2019). Myanmar’s human resources for health: Current situation and its challenges. Heliyon, 5(3), Article e01390. https://doi.org/10.1016/j.heliyon.2019.e01390

• Saw, Y. M., Win, K. L., Shiao, L. W.-S., Thandar, M. M., Amiya, R. M., Shibanuma, A., Tun, S., & Jimba, M. (2013). Taking stock of Myanmar’s progress toward the health-related Millennium Development Goals: Current roadblocks, paths ahead. International Journal for Equity in Health, 12(1), Article 78. https://doi.org/10.1186/1475-9276-12-78

• Sibley, L. M., & Glazier, R. H. (2009). Reasons for Self-reported unmet healthcare needs in Canada: A population-based provincial comparison. Healthcare Policy, 5(1), 87–101. https://doi.org/10.12927/hcpol.2009.20934

• Sibley, L. M., & Weiner, J. P. (2011). An evaluation of access to health care services along the rural-urban continuum in Canada. BMC Health Services Research, 11(1), Article 20. https://doi.org/10.1186/1472-6963-11-20

• Stevens, A., & Gillam, S. (1998). Health needs assessment: Needs assessment: From theory to practice. The BMJ, 316(7142), 1448–1452. https://doi.org/10.1136/bmj.316.7142.1448

• Syed, S. T., Gerber, B. S., & Sharp, L. K. (2013). Traveling towards disease: Transportation barriers to health care access. Journal of Community Health, 38(5), 976–993. https://doi.org/10.1007/s10900-013-9681-1

• United Nations. (2021). Least developed country category: Myanmar profile. https://www.un.org/development/desa/dpad/least-developed-country-category-myanmar.html

• United Nations. (2022). Human Development Index (HDI). https://hdr.undp.org/data-center/human-development-index#/indicies/HDI

• Varela, C., Young, S., Mkandawire, N., Groen, R. S., Banza, L., & Viste, A. (2019). Transportation barriers to access health care for surgical conditions in Malawi: A cross sectional nationwide household survey. BMC Public Health, 19(1), Article 264. https://doi.org/10.1186/s12889-019-6577-8

• Vongmongkol, V., Viriyathorn, S., Wanwong, Y., Wangbanjongkun, W., & Tangcharoensathien, V. (2021). Annual prevalence of unmet healthcare need in Thailand: Evidence from national household surveys between 2011 and 2019. International Journal for Equity in Health, 20(1), Article 244. https://doi.org/10.1186/s12939-021-01578-0

• World Bank. (2020). Indicators [Dataset]. https://data.worldbank.org/indicator

• World Bank. (2023). Data for Myanmar [Dataset]. https://data.worldbank.org/?locations=MM-XN

• World Health Organization. (2014). The Republic of the Union of Myanmar Health System Review. Health Systems in Transition, 4(‎3)‎. WHO Regional Office for the Western Pacific. https://iris.who.int/handle/10665/208211

• World Health Organization. (‎2015)‎. What are the challenges facing Myanmar in progressing towards universal health coverage? WHO Regional Office for the Western Pacific. https://iris.who.int/handle/10665/208247

• World Health Organization. (2017). Hospital beds (per 10,000 population). Indicators. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/hospital-beds-(per-10-000-population)

• World Health Organization. (2023, October 5). Universal Health Coverage. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)

• Wright, J., Williams, R., & Wilkinson, J. (1998). Health needs assessment: Development and importance of health needs assessment. The BMJ, 316(7140), 1310–1313. https://doi.org/10.1136/bmj.316.7140.1310

• Yangon General Hospital. (2022, January 18). Outpatient services: Online booking. https://m.facebook.com/story.php?story_fbid=pfbid02WRxHKzUmCQXaprCScP6ErgQDnBBp9j4FQi9p1puHosZiNKamL2uWggqKCcw3ZrbWl&id=1205203356213171

• Zaw, P. P. T., Htoo, T. S., Pham, N. M., & Eggleston, K. (2015). Disparities in health and health care in Myanmar. The Lancet, 386(10008), Article 2053. https://doi.org/10.1016/s0140-6736(15)00987-3