Determinants of healthcare access among older adults in Mandalay Region, Myanmar: A cross-sectional analysis 10.55131/jphd/2026/240215

Main Article Content

Yadanar Aung
Sutthida Chuanwan
Pojjana Hunchangsith
Pimonpan Isarabhakdi
Yothin Sawangdee
Marc Völker

Abstract

Population ageing is accelerating globally and poses significant challenges to health systems, especially in low- and middle-income countries. In Myanmar, access to healthcare services among older persons is under-researched, particularly in the Mandalay Region. This study investigates healthcare utilization patterns and associated socio-demographic factors among older adults in three high ageing-index districts: Meikhtila, Nyaung U, and Myingyan. A cross-sectional analytical design was employed, with data collected from June to August 2021. Results from a multivariate logistic regression revealed that older adults living in rural areas, those with moderate ability to perform daily activities, and those experiencing hearing difficulties were more likely to use public hospitals. In contrast, residents of Myingyan District were less likely to access public health facilities. Use of private hospitals was more common among older adults with moderate self-rated health and those residing in Myingyan. However, individuals with moderate functional ability and those with vision difficulties were significantly less likely to use private hospitals. Utilization of charity clinics was higher among older adults who were employed, including unpaid family workers, and among those who required regular follow-up care or had vision impairments. Conversely, those living in rural areas and individuals from wealthier households were less likely to use charity clinics. These findings highlight the complex and uneven patterns of healthcare access among older persons in Myanmar. They underscore the importance of addressing socio-demographic disparities—particularly in rural areas and among those with physical or sensory limitations—to promote equitable and effective healthcare delivery for an ageing population.

Article Details

How to Cite
1.
Aung Y, Sutthida Chuanwan, Pojjana Hunchangsith, Pimonpan Isarabhakdi, Yothin Sawangdee, Marc Völker. Determinants of healthcare access among older adults in Mandalay Region, Myanmar: A cross-sectional analysis: 10.55131/jphd/2026/240215. J Public Hlth Dev [internet]. 2026 May 8 [cited 2026 May 10];24(2):217-33. available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/280420
Section
Original Articles
Author Biographies

Yadanar Aung, Institute for Population and Social Research, Mahidol University, Bangkok, Thailand

Institute for Population and Social Research, Mahidol University, Bangkok, Thailand

Sutthida Chuanwan, Institute for Population and Social Research, Mahidol University, Bangkok, Thailand

Institute for Population and Social Research, Mahidol University, Bangkok, Thailand

Pojjana Hunchangsith, Institute for Population and Social Research, Mahidol University, Bangkok, Thailand

Institute for Population and Social Research, Mahidol University, Bangkok, Thailand

Pimonpan Isarabhakdi, Institute for Population and Social Research, Mahidol University, Bangkok, Thailand

Institute for Population and Social Research, Mahidol University, Bangkok, Thailand

Yothin Sawangdee, Institute for Population and Social Research, Mahidol University, Bangkok, Thailand

Institute for Population and Social Research, Mahidol University, Bangkok, Thailand

Marc Völker, Institute for Population and Social Research, Mahidol University, Bangkok, Thailand

Institute for Population and Social Research, Mahidol University, Bangkok, Thailand

References

United Nations, Department of Economic and Social Affairs, Population Division. (2024). World Population Prospects 2024: Summary of results (Table: Population aged 65 years or over). United Nations. https://www.unpopulation.org

Ogura S, Jakovljevic MM. Global population aging-health care, social and economic consequences. Frontiers Media SA; 2018. p. 335. doi: 10.3389/fpubh.2018.00335.

Department of Population. The 2014 Myanmar Population and Housing Census: Thematic report on the Older Population- Census Report. Nay Pyi Taw, Myanmar: Department of Population Ministry of Labour, Immigration and Population; 2017. https://www.dop.gov.mm

Tang K, Zhao Y, Li B, Zhang S, Lee SH. Health inequity on access to services in the ethnic minority regions of Northeastern Myanmar: a cross-sectional study. BMJ Open. 2017; 7(12):e017770. doi: 10.1136/bmjopen-2017-017770.

United Nations. (2015). Transforming our world: The 2030 Agenda for Sustainable Development. https://sdgs. un.org/2030agenda.

ChawYin M, Pavlova M, Groot W. Health insurance in Myanmar: Knowledge, perceptions, and preferences of Social Security Scheme members and general adult population. Int J. Health Plann. Manage. 2019; 34(1):346-69. doi: 10.1002/hpm.2643.

Li J, Shi L, Liang H, Ma C, Xu L, Qin W. Health care utilization and affordability among older people following China’s 2009 health reform evidence from CHARLS pilot study. Int J Equity Health. 2019;18(1):62. doi: 10.1186/s12939-019-0969-3.

Agyemang-Duah W, Peprah C, Peprah P. “Let’s talk about money”: how do poor older people finance their healthcare in rural Ghana? A qualitative study. Int J Equity Health. 2019; 18(1):47. doi: 10.1186/s12939-019-0927-0.

Raval NG, Patel K, Yasobant S. Are Elderly Population Healthy? : A Mixed Method Study from North Gujarat, India. J. Soc. Health. Syst. 2016 Aug 12;2(2):15-9. https://www. researchgate.net

Aye SKK, Hlaing HH, Htay SS, Cumming R. Multimorbidity and health seeking behaviours among older people in Myanmar: A community survey. PLoS One. 2019;14(7):e0219543. doi: 10.1371/journal.pone.0219543.

Gottlieb L, Fichtenberg C, Alderwick H, Adler N. Social determinants of health: what’s a healthcare system to do? J. Healthc. Manag. 2019;64(4):243-57. doi: 10.1097/JHM-D-18-00160.

Bethune R, Absher N, Obiagwu M, Qarmout T, Steeves M, Yaghoubi M, et al. Social determinants of self-reported health for Canada's indigenous peoples: a public health approach. Public Health. 2019;176:172-80. doi: 10.1016/j.puhe. 2018.03.007.

Milkowska-Shibata MA, Aye TT, Yi SM, Oo KT, Khaing K, Than M, et al. Understanding barriers and facilitators of maternal health care utilization in central Myanmar. Int. J. Environ. Res. Public Health. 2020;17(5):1464. doi: 10.3390/ijerph17051464.

Zaw PPT, Liabsuetrakul T, Htay TT, McNeil E. Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City, Myanmar. BMC Health Serv. Res. 2012;12(1):1-12. doi: 10.1186/1472-6963-12-458.

Andersen RM. Revisiting the Behavioral Model and Access to Medical Care: Does it Matter? J. Health Soc. Behav. 1995;36(1):1-10. https:// pubmed.ncbi.nlm.nih.gov/7738325/

Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med. Care. 1981:127-40. doi: 10.1097/00005650-198102000-00001

Kowal P, Chatterji S, Naidoo N, Biritwum R, Fan W, Lopez Ridaura R, et al. Data resource profile: the World Health Organization Study on global AGEing and adult health (SAGE). Int J Epidemiol. 2012;41(6):1639-49. doi: 10.1093/ije/dys210.

Wan He, Mark N Muenchrath, and Paul Kowal, U.S. Census Bureau. Shades of Gray: A Cross-Country Study of Health and Well-Being of the Older Populations in SAGE countries, 2007-2010: U.S. Government Printing Office, Washington, DC, 2012. https://www.census.gov/content/dam/Census/library/publications/2012/demo/p95-12-01.pdf

Andersen R. A behavioral model of families' use of health services. 1968. https://www.cabidigitallibrary.org/doi/full/10.5555/19702701913

Andersen RM. National health surveys and the behavioral model of health services use. Medical care. 2008;46(7): 647-53. doi: 10.1097/MLR.0b013 e31817a835d.

Ayón C, Ramos Santiago J, López Torres AS. Latinx undocumented older adults, health needs and access to healthcare. J. Immigr. Minor. Health. 2020;22:996-1009. doi: 10.1007/ s10903-019-00966-7.

Ferreira LS, Moreira LR, Paludo SDS, Meucci RD. Access to Primary Health Care by older adults from rural areas in Southern Brazil. Rev Saude Publica. 2020;54:149. doi: 10.11606/s1518-8787.2020054002316.

Garcia-Ramirez J, Nikoloski Z, Mossialos E. Inequality in healthcare use among older people in Colombia. Int J Equity Health. 2020;19(1):1-15. doi: 10.1186/s12939-020-01241-0.

Pastakia SD, Schutz H, Tiruneh T, De Vivero AG, Dodds L. Observational assessment of the utilization of donated point of care tests and glycemic control at free and charitable clinics across the United States. Pract. Lab. Med. 2025; 44:e00450. doi: 10.1016/j.plabm. 2025.e00450.

Ma C, Jiang Y, Li Y, Zhang Y, Wang X, Ma S, et al. Medical expenditure for middle-aged and elderly in Beijing. BMC Health Serv. Res. 2019;19:1-10. doi: 10.1186/s12913-019-4190-2.

Shepherd A. Myanmar medics resist military coup. BMJ. 2021;372:n368. doi: 10.1136/bmj.n368.

Soe ZW, Oo MM, Wah KS, Naing AT, Skalicky-Klein R, Phillips G. Myanmar's health leaders stand against military rule. The Lancet. 2021;397 (10277):875. doi: 10.1016/S0140-6736 (21)00457-8.

Zhang X, Dupre ME, Qiu L, Zhou W, Zhao Y, Gu D. Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China. BMC Geriatr. 2017;17(1):1-11. doi: 10.1186/s12877-017-0538-9.

Aung T, Lwin MM, Sudhinaraset M, Wei C. Rural and urban disparities in health-seeking for fever in Myanmar: findings from a probability-based household survey. Malar. J. 2016;15(1):386. doi: 10.1186/s12936-016-1442-z.

Goris ED, Schutte DL, Rivard JL, Schutte BC. Community leader perceptions of the health needs of older adults. West. J. Nurs. Res. 2015;37(5): 599-618. doi: 10.1177/0193945914 530046

Jeon B, Kwon S. Health and Long-Term Care Systems for Older People in the Republic of Korea: Policy Challenges and Lessons. Health Syst Reform. 2017;3(3):214-23. doi: 10.1080/23288604.2017.1345052.

Lin W. The relationship between formal and informal care among Chinese older adults: based on the 2014 CLHLS dataset. BMC Health Serv. Res. 2019;19(1):323. doi: 10.1186/ s12913-019-4160-8.

Latt NN, Cho SM, Htun NMM, Saw YM, Myint MNHA, Aoki F, et al. Healthcare in myanmar. Nagoya J. Med. Sci. 2016;78(2):123. https:// pubmed.ncbi.nlm.nih.gov/27303099/

Kyaw HK, Than KK, Diaconu K, Witter S. Community stressors and coping mechanisms in accessing the health system during a double crisis: a qualitative case study from Yangon Region, Myanmar. Int J Equity Health. 2023;22(1):39. doi: 10.1186/s12939-023-01851-4.

McMaughan D, Oloruntoba O, Smith M. Socioeconomic status and access to healthcare: interrelated drivers for healthy aging. Front. Public Health. 2020; 8: 231. 2020. doi: 10.3389/fpubh.2020.00231.

Awoke MA, Negin J, Moller J, Farell P, Yawson AE, Biritwum RB, et al. Predictors of public and private healthcare utilization and associated health system responsiveness among older adults in Ghana. Glob. Health Action. 2017;10(1):1301723. doi: 10.1080/16549716.2017.1301723.

Han SM, Lwin KS, Swe KT, Gilmour S, Nomura S. Military coup during COVID-19 pandemic and health crisis in Myanmar. BMJ Glob. Health. 2021;6(4):e005801. doi: 10.1136/ bmjgh-2021-005801.

Myanmar's democracy and health on life support. The Lancet. 2021. doi: 10.1016/S0140-6736(21)00656-5.