Availability and accessibility of subsidized mammogram screening program in peninsular Malaysia: A preliminary study using travel impedance approach

Abstract

Access to healthcare is essential in the pursuit of universal health coverage. Components of access are availability, accessibility (spatial and non-spatial), affordability and acceptability. Measuring spatial accessibility is common approach to evaluating access to health care. This study aimed to determine the availability and spatial accessibility of subsidised mammogram screening in Peninsular Malaysia. Availability was determined from the number and distribution of facilities. Spatial accessibility was determined using the travel impedance approach to represent the revealed access as opposed to potential access measured by other spatial measurement methods. The driving distance of return trips from the respondent’s residence to the facilities was determined using a mapping application. The travel expenditure was estimated by multiplying the total travel distance by a standardised travel allowance rate, plus parking fees. Respondents in this study were 344 breast cancer patients who received treatment at 4 referral hospitals between 2015 and 2016. In terms of availability, there were at least 6 major entities which provided subsidised mammogram programs. Facilities with mammogram involved with these programs were located more densely in the central and west coast region of the Peninsula. The ratio of mammogram facility to the target population of women aged 40–74 years ranged between 1: 10,000 and 1:80,000. In terms of accessibility, of the 3.6% of the respondents had undergone mammogram screening, their mean travel distance was 53.4 km (SD = 34.5, range 8–112 km) and the mean travel expenditure was RM 38.97 (SD = 24.00, range RM7.60–78.40). Among those who did not go for mammogram screening, the estimated travel distance and expenditure had a skewed distribution with median travel distance of 22.0 km (IQR 12.0, 42.0, range 2.0–340.0) and the median travel cost of RM 17.40 (IQR 10.40, 30.00, range 3.40–240.00). Higher travel impedance was noted among those who lived in sub-urban and rural areas. In summary, availability of mammogram facilities was good in the central and west coast of the peninsula. The overall provider-to-population ratio was lower than recommended. Based on the travel impedance approach used, accessibility to subsidised mammogram screening among the respondents was good in urban areas but deprived in other areas. This study was a preliminary study with limitations. Nonetheless, the evidence suggests that actions have to be taken to improve the accessibility to opportunistic mammogram screening in Malaysia in pursuit of universal health coverage.

Using Google Trends Data to Study Public Interest in Breast Cancer Screening in Malaysia

“…The ratio of mammogram facilities to the target population is satisfactory in the central region, particularly in Kuala Lumpur, where the ratio was 1:10,000 (assuming that one facility with mammogram service had one mammogram machine). However the ratio was poor in other parts of the country and ranged from 1:20,000 to 1:80,000 (Mahmud and Aljunid, 2018). The reason for the low search volume of "mammogram" in certain regions can be the low accessibility of mammography service.…”

Validity and Reliability of Health Belief Model Questionnaire for Promoting Breast Self-examination and Screening Mammogram for Early Cancer Detection

“…In Malaysia, although awareness of breast cancer is high, this did not correspond well with awareness of available screening measures (Yusof et al, 2014). According to studies conducted in the urban and sub-urban localities of Terengganu, Selangor and Kuala Lumpur, mammography screening uptake was between 10.5% and 31.9% amongst the population, while amongst women in rural localities of Perak and Pahang the mammography screening uptake was found to be less than 10% (Mahmud and Aljunid, 2018).…”

“…The Malaysian Clinical Practice Guidelines on the Management of Breast Cancer (2010) recommends that screening women which are at a high risk for breast cancer should be done from the age of 30 years utilizing both magnetic resonance imaging (MRI) and mammography as they are more effective than mammography alone. However, in low and intermediate risk women aged 40 to 49 years old breast cancer screening using mammography is highly recommended (Ministry of Health Malaysia, 2010; Mahmud and Aljunid, 2018). Nevertheless, in places that lack screening mammography, CBE is one of the most important methods for breast cancer detection where it identifies some cancers not found by mammography (Farid et al, 2014).…”

An age‐integrated approach to improve measurement of potential spatial accessibility to emergency medical services for urban areas

“…Approaches which measure the former method use real‐world data. For example, the actual response time of ambulances (time from call to a vehicle arriving at the scene) could be a proxy for actual accessibility to EMS . Potential accessibility is an indicator of the ability of individuals to use this service .…”