Effect of socioeconomic status and healthcare provider on post-transplantation care in Malaysia: A multi-centre survey of kidney transplant recipients

Abstract

Introduction As the rate of end-stage kidney disease rises, there is an urgent need to consider the catastrophic health expenditure of post-transplantation care. Even a small amount of out-of-pocket payment for healthcare can negatively affect households’ financial security. This study aims to determine the association between socioeconomic status and the prevalence of catastrophic health expenditure in post-transplantation care. Method A multi-centre cross-sectional survey was conducted in person among 409 kidney transplant recipients in six public hospitals in the Klang Valley, Malaysia. Catastrophic health expenditure is considered at 10% out-of-pocket payment from household income used for healthcare expenditure. The association of socioeconomic status with catastrophic health expenditure is determined via multiple logistic regression analysis. Results 93 kidney transplant recipients (23.6%) incurred catastrophic health expenditures. Kidney transplant recipients in the Middle 40% (RM 4360 to RM 9619 or USD 1085.39 –USD 2394.57) and Bottom 40% (<RM 4,360 or < USD 1085.39) income groups experienced catastrophic health expenditure compared to the Top 20% (>RM 9619 or > USD 2394.57) income group. Kidney transplant recipients in the Bottom 40% and Middle 40% income groups were more susceptible to catastrophic health expenditure at 2.8 times and 3.1 times compared to higher-income groups, even under the care of the Ministry of Health. Conclusion Universal health coverage in Malaysia cannot address the burden of out-of-pocket healthcare expenditure on low-income Kidney transplant recipients for long-term post-transplantation care. Policymakers must reexamine the healthcare system to protect vulnerable households from catastrophic health expenditures.