Household Catastrophic Healthcare Expenditure and Impoverishment Due to Rotavirus Gastroenteritis Requiring Hospitalization in Malaysia

Abstract

BackgroundWhile healthcare costs for rotavirus gastroenteritis requiring hospitalization may be burdensome on households in Malaysia, exploration on the distribution and catastrophic impact of these expenses on households are lacking.ObjectivesWe assessed the economic burden, levels and distribution of catastrophic healthcare expenditure, the poverty impact on households and inequities related to healthcare payments for acute gastroenteritis requiring hospitalization in Malaysia.MethodsA two-year prospective, hospital-based study was conducted from 2008 to 2010 in an urban (Kuala Lumpur) and rural (Kuala Terengganu) setting in Malaysia. All children under the age of 5 years admitted for acute gastroenteritis were included. Patients were screened for rotavirus and information on healthcare expenditure was obtained.ResultsOf the 658 stool samples collected at both centers, 248 (38%) were positive for rotavirus. Direct and indirect costs incurred were significantly higher in Kuala Lumpur compared with Kuala Terengganu (US$222 Vs. US$45; p<0.001). The mean direct and indirect costs for rotavirus gastroenteritis consisted 20% of monthly household income in Kuala Lumpur, as compared with only 5% in Kuala Terengganu. Direct medical costs paid out-of-pocket caused 141 (33%) households in Kuala Lumpur to experience catastrophic expenditure and 11 (3%) households to incur poverty. However in Kuala Terengganu, only one household (0.5%) experienced catastrophic healthcare expenditure and none were impoverished. The lowest income quintile in Kuala Lumpur was more likely to experience catastrophic payments compared to the highest quintile (87% vs 8%). The concentration index for out-of-pocket healthcare payments was closer to zero at Kuala Lumpur (0.03) than at Kuala Terengganu (0.24).ConclusionsWhile urban households were wealthier, healthcare expenditure due to gastroenteritis had more catastrophic and poverty impact on the urban poor. Universal rotavirus vaccination would reduce both disease burden and health inequities in Malaysia.

Health‐related quality of life and psychological distress among cancer survivors in a middle‐income country

“…Furthermore, cancer care subsidy in MOH hospitals are higher than in the public academic hospitals, making it possible for patients in MOH to experience less financial concerns than their counterparts seeking care in the academic and private hospitals, ultimately leading to a better sense of well‐being. Residual confounding from economic status may also explain the variations in HRQoL between the different hospitals given that patients managed in the academic hospital in this study largely comprise middle‐ and high‐income urban residents, who might have higher expectations from health services compared with low‐income patients.…”

“…Residual confounding from economic status may also explain the variations in HRQoL between the different hospitals given that patients managed in the academic hospital in this study largely comprise middle-and high-income urban residents, 31 who might have higher expectations from health services compared with low-income patients.…”

Rotavirus vaccines contribute towards universal health coverage in a mixed public–private healthcare system

“…A two‐year, prospective rotavirus study conducted at two public hospitals in Malaysia collected information on illness‐related expenditure for all children under‐five years admitted for acute diarrhoea . As income groups from this 2010 hospital‐based rotavirus study correspond with the national income quintiles from the NHMS 2011, we obtained healthcare expenditure for rotavirus episodes treated at public hospitals by income quintiles from this study .…”

“…Illness‐related expenditure incurred by households includes OOP direct medical costs on the receipt of care, like consultation and medication charges, and non‐medical costs above normal consumption for transportation, diapers and food, during an illness episode. We obtained direct medical costs for public inpatient care from the 2010 hospital‐based rotavirus study . The ratio of healthcare costs at private to public health care by income quintile from NHMS 2011 was multiplied to the public inpatient costs, to allow for the estimation of private inpatient costs.…”

“…This exposes many to the financial risks of out‐of‐pocket (OOP) payments for private health care . Recent evidence suggests that OOP expenses for rotavirus gastroenteritis requiring hospitalisation in Malaysia result in financially ‘catastrophic’ expenditure and even impoverishment, especially amongst the poor . Such OOP expenses are inconsistent with the stated aims of UHC, which is to deliver effective interventions while ensuring financial risk protection for all.…”