The elephant in the room- Universal coverage for Costly treatments in an upper middle income country

Kaur, Ravinder; Ho, Gwo Fuang; Mastura, M.Y.; Goh, Pik-Pin; Salowi, MA; Radzi, Megat Rusydi Megat; Hau, Andrew J.; Sathar, Jameela; Zambahari, Robaayah; Selladurai, B; Ab, Suleiman; Morad, Zaki; Ahmad, Ghazali; Lim, Teck Onn

doi:10.1101/214296

Cited by 3 publications

(3 citation statements)

References 28 publications

(23 reference statements)

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“…Screening services for hepatitis are under-developed, and access to anti-viral therapies are limited in Malaysia [27]. In response, a non-governmental organization, the Hepatitis Free Pahang Malaysia (HFPM) [28], has initiated a campaign since 2017 to raise awareness about hepatitis, to provide public screening services and improve access to costly treatments.…”

Section: Hepatitis Screening Campaign and Study Samplementioning

confidence: 99%

Prevalence of Chronic Hepatitis B and C in Malaysia- results from a community-based screening campaign

Lim¹,

Teo²,

Tan³

et al. 2020

Preprint

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Introduction The epidemiology of hepatitis, which is apparently endemic in Asia, is still poorly documented in Malaysia. Available statistics are modelled estimates based on expert input or estimated from small studies on special populations. We therefore determined the prevalence of chronic hepatitis B and C in Malaysia based on a large sample data from a screening campaign. Methods A total of 10,914 subjects participated in the hepatitis screening campaign in 2018 and 2019. A low-cost Point-of-care test, which has previously been validated, was used to screen for HBsAg and anti-HCV. All screen positive subjects were recalled to undergo confirmatory serology tests and nucleic acid tests. Results We estimated 1.17% or 238,971 Malaysian adults aged 20 or older had chronic HBV, while only 0.74% or 151,144 adults had chronic HCV. Young adults below age 30 years had very low prevalence of HBV (0.09%). Women had lower prevalence of HBV and HCV, Chinese had the highest prevalence of HBV while Malay had the highest prevalence of HCV. Conclusion Young adults seems to be protected from HBV perhaps owing to the introduction of universal HBV vaccination since 1989. Chronic HBV however remains prevalent in older adults especially among the Chinese. Chronic HCV is uncommon in Malaysia.

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Section: Hepatitis Screening Campaign and Study Samplementioning

confidence: 99%

Prevalence of Chronic Hepatitis B and C in Malaysia- results from a community-based screening campaign

Lim¹,

Teo²,

Tan³

et al. 2020

Preprint

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“…Supplementary PHI in Malaysia provides alternative access to healthcare treatment in private facilities, which are commonly perceived to be better equipped, deliver higher quality care and offer the freedom to choose one’s preferred healthcare providers. PHI also plays a less prominent complementary role by covering treatments not provided in public healthcare facilities, notably the costlier and latest medical treatments ( Kaur et al ., 2017 ). The purchase of PHI is voluntary, usually by individuals or in a group, as part of the job benefits provided by employers.…”

Section: Introductionmentioning

confidence: 99%

Effect of supplementary private health insurance on out-of-pocket inpatient medical expenditure: evidence from Malaysia

Ng,

Choo,

et al. 2024

Health Policy and Planning

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The vital role of healthcare financing in achieving Universal Health Coverage (UHC) is indisputable. However, most countries, including Malaysia, face challenges in establishing an equitable and sustainable healthcare financing system due to escalating healthcare costs, an ageing population, and a growing disease burden. With desirable pre-payment and risk pooling features, private health insurance (PHI) is considered an alternative financing option to reduce out-of-pocket (OOP) medical expenditure. However, ongoing theoretical and empirical debates persist regarding the adequacy of financial risk protection provided by PHI largely because it depends on its role, the benefit design, and the regulations in place. Our study aimed to investigate the effect of supplementary PHI on OOP inpatient medical expenditure in Malaysia. Secondary data analysis was conducted using the Malaysian National Health and Morbidity Survey 2019 dataset. A total of 983 respondents with a history of inpatient hospitalization in the past 12 months were included in the study. Instrumental variable (IV) analysis using a two-stage residual inclusion was performed to address endogeneity bias, with wealth status and education level as the IVs. Tobit regression model was used in the second stage considering the censored distribution of the outcome variable. Missing data was handled using multiple imputation. About one-fifth of the respondents had PHI. In this study, we found that having PHI significantly increased OOP inpatient medical expenditure in all three marginal effects. Additionally, age, residential location, ethnicity(citizenship), being covered by government guarantee letter, government funding, and employer-sponsored health insurance were other significant factors associated with OOP inpatient medical expenditure. Our findings undermine a key justification to advocate PHI uptake among the population, with a need for the Malaysian government to reassess the role of PHI in healthcare financing and reconsider PHI subsidization policy. Regulations should also be strengthened to enhance the financial risk protection provided by PHI.

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“…21 In spite of being an upper middle-income country, screening services for HBV and HCV in Malaysia remain under-developed, and access to modern antiviral therapies is even more limited. 22 There is a need for concerted public actions to address hepatitis as a significant public health concern. However, there is little progress on the public policy front to allocate significant healthcare resources to support hepatitis screening and treatment services in Malaysia.…”

Section: Introductionmentioning

confidence: 99%

Hepatitis Screening and Treatment Campaign in Malaysia- Validation of Low-cost Point of Care Screening Tests and Nucleic Acid Tests for Hepatitis B and C

Mohamed

Jaya

et al. 2018

Euroasian Journal of Hepato-Gastroenterology

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Background Two major challenges in implementing budget-constrained Hepatitis screening and treatment campaign in Malaysia are the availability of low-cost point of care tests (POCT) and nucleic acid tests (NAT) for hepatitis C virus ribonucleic acid (HCV RNA) and hepatitis B virus dioxyribo nucleic acid (HBV DNA). We evaluated the performance of these tests in this study. Methods We conducted a cross-sectional study to evaluate the diagnostic performance of four POCT brands at 12 sites in Malaysia. We assessed the sensitivity and specificity of the POCTs for the detection of HBsAg and anti-HCV in a finger-stick capillary or venepuncture whole-blood samples compared with test results from lab-based enzyme immunoassay (EIA) or chemi-luminescence immunoassay (CLIA) assay as the reference standard. We also conducted a cross-sectional study on 30 to 139 serum specimen panel to evaluate the diagnostic performance of a low-cost in-house Applied Biosystem ® TaqMan real-time polymerase chain reaction (PCR) assay (ABS) for the detection of HCV RNA and HBV DNA, compare with Roche Cobas ® Ampliprep/TaqMan assay (COBAS). Results Between March and December 2017, we enroll 295 participants for the evaluation of POCT for HBsAg and another 307 participants for POCT anti-HCV evaluation. Three of the four POCT brands dropped out of evaluation early on account of sub-optimal sensitivity. The sensitivity of the remaining POCT for HBsAg was 95.2%and specificity 100%, while the POCT for anti-HCV has a sensitivity of 98.1% and specificity 100%. Hepatitis B virus dioxyribo nucleic acid and HCV RNA concentrations detected by the ABS were systematically higher than those measured by COBAS (mean bias +0.10 and +0.17 log10 IU/mL respectively). The 95% limits of agreement between the two assays are -1.28 to 1.47 log10 IU/mL for HBV DNA and –0.41 to 0.75 log10 IU/mL for HCV RNA. Conclusion We found adequate evidence for the diagnostic validity of a low-cost POCT for anti-HCV and HBsAg, as well as for an in-house nucleic acid tests (NAT), to provide support for their broader use in our Hepatitis screening and treatment campaign. Abbreviations ABS: Applied Biosystem ® TaqMan real-time PCR assay, CI: Confidence interval, CLD: Chronic liver disease, CLIA: Chemi-luminescence immunoassay, COBAS: Roche Cobas ® Ampliprep/ TaqMan assay, DAA: Direct Acting Anti-Viral drugs, EIA: Enzyme immunoassay, HBV: Hepatitis B virus, HCV: Hepatitis C virus, HFPM: Hepatitis Free Pahang Malaysia, LOA: Limits of agreement, LOD: Limit of detection, MOH: Ministry of Health, Malaysia, NAT: Nucleic Acid Tests, POCT: Point of Care Tests, SD: Standard deviation, WHO: World Health Organization How to cite this article: Radzi AHM, Tan SS, Mohamed R, Jaya F, Senamjit K, Aun AC, Kutty GA, Wong HS, Abd...

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The elephant in the room- Universal coverage for Costly treatments in an upper middle income country

Cited by 3 publications

References 28 publications

Prevalence of Chronic Hepatitis B and C in Malaysia- results from a community-based screening campaign

Prevalence of Chronic Hepatitis B and C in Malaysia- results from a community-based screening campaign

Effect of supplementary private health insurance on out-of-pocket inpatient medical expenditure: evidence from Malaysia

Hepatitis Screening and Treatment Campaign in Malaysia- Validation of Low-cost Point of Care Screening Tests and Nucleic Acid Tests for Hepatitis B and C

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