The inequalities and determinants of Households’ Distress Financing on Out-off-Pocket Health expenditure in Malaysia

Abstract

Background Out-of-pocket (OOP) payments for healthcare services potentially have severe consequences on households, especially among the poor. Under certain circumstances, healthcare payments are financed through selling household assets, or borrowings. This certainly could influence households’ decision, which likely resorts to forgoing healthcare services. Thus, the focal point of this study is aimed to identify the inequalities and determinants of distress financing among households in Malaysia. Methods This study used secondary data from the National Health and Morbidity Survey (NHMS) 2019, a national cross-sectional household survey that used a two-stage stratified random sampling design involving 5,146 households. The concentration curve and concentration index were used to determine the economic inequalities in distress financing. Whereas, the determinants of distress financing were identified using the modified Poisson regression model. Results The prevalence of borrowing without interest was the highest (13.86%), followed by borrowing with interest (1.03%) while selling off assets was the lowest (0.87%). Borrowing without interest was highest among rural (16.21%) and poor economic status (23.34%). The distribution of distress financing was higher among the poor, with a concentration index of -0.245. The modified Poisson regression analysis revealed that the poor, middle, rich, and richest had 0.57, 0.58, 0.40 and 0.36 times the risk to develop distress financing than the poorest socio-economic group. Whereas, the presence of one and two or more elderly were associated with a 1.94 and 1.59 times risk of experiencing distress financing than households with no elderly members. The risk of developing distress financing was also 1.28 and 1.58 times higher among households with one and two members receiving inpatient care in the past 12 months compared to none. Conclusions The findings implied that the improvement of health coverage should be emphasized to curtail the prevalence of distress financing, especially among those caring for the elderly, requiring admission to hospitals, and poor socio-economic groups. This study could be of interest to policymakers to help achieve and sustain health coverage for all.

Stronger association of perceived health with socio-economic inequality during COVID-19 pandemic than pre-pandemic era

“…Lack of compensatory source in the middle of unexpected financial crisis during the lockdown of COVID-19 pandemic in lower socioeconomic position could be associated with enlarged association of monthly income with perceived health in physical, mental, and social domains. Risk of developing distress financing is higher in households with poor economic position, with elderly family members, or with family members receiving inpatient care in the past 12 months [64]. Further, being in the lower socioeconomic position could be associated with a susceptibility to the influences from neighboring environmental factors.…”

Healthcare cost coverage inequality and its impact on hypertension and diabetes: A five‐year follow‐up study in a Malaysian rural community

“…Health inequality evaluation is important to understand where reforms are required to improve health equity 14 . The common methods used to evaluate health inequality are the rich‐poor ratio, concentration curve, concentration index, Gini coefficient and slope index analysis 6,19–21 …”

“…14 The common methods used to evaluate health inequality are the rich-poor ratio, concentration curve, concentration index, Gini coefficient and slope index analysis. 6,[19][20][21] Although HCC is a mechanism adopted to address healthcare service inequalities, 22 HCC does not guarantee access to quality healthcare. Those with HCC could still report financial difficulties in access to desired healthcare, depending on their benefit package.…”

“…2,3 These include health insurance plans, healthcare maintenance plans or other security plans that cover healthcare charges, 4,5 such as the guarantee letters for free healthcare services for eligible government workers in Malaysia. 6 Health insurance plans could be social, community-based or private health insurance (PHI). 5 The PHI (a subtype of HCC) has provided a substantial platform to meet basic health financial demands with its wide coverage.…”

“…Financial security enables access to healthcare without financial barriers, mainly through healthcare cost coverage (HCC) plans that wholly or partly cater for healthcare expenditures 2,3 . These include health insurance plans, healthcare maintenance plans or other security plans that cover healthcare charges, 4,5 such as the guarantee letters for free healthcare services for eligible government workers in Malaysia 6 …”