Uptake and determinants of private health insurance enrollment in a country with heavily subsidised public healthcare: A cross-sectional survey in East Coast Malaysia

Khalim, Mohd Adli Abd; Sukeri, Surianti

doi:10.1371/journal.pone.0278404

Cited by 4 publications

(2 citation statements)

References 20 publications

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“…Our study also observed that health status generally was not significantly associated with OOP expenditure, perhaps indicating that Malaysia’s heavily subsidized healthcare system did confer adequate financial risk protection to the population for inpatient care ( Chua and Cheah, 2012 ). In addition, the determinants of PHI ownership status found in our study, which was not our main interest, were comparable to other studies conducted in Malaysia ( Balqis-Ali et al ., 2021 ; Al-Sanaani et al ., 2022 ; Abd Khalim et al ., 2023 ).…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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 private health sector is recognized as an important player in any health system, but many policymakers do not know the extent of its strengths and limitations. In some countries, efforts by the public sector to collaborate with private providers face political constraints, but there are many other opportunities for maximizing the sector to help improve public health [16]. Private insurance caters to several chronic diseases and can help to reduce the burden of personal medical expenses for policyholders [17].…”

Section: The Private Sector As An Under-utilized Entitymentioning

confidence: 99%

Perspective Chapter: Including the Private Sector to Achieve Universal Health Coverage

Adyas,

Jet Alamin,

Thabrany

2024

Health Insurance Across Worldwide Health Systems

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In implementing Universal Health Coverage (UHC), public healthcare financing is the dependable mechanisms to ensure equity and to minimize catastrophic health spending. However, public financing often creates long queueing and low satisfaction of the community and is less responsive to the demand from the public. On the other hand, the private sector has advantages in responding to the demand of the patients, higher efficiencies, and having higher customer or patient satisfaction. The combination of the two sectors is the best in achieving UHC. The government must provide and regulate the room for the private sector. However, the private sector has limitations in developing services because of obstacles in providing appropriate healthcare for everyone without conflicting with the business goals. In general, there are three roles of the private sector to be adopted in the health system of countries to ensure equitable access to quality healthcare, provide options, facilitate higher satisfaction for patients, increase private sector opportunities to participate in providing health services, that potentially establish competition that will improve the quality of services.

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Determinants of health insurance coverage among women in Mauritania: a multilevel analysis

Dowou,

Atanuriba,

Adzigbli

et al. 2024

BMC Public Health

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Background Health insurance has been documented as one of the primary methods of financing healthcare for Sustainable Development Goals (SDGs) by 2030. Yet, there is a dearth of evidence on the determinants of health insurance coverage among women in Mauritania. We examine the factors associated with health insurance coverage among women in Mauritania using a nationally representative survey dataset. Methods We analyzed secondary data from the 2019–2021 Mauritania Demographic and Health Survey. A weighted sample of 15,714 women of reproductive age (15–49 years) was included in the study. Multilevel regression analysis was used to examined the factors associated with health insurance coverage. The results were presented using an adjusted odds ratio (aOR) with a 95% confidence interval (CI). Results The coverage of health insurance among women was 8.7%. The majority of the women subscribed to social security health insurance (7.6%). Women aged 35 years and above [aOR = 1.54; 95% CI = 1.24, 1.92] were more likely to be covered by health insurance relative to those aged 15–24. The likelihood of being covered by health insurance increased with increasing level of education with the highest odds among women with higher education [aOR = 6.09; 95% CI = 3.93, 9.42]. Women in the richest wealth index households [aOR = 22.12; 95% CI = 9.52, 51.41] and those with grand parity [aOR = 2.16; 95% CI = 1.62, 2.87] had the highest odds of being covered by health insurance. Women who were working, those who watched television, and those who used the internet were more likely to be covered by health insurance relative to their counterparts who were not working, those who did not watch television, and those who did not use the internet. Women residing in Tiris zemour et Inchiri [aOR = 3.60; 95%CI = 1.60, 8.10], Tagant (aOR = 3.74; 95% CI = 1.61, 8.68], and Adrar [aOR = 2.76; 95% CI = 1.36, 5.61] regions were more likely to be covered by health insurance compared with those from Hodh Echargui. Conclusion Health insurance coverage among the women in our study was low. Achieving the SDG targets of ensuring universal health coverage and lowering maternal mortality to less than 70 deaths per 100,000 live births requires the implementation of interventions to increase health insurance coverage, taking into consideration the identified factors in the study. We recommend effective public education and awareness creation on the importance of being covered by health insurance by leveraging television and internet platforms. Also, interventions to increase health insurance coverage should consider younger women and those in rural areas.

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Uptake and determinants of private health insurance enrollment in a country with heavily subsidised public healthcare: A cross-sectional survey in East Coast Malaysia

Cited by 4 publications

References 20 publications

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

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

Perspective Chapter: Including the Private Sector to Achieve Universal Health Coverage

Determinants of health insurance coverage among women in Mauritania: a multilevel analysis

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