Estimating catastrophic health expenditure and impoverishment in adult asthma care in Malaysia

Clinical Research Results Abstract IntroductionPoor asthma control likely to increase usage of health care resources and this may involve patients’ out-of-pocket payments (OOPPs). High OOPPs can lead to financial hardships especially among poorer patients. In Malaysia, the public sector provides comprehensive health care at low user fees. It is claimed Malaysia provides Universal Health Coverage, however, there remains a possibility that adequate financial risk protection may not be achieved. We aimed to estimate incidence of catastrophic health expenditure (CHE) and medical impoverishment (MI) among adult patients with asthma in Selangor, Malaysia.MethodsThis study was conducted in six government-funded public health clinics in Selangor, Malaysia. Information on OOPPs for asthma care (outpatient care, purchase of medical devices and medications) in the last one month were collected. The incidence of CHE was estimated as the proportion of patients whose OOPPs exceeded 10% of their monthly household income. Incidence of poverty was estimated as the proportion of patients whose monthly household income falls below the poverty line. Incidence of MI was estimated by the change in poverty incidence after OOPPs had been deducted from household income. This study used the poverty line of the urban population for the state of Selangor. Results1092 patients were recruited. Only 1012 (93%) provided data on household income and OOPPs. 76% were from low-income groups with household income below RM4,850 (USD 1,174 ) per month. About half were working, 88% of them in private sector or self-employed; and 65% reported personal savings as the main source of health payment. The mean monthly OOPPs was RM16.30 (USD 3.88). The incidences of CHE and MI were 1.48% (15 patients) and 0.4% (4 patients). DiscussionThe government-funded public health sector in Malaysia has provided high financial risk protection, the majority of whom were from low-income group. Future step is to improve the quality of asthma care in these heavily subsidised public health services. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest Declaration of InterestThis research was commissioned by the UK National Institute for Health Research (NIHR) Global Health Research Unit on Respiratory Health (RESPIRE), using UK Aid from the UK Government to support global health research. References and Clinical Trial Registry Information