Abstract
Introduction: As a vulnerable group of people, older persons are not void from having to spend out-of-pocket (OOP) for health care services. Due to the higher risk of getting chronic diseases, older persons are expected to incur high OOP health expenditures. Hence, this study focuses on describing and measuring the inequalities of OOP health expenditure among older persons in public and private health facilities.
Methods: This is a secondary data analysis study using the Healthcare Demand module under National Health Morbidity Survey (NHMS) 2019. After removing the missing data, a total of 1,445 older person data were included in the analysis. In this study, an older person was defined as individual aged 60 years and above. Socio-economic status was calculated based on monthly household income and ranked into poorest (1st quintile), poor (2nd quintile), middle (3rd quintile), richer (4th quintile), and richest (5th quintile). The OOP health expenditure was calculated based on the self-reported OOP spending for health in the past 12 months. A descriptive analysis was conducted and concentration index (CI) was estimated using the CONCINDC module in STATA version 14. Concentration curves were plotted and shown in the form of a graph.
Results: The findings showed that on average, a total of MYR 1,043.30 OOP health expenditure was spent by the older person in the past 12 months. An average of MYR 1,004.45 was spent in the private healthcare sector, while OOP of MYR 38.85 OOP was spent in the public healthcare facilities. The CI and concentration curves showed that the total OOP health expenditure was concentrated among those from the lower socioeconomic status with a CI of -0.39. Older persons' OOP expenditure at the private healthcare facilities showed similar findings with a higher concentration among the lower socioeconomic group (CI of -0.41). However, OOP expenditure at public health facilities was more concentrated among those in the higher socioeconomic groups (CI of 0.14). Discussion: The findings showed that the overall healthcare system in Malaysia is yet to be protective of older persons in lower socioeconomic groups. Nevertheless, this inequality occurs mainly due to older persons, especially in the lower socioeconomic groups spending in the private health sector. The provision of health services by the public health sector through minimal fees has provided a safety net and successfully protect the older persons in lower socioeconomic groups. Despite that, there is still a need for older persons of lower socioeconomic status to rely upon the private healthcare sector for healthcare services. Deep dive into this matter would allow the government to intervene and provide greater financial risk protection for older persons.
Links
- https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-64.pdf
- https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed1909[...]
BibTeX (Download)
@proceedings{APCPH2022-P-64,
title = {Inequalities of Out-Of-Pocket Health Expenditure Among Older Persons in Malaysia: Findings from NHMS 2019},
author = {Nor Zam Azihan Mohd Hassan and Mohd Shaiful Jefri Mohd Nor Sham and Nur Amalina Zaimi and Fathullah Iqbal Ab Rahim},
url = {https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-64.pdf
https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed19095a89ed/Poster-ACPCH_OOP-elderly_finale-10308e6d681e2494aa7fb567a430b5c8.pdf},
year = {2022},
date = {2022-08-02},
urldate = {2022-08-02},
issue = {7},
abstract = {Introduction: As a vulnerable group of people, older persons are not void from having to spend out-of-pocket (OOP) for health care services. Due to the higher risk of getting chronic diseases, older persons are expected to incur high OOP health expenditures. Hence, this study focuses on describing and measuring the inequalities of OOP health expenditure among older persons in public and private health facilities.
Methods: This is a secondary data analysis study using the Healthcare Demand module under National Health Morbidity Survey (NHMS) 2019. After removing the missing data, a total of 1,445 older person data were included in the analysis. In this study, an older person was defined as individual aged 60 years and above. Socio-economic status was calculated based on monthly household income and ranked into poorest (1st quintile), poor (2nd quintile), middle (3rd quintile), richer (4th quintile), and richest (5th quintile). The OOP health expenditure was calculated based on the self-reported OOP spending for health in the past 12 months. A descriptive analysis was conducted and concentration index (CI) was estimated using the CONCINDC module in STATA version 14. Concentration curves were plotted and shown in the form of a graph.
Results: The findings showed that on average, a total of MYR 1,043.30 OOP health expenditure was spent by the older person in the past 12 months. An average of MYR 1,004.45 was spent in the private healthcare sector, while OOP of MYR 38.85 OOP was spent in the public healthcare facilities. The CI and concentration curves showed that the total OOP health expenditure was concentrated among those from the lower socioeconomic status with a CI of -0.39. Older persons' OOP expenditure at the private healthcare facilities showed similar findings with a higher concentration among the lower socioeconomic group (CI of -0.41). However, OOP expenditure at public health facilities was more concentrated among those in the higher socioeconomic groups (CI of 0.14). Discussion: The findings showed that the overall healthcare system in Malaysia is yet to be protective of older persons in lower socioeconomic groups. Nevertheless, this inequality occurs mainly due to older persons, especially in the lower socioeconomic groups spending in the private health sector. The provision of health services by the public health sector through minimal fees has provided a safety net and successfully protect the older persons in lower socioeconomic groups. Despite that, there is still a need for older persons of lower socioeconomic status to rely upon the private healthcare sector for healthcare services. Deep dive into this matter would allow the government to intervene and provide greater financial risk protection for older persons.},
howpublished = {published online at https://apcph.cphm.my},
note = {Type: POSTER PRESENTATION; Organisation: Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health (MOH) Malaysia},
keywords = {Healthcare, Inequalities, older persons, Out-of-pocket Expenditure},
pubstate = {published},
tppubtype = {proceedings}
}