Dataset Information

Socioeconomic Status Affecting Inequity of Healthcare Utilisation in Malaysia.

ABSTRACT: Background:Equity is one of the important aspects of universal health coverage. Variation in socioeconomic status (SES) has been proved to contribute discrepancies in the use of healthcare services. This study aimed to assess equity for inpatient, outpatient and dental care utilisation by household SES over time. Methods:This study used five series of National Health and Morbidity Survey data from 1986 to 2015. Healthcare utilisation for inpatient, outpatient and dental care were analysed. SES was grouped based on household expenditure variables accounting for total number of adults and children in the household using consumption per adult equivalents approach. The determination of healthcare utilisation across the SES segments was measured using concentration index. Results:The overall distribution of inpatient utilisation tended towards the pro-poor, although only data from 1996 (P-value = 0.017) and 2006 (P-value = 0.021) were statistically significant (P < 0.05). Out-patient care showed changing trends from initially being pro-rich in 1986 (P < 0.05), then gradually switching to pro-poor in 2015 (P < 0.05). Dental care utilisation was significantly pro-rich throughout the survey period (P < 0.05). Public providers mostly showed significantly pro-poor trends for both in- and out-patient care (P < 0.05). Private providers, meanwhile, constantly showed a significantly pro-rich (P < 0.05) trend of utilisation. Conclusion:Total health utilisation was close to being equal across SES throughout the years. However, this overall effect exhibited inequities as the effect of pro-rich utilisation in the private sector negated the pro-poor utilisation in the public sector. Strategies to improve equity should be consistent by increasing accessibility to the private sectors, which has been primarily dominated by the richest population.

SUBMITTER: Bakar NSA

PROVIDER: S-EPMC6719882 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Socioeconomic Status Affecting Inequity of Healthcare Utilisation in Malaysia.

Bakar Nurul Salwana Abu NSA Manual Adilius A Hamid Jabrullah Ab JA

The Malaysian journal of medical sciences : MJMS 20190701 4

<h4>Background</h4>Equity is one of the important aspects of universal health coverage. Variation in socioeconomic status (SES) has been proved to contribute discrepancies in the use of healthcare services. This study aimed to assess equity for inpatient, outpatient and dental care utilisation by household SES over time.<h4>Methods</h4>This study used five series of National Health and Morbidity Survey data from 1986 to 2015. Healthcare utilisation for inpatient, outpatient and dental care were ...[more]

PMID: 31496896

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Project description:BackgroundThere are two parallel systems in Malaysian primary healthcare services: government funded public primary care and privately-owned practices. While there have been several studies evaluating antibiotic utilisation in Malaysian public healthcare, there is a lack of literature on the use of antibiotics in the private sector. There is a dire need to evaluate the more recent performance of public vs. private community healthcare in Malaysia. As such, this study aimed at measuring and comparing the utilisation of antibiotics in the public and private community healthcare sectors of Malaysia in 2018-2021.MethodsThis study was a retrospective analysis of antibiotic utilisation in Malaysian primary care for the period of 1 January 2018 until 31 December 2021 using the nationwide pharmaceutical procurement and sales data from public and private health sectors. Rates of antibiotic utilisation were reported as Defined Daily Doses per 1000 inhabitants per day (DID) and stratified by antibiotic classes. The secondary analysis included proportions of AWaRe antibiotic category use for each sector and proportion of antibiotic utilisation for both sectors.ResultsThe overall national antibiotic utilisation for 2018 was 6.14 DID, increasing slightly to 6.56 DID in 2019, before decreasing to 4.54 DID in 2020 and 4.17 DID in 2021. Private primary care antibiotic utilisation was almost ten times higher than in public primary care in 2021. The public sector had fewer (four) antibiotic molecules constituting 90% of the total antibiotic utilisation as compared to the private sector (eight). Use of Access antibiotics in the public sector was consistently above 90%, while use of Access category antibiotics by the private sector ranged from 64.2 to 68.3%. Although use of Watch antibiotics in the private sector decreased over the years, the use of Reserve and 'Not Recommended' antibiotics increased slightly over the years.ConclusionAntibiotic consumption in the private community healthcare sector in Malaysia is much higher than in the public sector. These findings highlight the need for more rigorous interventions targeting both private prescribers and the public with improvement strategies focusing on reducing inappropriate and unnecessary prescribing.

Project description:BACKGROUND:The social gradient in chronic disease (CD) is well-documented, and the ability to effectively self-manage is crucial to reducing morbidity and mortality from CD. This systematic review aimed to assess the moderating effect of socioeconomic status on self-management support (SMS) interventions in relation to participation, retention and post-intervention outcomes. METHODS:Six databases were searched for studies of any design published until December 2018. Eligible studies reported on outcomes from SMS interventions for adults with chronic disease, where socioeconomic status was recorded and a between-groups comparison on SES was made. Possible outcomes were participation rates, retention rates and clinical or behavioural post-intervention results. RESULTS:Nineteen studies were retrieved, including five studies on participation, five on attrition and nine studies reporting on outcomes following SMS intervention. All participation studies reported reduced engagement in low SES cohorts. Studies assessing retention and post-intervention outcomes had variable results, related to the diversity of interventions. A reduction in health disparity was seen in longer interventions that were individually tailored. Most studies did not provide a theoretical justification for the intervention being investigated, although four studies referred to Bandura's concept of self-efficacy. CONCLUSIONS:The limited research suggests that socioeconomic status does moderate the efficacy of SMS interventions, such that without careful tailoring and direct targeting of barriers to self-management, SMS may exacerbate the social gradient in chronic disease outcomes. Screening for patient disadvantage or workload, rather than simply recording SES, may increase the chances of tailored interventions being directed to those most likely to benefit from them. Future interventions for low SES populations should consider focussing more on treatment burden and patient capacity. TRIAL REGISTRATION:PROSPERO registration CRD42019124760. Registration date 17/4/19.

Dataset Information

Socioeconomic Status Affecting Inequity of Healthcare Utilisation in Malaysia.

Publications

Socioeconomic Status Affecting Inequity of Healthcare Utilisation in Malaysia.

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