ArticleBMC public health2022
The inequalities and determinants of Households' Distress Financing on Out-off-Pocket Health expenditure in Malaysia.
Article in BMC public health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 19 citations in OpenAlex.
- Osteoporosis treatment with biosimilars in Malaysia and Thailand: a budget impact analysis.Archives of osteoporosis · 2026Article
- Exploring Out-of-Pocket Costs and Health-Related Quality of Life among Patients with Cancer and Diabetes in Malaysia.The Malaysian journal of medical sciences : MJMS · 2025Article
- Determinants of medical borrowing and associated inequalities in the Kingdom of Saudi Arabia: evidence from the Global Findex survey.Health economics review · 2025Article
- Disease-specific distress healthcare financing and catastrophic out-of-pocket expenditure for hospitalization care in Bangladesh.Cost effectiveness and resource allocation : C/E · 2025Article
- Factors influencing the intention to purchase health insurance among middle-income Malaysians: a qualitative study.BMC public health · 2025Article
- Determinants of distress financing for healthcare service utilization: a convergent mixed-method study at a tertiary hospital in Malaysia.Health policy and planning · 2025Article
- Health system efficiency and equity in ASEAN: an empirical investigation.Cost effectiveness and resource allocation : C/E · 2024Article
- Healthcare cost coverage inequality and its impact on hypertension and diabetes: A five-year follow-up study in a Malaysian rural community.Health science reports · 2024Article
- Article
- Stronger association of perceived health with socio-economic inequality during COVID-19 pandemic than pre-pandemic era.BMC public health · 2022Article
- Equity in Out-of-Pocket Payments for Healthcare Services: Evidence from Malaysia.International journal of environmental research and public health · 2022Article
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Authors and funding
7 authors at 3 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundOut-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.
methodsThis 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.
resultsThe 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.
conclusionsThe 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.
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