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Catastrophic Health Expenditure (CHE) among Cancer Population in a Middle Income Country with Universal Healthcare
Sharifa Ezat Wan Puteh1, Yang Rashidi Abdullah2, Azimatun Noor Aizuddin3
1Department of Public Health, Universiti Kebangsaan Malaysia, Malaysia.
Insights
Over half of Malaysian cancer patients face catastrophic health expenditure (CHE). Factors like low income, unemployment, and distance from hospitals significantly increase the risk of financial hardship.
Area of Science:
- Health Economics
- Oncology
- Public Health
Background:
- Investigated healthcare expenditure burden on cancer patients in Malaysia.
- Aimed to determine the prevalence of Catastrophic Health Expenditure (CHE) and its associated risk factors.
Purpose of the Study:
- To assess the level of Catastrophic Health Expenditure (CHE) among cancer patients.
- To identify sociodemographic, economic, disease, and treatment-related factors associated with CHE.
Main Methods:
- Cross-sectional study conducted in three Malaysian public hospitals.
- Recruited 630 cancer patients using multi-level sampling from February 2020 to February 2021.
- Defined CHE as monthly health expenditure exceeding 10% of total monthly household income; data collected via validated questionnaire.
Main Results:
- A high prevalence of CHE was observed in 54.4% of patients.
- CHE was significantly associated with Indian ethnicity, lower education, unemployment, low income, poverty, rural residence, and living far from hospitals.
- Treatment-related factors such as radiotherapy, chemotherapy, frequent treatments, and lack of a Guarantee Letter (GL) were also significant predictors of CHE.
Conclusions:
- Catastrophic Health Expenditure (CHE) is a significant issue for Malaysian cancer patients.
- Multiple sociodemographic, economic, disease, and treatment variables, along with health insurance and financial aid status, influence CHE.
- Findings highlight the need for targeted financial support and policy interventions for vulnerable cancer patient populations.
Background:
The study investigated healthcare expenditure from the perspective of cancer patients, to determine the level of Catastrophic Health Expenditure (CHE) and its associated factors.
Methods:
This cross-sectional study was conducted in three Malaysian public hospitals namely Hospital Kuala Lumpur, Hospital Canselor Tuanku Muhriz and the National Cancer Institute using a multi-level sampling technique to recruit 630 respondents from February 2020 to February 2021. CHE was defined as incurring a monthly health expenditure of more than 10% of the total monthly household expenditure. A validated questionnaire was used to collect the relevant data.
Results:
The CHE level was 54.4%. CHE was higher among patients of Indian ethnicity (P = 0.015), lower level education (P = 0.001), those unemployed (P < 0.001), lower income (P < 0.001), those in poverty (P < 0.001), those staying far from the hospital (P < 0.001), living in rural areas (P = 0.003), small household size (P = 0.029), moderate cancer duration (P = 0.030), received radiotherapy treatment (P < 0.001), had very frequent treatment (P < 0.001), and without a Guarantee Letter (GL) (P < 0.001). The regression analysis identified significant predictors of CHE as lower income aOR 18.63 (CI 5.71-60.78), middle income aOR 4.67 (CI 1.52-14.41), poverty income aOR 4.66 (CI 2.60-8.33), staying far from hospital aOR 2.62 (CI 1.58-4.34), chemotherapy aOR 3.70 (CI 2.01-6.82), radiotherapy aOR 2.99 (CI 1.37-6.57), combination chemo-radiotherapy aOR 4.99 (CI 1.48-16.87), health insurance aOR 3.99 (CI 2.31-6.90), without GL aOR 3.38 (CI 2.06-5.40), and without health financial aids aOR 2.94 (CI 1.24-6.96).
Conclusions:
CHE is related to various sociodemographic, economic, disease, treatment and presence of health insurance, GL and health financial aids variables in Malaysia.
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