Factors associated with the usage of health insurance among cancer patients in public hospitals in a middle-income country

INTRODUCTION: Private health insurance (PHI) plays an important supplementary role on top of the existing subsidised health financing system to prevent heavy reliance on out-of-pocket (OOP) expenses, especially in diseases with high costly treatment. This study was done to examine the factors associated with PHI usage among cancer patients and its associated influencing factors in Malaysia.

MATERIALS AND METHODS: This cross-sectional study was conducted in three Malaysian public hospitals using a multilevel sampling technique to recruit 630 respondents. A validated self-developed four-domain questionnaire which includes one domain for health insurance was used to collect the relevant data.

RESULTS: Approximately 31.7% of the respondents owned PHI. The PHI usage was significantly higher among male respondents (p=0.035), those aged 18-40 years old (p<0.001), Indian and Chinese ethnicities (p=0.002), with tertiary education level (p<0.001), employed (p<0.001), working in the private sector (p<0.001), high household income (T20) (p<0.001), home near to the hospital (p=0.001) and medium household size (p<0.001). The significant predictive factors were age 18-40 years aOR 3.01 (95% CI: 1.67-5.41), age 41-60 years aOR 2.22 (95% CI 1.41-3.49), medium (M40) income aOR 2.90 (95% CI: 1.92-4.39) and high (T20) income aOR 3.86 (95% CI: 1.68-18.91), home near to the hospital aOR 1.68 (95% CI: 1.10-2.55), medium household size aOR 2.20 (95% CI: 1.30-3.72) and female head of household aOR 1.79 (95% CI: 1.01-3.16). The type of cancer treatment, the location of treatment, prior treatment in private healthcare facilities and existence of financial coping mechanisms also were significant factors in determining PHI usage among cancer patients in this study.

CONCLUSION: Several factors are significantly associated with PHI usage in cancer patients. The outcome of this study can guide policymakers to identify high-risk groups which need supplementary health insurance to bear the cost for their cancer treatment so that a better pre-payment health financing system such as a national health insurance can be formulated to cater for these groups.