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Fulltext Willingness to pay for voluntary community-based health insurance: findings from an exploratory study in the state of Penang, Malaysia

Shafie AA, Hassali MA

Soc Sci Med, 2013 Nov;96:272-6.
PMID: 23528670 DOI: 10.1016/j.socscimed.2013.02.045

Health care in Malaysia is funded primarily through taxation and is no longer sustainable. One funding option is voluntary community-based health insurance (VCHI), which provides insurance coverage for those who are unable to benefit immediately from either a social or private health insurance plan. This study is performed to assess the willingness of Malaysians to participate in a VCHI plan. A cross-sectional study was performed in the state of Penang between August and mid-September 2009 with 472 randomly selected respondents. The respondents were first asked to select their preferred health financing plan from three plans (out-of-pocket payment, compulsory social health insurance and VCHI). The extent of the household's willingness to pay for the described VCHI plan was later assessed using the contingent valuation method in an ex-ante bidding game approach until the maximum amount they would be willing to pay to obtain such a service was agreed upon. Fifty-four per cent of the participants were female, with a mean age of 34 years (SD = 11.9), the majority of whom had a monthly income of Int$1157-2312. The results indicated that more than 63.1% of the respondents were willing to join and contribute an average of Int$114.38 per month per household towards VCHI. This amount was influenced by ethnicity, educational level, household monthly income, the presence of chronic disease and the presence of private insurance coverage (p
Wayward winds: Malay archetypes, and theory of personality in the context of shamanism

Laderman C

Soc Sci Med, 1988;27(8):799-810.
PMID: 3227379 DOI: 10.1016/0277-9536(88)90232-8

In comparing shamanistic healing with Western psychotherapy, the principal distinctions advanced by psychiatrists and psychologists have been: (1) that the shaman's patients receive 'remission without insight' while Western psychotherapy provides patients with a learning experience; and (2) that Western psychotherapy is based upon rational theory, whereas psychotherapeutic elements in shamanistic rituals are by-products of irrational magical activity. Anthropologists, on the other hand, have demonstrated the logic behind the shaman's seance, and its uses as a projective system which locates the patient's problems in external entities rather than within his own psyche. An investigation of the Malay shamanistic ritual (Main Peteri) expands the scope of discussion, since it reveals that embedded within this exorcistic spirit-raising seance is a nonprojective indigenous theory of psychic functioning, employing symbols internal to the patient, which is comparable to, and no more nor less rational than, mainstream Western theories.
Unmet needs among disabled elderly Malaysians

Momtaz YA, Hamid TA, Ibrahim R

Soc Sci Med, 2012 Sep;75(5):859-63.
PMID: 22632847 DOI: 10.1016/j.socscimed.2012.03.047

Unmet need as a significant factor affecting quality of life in later life has recently received considerable attention in gerontological research. The main aim of this study was to identify the prevalence, predicting factors, and negative consequence of unmet need among older Malaysians. The findings may be useful to reduce unmet need and the burden of its adverse consequence. The sample for this study consists of 400 functionally disabled elderly people aged 60 and over was obtained from a large national survey. Unmet need was operationally defined based on Manton's (1989) criteria. The findings from the present study showed about 18.0% of functionally disabled older Malaysians suffer from unmet need. Logistic regression revealed that gender (being male) and chronic health conditions are statistically associated with increased odds of unmet need after adjusting for other possible risk factors. Further results indicated that unmet need statistically increases odds of fall as a negative consequence of unmet need. The high prevalence rates of unmet need among disabled elderly men and chronically ill older persons suggest that policy makers should pay more attention to this vulnerable group to achieve good quality of life. The implications and limitations of the present study are discussed.
The traditional healer in obstetric care: A persistent wasted opportunity in maternal health

Aborigo RA, Allotey P, Reidpath DD

Soc Sci Med, 2015 May;133:59-66.
PMID: 25841096 DOI: 10.1016/j.socscimed.2015.03.046

Traditional medical systems in low income countries remain the first line service of choice, particularly for rural communities. Although the role of traditional birth attendants (TBAs) is recognised in many primary health care systems in low income countries, other types of traditional practitioners have had less traction. We explored the role played by traditional healers in northern Ghana in managing pregnancy-related complications and examined their relevance to current initiatives to reduce maternal morbidity and mortality. A grounded theory qualitative approach was employed. Twenty focus group discussions were conducted with TBAs and 19 in-depth interviews with traditional healers with expertise in managing obstetric complications. Traditional healers are extensively consulted to manage obstetric complications within their communities. Their clientele includes families who for either reasons of access or traditional beliefs, will not use modern health care providers, or those who shop across multiple health systems. The traditional practitioners claim expertise in a range of complications that are related to witchcraft and other culturally defined syndromes; conditions for which modern health care providers are believed to lack expertise. Most healers expressed a willingness to work with the formal health services because they had unique knowledge, skills and the trust of the community. However this would require a stronger acknowledgement and integration within safe motherhood programs.
The pragmatics of aesthetics: the performance of healing among Senoi Temiar

Roseman M

Soc Sci Med, 1988;27(8):811-8.
PMID: 2465577 DOI: 10.1016/0277-9536(88)90233-X

Indigenous healers in many societies use patterned sounds, movements, colors, shapes, and odors as therapeutic techniques; yet medical anthropology remains curiously inattentive to the aesthetics of healing rituals. Based on research among Senoi Temiar of Peninsular Malaysia, I propose an approach to the therapeutic efficacy of these symbolic forms. The music of Temiar healing ceremonies is examined from three perspectives: the formal musical structures, the indigenous theories that inform those structures, and the strategies through which they are performed and experienced by participants. Temiar healing performances present a moment of articulation between two domains of knowledge and action: musical composition, performance, and affect, on the one hand, and indigenous cosmology, illness etiology, and the pathogenicity of emotions, on the other. Songs of Temiar spirit-mediums cross-cut these two domains, and demonstrate the pragmatics of aesthetics.
The impact of lifestyle guidance intervention on health outcomes among Japanese middle-aged population with metabolic syndrome: A regression discontinuity study

Li Y, Babazono A, Jamal A, Liu N, Fujita T, Zhao R, et al.

Soc Sci Med, 2022 Dec;314:115468.
PMID: 36327638 DOI: 10.1016/j.socscimed.2022.115468

Metabolic syndrome (MetS) prevalence has increased globally with considerable morbidity and economic burden at both individual and national levels. Japan is the first and only country that has introduced a nationwide lifestyle guidance intervention program to manage and control MetS. We conducted a quasi-experiment approach-regression discontinuity design-to evaluate the impact of this intervention on health outcomes at the population level. We retrospectively collected data of adults aged ≥35 years who participated in health checkups in 2015. Age in 2015 was used as the assignment variable, and an age of 40 years old was the threshold because those with MetS aged ≥40 were required to receive lifestyle guidance intervention. Among 26,772 MetS adults, those who received the intervention had significant reductions in obesity measurements (bodyweight, waist circumference, and body mass index [BMI]) after 1 year of this intervention. Blood pressure was also significantly reduced in men after 1 year of undertaking the intervention. The results were similar when including demographic, socioeconomic, and behavioral covariates and using alternative functional forms to estimate the impact, or when bandwidths around intervention thresholds were changed. Our results showed that lifestyle guidance intervention for MetS has an important impact on weight loss and blood pressure reduction at the population level. This intervention could address the high burden of obesity and cardiovascular diseases in Japan and other countries with an unmet need for MetS prevention and management.
Fulltext The gender responsiveness of social entrepreneurship in health - A review of initiatives by Ashoka fellows

Khalid S, Dixon S, Vijayasingham L

Soc Sci Med, 2022 Jan;293:114665.
PMID: 34954676 DOI: 10.1016/j.socscimed.2021.114665

There are vocal calls to act on the gender-related barriers and inequities in global health. Still, there are gaps in implementing programmes that address and counter the relevant dynamics. As an approach that focuses on social problems and public service delivery gaps, social entrepreneurship has the potential to be a closer health sector partner to tackle and transform the influence of gender in health to achieve health systems goals better. Nevertheless, social entrepreneurs' engagement and impact on gender and health remain understudied. Using the Ashoka Fellows database as a sampling frame in November 2020 (n = 3352, health n = 129), we identified and reviewed the work of 21 organizations that implemented gender-responsive health-related programmes between 2000 and 2020. We applied the UNU-IIGH 6-I Analytic Framework to review the gender issues, interventions, included populations, investments, implementation, and impact in each organization. We found that a low proportion of fellows engage in gender-responsive health programming (<1%). Many organizations operate in low-and middle-income countries (16/21). The gender-responsive programmes include established health sector practices, to address gendered-cultural dynamics and deliver people-centred resources and services. Interestingly, most organizations self-identify as NGOs and rely on traditional grant funding. Fewer organizations (6/21) adopt market-based and income-generating solutions - a missed opportunity to actualise the potential of social entrepreneurship as an innovative health financing approach. There were few publicly available impact evaluations-a gap in practice established in social entrepreneurship. All organizations implemented programmes at community levels, with some cross-sectoral, structural, and policy-level initiatives. Most focused on sexual and reproductive health and gender-based violence for predominantly populations of women and girls. Closer partnerships between social entrepreneurs and gender experts in the health sector can provide reciprocally beneficial solutions for cross-sectorally and community designed innovations, health financing, evidence generation and impact tracking that improve the gender-responsiveness of health programmes, policies, and systems.
The developmental niche: a theoretical framework for analyzing the household production of health

Harkness S, Super CM

Soc Sci Med, 1994 Jan;38(2):217-26.
PMID: 8140448

Recent efforts to promote child survival and development internationally have focused new attention on the importance of the household as a mediator of both environmental risks and programmatic interventions to promote better health. In this paper, we introduce a theoretical framework, the 'developmental niche,' derived from studies of children's behavior and development in different cultural contexts, as a tool for analyzing the household production of health. The developmental niche is conceptualized in terms of three basic components: (1) the physical and social settings of the child's everyday life; (2) culturally regulated customs of child care and child rearing; and (3) the psychology of the caretakers. The relevance of each of these components to the household production of health is illustrated through examples from research in several cultures, including Malaysia, Kenya, Bangladesh, India, and the U.S. Further discussion centers on three corollaries of the developmental niche framework that point to the interactive relationships among the three components, between the niche and the larger environment, and between the niche and the child (or any individual seen from a developmental perspective). It is suggested that this approach is useful for identifying and collecting relevant information on household-level factors that affect health outcomes, and thus for organizing more effective interventions. At a theoretical level, the developmental niche framework also facilitates understanding processes of mutual adaptation between the individual and the environment as they are filtered through the constraints of household settings, customs and caretaker psychologies.
The ambiguity of symbols in the structure of healing

Laderman C

Soc Sci Med, 1987;24(4):293-301.
PMID: 2436303 DOI: 10.1016/0277-9536(87)90148-1

In his article, 'The Effectiveness of Symbols,' Lévi-Strauss contends that the details of a Cuna birth incantation evoke specific physiological responses from parturient women, aiding them through difficult labors. His argument, which analyzes the incantation as a text divorced from its social setting, has drawn criticism from students of Cuna society on a number of substantive points, primarily centering around the difficulties that the special linguistic form of ritual language would present to a non-adept. If the patient lacks a thorough comprehension of the mythic details, how can the incantation change her physiological processes? In an attempt to evaluate the effect of myth upon a woman in labor, this article calls upon Cuna and Malay ethnographic data, and presents a Malay birth incantation as interpreted by the ritual practitioner who recited it. Following a discussion of the non-semantic aspects of the incantation and the extent to which the patient shares the interpretation of the healer in both the Malay and Cuna societies, recent biomedical studies are cited in support of hypotheses concerning the physiological and biochemical effects of myth in the management of childbirth.
Syndemic anemia in British Malaya: An early global health encounter with hookworm and malaria Co-infections in plantation workers

Webb JLA

Soc Sci Med, 2020 Nov 26.
PMID: 33261905 DOI: 10.1016/j.socscimed.2020.113555

With the establishment of the International Health Commission in 1913, the Rockefeller Foundation sought governmental partnerships overseas to combat hookworm disease and improve feces disposal practices. In the Madras Presidency in British India, the India Research Fund Association carried out hookworm surveys but failed in its educational efforts to improve feces disposal practices. In British Malaya, the Uncinariasis [Hookworm] Commission to the Orient discovered a syndemic of anemia among Tamil plantation laborers from the Madras Presidency and Chinese laborers from southern China who suffered from hookworm and malarial co-infections. Confronted with the apparent infeasibility of improving feces disposal practices and the obdurate fact of re-infection with hookworm after purgative treatment, the Rockefeller Foundation ended its hookworm initiative in British Malaya without advocating for programmatic intervention against syndemic anemia. The essay concludes with a reflection on the engagement of historians with the syndemic paradigm.
Solidarity by demand? Exit and voice in international medical travel - the case of Indonesia

Ormond M

Soc Sci Med, 2015 Jan;124:305-12.
PMID: 24947552 DOI: 10.1016/j.socscimed.2014.06.007

Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts has been negligible and largely speculative. While proponents praise IMT's potential to make home health systems more responsive to the needs of market-savvy healthcare consumers, critics identify it as a way to further de-politicise the satisfaction of healthcare needs. This article draws from work on political consumerism, health advocacy and social movements to argue for a reframing of IMT not as a 'one-off' statement about or an event external to struggles over access, rights and recognition within medical travellers' home health systems but rather as one of a range of critical forms of on-going engagement embedded within these struggles. To do this, the limited extant empirical work addressing domestic impacts of IMT is reviewed and a case study of Indonesian medical travel to Malaysia is presented. The case study material draws from 85 interviews undertaken in 2007-08 and 2012 with Indonesian and Malaysian respondents involved in IMT as care recipients, formal and informal care-providers, intermediaries, promoters and policy-makers. Evidence from the review and case study suggests that IMT may effect political and social change within medical travellers' home contexts at micro and macro levels by altering the perspectives, habits, expectations and accountability of, and complicity among, medical travellers, their families, communities, formal and informal intermediaries, and medical providers both within and beyond the container of the nation-state. Impacts are conditioned by the ideological foundations underpinning home political and social systems, the status of a medical traveller's ailment or therapy, and the existence of organised support for recognition and management of these in the home context.
Smoking among urban Malaysian school children

Thambypillai V

Soc Sci Med, 1985;21(7):819-23.
PMID: 4071118 DOI: 10.1016/0277-9536(85)90130-3

A questionnaire on smoking habits was administered to 4106 Form IV school children in Kuala Lumpur. The period of survey was from 9 to 20 April 1984. 2099 boys and 2007 girls were studied and their mean age was 16.1 years. 32.8% of the students had been initiated to smoking and the mean age of initiation was 13.3 years. The prevalence of smoking was found to be 9.8% and the mean duration of smoking was 2.5 years. Most of the smokers and occasional smokers were boys. About 42% of the smokers wished to stop smoking and only 1% of the non-smokers intended to smoke in the future. The study recommended that health education programmes should be started earlier in school.
Salted fish and nasopharyngeal carcinoma in Malaysia

Armstrong RW, Eng AC

Soc Sci Med, 1983;17(20):1559-67.
PMID: 6635717 DOI: 10.1016/0277-9536(83)90100-4

The evidence for a hypothesis that eating salted fish is associated with nasopharyngeal carcinoma (NPC) is reviewed. The hypothesis was tested among Malaysian Chinese using a matched case-control design. The kinds of salted fish and patterns of use were also investigated in a control group comprising 100 Chinese, 50 Malay and 50 Indian households. During 1980, in Selangor, Malaysia, interviews with 100 Chinese cases of NPC and 100 non-disease controls indicated that salted fish consumption during childhood was a significant risk (relative risk = 3.0, P = 0.04), with an elevated risk for daily as opposed to less frequent consumption. Salted fish consumption during adolescence was a less significant risk, and current consumption not at all. There were 19 kinds of fishes reported as being eaten as salted fish by the 200 control households. There were marked differences between ethnic groups in preference for different kinds: Chinese preferred red snapper (74% of households), Malay jewfish (54%) and Indian red snapper (28%). Salted fish was hardly ever eaten daily by any household; weekly was a moderate frequency in all ethnic groups; less than weekly most common. There were no statistically significant differences between Chinese NPC case and non-disease control participants in kind of salted fish eaten. Results were the same when the data were analyzed by sex, subethnic group and income.
Relationship between water quality and human health: a case study of the Linggi River Basin in Malaysia

Lonergan S, Vansickle T

Soc Sci Med, 1991;33(8):937-46.
PMID: 1745918

Due to the increasingly documented prevalence of diarrhoeal diseases in Malaysia, a number of water-related programmes have been implemented in an attempt to improve health status through the reduction of incidence of waterborne communicable diseases associated with poor public water supplies. The implicit assumption underlying these projects is that the enhancement of the physical infrastructure, and subsequent improvements in the quality of the water supply, will substantially reduce water-related disease. The present study questions this hypothesis and uses a socio-ecological model as a framework to assess risk factors associated with the increased probability of waterborne disease. Research is centred on Port Dickson, a district which typifies existing water and sanitation conditions in much of semi-rural Malaysia. Health services utilization data and a 268-household diarrhoeal morbidity survey were used to measure the burden of illness of waterborne disease within the district and to identify predictors of morbidity. It was concluded that although treatment facilities will reduce the health burden in the region, a number of behavioural and sanitation factors may be more important and could act to minimize the potential impacts of improved water quality.
Regional inequalities of child mortality in peninsular Malaysia with special reference to the differentials between Perlis and Kuala Terengganu

Brehm U

Soc Sci Med, 1993 May;36(10):1331-4.
PMID: 8511619

In Peninsular Malaysia child mortality rates (5q0) vary from 13 to 63 per thousand at district level. The spatial pattern is closely associated with the regional distribution of socio-economic factors. But due to multicollinearity it is difficult to isolate the influence of socio-economic variables from other variables by employing aggregated data. However, individual data collected in a case-control-study that was conducted in Perlis and Kuala Terengganu confirm the important role of socio-economic factors. So it should be possible to achieve a further reduction of child mortality by raising the income and educational level of the under-privileged groups. Apart from that, as the case of Perlis shows, the provision of family planning and preventive medical services may also contribute to lower child mortality independent from socio-economic changes. But, as the comparison with Kuala Terengganu shows, the utilization of family planning and preventive medical services is not only influenced by the accessibility to, but also by the socio-culturally determined acceptability of such services.
Re-interpreting the citizen consumer: alternative consumer activism and the rights to health and development

Khoo SM

Soc Sci Med, 2012 Jan;74(1):14-9.
PMID: 21570757 DOI: 10.1016/j.socscimed.2011.02.048

Alternative Southern consumer activism, undertaken for example by the Consumers' Association of Penang (CAP) in Malaysia, presents significant sites of nodal governance through which local and global health rights are claimed. This alternative consumer approach distinctively integrates health with development, social justice and environmental issues. It has not always explicitly employed rights language, but consumer activism fits with rights-based approaches, emphasising entitlements, accountability and participation. This case-study traces the development of networked consumer campaigns to contest and shape global health governance. It highlights the important, yet under-researched role of Southern nodes within global networks mobilizing health rights and public health. Alternative consumer activism re-interprets the consumer as a countervailing force, collectively mobilizing citizens to claim their health rights.
Public health care provisions: access and equity

Bin Juni MH

Soc Sci Med, 1996 Sep;43(5):759-68.
PMID: 8870140

Within the current exercise of reforming the health care system, underlying all issues, is the reassessment of the role of government. It is a government's responsibility and concern that the health sector be accessible and equitable to the population, and more important that the health sector be more efficient and affordable. Many governments in the world attempt to provide universal health care services to their population through public health care provisions. This paper reviews and analyses the experience of the Malaysian health system, focusing on the performance of the system in relation to access and equity. The performance of the Malaysian health system has been impressive. At minimum cost it has achieved virtually accessible and equitable health care to the entire population. This is evident by analysing almost all the commonly used indicators. These clearly show that when matched to comparable countries, health outcome is even better than predicted value.
Problems and potential of researching epidemiological transition: examples from Southeast Asia

Phillips DR

Soc Sci Med, 1991;33(4):395-404.
PMID: 1948152

The concept of epidemiological transition is now quite widely recognized, if not so widely accepted. The transition appears to progress at varying speeds and to different extents spatially; it seems that there can be considerable international, regional and local variations in its progress. The paper examines this contention in the case of a number of countries in Southeast Asia, principally Hong Kong, Malaysia and Thailand. Drawing on evidence from this region, the paper highlights the importance when researching epidemiological transition of the time period under consideration; socio-cultural variations; the nature and quality of data, and spatial scale. It makes some suggestions as to the potential of the concept of epidemiological transition in health care planning and development studies.
Private medical practitioners and managed care in Malaysia: a survey of knowledge and attitudes held by Federal Territory based doctors

Marnoch G, Lian PC

Soc Sci Med, 2002 Mar;54(6):869-77.
PMID: 11996021

This paper considers the subject of managed care in Malaysia, providing a questionnaire-based analysis of the position adopted by private medical practitioners. Managed care is now seen as the dominant health care system in the United States, with many other countries around the world including Malaysia beginning to selectively use component parts to tackle particular health care problems. In this survey it was found that three out of four respondents have concerns regarding the implementation of managed care. The survey was used to identify and categorise these concerns. At the same time, three out of four respondents held the opinion that principles of managed care were already a reality or would be in the next 5 years. This group expressed an eagerness to be trained in managed care principles and be given the opportunity to be part of managed care organisations. It is argued that clinicians' knowledge and interest perceptions are an important influence on the implementation of managed care based systems. The survey-based evidence presented in this article is intended as a measure of current understandings and beliefs, in relation to clinical micro-management process associated with managed care.
Predicting intention to participate in self-management behaviors in patients with Familial Hypercholesterolemia: A cross-national study

Hagger MS, Hamilton K, Hardcastle SJ, Hu M, Kwok S, Lin J, et al.

Soc Sci Med, 2019 12;242:112591.
PMID: 31630009 DOI: 10.1016/j.socscimed.2019.112591

RATIONALE: Familial Hypercholesterolemia (FH) is a genetic condition that predisposes patients to substantially increased risk of early-onset atherosclerotic cardiovascular disease. FH risks can be minimized through regular participation in three self-management. BEHAVIORS: physical activity, healthy eating, and taking cholesterol lowering medication.
OBJECTIVE: The present study tested the effectiveness of an integrated social cognition model in predicting intention to participate in the self-management behaviors in FH patients from seven countries.
METHOD: Consecutive patients in FH clinics from Australia, Hong Kong, Brazil, Malaysia, Taiwan, China, and UK (total N = 726) completed measures of social cognitive beliefs about illness from the common sense model of self-regulation, beliefs about behaviors from the theory of planned behavior, and past behavior for the three self-management behaviors.
RESULTS: Structural equation models indicated that beliefs about behaviors from the theory of planned behavior, namely, attitudes, subjective norms, and perceived behavioral control, were consistent predictors of intention across samples and behaviors. By comparison, effects of beliefs about illness from the common sense model were smaller and trivial in size. Beliefs partially mediated past behavior effects on intention, although indirect effects of past behavior on intention were larger for physical activity relative to taking medication and healthy eating. Model constructs did not fully account for past behavior effects on intentions. Variability in the strength of the beliefs about behaviors was observed across samples and behaviors.
CONCLUSION: Current findings outline the importance of beliefs about behaviors as predictors of FH self-management behaviors. Variability in the relative contribution of the beliefs across samples and behaviors highlights the imperative of identifying sample- and behavior-specific correlates of FH self-management behaviors.

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