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Fulltext Economic Burden of ESRD to the Malaysian Health Care System

Ismail H, Abdul Manaf MR, Abdul Gafor AH, Mohamad Zaher ZM, Ibrahim AIN

Kidney Int Rep, 2019 Sep;4(9):1261-1270.
PMID: 31517145 DOI: 10.1016/j.ekir.2019.05.016

Introduction: Prevalence of chronic kidney disease (CKD) in Malaysia is 9.07% of the total population, of which 0.36% are at stage 5 CKD or end-stage renal disease (ESRD). Public-private partnership has improved accessibility of renal replacement therapies (RRT), especially dialysis, in Malaysia, but the economic burden of the existing RRT financing mechanism, which is predominantly provided by the public sector, has never been quantified.
Methods: Primary data were collected through a standardized survey, and secondary data analysis was used to derive estimates of the ESRD expenditure.
Results: Total annual expenditure of ESRD by the public sector has grown 94% within a span of 7 years, from Malaysian Ringgit [MYR] 572 million (US dollars [USD] 405 million, purchasing power parity [PPP] 2010) in 2010 to MYR 1.12 billion (USD 785 million, PPP 2016) in 2016. The total ESRD expenditure in 2010 constituted 2.95% of the public sector's total health expenditure, whereas in 2016, the proportion has increased to 4.2%. Only 6% of ESRD expenditure was spent on renal transplantation, and the remaining 94% was spent on dialysis.
Conclusion: The share of ESRD expenditure in total health expenditure for the public sector is considered substantial given only a small proportion of the population is affected by the disease. The rapid increase in expenditure relative to the national total health expenditure should warrant the relevant authorities about sustainability of the existing financing mechanism of ESRD and the importance to institutionalize more drastic preventive measures.

Matched MeSH terms: Health Expenditures
Faith-based health care

McAdam D

Lancet, 2016 Jan 30;387(10017):429-30.
PMID: 26869565 DOI: 10.1016/S0140-6736(16)00169-0
Matched MeSH terms: Health Expenditures
Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action

Horton S, Sullivan R, Flanigan J, Fleming KA, Kuti MA, Looi LM, et al.

Lancet, 2018 05 12;391(10133):1953-1964.
PMID: 29550030 DOI: 10.1016/S0140-6736(18)30460-4

Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings.

Matched MeSH terms: Health Expenditures
Fulltext Financing the future of WHO

Gostin LO, Klock KA, Clark H, Diop FZ, Jayasuriya D, Mahmood J, et al.

Lancet, 2022 Apr 16;399(10334):1445-1447.
PMID: 35338858 DOI: 10.1016/S0140-6736(22)00533-5
Matched MeSH terms: Health Expenditures*
The Lancet Commission on diabetes: using data to transform diabetes care and patient lives

Chan JCN, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, et al.

Lancet, 2021 Dec 19;396(10267):2019-2082.
PMID: 33189186 DOI: 10.1016/S0140-6736(20)32374-6
Matched MeSH terms: Health Expenditures
Fulltext Economic burden of diabetic care in government health facilities in Selangor

Sharifa Ezat, W.P., Azimatun, N.A., Amrizal, M.N., Rohaizan, J., Saperi, B.S.

Malaysian Journal of Community Health, 2009;15(2):17-26.
MyJurnal

Background : The worldwide prevalence of diabetes is increasing, as is the demand for and cost of medical care. Diabetic Mellitus (DM) prevalence in Malaysia rose from 6.3% of the population in 1986 to 8.3% in 1996 and costs need to be managed more effectively.
Objective : To estimate the financial burden of diabetic care, including providers’ and patients’ costs in government facilities in Selangor and to determine factors influencing cost of diabetic care.
Methodology : A cross-sectional study was conducted from September to November 2005 among Hospitals with and without Specialist and Health Clinics. Total sample of 361 subjects with type 2 diabetes representing both inpatient and outpatient were chosen randomly. Results were analyzed using SPSS version 13.0.
Results : The average cost for a diabetic patients’ admission in a Hospital with Specialist was RM1951 and RM1974 for patient admitted in a Hospital without Specialist and these cost difference was not statistically significant (p>0.05). Providers’ mean cost for outpatient care was RM772.69 and RM761.07 respectively for Hospital with Specialist and Hospital without Specialist per year. As for the health clinics the average providers’ cost for a patient was RM385.92 per year. The cost difference was statistically significant (p0.05). The mean total costs of outpatient care were RM841.46, RM832.80 and RM458.01 per year for Hospital with Specialist, Hospital without Specialist and Health Clinics respectively. Level of care and length of stay were the influencing factors for inpatient provider’s cost. The overall provider’s cost for outpatient diabetic care was influenced by level of care, number of visits and complications. Cost of treating diabetes mellitus year 2004, was estimated at RM18,956,021.51 which was equivalent to 3.3% of total state health expenditure.
Conclusion : As much as 60.2 % was spent on management of outpatient diabetic care and 39.8% for management of inpatient diabetic care. Financial burden of diabetic care is predominantly for outpatient care. Therefore, effective and efficient management of outpatient care is needed to improve allocate efficiency, equity, accessibility and appropriateness of the health care system so that the health care services delivered to the nation are of good quality.

Matched MeSH terms: Health Expenditures
Fulltext Pengurusan risiko : satu dimensi dalam pengurusan kesihatan

Ahmad Farid, A.R., Haidar Rizal, T., Jamsiah, M., Khalib, A.L.

Malaysian Journal of Community Health, 2009;15(2):27-34.
MyJurnal

Introduction : Health management is a tool to ensure an effective running of health program and at the same time avoiding flaws to its components including patients, workers and the entire organization. Risk management is a new concept in health management where the determinants of the problems or the risks are put to minima. It’s strategies are oriented towards prevention as well as controlling to all its administrative system.
Methodology : This is a systematic review on various papers, studies and observations put forwards by risk management experts. It is also supported by feedbacks from many scholars who are involved in research and teaching.
Results : It is been observed that risk management activities have been on practiced in health care delivery system. It is not a new form, but rather a situational action based on certain issues. In fact, it happens in any organization – public or private. Close observation on this area has triggered development of various risk management models including some administrative standard and guidelines.
Conclusion: Risk management is a new approach that need to be practiced by all manager and leader. Its discipline involves interpretation of risk at all angles. It is not only confined to the explicit component, but should also be expended to others area as well. It needs a good sense and good attitude of the manager. The essence of risk management is to minimize the risk to patient, staff, public and the entire organization.

Matched MeSH terms: Health Expenditures
Fulltext Ability and willingness to pay for health care and contribute to national healthcare financing scheme among farmers in Selangor

Aizuddin, A.N., Hoda, R., Rizal, A.M., Yon, R., Al Junid, S.M.

Malaysian Journal of Community Health, 2011;17(1):56-63.
MyJurnal

Introduction: In view of high healthcare expenditure, Malaysia also faces problems in healthcare financing. The policy option is to establish a national health financing scheme. However, it is a problem to develop mechanisms to cover social insurance package to more than one third of the population working in informal sector such as farmers. Therefore, there is an urgent need to assess the ability and willingness of the farming community. The main objective was to study the ability and willingness in the farming community to contribute to national healthcare financing scheme.

Methodology: This a cross sectional study involved 400 farmers in Selangor. A total of 92.3% farmers were able to pay for the healthcare.

Results: Willingness to contribute to The national healthcare financing scheme were RM2.00 per month.

Conclusion: The education level influenced the ability to pay while the educational level and per capita income influenced willingness to pay.

Matched MeSH terms: Health Expenditures
Fulltext Economic impact of a vaccine preventable disease: a scoping review on tuberculosis

Aidalina Mahmud, Azimatun Noor Aizuddin

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):254-261.
MyJurnal

Using pulmonary tuberculosis (pTB) as an example of a vaccine-preventable disease (VPD), we aimed to gather evidence on the economic impact of treating a case or managing an outbreak of a VPD. A scoping review was con- ducted. Online databases (MEDLINE and Google Scholar) were used to collate published studies from the year 2015 to 2019 on the management cost of one case or an outbreak of pTB. Keywords used were cost, treatment, outbreak, pulmonary tuberculosis, tuberculosis, economic, economic evaluation. A total of 29 studies were analysed. The costs of pTB treatment for individual patient were higher in high-income countries compared to middle-income and low-income countries. A case of pTB can result in household catastrophic health expenditure; while an outbreak can overwhelm the health system’s capacity, and disrupts the economy of a country. Therefore, accessibility of vaccines especially in low-income countries must be ensured. Also, vaccine-hesitant individuals must reconsider their stance on vaccination.

Matched MeSH terms: Health Expenditures
Fulltext Mapping kras gene in colon cancer pathway using string and cytoscape software

Sandya Menon Prabhakaran Menon, Asita Elengoe

Malaysian Journal of Medicine and Health Sciences, 2019;15(108):15-15.
MyJurnal

Introduction: Colorectal cancer is one of the top three most commonly occurring cancer worldwide with more than 1.8 million cases in 2018. In Malaysia, colorectal cancer is the most common cancer in males and the second most common cancer in females. Albeit being the second most common form of cancer in Malaysia, there is a lack of a formal or structured national colorectal cancer screening programme in Malaysia and it remains a low priority in healthcare planning and expenditure in Malaysia. The risk of developing colon cancer is greatly influenced by factors such as lifestyle habits, genetic inheritance, diet, weight, and exercise. Kras, the most frequently mutated oncogene in cancer, occurs in about 50 percent of colorectal cancers. Methods: This study maps the kras gene involved in colon cancer pathway, using bioinformatics applications such as STRING version 11.0 and Cytoscape version 3.7.0 to provide a clear visualisation of all the related and involved proteins and genes that interact with this kras gene in the pathway. Results: The 3391 protein interactions were assembled and visualized in y organic form. Six spe-cific non-overlapping clusters of various sizes, which emerged from the huge network of protein-interactors using MCODE version 1.32 clustering algorithm were found. Biological Networks Gene Ontology (BiNGO) was used to determine two ontologies (molecular function and biological process) involved in the protein network. Based on the resulting protein-protein network interaction map, each interaction plays an important role in the cell cycle, meta-bolic pathways and signal transduction. Conclusion: Understanding these interactions provide insight into cellular activities and thus assist in the understanding of the aetiology of disease.

Matched MeSH terms: Health Expenditures
Fulltext A review on hindering factors to maximize healthcare potential in poverty and Islamic way of promoting health

Farrah Farzana Abdullah, Mohd Rahman Omar

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):106-106.
MyJurnal

Introduction: Malaysia has been nominated among the top four well-established healthcare system in the world. However, with the status of a developing country, there are still lacking in offering healthcare services and aware-ness among poverty. The objective of this review is to look into the factors hindering healthcare coverage in poverty. Methods: These literature reviews were carried out by using the electronic databases included, Google Scholars, Medline, PUBMED and EBSCOhost. Results: In current economic status, poverty status needs to be revised as the cost of living has markedly increased especially in the urban. Many factors affect the health status, which include the issues in term of rising health expenditure, demography-geography and imbalance workload distribution. Less expo-sure to health and wellness and geographical-demographic profile are the main reasons for the lack of self-awareness in assessing health services. Various actions had been taken by the stakeholders to improve health statuses such as telehealth, referral system and integration between agencies. Suggestion to improve the existing plan with the atten-tion given especially in the rural area which composed of multi-ethnicity and demography-geographical distribution. In Islam, Prophet Muhammad PBUH promotes health through his eating habits, physical activities include prayer and sports, proper sleep habit and through fasting. Conclusion: Poor and lack of awareness of healthcare services and health ownership have been the main reason for low health-seeking in poverty. Factors such as rising health expenditure, demography-geography factors and lack of facilities provided and unbalance workload distribution in the public-private sector contribute to the issue of concern.

Matched MeSH terms: Health Expenditures
Fulltext Pilot evaluation of two childhood obesity prevention programmes in Malaysia

Lim, Chin Choon, Asrul Akmal Shafie, Mohamed Azmi Ahmad Hassali

Malaysian Journal of Pharmaceutical Science, 2015;13(1):1-2.
MyJurnal

Programmes that increase awareness of childhood obesity are vital to reducing the
number of obese adults and adults with cardiovascular diseases. However, the
effectiveness of these programmes must be evaluated to optimise resources for childhood
obesity awareness programmes. The present study was conducted to assess the
intermediate cost-effectiveness and provide a cost analysis of childhood obesity health
promotion programmes. This quasi-experimental study compared the intermediate
outcomes of the Sahabat Sihat and Be Best programmes over a six-month period. Data
regarding health-related quality of life (EQ-5D and EQ-VAS), the Knowledge, Attitude and
Practice questionnaire, and biomedical data were obtained from booklets prepared by
MySihat for childhood obesity-related health promotion programmes. Data regarding cost
was obtained from the expenditure records of the respective health promotion
programmes. The intergroup and intragroup comparisons between the EQ-5D and
EQ-VAS results, the Knowledge, Attitude, and Practice scores, and the biomedical data
were explored using the Mann-Whitney and Friedman tests. Descriptive statistics were
utilised in the analysis of the cost results. Be Best and Sahabat Sihat were successful in
helping to prevent overweight respondents from becoming obese. The Attitude score was
higher among the Sahabat Sihat cohort, but the Practice score was higher among the Be
Best cohort. Be Best had a lower mean cost per participant and was more cost-effective
than Sahabat Sihat.

Matched MeSH terms: Health Expenditures
Fulltext Island health review, progress and the way forward in the Western Pacific region

Zin, Thant, Myint, Than, Htay, Kyaw, Shamsul, B. S.

Malaysian Journal of Public Health Medicine, 2014;14(3):0-0.
MyJurnal

Island health differs from other health care systems, particularly in that there are limited resources and referral faculties available. With globalisation and climate change, island populations have become increasingly vulnerable to natural disasters and global pandemics. This study will identify, explore, compare and report on island health issues facing in the western Pacific, before making appropriate recommendations. A review of selected health indicators in Pacific islands was collected from the World Health Organization (WHO) and other publicly available resources. In the Pacific region, 15 islands saw lower health expenditure (

Matched MeSH terms: Health Expenditures
Fulltext Comparing cost for elective lower segment caesarean section costing using top-down and activity based costing methods

Aniza I., Putri, N., Azimatun Noor, A., Amrizal, M.N., Saperi, S., Aljunid, S.M.

Malaysian Journal of Public Health Medicine, 2011;11(1):36-46.
MyJurnal

Top-down costing and activity based costing are the most frequent costing methodologies used for analyzing cost. Top-down costing is accomplished by assigning total expenditure of hospital to patient by apportioning the expenditure of cost centers (unit of service) in hospital to give the cost per patient per visit, per day or per admission. Conversely, activity based costing is accomplished by tracking every resource used by patient individually. Since this study started in 2009, Top-down costing calculation was based on financial year in 2009 with adjusted up to 12.6% from 2008 data. This percentage was taken based on the trend of hospital expenditure during 2005 till 2008. An assumption was made that non-financial data (performance and administrative data) for 2009 was similar to 2008. Top-down costing was calculated using Clinical Cost Modeling Software developed by Unit Case-mix of UKMMC to obtain cost of elective lower segment caesarean section (LSCS) per day at ward which was RM922. Whereas activity based costing was calculated using clinical pathway of elective LSCS. Given the average length of stay in 2009 was 4 days, the cost of elective LSCS according to top-down costing was RM3, 688 and activity based costing was RM1774. As a result, cost of elective LSCS is 108% higher using top-down costing.

Matched MeSH terms: Health Expenditures
Fulltext The introduction of subsidised health insurance for the poor in the city of Padang, Indonesia: does the gap on health payment and health service utilisation still exist?

Ade Suzana Eka Putri, Syed Mohamed Aljunid, Amrizal Muhammad Nur

Malaysian Journal of Public Health Medicine, 2015;15(3):132-138.
MyJurnal

Indonesian government secures the access of the poor towards health services through subsidised schemes. This study is aimed to describe the pattern of health expenditure by households and to describe the pattern of health service utilisation across household’s socioeconomic level in the city of Padang after seven years of the introduction of subsidised schemes. A household survey was conducted involving 918 households, with multistage random sampling method. The proportion of out-of-pocket (OOP) health spending as a share of household’s capacity to pay was regressive across consumption quintiles. The proportion of households with catastrophic health expenditure was 1.6% while 1.1% faced impoverished health expenses. Among those who need health care, the utilisation among the rich was higher than the poor. Health insurance schemes in Padang provides financial protection, however with regards to household’s capacity to pay, the poor has the higher burden of health payment. The gap on health service utilisation between the poor and the better-offs was still apparent for outpatient services and it has been narrowed for inpatient care. This study suggests that the subsidised schemes for the poor are highly needed and the possibility of the leakage of subsidies to the rich should be considered by the government.

Matched MeSH terms: Health Expenditures
Fulltext Homeownership affordability: an analysis of household socio‐economic

Norizan Rameli, Dani Salleh, Mazlan Ismail

Malaysian Journal of Social Sciences and Humanities, 2016;1(1):10-16.
MyJurnal

Homeownership affordability is not only the ability of households to pay the housing cost. But homeownership affordability is also involving the ability of households to pay housing costs as well as to maintain the basic needs in the continuity of life. Thus, affordability aspect is important in home ownership. Meanwhile, home ownership is the biggest decision for a household in a term. The combination of affordability and homeownership led to research on factors that affect the affordability of homeownership, especially in terms of socio-economic households inclusively. Socio-economic factors as discussed include income, household expenditures, job type, education level, number of dependents, monthly housing loan and financial savings. Each factor plays the role of its own to ensure the affordability level of homeownership. In fact, the factors that affect the homeownership affordability is different between households. Analysis of the socio-economic factors is necessary because homeownership affordability issues impact the quality life of mankind.

Matched MeSH terms: Health Expenditures
Fulltext Urinary tract infections in pregnancy

Loh KY, Sivalingam N

Malays Fam Physician, 2007;2(2):54-57.
MyJurnal

Urinary tract infections frequently affect pregnant mothers. This problem causes significant morbidity and healthcare expenditure. Three common clinical manifestations of UTIs in pregnancy are: asymptomatic bacteriuria, acute cystitis and acute pyelonephritis. Escherichia coli remains the most frequent organism isolated in UTIs. All pregnant mothers should be screened for UTIs in pregnancy and antibiotics should be commenced without delay. Urine culture and sensitivity is the gold standard in diagnosing UTIs. Without treatment, asymptomatic bacteriuria in pregnancy is associated with preterm delivery, intrauterine growth retardation, low birth weight, maternal hypertension, pre-eclampsia and anaemia. Acute pyelonephritis can lead to maternal sepsis. Recurrent UTIs in pregnancy require prophylactic antibiotic treatment.

Matched MeSH terms: Health Expenditures
The Economic Impact of Managing Late Presentation of Developmental Dysplasia of Hip (DDH)

Anuar R, Mohd-Hisyamudin HP, Ahmad MH, Zulkiflee O

Malays Orthop J, 2015 Nov;9(3):40-43.
PMID: 28611908 MyJurnal DOI: 10.5704/MOJ.1511.006

Delayed presentation of Developmental Dysplasia of Hip (DDH) comes with challenges in treatment as well as high surgical cost. Therefore the objective of this study is to quantify the economic impact of management of late presentation of DDH during a last 3-year period. We conducted a retrospective study with analysis of DDH cases managed between years 2012 to 2014. Early and late presentations of DDH were identified and cost management for both was estimated. Out of twenty-four DDH cases, thirteen cases fulfilled the inclusion criteria. All were female with majority of them presenting with unilateral DDH predominantly of the left hip. Most patients presented after age of six months and the principal complaint was abnormal or limping gait. The grand total cost for managing DDH during the three years period was USD 12,385.51, with 86% of the amount having been used to manage late presentation of DDH that was mostly contributed by the cost of surgery. We concluded that delayed presentation of DDH contributes heavily to high national expenditure. Early detection of DDH cases with systematic neonatal screening may help to minimize the incidence of the late presenting DDH and subsequently reduce the economic burden to the government.

Matched MeSH terms: Health Expenditures
Fulltext Effects of leptin gene variants on obesity and its attributes in Malay population

Amiratul Athirah, S., Aryati, A., Wan Rohani, W.T.

Medicine & Health, 2018;13(2):58-71.
MyJurnal

Leptin is a hormone that regulates the energy intake and expenditure which is encoded by leptin gene. Leptin gene variants were studied comprehensively in relation with body weight status, but the evidences were indecisive. This study was to determine the association between leptin gene variants, G2548A, H1328080 and A19G with obesity and its attributes in Terengganu, Malaysian population. This study involved a total of 249 Malay subjects (101 healthy adults with normal BMI as the control group and 148 overweight and obese subjects). The anthropometrics data were obtained, blood samples were collected for genetic markers and lipid profile analyses. PCR-RFLP technique was performed to determine the genotype and allele distribution of leptin gene variants. The genotypic and allelic frequencies of leptin gene variants presented no significant difference between groups, G2548A (P = 0.93 and 0.74); H1328080 (P = 0.58 and 0.56); and A19G (P = 0.72 and 0.38) correspondingly. However, there was statistical significant difference between triglyceride level and genotypes of G2548A variant (P = 0.016); between total cholesterol level and H1328080 genotypes (P = 0.027). In addition, multivariate logistic regression projected the male gender (adjusted OR= 26.27; CI= 1.06-1.25; P = 0.009), waist circumference (adjusted OR = 1.15; CI = 1.06-1.25; P = 0.001) and body fat percentage (adjusted OR = 1.43; CI = 1.20-1.70; P

Matched MeSH terms: Health Expenditures
Gut microbiome: Microflora association with obesity and obesity-related comorbidities

Lone JB, Koh WY, Parray HA, Paek WK, Lim J, Rather IA, et al.

Microb Pathog, 2018 Nov;124:266-271.
PMID: 30138755 DOI: 10.1016/j.micpath.2018.08.036

Obesity and obesity-related comorbidities have transformed into a global epidemic. The number of people suffering from obesity has increased dramatically within the past few decades. This rise in obesity cannot alone be explained by genetic factors; however, diet, environment, lifestyle, and presence of other diseases undoubtedly contribute towards obesity etiology. Nevertheless, evidence suggests that alterations in the gut microbial diversity and composition have a role to play in energy assimilation, storage, and expenditure. In this review, the impact of gut microbiota composition on metabolic functionalities, and potential therapeutics such as gut microbial modulation to manage obesity and its associated comorbidities are highlighted. Optimistically, an understanding of the gut microbiome could facilitate the innovative clinical strategies to restore the normal gut flora and improve lifestyle-related diseases in the future.

Matched MeSH terms: Health Expenditures

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