A cross·sectional study was done to determine the capacity of Public Health Inspectors in Selangor using a seh administered questionnaire and universal sampling, to determine the enforcement of public health legislation and its influencing factors. A total of 99 respondents from the District Health Offices and 100 respondents from the Local Health Departments participated. The level of enforcement is generally low in all the units except for the Food Unit and Sanitary and Hygiene Units. Factors influencing enforcement of Public Health Legislations are the unit where the respondents worlc and the length of service with the unit. Further analysis using multiple logistic regression, found that respondents from the Food Unit (OR ZZ; 95% C1: 7 .9-58.9 ) , being in the
U8 category (OR 5; 95% C1: l.4» 17.6), service offour years and above in the same unit (OR 6; 95% C1: 2.2»13.8) , received service rewards (OR 3; 95% C1 : 1.2· 6.9); low exposure to bribery (OR 46; 95% C1: 2.3·100.0) and offered bribes while on the field (OR 3; 95% C1: 1.02» 4.8) have higher kvel enforcement performance. Attention must be given to the enforcement organization with respect to duration of service, service awards and monitoring of bribes exposure to help develop the enforcement of public health legislations.
Introduction : Limited access to health services, variations in quality of health care and pressure to contain escalation of health care cost are problems in health care systems that are faced by all the societies in the world especially in developing countries. There is an urgent need to conduct a study to assess perception of individual towards health care services in the new planned National Healthcare Financing Scheme.
Objective : The study objective is to examine the perception towards health care services among the farming community and to assess the willingness to contribute to The New National Health Financing Scheme.
Methods : A cross sectional study involving farmers in the state of Selangor in Peninsular Malaysia was conducted. A total of 400 farmers as the household head were selected using multistage random sampling method.
Results : The respondents’ mean score of perception towards public healthcare services were higher than the respondents’ mean score of perceptions towards private healthcare services except for accessibility and convenience aspects. There was no association between willingness to contribute to The New National Healthcare Financing Scheme and perception towards public healthcare services but there was association between willingness to contribute to The New National Healthcare Financing Scheme and perception towards private healthcare services.
Conclusion : Perception towards healthcare services is an important element in the implementation of The New National Healthcare Financing Scheme as it will determine the willingness of an individual to contribute to it.
A cost-utility analysis was performed desferrioxamine treatment in thalctssaemia patients at two tertiary hospitals in Malaysia in 2004. A hundred and twelve transfusion dependent thalassaemia patients were grouped according to the status of desferrioxamine; optimum and sulwptimum. Cost analysis was from a patient and hospital perspectives while Quality Adjusted Life Years (QALYs) was the health outcome of choice. Incremental Cost·Effectiveness Ratio (ICER) was also stipulated to show the difference in cost for an additional QALY if patient currently on suboptimum desferrioxamine to switch using optimum desferrioxamine. Results on cost analysis showed the mean cost of treatment for thalassaemia patients on optimum desferrioxamirie was higher than those on sub·optimum desferrioxamine; (RM14, 775.00+SDRM4,737.00 and RM10,780+RM3,655, respectively). QALYs were 19.186+6.591 and 9.859+5275 in the optimum and suboptirnum group, respectively. Costutility analysis showed the cost per QALYs in optimum desferrioxamine group was RM59,045.00 compared to RM44,665.00 in suboptimum desferrioxamine group. ICER of patients on sub-optimum desferrioxamine switching to optimum desferrioxarnine was only RM420.39. Sensitivity analysis showed that the results were robust in the best and worst scenarios. In conclusion, although it is expensive for thalassaemia patients to use optimum desferrioxamine compared to sub-optimum desferrioxamine, the cost per QALYs gained was undoubtedly low.
Background: A randomised clinical trial was carried out to study the cost-effectiveness of continuous venovenous hemofiltration using high volume and standard volume.
Methods: Study was done through interviews involving patients or their relatives and document review on patients’ treatment and progress note during the hemofiltration therapy in the Intensive Care Unit, Hospital University Kebangsaan Malaysia. Study also involved secondary data analysis and a structured questionnaire survey to assess the treatment and medical cost incurred by the hospital during the continuous venovenous hemofiltration therapy.
Results: The result of this study showed that the continuous venovenous hemofiltration given at high volume 4-6 litres/hour is more cost effective than standard volume of 2 litres/hour. The Sequential Organ Failure Assessment (SOFA) score reduction in the high volume hemofiltration is 3.0 units over 24 hours. This reduction is higher than the standard volume hemofiltration which is only 0.5 unit over 24 hours.
Conclusions: High volume hemofiltration is more cost effective than standard volume therapy, where only RM 5,552 compared to RM 23,512 is needed for every one unit of SOFA score reduction respectively.
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.
Background: A randomised single blinded clinical trial comparing the effectiveness of two methods of cataract surgery with intraocular lens implantation: extracapsular cataract extraction (ECCE) and phacoemulsification (PEA) was carried out at Hospital Universiti Kebangsaan Malaysia (HUKM) between March 2000 and August 2001. Methods: The effectiveness of cataract surgery was assessed from the quality of life specifically for vision via Visual Function 14 (VF-14) preoperatively, one week, two months and six months after surgery. Results: The result showed that there was a significant increased in VF-14 scores after a week, two months and six months postoperation compared to the score before surgery for both techniques. However there was no significant difference in VF-14 scores when compared between ECCE and PEA. Conclusions: This study indicated that both techniques give equal benefit to cataract patients. Since effectiveness of cataract surgery with intraocular lens implantation is unrelated to operative procedures, less costly technique should be promoted.