METHODS: This qualitative study examined the experiences of cancer patients with the CCTI program in Malaysia. Semi-structured interviews were conducted with 23 respondents, both CCTI recipients and non-applicants, from eight public hospitals. Data were anlaysed using the RE-AIM framework, focusing on the dimensions of reach, adoption, and implementation.
RESULTS: Patients' awareness of the CCTI varied, with recipients mostly informed through acquaintances, media, or healthcare providers. Non-recipients lacked awareness, with limited information provided by healthcare personnel. While the CCTI was perceived as valuable for alleviating financial burdens, particularly transportation costs, it did not appear to significantly influence treatment-seeking behaviours, as most patients expressed willingness to continue treatment even without financial aid. Implementation challenges included a burdensome application process requiring mandatory health screening, lack of clarity regarding procedures, and inadequate communication about claim approvals. Patients frequently encountered delays and confusion, exacerbated by insufficient support from healthcare providers. Additionally, many were unaware that transport incentives could be claimed for every hospital visit, further limiting the program's usefulness.
CONCLUSIONS: The study highlights critical gaps in the CCTI program's design and delivery, including inadequate communication strategies, complex administrative processes, and a lack of transparency. Addressing these challenges are essential to improve program reach and ensuring equitable access to CCTI. Policymakers should prioritise streamlining application process, enhancing information dissemination, and leveraging digital tools to improve patient experiences. Future studies should assess the program's long-term sustainability and impact on treatment adherence and outcomes. The findings underscore the importance of adopting patient-centred approaches in designing financial aid programs to enhance healthcare equity and access.
METHODS: A cross-sectional study was employed involving 239 ambulances from selected hospitals and clinics. Ambulance service utilization was based on the number of trips, distance and duration of travel obtained from travel logbooks. A mixed top-down and activity-based costing approach was used to estimate the monthly cost of ambulance services. This constituted personnel, maintenance, fuel, overhead, consumables, ambulance, and medical equipment costs. The utilization and costs of ambulance services were further compared between settings and geographical locations.
RESULTS: The average total cost of ambulance services was MYR 11,410.44 (US$ 2,756.14) for hospitals and MYR 9,574.39 (US$ 2,312.65) for clinics, albeit not significantly different. Personnel cost was found to be the main contributor to the total cost, at around 44% and 42% in hospitals and clinics, respectively. There was however a significant difference in the total cost in terms of the type and age of ambulances, in addition to their location. In terms of service utilization, the median number of trips and duration of ambulance usage was significantly higher in clinics (31.88 trips and 58.58 hours) compared to hospitals (16.25 trips and 39.25 hours).
CONCLUSIONS: The total cost of ambulance services was higher in hospitals compared to clinics, while its utilization showed a converse trend. The current findings evidence that despite the ambulance services being all under the MOH, their operating process and utilization reflected an inherent difference by setting.