Mahmud Aidalina, Aljunid Syed Mohamed
International Centre for Casemix and Clinical Coding, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Department of Health Policy & Management, Faculty of Public Health, Health Science Centre, Kuwait University, Kuwait.
PLoS One. 2018 Feb 1;13(2):e0191764. doi: 10.1371/journal.pone.0191764. eCollection 2018.
Access to healthcare is essential in the pursuit of universal health coverage. Components of access are availability, accessibility (spatial and non-spatial), affordability and acceptability. Measuring spatial accessibility is common approach to evaluating access to health care. This study aimed to determine the availability and spatial accessibility of subsidised mammogram screening in Peninsular Malaysia. Availability was determined from the number and distribution of facilities. Spatial accessibility was determined using the travel impedance approach to represent the revealed access as opposed to potential access measured by other spatial measurement methods. The driving distance of return trips from the respondent's residence to the facilities was determined using a mapping application. The travel expenditure was estimated by multiplying the total travel distance by a standardised travel allowance rate, plus parking fees. Respondents in this study were 344 breast cancer patients who received treatment at 4 referral hospitals between 2015 and 2016. In terms of availability, there were at least 6 major entities which provided subsidised mammogram programs. Facilities with mammogram involved with these programs were located more densely in the central and west coast region of the Peninsula. The ratio of mammogram facility to the target population of women aged 40-74 years ranged between 1: 10,000 and 1:80,000. In terms of accessibility, of the 3.6% of the respondents had undergone mammogram screening, their mean travel distance was 53.4 km (SD = 34.5, range 8-112 km) and the mean travel expenditure was RM 38.97 (SD = 24.00, range RM7.60-78.40). Among those who did not go for mammogram screening, the estimated travel distance and expenditure had a skewed distribution with median travel distance of 22.0 km (IQR 12.0, 42.0, range 2.0-340.0) and the median travel cost of RM 17.40 (IQR 10.40, 30.00, range 3.40-240.00). Higher travel impedance was noted among those who lived in sub-urban and rural areas. In summary, availability of mammogram facilities was good in the central and west coast of the peninsula. The overall provider-to-population ratio was lower than recommended. Based on the travel impedance approach used, accessibility to subsidised mammogram screening among the respondents was good in urban areas but deprived in other areas. This study was a preliminary study with limitations. Nonetheless, the evidence suggests that actions have to be taken to improve the accessibility to opportunistic mammogram screening in Malaysia in pursuit of universal health coverage.
获得医疗保健服务对于实现全民健康覆盖至关重要。获得医疗保健服务的要素包括可及性、可达性（空间和非空间方面）、可负担性和可接受性。衡量空间可达性是评估医疗保健服务可及性的常用方法。本研究旨在确定马来西亚半岛补贴性乳房X光筛查的可及性和空间可达性。可及性通过设施的数量和分布来确定。空间可达性采用出行阻抗法确定，以表示实际获得的服务，而非其他空间测量方法所衡量的潜在可及性。使用地图应用程序确定受访者住所到设施的往返驾车距离。出行费用通过将总出行距离乘以标准化出行补贴率再加上停车费用来估算。本研究的受访者为2015年至2016年期间在4家转诊医院接受治疗的344名乳腺癌患者。在可及性方面，至少有6个主要机构提供补贴性乳房X光检查项目。参与这些项目的配备乳房X光检查设备的设施在半岛中部和西海岸地区分布更为密集。乳房X光检查设施与40 - 74岁女性目标人群的比例在1:10000至1:80000之间。在可达性方面，3.6%的受访者接受过乳房X光筛查，他们的平均出行距离为53.4公里（标准差 = 34.5，范围8 - 112公里），平均出行费用为38.97马来西亚林吉特（标准差 = 24.00，范围7.60 - 78.40马来西亚林吉特）。在未进行乳房X光筛查的人群中，估计的出行距离和费用分布呈偏态，出行距离中位数为22.0公里（四分位距12.0，42.0，范围2.0 - 340.0），出行费用中位数为17.40马来西亚林吉特（四分位距10.40，30.00，范围3.40 - 240.00）。居住在郊区和农村地区的人群出行阻抗更高。总之，半岛中部和西海岸的乳房X光检查设施可及性良好。总体医疗服务提供者与人口的比例低于推荐水平。基于所采用的出行阻抗法，受访者中补贴性乳房X光筛查在城市地区的可达性良好，但在其他地区则较差。本研究是一项存在局限性的初步研究。尽管如此，证据表明为了实现全民健康覆盖，必须采取行动改善马来西亚机会性乳房X光筛查的可达性。
