Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
PLoS One. 2022 Feb 25;17(2):e0264422. doi: 10.1371/journal.pone.0264422. eCollection 2022.
The Sustainable Development Goal 3.8.2 is an indicator to track a country's progress toward universal health coverage on the financial protection against catastrophic health expenditure (CHE). The purpose of this study is to determine the proportion of households with catastrophic health expenditure, and its associated factors among Malaysian households. A secondary data analysis was performed using the Household Expenditure Survey 2015/2016. The inclusion criterion was Malaysian households with some health spending in the past 12 months before the date of the survey. Catastrophic health expenditure was defined as out-of-pocket health expenditures exceeding 10% of the total household consumption. The study included a total of 13015 households. The proportion of households with CHE in the sample was 2.8%. Female-led households (AdjOR 1.6; CI 1.25, 2.03; p-value <0.001), households in rural areas (AdjOR 1.29; 95% CI 1.04, 1.61; p-value = 0.022), small household size (AdjOR 2.4; 95% CI 1.81, 3.18; p-value <0.001) and heads of household under 60 years old (AdjOR2.34; 95% CI 1.81, 3.18; p-value <0.001) were significantly associated with CHE. Although the proportion of Malaysian households affected by CHE is small, it is increasing in comparison to previous findings. This is concerning because it may jeopardise efforts to achieve universal health coverage by 2030. To ensure financial protection and access to care, a health financing policy that includes safety net measures for households at risk of CHE is required.
可持续发展目标 3.8.2 是一个指标，用于跟踪一个国家在财务上实现全民健康覆盖以防范灾难性卫生支出（CHE）的进展情况。本研究的目的是确定马来西亚家庭中灾难性卫生支出的比例及其相关因素。使用 2015/2016 年家庭支出调查进行了二次数据分析。纳入标准是在调查日期前的 12 个月内有一些卫生支出的马来西亚家庭。灾难性卫生支出被定义为自付卫生支出超过家庭总消费的 10%。本研究共纳入了 13015 户家庭。样本中 CHE 家庭的比例为 2.8%。女性主导的家庭（调整后的优势比 1.6；95%置信区间 1.25，2.03；p 值<0.001）、农村地区的家庭（调整后的优势比 1.29；95%置信区间 1.04，1.61；p 值=0.022）、家庭规模较小（调整后的优势比 2.4；95%置信区间 1.81，3.18；p 值<0.001）和户主年龄在 60 岁以下（调整后的优势比 2.34；95%置信区间 1.81，3.18；p 值<0.001）与 CHE 显著相关。尽管受 CHE 影响的马来西亚家庭比例较小，但与之前的发现相比，这一比例呈上升趋势。这令人担忧，因为这可能会危及到到 2030 年实现全民健康覆盖的努力。为了确保财务保护和获得医疗服务，需要制定一项包括为面临 CHE 风险的家庭提供安全网措施的卫生融资政策。
