Abd Gani Siti Mariam, Thangiah Nithiah, Aiga Hirotsugu
School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan.
Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia.
Health Policy Plan. 2025 Aug 18;40(7):737-752. doi: 10.1093/heapol/czaf034.
Households with ill members often face financial hardship when seeking healthcare. Households mobilize their resources from various sources to pay for treatment costs. Financially, some households resort to borrowing money and selling their assets. This type of financial coping strategy is called distress financing (DF). This study aims to estimate the prevalence and determinants of DF among households with hospitalized members at University Malaya Medical Centre, Malaysia. It further explores the dynamics of DF and its impact on households' welfare by employing a convergent mixed-method approach. Quantitative data were collected using a structured interview. Households having reported to either borrow money, sell their assets, and/or withdraw from an employee provident fund were categorized as those suffering DF. To explore how households coped with high medical expenses and the consequences of DF, seven households adopting more than one DF strategy were purposively selected for in-depth interview. Of 199 households, 22 (11.1%) reported undergoing DF. Psychological distress, medical indebtedness, and poverty were typical consequences of DF. During hardship, the social network played a principal role in alleviating the financial burden, further emphasizing the importance of kinship. Households undergoing catastrophic health expenditure, headed by Chinese ethnicity, living in states other than Selangor, and living in a rental house were 8.2, 4.6, 4.4, and 3.5 times more likely to undergo DF, respectively. Targeted assistance in removing financial barriers would assure the continuum of care among households possibly suffering DF, thereby improving their health outcomes.
家庭成员患病的家庭在寻求医疗保健时往往面临经济困难。家庭会从各种渠道筹集资源来支付治疗费用。在经济方面，一些家庭会借钱和变卖资产。这种财务应对策略被称为困境融资（DF）。本研究旨在估计马来西亚马来亚大学医学中心住院患者家庭中困境融资的患病率及其决定因素。它还通过采用收敛性混合方法进一步探讨困境融资的动态及其对家庭福利的影响。定量数据通过结构化访谈收集。报告有借钱、变卖资产和/或从员工公积金中提款行为的家庭被归类为遭受困境融资的家庭。为了探究家庭如何应对高额医疗费用以及困境融资的后果，有目的地选择了七户采用多种困境融资策略的家庭进行深入访谈。在199户家庭中，有22户（11.1%）报告经历了困境融资。心理困扰、医疗债务和贫困是困境融资的典型后果。在困难时期，社会网络在减轻经济负担方面发挥了主要作用，进一步凸显了亲属关系的重要性。经历灾难性医疗支出的家庭、华裔家庭、居住在雪兰莪州以外地区的家庭以及租房居住的家庭经历困境融资的可能性分别高出8.2倍、4.6倍、4.4倍和3.5倍。消除财务障碍的有针对性援助将确保可能遭受困境融资的家庭能够持续获得医疗服务，从而改善他们的健康状况。
