1.Socioeconomic Status Affecting Inequity of Healthcare Utilisation in Malaysia
Nurul Salwana Abu Bakar ; Adilius Manual ; Jabrullah Ab Hamid
Malaysian Journal of Medical Sciences 2019;26(4):79-85
Background: Equity is one of the important aspects of universal health coverage. Variation
in socioeconomic status (SES) has been proved to contribute discrepancies in the use of healthcare
services. This study aimed to assess equity for inpatient, outpatient and dental care utilisation by
household SES over time.
Methods: This study used five series of National Health and Morbidity Survey data from
1986 to 2015. Healthcare utilisation for inpatient, outpatient and dental care were analysed. SES
was grouped based on household expenditure variables accounting for total number of adults and
children in the household using consumption per adult equivalents approach. The determination
of healthcare utilisation across the SES segments was measured using concentration index.
Results: The overall distribution of inpatient utilisation tended towards the pro-poor,
although only data from 1996 (P-value = 0.017) and 2006 (P-value = 0.021) were statistically
significant (P < 0.05). Out-patient care showed changing trends from initially being pro-rich in
1986 (P < 0.05), then gradually switching to pro-poor in 2015 (P < 0.05). Dental care utilisation
was significantly pro-rich throughout the survey period (P < 0.05). Public providers mostly showed
significantly pro-poor trends for both in- and out-patient care (P < 0.05). Private providers,
meanwhile, constantly showed a significantly pro-rich (P < 0.05) trend of utilisation.
Conclusion: Total health utilisation was close to being equal across SES throughout the
years. However, this overall effect exhibited inequities as the effect of pro-rich utilisation in the
private sector negated the pro-poor utilisation in the public sector. Strategies to improve equity
should be consistent by increasing accessibility to the private sectors, which has been primarily
dominated by the richest population.