Trends and Determinants of Catastrophic Health Expenditure among Low-income Group (B40) in Malaysia (2014-2019)

Abstract

Background Malaysia has performed strongly in protecting its population against severe financial risk from out-of-pocket (OOP) or catastrophic health expenditure (CHE). As the country leaps forward towards the status of a developed status nation, income inequality may exacerbate incidence of financial hardship among the B40 or the poorest 40% of the population. Our objectives are therefore to analyze the incidence of CHE in the past 5 years addressing potential determinants among the B40 population using normative spending method. Methods We analyzed data from the last three rounds of the Household Income and Expenditure Surveys conducted in 2014, 2016 and 2019. To identify CHE, the approach we adopted was normative spending on food, housing, and utilities (capacity-to-pay or CTP method), at the 40% threshold and compared this with the budget share method. Descriptive and logistics regression analyses were carried out using Stata. Results The two approaches produced diverging estimates with the household CTP approach showing significant increasing trend of CHE between 2014 and 2019, while the budget share method showed a much lower increase (1.78% versus 5.48%). Pharmaceuticals/medicines represented the highest mean monthly spending. Almost all factors in the final model are significant including spatial (state and rural status) and socio-demographic factors. For the socio-demographic profiles of head of household, higher likelihoods of CHE were observed among the non-Chinese, 35–54 and 55–64 age categories, lowest education level and among female and with divorced/widowed head of households. Larger households and older adults-only households have the largest odds ratio of CHE. Conclusions Although Malaysia has achieved improved financial protection for its population, greater attention to the poorest households is still needed. Higher estimations of CHE were found using the CTP approach. Therefore, it is important to consider the significant determinants of both spatial and sociodemographic characteristics found in this study when strengthening financial risk protection against CHE among Malaysia's B40.