SUITABILITY, FEASIBILITY, ACCEPTABILITY AND EFFECTIVENESS OF A PROVIDER DRIVEN MICROINSURANCE SCHEME IN IMPROVING HEALTH EQUITY AND CLINICAL OUTCOMES FOR PRIVATE PRIMARY CARE IN KUALA LUMPUR, MALAYSIA

Abstract

Malaysia has two parallel systems of healthcare. Many Malaysians seek care in private settings, especially in private primary care clinics, largely funded by Out-of-Pocket (OOP) payments. This study assessed the feasibility, acceptability and efficacy of a health microinsurance scheme (HMI) for private primary care clinics in Kuala Lumpur. This study was set in Jalan Ipoh, Kuala Lumpur and had three phases. Phase 1 consisted of a retrospective cohort cost analysis study determining annual average patient treatment costs and focus group discussions to establish the premium price, list of offered services and rules of provision for a feasible HMI. Phase 2 evaluated the acceptability of the scheme via a cross-sectional willingness/ability to pay study. Phase 3 was a quasi-experimental study which tested the scheme's efficacy on monthly health expenditures, utilization of health services and disease outcomes among sampled households. HMI premium price was set at RM 1500.00 for a family of five, with a defined benefit package and terms of service provision. 81.8% of the potential users surveyed found this price acceptable. From the 57 households followed-up over 6 months, those in the experimental arm (with microinsurance) had an average reduction of RM217.36 (95%CI 187.84-246.70) alongside a 9.6% (95%CI 8.2-11.3) reduction in % of health expenditure as % of total household expenditure. Delay in care seeking also reduced by 1.9 days (95%CI 1.3-2.4) and an increase of 62.4% (95%CI 56.8-66.7) in choice of private primary clinic as first choice for treatment. Almost all length of disease episodes decreased significantly for surveyed acute diseases. Diabetic patients in the experimental arm had an HbA1c reduction of 1.2 (95% CI 0.9-1.5) while reductions in other chronic diseases such as nephropathy (microalbuminuria levels reduced 73.4mg/L, 95%CI 38.5-99.4); bronchial asthma (% predicted of peak expiratory flow rates improved by 9.8%, 95%CI 7.1-11.4); systolic blood pressure (reduced 29mmHg, 95%CI 26-32); and chronic renal disease (4.0% reduction in creatine as % predicted from normal, 95%CI 2.2-7.6) This study established evidence on the implementation of health microinsurance schemes in Malaysia and other LMICs. This could provide a viable solution to fill gaps in healthcare provision in LMICs and hasten the road to universal healthcare coverage (UHC).