Determinants of distress financing for healthcare service utilization: a convergent mixed-method study at a tertiary hospital in Malaysia.

Abstract

Households with ill members often face financial hardship during healthcare seeking. 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 strategies 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 convergent mixed method approach. Quantitative data were collected using structured interview. Households having reported to either borrow money, sell their assets and/or withdraw 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 to underwent DF. Psychological distress, medical indebtedness and poverty were typical consequences of DF. During hardship, social network played a principal role in alleviating financial burden, further emphasizing the importance of kinship. Households undergoing catastrophic health expenditure, headed by Chinese ethnicity, living in other states, and living in 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 the households possibly suffering DF, thereby improve their health outcomes.