Catastrophic Health Expenditure and its Associated Factors among Adult Cancer Patients in a Teaching Hospital in East Coast of Malaysia.

Abstract

Objective: To determine the proportion of Catastrophic Health Expenditure (CHE) and its associated factors among adult cancer patients in a teaching hospital in the East Coast of Malaysia.

Methodology: A cross-sectional study was conducted at a teaching hospital involving 209 randomly-selected adult cancer patients who were diagnosed for at least one year. Guided interviews were conducted using a questionnaire. The Budget Share method i.e. out-of-pocket (OOP) health expenses exceeding 10% of household income was used to define CHE. To prevent overestimation of CHE, non-medical spending were excluded.

Results: The study revealed that 15.3% of patients experienced CHE. Significant factors associated with CHE were ethnicity, education level, ownership of guarantee letter (GL), and employment status. Non-Malay patients had 6.63 times the odds of experiencing CHE compared to Malay patients (p-value=0.013, 95% CI: 1.49, 29.57). Patients with primary school qualification had 9.56 times the odds of experiencing CHE compared to those with tertiary education (p-value=0.005, 95% CI: 2.01,45.57). Patients without GL were 4.81 times more likely to experience CHE than those with GL (p-value=0.008, 95% CI: 1.51, 15.34). Households where the head was unemployed had 6.55 times the odds of experiencing CHE compared to those with employed heads (p-value=0.014, 95% CI: 1.46,29.35).

Conclusion: The proportion of CHE is low, nevertheless the burden of non-medical spending and indirect costs, remains concerning. Financial aid may be considered on vulnerable groups such as non-Malay patients, those with lower education levels, individuals without GL, and unemployed head of households.