Household Catastrophic Health Expenditure From Oral Potentially Malignant Disorders And Oral Cancer In Public Healthcare Of Malaysia

Oral cancer causes a significant disease burden and financial distress, especially among disadvantaged groups. While Malaysia has achieved universal health coverage via its highly subsidized public healthcare, household expenditure for treatment of oral potentially malignant disorders (OPMD) and oral cancer remains a concern in the equitability of care. This study aims to estimate the extent of catastrophic healthcare expenditure (CHE) while identifying its cost drivers. This three-part study consists of a prospective cross-sectional survey to collect health utilization data of patients, a retrospective medical record abstraction to identify resources consumed, and cost estimation modeling in two tertiary public hospitals. Out-of-pocket (OOP) payments for transport, care in public healthcare facilities, and other healthcare expenditures were tallied. CHE was defined as OOP spendings of more than 10% from total annual household income. Multivariate binary logistic regression was further applied to identify the association between sociodemographic factors and CHE. A total of 104 patients were surveyed and their medical records abstracted. A Kruskal-Wallis test showed a statistically significant difference in OOP share over household income between OPMD, early- and late-stage oral cancer, χ2(2)=51.05, p<0.001, with the mean percentage of 9%, 22%, and 65% respectively. This study found that the prevalence of CHE in the first year of diagnosis was staggering at 86.5% for oral cancer and 19.2% for OPMD. Race (Indian) (OR=7.4, p=0.035) and active employment (OR=0.07, p=0.035) were shown as significant predictors for CHE. Our study demonstrated the provision of current subsidies may not be adequate to shield the more vulnerable group from CHE.

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