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Willingness to Pay for National Health Insurance: A Contingent Valuation Study Among Patients Visiting Public Hospitals in Melaka, Malaysia

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Abstract

Background

The Malaysian public healthcare system is tax funded, with healthcare costs highly subsidized by the Government. The current health financing is not sustainable to cover all the healthcare resources. Introducing a national health insurance (NHI), a prepayment method, would protect the population from financial hardship by reducing out-of-pocket payment, minimizing the barrier to accessing health and achieving equitable healthcare. Studies on the willingness to pay (WTP) for NHI are available in different contexts; however, little was found in Malaysia. In addition, factors affecting the WTP for NHI have been less researched in the Malaysian context.

Objective

This study investigates the WTP for NHI and factors influencing it in Melaka, Malaysia.

Method

Using the contingent valuation method, the researchers distributed a pre-tested self-administered questionnaire to 489 respondents in three leading public hospitals from 1 to 9 November 2019. Multi-stage sampling forms the selection of respondents. Respondents were presented with a hypothetical scenario on NHI and asked whether they would be willing to pay for NHI. Chi-square was used to examine the association between categorical independent variables and WTP for NHI, and binary logistic regression was applied to determine the variables with the most predictive effect towards WTP for NHI.

Results

Out of 462 usable responses, 344 respondents (74.5%) were willing to pay for NHI. The majority (51.3%) of the respondents were willing to pay 15 Malaysian Ringgit (3.70 US dollars) or more for the NHI scheme. Chi-square analysis revealed that age, marital status, education level, employment status, chronic diseases, and perception towards NHI were significantly associated with WTP for NHI. Binary regression analysis found that marital status and perception towards NHI have the most predictive effect on respondents’ WTP for NHI.

Conclusion

This study revealed that the majority of the respondents are willing to pay for NHI if implemented in Malaysia. The findings lay a foundation for implementing a future NHI framework in Malaysia and reference future health financing research.

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Acknowledgements

We would like to thank the Director General of Health Malaysia for his permission to publish this article. We would like to thank the Directors of Melaka State Health Department and Deputy Director of Pharmaceutical Services Division Melaka for their continuous support of this study. Our utmost gratitude goes to the Chief Pharmacists and staff of the Pharmacy Department of Melaka General Hospital, Alor Gajah Hospital, and Jasin Hospital for their assistance in data collection. Special thanks to Professor Robert Basaza for his kind assistance, Ms. Nadiah Rusli for providing insights into Malaysian healthcare financing, and Assoc. Prof. Dr. Nomahaza Mahadi, Mr. Kamaruddin Ahmad, and Mr. Ting Chuo Yew for the guidance and advice on statistical analysis.

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Corresponding author

Correspondence to Robin Tiow Heng Tan.

Ethics declarations

Funding

This study is self-sponsored, and the researchers did not obtain any external assistance.

Conflict of interest/competing interests

The authors declare they have no conflict of interest. The purpose of the study is solely for policy-making and improvement of the current framework.

Ethics approval

The study complied with ethical principles outlined in the Declaration of Helsinki and Malaysian Good Clinical Practice Guideline. Accordingly, it obtained approval from the Medical Research and Ethics Committee (MREC), with the approval number NMRR-19-3401-51919, and other relevant permissions before commencing research activities.

Consent to participate

Participants were given an information sheet and informed consent form before the research. The information sheet consists of research details. Participants were also informed that the research may be presented or published; however, their identity and personal information will not be revealed without their expressed consent. The respondents who agreed to participate in the study acknowledged their consent in the informed consent form.

Consent for publication

Participants of the study have been informed that the research may be presented or published, however their identity and personal information will not be revealed without their expressed consent.

Availability of data and material

The authors declare that the data supporting the findings of this study are available within the article and cited relevant references. The data of the study findings can be made available upon request.

Code availability

The researchers used IBM SPSS Statistics version 25 for data entry and analysis. The software, licensed under Universiti Teknologi Malaysia, is accessible using the university’s virtual private network and requires a student’s username and password as a security measure. Reading materials were obtained through UTM Library Online Database, in which extensive literature search is possible.

Author contributions

The study proposal, design, data analysis, interpretation, and manuscript writing were prepared by RTTH, with advice and review by SZAR. All authors were involved in the data collection. SZAR and WKWI reviewed, edited, and approved the final manuscript.

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Tan, R.T.H., Abdul Rasid, S.Z., Wan Ismail, W.K. et al. Willingness to Pay for National Health Insurance: A Contingent Valuation Study Among Patients Visiting Public Hospitals in Melaka, Malaysia. Appl Health Econ Health Policy 20, 255–267 (2022). https://doi.org/10.1007/s40258-021-00691-z

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