Health, Education and Welfare

Bakri Mat (Universiti Utara Malaysia (UUM)) · Ku Nurasyiqin Ku Amir (Universiti Utara Malaysia (UUM)) ·International Journal of Supply Chain Management ·2019

Food security is one of the non-traditional security components that forms the basic needs of a nation, households, and individuals. Any problem in food supply or disruption in any of the four key elements of food security will threaten security and well-being of the citizens. In Malaysia, although food availability is ensured through via local production and imports at national level, accessibility and utilization are not yet fulfilled as certain groups and households are still unable to access and utilise adequate food accordingly. Therefore, this research attempts to examine the socioeconomic factors that may contribute towards food insecurity among Malaysian households within communities in Malaysia-Thailand border using human security approach. This study is conducted using qualitative research method to collect and analyse both primary and secondary data. Primary data was obtained through official documents and an in-depth interview with key informants among Malaysian households of the communities near Malaysia-Thailand border, local leaders and academicians. Meanwhile, the secondary source of data was obtained from published materials and online documents such as books, journal articles and reports. The findings indicate that socioeconomic factors were pertinent in contributing towards food insecurity among the households in form of household income, insufficient assistance program, and high living costs. These factors form the main foundation in ensuring the sanctity and wellbeing of the households. In designing state policies, the socioeconomic issues should be prioritized as in ensuring human security of the vulnerable groups, specifically the B40 households. In addition, continuous effort in developing societal empowerment and resilience are vital to achieve citizen wellbeing.

Harriman Samuel Saragih · Peter Jonathan ·Journal of Asia Business Studies ·2019

Purpose Indonesians are known for their unique behaviour and willingness to travel abroad for healthcare treatments. More than half of the healthcare “tourists” who travel to Malaysia come from Indonesia, followed in numbers by those in India, Japan, and China, Libya, the UK, Australia, USA, Bangladesh and the Philippines. Malaysia is also geographically located near two Indonesian main islands, i.e. North Sumatera and North Kalimantan. These reasons contribute to making Indonesia one of the most productive healthcare consumers in Malaysia. This study aims to examine these Indonesian consumers’ through the use of behavioural lenses to examine their medical tourism experiences in Malaysia, its neighbouring country. Design/methodology/approach The theory of planned behaviour is used as the basis of these analyses and hypotheses development. In total, 7 variables and 18 indicators that built both the exogenous and endogenous variables were developed from previous literature. Through a purposive sampling technique, the authors collected 200 samples of individuals where each respondent must at least have been to Malaysia once for medical treatments related to a general check-up, cardiovascular, cancer, orthopaedics, nervous systems or dental problems. A partial least squares – structural equation modelling analysis was carried out to examine both the measurement model and the structural model. Findings Behavioural belief positively affects the attitude of Indonesian patients and their intentions to visit Malaysia for medical treatment, i.e. attitude, subjective norms and perceived behavioural control. Results show that as individuals, Indonesians have a strong belief that undergoing medical treatment in Malaysia will be more favourable than having that same medical treatment in Indonesia. The study also shows that people who are considered important to patients, e.g. family members or relatives, significantly influence their intention to visit Malaysian medical institutions. The authors also found that patients’ resources and capabilities – e.g. financial strength, supporting infrastructures and time availability – are essential factors for Indonesian patients to choose medical tourism and to visit Malaysia as their venue for medical services. Research limitations/implications The results of this study are consistent with the previous research, which has shown that attitude, subjective norms and perceived behavioural control positively affect visit intention. The results also suggest new interesting theoretical findings that Indonesia’s medical tourist intention to visit Malaysia is most strongly caused by subjective norms followed by individual attitudes and perceived behavioural control, all reasons that are identical to Japanese medical tourists’ visiting South Korea for similar purposes. Indeed, there are similar behavioural practices and beliefs among both Indonesian and Japanese medical tourists, despite the gap existing in these two countries’ economies. Practical implications The study proposes two managerial implications using its findings. First, this study can be a basis for the Malaysian medical tourism business to better understand Indonesian medical tourists’ behaviour when visiting their country. The study explicitly suggests that it is both collective and individual beliefs that drive Indonesian patients, who have the sufficient resources, to visit Malaysia because of better quality and affordability available there compared to Indonesian medical services. Second, this study raises a fundamental question about Indonesian stakeholders in the medical industry. In the near future, this type of medical tourism behaviour will, without a doubt, affect the Indonesian economy at large. Originality/value The contributions of this study are twofold. First, compared to previous studies that focussed specifically on the developed countries, this study focusses on Indonesian consumers’ point of view as an emerging country towards Malaysia’s medical tourism business. Second, this study provides quantifiable insights on the Indonesia-Malaysia medical tourism phenomenon, which previously has been frequently discussed, but only using a qualitative exploratory approach.

Lindsey Hiebert · Robert Hecht · ShanSoe-Lin · Rosmawati Mohamed · Fatiha H. Shabaruddin · Syed Mukhtar Syed Mansor · Maznah Dahlui MD, MPH · Amirah Azzeri · Scott A. McDonald ·Value in Health Regional Issues ·2019

Background In Malaysia, more than 330 000 individuals are estimated to be chronically infected with hepatitis C virus (HCV), but less than 2% have been treated to date. Objectives To estimate the required coverage and costs of a national screening strategy to inform the launch of an HCV elimination program. Methods We designed an HCV screening strategy based on a “stepwise” approach. This approach relied on targeting of people who inject drugs in the early years, with delayed onset of widespread general population screening. Annual coverage requirements and associated costs were estimated to ensure that the World Health Organization elimination treatment targets were met. Results In total, 6 million individuals would have to be screened between 2018 and 2030. Targeting of people who inject drugs in the early years would limit annual screening coverage to less than 1 million individuals from 2018 to 2026. General population screening would have to be launched by 2026. Total costs were estimated at MYR 222 million ($58 million). Proportional to coverage targets, 60% of program costs would fall from 2026 to 2030. Conclusions This exercise was one of the first attempts to conduct a detailed analysis of the required screening coverage and costs of a national HCV elimination strategy. These findings suggest that the stepwise approach could delay the onset of general population screening by more than 5 years after the program's launch. This delay would allow additional time to mobilize investments required for a successful general population screening program and also minimize program costs. This strategy prototype could inform the design of effective screening strategies in other countries.

C. S. Tan · M. A. Hassali · C. F. Neoh · F. Saleem · Rob Horne ·Value in Health Regional Issues ·2018

Background Low rate of adherence was found strongly associated with patients’ beliefs across the studies about chronic diseases with hypertension. A crucial move is needed to bridge the gap between appropriate assessment tools and local hypertensive patients’ medication adherence. Objective To produce a translated version in Malay language of Beliefs about Medicines Questionnaire (BMQ) that was “conceptually equivalent” to the original English version for use in local clinical practice and research. Methods The forward translation process was conducted by two independent professional translators and back translation was done by two other independent translators. A reliability analysis was conducted on 238 conveniently selected hypertensive patients. Intraclass correlation coefficient (ICC) was used to assess test-retest reliability for the randomly selected 40 patients in a period of 2 weeks. Discriminant validity was tested through Necessity-Concerns differential, BMQ subscales, and other parameters. Results The overall Cronbach alpha for the internal consistency was good (0.860). The subscales of the BMQ demonstrated adequate internal consistency, with Cronbach alpha value of 0.759 for Specific-Necessity, 0.762 for Specific Concern, 0.624 for General-Overuse, and 0.756 for General-Harm. The ICC was excellent (0.922). Discriminant validity revealed that BMQ Specific-Necessity score was significantly inversely correlated with the systolic blood pressure level. Systolic and diastolic blood pressure levels (P = 0.038; P = 0.05) were reported to be significantly correlated with the Necessity-Concerns differential, with Necessity score equal or exceeding Concerns score. Conclusions The Malay-translated version of BMQ is a reliable and valid tool to assess patient belief about medication, especially medication adherence among the hypertensive patients in Malaysia.

Syed Shahzad Hasan · Chia Siang Kow · Dalia Dawoud · Omneya Mohamed · Darrin Baines · Zaheer-Ud-Din Babar ·Value in Health Regional Issues ·2018

Medicine price directly affects affordability and access to medicines particularly in countries where a major portion of pharmaceutical spending is through out-of-pocket payment, such as in the Asia Pacific region. We have undertaken a detailed appraisal of the pharmaceutical policy reforms to regulate drug prices in 3 developed (Australia, New Zealand, and South Korea) and 3 emerging (China, India, and Malaysia) economies of the Asia Pacific region. Despite continuous efforts by the authorities in adopting a wide range of reformatory pharmaceutical pricing policies to ensure affordability of medicines, these policies may not be optimal where drug prices were not lowered as expected (eg, in Korea). On the contrary, considerable price reductions of various pharmaceuticals have been observed in New Zealand and India because of the reform in pharmaceutical pricing policy. This review of pharmaceutical pricing reforms reinforces the need for constant monitoring by policy makers in Asia Pacific countries to regulate drug prices and to undertake reform in pharmaceutical pricing policies when necessary to ensure affordability and access to medicines.

Scott A. McDonald · Amirah Azzeri (University of Malaya · Fatiha Hana Shabaruddin · Maznah Dahlui · Soek S. Tan · Adeeba Kamarulzaman · Rosmawati Mohamed ·Applied Health Economics and Health Policy ·2018

Introduction The World Health Organisation (WHO) has set ambitious goals to reduce the global disease burden associated with, and eventually eliminate, viral hepatitis. Objective To assist with achieving these goals and to inform the development of a national strategic plan for Malaysia, we estimated the long-term burden incurred by the care and management of patients with chronic hepatitis C virus (HCV) infection. We compared cumulative healthcare costs and disease burden under different treatment cascade scenarios. Methods We attached direct costs for the management/care of chronically HCV-infected patients to a previously developed clinical disease progression model. Under assumptions regarding disease stage-specific proportions of model-predicted HCV patients within care, annual numbers of patients initiated on antiviral treatment and distribution of treatments over stage, we projected the healthcare costs and disease burden [in disability-adjusted life-years (DALY)] in 2018–2040 under four treatment scenarios: (A) no treatment/baseline; (B) pre-2018 standard of care (pegylated interferon/ribavirin); (C) gradual scale-up in direct-acting antiviral (DAA) treatment uptake that does not meet the WHO 2030 treatment uptake target; (D) scale-up in DAA treatment uptake that meets the WHO 2030 target. Results Scenario D, while achieving the WHO 2030 target and averting 253,500 DALYs compared with the pre-2018 standard of care B, incurred the highest direct patient costs over the period 2018–2030: US$890 million (95% uncertainty interval 653–1271). When including screening programme costs, the total cost was estimated at US$952 million, which was 12% higher than the estimated total cost of scenario C. Conclusions The scale-up to meet the WHO 2030 target may be achievable with appropriately high governmental commitment to the expansion of HCV screening to bring sufficient undiagnosed chronically infected patients into the treatment pathway.