Date of Award

1-13-2025

Thesis Type

PhD

Document Type

Thesis

Divisions

Faculty of Medicine

Department

Department of Social and Preventive Medicine

Institution

Universiti Malaya

Abstract

Private health insurance (PHI) has emerged as an alternative health financing option to public health financing, with the goal of achieving and maintaining universal health coverage. Despite its growing prominence, there is ongoing debate about the extent to which PHI contributes to financial risk protection. In Malaysia, the prevalence of PHI coverage has increased due to factors such as an expanding affluent demographic, government encouragement, and challenges in public healthcare delivery. However, there have been very limited studies assessing the financial risk protection provided by PHI in Malaysia, making this a critical gap that this research aims to address. To evaluate the financial risk protection provided by PHI, three research objectives were established, each contributing distinct insights that enrich the overall conclusions. Firstly, a case study approach was employed to analyse the impact of PHI development on financial risk protection through document analysis and key informant interviews. The analysis, structured around the framework of Public Policy, Demand, Market Structure, Market Conduct, and Performance, revealed mixed effects of PHI development, with some aspects enhancing and others undermining financial risk protection. Secondly, a qualitative exploration of barriers and facilitators towards financial risk protection provided by PHI among insured patients and healthcare providers was performed using reflexive thematic analysis. As end-users, their lived experiences provided valuable insights into policy effectiveness and market consequences towards financial risk protection. Four major themes generated, namely PHI Coverage, Insurance Claim Management, Health Insurance Literacy, and Role of Insurance Agents, highlighting a range of perspectives with both appreciation for certain aspects and critiques that underscored the need for improvement. Among the themes, the level of health insurance literacy and how well insurance agents perform in their role can influence the other two themes. Thirdly, the National Health and Morbidity Survey 2019 was used for a quantitative assessment employing instrumental variable analysis examining the independent effect of PHI on financial risk protection. Out-of-pocket (OOP) expenditures and the occurrence of catastrophic health expenditure (CHE) from inpatient hospitalisation serve as outcome variables. The findings revealed that having PHI was associated with increased OOP inpatient medical expenditure and a higher likelihood of experiencing CHE. This research unveiled potential shortcomings of PHI in providing adequate financial risk protection to the insured population in Malaysia, despite considerable efforts directed towards strengthening its level and enhancing consumer protection over the years. It is essential for policymakers and industry stakeholders to discern positive contributions, address critiques, and act promptly on areas requiring improvement. As Malaysia embarks on health system reform outlined in the Health White Paper, it is critical to assess whether PHI has achieved its intended objectives and, more importantly, what role it should assume in the evolving healthcare landscape. To provide a more accurate and robust assessment of the relationship between PHI and financial risk protection, future studies should capture more detailed information about PHI policies, specifically regarding the coverage amounts and benefit design, as well as the health insurance literacy level.

Initial

khm

Additional Information

Thesis (PhD) – Faculty of Medicine, Universiti Malaya, 2025.

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