Health Care Quality, Access, and Evaluation, Insurance, Health
Conditions
Brief summary
This is the Phase 3 of a 3 phase study to determine the feasibility, acceptability and effectiveness of a health microinsurance scheme in improving health equity and clinical outcomes for private primary care (PPC) in Kuala Lumpur, Malaysia. This two-arm, pre-post, quasi-experimental trial consisted of utilizing a HMI scheme (experimental clinic) and normal OOP payments (control clinic) for 6 months. The HMI scheme enabled subscribed households to access a defined benefit package at a selected PPC for treatment and follow-up.
Detailed description
This will be a quasi-experimental study designed to determine the effectiveness of a community health microinsurance scheme (HMI) in private primary care clinics in Malaysia via a pre-post study of an experimental and control clinic. A proposed HMI scheme, whose price and benefit package have been defined through the earlier Phases 1 and 2, will be accessible to subscribed households at the experimental clinic, while the control clinic has subscribed patients paying as per normal practise, which is by Out-Of-Pocket payment. The HMI scheme enabled subscribers to visit the selected clinic chosen for any form of primary care diagnosis, treatment and follow-up. Both the clinics are located in the Jalan Ipoh area, a suburb of Kuala Lumpur, and have common sociodemographic characteristics. A pre-intervention questionnaire will aim to capture health seeking behaviour, delay in seeking medical care, monthly health expenditure and improvements in clinical outcome (assessed by clinical test results). After six months, a post-intervention questionnaire is administered again to the respondents which then allows assessment of the outcome variables.
Interventions
OTHERHMI
A defined priced package of primary care services, including investigation and treatment such as procedures and medication, available at a selected clinic for 6 months
Sponsors
Chulalongkorn University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. Households were located in the study area 2. Method of payment to clinic is by out-of-pocket 3. This is household's regular choice of primary care provider. 4. Patient has been seen in the clinic since at least the past two years i.e from before Jan 1, 2014
Exclusion criteria
1. Households had members who died in the year 2014. 2. Households had members who were away from this place of residence for work/transferred for more than 1 month in 2014. 3. Households had members who had regular follow-up in public facilities for chronic disease. 4. Households with members who have switched methods of payment in the last year- (e.g newly bought insurance or retired and lost health benefits so paying OOP) 5. Patients who refuse consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Health-seeking behavior | Change from Baseline health seeking behavior at 6 months | Delays in seeking healthcare (days) |
| Monthly health expenditure | Change from Baseline Monthly Health Expenditure at 6 months | How much has been spent for monthly health expenses (in Ringgit Malaysia) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Outcome of Diabetes Mellitus | Change from Baseline HbA1c at 6 months | Measurement of HbA1c |
| Clinical Outcome of Hypertension | Change from Baseline Resting Mean Blood Pressure at 6 months | Resting mean blood pressure |
| Clinical outcome of dyslipidemia | Change from Baseline serum cholesterol and LDL at 6 months | Total serum cholesterol and LDL |
| Clinical outcome of bronchial Asthma | Change from Baseline spirometry levels at 6 months | Spirometry levels |
Contacts
Primary ContactDr Murallitharan Munisamy
Backup ContactDr Tharini Thanapalan
Outcome results
None listed