PA02.03 Access to Care: Malaysia

Abstract

The Systemic Anti-Cancer Therapy (SACT) dataset collated by Public Health England reported the assessment of factors affecting 30-days mortality in national patient population. Although, the report was impressive, only 3% of lung cancer patient treated with curative intent died within 30 days of starting chemotherapy and 10% for palliative treatment. There was a vast disparity among some hospitals. This concluded that clinical decision making in can certainly impact on cancer mortality(Wallington et al., 2016). In the similar context, clinical decision making in Malaysia and the South East Asia (SEA) are hugely influenced by the affordability factor which can directly influence mortality rates. The clear evidence is seen in Globocan 2012 data. SEA despite having the lowest prevalence for all cancers combined has a highest mortality to incidences ratio when compare with countries which have universal health coverage with better access to innovative care. To understand why the clinical decision making in Malaysia or the SEA region is hugely influenced by the affordability factor we must first dive in the health-care systems in southeast Asia (SEA). There is an enormous social, economic and political diversity within and across the countries in SEA which is formed by its history, geography and position as a major trade route. All these have had contributed not only to the diverse population but also to the wide-ranging nature of its health systems which are at varying stages. This highly diverse health-care system, range from dominant tax-based financing to social insurance and high out-of-pocket payments across the regions. For example, The World Health Report 2006 estimated that the total private finance sources account for 41.8% of total health expenditure in Malaysia which is likely affect the equity of financing because private health payments might impose disproportionate financial burden on households (“WHO | The World Health Report 2006 - working together for health,” 2013). A subsequent analysis showed private health expenditure has dominant role in financing healthcare in five of the seven countries in the SEA, contributing more than 70% of the total spending on health in Laos and Cambodia. This urge for health-financing reform and there are multiple model which are considered by varies government. Among them are financial protections through payroll-financed social health insurance or tax-funded arrangements for formal employment. However, this approach still challenges the informal and the rest of the population with countries such as the Philippines and Vietnam (Tangcharoensathien et al., 2011) A reformed health-financing with universal coverage will not only decrease the Lung cancer mortality as seen in the developed countries but also hugely impact daily clinical practice and increase quality of services provided to the patients. Globocan (2012). Fact Sheets by Cancer. Retrieved October 14, 2016, from http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx Tangcharoensathien, V., Patcharanarumol, W., Ir, P., Aljunid, S. M., Mukti, A. G., Akkhavong, K., … Wagstaff, A. (2011). Healthfinancing reforms in southeast Asia: challenges in achieving universal coverage. The Lancet, 377(9768), 863873. http://doi.org/10.1016/S01406736(10)618909 Wallington, M., Saxon, E. B., Bomb, M., Smittenaar, R., Wickenden, M., McPhail, S., … Dodwell, D. (2016). 30-day mortality after systemic anticancer treatment for breast and lung cancer in England: a population-based, observational study. The Lancet Oncology, 17(9), 1203–1216. http://doi.org/10.1016/S1470-2045(16)30383-7 WHO | The World Health Report 2006 - working together for health. (2013). WHO. Access, advocacy, patient, Malaysia