Factors Influencing the use of Preventive Medical Care in Malaysia: Evidence from National Health and Morbidity Survey Data

• DOI: http://doi.org/10.1111/asej.12115
• Author: Chor Foon Tang,Yong Kang Cheah
• Date: 01 June 2017
• Published date: 01 June 2017

Factors Influencing the use of Preventive Medical

Care in Malaysia: Evidence from National Health

and Morbidity Survey Data*

Yong Kang Cheah and Chor Foon Tang

Received 6 September 2014; accepted 19 March 2017

An increase in the prevalence of modifiable health risk factors, such as diabetes,

hypertension and hypercholesterolemia, has become a serious public health issue

in developed and developing countries. It is the main contributing factor to the rise

in non-communicable diseases (NCD). The use of preventive medical care remains

the best method to prevent NCD. The objective of the present study is to examine

the factors affecting the decisions of people to use preventive medical care (e.g.

blood glucose tests, blood cholesterol tests and blood pressure test). An ordered

logit model is estimated based on a nationally representative sample. The present

study finds that income, age, education, ethnicity, employment status, health

insurance and smoking are significantly associated with the use of preventive

medical care. As a measure towards increasing the prevalence of the preventive

medical care usage, the government should pay special attention to low income

earners, the young and the elderly, the less-educated, the ethnic minorities,

employed individuals, individuals whose medical expenses are not paid by

insurance carriers, as well as smokers.

Keywords: age, education, income, insurance, preventive medical care, screening.

JEL classification codes: D01, I12, I18.

doi: 10.1111/asej.12115

I. Introduction

Non-communicable diseases (NCD), such as heart and pulmonary system diseases,

have become a serious public health concern in Malaysia (World Health

Organization, 2011). In 2010, approximately 16.05 percent of the total deaths in

government hospitals were associated with heart diseases. Moreover,the latest data

revealed that adults who had NCD were 19.6 percent more likely to die prematurely

than their counterpartswho did not have NCD. In termsof disease burden, Ischemic

*Cheah: School of Economics, Finance and Banking, College of Business, Universiti Utara

Malaysia, 06010 UUM Sintok, Kedah Darul Aman, Malaysia. Tang (corresponding author): Centre

for Policy Research and International Studies, Universiti Sains Malaysia, 11800 USM, Penang,

Malaysia. Email: tcfoon@usm.my The authorswould like to thank the anonymous reviewers for their

valuable comments and suggestions on the earlier draft of this paper. The authors would also like to

thank the Director General of Health, Malaysia for his permission to use the data from the National

Health and Morbidity Survey 2011 and to publish this paper. Research funding from the Population

Studies Unit (PSU), University of Malaya (IF002–2014) is acknowledged.

© 2017 East Asian Economic Association and John Wiley & Sons Australia, Ltd

Asian Economic Journal 2017, Vol.31 No. 2, 119–137 119

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heart disease (IHD) and other cardiovascular diseases (CVD) were responsible for

9.8 and 6.4 percent of disability-adjusted life years (DALY), respectively.

Apart from demographic changes, modifiable health risk factors, such as

diabetes, hypercholesterolemia and hypertension, are the main causes of NCD

(World Health Organization, 2011). Given that the costs of treating NCD are high,

intervention strategies directedtoward reducing the prevalence of modifiable health

risk factors have been given high priority. As pointed out by Phua (2007), the

Malaysian Government has been facing the problem of rising health-care costs

because of the increases in the prevalence of NCD. Although this problem is not

as alarming as the health-care problems of well-developed countries, it should be

given special attention. Thisis because high expenditure on health care will reduce

the budget allocated for a country’s development (Phua, 2007).

Malaysia will become an aging society in the near future. Ong (2007) estimates that

12 percent of the total population will be the elderly by 2030. The elderly population

has been growing faster than the total population. In 2010, the growth rate of the

elderly population was 4.2 percent, whereas the growth rate of the total population

was only 2.2 percent (Ong, 2007). The main problem caused by the sharp rise in

the number of aged population is NCD and health risk factors will become more

prevelant, thereby increasing health care costs (Ong, 2007; Phua, 2007).

To reduce the prevalence of NCD in a cost-efficient way, public health

administrators have promoted the use of preventive medical care. As pointed out

by Kenkel (2000), preventive medical care remains an important aspect of disease

prevention in developed and developing countries. In spite of the efforts that

the government puts into disease prevention, preventive medical care is still

underutilized. Perhaps this is because of the poor understanding of the determinants

of preventive medical care’s use. The government may not be able to design

appropriate intervention measures and policies without information on which

groups of individuals have low or high tendencies to use preventive medical care.

Having a better understanding of the factors that alter individuals’preventive

behavior is a prerequisite for achieving the goal of reducing the prevalence of NCD.

In light of the fact that good knowledge about the factors affecting the use of

preventive medical care can provide policy-makers with useful information, there

appears to be a growing literature in economics and public health that examines

the impact of socioeconomic factors on the use of preventive medical care

(Kenkel, 1994; Hsieh and Lin, 1997; Zhang et al., 2000; Lairson et al., 2005;

Belkar et al., 2006; Lin, 2008; Tian et al., 2010). To the best of our knowledge,

there has only been limited analysis of this issue in Malaysia. Dunn and Tan

(2010, 2011) are notable in investigating the determinants of the use of preventive

medical care in Malaysia, but their analysis does not consider health insurance and

lifestyle variables. Moreover, they only study the use of cervical and breast cancer

screenings among females. Therefore, the primary objective of the present study

is to narrow the gap in the existing literature by investigating the effects of health

insurance and lifestyle factors on the use of preventive medical care among both

males and females.

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© 2017 East Asian Economic Association and John Wiley & Sons Australia, Ltd