title: Equity in access to health care in a rural population in Malaysia: A cross-sectional study.
abstract: OBJECTIVE
  To examine the extent of equity in access to health care, their determinants and reasons of unmet need of a rural population in Malaysia.
  
  
  METHODS
  Exploratory cross-sectional survey administered by trained interviewers among participants of a health screening program.
  
  
  METHODS
  A rural plantation estate in the West Coast of Peninsular Malaysia.
  
  
  METHODS
  One hundred and thirty out of 142 adults above 18 years old who attended the program.
  
  
  METHODS
  Percentages of respondents reporting realised access and unmet need to health care, determinants of both access indicators and reasons for unmet need. Realised access associated with need but not predisposing or enabling factors and unmet need not associated with any variables were considered equitable.
  
  
  RESULTS
  A total of 88 (67.7%) respondents had visited a doctor (realised access) in the past 6 months and 24.8% (n = 31) experienced unmet need in the past 12 months. Using logistic regression, realised access was associated with presence of chronic disease (OR 6.97, P < 0.001), whereas unmet need was associated with low education level (OR 6.50, P < 0.05), 'poor' or 'fair' self-assessed health status (OR 6.03, P < 0.05) and highest income group (> RM 2000 per month) (OR 51.27, P < 0.05). Personal choice (67.7%) was more commonly expressed than barriers (54.8%) as reasons for unmet need.
  
  
  CONCLUSIONS
  The study found equity in realised access and inequity in unmet need among the rural population, the latter associated with education level, subjective health status and income. Despite not being generalisable, the findings highlight the need for a national level study on equity in access before the country reforms its health system.
authors.affiliation: National Clinical Research Centre, Kuala Lumpur, Malaysia.
authors.forename: Ka Keat
authors.initials: KK
authors.lastname: Lim
authors.affiliation: National Clinical Research Centre, Kuala Lumpur, Malaysia.
authors.forename: Sheamini
authors.initials: S
authors.lastname: Sivasampu
authors.affiliation: National Clinical Research Centre, Kuala Lumpur, Malaysia.
authors.forename: Fatihah
authors.initials: F
authors.lastname: Mahmud
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007407:Interviews as Topic; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012424:Rural Population; D055815:Young Adult
keywords: Malaysia; health care reform; health services accessibility; rural health; rural health service