title: Does tax-based health financing offer protection from financial catastrophe? Findings from a household economic impact survey of ischaemic heart disease in Malaysia.
abstract: Malaysia is an upper-middle income country with a tax-based health financing system. Health care is relatively affordable, and safety nets are provided for the needy. The objectives of this study were to determine the out-of-pocket health spending, proportion of catastrophic health spending (out-of-pocket spending >40% of non-food expenditure), economic hardship and financial coping strategies among patients with ischaemic heart disease (IHD) in Malaysia under the present health financing system.
  
  
  
  A cross-sectional study was conducted at the National Heart Institute of Malaysia involving 503 patients who were hospitalized during the year prior to the survey.
  
  
  
  The mean annual out-of-pocket health spending for IHD was MYR3045 (at the time US$761). Almost 16% (79/503) suffered from catastrophic health spending (out-of-pocket health spending ≥40% of household non-food expenditures), 29.2% (147/503) were unable to pay for medical bills, 25.0% (126/503) withdrew savings to help meet living expenses, 16.5% (83/503) reduced their monthly food consumption, 12.5% (63/503) were unable to pay utility bills and 9.0% (45/503) borrowed money to help meet living expenses.
  
  
  
  Overall, the economic impact of IHD on patients in Malaysia was considerable and the prospect of economic hardship likely to persist over the years due to the long-standing nature of IHD. The findings highlight the need to evaluate the present health financing system in Malaysia and to expand its safety net coverage for vulnerable patients.
authors.affiliation: Department of Community Medicine, School of Medical Sciences, USM Health Campus, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia surianti@usm.my.
authors.forename: Surianti
authors.initials: S
authors.lastname: Sukeri
authors.affiliation: Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.|Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Masoud
authors.initials: M
authors.lastname: Mirzaei
authors.affiliation: The George Institute for Global Health, University of Sydney,Sydney, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D061889:Healthcare Financing; D006801:Humans; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000191:economics* / Q000628:therapy*; D011203:Poverty; D011795:Surveys and Questionnaires; D013660:Taxes / Q000191:economics*
keywords: Catastrophic health spending; Economic hardship; Financial coping; Malaysia; Tax-based health financing