title: Patients' willingness to pay for their drugs in primary care clinics in an urbanized setting in Malaysia: a guide on drug charges implementation.
abstract: BACKGROUND
  Malaysia is an upper middle income country that provides subsidized healthcare to ensure universal coverage to its citizens. The challenge of escalating health care cost occurs in most countries, including Malaysia due to increase in disease prevalence, which induced an escalation in drug expenditure. In 2009, the Ministry of Health has allocated up to Malaysian Ringgit (MYR) 1.402 billion (approximately USD 390 million) on subsidised drugs. This study was conducted to measure patients' willingness to pay (WTP) for treatment of chronic condition or acute illnesses, in an urbanized population.
  
  
  METHODS
  A cross-sectional study, through face-to-face interview was conducted in an urban state in 2012-2013. Systematic random sampling of 324 patients was selected from a list of patients attending ten public primary cares with Family Medicine Specialist service. Patients were asked using a bidding technique of maximum amount (in MYR) if they are WTP for chronic or acute illnesses.
  
  
  RESULTS
  Patients are mostly young, female, of lower education and lower income. A total of 234 respondents (72.2%) were not willing to pay for drug charges. WTP for drugs either for chronic or acute illness were at low at median of MYR10 per visit (USD 3.8). Bivariate analysis showed that lower numbers of dependent children (≤3), higher personal and household income are associated with WTP. Multivariate analysis showed only number of dependent children (≤3) as significant (p= 0.009; 95% CI 1.27-5.44) predictor to drugs' WTP.
  
  
  CONCLUSIONS
  The result indicates that primary care patients have low WTP for drugs, either for chronic condition or acute illness. Citizens are comfortable in the comfort zone whereby health services are highly subsidized through universal coverage. Hence, there is a resistance to pay for drugs.
authors.affiliation: Faculty of Medicine, Department of Community Health, University Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
authors.forename: Sharifa Ezat Wan
authors.initials: SEW
authors.lastname: Puteh
authors.affiliation: Health Administration, Faculty of Business Management, Universiti Teknologi MARA, Puncak Alam, Selangor Malaysia.
authors.forename: Siti Nurul Akma
authors.initials: SNA
authors.lastname: Ahmad
authors.affiliation: Faculty of Medicine, Department of Community Health, University Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
authors.forename: Azimatun Noor
authors.initials: AN
authors.lastname: Aizuddin
authors.affiliation: Institute for Health Systems Research, Ministry of Health, Kuala Lumpur, Malaysia.
authors.forename: Ramli
authors.initials: R
authors.lastname: Zainal
authors.affiliation: Health District Office, Sepang, Malaysia.
authors.forename: Ruhaini
authors.initials: R
authors.lastname: Ismail
keywords: Acute diseases; Chronic conditions; Urban state; Willingness-to-pay; drugs expenditure