Effectiveness of A Health Microinsurance Scheme for Private Primary Care in Malaysia

Study Overview
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Brief Summary
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This is the Phase 3 of a 3 phase study to determine the feasibility, acceptability and effectiveness of a health microinsurance scheme in improving health equity and clinical outcomes for private primary care (PPC) in Kuala Lumpur, Malaysia. This two-arm, pre-post, quasi-experimental trial consisted of utilizing a HMI scheme (experimental clinic) and normal OOP payments (control clinic) for 6 months. The HMI scheme enabled subscribed households to access a defined benefit package at a selected PPC for treatment and follow-up.

Detailed Description
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This will be a quasi-experimental study designed to determine the effectiveness of a community health microinsurance scheme (HMI) in private primary care clinics in Malaysia via a pre-post study of an experimental and control clinic. A proposed HMI scheme, whose price and benefit package have been defined through the earlier Phases 1 and 2, will be accessible to subscribed households at the experimental clinic, while the control clinic has subscribed patients paying as per normal practise, which is by Out-Of-Pocket payment. The HMI scheme enabled subscribers to visit the selected clinic chosen for any form of primary care diagnosis, treatment and follow-up. Both the clinics are located in the Jalan Ipoh area, a suburb of Kuala Lumpur, and have common sociodemographic characteristics. A pre-intervention questionnaire will aim to capture health seeking behaviour, delay in seeking medical care, monthly health expenditure and improvements in clinical outcome (assessed by clinical test results). After six months, a post-intervention questionnaire is administered again to the respondents which then allows assessment of the outcome variables.

Official Title
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Effectiveness of A Health Microinsurance Scheme in Improving Health Equity and Clinical Outcomes for Private Primary Care in Kuala Lumpur, Malaysia

Conditions
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Health Care Quality, Access, and Evaluation, Insurance, Health

Intervention / Treatment
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* Other: HMI


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Households were located in the study area Method of payment to clinic is by out-of-pocket This is household's regular choice of primary care provider. Patient has been seen in the clinic since at least the past two years i.e from before Jan 1, 2014 Exclusion Criteria: Households had members who died in the year 2014. Households had members who were away from this place of residence for work/transferred for more than 1 month in 2014. Households had members who had regular follow-up in public facilities for chronic disease. Households with members who have switched methods of payment in the last year- (e.g newly bought insurance or retired and lost health benefits so paying OOP) Patients who refuse consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Health Microinsurance Scheme<br>Households owning the HMI package, entitling them to visit and receive treatment from the selected primary care clinic | Other: HMI<br>* A defined priced package of primary care services, including investigation and treatment such as procedures and medication, available at a selected clinic for 6 months<br>* Other names: Health Microinsurance Scheme;|
| No Intervention: Out-Of-Pocket<br>Households who visit the selected primary care clinic, but pay by Out-Of-Pocket | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Health-seeking behavior | Delays in seeking healthcare (days) | Change from Baseline health seeking behavior at 6 months | 
| Monthly health expenditure | How much has been spent for monthly health expenses (in Ringgit Malaysia) | Change from Baseline Monthly Health Expenditure at 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical Outcome of Diabetes Mellitus | Measurement of HbA1c | Change from Baseline HbA1c at 6 months | 
| Clinical Outcome of Hypertension | Resting mean blood pressure | Change from Baseline Resting Mean Blood Pressure at 6 months | 
| Clinical outcome of dyslipidemia | Total serum cholesterol and LDL | Change from Baseline serum cholesterol and LDL at 6 months | 
| Clinical outcome of bronchial Asthma | Spirometry levels | Change from Baseline spirometry levels at 6 months |