Trends in the Cost of Medicines, Consultation Fees and Clinic Visits in Malaysia’s Private Primary Healthcare System: Employer Health Insurance Coverage

Abstract

Objective

To examine trends in the cost of medicines, consultation fees and clinic visits among the employees covered by the employer health insurance in Malaysia’s private primary healthcare system in Malaysia.

Designs

Retrospective cross-sectional study.

Setting

PMCare claims database from January 2016 to August 2019.

Participants

A total of 83,556 outpatient clinic visits involving 10,150 IIUM employees of the International Islamic University Malaysia (IIUM) to private general practitioners (GPs). During the study period, IIUM adopts the incentive structure of capping coverage at Ringgit Malaysia (RM) 45/outpatient visit (USD 10.58) to cover for consultation fees and medicine costs.

Main Outcome Measures

The monthly percentage change in the number of clinic visits, medicine costs, consultation fees and total costs between January 2016 and August 2019. A simple linear regression using Stata v15.1 was also performed to measure the association between the characteristics of the prescribed medicines and medicine charges.

Results

The number of clinic visits per patient increased by 17% from January 2016 to August 2019, with consultation fees increasing by 113.9% and total costs by 7.9% per clinic visit per patient. Conversely, the cost of medicines and the number of medicines prescribed per clinic visit per patient decreased by 39.7% and 6.3%, respectively.

Conclusion

Within the incentive structure of capping the total amount of coverage per clinic visit, medicine costs were reduced by decreasing the number of medicines prescribed, to offset the increased consultation fees. This may create perverse incentives that affect medicine use with negative consequences for the health system and health insurers.

Keywords:

• medicine costs
• employer health insurance
• incentive structure
• private health system Malaysia
• quality targets

Data Sharing Statement

The datasets generated and/or analysed during the current study are not publicly available. Request to access the datasets should be directed to International Islamic University Malaysia Research Ethical Committee. The de-identified data could be shared with interested researchers after obtaining the approval from the above ethical committee (http://www.iium.edu.my/centre/irec). The reason for the restriction on public data deposition is due to the privacy and confidentiality of patients’ health data.

Ethics Approval

Ethics approval for this study was granted by the International Islamic University Malaysia Ethical Committee (IREC-2019-212). De-identified data were used, and the results were reported in an aggregated manner. The analysis of patient information for research purposes without any direct involvement of patients or public required the approval from the Ethical Committee only and waived the requirement for informed consent.

Acknowledgments

The authors would like to thank the staff from PMCare and IIUM Health Wellness Centre for their assistance and cooperation with data extraction.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

CSZ was supported by a research grant from The Ministry of Education Malaysia (Fundamental Research Grant Scheme, FRGS/1/2022/SKK16/UIAM/01/3). The funders were not involved in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.