Chasm in primary care provision in a universal health system: Findings from a nationally representative survey of health facilities in Malaysia

Malaysia has achieved universal health coverage since 1980s through the expansion of direct public provision, particularly in rural areas. However, no systematic examination of the rural-urban distribution of primary care services and resources has been conducted to date for policy impact evaluation...

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Bibliographic Details
Published in:PloS one 2017-02, Vol.12 (2), p.e0172229-e0172229
Main Authors: Lim, Huy Ming, Sivasampu, Sheamini, Khoo, Ee Ming, Mohamad Noh, Kamaliah
Format: Article
Language:English
Subjects:
Availability
Biology and Life Sciences
Confidence intervals
Delivery of Health Care
Demographics
Earth Sciences
Expansion
Family physicians
Female
Health care
Health care facilities
Health facilities
Health services
Humans
Malaysia
Male
Management
Maternal & child health
Medical personnel
Medicine and Health Sciences
Morbidity
National health insurance
Ownership
People and Places
Physicians
Population
Primary care
Primary Health Care
Private sector
Public health
Public sector
Random sampling
Regression analysis
Resource availability
Rural areas
Social Planning
Statistical analysis
Surveys and Questionnaires
Sustainable development
Toolkits
Urban areas
Urban Renewal
Young adults
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Summary:Malaysia has achieved universal health coverage since 1980s through the expansion of direct public provision, particularly in rural areas. However, no systematic examination of the rural-urban distribution of primary care services and resources has been conducted to date for policy impact evaluation. We conducted a national cross-sectional survey of 316 public and 597 private primary care clinics, selected through proportionate stratified random sampling, from June 2011 through February 2012. Using a questionnaire developed based on the World Health Organization toolkits on monitoring health systems strengthening, we examined the availability of primary care services/resources and the associations between service/resource availability and clinic ownership, locality, and patient load. Data were weighted for all analyses to account for the complex survey design and produce unbiased national estimates. Private primary care clinics and doctors outnumbered their public counterparts by factors of 5.6 and 3.9, respectively, but the private clinics were significantly less well-equipped with basic facilities and provided a more limited range of services. Per capita densities of primary care clinics and workforce were higher in urban areas (2.2 clinics and 15.1 providers per 10,000 population in urban areas versus 1.1 clinics and 11.7 providers per 10,000 population in rural areas). Within the public sector, the distribution of health services and resources was unequal and strongly favored the urban clinics. Regression analysis revealed that rural clinics had lower availability of services and resources after adjusting for ownership and patient load, but the associations were not significant except for workforce availability (adjusted odds ratio [OR]: 0.82; 95% confidence interval [CI]: 0.71-0.96). Targeted primary care expansion in rural areas could be an effective first step towards achieving universal health coverage, especially in countries with limited healthcare resources. Nonetheless, geographic expansion alone is inadequate to achieve effective coverage in a dichotomous primary care system, and the role of the private sector in primary care delivery should not be overlooked.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0172229