Achieving SDG 3.8.2: Financial Protection Against Catastrophic Health Expenditure in Malaysia
Abstract Background: The Sustainable Development Goal (SDG) 3.8.2 is one of the two indicators to monitor a country's progress towards universal health coverage. It concerns the financial protection against catastrophic spending on health based on the budget share approach. The purpose of this study is twofold: 1) to measure SDG 3.8.2 on the proportion of households with catastrophic health expenditure (CHE), and 2) to determine households at risk of CHEMethods: A cross-sectional study was conducted using secondary data from the 2015/2016 Household Expenditure Survey. The inclusion criterion was Malaysian households with some health spending in the past 12 months before the date of the survey. The World Health Organization method of calculating CHE was applied in the calculation, and a threshold of 10% out-of-pocket health spending from total household expenditures was used to determine CHE. Data were analysed descriptively, and multiple logistic regression was used to determine factors associated with CHE.Results: A total of 13015 households were involved in the study. The proportion of CHE was 2.8%. Four associated factors that were statistically significant were female-headed household (Adjusted OR 1.6; CI 1.25, 2.03; p-value <0.001), household that lived in rural area (Adjusted OR 1.29; 95% CI 1.04, 1.61; p-value =0.022), small household size (Adjusted OR 2.4; 95% CI 1.81, 3.18; p-value <0.001) and head of household aged below 60 years old (Adjusted OR2.34; 95% CI 1.81, 3.18; p-value <0.001).Conclusions: The low proportion of CHE revealed that Malaysia is on the right track towards achieving SDG 3.8 on universal health coverage status by 2030. However there is an increasing trend in the proportion of CHE. Households at risk of CHE require financial protection to afford healthcare and safety net measures to prevent from spiralling further into the vicious cycle of illness and poverty.