Parents‘ and healthcare professionals’ perception toward the introduction of a new fully liquid hexavalent vaccine in the Malaysian national immunization program: a cross-sectional study instrument development and its application

A newly developed fully liquid hexavalent vaccine that comprises six antigens for Diphtheria, Tetanus, acellular Pertussis, Inactivated Poliomyelitis, Haemophilus Influenza type b., and Hepatitis B, is proposed to be introduced in the Malaysian national immunization program, instead of the non-fully liquid pentavalent vaccine and monovalent Hepatitis B vaccine that is currently employed in the immunization schedule. Although the introduction of new vaccines is a necessary intervention, it still needs to be accepted by parents and healthcare professionals. Hence, this study aimed to develop three structured questionnaires and to investigate the participants’ perception and acceptability toward the incorporation of the new fully liquid hexavalent vaccine. A cross-sectional study was conducted among a sample of 346 parents, 100 nurses, and 50 physicians attending twenty-two primary health care centers in the states of Selangor and the Federal Territory of Kuala Lumpur and Putrajaya during 2019-2020. The study found that Cronbach’s alpha coefficients for the study instruments ranged from 0.825 to 0.918. Principal components analysis produced a good fit with KMO>0.6. For the parents’ perception questionnaire, the only extracted factor explained 73.9 % of the total variance; for the nurses’ perception toward a non-fully and fully liquid combined vaccine, there was a sole extracted factor that explained 65.2 % and 79.2% of the total variance, respectively. Whereas for the physicians’ perception, there was one factor extracted that explains 71.8 % of the total variance. The median score for all the questionnaire items ranged from 4 to 5 (Q1 and Q3 vary between 3-5). Parents' ethnicity was significantly associated (P-value ≤ 0.05) with the perception that the new hexavalent vaccine would reduce their transportation expenses. Moreover, a significant association (P-value ≤ 0.05) was found between physicians' age and the perception of the hexavalent vaccine's ability to decrease patient overcrowding in primary healthcare centers. The instruments used in this study were valid and reliable. Parents of Malay ethnicity were the most concerned about transportation expenses since they have the lowest income and are more concentrated in rural areas compared to other races. Younger physicians were concerned about reducing patient crowding and hence reducing their workload and burnout

Capacity of public health laws enforcement by health inspectors in state of Selangor, Malaysia

A cross sectional study initiated among the Public Health Enforcement Inspectors in state of Selangor, Malaysia in July 2003 using a self administered questionnaire and universal sampling with the purpose to determine the capacity of public health laws enforcement and factors influencing it. A total of 99 respondents from the Health Districts Ofices and I00 respondents from the Local Municipal Health Departments participated in this study. It was found that the level of enforcement is generally low in all the units except for two units; the Food Unit and Sanitary and Hygiene Units. Factors found to influence enforcement capacity are the units' the enforcers work in and the length of service being in the same unit. Further analysis using multiple logistic regression, showed that respondents from the Food Unit (adjusted odds ratio 22; CI 95% : 7.851, 58.896), enforcers from the middle level category (adjusted odds ratio 5; CI 95%: 1.397, 17.630), duration of service of 4 years and above in the same unit (adjusted odds ratio 6; CI 95%: 2.174, 13.747), past acceptance of formal service rewards from their departments (adjusted odds ratio 3; CI 95% : 1.150, 6.917); low exposure to bribery (adjusted odds ratio 46; CI 95% : 2.336, 1000) and have in the past being oflered bribes while on the field (adjusted odds ratio 3; CI 95% : 1.018, 4.772) are associated with higher enforcement capacity. In conclusion; die attention must be looked into the enforcement organization with respect to the duration of service, acknowledgement via service rewards and monitoring of bribes exposure will help shape a better public health laws' enforcement capacity

Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in Indonesia

ObjectiveTo identify the incidence of moral hazards among health care providers and its determinant factors in the implementation of national health insurance in Indonesia.MethodsData were derived from 360 inpatient medical records from six types C public and private hospitals in an Indonesian rural province. These data were accumulated from inpatient medical records from four major disciplines: medicine, surgery, obstetrics and gynecology, and pediatrics. The dependent variable was provider moral hazards, which included indicators of up-coding, readmission, and unnecessary admission. The independent variables are Physicians' characteristics (age, gender, and specialization), coders' characteristics (age, gender, education level, number of training, and length of service), and patients' characteristics (age, birth weight, length of stay, the discharge status, and the severity of patient's illness). We use logistic regression to investigate the determinants of moral hazard.ResultsWe found that the incidences of possible unnecessary admissions, up-coding, and readmissions were 17.8%, 11.9%, and 2.8%, respectively. Senior physicians, medical specialists, coders with shorter lengths of service, and patients with longer lengths of stay had a significant relationship with the incidence of moral hazard.ConclusionUnnecessary admission is the most common form of a provider's moral hazard. The characteristics of physicians and coders significantly contribute to the incidence of moral hazard. Hospitals should implement reward and punishment systems for doctors and coders in order to control moral hazards among the providers

The experiences of parents and caregivers of children with disability on community-based rehabilitation (CBR) services in Malaysia: A Qualitative study

Background: The rehabilitation program for disabled children is provided through community-based rehabilitation (CBR) services by an initiative of the Department of Social Welfare Malaysia. This long-term program needs commitment and compliance, which relates to the quality of services experienced by parents and caregivers. Thus, the purpose of this study was to explore the experiences of the parents and caregivers of disabled children on the CBR services. Methods: This qualitative study utilized in-depth interview sessions held from March to May 2015. Fifteen parents and caregivers who had disabled children participating in the CBR program were selected using a purposive sampling method. All recorded conversations were transcribed verbatim and analyzed using Atlas.ti version 8.0. The thematic analysis was used for identifying, analyzing, and reporting the data obtained. The themes that emerged were read, reread, and peer checked until the researcher agreed on the thematic representation of the data. Results: Six major themes emerged from this study, including CBR activity, facilities, environment, communication, program impact, and management system. Conclusion: The majority of the parents and caregivers had good experiences with CBR services. However, several aspects could be given further attention to improve the CBR quality and to sustain its services for disabled childre

DOES MORAL HAZARD OCCOUR IN THE IMPLEMENTATION OF SOCIAL HEALTH INSURANCE? EVIDENCE FROM PUBLIC HOSPITALS IN A RURAL PROVINCE OF INDONESIA

Indonesia is now encountering moral hazard problems in the implementation of social health insurance. BPJS, as the administrator of Indonesia’s National Health Insurance, reported that there was an increase in deficit in the 4 years of the implementation of National Health Insurance from US$228 million in 2014 to US$ 470 million in 2016. Despite efforts conducted to overcome the problem, no evidence-based predictor that might be significantly associated with moral hazard in a rural province hospital in Indonesia. The purpose of this research is to identify the incidence of moral hazard in the implementation of National Health Insurance in Indonesia. Data consisting of 180 medical records obtained from three public hospitals in rural province of Indonesia were selected as samples in this study. These medical records were reviewed by Independent Senior Coder (ISC) who had more than 5 years experiences as a coder. The indicators of moral hazard in this study were upcoding, readmission, and possible unnecessary admission. Logistic regression was used to explore determinant of moral hazard from patient, coder, and physician side. The results show that rate of moral hazard cases for upcoding is 10%, readmission is 2.8%, and possible unnecessary admission is 18.9%. It can be seen from multivariate analysis that discharge status, severity level and LOS have a significant relationship with moral hazard. Illness severity level, Discharge against Medical Advice, and higher Length of Stay are risk factors for moral hazard incidence

Ability to Pay for Future National Health Financing Scheme among Malaysian Households

BackgroundMalaysia is no exception to the challenging health care financing phenomenon of globalization.ObjectivesThe objective of the present study was to assess the ability to pay among Malaysian households as preparation for a future national health financing scheme.MethodsThis was a cross-sectional study involving representative samples of 774 households in Peninsular Malaysia.FindingsA majority of households were found to have the ability to pay for their health care. Household expenditure on health care per month was between MYR1 and MYR2000 with a mean (standard deviation [SD]) of 73.54 (142.66), or in a percentage of per-month income between 0.05% and 50% with mean (SD) 2.74 (5.20). The final analysis indicated that ability to pay was significantly higher among younger and higher-income households.ConclusionsSociodemographic and socioeconomic statuses are important eligibility factors to be considered in planning the proposed national health care financing scheme to shield the needed group from catastrophic health expenditures

A review of international developments in occupational safety and health auditing practices

Auditing is an integral component of the occupational safety and health management system (OSHMS). Why, how and who conducts the OSH audits vary. There are rapid developments in OSH auditing. These are in the context of standardization of the audit mechanism, eg. the development of international guidelines and OSH performance indicators. Criticism has been raised by different professionals in facing both old and new audit approaches occupational safety and health. Malaysia could learn from these experiences in developing the suitable auditing practices. In short, few key areas were learned from the literature review that found important as a good input to local audit practitioners. Firstly, the OSH MS audit should be conducted in the more value added to the organization than just merely conforming to the own disciplinary standard. For instance, OSH audit should incorporate or integrate with other main business functions. Secondly, OSH audit should be adopting more process based performance than just the downstream accident rate measurement. Thirdly, program audit approach should be replace with the system approach so that the real root cause problem could be identified rather then the symptom problem. Forth, there is no right set of OSHMS elements that means any effort to adopt any new standard should be tested thoroughly before blindly adopted it completely. Fifth, audit should go beyond merely comply to the laws and conformance to any standard procedures as well as its rigid definition. Off-job injuries statistic is in fact far more severe compare to the formal workplace injuries rate. Blindly abide to narrow laws definition or standard will result the bigger losses were fail to identify

Does Health Insurance Ownership Determine Access and Frequency of Hospitalization? Evidence from the Two-part Poisson Model

This paper examined the effect of health insurance ownership on hospitalization within the context of Malaysia. The study utilized the data from Malaysia National Health and Morbidity Survey III (2006) and 14,234 respondents were selected for this purpose. Malaysia provides new evidence from an emerging market where voluntary purchase of private health insurance co-exists with almost free public health care. We used the standard and two-part Poisson models in determining the effect of insurance ownership on utilization. Based on two selection criteria, two-part Poisson model was found to be superior to the standard specification. Insurance ownership was found to be significant in determining access while it has no significant effect on frequency of hospitalization. Other significant variables that determine access were age, marital status, household size, health status and income while health status is the sole factor that affects frequency. Keywords: health insurance, hospital utilization, Poisson model JEL Classification: I1