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

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

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.

Study Overview

• Status: Unknown
• Conditions: Health Care Quality, Access, and Evaluation; Insurance, Health
• Intervention / Treatment: Other: HMI

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Anticipated): 114
• Phase: Not Applicable

Contacts and Locations

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Households were located in the study area
2. Method of payment to clinic is by out-of-pocket
3. This is household's regular choice of primary care provider.
4. Patient has been seen in the clinic since at least the past two years i.e from before Jan 1, 2014

Exclusion Criteria:

1. Households had members who died in the year 2014.
2. Households had members who were away from this place of residence for work/transferred for more than 1 month in 2014.
3. Households had members who had regular follow-up in public facilities for chronic disease.
4. 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)
5. Patients who refuse consent

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Health Microinsurance Scheme; Households owning the HMI package, entitling them to visit and receive treatment from the selected primary care clinic	Other: HMI; 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; Other Names: Health Microinsurance Scheme
No Intervention: Out-Of-Pocket; Households who visit the selected primary care clinic, but pay by Out-Of-Pocket

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Chulalongkorn University
• Investigators: Principal Investigator: Dr Murallitharan Munisamy, College of Public Health Sciences Chulalongkorn University

Study record dates

Study Major Dates

• Study Start: April 1, 2016
• Primary Completion (Anticipated): September 1, 2016
• Study Completion (Anticipated): December 1, 2016

Study Registration Dates

• First Submitted: February 22, 2016
• First Submitted That Met QC Criteria: February 25, 2016
• First Posted (Estimate): March 2, 2016

Study Record Updates

• Last Update Posted (Estimate): March 10, 2016
• Last Update Submitted That Met QC Criteria: March 9, 2016
• Last Verified: March 1, 2016

More Information

Terms related to this study

• Other Study ID Numbers: NMRR 29311

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

Study Data/Documents

1. Study Protocol
   Information comments: Username: HMI Password: insurance Total protocol FILE named protocol.pdf
2. Informed Consent Form
   Information comments: Username: HMI Password: insurance Patient Information Sheet and Consent forms in English and Bahasa Malaysia
3. Questionnaires
   Information comments: Username: HMI Password: insurance All questionnaires (English) uploaded