Effect of socioeconomic status and healthcare provider on post-transplantation care in Malaysia: A multi-centre survey of kidney transplant recipients

INTRODUCTION: As the rate of end-stage kidney disease rises, there is an urgent need to consider the catastrophic health expenditure of post-transplantation care. Even a small amount of out-of-pocket payment for healthcare can negatively affect households’ financial security. This study aims to determine the association between socioeconomic status and the prevalence of catastrophic health expenditure in post-transplantation care. METHOD: A multi-centre cross-sectional survey was conducted in person among 409 kidney transplant recipients in six public hospitals in the Klang Valley, Malaysia. Catastrophic health expenditure is considered at 10% out-of-pocket payment from household income used for healthcare expenditure. The association of socioeconomic status with catastrophic health expenditure is determined via multiple logistic regression analysis. RESULTS: 93 kidney transplant recipients (23.6%) incurred catastrophic health expenditures. Kidney transplant recipients in the Middle 40% (RM 4360 to RM 9619 or USD 1085.39 –USD 2394.57) and Bottom 40% (<RM 4,360 or < USD 1085.39) income groups experienced catastrophic health expenditure compared to the Top 20% (>RM 9619 or > USD 2394.57) income group. Kidney transplant recipients in the Bottom 40% and Middle 40% income groups were more susceptible to catastrophic health expenditure at 2.8 times and 3.1 times compared to higher-income groups, even under the care of the Ministry of Health. CONCLUSION: Universal health coverage in Malaysia cannot address the burden of out-of-pocket healthcare expenditure on low-income Kidney transplant recipients for long-term post-transplantation care. Policymakers must reexamine the healthcare system to protect vulnerable households from catastrophic health expenditures.