A Review on The Current Burden of Catastrophic Health Expenditure from Major Illnesses in Malaysia

Abstract

Several illnesses continue to generate disproportionate financial burdens for Malaysian households despite a subsidised health system. This review synthesised 12 studies published between 2020 and 2025 that reported catastrophic health expenditure (CHE) associated with chronic and infectious diseases. National surveys showed low CHE prevalence (2–3%), yet disease-specific studies reported much higher rates: 15% - 87% in cancer patients, 24% in kidney transplant recipients, 38%-80% in malaria (depending on CHE threshold), and 2% in adult asthma patients. Key drivers included low income, treatment intensity (chemotherapy, radiotherapy, transplant), absence of financial aid or Guarantee Letters, and sociodemographic vulnerabilities such as small or female-headed households, rural residence, and minority ethnicity. Non-medical and indirect costs, particularly transport and productivity loss, contributed substantially but were often under-measured. These findings highlight persistent gaps in financial protection, underscoring the need to expand coverage for non-medical costs, address inequities, and systematically integrate productivity loss into CHE monitoring to advance universal health coverage and safeguard household financial stability in Malaysia.