[COLUMNIST] Health literacy and preventative care: Reducing the burden on healthcare systems

THE growing ageing population, coupled with the rise in non-communicable diseases (NCDs) and medical inflation, pose pressing concerns for the healthcare system in Malaysia.

As 2023 National Health and Morbidity Survey (NHMS) highlights, approximately half a million (2.5%) Malaysian adults live with four types of NCDs, while 2.3 million adults live with three types of NCDs. Most of these individuals are young adults. NCDs encompass diabetes, hypertension, high cholesterol, and obesity.

Also, shockingly, among these individuals, two in five adults with diabetes and one in two adults with high cholesterol are unaware of their conditions, often until they visit clinics or hospitals.

As previously emphasised in EMIR Research’s article (refer to “Addressing the Socioeconomic Gaps in Nutrition Transition on Health, 2024), nutrition plays a crucial role in both the development and treatment of these NCDs.

In today's hectic world, the frequent consumption of nutrient-poor, calorie-dense foods negatively impact long-term health, largely due to overlooked poor health literacy among individuals.

Health literacy, crucial for empowering individuals to actively manage their healthcare, involves educating them about their health, medical issues, and treatment options.

Poor health literacy, often linked to the older generation, lower-income households and rural communities, is widespread. Norrafizah et al.’s 2021 analysis of the 2019 NHMS found it prevalent among older (68%), less educated (64.8%), and lower-income (49.5%) respondents.

Evidently, the 2023 NHMS also indicates that outpatient healthcare utilisation is predominantly used by the rural population (66.9%), followed by the B40 population (57%).

The poorer health outcomes reflect on the poor health literacy of these demographics. Challenges in managing chronic diseases, comprehending medical instructions, and navigating healthcare systems, particularly for rural residents, can result in more untreated illnesses, delayed diagnosis, and increased hospitalisation.

Poor health literacy leads to inadequate patient education and engagement, creating significant health risks and hidden challenge within the healthcare system.

Also, the long waiting time for appointments, transportation challenges, cultural competence, and medical staff burnout, etc., coupled with the lack of access and availability to primary care services, exacerbate the situation.

For instance, the Health White Paper for Malaysia revealed that public sector clinics comprise 28% of total primary healthcare facilities but handle almost 64% of outpatient visits. In contrast, private clinic facilities, which make up 72% of the total, only account for 36% of outpatient visits.

Despite the Ministry of Health (MOH) extending the operating hours of community clinics, inadequate staffing within the public healthcare system will continue to place excessive workloads on medical officers, including doctors and nurses.

Unveiling the other side: Hospital service misuse!

The increased prevalence of healthcare misuse is another effect of low health literacy. When people utilise healthcare services inappropriately, whether intentionally or unintentionally, it is known as healthcare misuse.

“Healthcare misuse” is often associated with:

I. Intentional misuse, such as seeking unnecessary treatments, falsifying symptoms for prescriptions, or using emergency services for non-emergencies often arising from misunderstanding appropriate healthcare utilisation or exploiting the system for personal advantage.

II. Unintentional misuse, often stemming from miscommunication or misunderstanding of medical instructions, improper medication use, or non- adherence to treatment plans. This includes not following dosage instructions, missing follow-ups, or using emergency services when primary care would suffice.

Although free healthcare coverage is provided at a minimal cost of RM1 to RM5, have certain people been taking advantage of this privilege?

A local community clinic doctor noted that patients, especially seniors, often feign sickness solely to obtain prescriptions for medications like Panadol and balms. This not only wastes medication but also monopolises doctor's time, hindering care for genuinely ill patients.

As it takes two to tango, healthcare professionals, especially in the private healthcare sector, also contribute to hospital service misuse.

As highlighted in a press release by WTW, a data-driven research firm, insurance companies report that overuse of care (81%)—the result of doctors prescribing excessive amounts of care or advocating too many services—remains the main cause of medical costs.

Patients, even with basic health literacy, can empower themselves by requesting itemised bills, understanding and avoiding unnecessary procedures. This promotes cost transparency and prevents unnecessary healthcare expenses.

Rising medical costs

As 2024 Global Medical Trends Survey report highlights, Malaysia's gross medical inflation is projected to rise substantially to 13.36%. This projection places Malaysia second only to the Philippines (13.94%) among its Asia Pacific peers, such as Vietnam (11.33%), Singapore (10.67%), and Thailand (9.27%).

The rising cost of medical care will increasingly force socioeconomically disadvantaged individuals to depend on public healthcare services. Therefore, the government must proactively prepare for this potential surge in demand. A key strategy for addressing this challenge is to prioritise preventive care.

The term "preventive care" describes the medical procedures and methods intended to fend off disease, identify issues early, and enhance well-being. It consists of vaccinations, behavioural counselling, routine health screenings, and education.

As highlighted by the World Health Organization (WHO), preventive care health encompasses primary prevention (e.g., vaccination, lifestyle changes) and secondary prevention (e.g., screenings, early detection).

A prime example for Malaysia could be drawn from Australia. In Australia, the Remote Area Health Corps (RAHC) established by the Australian Government Department of Health, sends medical personnel to isolated Indigenous communities to alleviate healthcare disparities. Through this initiative, healthcare professionals can effectively interact and communicate with these people by receiving cultural training.

RAHC, focuses on chronic illness management, preventive care, and encouraging healthy lifestyles, greatly improves results and knowledge through health literacy programmes. With improved access to primary healthcare services in remote locations, this effort helps Indigenous populations better manage chronic diseases like hypertension and diabetes.

Recently, Prime Minister Anwar Ibrahim highlighted the need for investment in the silver economy. In relation to that, there is an important need to focus on healthcare infrastructure, management, and patient education in Malaysia.

In Budget 2024, the government has allocated RM41.2 billion to the Health Ministry, marking an increase from RM36.3 billion in the previous year. Notably, only 0.1% (RM 56,005,700) is allocated to health education, while 2.6% (RM 950,326,500) is designated for disease control. It is recommended that the government place a greater emphasis on early disease prevention efforts to mitigate future healthcare costs that are eventually imposed on the government.

In addition to that, it is also recommended that the government focus on:

1. Enhancing Patient Engagement via Digital Health Tools and Improving Patient-Doctor Communication in Rural Areas

As we are moving into an IT-savvy era where technology is used for everything, more emphasis, education and allocation of resources should be invested in the digital health care system. To address this, it is essential to equip healthcare professionals with the necessary digital tools and infrastructure.

Patients living in remote areas with restricted access to digital gadgets frequently rely on medical personnel for interaction and communication. Ensuring healthcare personnel obtain sufficient training and exposure to successfully connect with these communities is crucial in addressing this situation.

2. Prescription Monitoring Programs (PMPs) in Public and private Healthcare

The implementation of prescription monitoring programmes is essential for both the public and private healthcare systems. These initiatives support patient safety, prevent drug misuse, and monitor the usage of prescription drugs. By incorporating PMP’s into their practices, healthcare professionals can improve prescription management, reduce adverse drug events, and ensure optimal usage for all patient populations.

3. Patient-centred models that prioritise patient education and engagement, with a particular focus on rural areas and the indigenous community.

To support and motivate patient education and engagement efforts, patient-centred models must be developed. Providing patients with information about treatment alternatives, preventive care, and healthy lifestyle choices should be a top priority in these models. Healthcare systems can promote informed decision-making, enhance health outcomes, and lower long-term healthcare costs by funding patient education and engagement initiatives.

In summary, improving health literacy is essential to reducing the burden on healthcare systems.

By reducing the prevalence of preventable diseases and hospitalisations, the burden on healthcare professionals is significantly reduced. This reduction in burden helps to mitigate burnout and improve job satisfaction among healthcare workers, ultimately leading to better patient care.

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Jachintha Joyce is Research Assistant at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.

** The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the position of Astro AWANI.

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