Availability and accessibility of subsidized mammogram screening program in peninsular Malaysia: A preliminary study using travel impedance approach
Availability and accessibility of subsidized mammogram screening program in peninsular Malaysia: A preliminary study using travel impedance approach
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DOI：
10.1371/journal.pone.0191764
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发表时间：
2018-02-01
期刊：
影响因子：
3.7
通讯作者：
Aljunid, Syed Mohamed
中科院分区：
文献类型：
--
作者：
Mahmud, Aidalina;Aljunid, Syed Mohamed
获得医疗保健对于实现全民健康覆盖至关重要。获取的组成部分是可获得性、可获取性（空间和非空间）、可负担性和可接受性。衡量空间可达性是评估获得卫生保健的常用方法。本研究旨在确定马来西亚半岛有补贴的乳房X光检查的可用性和空间可及性。可用性是根据设施的数量和分布情况确定的。空间可达性确定使用的旅行阻抗的方法来表示显示的访问，而不是潜在的访问由其他空间测量方法测量。使用绘图应用程序确定了从答复者住所到设施的回程行车距离。差旅支出的估算方法是将总差旅距离乘以标准化差旅津贴率，再加上停车费。这项研究的受访者是2015年至2016年期间在4家转诊医院接受治疗的344名乳腺癌患者。就可获得性而言，至少有6个主要实体提供有补贴的乳房X光检查方案。与这些方案有关的乳房X光检查设施更密集地位于半岛的中部和西部海岸地区。乳房X光检查机构与40-74岁女性目标人群的比例范围在1：10，000至1：80，000之间。在可获得性方面，3.6%的受访者接受了乳房X光检查，他们的平均旅行距离为53.4公里（SD = 34.5，范围8-112公里），平均旅行支出为38.97马币（SD = 24.00，范围7.60 -78.40马币）。在那些没有去做乳房X光检查的人中，估计的旅行距离和支出呈偏态分布，中位旅行距离为22.0公里（IQR 12.0，42.0，范围2.0-340.0），中位旅行费用为RM 17.40（IQR 10.40，30.00，范围3.40-240.00）。居住在郊区和农村地区的人的旅行阻抗更高。总之，在半岛的中部和西部海岸，乳房X光检查设施的可用性很好。提供者与人口的总体比率低于建议的比率。根据所使用的旅行阻抗方法，城市地区的受访者获得补贴的乳房X光检查的机会很好，但在其他地区被剥夺了。这项研究是一项具有局限性的初步研究。尽管如此，有证据表明，必须采取行动，改善马来西亚机会性乳房X光检查的可及性，以实现全民健康覆盖。
Access to healthcare is essential in the pursuit of universal health coverage. Components of access are availability, accessibility (spatial and non-spatial), affordability and acceptability. Measuring spatial accessibility is common approach to evaluating access to health care. This study aimed to determine the availability and spatial accessibility of subsidised mammogram screening in Peninsular Malaysia. Availability was determined from the number and distribution of facilities. Spatial accessibility was determined using the travel impedance approach to represent the revealed access as opposed to potential access measured by other spatial measurement methods. The driving distance of return trips from the respondent's residence to the facilities was determined using a mapping application. The travel expenditure was estimated by multiplying the total travel distance by a standardised travel allowance rate, plus parking fees. Respondents in this study were 344 breast cancer patients who received treatment at 4 referral hospitals between 2015 and 2016. In terms of availability, there were at least 6 major entities which provided subsidised mammogram programs. Facilities with mammogram involved with these programs were located more densely in the central and west coast region of the Peninsula. The ratio of mammogram facility to the target population of women aged 40-74 years ranged between 1: 10,000 and 1: 80,000. In terms of accessibility, of the 3.6% of the respondents had undergone mammogram screening, their mean travel distance was 53.4 km (SD = 34.5, range 8-112 km) and the mean travel expenditure was RM 38.97 (SD = 24.00, range RM7.60-78.40). Among those who did not go for mammogram screening, the estimated travel distance and expenditure had a skewed distribution with median travel distance of 22.0 km (IQR 12.0, 42.0, range 2.0-340.0) and the median travel cost of RM 17.40 (IQR 10.40, 30.00, range 3.40-240.00). Higher travel impedance was noted among those who lived in sub-urban and rural areas. In summary, availability of mammogram facilities was good in the central and west coast of the peninsula. The overall provider-to-population ratio was lower than recommended. Based on the travel impedance approach used, accessibility to subsidised mammogram screening among the respondents was good in urban areas but deprived in other areas. This study was a preliminary study with limitations. Nonetheless, the evidence suggests that actions have to be taken to improve the accessibility to opportunistic mammogram screening in Malaysia in pursuit of universal health coverage.