Assessing the utilization and cost-utility of the “Skim peduli kesihatan for the B40 group” (peka B40) program among felda residents at Kedah: a mixed-methods study

In response to the increasing prevalence of non-communicable diseases (NCDs) among the Malaysian population, the government has introduced the Skim Peduli Kesihatan untuk Kumpulan B40 (PeKa B40) program. However, the prevalence of the utilization of this health service was reportedly low. This study aims to examine the factors influencing the utilization of the PeKa B40 program and perform a cost-utility analysis (CUA). This study used a sequential explanatory mixed methods design. It involved a quantitative cross-sectional study to examine participants’ sociodemographic, socioeconomic, health status, and health-seeking behaviors. Then, focus group discussions (FGDs) were conducted to explain the quantitative results based on the participants’ experiences, understanding, and perceived benefits of the program. The study included 237 samples through convenience sampling for the quantitative part and 10 samples through purposive sampling for the qualitative part. This study was conducted at Felda Lubuk Merbau from January to April 2023. The determinant factor for utilization of the PeKa B40 program was analyzed using multiple logistic regressions. The CUA was presented as the average cost-utility ratio (ACUR) and incremental cost-utility ratio (ICUR), while the qualitative part was analyzed through thematic analysis. Data integration was performed to elucidate the quantitative findings with qualitative insight. This study found that the prevalence of the PeKa B40 program utilization among Felda Lubuk Merbau residents was 41.8%. The factors of utilization of the PeKa B40 program were positively associated with age (adj. OR: 1.064 [95%CI: 1.03, 1.10]), the female gender (adj. OR: 2.32 [95%CI: 1.15, 4.66]), presence of chronic diseases (adj. OR: 2.621 [95%CI: 1.28, 5.37]), persistent pain that mildly disturbs daily activities (adj. OR: 3.30 [95%CI: 1.31, 8.33]), and high disturbance of daily activities (adj. OR: 14.34 [95%CI: 2.18, 94.26]). The factors that were negatively associated with the utilization of the PeKa B40 program are poor self-rate health (adj. OR: 0.05 [95%CI: 0.01, 0.47]), intermediate self-rate (adj. OR: 0.25 [95%CI: 0.06, 0.95]) and good self-rate (adj. OR: 0.22 [95%CI: 0.06, 0.82]). The qualitative findings revealed low awareness of the PeKa B40 program among Felda Lubuk Merbau residents, with reliance on healthcare providers for information. The program helped to detect the undiagnosed conditions of chronic diseases. The challenges in the implementation of this program included limited promotion, rural demographic barriers, and stigma surrounding chronic diseases, which may hinder individuals from utilizing the program. The economic evaluation indicated that the total annual health expenditures for individuals utilizing the PeKa B40 program were significantly lower, at RM 571.74, compared to RM 728.74 for those not enrolled. The ACUR for the PeKa group was RM 618/QALY, while non-PeKa is RM 768/QALY. The ICUR for the PeKa B40 program was RM 6452.44 per QALY, which was below the Malaysia GDP as recommended by the World Health Organization (WHO). In conclusion, this study determined that the prevalence of the PeKa B40 program uptake among Felda Lubuk Merbau residents was higher compared to both the national and state levels. The program’s success in this locality can be attributed to the proactive participation of healthcare personnel and Felda management in its implementation within the community. The economic evaluation indicated that the PeKa B40 program is cost- effective; hence, it should be continued in the future to benefit the low socioeconomic group in Malaysia.