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. 2025 May 19;8(5):e70740.
doi: 10.1002/hsr2.70740. eCollection 2025 May.

Healthcare Cost Coverage and Hypertension and Diabetes Care Step Movement: A Five-Year Follow-Up Study in a Malaysian Semi-Rural Community

Adeola Folayan  1 , Quek Kia Fatt  2 , Mark Wing Loong Cheong  3 , Tin Tin Su  1
Affiliations

Healthcare Cost Coverage and Hypertension and Diabetes Care Step Movement: A Five-Year Follow-Up Study in a Malaysian Semi-Rural Community

Adeola Folayan et al. Health Sci Rep. .

Abstract

Background and aims: This study aims to understand how healthcare cost coverage (HCC) status affects hypertension and diabetes care across the three major care steps: awareness, treatment initiation and control.

Methods: The probability of progressing the care steps was determined with logistic regression. The backward movements of two care steps (treatment and control) were investigated using McNemar's tests and presented with a Sankey diagram. All results were disintegrated by HCC status.

Result: There was no evidence that having HCC contributed to any care step progression. However, there was no significant backward movement for diabetes treatment and blood pressure control for those with HCC, while those without HCC had a significant backward movement for diabetes treatment (54.3% [152/280], p < 0.001) and blood pressure control (31.6% [43/136], p = 0.04).

Conclusion: Our results suggest that HCC supported a reduction in backward movement for some care steps but did not contribute to care step progression. HCC policies should aim to progress enrolees from awareness to initiating treatment and achieving control to attaining long-term hypertension and diabetes control in low- and middle-income countries.

Keywords: care step backward movement; care step progression; care steps; healthcare cost coverage; hypertension and diabetes.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Distribution of hypertension and diabetes awareness, treatment and control among participants by healthcare cost coverage status in 2013 and 2018. ɪ 95% CI, Significant difference ***p < 0.001, **p < 0.01, *p < 0.05.
Figure 3
Figure 3
Care step backward movement in hypertension management by healthcare cost coverage status. *Significantly backward movement, p < 0.001. ^Significantly backward movement, p = 0.04.
Figure 4
Figure 4
Care step backward movement in diabetes management by healthcare cost coverage status. *Significantly backward movement, p < 0.001.
See this image and copyright information in PMC

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