Incidence and Determinants of Post-Pandemic Catastrophic Health Expenditure Among Households in a Southern State of Malaysia

The COVID-19 pandemic caused an unprecedented burden on healthcare and significantly disrupted household economies that reshaped households’ expenditure patterns, particularly in health-related expenditure. High out-of-pocket health expenditure (OOPHE) inherently exposed households at risk of incurring catastrophic health expenditure (CHE). This study aimed to investigate the incidence and key determinants of CHE in the post-pandemic period among households in a southern state of Malaysia. A cross-sectional survey was conducted in Negeri Sembilan, a southern state of Malaysia between February and August 2024. A total of 400 head of households participated via proportionate stratified sampling. CHE was defined as the amount of OOPHE exceeding 10% of the monthly household’s expenditure. Descriptive analysis was performed to examine the sociodemographic characteristics of household heads and to determine the median monthly OOPHE (in MYR), while regression analysis was conducted to identify the determinants of CHE. The incidence of CHE was 16.8%. The determinants of CHE included smallest household size (aOR;2.874, 95% CI;1.317,6.271), household in Rembau district (aOR;13.191, 95% CI;3.061,56.843), household with higher education (aOR;2.995, 95% CI:1.599,5.609), and those who are not working (aOR;2.566, 95% CI;1.349,4.880). The post-pandemic incidence of CHE among households in Negeri Sembilan, Malaysia was high. Lower household size, district’s location, higher educational level and lack of occupation were significant determinants of CHE. Findings from this study highlight the urgent need for regular monitoring and targeted financial protection strategies to reduce CHE and promote equitable healthcare access in the post-pandemic period.