Analysis of costs and utilization of ambulance services in the ministry of health facilities, Malaysia

Mohd Shahri Bahari; Farhana Aminuddin; Sivaraj Raman; Ainul Nadziha Mohd Hanafiah; Mohd Shaiful Jefri Mohd Nor Sham Kunusagaran; Nur Amalina Zaimi; Nor Zam Azihan Mohd Hassan; Ahmad Tajuddin Mohamad Nor

doi:10.1371/journal.pone.0276632

Analysis of costs and utilization of ambulance services in the ministry of health facilities, Malaysia

PLoS One. 2022 Nov 4;17(11):e0276632. doi: 10.1371/journal.pone.0276632. eCollection 2022.

Authors

Mohd Shahri Bahari¹, Farhana Aminuddin¹, Sivaraj Raman¹, Ainul Nadziha Mohd Hanafiah¹, Mohd Shaiful Jefri Mohd Nor Sham Kunusagaran¹, Nur Amalina Zaimi¹, Nor Zam Azihan Mohd Hassan¹, Ahmad Tajuddin Mohamad Nor²

Affiliations

¹ Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Malaysia.
² Hospital Tengku Ampuan Rahimah, Selangor, Malaysia.

Abstract

Background: Despite emergency ambulance services playing a pivotal role in accessibility to life-saving treatments in Malaysia, there are still numerous gaps in knowledge in terms of their utilization and cost. This leads to current policies on procurement, maintenance, and allocation being predicated on historical evidence and expert opinions. This study thus aims to analyse the cost and utilization of ambulance services in selected public health facilities in Malaysia.

Methods: A cross-sectional study was employed involving 239 ambulances from selected hospitals and clinics. Ambulance service utilization was based on the number of trips, distance and duration of travel obtained from travel logbooks. A mixed top-down and activity-based costing approach was used to estimate the monthly cost of ambulance services. This constituted personnel, maintenance, fuel, overhead, consumables, ambulance, and medical equipment costs. The utilization and costs of ambulance services were further compared between settings and geographical locations.

Results: The average total cost of ambulance services was MYR 11,410.44 (US$ 2,756.14) for hospitals and MYR 9,574.39 (US$ 2,312.65) for clinics, albeit not significantly different. Personnel cost was found to be the main contributor to the total cost, at around 44% and 42% in hospitals and clinics, respectively. There was however a significant difference in the total cost in terms of the type and age of ambulances, in addition to their location. In terms of service utilization, the median number of trips and duration of ambulance usage was significantly higher in clinics (31.88 trips and 58.58 hours) compared to hospitals (16.25 trips and 39.25 hours).

Conclusions: The total cost of ambulance services was higher in hospitals compared to clinics, while its utilization showed a converse trend. The current findings evidence that despite the ambulance services being all under the MOH, their operating process and utilization reflected an inherent difference by setting.

Copyright: © 2022 Bahari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Ambulances*
Cross-Sectional Studies
Emergency Medical Services*
Health Facilities
Malaysia

Grants and funding

This research was supported/ funded by Ministry of Health Malaysia, grant number NMRR-18-2944-44909 and it had no role in the study design, data collection, data analysis, data interpretation or preparation of the manuscript.