Are People Living With Diabetes Using More Outpatient Healthcare? Insights from Malaysia

Abstract:

Introduction:
Diabetes mellitus has markedly increased demand for outpatient healthcare services (OPHCU) in Malaysia’s mixed public-private system, driven by high prevalence and frequent comorbidities. Understanding utilisation patterns and associated factors enables improved health system planning.

Methods:
A cross-sectional study was conducted using data from 18,616 Malaysian adults aged 18–90 years, drawn from the 2015 National Health and Morbidity Survey. Diabetes is identified through self-report, laboratory results, or medication use. OPHCU is defined as visits to non-hospital outpatient care providers within the past 2 weeks. Sociodemographic and clinical variables (age, sex, ethnicity, income, marital status, education, comorbidities) were analysed. Multivariable logistic and multinomial regression examined associations and effect modification.

Results:
Diabetes prevalence was 21.8%. OPHCU occurred in 11.8% (95% CI: 10.45–13.28) of people living with diabetes, versus 8.1% (95% CI: 7.47–8.81) of non-diabetics. Diabetes was associated with 23% higher odds of OPHCU (aOR 1.23, 95% CI: 1.05–1.43; p=0.008). Greater utilisation was observed in Malay ethnicity (aOR 1.28), lower income (<RM1,500; aOR 1.25), unmarried status (aOR 1.34), and absence of hypercholesterolemia (aOR 1.73). Age, sex, and education did not have a significant effect. Public outpatient services were accessed by 8.8% of people with diabetes, compared to 4.4% of non-diabetics. Private OPHCU was higher in non-diabetics (3.6%) than in people with diabetes (2.9%), with minimal mixed use. Relative risk analysis confirmed people with diabetes were 1.44 times more likely to use public OPHCU and private services complemented rather than substituted for public services.

Discussion & Conclusion:
People living with diabetes utilised outpatient healthcare more than non-diabetics, with disparities by ethnicity, income, and marital status. Public sector OPHCU predominated, while private services complemented care for select groups. Addressing utilisation disparities through integrated policies is key to optimising diabetes management in Malaysia.