Factors Influencing Demand for Medical Care among Urban Dwellers in Sarawak

In recent years, the growth of health sector and medical inflation coupled with the lack of fund has lead to growing number of health reforms. Sarawak is experiencing rising
income, changing role of women and family characteristic, rising life expectancy and the upward trend of health insurance which have exerted significant impact on medical
care demand. Thus, the objective of the study is to provide important insight to study medical demand in Sarawak. Different from other studies, the Hurdle Model is employed to study outpatient and hospital care demand in family context. Medical demand is determined by (a) price of medical care (b) opportunity cost of time (c) price of home care (d) externalities (e) health status (f) age (g) education and (h) income of the head of family. The medical equations are estimated separately since outpatient and hospital care demand differs systematically. Due to the distinctive pattern of gender utilization, medical equations are estimated separately for male and female The units of the study consist of 394 families in the urban regions of Sarawak, namely Kuching, Sibu, Miri and Bintulu which undergo rapid urbanization. It reveals that due to the changing role of women, married men are not able to substitute home care for market care as readily as before. Increase in price of home care has lead to increase demand for market care. The number of children under six years old has exerted significant impact on mother's use of medical care rather than men. It is evidenced that a loss in women's health is likely to be borne by family compared with
men. The study infers that medical care is a necessity good. It reveals that insurance often excludes those who are poor and sick. Since medical demand is triggered by
poor health status, public involvement is essential for the health of the population. It suggests that health reforms which reduce wastage and disparities between income, health status and source of care should be emphasized. It concludes that changes in the family characteristic and distinctive different pattern of gender utilization should be taken into consideration by policy maker to ensure equity and equality in the health care system.