Correction Report Response to xxxxxxProfessor Dr.
Andrew Tan Khee Guan
No Comment
Abstract
1. The flow of the abstract can be improved. It
would be preferred if it starts off with the basic
1-2 lines of introduction, followed by list of
objectives of the study, types of methodology
utilized, brief results of each objective and
snippets of policy implications or conclusions.
In other words, (i) background, (ii) objectives,
(iii) methodology and data, (iv) results, and (v)
discussions.
Chapter 1
1. [page 1, paragraph 2, lines 6-8]- Clarification
required. 81% +36%>100%?
Response Page
Has been changed accordingly for the Malay version of abstract xii- xv
and English version of abstract with the sequence of started with
background, followed by objectives, methodology and data,
results, and ended with discussions.
The percentage given does not refer to the distribution of N/A
allocation for healthcare financial sources which sum up to be
100%. This is just a statistic which indicated that there are
81.00% of Malaysians who used their current income to pay for
healthcare bills. In addition, there are 36.00% of Malaysians who
used their savings to pay for healthcare bills. In another words,
consumers can finance their healthcare bills with different
channels of financial sources and a combination of more than
one channels. For instance, consumers can fund their healthcare
bills through i) current income, ii) savings, iii) current income
1

2. [page 59-61, Section 4.1 Conceptual
Framework]- Can/should this section be moved
to Chapter 1? Figure 4.1 explains what is being
done in this study very well. This figure (“road
map”) describes each objective, methodology,
and variable used in the current study.
3. [page 2, paragraph 1]- You made a case to
examine curative and curative + preventive
healthcare in your background of study. But
discussions later focus mostly on preventive
only. Granted your results show few factors are
associated with curative healthcare (e.g., only
education). Will need to elaborate more on
these two types of healthcare and the lack of
association.
4. [page 4, paragraph 1, line 1]- Any reason why
Penang consumers rely more on private health
insurance as payor for healthcare and rely less
on government?
5. [page 5, paragraph 2, lines 11-12]- How do you
support the notion that Kuala Lumpur, Penang,
and Malacca are among the famous medical
tourism hubs in Malaysia?
together with savings, and etc. Therefore, the statistics will not
sum up to 100%.
Section 4.1 of conceptual framework and Figure 4.1 will remain N/A
in Chapter 4 instead of moving to Chapter 1 as the framework is
a summary/conception of ideas developed from literature review.
Instead, to provide the “road map” of the study, a synopsis on the
direction of study can be found in page 10-12 under the Section
1.6 Scope of Study.
The discussion on policy implications mainly focused on N/A
preventive healthcare only as findings showed that preventive
healthcare helps to reduce productivity loss. Given that spending
on curative healthcare is needed only in the event of falling ill,
hence the spending on curative healthcare is usually beyond the
consumers’ control as compared to spending on preventive
healthcare. With the limitation of current scope of study, the lack
of association in curative healthcare cannot be addressed and
further research is needed in future to elaborate more on this
phenomenon.
There was no explanation given from Institute of Public Health N/A
(2015b) on the findings on why Penang rely more on private
health insurance as payor for healthcare and rely less on
government. This can be suggested for future research.
This can be supported by Malaysia Healthcare Travel Council 6,
(2019) which reported that Penang is the top medical tourism footnote
destination in Malaysia which generated 40.00% to 50.00% of 1, page 6
the medical tourism income in Malaysia. This new information
has now been added to Page 6, paragraph 1, lines 3-5.
2
 Furthermore, footnote 1 has been added in page 6.
Footnote that has been added is as below:
New Straits Time (2018) reported that Malacca is one of the
leading states in medical tourism. In addition, Malaysia
Healthcare Travel Council (MHTC) even set up a MHTC
concierge at Kuala Lumpur International Airport (Wonderful
Malaysia, 2019). Furthermore, Abdul Manaf, Hussin, Kasim,
Alavi, & Dahari (2015) examined medical tourists’ perception on
Malaysia as a medical tourism country. Their study was carried
in Penang, Selangor, Kuala Lumpur, and Malacca as these states
are the major tourism hub in Malaysia.
References:
Abdul Manaf, N. H., Hussin, H., Kasim, P. N. J., Alavi, R., &
Dahari, Z. (2015). Country perspective on medical tourism:
the Malaysian experience. Leadership in Health Services,
28(1), 43–56. https://doi.org/doi: 10.1108/LHS-11-2013-
0038
New Straits Times. (2018, June 7). Banking on Melaka ooming
tourism. Retrieved from
https://www.nst.com.my/property/2018/06/377580/banking-
melaka-booming-tourism
Wonderful Malaysia. (2019). Everything there is to know about
Medical Tourism in Malaysia. Retrieved May 28, 2021,
from https://www.wonderfulmalaysia.com/medical-tourism-
in-malaysia.htm
6. [page 9, paragraph 2]- This paragraph The paragraph has been removed from problem statement and 11
elaborates on the scope of the study and has moved to scope of study which can be found in page 11,

3
 justifies why the study is conducted in Penang.
It is not a problem statement and does not
belong in the section.
7. [page 12, paragraph 1, lines 1-3]- Cite. Any
statement that does not belong to you nor from
general knowledge will have to be cited.
Chapter 2
1. [page 15, footnote 3]- These notations are not
defined yet. There needs to be a better
explanation if mentioned here. Can be better
explained above and removed footnote here.
Chapter 3
1. [page 33]-First line. Incorrect numbering for
the sentence “3) contact with ambulatory
mental healthcare within a year, and 4) contact
with dentist within a year.”
2. [page 55]- Suggest adding a Table of Summary
of the empirical review (and signs) right before
3.4 Literature Gap.
Chapter 4
1. [page 59–61, Section 4.1 Conceptual
Framework] – Can/should this section be
Section 1.6, lines 1-8 of paragraph 1.
Has been added with the citation “World Health Organization 12
(2021)” in paragraph 3, line 3 of page 12.
H
Footnote has been removed and the definition of n and ❑❑ has
16
been added in the main text above. The sentence of “Hence, for
consumer to stay alive, health stock that the consumer holds
must be greater than the minimum level of health stock
required.” has changed to “Hence, for consumer to stay alive,
H
health stock ( n ) that the consumer holds must be greater than
the minimum level of health stock ( ❑❑ ) required.” This can be
found in page 16, paragraph 1, lines 10-12.
Numbering has been corrected to 4) contact with ambulatory 34
mental healthcare within a year, and 5) contact with dentist
within a year.
Table of summary for empirical review has been added in page 43-44,
43-44 for demand for healthcare (Table 3.1) and page 61-62 for 61-62
demand for health insurance (Table 3.2).
Section 4.1 of conceptual framework and Figure 4.1 will remain N/A
in Chapter 4 instead of moving to Chapter 1 as the framework is
4
 moved to Chapter 1? Figure 4.1 explained very a summary/conception of ideas developed from literature review.
well what was being done in this study. This Instead, to provide the “road map” of the study, a synopsis on the
figure (“road map”) described each objective, direction of study can be found in page 10-12 under the Section
methodology, and variable used in the current 1.6 Scope of Study.
study.
2. [page 61, paragraph 3, line 7] – Pilot study of The misleading sentence of “Pilot study was carried out before 68-69
500 respondents? the data collection from 500 respondents and this study utilised
STATA 12.0 software package for data and econometric
analysis.” has been split into two:
i) Pilot study which consisted of 50 respondents was carried
out before the data collection to check on whether the
respondents able to understand the questionnaire. (page
68, last 2 lines)
ii) This study employed 500 respondents and utilised
STATA 12.0 software package for data and econometric
analysis. (page 69, first 2 lines)
3. [page 64, paragraph 1, line 1] – Why the choice The reasons for included working adults aged 61-64 years old 71
of study population of working adults aged has been added as below in page 71, paragraph 2:
between 18–64 years old? Why not 18–60
years? 60 years is the official retirement age of “According to World Bank (2020), Malaysia is currently facing a
the government sector. rapid aging trend where more than 7.00% of the population are
aged 65 years old in 2020. The aging rate will further increase to
14.00% of the population in year 2044 while more than 20.00%
of the population in year 2056. Given the rising of aging
population and life expectancy, this study included working
adults who aged between 61-64 years old. Even though the
mandatory retirement age for government employee in Malaysia

5

4. [page 68, Section 1] – For household income
range, please state clearly did you follow the
national numbers or Penang numbers?
Remember that Penang numbers might not be
reflected by national figures and vice versa. In
other words, the income thresholds for
household income class (e.g., T20) might be
higher/lower than that of the nation. Check
Khazanah Research Institute (2018).
5. [page 73, footnote 12] – Why did you exclude
dental check-ups/oral health? Can that also be
considered akin to health screening under
preventive healthcare?
is 60 years old, there are still high percentage of older age (60-64
years old) self-employed in Malaysia. For instance, World Bank
(2020) reported that in Malaysia, 43.10% of employed men and
50.00% of employed women between age 60-64 years old are
self-employed.”
It followed the national figures instead of the figures in Penang 76
state. The word “national” has been added in the sentence as
below:
“Household income [the interval follows approximately the
national income group categorisation outlined in the Eleventh
Malaysia Plan (Economic Planning Unit, 2015a) for low (B40),
middle (M40), and high (T20) income groups]”
Certain dental/oral healthcare that belongs to curative healthcare Footnote
are included in this study. Footnote 14 in page 81 listed down 15, page
types of dental/oral health that do not belong to curative 81
healthcare. Since regular dental check-ups with the purpose of
preventing tooth decay, tartar, plaque, and oral diseases belongs
to preventive healthcare, hence, were excluded in curative
healthcare. Besides that, aesthetic dental or cosmetic dental
which do not belong to curative healthcare were excluded too.
However, in preventive healthcare, this study excluded oral
healthcare too. This is due to preventive oral healthcare may turn
out to be curative oral healthcare in some circumstances. For
instance, regular dental check-ups (preventive healthcare) may
6

6. [page 73 & 75] – What about the components
for the combo of curative + preventive
healthcare (treatment + non-treatment)? You
did this later in page 75 by describing the
questionnaire. Be consistent in explaining this
component in this part.
7. [page 74, paragraph 2, Section 4.4.2
Econometric Model] – Justify the use of the
multinomial logit model by stating there is no
ordering between each type of healthcare (to
differentiate from the ordered logit/probit
where ordering is a criteria).
8. [page 77, Figure 4.5] – Add some rows to
briefly describe the dependent variables in
tabular form too. It could be a somewhat
extended version of Figure 4.2. Of course,
end up to be curative healthcare if tooth decay was discovered
and filling treatment was needed. Besides that, according to
Health Minister Datuk Seri Dr. Dzulkefly Ahmad, Malaysians
have low awareness on dental healthcare where only 27.40% of
adults go for dental check-up yearly while 42.00% of adults visit
dentists every two years (The Star Online, 2019). This new
information has been added to page 81, footnote 15.
The components for curative and preventive healthcare has been 82
added as below in page 82, paragraph 2:
“Meanwhile, types of out-of-pocket spending for treatment
(curative healthcare) and non-treatment purposes (preventive
healthcare) taken into consideration are: i) medical services, ii)
medicine or drugs prescribed by doctor, and iii) non-prescription
drugs or over-the-counter medicine or traditional medicine, iv)
vitamins or supplements, and v) vaccination and health
screening.”
Justification for using multinomial logit model has been added as 82
below in page 82, paragraph 3, lines 3-5.
“Given that there is no ordering between each type of healthcare,
hence multinomial logit model is chosen in this study.”
Table 4.5 has been added into page 85 to provide a brief 85
description of the dependent variables.
7
 there will not be expected signs for these
dependent variables.
9. [page 79 – 87] – If you had a table in Chapter
3, you could then refer to it in this section
when discussing previous studies and expected
signs.
10. [page 81, paragraph 1, lines 5–9] – Again, are
these income ranges based on Malaysia or
Penang? Cite?
11. [page 85, paragraph 1, line 4]- Repeated word
of “due to” in the sentence.
12. [page 95, paragraph 2, Ethnicity] –
Malay/Muslims will buy Takaful instead of
conventional insurance. How did you
differentiate this in the questionnaire and your
study? Based on your questionnaire, you did
not state whether Takaful is included.
Otherwise, you might be under-counting.
Takaful insurance is a fast-growing market and
could be “… overtaking conventional
insurance” (The Star, 5 May 2020).
13. [page 104, paragraph 3, line 5]- Numbering
should be ii) instead of iii).
Chapter 5
1. [page 106, paragraph 3, Section 5.1.1 Sample
Characteristics] – What is the breakdown
according to the breakdown of curative
Table of summary for selected past empirical studies has been N/A
added in Chapter 3. This can be found in Table 3.1 on page 43-
44, and Table 3.2 on page 61-62.
These income ranges are based on Malaysia following the data N/A
from Economic Planning Unit (2015a) instead of Penang state.
The word “national” has been added to page 76, Section I, vi.
Repeated word of “due to” has been removed from fifth line of 94
page 94.
This study included Takaful health insurance. However, the N/A
word “Takaful” is not included in the questionnaire as to avoid
confusion. This is to avoid having respondents who have Takaful
insurance instead of Takaful health insurance to check “yes”
when they answer the question regarding to private health
insurance ownership. To ensure that respondents are aware that
Takaful health insurance is included in this study, I had verbally
informed the respondents that Takaful health insurance is
included in this study before getting their consent to participate
in this study.
Numbering has been corrected to ii) in page 113, paragraph 3, 113
line 5.
Breakdown according to the breakdown of curative healthcare, N/A
preventive healthcare, both curative and preventive healthcare,
and no out-of-pocket healthcare spending can be found in page
8
 (treatment), preventive (non-treatment) and
curative+preventive (treatment +non-
treatment), and no-spending. Refer Figure 4.2,
pg. 72.
2. [page 107, paragraph 1, lines 9–10] – “… less
likely to not spend …”. Double negation?
Confusing.
3. [page 116, paragraph 2] – Elaborate why only
one factor (i.e., tertiary education) is
statistically significant in curative healthcare.
This result stands out like a sore thumb.
4. [page 116–126] – Define and abbreviate some
of the terminologies (e.g., multinomial log-
odds etc) or leave some out (e.g., all other
variables held constant, holding all other
variables remain constant, keeping all variables
unchanged etc). For example, you can state “…
multinomial log-odds (henceforth, odds)” and
then define it later simply as “odds”. It can also The repeated usage of “all other variables held constant etc. has
be assumed that all results described assume been removed accordingly throughout Chapter 5. To avoid
125 (last paragraph, lines 6-9) and page 126 (first line).
Sentences has been changed to “This indicates that males 117
(62.70%) are more likely to not spend on out-of-pocket
healthcare than females (37.30%)” in page 117, paragraph 1,
lines 9-10.
Given that spending on curative healthcare is needed only in the N/A
event of falling ill, hence the spending on curative healthcare is
usually beyond the consumers’ control as compared to spending
on preventive healthcare. With the limitation of current scope of
study, the lack of association in curative healthcare cannot be
addressed and further research is needed in future to elaborate
more on this phenomenon. However, one of the possible reasons
for consumers with higher education to be more likely to spend
on curative healthcare may be due to they being more health
conscious and have better knowledge in accessing healthcare.
Multinomial log-odds has been abbreviated as log-odds in page 125-131
125, last paragraph, line 2 as below:
“Here, coefficient is interpreted in terms of multinomial log-odds
(henceforth log-odds) and relative risk ratio is interpreted as the
risk of the outcome falling in the comparison group compared to
falling in the base outcome.”
9
 ceteris paribus. Also, the sub-headings already
state “… Relative to No Out-of-Pocket
Healthcare”. Therefore, this comparison can be
assumed, and it is not necessary to repeat the
phrase. Otherwise, it is quite laborious to read
these terms repeatedly.
5. [page 116–126] – I am unsure about the
lengthy illustrations of the multinomial logit
regression coefficients and relative risk ratios. risk ratio.
Please check do these make intuitive sense. If
not, you may state “Since the multinomial logit
parameter estimates do not have direct
interpretations, the following discussions focus
on the marginal effects of the respective factors 2012).”
associated with …” Further, you sometimes
refer to these odds as likelihoods.
repeated usage of “all other variables held constant etc.”
Sentences as below has been added to page 126, lines 7-8:
“Furthermore, all results that discussed next are assumed ceteris
paribus.”
Given that the sub-headings already stated “…Relative to No
Out-of-Pocket Healthcare”, the phrase of “relative to no out-of-
pocket healthcare spending” has been removed accordingly
throughout page 126-131.
Discussion of log-odds has been removed since log-odds do not 125
have intuitive sense. The discussion will be focused on relative
The information as below has been added to page 125, last
paragraph, lines 4-5:
“The discussion on this section will be focused on relative risk
ratio since log-odds do not carry intuitive meaning (Greene,
Even though marginal effects may be easier to understand than
relative risk ratio, the results between this two are consistent and
not contradicted. Besides that, it provides different interpretation
and extra information. For instance, in this study, the discussion
on relative risk ratio is interpreted as the risk of the outcome
falling in the comparison group (spending curative healthcare
only, spending preventive healthcare only, spending both
curative and preventive healthcare) compared to falling in the
base outcome (no out-of-pocket healthcare spending). On the
10
 other hand, marginal effects examined on how the changes in the
independent variables will affect the probability of being in the
various out-of-pocket healthcare spending possibilities for a
given “hypothetical” respondent.

The word “likelihood” has been removed accordingly throughout

the discussion of log-odds in Section 5.1.3.
6. [page 116 – 126] - Do not repeatedly report Results that are not statistically significant has been removed 126-133
results which are not statistically significant. from page 126-133.
These exposure variables are not associated
with your outcome variables.
7. The overall discussions in this sub-section can The overall discussions in this sub-section have been revised 126-133,
be further improved. For example, [page 126, accordingly. 164-165
paragraph. 1, lines 1–5] can be revised into
simply “Individuals are 1.55 times less likely to The changes are listed as below:
spend on curative than preventive healthcare [page 126, last 2 lines]- “This suggests that respondent who
than otherwise.” received tertiary education will be more likely to spend on
curative healthcare only than otherwise.”

[page 129, paragraph 2, lines 3-6]- “The relative risk for

spending on preventive healthcare only increases by a factor of
1.80 for being a female than otherwise. Similarly, the relative
risk for spending on preventive healthcare only increases by a
factor of 2.00 for being married than otherwise (significant at
10% level of significance).

[page 130, paragraph 2, lines 2-4]- “The relative risk of spending

preventive healthcare only would be expected to increase by a

11
factor of 3.85 for those who have health coverage than
otherwise.”
[page 131, paragraph 1, lines 4-6]- “Having achieved tertiary
education than otherwise increases the relative risk of spending
both curative and preventive healthcare by a factor of 2.54.

[page 131, paragraph 2, lines 3-4]- “This suggests that being

healthy would reduce the relative risk for spending on both
curative and preventive healthcare by a factor of 0.46 than
otherwise.”

[page 131, paragraph 3, lines 2-4]- “For those having health

coverage than otherwise, the relative risk for spending on both
curative and preventive healthcare would be expected to increase
by a factor of 2.14.”

[page 132, paragraph 3, lines 2-6]- “Those who are married than
otherwise are less likely to spend on curative healthcare only
than preventive healthcare only. Relative risk for spending on
curative healthcare only compared to spending on preventive
healthcare only would be expected to decrease by a factor of
0.47 for married respondents than otherwise.”

[page 133, paragraph 2, lines 3-5]- “The relative risk of those

who have health coverage than otherwise to spend curative
healthcare only relative to spending preventive healthcare only
would be expected to decrease by a factor of 0.21.”

12
 Similarly, the discussions on logit model have been revised
accordingly.

The changes are listed as below:

[page 164, paragraph 2, lines 4-6]- “Having tertiary education
positively associated to private health insurance purchase
decision whereby the odds for a respondent who achieved
tertiary education to purchase private health insurance is 1.71
times greater than otherwise.”

[page 164, last paragraph, lines 4-6]- “This study found that the
odds for a healthy respondent to purchase private health
insurance is 1.55 times higher than otherwise.”

[page 165, paragraph 1, lines 4-5]- “The odds for a respondent

who has at least a child to financially take care of is 1.84 times
greater than otherwise.”

[page 165, paragraph 2, lines 3-5]- “Respondent who perceived

private health insurance as important has 4.66 times greater the
odds to purchase private health insurance than otherwise.”
8. [page 126–133] – Section 5.1.4 Marginal The results for marginal effects are consistent with the results in N/A
Effects … How do these results differ from Section 5.1.3. There are no contradiction between these two
Section 5.1.3? Do they contradict? If so, how sections.
would your conclusions change?
9. [page 135, paragraph 2] – One would expect The reason that age is only found significant in preventive N/A
(age) older individuals to be associated with healthcare instead of curative healthcare may be due to the fact
(spend more on) curative healthcare (e.g., that curative healthcare spending are usually beyond the control

13
 hospital bills, X-rays). They might fall sick
more. But why was this association found only
for preventive healthcare? Any comments?
10. [page 138, paragraph. 2, lines 16–18] – The
discussions on the role of education seem to
focus only on preventive healthcare while little
is mentioned on curative healthcare.
Nonetheless, while I agree that higher educated
individuals are more likely to spend on
preventive healthcare (vaccination, screening
etc) perhaps because of better knowledge, your
results show higher educated individuals are
more likely to spend on items that cure and
promote recovery (i.e., hospital rooms, x-rays
etc). In other words, higher educated
individuals tend to spend on getting themselves
fixed instead of preventing themselves from
needing to be fixed?
11. [page 154–159] – Again, interpretations of
estimated regression coefficients (log-odds)
and even odds ratio of the logit estimates are
questionable. Or it should be stated as "Since
Logit parameter estimates do not have direct
interpretations, the following discussions
focuses on the marginal effects of the
respective factors associated with private
health insurance ownership decisions."
of consumers as it only occurred in the event of falling ills.
Conversely, spending on preventive healthcare can be decided by
consumers at any time.
Education was found to be significant among consumers with N/A
curative healthcare only However, education was also found
significant among consumers with both curative and preventive
healthcare spending together. This showed that while consumers
spend on curative healthcare to restore their health status,
concurrently they also spend on preventive healthcare to enhance
their health status.
Discussions of log-odds have been removed since log-odds do 163
not have intuitive sense. The discussions will focus on odds
ratio.
The information as below has been added to page 163, first 2
lines:
“The discussion on this section will be focused on odds ratio
since log-odds do not carry intuitive meaning (Greene, 2012).”
Even though marginal effects may be easier to understand than
14
 odds ratio, the results between these two are consistent and not
contradicted. Besides that, it provides different interpretation and
extra information. In this study, marginal effects looking on how
the changes in the independent variables affected the probability
of purchasing private health insurance for a given “hypothetical”
respondent. On the other hand, odds ratio measured the odds that
private health insurance purchased will occur given a particular
exposure, compared to the odds that private health insurance
purchased will occur in the absence of that exposure.
12. [page 172, line 2]- “Spending on preventive Has been corrected to “Spending on preventive healthcare only 178
healthcare only (health enhancement) (health enhancement) positively associated with
positively affected by respondent’s…”. The respondent’s…”in page 178, lines 3-5.
word “affected” should be “associated with” as
there is no cause and effect.
13. [page 172, line 4]- The correct word should be Has been corrected to “are positively associated with” in page 178
“positively associated” instead of “positively 178, line 6.
related”.
14. [page 172, paragraph 2, line 4]- The correct Has been corrected to “statistically associated with” in page 178, 178
word should be “statistically associated with” paragraph 3, line 4.
instead of “statistically significant related to”.
Chapter 6
1. [page 174, paragraph 2] – This paragraph is not This paragraph has been removed. N/A
a summary of main findings, policy
implications, nor conclusions.
2. [page 178, paragraph 3] – Policy implications Sentences has been revised to make it clearer by tied up age with 184
should be related to the results of the study. For policy as below in page 184, lines 6-10:
example, how does the recommendation of 2- “With such, hospitals and healthcare screening companies such

15
 in-1 package related to age and the fact that the as BP healthcare and PATHLAB should collaborate with
trend for private health insurance is increasing insurance companies to attract more potential consumers
among the younger generation? Need to tie up (younger generation). For instance, they can offer an attractive
age with policies. 2-in-1 package which offers healthcare screening promotion to
those who sign up private health insurance and vice versa among
the younger generation within 35-39 years old.”
3. [page 178, paragraph 4] – Since the study Findings in this study which found that females are more likely N/A
found females are more likely to spend on to spend on preventive healthcare are not contradicted with the
preventive healthcare, how is this related to the fact that 60% of females did not undergo cervical cancer
fact that 60% did not undergo cervical cancer screening and BSE. This is because the findings in this study
screening & BSE? How does your compared the preventive healthcare spending among females and
recommendation that more campaigns and free males while the findings from Institute for Public Health (2020)
PAP smear and mammograms to detect early are solely reported the statistics of females who did not undergo
detection be related to your study? Aren’t cervical cancer screening and BSE.
women already more likely to spend on
preventive healthcare? This study suggested policy for both females and males. Policy
recommendation for males can be found in page 185, paragraph
2, lines 1-5 as below:
“Although females found to be in higher likelihood in spending
preventive healthcare, males should not be neglected. Indeed,
more focus should be concentrated on males too. For instance,
more campaigns on the awareness of prostate cancer should be
carried out and free screening should be provided to those in
high-risk group to increase the screening rate.”
4. [page 179, paragraph 2] – As previously Takaful health insurance is included in this study and the N/A
questioned, is it true that Bumiputeras are respondents were aware about it as they were verbally informed
lacking in purchasing health insurance or they before getting consent to participate in this study.

16
 are already buying Takaful instead? Did your
questionnaire take this into account? A blanket
statement that Bumiputeras are least likely to
purchase private health insurance might be
misleading. Or you may even acknowledge this
somewhere as limitations or even suggestions
for future research.
5. [page 180, paragraph 2] – Are there any Policy recommendation on singles has been added as below in 187
recommendations to singles who are less likely page 187, lines 5-9:
to spend on preventive healthcare? Your results “On the other hand, since singles are less likely to spend on
show married consumers are more likely to preventive healthcare, this study suggested that government to
spend on preventive healthcare, so while I provide extra allocation of tax relief or tax subsidy to singles
agree that attractive family package plans can who are keen in taking precautionary measurements on their own
provide benefits to this group, should there also health by undergoing full healthcare screening.”
be targeted policies to those less likely to be
more involved in this activity (singles)?
6. [page 181, paragraph 1] – Suggested policy Policy recommendation on consumers with lower education has 187
implications of “promoting private health been added as below in page 187, paragraph 2, lines 5-10:
insurance (to be) carried out in tertiary “On the other hand, to increase the rate of private health
institutions to attract students (young adults) insurance purchased, consumers who have lower education level
who will be the potential consumers”. Since the should be targeted too since they are less likely to purchase
results show that education level is positively private health insurance. Private health insurance companies
associated with private health insurance should use wordings that are easier to understand in the policy so
purchases, shouldn’t the targeted group be that consumers with lower education levels can easily understand
those with lower education levels instead? Why and will not be shy away from the purchase.”
still target higher educated individuals when
they are already buying it?

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7. [page 181, paragraph 2] – Exactly which
results are you referring to in recommending
this policy measure? It is not clear to me or is
this some form of general statement from your
own point of view (which should not be the
case). You need to relate the specific findings
of your study to the policy recommendations.
Otherwise, this paragraph is too vague.
8. [page 180–181, Section 6.3 Policy
Implications] – The majority of policy
implications addressed RO1 (types of
healthcare usage, specifically preventive
healthcare and not even on curative and
curative+preventive) and RO3 consumer
decisions to purchase private health insurance.
It would be nice to see a more balanced and
greater emphasis on how RO2 (whether lower
productivity loss associated with spending on
preventive healthcare) and RO4 (whether
private health insurance shifts the cost burden)
affect policy measures. Moreover, while it is
true that factors associated with curative
healthcare are limited (education only), most
discussions and policy implications focus only
The results are based on income where lower-income groups are 188
less likely to spend both curative and preventive healthcare
compared to high-income groups.
Sentences as below has been added to page 188, paragraph 1,
lines 11-14 to relate the findings and policy recommendation:
“Since lower-income consumers are less likely to spend both
curative and preventive healthcare compared to high-income
consumers, subsidy on healthcare screening could reduce the
cost of healthcare screening and make it more appealing and
affordable to the lower-income consumers.”
Policy implications in this study are focused on research 183-184
objective 2 and objective 4 since the findings in this study
showed that preventive healthcare usage reduces productivity
loss and private health insurance purchased helps to shift
healthcare cost burden from public healthcare to private
healthcare.
To make it clearer, sentences as below has been added in the
beginning of the discussion of policy implications in page 183,
last paragraph, lines 2-5 to first line of page 184:
“Suggestions of policy implications will be focused on ways to
increase the usage of productivity loss and private health
insurance purchased since findings showed that preventive
healthcare usage reduces productivity loss and private health
insurance purchased helps to shift healthcare cost burden from
public healthcare to private healthcare.”
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 on preventive healthcare. Even the
combinations of curative+preventive are
limited. You need to answer your own
justification on why you chose to do those
types of healthcare usage and how this study
has contributed to the literature on these
objectives. Otherwise, why even do it?
9. [page 182, Section 6.4 Limitations of study] –
Why did you leave out dental? Did you
consider Takaful? Would your results be more
insightful if you use panel data or time series?
Say something like “The use of a single cross
section study may prevent a closer examination
of the dynamics of healthcare financing
decisions. Studies in the future may consider
panel samples based on nationwide data when
such information are available.”
References
The reasons that policy implications are focus only on preventive
healthcare instead of curative healthcare is because findings
showed that preventive healthcare spending reduces productivity
loss. Besides that, curative healthcare spending are usually
beyond the control of consumers.
This study excluded dental healthcare in preventive healthcare 188-189
spending as preventive oral healthcare may turn out to be
curative oral healthcare in some circumstances. Besides that,
Malaysians have low awareness on dental healthcare. This new
information has been added earlier in page 81, footnote 15.
Yes, this study included Takaful health insurance.
Sentences as below has been added to Section 6.4 Limitations of
Study in page 188, last paragraph, lines 3-4:
“Moreover, the use of a single cross-section study may prevent a
closer examination of the dynamics of healthcare financing
decisions.”
Furthermore, sentences as below has been added to Section 6.5
Suggestions for Future Research in page 189, paragraph 2, lines
3-4:
“Furthermore, studies in the future may consider panel samples
based on nationwide data when such information are available.”
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1. [page 187, Grossman (1972a)]- The correct Has been corrected to “Economy” as below in page 194: 194
word should be “Economy” instead of
“Economic”. Grossman, M. (1972a). On the concept of health capital and the
demand for health. Journal of Political Economy, 80(2),
223–255.
2. [page 188, Hadley & Reschovsky (2003)]- Has been corrected to “INQUIRY: The Journal of Health Care 194
Journal is “INQUIRY: The Journal of Health Organization, Provision, and Financing” as below in page 194:
Care Organization, Provision, and
Financing” instead of just “INQUIRY”. Hadley, J., & Reschovsky, J. D. (2003). Health and the Cost of
Nongroup Insurance. Inquiry: The Journal of Health Care
Organization, Provision, and Financing, 40(3), 235–253.
https://doi.org/10.5034/inquiryjrnl_40.3.235
3. [page 189, Kapur et al. (2007)]- Journal is Has been corrected to “INQUIRY: The Journal of Health Care 196
“INQUIRY: The Journal of Health Care Organization, Provision, and Financing” as below in page 196:
Organization, Provision, and Financing”
instead of just “INQUIRY”. Kapur, K., Escarce, J. J., & Marquis, M. S. (2007). Individual
Health Insurance within the Family: Can Subsidies Promote
Family Coverage? Inquiry: The Journal of Health Care
Organization, Provision, and Financing, 44(3), 303–320.
https://doi.org/10.5034/inquiryjrnl_44.3.303
4. [page 194, Yamada et al. (2014)]- Typing Has been corrected to 2(1) as below in page 202: 202
error “2(920710)”. It should be “2(1)”.
Yamada, T., Yamada, T., Chen, C. C., & Zeng, W. (2014).
Determinants of health insurance and hospitalization.
Cogent Economics & Finance, 2(1), 1–27.
https://doi.org/10.1080/23322039.2014.920271

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