Influence of mental health perception and willingness-to-pay towards intention-to-support inclusion of mental health coverage in health insurance schemes: a cross sectional study in Malaysia

Maaheend R. Kumaran, Amuthaganesh Mathialagan, Kayilvezhi Katheravan, Kumaraswamy Kadamane, Priyananthini Rajagopal, Fuad R. Mahabot, Java K. M. Oblenda, Arshad Begum, Arulmuli Suppiah, Renu Ramalinggam


Background: Across the globe, there have been many mental health disorders and one of the suggested ways of financing mental health disorders is mental health insurance coverage. This study is aimed at determining the influence of mental health perception (MHP) and willingness- to-pay (WTP) towards supporting inclusion of mental health coverage in health insurance schemes in Malaysia.

Methods: A validated questionnaire was utilized for this study whereby three variables of the study (MHP, WTP and intention-to-support) were measured. The structured questionnaire contained closed ended questions where present of dichotomous (yes/no), multiple choice questions and 7-point Likert scale questions. 800 questionnaires were distributed to target respondents through online platforms. The inclusion criteria were local citizen of Malaysia, those who gave consent to take part in the study, literate in English, aged 21 years old and above. The data were analysed utilizing statistical package for the social sciences (SPSS) software version 23.0.

Results: More than half (87.7%) of the respondents agreed to pay for monthly mental health insurance premiums. Among those who were unwilling to pay (12.4%), were unable to afford the mental health insurance. Similarly, majority of respondents had favourable perception of mental health disorders. Correlation and regression analysis revealed that both WTP and influence of MHP were significant predictors of intention to support.

Conclusions: WTP and influence of MHP are important predictors that should be highlighted in creating equitable mental health care for all.


Mental health perception, Willingness-to-pay, Health insurance, Mental health coverage

Full Text:



GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789-858.

Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, Silove D. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol. 2014;43(2):476-93.

Salleh MR. The burden of mental illness: An emerging global disaster. J Clin Health Sci. 2018;3(1):5.

Ibrahim N, Amit N, Shahar S, Wee LH, Ismail R, Khairuddin R, et al. Do depression literacy, mental illness beliefs and stigma influence mental health help-seeking attitude? A cross-sectional study of secondary school and university students from B40 households in Malaysia. BMC Public Health. 2019;19(4):544.

Schoeps A, Lietz H, Sié A, Savadogo G, De Allegri M, Müller O, et al. Health insurance and child mortality in rural Burkina Faso. 2015;8.

Mezones-Holguín E, Amaya E, Bellido-Boza L, Mougenot B, Murillo JP, Villegas-Ortega J, Sara JCDC. Cobertura de aseguramiento en salud: el caso peruano desde la Ley de Aseguramiento Universal [Health insurance coverage: the peruvian case since the universal insurance act]. Rev Peru Med Exp Salud Publica. 2019;36(2):196-206.

All you need to know when buying medical insurance. Available at: Accessed on 22 February 2020.

Kalbe P. Neuordnung des BG-lichen Heilverfahrens aus der Sicht eines niedergelassenen D‑Arztes [Reform of occupational insurance medical treatment from the perspective of an accident insurance consultant]. Unfallchirurg. 2016;119(11):915-20.

Bogusz GB. Health insurers still don't adequately cover mental health treatment. Available at: couple%20of%20reasons%3A%20One,insurance%20companies%20for%20their%20services. Accessed on 22 February 2020.

Wong EC, Collins RL, Cerully JL, Roth E, Marks J, Yu J. Effects of stigma and Discrimination Reduction TRAININGS conducted under the California mental health Services AUTHORITY: An evaluation of the National alliance on mental ILLNESS adult programs. Rand Health Q. 2016;5(4):9.

Toohey MJ, Muralidharan A, Lucksted A, Dixon L. Caregiver positive and NEGATIVE Appraisals: Effects of the National alliance on mental Illness FAMILY-TO-FAMILY Intervention. J Nerv Ment Dis. 2016;204(2):156-9.

Stevens M, Manthorpe J, Martineau S, Steils N, Norrie C. An exploration of why health professionals seek to hold statutory powers in mental health services in England: considerations of the approved mental health professional role. J Ment Health. 2019:1-7.

Weil TP. With Additional Insurance Available, Why Are Not More Mental Health Services Being Provided? J Nerv Ment Dis. 2015;203(12):906-8.

The pros and cons of using health insurance for mental health care. On-demand mental health care. Larkr. 2018. Available at: Accessed on 22 February 2020.

Korolenko CP, Kensin DV. Reflections on the past and present state of Russian psychiatry. Anthropol Med. 2002;9(1):51-64.

Maust DT, Moniz MH, Zivin K, Kales HC, Davis MM. Attitudes About Required Coverage of Mental Health Care in a U.S. National Sample. Psychiatric services (Washington, D.C.). 2017;66(10):1101-4.

Krejcie RV, Morgan DW. Determining Sample Size For Research Activities. Sage J. 1970;30(3).

Arshat H, Tey Nai Peng. An overview of the population dynamics in Malaysia. Malays J Reprod Health. 1988;6(1):23-46.

Tafran K, Tumin M, Osman AF. Poverty, Income, and Unemployment as Determinants of Life Expectancy: Empirical Evidence from Panel Data of Thirteen Malaysian States. Iran J Public Health. 2020;49(2):294-303.

Stahlberg O, Soderstrom H, Rastam M, Gillberg C. Bipolar disorder, schizophrenia, and other psychotic disorders in adults with childhood onset AD/HD and/or autism spectrum disorders. J Neural Transm (Vienna). 2004;111(7):891-902.

Kingdon D. Everybody gets stressed, it's just the way we react that differs. Psychiatric Bulletin. 2009;33(12):441-2.

Parekh R. What is mental illness? 2018. Available at: Accessed on 26 March 2021.

Herman A, Stein D, Seedat S, Heeringa S, Moomal H, Williams D. The South African stress and Health (SASH) Study: 12- month and lifetime prevalence of common mental disorders. S Afr Med J. 2009;99(5):339-44.

Pervanidou P, Chrousos GP. Metabolic consequences of stress during childhood and adolescence. Metabolism. 2012;61(5):611-9.

Rowan K, McAlpine DD, Blewett LA. Access and cost barriers to mental health care, by insurance status, 1999-2010. Health Aff (Millwood). 2013;32(10):1723-30.

Rowan K, McAlpine DD, Blewett LA. Access and cost barriers to mental health care, by insurance status, 1999-2010. Health Aff (Millwood). 2013;32(10):1723-30.

Geoffrey R, Chris L. The Employment of People with Mental Illness. Australian e-Journal for the Advancement of Mental Health. 2005;4(2):129-71.

Yasemin C, Hasan C. Social Problems of People with Psychiatric Disorders and Their Families: A Qualitative Study on Patient and Patient Relatives. International Mediterranean Social Sciences Congress (MECAS)At: Budapest. 2020.

Harvey SB, Henderson M, Lelliott P, Hotopf M. Mental health and employment: Much work still to be done: The Br J Psychiatr. 2018;194(3).

Riffel T, Chen SP. Exploring the Knowledge, Attitudes, and Behavioural Responses of Healthcare Students towards Mental Illnesses-A Qualitative Study. Int J Environ Res Public Health. 2019;17(1):25.

Hanafiah AN, Bortel TV. A qualitative exploration of the perspectives of mental health professionals on stigma and discrimination of mental illness in Malaysia. Int J Ment Health Syst. 2015;10.

Povera A. Include mental health treatment in insurance coverage, says MPA: New Straits Times. 2018. Available at: nation/2019/05/490498/include-mental-health-treatment-insurance-coverage-says-mpa. Accessed on 04 March 2021.

Arif AR. Willingness to Pay For Health Insurance in Sarawak, Malaysia: A Contingent Valuation Method. Bangladesh J Med Sci. 2018;17(2).

Churchill C. Insuring the Low-Income Market: Challenges and Solutions for Commercial Insurers. Geneva Pap Risk Insur Issues Pract. 2007;32:401-12.

Nosratnejad S, Rashidian A, Akbari Sari A, Moradi N. Willingness to Pay for Complementary Health Care Insurance in Iran. Iran J Public Health. 2017;46(9):1247-55.

Hoffmann F, Koller D. Verschiedene Regionen, verschiedene Versichertenpopulationen? Soziodemografische und gesundheitsbezogene Unterschiede zwischen Krankenkassen [Different Regions, Differently Insured Populations? Socio-demographic and Health-related Differences Between Insurance Funds]. Gesundheitswesen. 2017;79(1):1-9.

Bernard P, Ellingrud K, Godsall J, Kotanko B, Reich A. The future of life INSURANCE: Reimagining the industry for the decade ahead. 2020. Available at: Accessed on 15 March 2021.

Singh J. Psychiatric and Mental Health Services Operational Policy. Available at: https://www.moh. Accessed on 15 March 2021.

Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry. 2002;1(1):16-20.

Subu MA, Holmes D, Elliot JE, Jacob JD. Persistent taboo understanding mental illness and stigma among Indonesian Adults through grounded theory. 1970.