International Journal of Business and Social Science Vol. 2 No. 21 [Special Issue November 2011]

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1 Iteratoal Joural of Busess ad Socal Scece Vol. No. [Specal Issue November 0] AN ASSESMENT OF THE PERFORMANCE OF REFORM IN NIGERIA AN MALAYSIAN NATIONAL HEALTH SCHEME PROGRAMME Yahya Saleh Ibrahm Uverst Utara Malaysa, College of Arts ad Socal Sceces octoral egree Caddate, Occupatoal Safety ad Health Maagemet, pp Maybak, Studet Resdetal Hall, Block W Room 04 UUM, 0600 Stok Kedah arul Ama Mohamad Kha Jamal Kha Cyberjaya Uversty College of Medcal Sceces (CUCMS) Jala Tekokrat 3, Cyber 4, 6300 Cyberjaya Selegor arul Ehsa Malaysa Abstract The study assesed the performace of health care ad safety servces reform Ngera ad Malaysa Natoal Health Scheme. Survey method of resaerch was adopted usg questoare as the major tool of data collecto. The data collected through the questoare method were subjected to fferece--fferece ecoometrc statstcal model aalyses. The am was to arrve at a cocluso o the comparatve aalyss of health care reform the two coutres (Ngera ad Malaysa), ad as well betwee two perods (before ad after reform). The fdgs revealed a mpressve result supportg health care reform the two coutres. The comparatve aalyss also revealed a result showg the superorty of Malaysa healthcare reform over that of Ngera. The result of performace testg of the reform before ad after shows that the reform mpacted postvely o healthcare ad safety servces delvery to the employees both Ngera ad Malaysa. The study cocludes that, reform s oe of the vartable tools to use mprovg health care ad safety servces performace Ngera ad Malaysa. KEYWORS: Natoal Health Scheme, fferece--ffereces, Safety Nets. 0 INTROUCTION A desre to evolve a system that wll provde for a way of facg health care that would esure the achevemet of care that wll prevets the deprvato of patet s due to ther ablty to pay s most mportat. A attempt at avodace of wasteful spedg ad as a move to esures health care that s geared towards reflectg the dfferet demads of dvdual patets preoccupes most govermetal health polces today. Reform as oe of the strumet to esure all the above were preseted dfferet facets ad style by dfferets govermet ad polcy makg bodes dfferet coutres. It s based o ths desre that Ngera evolve Natoal Health Isurace Scheme as the ma facg ad galvazg agets of ts reform healthcare sector, wth focus o formal sector as base le faacg source (NHIS ecree 35, 999). The Malaysa govermet troduces the Natoal Health Accouts ad as well ope up doors sce 980 s to the operato of prvate health surace outfts whch gave brth to CUEPECS care as a example (Jamla, 00; Abdurrahm, 009; Nk & ael, 009). The attempt to reform health care delvery was frst tated by the most developed coutres such as USA, Caada ad the comg together of most wester Europea coutres uder OEC arragemet. The ma goal s to esure equty, affordblty, accessblty, reduce watg tme ad mprove delvery effcecy (OEC, 006/07; Joh, Allso, & Lsa, 007). The uversal, atoal health surace systems created usually emvelope a clear goal of esurg equty of health care to all at a affordable cost. Sce 980, more ad more coutres ca o loger afford the commtmet of publc fud to faacg complete health care for the whole populato (Cutler, 00). May health ecoomsts advocates ad polcymakers have resolved to evolve a ew health surace system wth co-paymet opto. I addto to copaymet opto a publc/prvate/ mxed surace system or smply called parallel system, whch prvate health surace wll play a mportat role (Cherchovsky, 000; Hurley et al, 00), meetg up wth the ever creasg healthcare servces demads of the ctzes s sorted. Most of the prevous studes focused o the healthcare reform of developed coutres, such as the Uted States, the Germay, OEC ad Caada, etc. 45

2 The Specal Issue o Cotemporary Research Arts ad Socal Scece 46 Cetre for Promotg Ideas, USA The aalyss of health care ad health surace systems emergg markets especally Ngera (Afrca) ad Malaysa (East Asa) s very lmted whch make ths study relevat at ths perod. Therefore, ths study focuses o assessg the performace of the ew healthcare market Ngera ad Malaysa, wth specal atteto to servces redered by both publc ad prvate provders the two coutres, ad at the same tme compares same the two coutres, usg before ad after dces.. 0 LITERATURE REVIEW Prevous research was coducted to determe whether or ot reform has ay postve mpact o the ssue of access, there was o dscrmato as to whether the healthcare ad safety servces s provded by the publc wth partal commercalzato or prvate-for-proft. To do that, umber of physca vsts was measured wth a self admstered questoare, wth questos such as urg the past twelve moth about how may tmes dd you see or talk to medcal doctor about your health?. I 998 a mea of 3.7 was obtaed. Aother questo has to do wth the medcato ad a questo Are you curretly takg prescrbed medcato f yes the; how may dfferet prescrbed medcato do you ow take? Those who aswer o were coded (0), the umber of prescrbed medcato raged from 0 to or more, a mea of.4 was obtaed (Cathere & Joh, 000). I addto to the above research, the study coducted by Nk ad ael, (009), revealed that 983, prvate surace played a very lttle role the provso of healthcare ad safety servces Malaysa wth oly.5percet of the populato beg covered by prvate healthcare ad safety provders. But the chage govermet polcy to support prvate publc partershp led to a expaso of prvate clc partcpato Malaysa to up to 5 percet 995, 8.8 percet of the populato aged 8 ad above 006 have regstrato wth prvate healthcare ad safety outfts. I Ngera the out-of-pocket healthcare ad safety expeses by the geeral populato costtuted over 70 percet of the healthcare ad safety faces whch ecesstated the evoluto of the ew Natoal Health Isurace Scheme, to serve as a brdge betwee the workg class ad the poor populato, wth pla for the workg class to susdzed for the poor populato (WHO, 007; Labra et at., 008; ogo, 009). A smlar study whch uses correlato some developg coutres such as, Seegal, Thalad, Ida, ad Rwada shows a less tha 0. percet sgfcat pot effects (Johaes, 004). The problem of equty s oe of the greatests challeges most reforms that has relatoshp wth healthcare ad safety most of the developed world, developg atos clusve. I Amerca for stace Blacks ad Hspac are btter specfcally o ssue of equal treatmet of equal or uequal treatmet of uequal (Ncholas, 006). Bererd, Pedro ad Bultma, (004); avd, Mattha ad Claude, (004), coducted a smlar study that treated the ssue of effcecy, effectveess ad equty, as a results of reform o healthcare ad safety delvery ad the study succeeded obtag smlar results wth ths research. Mafred, Adre ad Wedy, (004) hghlghted o the ssue of resposveess whch s otherwse defed as effcecy, patet satsfacto whch s also defed as effcecy, outcomes referg to equty, whch teds to agree wth the results of ths research. Study coducted Europe pror to the comg of the tax-fuded system of health Care emark, Italy, Portugal, Greece, ad Spa, the year 973, 978, 979, 983, ad 986 respectvely, show a arguemet for or agast, whch revealed a rather coflctg results wth some reportg postve effects of prvate surace as doe by ths research ad wth lttle challeges awatg the publcally owed health ad safety surace outfts (Cathere ad Joh, 000; Rchard, 004)). O whether or ot uversal surace would mprove health of the populato, ths posto was serously querred (Sylverso, Chark, & Atrash et al., 99). From the prevous studes Smo, (004) submts that ay predcto usg pre-reform ad post-reform data comparso or from oe healthcare ad safety surace type to aother usg a smple comparso techque, may teds to fd out that strget law agast provders has the potetalty of reducg coverage whch wll traslates to servce equalty. Commetg o the Amerca healthcare reform Smo, (004), states that, to smply agree that f the reform had ot bee put place coverage would have stablze s to say the least that the reform s a falure. A aalyss coducted o the reform by US states departmet of surace shows that, 40 percet of the cosumers saw ther premum fall by certa amout. Ad o the other way roud prces creased for the youger cosumers, ths act provded more access for older cosumers ad equalty for youger cosumers.

3 Iteratoal Joural of Busess ad Socal Scece Vol. No. [Specal Issue November 0] Ths study show a clear test for the hypothess that commuty ratg reduces coverage by drvg lower rsks (youg) cosumers from havg access through premum charges equalty (Nardo & Buchmueller,004). From the pot of vew of effcecy reform has sought to create a market evromet whch surers would compete o the bass of health plas, cost, ad equty through mproved rsk maagemet rather tha through rsk selecto (Hall, 99). I aother research t was revealed that from the equty pot of vew, reform has sought to ecourage a reverse from the ssue of co-modfcato of healthcare ad safety as well as health surace to the promoto of a alteratve vso whch dstrbuto of coverage s cosstet wth prcples of socal soldarty ad mutual ad rather tha actural faress (Stoe, 004; Olver & Fedler, 004). The cocluso of the research coducted by Marre-Pascale et al. (007) beleve that, the oly ovato that wll help esurg the success of ay reform, order to meet up the goals of equtable access, ad affordable drugs addto to meetg the challeges of cost cotamet ad effcet delvery of servces, s a accompayg polcy of reform wth evaluato ad adjustmet durg mplemetato. A research coducted to test the realtoshp betwee hosptal bll ad surace coverage Malaysa revealed a sgfcat value of 0.37, where p>0.05. The reults above revealed a o relatoshp betwee bll ad surace coverage. Ths study appled Pearso correlato tests to obta the results. I the study usg ANOVA to asses 4 hosptals admsso Malaysa revealed that hosptal charges based o admsso raged from 4 percet doctors charges, 36 percet faclty charges, medcato has 4 percet, whle the least fee beg room charges wth 8 percet ( Nk & ael, (009); Ncholas, (006), coducted a research o those Amercas popularly called the tweeers. The research revealed that majorty of the tweeers have access to healthcare ad safety facltes but fd t dffcult to afford the premum. The tweeers are those ctzes whom prvate surace s obtaable but ot affordable. A research coducted by Cathere ad Joh, (000), revealed that oe way of determg access to healthcare ad safety servces by the employee s through self reported questoare whch wll show case the umber of tme a employee atteds or have access to doctor. Ths research admstered self reported questo thus; relato to umber of physca vsts urg the past moth about how may tmes dd you see or talk to medcal doctor about your health? The results of ths research revealed 3.74 mea value pot. The secod questo has to do wth medcato, Are you curretly takg prescrbed medcatos for ay health problems; f yes; the how may dfferets prescrbed medcato do you ow take? The mea value pot for ths research revealed.4. Ths shows the state of relatoshp betwee access to hosptal ad medcato a reform stuato (Cathere & Joh, 000). Ad fally, aother research whch try to asses the level of bas selecto ad access to healthcare ad safety servces. It was reported that 9 percet of the patet wth coverage reported that, they ad ther famles had three or fewer vsts, 3 percet reported four to sx vsts ad 49 percet reported seve or more vsts. Ths show hgh level of access to healthcare ad safety servces (Pamela et at., 004). I aother study coducted the Uted States ad Caada, to determe the cost of health care relato to admstratve charges, costs of health surers, employers health beeft programs, hosptals or facltes charges, practtoers charges, ursg home care servces charges, revealed a terestg result. The study uses ad aalyzed a secodary data, surveys of physcas employmet data, as well as cost reports fled by hosptals, ursg homes,ad home care servces provders. The aalyss excluded the parts that volved admstratve share of health care spedg, retal pharmacy sales ad a few other categores due to lack of data o the real admstratve costs. The study used cesus surveys to explore treds over tme admstratve ad employmet health care settgs. Costs are reported U.S. dollars. The results revealed health admstratve cost of at least $94.3 bllo the Uted States, or $,059 per capta, as compared wth $307 per capta Caada. After exclusos, of other charges, admstrato accouted for 3.0 percet of health care expedtures the Uted States ad 6.7 percet of health care expedtures Caada. Caada s atoal health surace program had overhead of.3 percet; the overhead amog Caada s prvate surers was hgher tha that the Uted States wth 3. percet ad.7 percet. At the same tme provders admstratve charges were far lower Caada as compared wth the Uted States (OEC, 006/007; Joh, Allso, & Lsa, 007). Acordg to Joh, et al., (007) the healthcare labour force accouted for by the admstratve records the Amerca ad Caada healthcare workforce as from 969 ad 999 are betwee 8. to 9. percet of the total health workforce. Ths umber grew further 97 ad 996 wth 7.3 percet ad 9. respectvely both coutres. It was therefore cocluded that should the admstratve cost be trmmed the system would have beeftted ad mprove tremedously. 47

4 The Specal Issue o Cotemporary Research Arts ad Socal Scece Cetre for Promotg Ideas, USA 3. 0 RESEARCH METHO I a evaluato research, the major statstcal compoets form the bass of the research desg whch cludes both the samplg pla ad the estmato procedures. The samplg pla s the methodology used for selectg the sample from the populato. The estmato procedures are the algorthms or formulae used for obtag estmates of populato values from the sample data ad for estmatg the relablty of these populato estmates (Levy & Lemeshow, 008) 3. Sample Sze etermato I ths research desg, havg cosdered all the factors volved, the stratfed radom samplg wth proportoal allocato s the chose samplg desg. A sample s a part, of a fracto, or a subset of the populato. Samples are usually draw wth the am of estmatg the populato quattes. Samplg s the act of drawg samples from the populato; whch saves tme ad cost. Usually uts are selected from the etre N uts of the populato. I ths case, s called the sample sze. I ths research work, samples wll be draw from the target populato based o a statstcally determed, effcet sample sze so as to estmate some parameters of the populato. I ths research sx samples were take each usg a stratfed radom samplg ad proportoate probablty. The sttutos so selected were the strata represetg the medcal experts, safety experts, ad the beefcares of healthcare ad safety servces the two coutres. The selected stratum s as follows: Ahmadu Bello Uversty, Bayero Uversty, Kadua Polytechc (Kadua cty uverslty), Shehu Idrs College of Health Techology, Amerca Uverslty (AUNgera) ad Prvate ad Publc Clcs Ngera. Uverst Malaya, Uverst Utara Malaysa, Uverst Sas Malaysa, Cyberjaya Uversty College of Medcal Sceces Malaysa, ad publc/prvate Clcs malaysa. The determato of sample sze s a commo task for may orgazatoal researchers. Iapproprate, adequate, or excessve sample szes cotue to fluece the qualty ad accuracy of research. A formula for selectg the sample sze for a research problem based o a level of sgfcace ad a set error rate was proposed by Cochra, (977). I order to obta the most effcet, represetatve sample, for our research, we use the followg Cochra s formula for sample sze determato: 48 Z ˆ / Where; Sample sze Z / the value of the stadard ormal ordate at % level of sgfcace Hece, at the 5% level of sgfcace, we ca compute the value as; Z / Z s the chose error rate; we ca set ˆ the estmated populato stadard devato (for educatoal level)=0.4 The followg table depcts the value of the sample stadard devato whch s a estmator for the populato stadard devato. 3. escrptve Statstcs N Mmum Maxmum Mea Std. evato Hghest Educatoal Achevemet Vald N (lstwse) 90 Z ˆ / That s, we eed a sample sze of at least 7 to arrve at a sample wth a samplg error of at most 3%. Hece, for coveece, we shall take our sample sze to be 750. Based o the above computato, ths study eeded 750 respodets to complete the survey usg the questoare strumet. Ths sze rage was as suggested by Ferketch, (99) & llma, (000), that the sze of should be cosdered for a survey.

5 Iteratoal Joural of Busess ad Socal Scece Vol. No. [Specal Issue November 0] It was wth the sample frame of plus or mus 5% marg errors based o the formular ad sample sze table of Krejge & Morga, (970). Normally p s set at 0.0 or 0.05 for more homogeeous sample (ll ma, 000). However, usg 0.05 would lead to a larger sample sze therefore, 0.05 was choose ad used ths research (Weaver, 006) though t always provdes eough sample sze for smaller or larger populato (Brus et, al., 003; & Lyberg, 003). 3.3 fferece--fferece () Models I order to apply the dfferece--dfferece model, we eed to record the resposes o the fve Lkert scales to bary varables dcatg the mpact of the NHS scheme or otherwse; for both Ngera ad Malaysa. We could obta the dfferece--dfferece model through the regresso model wth bary regressors wth a sgle depedet varable. Oe of the most useful devces regresso aalyss, especally for models, s the bary or dummy varable. A dummy varable takes the value oe for some observatos to dcate the presece of a effect or membershp of a group ad zero for the remag observatos. Bary varables are a coveet meas of buldg dscrete shft of the fucto to a regresso model (Gree, 003). ummy varables are usually used regresso equatos that also cota other quattatve varables. I recet applcatos, researchers may felds have studed the effects of treatmet o some kd of respose. Examples clude the effect of educato o come, sex dfferece labour supply (or salary), pre-versus post regme shft mcroecoomc models, to meto but a few. These examples ca all be formulated regresso model volvg a sgle dummy varable. ' Thus; Y X. Whe there are several categores, a set of bary varable s ecessary. Correctg for seasoal factors mcroecoomc data s a commo applcato. We could wrte a cosumpto fucto for quarterly data the form below: C t 0 X t t t 3t3 Where; X sposable come t t Here, oly three of the four quarterly dummy varables are cluded the model. If the fourth were cluded, the the four dummy varables would sum to oe at every observato, whch would reproduce the costat term a case of perfect multcollearty. Ths s kow as the dummy varable trap. Thus to avod the dummy varable trap, we drop the varable for the fourth quarter. Ay of the four quarters ca be used as the base perod (also called the referece category). I ths case, the requred model s of the form: Y 0 P N 3( P * N) e Where; Y s the average respose wth respect to the effcacy of the scheme P s the perod dummy for the NHS scheme N s the coutry dummy for Ngera P*N s the teracto of the perod ad Ngera s dummy e s the radom error compoet The dfferece--dfferece model s therefore the process of buldg multple regresso models wth bary regressors usg the method of least squares. Hece, the requred regresso model s of the form gve below: Y 0 Where; Y s the average respose wth respect to the effcacy of the scheme Populato regresso costat 0 Populato regresso coeffcet for coutry Populato regresso coeffcet for perod ~ N(0, ) Radom error compoet Equato above s always estmated by the model gve below: ˆ ˆ ˆ ˆ Y 0 49

6 The Specal Issue o Cotemporary Research Arts ad Socal Scece Where; Ŷ Estmated average respose wth respect to the effcacy of the scheme 0 ˆ Estmated regresso costat ˆ Estmated regresso coeffcet for coutry ˆ Estmated regresso coeffcet for perod 50 Coutry ( Ngera ad 0 Malaysa) Perod ( after the NHS scheme ad 0 before the scheme) Cetre for Promotg Ideas, USA The method of dfferece--dfferece model va the multple regresso models was used for aalyzg the part of the data. I addto, dfferece--dfferece coeffcets, varous statstcal fereces ad dagostc methods were computed ad compared. The Statstcal Package for Socal Sceces (SPSS) was employed for the aalyss. Recall the estmated model above: Yˆ ˆ 0 ˆ ˆ.Where the parameters are obtaed through the method of least squares by solvg the followg systems of ormal equatos: () Yˆ ˆ ˆ ˆ 0 Yˆ ˆ 0 Yˆ ˆ 0 ˆ ˆ ˆ ˆ Automated soluto creases accuracy, precso ad speed. Hece the bulk of the calculatos wll be doe by SPSS. Automated soluto creases accuracy, precso ad speed. Hece the bulk of the calculatos wll be doe by SPSS. 4.0 RESULTS PRESENTATION Am The am here s to compare, betwee Ngera ad Malaysa, as well before ad after the NHS scheme, whether employees are treated well prvate clc more tha publc clc. The techque through a lear regresso model s hereby employed for the aalyss, dcated the fferece--fferece Coeffcets ad fferece--fferece ANOVA 4. Cocluso From the ANOVA table the appedxe, the p-value (0.000) mples that all the regresso coeffcets are statstcally sgfcat. Hece, from the coeffcet table, mples that Malaysa employees are treated well prvate clc more tha publc wth the recet developmet healthcare sector more tha Ngera employees. Also from the coeffcet table, mples that after the NHS scheme employees are treated well prvate clcs more tha publc clcs tha before the scheme. The stadardzed coeffcet 0.64 mples that Malaysa employees are 6.4% better treated prvate clc more tha publc wth the recet developmet healthcare sector more tha Ngera employees. Also stadardzed coeffcet 0.00 mples that after the NHS scheme employees are.0% better treated prvate clcs more tha publc clcs tha before the scheme. Am To compare, betwee Ngera ad Malaysa, as well before ad after the NHS scheme, whether the effcecy provded the recet developmet as from 006 the health sector wll esures equty, safety ad healthcare servces to employees the workg place. The techque through a lear regresso model s hereby employed for the aalyss. () (3)

7 Iteratoal Joural of Busess ad Socal Scece Vol. No. [Specal Issue November 0] 4. Cocluso From the ANOVA table the appedx, the p-value (0.000) mples that all the regresso coeffcets are statstcally sgfcat. Hece, from the coeffcet table, mples that the effcecy provded the recet developmet as from 006 the health sector Malaysa has esured equty, safety ad healthcare servces to employees the workg place more tha Ngera. Also from the coeffcet table, mples that the s effcecy provded the recet developmet as from 006 the health sector has esured equty, safety ad healthcare servces to employees the workg place more tha before the scheme. The stadardzed coeffcet mples that Malaysa scheme s 6.5% more tha Ngera terms of the effcecy provded the recet developmet as from 006 the health sector to esure equty, safety ad healthcare servces to employees the workg place. Also stadardzed coeffcet mples that the effcecy s 0.% better tha before the scheme. Am To compare, betwee Ngera ad Malaysa, as well before ad after the NHS scheme; whether reform healthcare sector wll esures equty ad affordablty to healthcare ad safety servces to all employees Ngera ad Malaysa. The techque through a lear regresso model s hereby employed for the aalyss. 4.3 Cocluso 3 From the ANOVA table the appedx, the p-value (0.000) mples that all the regresso coeffcets are statstcally sgfcat. Hece, from the coeffcet table, mples that the effcecy provded the recet developmet healthcare sector Malaysa has esured equty to healthcare servces to all employees ther workg place more tha Ngera. Also from the coeffcet table, mples that there s effcecy provded the recet developmet healthcare sector whch wll esure equty to healthcare servces to all employees ther workg place more tha before the scheme. The stadardzed coeffcet mples that Malaysa scheme s 6.7% more tha Ngera terms of the effcecy provded the recet developmet as from 006 the health sector to esure equty to employees the workg place. Also stadardzed coeffcet mples that the effcecy s 4.9% better tha before the scheme. Am To compare, betwee Ngera ad Malaysa, as well before ad after the NHS scheme, whether the recet developmet healthcare sector wll successfully creases the umber of tme employees wll atteds hosptal/clcs the workg place. The techque through a lear regresso model s hereby employed for the aalyss. 4.4 Cocluso 4 From the ANOVA table the appedx, the p-value (0.000) mples that all the regresso coeffcets are statstcally sgfcat. Hece, from the coeffcet table, mples that the recet developmet healthcare sector has successfully creased the umber of tme employees wll atteds hosptal/clcs Malaysa ther workg place more tha Ngera. Also from the coeffcet table, mples that the recet developmet healthcare sector wll successfully creases the umber of tme employees wll atteds hosptal/clcs the workg place tha before. The stadardzed coeffcet mples that Malaysa attedace rate s 63.3% more tha Ngera. Also stadardzed coeffcet mples that the attedace rate ow s 8.0% better tha before the scheme. Am To compare, betwee Ngera ad Malaysa, as well before ad after the NHS scheme; whether the recet developmet wll esures better access to health care servces to employees tha wthout t. The techque through a lear regresso model s hereby employed for the aalyss. 4.5 Cocluso 5 From the ANOVA table the appedx, the p-value (0.000) mples that all the regresso coeffcets are statstcally sgfcat. 5

8 The Specal Issue o Cotemporary Research Arts ad Socal Scece Cetre for Promotg Ideas, USA Hece, from the coeffcet table, mples that the recet developmet has esured better access to health care servces to employees Malaysa more tha Ngera. Also from the coeffcet table, mples that the recet developmet has esured better access to health care servces to employees tha wthout t more tha before. The stadardzed coeffcet mples that Malaysa access rate s 6.7% more tha Ngera. Also stadardzed coeffcet mples that the access rate ow s 5.0% better tha before the scheme. 5.0 SUMMARY ISCUSSION AN CONCLUSION Ths study makes cotrbuto to the developmet of lterature o Ngera ad Malaysa Natoal Healthcare Scheme reform. It also cotrbuted to the developmet of methodologcal approach to health care reform studes usg ecoometrc strumets or tool of aalyss. It has also appled dfferece--dfferece method usg questoare acqured data; ths wll serve as secodary data for future research edeavour. The study regressed healthcare ad safety servces effcecy (depedet varable) o healthcare ad safety access, equty, affordablty ad govermetal cotrol mechasms of reform (depedet varable). All the results mpressvely supported the alteratve hypotheses predcto wth a postve result of reform effects o all the parameters. The frst effect of reform s o the treatmet effcecy ad meetg up wth the satsfacto of employees, the results shows a coeffcet value postvely supportg the predcto that, employees are treated well prvate clcs more tha publc clcs wth reform Malaysa more tha Ngera. The coeffcet value (β²) shows that employees both Ngera ad Malaysa are treated well prvate clcs more tha publc after reform tha before the reform. The stadardse coeffcet shows that Malaysa employees are 6.4 percet better treated prvate clcs tha publc compared to Ngera employees. I geeral the stadardse coeffcet shows both Ngera ad Malaysa there s.0 percet better treatmet of employees the prvate clcs tha the publc. The results supported the alterate hypotheses that, there s sgfcat relatoshp betwee effcecy of healthcare ad safety servces delvery the prvate clcs tha the publc clcs. The secod part of the model revealed a postve relatoshp betwee reform ad healthcare ad safety delvery effcecy both Ngera ad Malaysa. The results from the regresso shows a postve coeffcet dcatg that reform has esured equty, safety, ad healthcare ad safety delvery servces to the employees the workg place Malaysa more tha Ngera. The coeffcet value (β²) show a mpressve outcome that the reform supported the effcecy provded by the reform esured equty of healthcare ad safety servces to the employees tha before the reform. Whle, the stadardsed coeffcets mples that, the effects of the reform s 6.7 percet more tha Ngera 006 ad t geerally shows a stadardsed coeffcet coverted to percetage to be 4.9 percet better tha befrore the reform both Ngera ad Malaysa pror to 006. The results also postvely supporte the alteratve hypotheses that, there s sgfcat relatoshp betwee goveremetal cotrol mechasms ad mprovemet of healthcare ad safety access ad equty of healthcare ad safety servces to the employees. The results of the study also tested whether reform effcecy as a depedet varable have successfully fluece the frequecy (affordablty, access) of clc attedace by the employees, both Ngera ad Malaysa. The results of the coeffcet of the regresso aalyss shows that reform has creased the frequecy of employees clc attedace both Ngera ad Malaysa, wth Malaysa havg a edge over Ngera. The (β²) coeffcet value shows that reform wll cotue to crease affordablty ad access to employees varous workg places the two coutres tha before the reform. The stadardze coeffcet shows that Malaysa employees has 63.3 percet more frequecy of affordablty ad access to healthcare servces attedace by the employees tha the Ngera employees. It geerally shows that both coutres there s 8.0 percet attedace rate crease ow tha before the reform. The results of ths study supported the tal alteratve hypotheses or predcto that; there s correlato betwee healthcare ad safety cost, affordablty ad effcecy to employees Ngera ad Malaysa. The fal results aalyss tests whether reform has effects o access to healthcare ad safety servces geeral to the employees, the results show a p-value=(0.000) whch s sgfcat, ad the coeffcet value B shows that there s better access healthcare ad safety servces to rhe employees Malaysa tha Ngera. The (β²) value shows that reform succeeded esurg access to healthcare ad safety servces to the employees more tha before the reform. 5

9 Iteratoal Joural of Busess ad Socal Scece Vol. No. [Specal Issue November 0] The stadardze coeffcet shows access rate of 6..7 percet Malaysa more tha Ngera. The stadardze coeffcet for the geeral assesmet of the reform both Ngera ad Malaysa shows 5.0 percet better access rate tha before the reform. These results also supported the alterate hypotheses that reform has succeeded mprovg access tha wthout t the two coutres. 5. CONCLUSION Coclusvely, ths research s a ogog oe, the future study wll focus o gatherg logtudal data to asses the log tme effect or mpact of the reform both Ngera ad Malaysa. Cosderato s also gog to be o the effect or mpact of reform o demographc varables, such as geder, come, employmet type, educatoal level, lfestyle (drukardess, famly sze, smokg, employmet type) the future study. The mpact of govermetal cotrol mechasm o the reform parameters ad major actors (such as, HMO s, healthcare ad safety servce provders, health surace servce provders, health facltes) o whether or ot have succeeded mprovg healthcare ad safety servces delvery effcecy, cost reducto ad/or affordablty to a accessble healthcare ad safety servces to the employees Ngera ad Malaysa formal ad formal sector employees should preoccufy future research. The possblty of researchg o the developmet of safetyet servces to the poor, uemployed, retrees, ad uderprvledge ctzes, through safetyet fud rasg through govermet ageces, prvate orgazats as a socal ad commuty resposblty fucto to mprove healthcare servces delvery to all should be cosdered the future both Ngera ad Malasa. REFERENCES Abdurrahm, M. (009) Future of Health Care Facg I Malaysa; evelopmet vso, Mstry of Health Malaysa Bererd, A., Pedro, L. B. & Bultma, J. (004). Health Isurace Systems Wester Europe: Health Care System Trasto; Frace. Cathere, E., & Joh, M. (000). oes Medcal Isurace Cotrbute to Socoecoomc fferetals Health. Mlbak Joural, Volume 78,No., 9-3. Cherchovsky,. (00). Pluralsm, Publc Choce, ad the State the Emergg Paradgm Health System: Mllbak Quarterly Vol.80, No.; P Cochra, J. J. (000). Career records for all moder posto players elgble for the Major League Baseball Hall Fame. Joural of statstcs educato, vol.8. No. -5 Cochra, W. (977). Samplg Techque. New York; Wley ad sos Ltd. CUEPECS (008). Malaysa Health Care: the sahpe of thgs to come; prvatzato of Malaysa Health care. Httpp:// Cutler,. M. (00). Health Care ad the Publc Sector: Hadbook of Publc Ecoomcs; vol. 4 p NBER, Harvard Uversty. avd, C. Mathas, W. & Claude, Le, P. (00). Goverace ad (self) regulato socal health surace systems; Rchard et al. (Ed) socal health surace Wester Europe. Ope Uversty press New York. llma,. A. (000) Mal ad Iteret Surveys; the talored desg ( d edto) New York: Joh Wley ad Sos c. Nardo, J., & Buchmueller, T. C. (004). d Commuty Ratg Iduce a Adverse Selecto eath Sprl?". I Ala ad Joel, State Health Isurace Market Reform (pp ). Lodo: Routledge, Taylor ad Fracs Group. ogo, W. M. (009). Ngera Natoal Health Isurace Scheme Sestzato Workshop; Speech by the NHIS Executve Secretary Abuja Ngera Ferketch, S. (99) Aspects of Item Aalyss: Research Nursg ad Health Vol 4, Hall, M. A. (99). The polotcal Ecoomy of Health Isurace Market Reform; Health Affars vol. () p 7-7 Hurley, R. Grossma, J. Lake, J. Casaho, L. (00). A logtudal Perspectve o Health Pla-Provder Rsk Cotractg; Health Affars Vol., No.4, P Jamla Zaudd, (00). Isttutoalzatoof Natoal Health Accouts Malaysa; Head of MNHA ut: Plag ad evelopmet vso MOH Malaysa. 53

10 The Specal Issue o Cotemporary Research Arts ad Socal Scece Cetre for Promotg Ideas, USA Johaes, P. P. (005). Health Isurace For The Poor I evelopg Coutres. Eglad: Ashgate Publshg Compay Lmted. Joh, H. Allso, C. & Lsa,. (007). Medcal ad the Usured: Characterstcs of the Usured; Who s Elgble for Publc Coverage ad Who Needs Help Affordg Coverage? Kaser Famly Foudato. Krejge, R. &. W. Morga (970) etermg the Sample Sze for Research Actvtes Educatoal ad Psychologcal Measuremet Vol. 30, Labra, A., Margaret, M., Bayo, O., & Eytayo, L. (008). Health Workforce Coutry Profle For Ngera. Ngera: Prtg press. Levy, S.P, & Lemeshaw, S. (008). The road to result; desgg ad coductg effectve developmet evaluato. Ndejj uversty press. Lyberg ad Lyberg (003/99). Calculato of Health Expectaces: harmozato, cosesus acheved; Joh Wley ad Compay Ltd. Mafred, W. Adre, P. de & Wedy, G. M. va der kraa (004). The chagg role of the dvdual socal health surace systems, cted Rchard, Rehard & Joseph (ed) Socal surace Wester Europe; p ; Ope Uversty Press, USA. Mare-Pascale, P., Perre-Gerle, F., Howard, A., & Elzebeth, M. (007). Publc-Prvate Partershps for Prescrpto rug Coverage:Polcy Formulato ad Outcomes Quebec's Uversal rug Isurace Programs wth comparsso to the Medcare prescrpto rug programm Uted State. Mlbak,Quarterlly Joural,volume 85,No.3, Ncholas, L. M. (004). Improvg States Isurace Market: what's left to try? I Ala ad Joel (Ed), state health surace market reform; towards clusve ad sustaable health surace markets. Lodo & New York: Routledge Taylor & Fracs Group. Ngera NHIS ecree No35. (999). Law of the Federato of Ngera. Abuja-Ngera: FGN. Nk Rosah, W. A. & K. E. ael Ng (009) Prvate Health Isurace I Malaysa: Polcy Opto for a Publc- Prvate: OEC, (006/07) OEC Fgures 006/007 edto: emography, Ecoomy, Eergy, Labour, Scece, ad Techology, Evromet, Educato, Publc Face, Iteratoal Trade ad Ivestmet;OEC Observer. Olver, T. R., & Fedler, R. M. (004). "State Govermet ad Health Isurace Market Reform". I A. a. Joel, Stete Health Isurace Reform;Toward clusve ad sustaable health surace market reform (pp. - 7). New York: Fracs ad Taylor Group. Pamela, B., Judth, R., Jee, T., & Joh, H. (000). Employer-Sposored Health Isurace:Are Employers God Agets for ther Employees. Mlbak Joural volume78,no., 5-. Rchard,. (009). Uversal health care s ear at had. Bagor aly News, p. of. Retreved o 6 th Jue, 009 from Smo, K. (004). "Adverse Selecto Health Isurace Markets? Evdece from State Small-Group Health Isurace Reform. I A. a. Joe, State Health Isurace Market Reform, Toward clusve ad sustaaable health surace market (pp. 64-8). Lodo ad New York: Routledge, Taylor ad Fracs Group. Stoe,. (004). "The struggle for the soul of Health Isurace. I A. A. Joel (Ed.), State Health Isurace Reform; towards clusve ad sustaable health surace market reform (pp. 5-64). New York: Fracs ad Taylor Group Weaver, M. (006) Formula for Calculatg Sample Sze; A Statstc Cosultg at Research Support Cetre, School of Nursg, Uversty of North Carola Chapel Hll, WHO. (007). Health Facg ad Socal Protecto. Retreved from 54

11 Iteratoal Joural of Busess ad Socal Scece Vol. No. [Specal Issue November 0] Table. fferece--fferece Coeffcets Ustadardzed Coeffcets Stadardzed Coeffcets Model B Std. Error Beta T Sg. (Costat) Coutry Employees are treated well prvate clc more tha publc wth the recet developmet healthcare sector. fferece--fferece ANOVA Model Sum of Squares f Mea Square F Sg. Regresso Resdual Total Table. fferece--fferece Coeffcets Ustadardzed Coeffcets Stadardzed Coeffcets T Model B Std. Error Beta (Costat) Coutry The effcecy provded the recet developmet as from 006 the health sector wll esures equty, safety ad healthcare servces to employees the workg place fferece--fferece ANOVA Model Sum of Squares df Mea Square F Sg. Regresso Resdual Total Table 3 fferece--fferece Coeffcets 3 Ustadardzed Coeffcets Stadardzed Coeffcets Model B Std. Error Beta T Sg. (Costat) Coutry The recet developmet healthcare sector wll esures equty to healthcare servces to all employees ther workg place fferece--fferece ANOVA 3 Model Sum of Squares df Mea Square F Sg. Regresso Resdual Total Sg. 55

12 The Specal Issue o Cotemporary Research Arts ad Socal Scece Table 4 fferece--fferece Coeffcets 4 Ustadardzed Coeffcets Cetre for Promotg Ideas, USA Stadardzed Coeffcets Model B Std. Error Beta T Sg. (Costat) Coutry The recet developmet healthcare sector wll successfully creases the umber of tme employees wll atteds hosptal/clcs the workg place. fferece--fferece ANOVA 4 Model Sum of Squares f Mea Square F Sg. Regresso Resdual Total Table 5 fferece--fferece Coeffcets 5 Ustadardzed Coeffcets Stadardzed Coeffcets Model B Std. Error Beta T Sg. (Costat) Coutry The recet developmet wll esures better access to health care servces to employees tha wthout t. fferece--fferece ANOVA 5 Sum of Model Squares df Mea Square F Sg. Regresso Resdual Total