The maternal mortality rate (MMR) is defined as the number of maternal deaths per 100,000 live births, and it serves as an important indicator of the quality of healthcare systems and the overall health of women in a given population. There is hybrid system in Malaysia in which the public sector and private sector coexist to provide medical services to the society where that are different structures of expenditure such as public expenditure, private expenditure and OOP expenditure. Each different expenditure plays their role in determining the outcome of interest, MMR. Increase in public expenditure helps to reduce MMR. While there is a consensus that increased public health expenditure is critical to improving maternal health outcomes, its efficacy is contingent upon strategic planning and implementation that addresses the unique health challenges faced by specific populations. An intricate relationship between private expenditure and maternal mortality underscores a pressing need for comprehensive policy approaches that emphasize financial investment in healthcare infrastructure, capacity building, and improved access to care. Higher private spending on maternal healthcare has been associated with decreased maternal deaths in some contexts, suggesting that private healthcare can complement public efforts, particularly in regions with limited public resources. combined strategy that incorporates both public investments and the optimization of private healthcare resources is imperative for advancing maternal health and reducing mortality rates effectively. OOP expenditure is a significant determinant of access to and utilization of maternal health services, with profound implications for maternal mortality rates. Keyword GDP, MMR, OOP, public expenditure