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Catastrophic health expenditure in Vietnam: studies of problems and solutions
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0002-5348-7698
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In Vietnam, problems of high out-of-pocket payments for health, leading to catastrophic health expenditure and resulting impoverishment for vulnerable groups, has been at focus in the past decades. Since the beginning of the 1990’s, the Vietnamese government has launched a series of social health insurance reforms to increase prepayment in the health sector and thereby better protect the population from the financial consequences of health problems.

Objective: The objective of this thesis is to contribute to the discussion in Vietnam on how large the problems of catastrophic health expenditure are in the population as a whole and in a special subgroup; the elderly households, and to assess important aspects on health insurance as a means to reduce the problems.

Methods: Catastrophic health expenditure has been estimated, using an established and common method, from two different data sources; the Epidemiological Field Laboratory for Health Systems Research (FilaBavi) in the Bavi district, and Vietnam Household Living Standards Survey (VHLSS) 2010. Results from two cross-sectional analyses and a panel study have been compared, to gain information on whether the estimates of catastrophic health spending may be overestimated when using cross-sectional data. Then, the size of the problem for one group, the elderly households; hypothesized to be particularly vulnerable in this context, has been estimated. The question of to what extent a health insurance reform; the Health Care Funds for the Poor (HCFP), has offered protection for the insured against health spending is being assessed in another study over the period 2001 – 2007, using propensity score matching. The value that households attach to health insurance has also been explored through a willingness to pay (WTP) study.

Results: Comparing results from two cross-sectional studies with a panel study over a full year in which the respondents were interviewed once every month, the estimates of catastrophic spending vary largely. The monthly estimates in the panels study are half as large as the cross-sectional estimates; the latter also having a recall period of one month. Among the elderly households, catastrophic health spending and impoverishment are found to be problems three times as large as for the whole population. However, household health care expenditure as a percentage of total household expenditure was affected by the HCFP, and significantly reduced for the insured. In the study of household WTP for health insurance, it was iiifound that households attach a low value to this insurance form; WTP being only half of household health expenditure.

Conclusions: Cross-sectional studies of catastrophic spending with a monthly recall period are likely to be affected by recall bias leading to overestimations through respondents including expenditure in the period preceding the recall period. However, such problems should not deter researchers form studying this phenomenon. If using the same method, estimates of catastrophic spending and impoverishment can be compared between different groups – as for the elderly households – and over time; e.g. studying the protective capacity of health insurance. It should be used more, not less. The VHLSS rounds offer the Vietnamese a possibility to regularly study this. The HCFP were found to be partly protective but important problems remain to be solved, e.g. the fact that people are reluctant to use their health insurance because of e.g. quality problems and possible discrimination of the insured. The findings of a low WTP for health insurance may be another reflection of this.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2014. , 121 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1673
Keyword [en]
Catastrophic health expenditure, impoverishment, elderly, health insurance, Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-93259ISBN: 978-91-7601-129-4 (print)OAI: oai:DiVA.org:umu-93259DiVA: diva2:746852
Public defence
2014-10-10, Sal B, Rosa salen, 9 tr, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2014-09-19 Created: 2014-09-15 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Catastrophic Health Expenditure and Impoverishment among the Elderly Households in Vietnam.
Open this publication in new window or tab >>Catastrophic Health Expenditure and Impoverishment among the Elderly Households in Vietnam.
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(English)In: Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-93256 (URN)
Available from: 2014-09-15 Created: 2014-09-15 Last updated: 2015-04-29
2. People's willingness to pay for health insurance in rural Vietnam
Open this publication in new window or tab >>People's willingness to pay for health insurance in rural Vietnam
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2008 (English)In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, E-ISSN 1478-7547, Vol. 6, 16- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The inequity caused by health financing in Vietnam, which mainly relies on out-of-pocket payments, has put pre-payment reform high on the political agenda. This paper reports on a study of the willingness to pay for health insurance among a rural population in northern Vietnam, exploring whether the Vietnamese are willing to pay enough to sufficiently finance a health insurance system.

METHODS: Using the Epidemiological Field Laboratory for Health Systems Research in the Bavi district (FilaBavi), 2070 households were randomly selected for the study. Existing FilaBavi interviewers were trained especially for this study. The interview questionnaire was developed through a pilot study followed by focus group discussions among interviewers. Determinants of households' willingness to pay were studied through interval regression by which problems such as zero answers, skewness, outliers and the heaping effect may be solved.

RESULTS: Households' average willingness to pay (WTP) is higher than their costs for public health care and self-treatment. For 70-80% of the respondents, average WTP is also sufficient to pay the lower range of premiums in existing health insurance programmes. However, the average WTP would only be sufficient to finance about half of total household public, as well as private, health care costs. Variables that reflect income, health care need, age and educational level were significant determinants of households' willingness to pay. Contrary to expectations, age was negatively related to willingness to pay.

CONCLUSION: Since WTP is sufficient to cover household costs for public health care, it depends to what extent households would substitute private for public care and increase utilization as to whether WTP would also be sufficient enough to finance health insurance. This study highlights potential for public information schemes that may change the negative attitude towards health insurance, which this study has uncovered. A key task for policy makers is to win the trust of the population in relation to a health insurance system, particularly among the old and those with relatively low education.

Place, publisher, year, edition, pages
BioMed Central, 2008
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-10325 (URN)10.1186/1478-7547-6-16 (DOI)18691440 (PubMedID)
Available from: 2008-08-13 Created: 2008-08-13 Last updated: 2017-12-14Bibliographically approved
3. An assessment of the implementation of the Health Care Funds for the Poor policy in rural Vietnam.
Open this publication in new window or tab >>An assessment of the implementation of the Health Care Funds for the Poor policy in rural Vietnam.
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2010 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 98, no 1, 58-64 p.Article in journal (Refereed) Published
Abstract [en]

User fees at public health care facilities and out-of-pocket payments for health care services are major health financing problems in Vietnam. In 2002, the Government launched the Health Care Funds for the Poor (HCFP) policy which offered free public health care services to help the poor access public health services and reduce their health care expenditure (HCE). This paper is an assessment of the implementation of the HCFP in a rural district of Vietnam. The impacts of HCFP on household HCE as a percentage of total expenditure and health care utilization were assessed by a double-difference propensity score matching method using panel data of 10,711 households in 2001, 2003, 2005 and 2007. The results showed that the HCFP significantly reduced the HCE as a percentage of total expenditure and increased the use of the local public health care among the poor. However, the impacts of HCFP on the use of the higher levels of public health care and the use of go-to-pharmacies were not significant. In conclusion, this assessment indicates that the HCFP has met its objectives by reducing HCE for the poor and increasing their use of the local public health care services. However, further efforts are needed to help them access higher levels of public health care. Pharmacists should be better regulated and incorporated with primary health care to improve efficiency of the system.

Place, publisher, year, edition, pages
Elsevier, 2010
Keyword
Assessment, Health Care Funds for the Poor, Vietnam
Identifiers
urn:nbn:se:umu:diva-35322 (URN)10.1016/j.healthpol.2010.05.005 (DOI)000284556200007 ()20627438 (PubMedID)
Available from: 2010-08-12 Created: 2010-08-12 Last updated: 2017-12-12Bibliographically approved
4. Are the estimates of catastrophic health expenditure among rural poopulation too high? A comparison of studies in Vietnam.
Open this publication in new window or tab >>Are the estimates of catastrophic health expenditure among rural poopulation too high? A comparison of studies in Vietnam.
2008 (English)In: Open Public Health Journal, ISSN 1874-9445, Vol. 1, 25-31 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To describe the proportion of the households that experienced catastrophic health expenditure and to compare the magnitude of catastrophic health expenditure that is estimated from three different data sets in Vietnam.

Methods: The study we are comparing with is based on data from the Vietnam Living Standard Survey (VLSS) 1997/98. We have used data from the 2001 re-survey. The FilaBavi sample consists of 11,089 households. We have also conducted a special survey from July 2001 to June 2002. The sample is smaller, 629 households, but they have been followed for an entire year with monthly interviews. For VLSS and FilaBavi, re-census survey households were interviewed once with a recall period of one month.

Findings: In the VLSS data and in the FilaBavi re-census survey it was found that 9%-10% of the households experienced catastrophic healthcare spending. But, only 5% (average per month) and 1% (for the whole year) of the households in the special survey report catastrophic spending.

Conclusions: We suggest that the major reason for the difference in the estimates is the different data collection methods. When doing a cross sectional study with a relatively short recall period there is a risk that households will tend to overestimate non-recurrent large expenditures as that for health.

Place, publisher, year, edition, pages
Bentham Open, 2008
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-21843 (URN)10.2174/1874944500801010025 (DOI)
Available from: 2009-04-20 Created: 2009-04-20 Last updated: 2017-12-13Bibliographically approved

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