Expanding co-payment for methadone maintenance services in Vietnam: the importance of addressing health and socioeconomic inequalities

Abstract

BackgroundEnsuring high enrollment while mobilizing resources through co-payment services is critical to the success of the methadone maintenance treatment (MMT) program in Vietnam. This study assessed the willingness of patients to pay (WTP) for different MMT services delivery models and determined its associated factors.MethodsA facility based survey was conducted among 1016 MMT patients (98.7% male, 42% aged 35 or less, and 67% living with spouse) in five MMT clinics in Hanoi and Nam Dinh province in 2013. Socioeconomic, HIV and health status, history of drug use and rehabilitation, and MMT experience were interviewed. WTP was assessed using contingent valuation method, including a set of double-bounded binary questions and a follow-up open-ended question. Point and interval data models were used to estimate maximum willingness to pay.Results95.5% patients were willing to pay for MMT at the monthly mean price of US$ 32 (95%CI = 28–35). Higher WTP was associated with higher level of educational attainment, higher income, male sex, and had high expenses on opiates prior to MMT. Patients who reported having any problem in Pain/ Discomfort, and who did not have outpatient care last year were willing to pay less for MMT than others.ConclusionHigh level of WTP supports the co-payment policies as a strategy to mobilize resources for the MMT program in Vietnam. However, it is necessary to ensure equalities across patient groups by acknowledging socioeconomic status of different settings and providing financial supports for disadvantaged patients with severe health status.

Follow-up Study of Drug Use, Depression, and Anxiety Reduction and Quality of Life in Addicts on Methadone Maintenance Therapy

“…Various studies indicate the effectiveness of MMT centers in reducing the risks of addiction, e.g., to injecting drug use, and its adverse effects related to diseases such as AIDS and hepatitis (14). Considering the lack of a comprehensive study in this regard in Kermanshah province, this study attempted to evaluate the therapeutic effectiveness of MMT in reducing depression, anxiety, and quality of life among addicts.…”

Treatment adherence amongst drug users attending public and private methadone maintenance clinics in a northern province of Vietnam

“…In the Vietnamese context, MMT has been proved to be effective to reduce HIV transmission [11,12]. The long-term effects of opioids (physical dependence and addiction) are reducing among patients having MMT treatment [13].…”

Social and structural barriers for adherence to methadone maintenance treatment among Vietnamese opioid dependence patients

“…Since its first introduction in 2008, 251 MMT clinics have been established and providing treatment for over 46,000 patients [ 34 ]. The Vietnam’s MMT program has been proved to effectively contribute to the control and prevention of HIV/AIDS [ 35 – 37 ]. However, poor medication adherence poses a great challenge to health managers in the rapid expansion of MMT services in Vietnam.…”