Is Health Insurance Associated with Health Service Utilization and Economic Burden of Non-Communicable Diseases on Households in Vietnam?

Abstract

The rising burden of Non-Communicable Diseases (NCDs) in developing countries has caused high out-of-pocket (OOP) health spending leading to many households suffering Catastrophic Health Expenditure (CHE). This study examined the association between health insurance (HI) on health-care utilization and the burden of OOP expenditure among people with reported NCDs and on their households in Vietnam. The study draws on a cross-sectional household survey of accessibility and utilization of health services in Vietnam. Data were obtained from three provinces to represent urban, rural and mountainous areas of the country. The study used a sample of 2,038 individuals with reported NCD aged over 18 years from 1,642 households having at least one person with reported NCD. The results show that people with reported NCD who had HI were twice as likely to use outpatient care compared with those without HI. Having more than one member with reported NCD resulted in double the odds of a household suffering CHE. Households in the three lowest wealth quintiles were more likely to encounter CHE and financial distress than economically better-off households. HI did not provide a protective effect to households, as there was no significant association between the HI status of household members with reported NCD and CHE or financial distress. Seeking care at higher-level facilities was significantly associated with CHE. This study highlights the need for evidence to design future HI-based interventions targeting susceptible populations to narrow the gaps in health service utilization among the population and mitigate financial catastrophe associated with NCDs.

Determinants of catastrophic health expenditure in Vietnam

“…This study shows that severe illness or injury is also a determinant of risk of CHE. This result is consistent with other studies 2,28,45,49,50 . Because of a severe illness, people need more healthcare, leading to an increased probability of incurring CHE.…”

“…This study finds that the likelihood of experiencing CHE increases significantly in households with a household head aged above 50, or with a high proportion of people aged above 60. These results are in agreement with those obtained in Vietnam by Hoang et al (2012) 1 , Ahmed et al (2018) 21 , and Giang et al (2019) 45 . These results may be explained by the fact that Vietnam is facing an ageing population issue, with the fastest ageing rate in the world 46 .…”

“…This study finds that the likelihood of experiencing CHE increases significantly in households with a household head . 45 These results may be explained by the fact that Vietnam is facing an ageing population issue, with the fastest ageing rate in the world. 46 Senior citizens require more healthcare, because they are at a higher risk of burden of disease, especially noncommunicable diseases (NCDs).…”

“…This result is consistent with other studies. 2,28,45,49,50 Because of a severe illness, people need more healthcare, leading to an increased probability of incurring CHE.…”

Health Status and Health Service Utilization among Vietnamese Farmers in a Mountainous Province

“…Domestic resources, including a social health insurance scheme and out-of-pocket payment, are the main funding sources for health care [33]. In a previous study, the proportion of mountainous people with health insurance was much higher than those living in rural and urban areas [34]. Similar to other developing countries, Vietnamese people living in mountainous areas suffer from typical problems such as an undeveloped economy, low access to health information and education, and limited public transportation [22,23,24,25,26,35], which, in turn, would adversely impact health status as well as leading to disadvantages in health care access and utilization.…”