Determining the impacts of hospital cost-sharing on the uninsured near-poor households in Vietnam

International Journal for Equity in Health

Reinhard Busse¹  Khue Ngoc Luong²  Son Thai Ha²  Paul Marschall³  Steffen Flessa³  Duong Anh Vuong² 

[1] Department of Health Care Management, Berlin University of Technology, Berlin, Germany;Department of Medical Service Administration, Vietnam Ministry of Health, Hanoi, Vietnam;Department of Business Administration and Health Care Management, Ernst-Moritz-Arndt-University of Greifswald, Greifswald, Germany

关键词: Vietnam;    Catastrophic health expenditure;    User fee;    Hospital unit cost;    Cost-sharing;   

Others  :  802277
DOI  :  10.1186/1475-9276-13-40

 received in 2013-04-10, accepted in 2014-05-06,  发布年份 2014

【 摘 要 】

Objectives

The study objective was to identify the size of different hospital financing sources for different hospital services and their impact on the uninsured.

Methods

A panel dataset of 84 public general hospitals (2005–2008) with cross-section data on hospital activity and hospital revenue was created and used to calculate unit costs of different hospital services by applying multiple regression models. The resulting risk of catastrophic health expenditure (CHE) was estimated based on official income statistics.

Results

Average user fees (UF) for outpatient visits and inpatient bed days were US$4.13 and US$20.27, while actual full costs (AFC) were US$8.41 and US$36.66, respectively. These unit costs were 2.5 times higher in hospitals at the central versus the provincial level. UF for surgical inpatient bed days were 3.6 times that of non-surgical treatments (US$47.50 vs. 12.87) and AFC 5.0 times (US$101.72 vs. 20.08). UF accounted for 44.6%-77.9% of the AFC, the rest (22.1%-55.4%) was provided by direct government support (DGS). One surgical inpatient treatment at either central or provincial hospital level and one non-surgical inpatient treatment at central hospital level, immediately pushed uninsured near-poor households at risk of CHE.

Conclusions

Around 45% of hospital AFC was paid by DGS, the larger rest by UF. UF have become a great financial burden on the uninsured near-poor households, who have to pay for these out-of-pocket and therefore may not utilize even necessary services. If the rate of DGS were reduced, this would have the effect of increasing UF, but the savings to Government could be spent on subsidizing insurance to ensure that a larger part of the population can cover UF through insurance, especially the near-poor households.

【 授权许可】

   
2014 Vuong et al.; licensee BioMed Central Ltd.

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