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Policy of free healthcare for children under six in Vietnam: assessment of its non-usage during hospitalization for diarrhea in Ho Chi Minh City

Shieh, Mae Mae Yi Fong and Thompson, Corinne and My, Phan Vu Tra and Van, Thi Thuy Linh and Tediosi, Fabrizio and Merson, Laura and Farrar, Jeremy and Ha, Manh Tuan and Ho, Lu Viet and Pham, Thi Ngoc Tuyet and Baker, Stephen (2013) Policy of free healthcare for children under six in Vietnam: assessment of its non-usage during hospitalization for diarrhea in Ho Chi Minh City. Tropical Medicine & International Health.

Abstract

Objective: To assess the proportion of, and reasons for, households not utilising the policy of free
healthcare for children under 6 years of age (FCCU6) for hospitalisation with diarrhoea, and assess
the risk of catastrophic expenditure for households that forgo FCCU6 and pay out of pocket.
Methods: Invoices detailing insurance information and charges incurred from 472 hospitalised
diarrhoeal cases in one paediatric hospital in Ho Chi Minh City were retrieved. Hospital charges and
the utilisation of elective services were analysed for patients utilising and not utilising FCCU6.
Associations between socio-economic factors with non-utilisation of FCCU6 were evaluated.
Results: Overall, 29% of patients were FCCU6 non-users. The FCCU6 non-users paid a median
hospital charge of $29.13 (interquartile range, IQR: $18.57–46.24), consuming no more than 1.4%
of a medium-income household’s annual income. Seventy per cent of low-income FCCU6 non-users
utilised less-expensive elective services, whereas only 43% of medium income patients and 21% of
high-income patients did (P = 0.036). Patients from larger households and those with a parent
working in government were more likely to use FCCU6.
Conclusions: The rate of FCCU6 non-usage in this study population was 29%. A significant
proportion of those that did not use FCCU6 was from lower income households and may perceive a
justifiable cost–benefit ratio when forgoing FCCU6. Although a single diarrhoeal hospitalisation is
unlikely to induce a catastrophic expenditure, FCCU6 non-usage may disproportionately increase the
risk of catastrophic expenditure for lower income households over multiple illnesses.

Item Type: Article
Additional Information: This research was done as part of a masters thesis in International Health
Keywords: Social health insurance, health insurance utilization, child health, acute diarrhea, out-of-pocket expenditures, hospital charges, Vietnam
Date Deposited: 13 Oct 2015 13:13
Last Modified: 13 Oct 2015 13:13
URI: https://oak.novartis.com/id/eprint/9330

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