Socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with non-communicable diseases in urban Hanoi, Vietnam

Abstract

BackgroundThe catastrophic health expenditure and impoverishment indices offer guidance for developing appropriate health policies and intervention programs to decrease financial inequity. This study assesses socioeconomic inequalities in catastrophic health expenditure and impoverishment in relation to self-reported non-communicable diseases (NCD) in urban Hanoi, Vietnam.MethodsA cross-sectional survey was conducted from February to March 2013 in Hanoi, the capital city of Vietnam. We estimated catastrophic health expenditure and impoverishment using information from 492 slum household and 528 non-slum households. We calculated concentration indexes to assess socioeconomic inequalities in catastrophic health expenditure and impoverishment. Factors associated with catastrophic health expenditure and impoverishment were modelled using logistic regression analysis.ResultsThe poor households in both slum and non-slum areas were at higher risk of experiencing catastrophic health expenditure, while only the poor households in slum areas were at higher risk of impoverishment because of healthcare spending. Households with at least one member reporting an NCD were significantly more likely to face catastrophic health expenditure (odds ratio [OR] = 2.4; 95 % confidence interval [CI], 1.8–4.0) and impoverishment (OR = 2.3; 95 % CI, 1.1–6.3) compared to households without NCDs. In addition, households in slum areas, with people age 60 years and above, and belonging to the poorest socioeconomic group were significantly associated with increased catastrophic health expenditure, while only households that lived in slum areas, and belonging to the poor or poorest socioeconomic groups were significantly associated with increased impoverishment because of healthcare spending.ConclusionFinancial interventions to prevent catastrophic health expenditure and impoverishment should target poor households, especially those with family members suffering from NCDs, with older members and those located in slum areas in Hanoi Vietnam. Potential interventions derived from this study include targeting and monitoring of health insurance enrolment, and developing a specialized NCD service package for Vietnam’s social health insurance program.

The Households Health Spending and Impoverishment: A Study After Iran's Health Transformation Plan

“…It shows that HTP could not reach their goals absolutely in this province. This is in line with the study by Kien who studied impoverishment associated with non-communicable diseases in urban Hanoi, Vietnam and found that although the poor households in both slum and non-slum areas were at higher risk of experiencing CHE, only the poor households in slum areas were at higher risk of impoverishment due to healthcare spending (18). Moreover, Khan found that the poverty headcount increased by 3.5% due to OOP payments in Bangladesh (19).…”

“…A study done in China showed that 36.2 of the house- holds in the lowest economic status were impoverished by health care expenditure (21). The findings of various studies performed in both developing and developed countries have also confirmed the effect of the households' economic status on their being faced with poverty and CHE (16,22,23). Another study shows that households with higher income had a higher willing to pay and access ability to health services (24).…”

“…Since impoverishment indices offer guidance for developing appropriate health policies and intervention programs to decrease financial inequity (18), it is recommended for health policy makers' attention to poverty regions.…”

Impoverishing effects of catastrophic health expenditures in Malawi

“…In LIMC context, many studies have concentrated on assessing determinants of CHE and OOP and established that poverty, gender, age, education, location have significant influence [14, 16, 19, 21, 25]. Other empirical evidence also suggest that insurance offers some protection against CHE and poverty [14, 26].…”

Catastrophic Expense & Financial Protection Mechanisms to Achieve Universal Health Coverage: A Review

“…2,3,5,6,9,11,12,14,15 Patients had to take loans and dispose assets to meet the catastrophic expenses. [16][17][18] Studies indicate that expenses on indoor hospitalizations are catastrophic especially for poor. 4,7,10,17,19 Some researchers have documented the catastrophic expenses in specific disease conditions.…”