Coping With Health Care Expenses Among Poor Households in Dai Dong, a Rural Commune of Hanoi Vietnam

Abstract:     
Objective: To study coping strategies used by residents of a Vietnamese rural commune in paying healthcare costs, and the effects of fees on economic and health stability.

Design: A household survey study in 2008

Setting: The rural commune of Dai Dong, Vietnam.

Subjects/Participants: 706 households (166 poor, 184 near-poor, 356 others)

Main outcome measures: inpatient, outpatient, and self-care treatment, out-of-pocket expenditures, and funding sources for healthcare costs.

Results: Poor, near-poor and other households alike borrowed to pay for inpatient treatments. Borrowing funded more outpatient treatments for poor (20%) and near-poor households (24%) than for others (12%). Extremely high-cost treatments were more likely funded by loans for all poverty levels (OR = 17.62, p<0.05 for poor, 144.75, p<0.05 for near-poor, and 10.98, p<0.001 for other households) than low-cost inpatient treatments. For extremely high-cost outpatient treatment, there was greater likelihood of loans among poor and near-poor (OR=5.04, p<0.001; OR=5.16, p<0.001) than other households (OR=3.70, p<0.001). Extremely high self-treatment costs were more likely funded by loans for all, with poor having the highest likelihood (OR=3.13, p<0.05). Likelihood of reducing food consumption to pay for extremely high-cost treatments versus low-cost treatments, increased most for poor in both inpatient (OR=44.12, p<0.10) and outpatient (OR=3.90, p<0.10).

Conclusion: Decreased healthcare funding and increased healthcare costs posed substantial challenges for Dai Dong’s population. Future reforms should focus on preventing detrimental coping strategies among at-risk populations.

Keywords: Vietnam, rural, healthcare expenditures, out-of-pocket fees, coping strategies, Hanoi, Dai Dong

JEL Classifications: I11, I18

Working Paper Series