Coping with Health Care Expenses Among Poor Households: Evidence from a Rural Commune in Vietnam

Social Science & Medicine, Vol. 74, No. 5, pp. 724-733, 2012

10 Pages Posted: 18 Jul 2009 Last revised: 16 Feb 2012

See all articles by Kim Thuy Nguyen

Kim Thuy Nguyen

Yale University - School of Medicine

Oanh Thi Hai Khuat

Institute for Social Development Studies

Steven Ma

Yale University - School of Public Health

Duc Cuong Pham

Institute for Social Development Studies

Giang Thi Hong Khuat

Institute for Social Development Studies

Jennifer Prah Ruger

University of Pennsylvania - School of Social Policy & Practice; University of Pennsylvania - Perelman School of Medicine

Date Written: December 2011

Abstract

With the 1980s “Doi Moi” economic reforms, Vietnam transitioned from state-funded health care to a privatized user fee system. Out-of-pocket payments became a major source of funding for treatments received at both public and private health facilities. We studied coping strategies used by residents of Dai Dong, a rural commune of Hanoi, for paying health care costs, assessing the effects of such costs on economic and health stability.

We developed a 2008 survey of 706 households (166 poor, 184 near-poor, 356 non-poor; 100% response rate). Outcome measures were reported episodes of illness; inpatient, outpatient, and self-treatments; out-of-pocket expenditures; and funding sources for health care costs. Households of all income levels borrowed to pay for inpatient treatments; loans are also more heavily used by the poor and near-poor than the non-poor for outpatient treatments. Compared to low cost treatments, the use of loans is intensified for extremely high cost health treatments for all poverty levels, but especially for the poor and near-poor. The likelihood of reducing food consumption to pay for extremely high cost treatment versus low cost treatments increased most for the poor in both inpatient and outpatient contexts.

Decreased funding and increased costs in health care rendered Dai Dong’s population vulnerable to the consequences of detrimental coping strategies such as debt and food reduction. Future reforms should focus on obviating these funding measures among at-risk populations.

Keywords: Vietnam, Coping strategies, Health financing, Catastrophic expenditures, Out-of-pocket payments, Health care expenses, Poverty, Rural

JEL Classification: I11, I18

Suggested Citation

Nguyen, Kim Thuy and Khuat, Oanh Thi Hai and Ma, Shuangge and Pham, Duc Cuong and Khuat, Giang Thi Hong and Prah Ruger, Jennifer, Coping with Health Care Expenses Among Poor Households: Evidence from a Rural Commune in Vietnam (December 2011). Social Science & Medicine, Vol. 74, No. 5, pp. 724-733, 2012, Available at SSRN: https://ssrn.com/abstract=1435832 or http://dx.doi.org/10.2139/ssrn.1435832

Kim Thuy Nguyen (Contact Author)

Yale University - School of Medicine ( email )

333 Cedar Street
New Haven, CT 06520-8034
United States

Oanh Thi Hai Khuat

Institute for Social Development Studies ( email )

Hanoi
Vietnam

Shuangge Ma

Yale University - School of Public Health ( email )

PO Box 208034
60 College Street
New Haven, CT 06520-8034
United States

Duc Cuong Pham

Institute for Social Development Studies ( email )

Hanoi
Vietnam

Giang Thi Hong Khuat

Institute for Social Development Studies ( email )

Hanoi
Vietnam

Jennifer Prah Ruger

University of Pennsylvania - School of Social Policy & Practice ( email )

3701 Locust Walk
Philadelphia, PA 19104-6214
United States

University of Pennsylvania - Perelman School of Medicine

423 Guardian Drive
Philadelphia, PA 19104
United States

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