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.
Highlights
The catastrophic health expenditure and impoverishment indices offer guidance for developing appropriate health policies and intervention programs to decrease financial inequity
We focused only in the urban areas, our results are consistent with previous studies and show that non-communicable diseases (NCD) and lower socioeconomic status increase the risk of households facing catastrophic health expenditure and impoverishment [8, 39]
Our study provides evidence that socioeconomic inequalities in catastrophic health expenditure exist in both slum and non-slum areas, while socioeconomic inequalities in impoverishment existed only in slum areas in urban Hanoi, Vietnam
Summary
The catastrophic health expenditure and impoverishment indices offer guidance for developing appropriate health policies and intervention programs to decrease financial inequity. The rates of catastrophic health expenditure and impoverishment due to medical expenses are important indicators for assessing the level of financial protections—in the form of subsidization or health insurance—a country provides for its population. These indicators offer guidance for developing appropriate health policies and intervention programs to decrease financial inequity and achieve fairness in financial contribution to the health system [2,3,4,5]. Several studies have showed the strong association between having older people as household members with catastrophic health expenditure and impoverishment [2, 4, 9,10,11]
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