The policy of free healthcare for children under the age of 6 years in Vietnam: assessment of the uptake for children hospitalised with acute diarrhoea in Ho Chi Minh City

Van Thi Thuy Linh,My Phan Vu Tra,Stephen Baker,Pham Thi Ngoc Tuyet,Jeremy J. Farrar,Fabrizio Tediosi,Ho Lu Viet,Ha Manh Tuan,Corinne Thompson,Mae Shieh,Laura Merson

doi:10.1111/tmi.12208

Abstract

ObjectiveTo 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.MethodsInvoices 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.ResultsOverall, 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.ConclusionsThe 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.

Highlights

Vietnam has one of the highest percentages of households at-risk of catastrophic health expenditures among East Asian countries in a comparable stage of development (Xu et al 2003; van Doorslaer et al 2006, 2007)
The state contributes the premiums for both groups, who are protected under the compulsory social health insurance scheme
Predictive factors, and the risk of catastrophic expenditure we aimed to understand how FCCU6 is performing in children hospitalised with acute diarrhoea in a tertiary hospital in Ho Chi Minh City (HCMC)

Summary

Introduction

Vietnam has one of the highest percentages of households at-risk of catastrophic health expenditures (expenses potentially driving households into poverty) among East Asian countries in a comparable stage of development (Xu et al 2003; van Doorslaer et al 2006, 2007). The Vietnamese government has aimed to reduce out-of-pocket (OOP) health expenditures for households through the introduction of universal health insurance, which includes special policies providing free healthcare to the poor and children under 6 years old (FCCU6). The state contributes the premiums for both groups, who are protected under the compulsory social health insurance scheme. Under this policy children under the age of 6 years old are entitled to no-cost treatment, laboratory tests and generic medications at public outpatient and inpatient facilities. In order to access this free healthcare, the child must hold a government health insurance card and access healthcare at the local public facility to which they are registered.

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