10.Nguyen Hoang Long

Research papera Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam b Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United St

Research paper

a

Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam

b

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States

c

Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Viet Nam

d School of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam

e

Institute for Global Health Innovation, Duy Tan University, Da Nang, Viet Nam

f

Foreign Trade University, Hanoi, Viet Nam

g

Center for AIDS Control, Hanoi Department of Health, Hanoi, Viet Nam

Introduction

(Nguyen,Tran,Tran,Le,&Tran,2014;Tranetal.,2012a,2013a;

Tran,2013).MurphyandScottdefinedthe‘‘economicvulnerability

2013a) In addition, it has also been a barrier for those who

A R T I C L E I N F O

Article history:

Received 18 October 2015

Received in revised form 29 November 2015

Accepted 21 January 2016

Keywords:

Methadone

Integrative services

Health services

Costs

Catastrophic

Vietnam

A B S T R A C T

* Corresponding author at: Hanoi Medical University, Viet Nam.

Tel.: +84 982228662.

E-mail addresses: bach@hmu.edu.vn , bach@jhu.edu (B.X Tran).

j ou rna l h om e pa ge : w w w e l s e v i e r co m/ l oc a t e / dru gpo

http://dx.doi.org/10.1016/j.drugpo.2016.01.017

0955-3959/ß 2016 Elsevier B.V All rights reserved.

(Burns et al., 2015; Tran et al., 2012b, 2012c, 2012d; Zhou &

Zhuang,2014).InVietnam,patientshavebeenreceivingMMT

Nguyen,&Latkin,2015).Findingfrompriorreviewsdemonstrated

2011;Pilgrim,McDonough,&Drummer,2013;Sunetal.,2015;

Wang,Wouldes,&Russell,2013;Weimer&Chou,2014).Among

Nguyen,2013).Thus,implementingandscaling-upMMTprogram

Mirahmadizadeh, Heidari, & Javanbakht, 2014; Roncero et al.,

2015;Tranetal.,2012c,2012d,2012e;Tran,Nguyen,Phan,etal.,

Pham,Vu,&Mulvey,2012).Duringtheperiodofthisstudy,some

Nguyen, 2013) Primary medical care services are provided

Laohasiriwong,Stewart,Tung,&Coyte,2013;Nguyenetal.,2012b;

Nguyen,Ivers,Jan,&Pham,2015;Pham,Kizuki,Takano,Seino,&

Watanabe, 2013; Tran et al., 2013a) The percentage of public

Tran,Nguyen, Phan, et al., 2015) This model also reduces the

Clark,2008),therefore,itmayimprovetheefficiencyoftheservice

Nguyenetal.,2015b,2015c;Tran,Ohinmaa,Nguyen,Nguyen,& Nguyen, 2011; Tran,Van Hoang,et al.,2013) Thus, comparing

&Pham,2014).Itisestimatedthatabout180,000peopleareusing

Epidemi-ology, 2011) The MMT program has been prioritized in the

Ohinmaa, & Nguyen, 2012) Health related quality of life was

2011, 2012f; Tran, Nguyen, Ohinmaa, Maher, Nong, & Latkin,

2014; Tran, Nong, Maher, Nguyen, & Luu, 2014) Catastrophic

Li,&Murray,2009;Saitoetal.,2014;Wagstaff&vanDoorslaer,

2003)

2013;Tran&Nguyen,2012;Tranetal.,2011,2013a,2013c;Tran,

Nguyen, Nguyen, Hoang, & Hwang, 2013; Tran, Nguyen, Do,

Nguyen,&Maher,2014).Costperinpatientandoutpatientvisit

Results

Table4,wefoundthatmedicationwasthemajordriverofhealth

Table 1

Study settings and sample size.

Province Nam Dinh City Provincial AIDS Centre (PAC) MMT + VCT 270 District (rural) Xuan Truong District District Health Centre (DHC) MMT + VCT + ART + GH 151 District (urban) Tu Liem District District Health Centre (DHC) MMT + VCT + ART + GH 201 District (urban) Long Bien District District Health Centre (DHC) MMT + VCT + ART + GH 184 District (urban) Ha Dong District Regional Polyclinic (RPC) MMT + GH 210 VCT: voluntary HIV counseling and testing.

ART: antiretroviral treatment; GH: General healthcare (apart from ART, VCT, MMT).

Table 2

Health care services utilization and economic burden of MMT patients.

MMT + VCT + ART + District GH p-Value (compare

4 groups) MMT + VCT Rural Urban MMT + RPC All

Having inpatient care last year 15 5.6 10 6.6 36 9.4 22 10.5 83 8.2 0.16

Level of inpatient health services

Provincial 10 66.7 2 20.0 7 21.2 9 42.9 28 35.4

Ability to pay

Having outpatient care last year 53 19.6 68 45.0 109 28.3 62 29.5 292 28.7 <0.01

Level of outpatient health services

Central 6 11.3 5 7.6 46 45.1 18 30.5 75 26.8 <0.01

Provincial 37 69.8 9 13.6 16 15.7 15 25.4 77 27.5

Private clinic 8 15.1 6 9.1 14 13.7 12 20.3 40 14.3

Ability to pay

% catastrophic health expenditure 30 11.1 28 18.5 48 12.4 24 11.4 130 12.8 0.14

% catastrophic health expenditure

(without subsidy)

191 70.7 115 76.2 218 56.6 121 57.6 645 63.5 0.14

Table 3

Expenditure for the last inpatient and outpatient care.

MMT + VCT + ART + District GH

Inpatient care

# working days lost by care givers 11 15 8 11 36 97 8 15 18 48 Non-medical cost

Cost for transportation 594 1324 341 380 613 1335 230 354 1209 3494 Cost for boarding and lodging 667 1164 390 273 984 2083 905 1455 1293 2068 Direct medical cost 10,197 16,599 4350 5114 11,202 12,815 10,495 13,198 10,516 13,861 Outpatient care

# working days lost by care givers 1 4 2 14 3 21 0 1 2 14 Non-medical cost

Cost for transportation 120 372 83 156 155 851 113 290 1793 22,902 Cost for boarding and lodging 135 504 38 91 89 771 107 445 889 15,243 Direct medical cost 1198 2063 419 861 1047 1689 985 1201 905 1594 Monetary unit: 1000 Vietnam Dong (US$ 1 = 20,000 VND).

Tranetal.,2013a).Thisstudyalsofoundahighexpenditureon

(Nguyenetal.,2014;Tranetal.,2013a).AlthoughMMTservices

2012b,2012e).Findingsofthisstudyconfirmedthatotherhealth

2012d) Second, financial supports for MMT services are still

Table 5

Household’s monthly expenditure and OOP health expenditure in the past year (unit: 1000 Vietnam Dong 1 USD  20,000 in 2013).

MMT + VCT + ART + District GH p-Value (compare

4 groups) MMT + VCT Rural Urban MMT + RPC

Mean SD Mean SD Mean SD Mean SD OOP health expenditure last year 2607 9094 4383 11,730 3940 10,824 3632 8700 0.28

Direct medical cost 1928 6781 2858 9105 3230 9467 2986 7648 0.26

Inpatient care 1541 6651 2557 8965 2876 9368 2621 7492 0.22

Outpatient care 386 1117 302 799 354 1030 365 885 0.87

Household monthly recurring expenses 4118 3271 3366 2753 6232 4841 5930 3992 0.00

Water and electricity 16% 19% 11% 16% 17% 18% 18% 21%

Household monthly non-recurring expenses 2422 10,220 2985 7002 4268 19,375 8964 40,021 0.01

Total household monthly expenditure 6540 11,104 6351 7779 10,499 20,581 14,894 41,661 <0.01

Per capita 2070 4310 1669 2143 2810 5152 3956 10,904

* ANOVA test.

Table 4

Costs for the last inpatient and outpatient care by components and payers.

Direct medical costs Inpatient care Outpatient care

By cost components

Medication 43% 32% 59% 38%

Hospital fee 36% 33% 11% 27%

By payers

Self financed 86% 28% 95% 19%

Health insurer 9% 21% 4% 16%

Other supports 5% 19% 1% 10%

offered

(Thuan,Lofgren,Chuc,&Lindholm,2008).Thismightberelatedto

Conclusion

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Table 6

Factors associated with health care utilization and expenditure among MMT patients.

OOP health expenditure (unit:

1000 Vietnam Dong)

Experiencing catastrophic health expenditure

Having inpatient care Having outpatient

care

Coef 95% CI OR 95% CI OR 95% CI OR 95% CI MMT model (MMT + VCT – ref)

Rural MMT-ART-VCT-DGH 1405 ( 1165 to 3975) 2.87 ***

(1.33–6.20) 0.73 (0.23–2.31) 4.78 ***

(2.54–9.01) Urban MMT-ART-VCT-DGH 794 ( 913 to 2502) 1.15 (0.62–2.12) 1.69 (0.80–3.58) 1.93 ***

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(0.98–4.96) 1.87 **

(1.13–3.09) Education (High school or Lower – ref)

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(0.28–0.78) Employment (Unemployed – ref)

Self-employed 1214 *

( 211 to 2638) 2.05 ***

(1.22–3.45) 0.39 ***

(0.22–0.70)

(0.26–1.05)

(0.63–384.49)

Age groups (18–<25 – ref)

(0.06–0.68)

(0.11–0.58) Years since first drug use 1.06 ***

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(1.50–5.35) 1.61 *

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(1.65–6.84)

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( 219 to 3044) 1.58 *

(0.95–2.63) Constant 471 ( 1116 to 2057) 0.03 ***

(0.01–0.07) 0.10 ***

(0.05–0.21) 0.75 (0.35–1.59)

*

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