Objectives: To calculate the out of pocket payment for the case of appendectomy treatment at Sonla General Provincial Hospital in 2012 - 2013. Subjects and methods: All of 322 appendicitis patients who were treated at Sonla General Provincial Hospital from Jan 2012 to Dec 2013 were interviewed by using a structured questionnaire.
Trang 1OUT OF POCKET PAYMENT FOR HEALTH CARE IN VIETNAM:
AN EXAMPLE FROM THE CASE OF APPENDECTOMY TREATMENT
AT SONLA GENERAL PROVINCIAL HOSPITAL IN 2012 - 2013
Nguyen Duc Toan 1 ; Pham Le Tuan 2 ; Quach Thi Can 3
SUMMARY
Objectives: To calculate the out of pocket payment for the case of appendectomy treatment
at Sonla General Provincial Hospital in 2012 - 2013 Subjects and methods: All of 322
appendicitis patients who were treated at Sonla General Provincial Hospital from Jan 2012 to
Dec 2013 were interviewed by using a structured questionnaire The direct cost for treatment of
patients was also collected using payment receipts from the hospital Data were analyzed using
the STATA version 14.0 Results and conclusion: The study found the out of pocket payment
for appendectomy treatment was 2.228 million VND and accounted for 43.8% of the total
direct cost The corresponding figure for patients with health insurance was 1.822 million VND
and 34.4% The better health insurance coverage will reduce the out of pocket
* Keywords: Appendectomy treatment; Out of pocket payment; General provincial hospital
INTRODUCTION
Out-of-pocket payments (OOPs) are
defined as direct payments made by
individuals to health care providers at the
time of service use This excludes any
prepayment for health services, for
example in the form of taxes or specific
insurance premiums or contributions and,
where possible, net of any reimbursements
to the individual who made the payments [8]
Reducing the OOP for health care is a
trying of any government in developing
countries in order to get equity in health
care In Vietnam, National health insurance
was introduced in 1992 Time by time,
the health insurance (HI) coverage has
increased and it’s an important factor
effecting to reduce the OOP There are some studies in Vietnam to look at the OOP and/or financial burden of household
in general [5, 6] or a group of diseases, like non comunicable disease [4] but it’s limitation of OOP for Sonla province specially and for the whole of Vietnam in generally So that, this study was conducted
with aim: To calculate the out of pocket
payment for the case of appendectomy treatment at Sonla General Provincial
Hospital in 2012 - 2013
SUBJECTS AND METHODS
1 Subjects
322 patients who were hospitalized for appendectomy treatment during the period from Jan 2012 to December 2013
1 ENT Hospital, Hochiminh City
2 Medicine and Pharmacy University
3 Medicine and Pharmacy University
Corresponding author: Nguyen Duc Toan (@gmail.com)
Trang 2SUBJECTS AND METHODS
1 Subjects
322 patients who were hospitalized for
appendectomy treatment during the period
from Jan 2012 to December 2013
2 Methods
* Study design and setting: It was a
cross sectional study during the time from
Jan 2012 to Dec 2013 at the Sonla General
Provincial Hospital
* Data collection:
Face-to-face interview using a structured
questionnaire was conducted with either
patients themselves or their close relatives
The interview was conducted immediately after hospitalization at patients’room The longest interval was 3 months Interviewers included 15 medical doctors who worked at the general provincial hospital However, some expenditure also got from the Finance Department of the Hospital
* Data analysis: STATA program
version 14.0 was used for data analysis The costs were calculated by using mean (SD) and median (25 - 75%) The non-parameter Mann-Whitney test was used for testing the difference in the cost between different groups
RESULTS AND DISCUSSION
* Characteristics of patients:
Among 322 patients studied, more than 80% were from 18 to 60 years old and up The mean of age was 41.7 ± 18.2 years The proportion of male and female was 53.1% and 46.9%, respectively The main occupation was farmer (35.4%), following public servants (19.9%) Unemployment was accounted for 13.7% The patients had HI was
265 patients (82.3%), among them only 10 patients covered 100% by HI Average duration time for appendectomy treatment was about 5 days These figures were similar to the information from 103 Military Hospital [3] The number of appendectomy cases at Sonla General Provincial Hospital in 2012 and 2013 were about almost the same as number of that at 103 Military Hospital in 1995 [3]
Table 1: Direct cost for one case of appendectomy treatment
Unit: Million VND
Cost
Median (25 - 75%)
p*
(* Mann-Whitney test)
Trang 3There was about 18% of studied patients having no HI The difference between group with and without HI was statistically significant for some comparison except the direct non-medical cost and indirect cost
(*: Direct cost and OOP were significantly different between different groups)
Figure 1: Average OOP and HI payment for direct cost (Unit: thousand VND)
For the patients without IH, they had
to pay 100%, while the patients with HI
had to pay 34.4% for direct cost of
appendectomy treatment The OOP
percentage was different from year 2012
and 2013 and from open surgery and
laparoscopy In general, the OOP was
2,228 million VND and accounted for
almost 44.0% of total direct cost The
direct cost and OOP were statistically
significant difference by years, surgery
methods and between those with and
without HI (p < 0.05) So far, we have not
found the timing relevant figures to compare
with the result of our study But in
Pakistan in 2004 - 2004, OOP on health care was 67% [6] Hoang Van Minh and others showed OOP in Vietnam at some points of time was much lower than that from our study: in 2002; 2004; 2006; 2008 and 2010 was VND 67,300; VND 126,400; VND 114,000; VND 201,300; and VND 243,000, respectively [5] The difference between OOP absolute figures in Hoang Van Minh,s study and our study can be explained by the methodology We just calculated OOP for a specific acute case
at one province while Hoang Van Minh analyzed data from a sery of National
surveys
Trang 4Table 2: Detail direct cost for appendectomy treatment
Unit: Million VND
Cost item
Median
Median
0.081
0.245
0.210
0,011
Consultation
and bed
0.037
0.060
Others (Direct
0.650
All direct non-medical payment was covered by 100% patients Beside as it included transportation fees, food, accommodation for the patients and their relatives For all patients, the expenditures for medicine was accounted for nearly 30% These figures came not only from non-insured patients but from all patients together The result looked like that as there are lists of tests and of medicines that HI will cover The tests
or medicines are not included in the lists patients have to pay regardless with or without
IH For example, the test to detect is not included in the list
Table 3: Expenditure for medicines of appendectomy treatment
Unit: thousand VND
Kind of
Medicines
Paid by HI (n = 322) OOP (n = 322)
p
The biggest parts of OOP medicines were for antibiotics and painkillers It’s reasonable because the operated patients are suffering from the pain and have high risk with infection
Trang 5The table 4 showed that the higher
income patients had the less paid by HI
The patients who paid all by themself had
daily income almost three time higher
than that of patients who were totally
covered by HI It’s not be sure to say that
the better income group had no HI
Appendectomy treatment can be done at
district hospitals and the HI will pay for
insured patients but for some cases the
insured want to take health service at
higher level and they are able and happy
to pay
The study had some limitation, such as:
- Recall bias could be existed in the case of the interviewing was conducted long time after the hospitalization
- It did not include the household income and economical quintile groups, therefore we cannot calculate the economical burden of the household in general and for each quintile group
- It just look at OOP for one acute condition (one episode) at individual level but not for the whole family for longer time period (usually one year)
Unit: thousand VND
Averagely, the patients had to pay 23.9 daily income for appendectomy treatment at the province hospital The figure for patients with totally covered by HI, partly covered
by HI and totally covered by themselves was 18.1; 20.8 and 41.6 daily income , respectively The more covered by HI the less daily income was
CONCLUSION
The average OOP for appendectomy
treatment at Sonla General Provincial
Hospital in 2012 and 2013 for all patients
was 2,228 million VND and accounted
for 43.8% of total direct cost The
corresponding figure for patients with HI
was 34.4% The better HI coverage will
reduce the OOP
REFERENCES
1 The Sonla provincial ethnic committee
The report N053/BC-BDT on the situation of ethnic minorities and the implementation of policies for small ethnic minority groups 2018
2 The Ministry of Labour, Invalids and
Social Affairs Decision 749/QĐ-LDTBXH dated 13rd May 2013 approving the results of the survey on poor households 2013
Trang 63 103 Military Hospital Acute appendicitis
Internet access, available on 3rd Sept 2018
4 Vu Duy Kien, Hoang Van Minh, Kim Bao
Giang, Amy Dao, Le Thanh Tuan and Nawi
Ng Socioeconomic inequalities in catatrophic
health expenditure and impoverishment
associated with non-communicable disease in
urban Hanoi, Vietnam International Journal
for Equity in Health 2016, 5, 169 DOI
10.1186/s12939-016-0460-3
5 Hoang Van Minh, Nguyen Thi Kim
Phuong, Privanka Saksena Chris D.James,
Ke Xu Financial burden of household out-of
pocket health expenditure in Viet Nam: Findings
from the National living standard survey
2002 - 2010 Social Science & Medicine 2012, pp.1-6
6 Ashar Muhammad, Azam Syed
Socio-economic determinants of household out-of-pocket payments on healthcare in Pakistan
Int J Equity Health 2012, pp.11-51
7 Natascha Wagner, Stella Quimbo, Riti Shimkhada, John Peabody Does health
insurance coverage or improved quality protect better against out-of-pocket payment? Experimental evidence from the Philippines Social Science & Medicine 2018, 204, pp.51-58
8 WHO Out-of-pocket payments, user fees and catastrophic expenditure www.who.int/health_financing/topics/financial-protection/out pocket-payments