Nguyen Ha, Ivers Rebecca, Jan Stephen, Pham Cuong
School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
BMJ Glob Health. 2017 Feb 14;2(1):e000082. doi: 10.1136/bmjgh-2016-000082. eCollection 2017.
In Vietnam, over 39 000 people die and millions are hospitalised due to injuries every year. Injuries create a significant financial burden for families. In this study, we estimated out-of-pocket payment for medical care of injuries and the role of health insurance in containing such costs.
A prospective cohort study of 892 hospitalised injury patients admitted to a provincial general hospital in 2010 in Vietnam was conducted. Data on demographic, injury characteristics and costs by specific categories paid out-of-pocket by patients were included in the analyses. Generalised linear models with log link and γ distribution were employed to examine the associations between insurance status and total costs.
The average total medical care costs paid out-of-pocket by patients during hospitalisation were over US$ 270. Major drivers of the costs related to surgery (nearly 25%), diagnostic test/examination (24%) and drugs (23%). Burns incurred the highest total costs during hospitalisation ($321) and assault incurred the lowest ($167). Total costs were higher for more severe injuries and those that required a more complex surgery. Patients using health insurance paid less those who did not. However, there were no statistically significant associations between health insurance and total costs, costs for surgery, diagnostic tests/examinations or drugs.
The study provides estimates and distribution of medical care costs for injuries in hospital. In addition to ongoing efforts in prevention, the study provides further evidence on the limited benefits of health insurance in protecting patients and their family from the high costs of hospitalisation in Vietnam.
在越南，每年有超过3.9万人因伤死亡，数百万人因伤住院。伤害给家庭带来了沉重的经济负担。在本研究中，我们估计了伤害医疗的自付费用以及医疗保险在控制此类费用方面的作用。
对2010年越南一家省级综合医院收治的892名住院伤害患者进行了一项前瞻性队列研究。分析纳入了患者按特定类别自付的人口统计学、伤害特征和费用数据。采用对数链接和γ分布的广义线性模型来检验保险状况与总费用之间的关联。
患者住院期间自付的平均医疗总费用超过270美元。费用的主要驱动因素与手术（近25%）、诊断检查（24%）和药品（23%）有关。烧伤住院期间的总费用最高（321美元），袭击导致的费用最低（167美元）。伤势越严重、手术越复杂，总费用越高。使用医疗保险的患者支付的费用比未使用的患者少。然而，医疗保险与总费用、手术费用、诊断检查费用或药品费用之间没有统计学上的显著关联。
该研究提供了医院伤害医疗费用的估计和分布情况。除了持续的预防努力外，该研究进一步证明了医疗保险在保护越南患者及其家庭免受高额住院费用影响方面的益处有限。
