Tran Bach Xuan, Tran Tho Dinh, Nathan Nila, Ngo Chau Quy, Nguyen Loi Thi, Nguyen Long Hoang, Nguyen Huong Lan Thi, Nguyen Cuong Tat, Do Huyen Phuc, Nguyen Trang Huyen Thi, Tran Tung Thanh, Thai Thao Phuong Thi, Dang Anh Kim, Nguyen Nam Ba, Latkin Carl A, Ho Cyrus S H, Ho Roger C M
Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Clinicoecon Outcomes Res. 2019 Feb 11;11:151-158. doi: 10.2147/CEOR.S191379. eCollection 2019.
Despite gallstone diseases (GSDs) being a major public health concern with both acute and chronic episodes, none of the studies in Vietnam has been conducted to investigate the household expenditure for the GSD treatment. The objective of this study was to estimate the costs of managing GSD and to explore the prevalence and determinants of catastrophic health expenditure (CHE) among Vietnamese patients.
A cross-sectional study was conducted from June 2016 to March 2017 in the Department of Hepatobiliary and Pancreatic Surgery, Viet Duc Hospital in Hanoi, Vietnam. A total of 206 patients were enrolled. Demographic and socioeconomic data, household income, and direct and indirect medical costs of patients seeking treatment for GSD were collected through face-to-face interview. Multivariate logistic regression was used to explore factors associated with CHE.
The prevalence of CHE in patients suffering from GSD was 35%. The percentage of patients who were covered by health insurance and at risk for CHE was 41.2%, significantly higher than that of those noninsured (15.8%). Proportions of patients with and without health insurance who sought outpatient treatment were 30.6% and 81.6%, respectively. Patients who were divorced or widowed and had intrahepatic gallstones were significantly more likely to experience CHE. Those who were outpatients, were women, had history of pharmacological treatment to parasitic infection, and belong to middle and highest monthly household income quantile were significantly less likely to experience CHE.
The findings suggested that efforts to re-evaluate health insurance reimbursement capacity, especially for acute diseases and taking into account the varying preferences of people with different disease severity, should be conducted by health authority. Further studies concerning CHE of GSD in the context of ongoing health policy reform should consider utilizing WHO-recommended measures like the fairness in financial contribution index, as well as taking into consideration the behavioral aspects of health care spending.
尽管胆结石疾病（GSDs）是一个涉及急性和慢性发作的重大公共卫生问题，但越南尚未开展任何研究来调查GSD治疗的家庭支出。本研究的目的是估计GSD的管理成本，并探讨越南患者中灾难性卫生支出（CHE）的患病率及其决定因素。
2016年6月至2017年3月在越南河内越德医院肝胆胰外科进行了一项横断面研究。共纳入206例患者。通过面对面访谈收集了寻求GSD治疗患者的人口统计学和社会经济数据、家庭收入以及直接和间接医疗费用。采用多因素逻辑回归分析探讨与CHE相关的因素。
GSD患者中CHE的患病率为35%。参加医疗保险且有CHE风险的患者比例为41.2%，显著高于未参保患者（15.8%）。参加和未参加医疗保险的患者寻求门诊治疗的比例分别为30.6%和81.6%。离婚或丧偶且患有肝内胆结石的患者发生CHE的可能性显著更高。门诊患者、女性、有寄生虫感染药物治疗史且属于家庭月收入中高四分位数的患者发生CHE的可能性显著更低。
研究结果表明，卫生当局应努力重新评估医疗保险报销能力，特别是针对急性疾病，并考虑不同疾病严重程度人群的不同偏好。在当前卫生政策改革背景下，关于GSD的CHE的进一步研究应考虑采用世界卫生组织推荐的措施，如财务贡献公平指数，并考虑医疗保健支出的行为因素。
