Severe injuries and household catastrophic health expenditure in Vietnam: findings from the Household Living Standard Survey 2014.

OBJECTIVES

To assess the extent that the presence of severe injuries among rural and urban household members is associated with household catastrophic expenditure.

STUDY DESIGN

Vietnam's Household Living Standard Survey of 2014 was used for this study.

METHODS

A two-level (household and community) logistic regression analysis was used to identify factors associated with catastrophic health expenditure.

RESULTS

The incidence of catastrophic health expenditure was significantly higher in rural areas (3.1-11.7%) than in urban areas (1.4-6.1%). Households with members with severe injuries were significantly more likely to incur catastrophic health expenditure than those without severe injuries, and the increase was more pronounced for the rural poor and near poor (5.5-8.7 times) than for the rural rich (1.5-2.5 times). Having at least one inpatient contact at a higher level public hospital increased the risk of catastrophic health expenditure significantly for both rural and urban residents, and the increase was significantly greater among the rural residents than the urban residents. Having more household members with health insurance had little effect on the incidence of catastrophic health expenditure faced by urban residents, while it increased the incidence of catastrophic health expenditure faced by rural residents.

CONCLUSION

The presence of severe injuries among household members was strongly associated with catastrophic health expenditure. To protect households against the financial consequences of severe injuries, efforts should be directed at injury prevention and strengthening the quality of primary and trauma care at the lower level public health facilities as well as extending the breadth and depths of insurance coverage.