Socioeconomic differences in a rural district in Vietnam : Effects on health and use of health services

Abstract: Background: Differences in health status and health care utilization between socioeconomic groups are evident in low-income and high-income countries. The situation in rural Vietnam is not well known. Empirical results on health by socioeconomic group, or geographic location may provide useful information for designing equity-oriented health policy and poverty focused interventions. Objective: To study socioeconomic differences and deviations from equality in health, health care utilization and health care expenditure in a rural district in Vietnam in relation to existing health care policy and available services. Methods: The studies were conducted within a demographic surveillance system (FilaBavi) in the BaVi district, northern rural Vietnam. The basic study used was the FilaBavi baseline survey with 11,547 house¬holds and 49,893 persons. The results on utilization and payment for outpatient services were based on a sub-study of 4,769 individuals. Socioeconomic differentials in prolonged cough prevalence were estimated for 35,832 individuals aged 15 or more. The socioeconomic differences in mortality were estimated using the quarterly follow-ups during 1999-2002. Main findings: Different indicators: income, expenditure, household asset, housing conditions and official classification give different descriptions of the economic situation. The indicators are not closely correlated. Sensitivity and positive predictive value for poverty are low for all indicators. Self-treatment is the most common choice and accounts for 50.7 % of the health care actions taken. It is reported more often by the better-off than the poor (56.1 % vs. 41.2 %). Private practitioners are important sources of health care. They account for 18%, and are consulted more often by the poor than by the better-off (21.0 % vs. 16.1 %). The poor choose commune health centers more often than the better-off (20.0 % vs. 15.5 %). Poor patients are more likely to deter from seeking health care in public health facilities. Twenty percent in the lowest income quintile deter from seeking health care in public health services due to financial difficulties, compared to 8.2 percent in the highest income quintile. The mean payment for treatment during a 4-week recall period is 7.4 percent of the household monthly income, a substantial share. The percentage of the household income used for treatment decreases as the income increases. The poorest quintile spends 16.9 % of their monthly household income, while the richest quintile spends only 3.7 %. There are differences in sources of payments between income groups. The richest income quintile relies on household saving more often than the poorest (37.8 % vs. 28.6 %), while the latter reports borrowing money as a main source of payment for health care to a larger extent than the richest quintile (38.1 % and 21.3 % respectively). The estimated prolonged cough prevalence is higher for persons classified as poor, regardless of indicator used. The standardized mortality rate of males in the lowest wealth quintile is much higher than that of males in the highest wealth quintile. Conclusions and recommendations: The studies gave indications as regards socioeconomic differences in health and in access to health services especially for the poorer groups of the population in the study area. Poor persons and households are in worse situations regarding health, utilization of health care and payments for health services. The results urge for policy initiatives to reduce the burden of the poor and to satisfy the greater needs of the poorer part of the population. For egalitarian health polices, it is important to ensure not only an absolute level of health but also smaller relative differentials between socioeconomic groups. A combination of developing risk-sharing schemes; exemption, partial or full from payment; differentiation of prices; appropriate allocation of scarce public resources; supporting and regulating the private health sector; government subsidized health insurance for low income groups, and in the long-run universal coverage of health insurance may be possible solutions to improve access to health care for the poorer section of the population.