Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2002 Jul;56(7):497–505. doi: 10.1136/jech.56.7.497

Economic transition should come with a health warning: the case of Vietnam

M Segall 1, G Tipping 1, H Lucas 1, T Dung 1, N Tam 1, D Vinh 1, D Huong 1
PMCID: PMC1732209  PMID: 12080156

Abstract

Design: Observational study by cross sectional socioeconomic survey, longitudinal healthcare seeking survey, and qualitative semi-structured interviews and focus group discussions; qualitative follow up over six years.

Setting: Four rural communes in north of Vietnam between 1992 and 1998.

Survey participants: 656 households (2995 people) selected by systematic random sampling.

Main results: Compared with non-poor households, poor households had significantly lower average per capita rates of healthcare consultation and expenditure (p<0.01 in both cases). Poor households delayed and minimised healthcare seeking, especially of expensive hospital services. Two thirds of average healthcare spending by poor households was on relatively inexpensive but frequent acts of local ambulatory care. The poor restrained their healthcare seeking but not in proportion to income: for households reporting illness, the average proportion of income devoted to health care was 21.9% for the poor compared with 8.2% for the non-poor (p<0.01). To meet healthcare costs, many poor households reduced essential consumption, sold assets and incurred debt, threatening their future livelihood.

Conclusions: In the short-term the poor need exemption from public sector user fees in both primary and hospital care. In the longer run the government budget and prepayment schemes should replace direct user charges in healthcare finance. Transitional economies like Vietnam should preserve the public health services built up under the planned economy. Market reforms that stimulate growth in the economy appear inappropriate to reform of social sectors.

Full Text

The Full Text of this article is available as a PDF (180.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adeyi O., Chellaraj G., Goldstein E., Preker A., Ringold D. Health status during the transition in Central and Eastern Europe: development in reverse? Health Policy Plan. 1997 Jun;12(2):132–145. doi: 10.1093/heapol/12.2.132. [DOI] [PubMed] [Google Scholar]
  2. Ensor T. Introducing health insurance in Vietnam. Health Policy Plan. 1995 Jun;10(2):154–163. doi: 10.1093/heapol/10.2.154. [DOI] [PubMed] [Google Scholar]
  3. Ensor T., San P. B. Access and payment for health care: the poor of Northern Vietnam. Int J Health Plann Manage. 1996 Jan-Mar;11(1):69–83. doi: 10.1002/(SICI)1099-1751(199601)11:1<69::AID-HPM414>3.0.CO;2-P. [DOI] [PubMed] [Google Scholar]
  4. Ensor T., Savelyeva L. Informal payments for health care in the Former Soviet Union: some evidence from Kazakstan. Health Policy Plan. 1998 Mar;13(1):41–49. doi: 10.1093/heapol/13.1.41. [DOI] [PubMed] [Google Scholar]
  5. Fabricant S. J., Kamara C. W., Mills A. Why the poor pay more: household curative expenditures in rural Sierra Leone. Int J Health Plann Manage. 1999 Jul-Aug;14(3):179–199. doi: 10.1002/(SICI)1099-1751(199907/09)14:3<179::AID-HPM548>3.0.CO;2-N. [DOI] [PubMed] [Google Scholar]
  6. Hein N. T., Ha L. T., Rifkin S. B., Wright E. P. The pursuit of equity: a health sector case study from Vietnam. Health Policy. 1995 Sep;33(3):191–204. doi: 10.1016/0168-8510(94)00706-k. [DOI] [PubMed] [Google Scholar]
  7. Hotchkiss D. R., Gordillo A. Household health expenditures in Morocco: implications for health care reform. Int J Health Plann Manage. 1999 Jul-Aug;14(3):201–217. doi: 10.1002/(SICI)1099-1751(199907/09)14:3<201::AID-HPM547>3.0.CO;2-H. [DOI] [PubMed] [Google Scholar]
  8. Leon D. A., Chenet L., Shkolnikov V. M., Zakharov S., Shapiro J., Rakhmanova G., Vassin S., McKee M. Huge variation in Russian mortality rates 1984-94: artefact, alcohol, or what? Lancet. 1997 Aug 9;350(9075):383–388. doi: 10.1016/S0140-6736(97)03360-6. [DOI] [PubMed] [Google Scholar]
  9. McKee M., Figueras J., Chenet L. Health sector reform in the former Soviet Republics of Central Asia. Int J Health Plann Manage. 1998 Apr-Jun;13(2):131–147. doi: 10.1002/(SICI)1099-1751(199804/06)13:2<131::AID-HPM506>3.0.CO;2-8. [DOI] [PubMed] [Google Scholar]
  10. Pannarunothai S., Mills A. The poor pay more: health-related inequality in Thailand. Soc Sci Med. 1997 Jun;44(12):1781–1790. doi: 10.1016/s0277-9536(96)00287-0. [DOI] [PubMed] [Google Scholar]
  11. Russell S. Ability to pay for health care: concepts and evidence. Health Policy Plan. 1996 Sep;11(3):219–237. doi: 10.1093/heapol/11.3.219. [DOI] [PubMed] [Google Scholar]
  12. Russell S., Gilson L. User fee policies to promote health service access for the poor: a wolf in sheep's clothing? Int J Health Serv. 1997;27(2):359–379. doi: 10.2190/YHL2-F0EA-JW1M-DHEJ. [DOI] [PubMed] [Google Scholar]
  13. Sauerborn R., Nougtara A., Hien M., Diesfeld H. J. Seasonal variations of household costs of illness in Burkina Faso. Soc Sci Med. 1996 Aug;43(3):281–290. doi: 10.1016/0277-9536(95)00374-6. [DOI] [PubMed] [Google Scholar]
  14. Sauerborn R., Nougtara A., Latimer E. The elasticity of demand for health care in Burkina Faso: differences across age and income groups. Health Policy Plan. 1994 Jun;9(2):185–192. doi: 10.1093/heapol/9.2.185. [DOI] [PubMed] [Google Scholar]
  15. Segall M. From cooperation to competition in national health systems--and back?: impact on professional ethics and quality of care. Int J Health Plann Manage. 2000 Jan-Mar;15(1):61–79. doi: 10.1002/(SICI)1099-1751(200001/03)15:1<61::AID-HPM573>3.0.CO;2-4. [DOI] [PubMed] [Google Scholar]
  16. Soucat A., Gandaho T., Levy-Bruhl D., de Bethune X., Alihonou E., Ortiz C., Gbedonou P., Adovohekpe P., Camara O., Ndiaye J. M. Health seeking behaviour and household health expenditures in Benin and Guinea: the equity implications of the Bamako Initiative. Int J Health Plann Manage. 1997 Jun;12 (Suppl 1):S137–S163. doi: 10.1002/(sici)1099-1751(199706)12:1+<s137::aid-hpm469>3.3.co;2-7. [DOI] [PubMed] [Google Scholar]
  17. Street A., Jones A., Furuta A. Cost-sharing and pharmaceutical utilisation and expenditure in Russia. J Health Econ. 1999 Aug;18(4):459–472. doi: 10.1016/s0167-6296(98)00042-3. [DOI] [PubMed] [Google Scholar]
  18. Thompson R., Witter S. Informal payments in transitional economies: implications for health sector reform. Int J Health Plann Manage. 2000 Jul-Sep;15(3):169–187. doi: 10.1002/1099-1751(200007/09)15:3<169::AID-HPM589>3.0.CO;2-2. [DOI] [PubMed] [Google Scholar]
  19. Tipping G., Segall M. Using a longitudinal illness record to study household health care decision-making in rural communes of Viet Nam. Health Policy Plan. 1996 Jun;11(2):206–211. doi: 10.1093/heapol/11.2.206. [DOI] [PubMed] [Google Scholar]
  20. Tkatchenko E., McKee M., Tsouros A. D. Public health in Russia: the view from the inside. Health Policy Plan. 2000 Jun;15(2):164–169. doi: 10.1093/heapol/15.2.164. [DOI] [PubMed] [Google Scholar]
  21. Yip W. C., Wang H., Liu Y. Determinants of patient choice of medical provider: a case study in rural China. Health Policy Plan. 1998 Sep;13(3):311–322. doi: 10.1093/heapol/13.3.311. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES