ArticleBMC health services research2019
Use of high-level health facilities and catastrophic expenditure in Vietnam: can health insurance moderate this relationship?
Article in BMC health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 36 citations in OpenAlex.
- The socioeconomic and health system determinants of financial protection indicators: a global systematic review (2008-2023).BMJ global health · 2025Pooled it
- Strengthening upper gastrointestinal endoscopy service in primary healthcare settings in low- and middle-income countries: Proposals from an implementation study in Vietnam.Global health & medicine · 2026Review
- Determinants of catastrophic health expenditure: Evidence from a patient survey at public hospitals in the Northern midlands and mountainous areas, Vietnam.Journal of public health research · 2026Article
- Temporal Trends in Patient Choice of Outpatient Care Provider Among Vietnam's Insured Rural Residents, 2006-2020.The International journal of health planning and management · 2025Article
- Progress and inequalities in financial risk protection toward universal health coverage: insights from Vietnam.International journal for equity in health · 2025Article
- A Cross-Sectional Study of Factors Associated With Hospital Meal Choice in Medical Facilities in Hanoi, Vietnam.Cureus · 2025Article
- Impact of NHI copayment adjustments on healthcare seeking behavior: the mediating role of health facility identification.BMC health services research · 2024Article
- Beyond Medical Bills: High Prevalence of Financial Toxicity and Diverse Management Strategies Among Vietnamese Patients With Cancer.Journal of preventive medicine and public health = Yebang Uihakhoe chi · 2024Article
- Mobilizing morality: how caregivers in Vietnam handle the challenges of daily diabetes care.BMC public health · 2023Article
- How public health insurance expansion affects healthcare utilizations in middle and low-income households: an observational study from national cross-section surveys in Vietnam.BMC public health · 2023Observational
- Healthcare seeking behavior among patients visiting public primary and secondary healthcare facilities in an urban Indian district: A cross-sectional quantitative analysis.PLOS global public health · 2023Article
- Everyday disease diplomacy: an ethnographic study of diabetes self-care in Vietnam.BMC public health · 2022Article
- Social determinants of the changing tuberculosis prevalence in Việt Nam: Analysis of population-level cross-sectional studies.PLoS medicine · 2022Article
- Multimorbidity and catastrophic health expenditure among patients with diabetes in China: a nationwide population-based study.BMJ global health · 2022Article
- Costs of breast cancer treatment incurred by women in Vietnam.BMC public health · 2022Article
- How Jaminan Kesehatan Nasional (JKN) coverage influences out-of-pocket (OOP) payments by vulnerable populations in Indonesia.PLOS global public health · 2022Article
- Factors Influencing the Vietnamese Older Persons in Choosing Healthcare Facilities.Health services insights · 2021Article
- Impact of Public Health Insurance on Out-of-Pocket Health Expenditures of the Near-Poor in Vietnam.Health services insights · 2021Article
- Health Insurance Reimbursement to Hosptials in Vietnam: Policy Implementation Results and Challenges.Health services insights · 2021Article
- Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder.Global mental health (Cambridge, England) · 2021Article
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Authors and funding
5 authors at 3 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOvercrowding of high-level health facilities is a major concern in a Vietnamese health system. This may increase an economic burden to the households since health insurance is still insufficient in providing financial risk protection. This paper sought to examine the association between the use of high-level health facilities and household-level expenditure status such as out-of-pocket (OOP), and catastrophic expenditure on health, as well as a moderating effect of health insurances in rural and urban districts of Vietnam.
methodsData utilized a health system community survey collected between 2015 and 2017 in two districts of Vietnam (one from rural area in northern part, and the other one from urban area in sourthern part). The world Health Organization's definition of catastrophic expenditure was used. Multivariate tobit and logistic regression were employed for catastrophic expenditure and OOP respectively. Interaction term between health insurance status and visit frequency in high-level facilities was included to investigate the moderating effect of health insurance.
resultsHealth insurance status was associated with neither OOP health expenditure nor catastrophic expenditure occurrence, whereas visit frequency of high-level health facilities was strongly associated with both outcomes in both districts(e.g., for catastrophic expenditure, ORs are 1.77 and 1.30 in northern and southern district respecitvely. P values are < 0.001). Significant interaction between health insurance status and use of high-level facilities on catastrophic expenditure occurrence was found in Quoc Oai district (OR = 0.68, p < 0.05).
conclusionsThe present study demonstrated negative financial impact of utilizing high-level facility on household financial status and weak role of health insurance in decreasing this impact. Multi-faceted approach is called for to mitigate the patient's financial burden.
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