Study on contribution of hidden out-of-pocket expenses to household catastrophic expenditure on health in Vietnam

2022 Fiscal Year Final Research Report

• Project/Area Number: 20K23228
• Research Category: Grant-in-Aid for Research Activity Start-up
• Allocation Type: Multi-year Fund
• Review Section: 0908:Society medicine, nursing, and related fields
• Research Institution: Nagasaki University
• Principal Investigator: Aiga Hirotsugu 長崎大学, 熱帯医学・グローバルヘルス研究科, 教授 (20884175)
• Project Period (FY): 2020-09-11 – 2023-03-31
• Keywords: 医療費 / ベトナム / ユニバーサルヘルスカバレッジ / 保健財政 / 健康保険

Outline of Final Research Achievements

Incidence of catastrophic household health expenditure is defined as the proportion of households having spent >10% or >25% of total household expenditure on health . Yet, when calculating out-of-pocket expenses (OOP) expenses, the following hidden expenses have been excluded by WHO: (i) transport costs to/from health facilities; (ii) assistance to inpatients by their household members such as feeding/bathing/toileting/laundry; and (iii) patients’ and their household members’ income loss due to inability to work. There is a concern about possible underestimation of incidence of catastrophic household health expenditure. This study aimed to estimate the magnitude of the underestimation due to exclusion of hidden OOP expenses. A total of 219 households of patients of Phu Tho General Hospital, Vietnam, participated in the study. It was found that the incidence calculated by including hidden OOP expenses was 1.77- 2.17 times significantly higher than that by excluding it.

Free Research Field

保健システム

Academic Significance and Societal Importance of the Research Achievements

ユニバーサルヘルスカバレッジの実現には、破滅的保健支出世帯率をより正確に推定することが重要である。現行の、『隠れたOOP支出』を排除した『国際定義に基づくOOP支出』に拠る破滅的保健支出世帯率の算出は、破滅的保健支出世帯率の有意な過小評価となることが本研究で明らかになった。この分野での先行研究は殆どないだけに、本研究の独創性や意義は高い。また、世界各国における公正な保健医療政策の実現に向けての本研究の貢献度も高いと考えられる。『隠れたOOP支出』をOOPの算出時に取り込むことにより、破滅的保健支出世帯率の過小評価を回避するよう世界保健機関WHOや世界銀行WBに問いかけたいと考える。