Manual Vietnam’s New Order: International Perspectives on the State and Reform in Vietnam

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Vietnam's New Order: International Perspectives on the State and Reform in Vietnam (CERI Series in International Relations and Political Economy) [S. Balme.
Table of contents

Women tend to use drugs or services more often than men. We recognize, however, that women and men have different healthcare problems and different perceptions of the importance of selecting and utilizing healthcare services [ 20 ]. The decision to use drugs or a medical provider is significantly influenced by the seriousness of the illness and by the SES of the household. These analyses helped to realize that if a visit to the local healthcare facility does not help or if the person is diagnosed with a serious illness, they should be encouraged to contact a higher-level public hospital where more extensive diagnoses and appropriate treatment and care are available under doctors' supervision.

Our research suggests that public providers still play the decisive role of the healthcare system in Vietnam. Our findings also show that the cost of basic healthcare is of critical importance in the decision of when and what services to use. Income for the poor frequently derives from physical labor. When sick or confined to hospital due to illness, the poor are unable to work to earn money. Compounding the problem is the typical lack of savings by the poor. As a result, they will generally choose to ignore their illness or self-treat.

When state of health has deteriorated to such an extent that they are incapacitated, they may fall even deeper into poverty as a result of the cost of healthcare and the corresponding loss of income whilst sick [ 26 ]. Those results support the discussion above that for more serious illnesses, people often chose public or higher public providers; for minor illnesses, people often undergo self-treatment or seek treatment from private providers.

However, the evidence shows that the number of poor who utilize self-treatment as well as their expenditure on such treatment is higher than that of the non-poor, whereas use of public healthcare is less.

International Perspectives on the State and Reform in Vietnam

In general, healthcare fees are the same for both the poor and non-poor, which mean that public sources mainly subsidize the rich rather than the poor. Average household expenditure per episode by providers and expenditure quintiles in Vietnamese dong. Table 5 shows that the average household expenditure per episode of illness is less for self-treatment , VND and for private providers 35, VND than for public providers 95, VND.

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The average household health expenditure for a single illness episode is higher for hospital treatment than for district health centres and commune health stations. Taking into account the limitations of the study, we consider the distance to healthcare providers, either in physical units or in time, has generally been found to be associated with utilization of health services.

Unfortunately, our data are likely to underestimate this association and are unable to paint a full picture of all factors that might influence a person's choice of healthcare services. A major concern in is the substantial difference in access to different healthcare providers between the rich and poor. Part of this difference can be attributed to the transition from a socialist system to a market economy. However, during the time of our study the government has made considerable progress in developing and supporting programs for providing healthcare for the poor. In particular, the Government issued a program providing for and supporting the socio-economic development of the extreme rural areas of the country [ 27 ].

A major components of the government's program were the introduction of healthcare insurance and the public funding of healthcare expenses targeted specifically at the poor [ 28 , 29 ]. This progress could be expected to affect our findings. One of the objectives of the Government's program is to reduce the burden healthcare among the poor households in communes with special difficulties and to decrease the gap between poor and rich. The results of this study should be of interest to policy-makers and healthcare professionals who are formulating healthcare policies.

Of particular importance are the methods to reduce self-treatment and no-treatment. Our research has also identified several other significant issues.

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These include the management of private practices and maintaining public healthcare providers at all levels, particularly at the basic levels district, commune where the poor seek care more than the rich. Healthcare at the basic level is also vital because it is mostly utilized by the poor who find it very difficult and costly to access health facilities at higher levels. If we can improve the quality of such services, then it can help improve the treatment quality for a large portion of people, including the seriously ill in both the poor and non poor groups.

The findings of this study could also provide a background for further studies and strategic policy-making on healthcare utilizations and healthcare financing. We, the authors, declare that there are no financial or non-financial conflicts of interest political, personal, religious, academic, ideological, intellectual, commercial or any other.

We are co-authors in this paper. Each author has participated sufficiently in the study to take responsibility for appropriate portions of the content as follow: NTBT: The first author, who designed the questionnaire, was responsible for monitoring the interview process, performing the statistical analysis, drafting and revising the manuscript CL: The second author, who participated in the planning of the study, was involved in drafting and revising the manuscript.

LL and NTKC: The third and fourth authors, who participated in the planning of the study, and in the revisions of the manuscript. All co-authors read and approved the final manuscript.

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National Center for Biotechnology Information , U. Published online Jul Author information Article notes Copyright and License information Disclaimer. Corresponding author.


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Nguyen Thi Bich Thuan: moc. Received Dec 13; Accepted Jul This article has been cited by other articles in PMC. Abstract Background In Vietnam, the health-sector reforms since have lead to a rapid increase in out-of-pocket expenses. Methods The study consisted of twelve monthly follow-up interviews of randomly selected households. Conclusion The results are useful for policy makers and healthcare professionals to i formulate healthcare policies-of foremost importance are methods used to reduce self-treatment and no treatment; ii the management of private practices and maintaining public healthcare providers at all levels, particularly at the basic levels district, commune where the poor more easily can access healthcare services, is also important, as is the management of private practices and iii provide a background for further studies on both short and long-term health service strategies.

Background Access to healthcare providers is a significant factor in improving public health and helping poor households escape from poverty [ 1 ]. Methods This study was conducted in the Bavi district of Hatay province in Vietnam. Definitions used in this study To be considered in this study, an illness episode must meet at least one of the following criteria: the subject stayed in bed; had been restricted from normal activities e.

Results Based on the survey data, there were 8, illness episodes reported by 2, individuals in households. Equalized household expenditure quintiles Total p-value Poorest 2 3 4 Richest No drug or service used 76 5.

Vietnam's New Order: International Perspectives On The State And Reform In Vietnam

Open in a separate window. Table 3 Multivariate logistic regression showing variables influencing the odds of using services or drugs and the choice of providers when being ill. Using vs. Self-treatment Public vs. Equalized household expenditure quintiles Total p-value Bottom 2 3 4 Top Self-treatment 44, Discussion and Conclusion Monthly data collection and interview-based follow-ups tracked households for the period of one year.

Table 5 Average household expenditure per episode by providers and expenditure quintiles in Vietnamese dong. Competing interests We, the authors, declare that there are no financial or non-financial conflicts of interest political, personal, religious, academic, ideological, intellectual, commercial or any other. Authors' contributions We are co-authors in this paper. Preventing impoverishment though protection against catastrophic health expenditure. Bulletin of the World Health Organization. Who pays more for health services in middle-income countries: lessons from Mexico.

Public Health. Determinants of patient choice of medical provider: a case study in rural China. Health policy and planning. Issues of equity and effectiveness in health care in Vietnam. Efficient, Equity-oriented strategies for health international perspectives-focus on Vietnam. Development Indicators. Health Statistics Yearbook. Hanoi: Ministry of Health; Hanoi Vietnam: Ministry of Health; Discussion paper. Ministry of Health.

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Medical Publishing House, Hanoi Vietnam; Vietnam Health Report Efficient equity-oriented health sector reform: A Vietnamese perspective on some key issues. Royal Netherlands Embassy. Ha NTH. New articles related to this author's research.