NEWS The risk of being hit by catastrophic private healthcare bills and dropping under the poverty line is large for elderly households in Vietnam. Curt Löfgren shows this in his doctoral thesis that he defended at Umeå University, Sweden, in October.
"Catastrophic healthcare expenditure" is a concept used in research to describe a situation in which a household's healthcare bills are so large that the family is likely to be impoverished. In many low- and middle income countries health care is mainly paid for when you use it, cash coming directly out of your pocket. The care receiver's own costs for the treatment of severe diseases and accidents can be very high, as much as several years' salary.
In Vietnam, this problem has been particularly serious. In 2000, the World Health Organization reported that Vietnam was one of the world's most unfair countries in terms of health care financing. The Vietnamese Government is striving to solve the problem by health insurance. Considerable progress has been made. Around 2000, fewer than every fifth Vietnamese had health insurance. Today, almost seven out of ten are covered by an insurance programme.
And the health insurance reform process has positive effects. In one of the studies done by Curt Löfgren, doctoral student at Epidemiology and Global Health, the introduction of a special health insurance policy for the poor was evaluated. This insurance meant that poor households' private health expenditure, as a proportion of their income, was considerably reduced. For households as a whole, the problem has decreased significantly. In 2000, 80% of total health care costs in Vietnam consisted of out-of-pcoket payments by care receivers. Today, the proportion is less than 50%.
"The problem has been reduced, but it is still large. And for poor groups with high morbidity, such as elderly households, the situation is difficult. This problem is compounded by the fact that the Vietnamese population is now rapidly ageing and urbanisation is pronounced. "It is young people who move into the cities, leaving the elderly behind" says Curt Löfgren.
One problem with health insurance is that it is not comprehensive. The insured person may have to pay up to 20% of the costs privately, and there are no high-cost protection schemes. For serious diseases, the amounts can be very large. In another of the studies in the thesis, people's evaluations of the healthcare insurance system have been examined in a "willingness to pay" study. It was found that willingness to pay was low in relation to healthcare costs.
"Many Vietnamese are reluctant to use their healthcare insurance. They may fear problems with quality, for example, and longer waiting times in the care offered," says Curt Löfgren.
He points out that the discussion about improved insurance protection is not just about covering a larger proportion of the population, but also widening the areas covered so that a greater proportion of healthcare costs are covered, and that care quality and waiting times are not a problem.
Curt Löfgren was born in Ånäset and grew up in Skellefteå. He is a senior lecturer at the Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Curt LöfgrenPhone: 090-786 51 69, 073-818 20 82
Editor: Mattias Grundström Mitz