Health care seeking behaviour and economic burden of health care expenditure among people with non-communicable diseases in Vietnam

Abstract

There have been significant shifts in the pattern of disease in Vietnam since 1990, and non-communicable diseases (NCD) have become the leading cause of morbidity and mortality. To fill a gap in the literature, this thesis aims to study health care seeking behaviour (HCSB) and the economic burden of health care expenditure among people with NCD in Vietnam. The first study was based on secondary analysis of the Health Strategy and Policy Institute (HSPI) household survey data comprising a sample of 3,452 households in three provinces. Andersen’s model of health care utilization guided the selection of determinants of three types of health care (no care, informal care, and formal care) among individuals with NCD. Analysis using multinomial logistic regression of the sample showed that perceived illness severity, age, ethnicity, physical inactivity, smoking, health insurance status and geographical location were associated with HCSB. The study estimated economic burden on households with NCD, including catastrophic and impoverishing health expenditure, and financial distress. The results showed that households with NCD are more likely to have higher health expenditure and a higher possibility of financial catastrophe and distress than households without NCD. The association of health insurance with HCSB and the economic burden was examined, and the findings indicated that while health insurance coverage was positively associated with health service utilization among individuals with NCD, there was a lack of evidence of the protective effect of health insurance on the economic burden of health expenditure among households with NCD. A sequential qualitative study explored HCSB and barriers to long-term care among patients with hypertension and diabetes. The findings highlighted a number of barriers at the primary care setting, including unproductive patient-provider interaction, complicated and inflexible service delivery, long waiting times, limited and interrupted provision of medicines, and financial diffculities due to health insurance co-payments. This study suggests that individuals and households with NCD are facing barriers to access health services and long-term care in particular as well as bearing considerable economic burden. There is a need for policy interventions targeting NCD to improve access to long-term care and mitigate its associated financial hardship in Vietnam.