Background
Methods
Data and key variables
Poverty line and impoverishment
Econometric analysis
Results
Characteristics of respondents
Characteristics | Mekong Delta region (N = 1905) | Rest of Vietnam (N = 7494) | P-value | ||
---|---|---|---|---|---|
% | (95% CI) | % | (95% CI) | ||
Sex of the household head | |||||
Male | 71.9 | (69.9–73.9) | 76.0 | (75.1–77.0) | 0.0001) |
Female | 28.1 | (26.1–30.1) | 24.0 | (23.0–24.9) | |
Age of household head | |||||
Under 60 years | 74.0 | (72.0–76.0) | 77.6 | (76.6–78.5) | 0.0011) |
60+ | 26.0 | (24.0–28.0) | 22.4 | (21.5–23.4) | |
Ethnicity of household head | |||||
Kinh | 91.9 | (90.6–93.1) | 79.8 | (78.9–80.7) | 0.0001) |
Other | 8.1 | (6.9–9.4) | 20.2 | (19.3–21.1) | |
Education of the household head | |||||
Up to primary | 75.2 | (73.2–77.1) | 45.1 | (44.0–46.2) | 0.0002) |
Secondary | 21.5 | (19.7–23.4) | 48.1 | (46.9–49.2) | |
University and others | 3.3 | (2.5–4.1) | 6.8 | (6.3–7.4) | |
Household size | |||||
1–2 persons | 16.6 | (15.0–18.3) | 19.8 | (18.9–20.7) | 0.0052) |
3–4 persons | 51.4 | (49.1–53.6) | 50.2 | (49.1–51.3) | |
5 persons or more | 32.0 | (29.9–34.1) | 30.0 | (28.9–31.0) | |
Having elderly people in the household | |||||
No | 65.9 | (63.8–68.1) | 69.7 | (68.6–70.7) | 0.0021) |
Yes | 34.1 | (31.9–36.2) | 30.3 | (29.3–31.4) | |
Having child in the household | |||||
No | 35.6 | (33.5–37.8) | 41.8 | (40.7–42.9) | 0.0001) |
Yes | 64.4 | (62.2–66.5) | 58.2 | (57.1–59.3) | |
Observed economic/environmental shock during past 5 years | |||||
No | 73.0 | (71.0–75.0) | 85.6 | (84.8–86.4) | 0.0001) |
Yes | 27.0 | (25.0–29.0) | 14.4 | (13.6–15.2) | |
Location | |||||
Urban | 23.9 | (22.0–25.9) | 30.0 | (28.9–31.0) | 0.0001) |
Rural | 76.1 | (74.1–78.0) | 70.0 | (69.0–71.1) | |
Household with at least one health insurance enrolee | |||||
No | 17.4 | (15.7–19.1) | 10.8 | (10.1–11.6) | 0.0001) |
Yes | 82.6 | (80.9–84.3) | 89.2 | (88.4–89.9) | |
Hospitalized member | |||||
No | 19.6 | (17.8–21.4) | 42.3 | (41.2–43.4) | 0.0001) |
Yes | 80.4 | (78.6–82.2) | 57.7 | (56.6–58.8) | |
Utilized healthcare from private facility | |||||
No | 51.1 | (48.8–53.3) | 72.5 | (71.5–73.5) | 0.0001) |
Yes | 48.9 | (46.7–51.2) | 27.5 | (26.5–28.5) | |
Expenditure quintile | |||||
Poorest | 28.8 | (26.7–30.8) | 17.8 | (16.9–18.6) | 0.0002) |
2nd | 25.6 | (23.6–27.5) | 18.6 | (17.7–19.5) | |
3rd | 18.2 | (16.5–19.9) | 20.5 | (19.5–21.4) | |
4th | 16.2 | (14.5–17.8) | 21.0 | (20.1–21.9) | |
Richest | 11.3 | (9.9–12.7) | 22.2 | (21.3–23.1) |
Out-of-pocket payments
Expenditure | Region | p-value* | ||||
---|---|---|---|---|---|---|
Mekong Delta region (N = 1905) | Rest of Vietnam (N = 7494) | |||||
In 1000 VND | In USD | In 1000 VND | In USD | |||
Monthly consumption expenditure | Mean | 4900.4 | 235.3 | 6266.6 | 300.9 | 0.000 |
Median | 3911.3 | 187.8 | 5222.0 | 250.7 | ||
SD | 4593.3 | 220.5 | 5037.1 | 241.8 | ||
Monthly non-food expenditure | Mean | 870.3 | 41.8 | 836.4 | 40.2 | 0.075 |
Median | 710.0 | 34.1 | 645.0 | 31.0 | ||
SD | 720.2 | 34.6 | 747.4 | 35.9 | ||
Monthly OOP healthcare expenditure | Mean | 339.5 | 16.3 | 284.4 | 13.7 | 0.003 |
Median | 112.9 | 5.4 | 91.7 | 4.4 | ||
SD | 876.4 | 42.1 | 685.7 | 32.9 |
Catastrophic health expenditure
Characteristics | CHE using 10% of total household expenditure as threshold level | P-value | CHE using 40% of household non-food expenditure as threshold level | P-value | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Mekong Delta region | Rest of Vietnam | Mekong Delta region | Rest of Vietnam | |||||||
% | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | |||
Sex of the household head | ||||||||||
Male | 17.3 | (15.3–19.3) | 11.2 | (10.4–12.0) | 0.0001) | 25.7 | (23.4–28.0) | 23.3 | (22.2–24.4) | 0.0001) |
Female | 23.2 | (19.6–26.8) | 13.3 | (11.7–14.9) | 31.8 | (27.8–35.7) | 26.4 | (24.3–28.4) | ||
Age of household head | ||||||||||
Under 60 years | 16.4 | (14.5–18.3) | 9.3 | (8.5–10.0) | 0.0001) | 23.3 | (21.1–25.5) | 20.1 | (19.1–21.2) | 0.0001) |
60+ | 26.3 | (22.4–30.1) | 20.1 | (18.1–22.0) | 39.0 | (34.7–43.3) | 37.6 | (35.3–39.9) | ||
Ethnicity of household head | ||||||||||
Kinh | 19.7 | (17.8–21.5) | 13.4 | (12.6–14.3) | 0.0001) | 28.3 | (26.2–30.4) | 27.0 | (25.8–28.1) | 0.0001) |
Other | 11.0 | (6.0–15.9) | 4.8 | (3.7–5.9) | 17.4 | (11.4–23.4) | 12.5 | (10.9–14.2) | ||
Education of the household head | ||||||||||
Upto primary | 20.5 | (18.4–22.6) | 12.3 | (11.2–13.4) | 0.0002) | 28.6 | (26.3–31.0) | 23.7 | (22.3–25.2) | 0.0042) |
Secondary | 14.1 | (10.8–17.5) | 11.4 | (10.3–12.4) | 24.1 | (20.0–28.3) | 25.1 | (23.7–26.5) | ||
University and other | 15.9 | (6.8–25.0) | 9.9 | (7.3–12.5) | 20.6 | (10.6–30.7) | 18.7 | (15.3–22.1) | ||
Household size | ||||||||||
1–2 persons | 24.9 | (20.2–29.7) | 18.7 | (16.7–20.7) | 0.0002) | 36.6 | (31.3–41.9) | 36.6 | (34.2–39.1) | 0.0002) |
3–4 persons | 15.5 | (13.3–17.8) | 10.1 | (9.1–11.0) | 22.5 | (19.9–25.1) | 20.4 | (19.1–21.7) | ||
5 persons or more | 21.3 | (18.1–24.6) | 9.7 | (8.5–11.0) | 30.5 | (26.9–34.2) | 21.9 | (20.1–23.6) | ||
Having elderly people in the household | ||||||||||
No | 15.3 | (13.3–17.3) | 9.3 | (8.5–10.1) | 0.0001) | 21.5 | (19.2–23.8) | 19.7 | (18.6–20.7) | 0.0001) |
Yes | 26.0 | (22.7–29.4) | 17.2 | (15.6–18.7) | 38.8 | (35.1–42.6) | 34.1 | (32.2–36.1) | ||
Having child in the household | ||||||||||
No | 20.6 | (17.6–23.7) | 15.3 | (14.1–16.6) | 0.0001) | 30.5 | (27.0–34.0) | 30.4 | (28.8–32.1) | 0.0001) |
Yes | 18.0 | (15.9–20.2) | 9.1 | (8.2–9.9) | 25.7 | (23.2–28.1) | 19.5 | (18.3–20.6) | ||
Observed economic/environmental shock during past 5 years | 0.0 | |||||||||
No | 15.0 | (13.1–16.8) | 9.9 | (9.1–10.6) | 0.0001) | 23.8 | (21.6–26.1) | 22.0 | (21.0–23.0) | 0.0001) |
Yes | 29.7 | (25.8–33.7) | 22.6 | (20.1–25.1) | 37.1 | (32.9–41.3) | 36.2 | (33.3–39.0) | ||
Location | ||||||||||
Urban | 16.4 | (13.0–19.9) | 11.9 | (10.5–13.2) | 0.3541) | 22.8 | (19.0–26.7) | 22.3 | (20.5–24.0) | 0.0001) |
Rural | 19.7 | (17.7–21.8) | 11.6 | (10.7–12.5) | 28.8 | (26.5–31.2) | 24.8 | (23.6–26.0) | ||
Household with at least one health insurance enrolee | ||||||||||
Yes | 15.1 | (11.2–18.9) | 11.9 | (9.7–14.2) | 0.7311) | 21.7 | (17.2–26.1) | 22.9 | (20.0–25.8) | 0.0671) |
No | 19.8 | (17.8–21.7) | 11.7 | (10.9–12.4) | 28.6 | (26.4–30.8) | 24.2 | (23.2–25.2) | ||
Hospitalized member | ||||||||||
No | 2.4 | (0.9–4.0) | 1.8 | (1.3–2.3) | 0.0001) | 4.6 | (2.4–6.7) | 7.3 | (6.4–8.2) | 0.0001) |
Yes | 23.0 | (20.9–25.1) | 18.9 | (17.8–20.1) | 33.0 | (30.6–35.3) | 36.3 | (34.9–37.8) | ||
Utilized healthcare from private facility | ||||||||||
No | 15.3 | (13.0–17.6) | 10.2 | (9.4–11.0) | 0.0001) | 22.8 | (20.2–25.5) | 20.5 | (19.4–21.6) | 0.0001) |
Yes | 22.7 | (20.1–25.4) | 15.7 | (14.1–17.2) | 32.2 | (29.2–35.2) | 33.4 | (31.3–35.4) | ||
Expenditure quintile | ||||||||||
Poorest | 19.5 | (16.2–22.8) | 13.3 | (11.5–15.1) | 0.0002) | 27.0 | (23.3–30.7) | 25.0 | (22.7–27.3) | 0.0012) |
2nd | 18.7 | (15.2–22.2) | 11.3 | (9.7–13.0) | 24.6 | (20.8–28.5) | 21.5 | (19.4–23.7) | ||
3rd | 19.6 | (15.4–23.8) | 9.8 | (8.4–11.3) | 25.9 | (21.3–30.6) | 22.0 | (19.9–24.1) | ||
4th | 19.2 | (14.8–23.6) | 12.0 | (10.4–13.6) | 32.1 | (26.9–37.4) | 24.4 | (22.3–26.6) | ||
Richest | 16.7 | (11.7–21.7) | 12.1 | (10.6–13.7) | 30.2 | (24.1–36.4) | 26.9 | (24.8–29.1) | ||
Total | 19.0 | (17.3–20.8) | 11.7 | (11.0–12.4) | 0.000 | 30.2 | (25.4–29.5) | 24.0 | (23.1–25.0) | 0.002 |
Impoverishment effects
Poverty estimate | Mekong Delta region | Rest of Vietnam | P-value* |
---|---|---|---|
% (95% CI) | % (95% CI) | ||
Poverty headcount | 41.1 (38.9–43.3) | 25.8 (24.8–26.8) | 0.000 |
Poverty headcount associated with OOP health expenditure | 5.0 (4.0–6.0) | 2.3 (2.0–2.7) | 0.000 |
Number of individual fell into poverty in association with OOP health expenditure | 875,880 | 1,683,860 |
Determinants of CHE and impoverishment
Variable | Description | Model 1 (Dependent = CHE using 10% of total household expenditure as threshold level) | Model 2 (Dependent = CHE using 10% of total household expenditure as threshold level) | Model 3 (Dependent = CHE using 40% of household non-food expenditure as threshold level) | Model 4 (Dependent = CHE using 40% of household non-food expenditure as threshold level) | ||||
---|---|---|---|---|---|---|---|---|---|
OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | ||
Mekong region | Yes (Ref = No) | 1.766*** | (1.544,2.021) | 1.154 | (0.989,1.346) | 1.192** | (1.064,1.336) | 0.815*** | (0.714,0.931) |
Sex of household head | Male (Ref = Female) | 0.96 | (0.826,1.118) | 0.94 | (0.829,1.063) | ||||
Age of household head | 60+ (Ref = Under 60 years) | 1.014*** | (1.007,1.021) | 1.015*** | (1.009,1.020) | ||||
Ethnicity | Kinh (Ref = Other) | 0.426*** | (0.336,0.542) | 0.517*** | (0.436,0.613) | ||||
Education of household head | Secondary (Ref = Upto primary) | 1.01 | (0.870,1.172) | 1.190** | (1.057,1.341) | ||||
University and other (Ref = Upto primary) | 0.97 | (0.707,1.334) | 0.85 | (0.659,1.098) | |||||
Household size | 3–4 persons(Ref = 1–2 persons) | 0.660*** | (0.539,0.808) | 0.522*** | (0.442,0.617) | ||||
5 persons or more(Ref = 1–2 persons) | 0.619*** | (0.485,0.790) | 0.497*** | (0.408,0.607) | |||||
Having elderly people in the household | Yes (Ref = No) | 1.09 | (0.906,1.309) | 1.235** | (1.067,1.429) | ||||
Having child in the household | Yes (Ref = No) | 0.94 | (0.786,1.115) | 0.920 | (0.797,1.052) | ||||
Observed economic/environmental shock during past 5 years | Yes (Ref = No) | 2.323*** | (1.997,2.702) | 1.900*** | (1.663,2.171) | ||||
Household with at least one health insurance enrolee | Yes (Ref = No) | 1.02 | (0.826,1.252) | 1.180 | (0.995,1.400) | ||||
Hospitalized member | Yes (Ref = No) | 1.238*** | (1.062,1.442) | 1.545*** | (1.363,1.750) | ||||
At least one member utilized private facility in last 30 days | Yes(Ref = No) | 11.60*** | (8.944,15.04) | 6.825*** | (5.873,7.931) | ||||
Location | Rural (Ref = Urban) | 0.95 | (0.831,1.090) | 1.102 | (0.985,1.234) | ||||
Expenditure quintiles | 2nd (Ref = Poorest) | 1.242* | (1.007,1.532) | 1.199* | (1.006,1.429) | ||||
3rd (Ref = Poorest) | 1.12 | (0.894,1.398) | 1.251* | (1.043,1.501) | |||||
4th (Ref = Poorest) | 1.340* | (1.066,1.686) | 1.549*** | (1.284,1.868) | |||||
Richest (Ref = Poorest) | 1.374* | (1.072,1.760) | 1.841*** | (1.507,2.247) | |||||
Constant | 0.132*** | (0.123,0.142) | 0.008*** | (0.004,0.014) | 0.317*** | (0.300,0.334) | 0.0187*** | (0.012,0.030) | |
N | 9399 | 9399 | 9399 | 9399 | |||||
LR chi2(19) | − 3628 | − 3080 | − 5252 | − 4419 | |||||
Prob > chi | 0.000 | 0.000 | 0.003 | 0.000 | |||||
Pseudo R | 0.009 | 0.158 | 0.001 | 0.159 |
Variable | Description | Model 5 (Dependent = Poverty from OOP healthcare payments) | Model 6 (Dependent = Poverty from OOP healthcare payments) | ||
---|---|---|---|---|---|
OR | 95% CI | OR | 95% CI | ||
Mekong Delta region | Yes (Ref = No) | 2.182*** | (1.692,2.816) | 1.356* | (1.005,1.828) |
Sex of household head | Male (Ref = Female) | 0.738 | (0.534,1.020) | ||
Age of household head | 60+ (Ref = Under 60 years) | 1.014* | (1.000,1.027) | ||
Ethnicity of household head | Kinh (Ref = Other) | 0.490** | (0.309,0.775) | ||
Education of household head | Secondary (Ref = Upto primary) | 1.010 | (0.750,1.348) | ||
University and other (Ref = Upto primary) | 0.400 | (0.121,1.340) | |||
Household size | 3–4 persons(Ref = 1–2 persons) | 0.581** | (0.386,0.875) | ||
5 persons or more(Ref = 1–2 persons) | 0.502** | (0.305,0.827) | |||
Having elderly people in the household | Yes (Ref = No) | 1.170 | (0.799,1.710) | ||
Having child in the household | Yes (Ref = No) | 1.485* | (1.005,2.195) | ||
Observed economic/environmental shock during past 5 years | Yes (Ref = No) | 2.078*** | (1.548,2.790) | ||
Household with at least one health insurance enrolee | Yes (Ref = No) | 1.140 | (0.741,1.738) | ||
Hospitalized member | Yes (Ref = No) | 1.190 | (0.860,1.650) | ||
At least one utilized of private facility in last 30 days | Yes(Ref = No) | 5.559*** | (3.667,8.425) | ||
Location | Rural (Ref = Urban) | 0.810 | (0.604,1.076) | ||
Expenditure quintile | 2nd (Ref = Poorest) | 65.32*** | (20.56,207.6) | ||
3rd (Ref = Poorest) | 10.15*** | (3.098,33.26) | |||
4th (Ref = Poorest) | 4.533* | (1.313,15.65) | |||
Richest (Ref = Poorest) | 1.000 | (1.000,1.000) | |||
Constant | 0.0241*** | (0.0207,0.0279) | 0.0003*** | (0.000,0.001) | |
N | 9399 | 7519 | |||
LR chi2(19) | − 1211.6 | − 864.2 | |||
Prob > chi2 | 0.000 | 0.000 | |||
Pseudo R2 | 0.013 | 0.259 |