Elsevier

Injury

Volume 44, Issue 5, May 2013, Pages 684-690
Injury

Catastrophic household costs due to injury in Vietnam

https://doi.org/10.1016/j.injury.2012.05.006Get rights and content

Abstract

Objective

Little is known about the costs of injury and their impact on injured persons and their families in Vietnam. This study aimed to examine the cost of injury in hospitalised patients and to identify the most costly injuries and those more likely to result in catastrophic household expenditure.

Method

A prospective cohort study was conducted, recruiting individuals admitted to Thai Binh General Hospital due to injury in Vietnam from January to August 2010. During the hospitalisation period, data on expenditure including direct medical, direct non-medical and indirect costs were collected. Demographic and injury characteristics were also obtained. The associations between the risk of catastrophic expenditure and injury cause, severity and principal injured region were examined by modified Poisson regression approach. Payment of more than 40% of the household non-subsistence spending was considered a catastrophic expenditure.

Results

Of 918 patients approached, 892 (97%) were recruited. Total costs for all participants during the hospitalisation period were US$ 325,812. Patients admitted for road injury accounted for the largest number of injuries (n = 477, 53%), and the largest percentage of the total costs (US$ 175,044, 57%). This was followed by individuals hospitalised due to falls, representing 29% of the sample (n = 261) and 31% of the total costs (US$ 103,128). In terms of cost per hospital stay, burn injuries were the most costly (US$ 427), followed by falls (US$ 395) and road crashes (US$ 367). Of all sample, 26% experienced catastrophic expenditure due to their injuries. Factors significantly associated with increased risk of catastrophic expenditure were having more severe or higher MAIS injuries (RR = 2.02, 95% CI: 1.14–3.57), principal injured region to lower extremities (RR = 3.34, 95% CI: 1.41–7.91) or head (RR = 3.21, 95% CI: 1.37–7.52), longer hospital stay (RR = 1.09, 95% CI: 1.07–1.10), older age, lower income and not having insurance (RR = 1.63, 95% CI: 1.21–2.21).

Conclusion

A high proportion of households experienced catastrophic expenditure following injury, highlighting the important need for programmes to prevent injuries, road traffic and fall-related injuries in particular. Furthermore, expansion of health insurance coverage may help individuals cope with the financial consequences of injury.

Introduction

Injury is a serious public health issue in Vietnam, the thirteenth most populous country in the world with a population of 85.8 million.1 Every day in Vietnam, injuries claim almost 100 lives, or about 35,000 lives per year.2, 3 It has been estimated that the number of potential life years lost due to injuries in Vietnam is more than double those due to non-communicable diseases, and more than six times higher than those due to communicable diseases.4 In addition to fatalities, injuries are also the cause of hundreds of thousands of hospital admissions.4 Because the largest proportion of injuries occur among people under 60 years of age5 who comprise the majority of the labour force, injuries may have a serious economic impact at the country level. The impact not only results from the loss of productivity, but also from significant expenses for medical treatment, rehabilitation and recovery.6

Injuries can potentially lead to catastrophic financial losses to injured persons and their families, leading to a substantial risk of impoverishment. The idea of financial catastrophe comes from an ethical position that no one ought to spend more than a given of fraction of their income on health care.7 In Vietnam, health care costs are paid directly from the income of patients and their families. According to Ministry of Health estimates, health expenditure in Vietnam consists of private out-of-pocket payments (67%), public sources including from central government budgets (6%), provincial government budgets (10%), official development assistance funds (2%), and social insurance and primary health insurance (9%).8 During 2001–2006, despite fluctuations, the average household expenditure on health contributed more than 60% of the total health expenditure in the country.8 In a study comparing 59 countries, Xu et al. found that Vietnam had the highest proportion of households facing catastrophic payments for health. Specifically, more than 10.5% of households had health expenditures exceeding 40% of the household capacity to pay.9 In a study on costs of traumatic brain injury, Hoang et al. found that 84% of the sample, which included 35 households, faced catastrophic expenditure.10

By converting the impact of injuries into monetary terms, cost of injury studies can provide a common language for policy and decision makers.11 Cost of injury studies have been widely conducted, particularly in high or middle income country settings. For instance, Meerding et al. reported total health care costs due to injuries in the Netherlands in 1999 were € 1.2 billion or 3.7% of the total health care budget.12 In Australia, a snap shot of injuries presented by the Australian Bureau of Statistics show that, resources spent on injured people during 2000–2001 were 8% of total allocated health expenditure, almost AU$ 4 billion.13 In China, Zhou et al. estimated the economic cost of injury in 1999 at US$ 12.5 billion, almost four times the total public health services budget of China.6 More recently in South Korea, estimated medical treatment costs for injuries in 2006 accounted for 9.5% of the national health expenditure, and the annual economic burden associated with injury was more than US$ 39.8 billion.14 A recent World Health Organisation Global Status Report on Road Safety also highlighted a need for comprehensive cost estimates of injuries in addition to cost-effectiveness of various interventions to inform preventive action and mobilise support.15

In Vietnam, very little is known about the costs of injury and their impact on injured persons and their families. Existing knowledge on costs of injury in Vietnam comes from work conducted by Thanh et al. in 2000 and Hoang et al. in 2008. However, the first study was limited in identification of injury cause, which was self-reported by respondents,16 and he later study had a small sample size,10 limiting the conclusions that can be drawn from these works. The present study is an effort to fill in knowledge gaps by estimating the costs of injuries to the injured persons and their families during the hospitalisation period. These will be examined in greater detail in terms of injury characteristics, patient demographics, insurance status, external causes of injury, severity, and body region injured. This study also aims to identify the most costly injuries and those most likely to result in a catastrophic expenditure for the household.

Section snippets

Methods

A prospective cohort study was used to examine the economic burden of injuries. The study was conducted in Thai Binh General Hospital, the largest trauma hospital in Thai Binh province, with 440 beds. The Thai Binh province is in the Red River delta, approximately 100 km south of Hanoi, the capital city of Vietnam. In 2009, the population of this province was 1,900,000.17 According to the National Household Living Standards survey in 2010, the average monthly per capita income in Thai Binh

Results

Table 1 summarises the demographic characteristics of the study sample. Younger (18–29 years) and older (60 years plus) participants accounted for the majority of the sample (27.8% and 24.1% respectively). Males made up a disproportionate share with more than twice the number of females, 634 males (71.1%) in comparison with 258 females (28.9%). In terms of occupation, more than 50% were farmers. This was more than twice the percentage of the second most common group (24.1%), which included

Discussion

This study investigated the cost of injuries for individuals admitted to a provincial hospital in Vietnam, Thai Binh province. On average, the total cost of an injury was US$ 365, which was equivalent to an economic loss of more than the average income for 6 months. We found that burns, falls and RTIs were the most costly injuries. This is partly due to a longer hospital stay for these injuries. In addition, more severe injuries were also associated with increased costs.

In terms of mean costs

Conflict of interest statement

H. Nguyen was funded by Atlantic Philanthropies for the study and the George Institute for Global Health, University of Sydney for student scholarship. R. Ivers and S. Jan were funded by the National Health and Medical Research Council of Australia. A. Martiniuk was funded in part by an unrestricted educational Fellowship from Merck Inc. in 2011. C. Pham was funded in part by Atlantic Philanthropies.

Acknowledgements

The researchers would like to thank participants and their relatives in providing information used in this study and gratefully acknowledge the huge effort made by individual doctors and nurses in Thai Binh General Hospital in collecting data.

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