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Forse, Rachel, Yoshino, Clara Akie, Nguyen, Thanh Thi, Phan, Thi Hoang Yen, Vo, Luan N. Q., Codlin, Andrew J., Nguyen, Lan, Hoang, Chi, Basu, Lopa, Pham, Minh, Nguyen, Hoa Binh, Van Dinh, Luong, Caws, Maxine 
ORCID: https://orcid.org/0000-0002-9109-350X, Wingfield, Tom ORCID: https://orcid.org/0000-0001-8433-6887, Lönnroth, Knut and Sidney-Annerstedt, Kristi
(2024)
'Towards universal health coverage in Vietnam: a mixed-method case study of enrolling people with tuberculosis into social health insurance'. Health Research Policy and Systems, Vol 22, Issue 1, e40.
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12961_2024_Article_1132.pdf - Published Version Available under License Creative Commons Attribution. Download (894kB) | Preview |
Abstract
Background: Vietnam’s primary mechanism of achieving sustainable funding for universal health coverage (UHC) and financial protection has been through its social health insurance (SHI) scheme. Steady progress towards access has been made and by 2020, over 90% of the population were enrolled in SHI. In 2022, as part of a larger transition towards the increased domestic financing of healthcare, tuberculosis (TB) services were integrated into SHI. This change required people with TB to use SHI for treatment at district-level facilities or to pay out of pocket for services. This study was conducted in preparation for this transition. It aimed to understand more about uninsured people with TB, assess the feasibility of enrolling them into SHI, and identify the barriers they faced in this process.
Methods: A mixed-method case study was conducted using a convergent parallel design between November 2018 and January 2022 in ten districts of Hanoi and Ho Chi Minh City, Vietnam. Quantitative data were collected through a pilot intervention that aimed to facilitate SHI enrollment for uninsured individuals with TB. Descriptive statistics were calculated. Qualitative interviews were conducted with 34 participants, who were purposively sampled for maximum variation. Qualitative data were analyzed through an inductive approach and themes were identified through framework analysis. Quantitative and qualitative data sources were triangulated.
Results: We attempted to enroll 115 uninsured people with TB into SHI; 76.5% were able to enroll. On average, it took 34.5 days to obtain a SHI card and it cost USD 66 per household. The themes indicated that a lack of knowledge, high costs for annual premiums, and the household-based registration requirement were barriers to SHI enrollment. Participants indicated that alternative enrolment mechanisms and greater procedural flexibility, particularly for undocumented people, is required to achieve full population coverage with SHI in urban centers.
Conclusions: Significant addressable barriers to SHI enrolment for people affected by TB were identified. A quarter of individuals remained unable to enroll after receiving enhanced support due to lack of required documentation. The experience gained during this health financing transition is relevant for other middle-income countries as they address the provision of financial protection for the treatment of infectious diseases.
| Item Type: | Article | ||||
|---|---|---|---|---|---|
| Subjects: | WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Administration and Organization > WA 540 National and state health administration WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) |
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| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department | ||||
| Digital Object Identifer (DOI): | https://doi.org/10.1186/s12961-024-01132-8 | ||||
| SWORD Depositor: | JISC Pubrouter | ||||
| Depositing User: | JISC Pubrouter | ||||
| Date Deposited: | 18 Apr 2024 09:01 | ||||
| Last Modified: | 18 Apr 2024 09:16 | ||||
| URI: | https://archive.lstmed.ac.uk/id/eprint/24324 |
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