Family-Based Health Insurance for Informal Sector Workers in Vietnam: Why Does Enrolment Remain Low?

Fragmented understanding: exploring the practice and meaning of informed consent in clinical trials in Ho Chi Minh City, Vietnam

BACKGROUND

The informed consent process in clinical trials has been extensively studied to inform the development processes which protect research participants and encourage their autonomy. However, ensuring a meaningful informed consent process is still of great concern in many research settings due to its complexity in practice and interwined socio-cultural factors.

OBJECTIVES

This study explored the practices and meaning of the informed consent process in two clinial trials conducted by Oxford University Clinical Research Unit in collaboration with the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam.

METHODS

We used multiple data collection methods including direct observervations, in-depth interviews with study physicians and trial participants, review of informed consent documents from 2009 to 2018, and participant observation with patients' family members. We recruited seven physicians and twenty-five trial participants into the study, of whom five physicians and thirteen trial participants completed in-depth interviews, and we held twenty-two direct observation sessions.

RESULTS

We use the concept "fragmented understanding" to describe the nuances of understanding about the consent process and unpack underlying reasons for differing understandings.

CONCLUSIONS

Our findings show how practices of informed consent and different understanding of the trial information are shaped by trial participants' characteristics and the socio-cultural context in which the trials take place.

Health Services Utilization Among Older Adults in Vietnam: Evidence From the National Household Living Standard Survey 2016

This study-using multinomial logistic regressions-analyzed a national sample of 2977 older adults to examine factors associated with their health services utilization in four types of health providers-namely, commune health stations (CHSs), private clinics, private hospitals, and public hospitals in Vietnam. Older Vietnamese favored using public hospitals for their health consultancies, even for regular health checkups. For nonsevere illness, the relative risk ratio of choosing private clinics was three times (95% CI: 2.2-4.1) that of CHSs. Possession of public health insurance was a key enabling factor that influenced the older adults' choice of CHSs over private clinics. Older adults of ethnic minority and living in rural areas were more likely to use CHSs than other health facilities. This study suggests a substantial quality improvement of services at CHSs, an innovative reform toward a diversified structure of private and public clinics to address diverse needs and to strengthen primary care for older adults.

Understanding family-based health insurance enrolment among informal sector workers in a rural district of Vietnam: Adverse selection and key determinants

Background: Challenges remain in the implementation of family-based health insurance (FHI) - the key strategy for achieving universal health coverage in Vietnam. Objectives: To explore the experiences of and factors influencing enrolment in FHI among informal sector workers (ISW) in a rural district in Vietnam. Methods: A cross-sectional study was conducted from January to June 2016 in Tien Du, a rural district in Bac Ninh province. Secondary data were extracted from provincial social insurance databases to identify the rate of FHI among ISW in the district. Qualitative data were collected from 55 participants: 20 semi-structured in-depth interviews (IDI) and 6 focus group discussions (FGD). Data were transcribed verbatim. Thematic analysis was conducted. Results: Only 25.1% of ISW had FHI. Those individuals with FHI tended to be older or already experiencing health problems or have 'risky' jobs. The key determinants of adverse selection from different levels included: individual, family and health system. Conclusions: Low health insurance uptake remains an issue for ISW. Policy makers should consider raising awareness of FHI and improve the quality of primary health services, simplify the procedures of enrolment and claim for ISW. Additional government premium subsidy is required to increase FHI enrolment among ISW.

Pooling financial resources for universal health coverage: options for reform

Universal health coverage (UHC) means that all people can access health services of good quality without experiencing financial hardship. Three health financing functions - revenue raising, pooling of funds and purchasing health services - are vital for UHC. This article focuses on pooling: the accumulation and management of prepaid financial resources. Pooling creates opportunities for redistribution of resources to support equitable access to needed services and greater financial protection even if additional revenues for UHC cannot be raised. However, in many countries pooling arrangements are very fragmented, which create barriers to redistribution. The purpose of this article is to provide an overview of pooling reform options to support countries who are exploring ways to enhance redistribution of funds. We outline four broad types of pooling reforms and discuss their potential and challenges in addressing fragmentation of health financing: (i) shifting to compulsory or automatic coverage for everybody; (ii) merging different pools to increase the number of pool members and the diversity of pool members' health needs and risks; (iii) cross-subsidization of pools that have members with lower revenues and higher health risks; and (iv) harmonization across pools, such as benefits, payment methods and rates. Countries can combine several reform elements. Whether the potential for redistribution is actually realized through a pooling reform also depends on the alignment of the pooling structure with revenue raising and purchasing arrangements. Finally, the scope for reform is constrained by institutional and political feasibility, and the political economy around pooling reforms needs to be anticipated and managed.