Exploring affordability and healthcare-seeking behaviour for delivery and antenatal care among the poor and ethnic minorities in rural Northwestern Viet Nam

Figures & data

Table 1. Socio-demographic status of the mothers who had deliveries in 2013 in the Luong Son district, Hoa Binh province, Viet Nam (n = 315).

	Health insurance enrolment
	Yes		No
	n	(%)	n	(%)	p-value
Ethnicity (Missing = 3)
Kinh (Viet)	60	(51.7)	56	(48.3)	<0.001
Minority	167	(85.2)	29	(14.8)
Household annual income (Missing = 2)
Lowest quartile	70	(74.5)	24	(25.5)	0.17
2nd quartile	58	(65.9)	30	(34.1)
3rd quartile	47	(72.3)	18	(27.7)
Highest quartile	54	(81.8)	12	(18.2)
Age
(mean, yrs)	(27.2)		(27.0)		0.22
Education (Missing = 10)
Primary	12	(70.6)	5	(29.4)	0.19
Secondary	61	(70.1)	26	(29.9)
High school	90	(69.8)	39	(30.2)
University	59	(83.1)	12	(16.9)
Occupation (Missing = 68)
Farmer	111	(74.5)	38	(25.5)	<0.001
Formal sector/Industrial worker	33	(86.8)	5	(13.2)
Shop/Restaurant	2	(20.0)	8	(80.0)
Civil servant	47	(94.0)	2	(6.0)
Zone
Zone 1　(near district hospital)	70	(63.6)	40	(36.4)	0.003
Zone 2　(near CHC)	86	(84.3)	16	(15.7)
Zone 3　(no health facility)	74	(71.8)	29	(28.2)
Total number of ANC (Missing = 1)
(mean, times)	(6.3)			(5.7)	0.15
0 to 3 times	53	(75.7)	17	(24.3)	0.55
≥4 times	176	(72.1)	68	(27.9)
Place of ANC (Missing = 1)
CHC (mean, times)	(2.2)		(1.7)		0.006
District hospital (mean, times)	(0.5)		(0.2)		0.028
Provincial hospital (mean, times)	(0.2)		(0.2)		1.00
National hospital (mean, times)	(0.4)		(0.2)		0.18
Private clinic (mean, times)	(3.0)		(3.4)		0.33
Place of Delivery (Missing = 3)
Home	0		0
CHC	15	(75.0)	5	(25.0)	0.53
District hospital	152	(71.7)	60	(28.3)
Provincial hospital	32	(78.0)	9	(22.0)
National hospital	18	(75.0)	6	(25.0)
Private clinic	10	(66.7)	5	(33.3)
Caesarean delivery (Missing = 5)
Yes	50	(71.4)	20	(27.4)	0.81
No	175	(72.9)	65	(27.1)

Abbreviations: CHC, Commune Health Centre; ANC, Antenatal Care.

Table 2. Logistic regression analysis of factors associated with health insurance coverage in the Luong Son district, Hoa Binh province, Viet Nam in 2013.

		Health insurance coverage (n = 284)
		B	S.E.	p-value	AOR	95%CI
Zone
Zone 1 (near district hospital)	Ref.
Zone 2 (near CHC)		2.35	0.62	<0.001	10.45	(3.10–35.27)
Zone 3 (no health facility)		1.56	0.53	0.003	4.72	(1.68–13.28)
Age		0.04	0.05	0.42	1.04	(0.95–1.13)
Education
Elementary	Ref.
Junior High		0.74	0.82	0.37	2.10	(0.42–10.45)
High School		1.36	0.89	0.13	3.91	(0.68–22.41)
University or higher		3.35	1.17	0.004	28.55	(2.89–281.69)
Occupation
Farmer	Ref.
Formal sector/Industrial worker		2.10	0.73	0.004	8.19	(1.98–33.96)
Shop/Restaurant owner or worker		−1.26	1.21	0.30	0.28	(0.03–3.05)
Civil servant		1.82	1.05	0.08	6.15	(0.79–47.91)
Household annual income
Lowest	Ref.
2nd quartile		−0.37	0.53	0.48	0.69	(0.25–1.94)
3rd quartile		−0.46	0.66	0.48	0.63	(0.17–2.29)
Highest		0.53	0.82	0.51	1.71	(0.34–8.47)
Ethnicity
Kinh (Viet)	Ref.
Muong		2.91	0.54	<0.001	18.33	(6.38–52.62)
Caesarean section
No	Ref.
Yes		−0.60	0.52	0.25	0.55	(0.20–1.52)
ANC 4 ≥ times
No	Ref.
Yes		−0.16	0.47	0.81	0.89	(0.36–2.23)

Cox-Snell R² = 0.30; Nagelkerke R² = 0.46.

Abbreviations: SE, Standard Error; AOR, Adjusted Odds Ratio; CI, Confidence Interval; CHC, Commune Health Center; ANC, Antenatal Care. Missing = 28.

Figure 1. Reason(s) for choosing the place of delivery and antenatal care by Kinh (Viet, Majority) and Muong (Minority) in the Luong Son district, Vietnam in 2014 (Multiple answers).

Table 3. Median payment to health facility for normal delivery (n = 234) and caesarean section delivery (n = 66) among mothers, with and without health insurance, who delivered in the Luong Son district, Hoa Binh province, Viet Nam, in 2013 by household annual income quartile.

		Health insurance
		Insured		Uninsured
Household annual income quartile	p-value	n	Median (VND)	n	Median (VND)
Normal delivery (n = 234)
Lowest	< 0.001	37	150,000	19	900,000
2nd quartile	0.01	56	200,000	21	980,000
3rd quartile	0.006	44	250,000	14	1,200,000
Highest	0.07	37	265,000	6	735,000
Caesarean section delivery (n = 66)
Lowest	0.15	9	650,000	4	2,500,000
2nd quartile	0.013	8	1,650,000	6	4,850,000
3rd quartile	0.004	12	775,000	8	3,050,000
Highest	0.77	13	1,550,000	6	2,950,000

Abbreviation: VND, Vietnamese Dong. USD 1 = VND 22,692 VND as of March, 2017.

Table 4. Rate of catastrophic payment caused by normal delivery and caesarean section delivery among mothers, with and without health insurance, who delivered in the Luong Son district, Hoa Binh province, Viet Nam in 2013.

		Payment to health facility	Transportation cost	Other non-medical expenditure	Catastrophic payment^§
	n	Median (VND)	Median (VND)	Median (VND)	>5% (%)	>10% (%)
Normal delivery
Insured	165	200,000	150,000	200,000	17.6	6.7
Uninsured	60	1,000,000	200,000	300,000	31.7	10.0
Caesarean delivery
Insured	47	850,000	650,000	1,025,000	51.1	19.5
Uninsured	20	3,050,000	550,000	1,500,000	80.0	45.0

§Catastrophic payment >5% and >10% means the % of households whose total cost for delivery was more than 5% and 10% of annual household income, respectively.

Abbreviation: VND, Vietnamese Dong. USD 1 = VND 22,692 VND as of March, 2017.

Figure 2. Average number of antenatal care (ANC) visits by place and household annual income quartile, with and without health insurance, in the Luong Son district of Hoa Binh province, Viet Nam in 2014.

Abbreviation: ANC, Antenatal care; CHC, Commune health centre; PC, Private clinic

Abbreviation: CHC: ANC, Antenatal care; Commune health centre, PC: Private clinic