Catastrophic health expenditure of Vietnamese patients with gallstone diseases – a case for health insurance policy revaluation

Figures & data

Table 1 Comparison of demographic characteristics between patients with and without health insurance

Characteristics	With health insurance		Without health insurance		Total		P-value
	n	%	n	%	n	%
Total	157	76.2	59	23.8	206	100.0
Age group (years)							0.02
18–45	48	30.6	24	49.0	72	35.0
46–60	51	32.5	16	32.7	67	32.5
61–75	40	25.5	9	18.4	49	23.8
>75	18	11.5	0	0.0	18	8.7
Gender							0.02
Male	67	42.7	12	24.5	79	38.4
Female	90	57.3	37	75.5	127	61.7
Treatment setting							<0.05
Inpatient	109	69.4	9	18.4	118	57.3
Outpatient	48	30.6	40	81.6	88	42.7
Marital status							0.80
Single	10	6.4	2	4.1	12	5.8
Stay with spouse/partner	129	82.2	42	85.2	171	83.0
Divorced/widow	18	11.5	5	10.2	23	11.2
Occupation							0.57
Unemployment	23	14.7	11	22.5	34	16.6
Freelancera	33	21.2	12	24.5	45	22.0
White-collar workersb	14	9.0	2	4.1	16	7.8
Farmer	43	27.6	12	24.5	55	26.8
Others	43	27.6	12	24.5	55	26.8
Education attainment							0.21
No formal or primary school education	89	56.7	24	49.0	113	54.9
Secondary school education	32	20.4	16	32.7	48	23.3
Postsecondary school education	36	22.9	9	18.4	45	21.8
Monthly household income quantiles							0.07
Poorest	37	23.6	5	10.2	42	20.4
Poor	30	19.1	11	22.5	41	19.9
Middle	32	20.4	18	36.7	50	24.3
Rich	28	17.8	9	18.4	37	18.0
Richest	30	19.1	6	12.2	36	17.5
Catastrophic health expenditure							<0.05
Yes	49	41.2	6	15.8	55	35.0
No	70	58.8	32	84.2	102	65.0
	Mean	SD	Mean	SD	Mean	SD
Monthly household income (USD)	431.7	339.2	449.3	312.8	436.1	334.8	0.37

Notes:

a Freelancers: those working without the formal labor contract.

b White-collar workers: those with office or administrative jobs. Exchange rate: 22,700 VND =1 US$ (2017).

Table 2 Comparison of illness and treatment characteristics between patients with and without health insurance

Characteristics	With health insurance		Without health insurance		Total		P-value
	n	%	n	%	n	%
Location of gallstones
Gallbladder	50	31.9	28	57.1	78	37.9	<0.01
Liver (intrahepatic)	43	27.4	12	24.5	55	26.7
Bile duct	61	38.9	7	14.3	68	33.0
Unknown	3	1.9	2	4.1	5	2.4
Type of treatment
No treatment	23	14.7	21	42.9	44	21.4	<0.01
Pharmacological treatment (eg, antiparasitic)	26	16.6	18	36.7	44	21.4	<0.01
Extracorporeal shockwave lithotripsy	7	4.5	0	0.0	7	3.4	0.15
Surgery	112	71.3	12	24.5	124	60.2	<0.01
Other treatments	1	0.6	5	10.2	6	2.9	<0.01
History of pharmacological treatment to treat parasitic infection in the past 12 months
Yes	61	38.9	18	36.7	79	38.4	0.79
No	96	61.2	31	63.3	127	61.7
History of parasitic infection in the biliary system
Yes	37	23.6	4	8.2	41	19.9	0.05
No	108	68.8	39	79.6	147	71.4
Unknown	12	7.6	6	12.2	18	8.7

Table 3 Inpatient and outpatient medical costs and ability to pay (N=118)

Medical costs (USD/year)a	Inpatient		Outpatient
	Mean	SD	Mean	SD
Direct medical cost	951.5	669.6	57.7	95.6
Direct nonmedical costs
Travel expenses	57.3	61.7	14.5	20.3
Cost for food and accommodation	88.1	185.0	6.2	11.9
Total	145.4	198.2	20.7	28.2
Indirect medical costs
Loss of income by patients	35.2	57.3	4.8	7.5
Loss of income by caregivers	83.7	88.1	8.4	15.0
Total	118.9	105.7	13.2	17.6
Total cost	1,207.0	748.9	90.7	107.5
	n	%	n	%
Ability to pay
Fully	42	28	122	71.4
Partially	83	55.3	42	24.6
Unable	25	16.7	7	4.1

Note:

a Exchange rate: 22,700 VND =1 US$ (2017).

Table 4 Factors associated with CHE

	CHEa
	OR	P-value	95% CI
Type of patient (inpatient status as the reference)
Outpatient	0.05	<0.01	0.01–0.29
Gallstone position (gallbladder as the reference)
Liver (intrahepatic)	5.69	<0.01	1.65–19.61
Gender (male gender as the reference)
Female	0.32	0.05	0.10–1.01
Marital status (single status as the reference)
Divorced/widow	8.38	<0.01	1.76–39.83
History of pharmacological treatment to treat parasitic infection in the past 12 months (yes vs no)	0.33	0.07	0.11–0.99
Monthly household income quantiles (lowest quantile as the reference)
Middle quantile	0.28	0.07	0.07–1.10
Highest quantile	0.05	0.01	0.00–0.52

Note:

a CHE: 1 = yes, 0 = no.

Abbreviation: CHE, catastrophic health expenditure.