title: The policy of free healthcare for children under the age of 6 years in Vietnam: assessment of the uptake for children hospitalised with acute diarrhoea in Ho Chi Minh City.
abstract: OBJECTIVE
  To assess the proportion of, and reasons for, households not utilising the policy of free healthcare for children under 6 years of age (FCCU6) for hospitalisation with diarrhoea, and assess the risk of catastrophic expenditure for households that forgo FCCU6 and pay out of pocket.
  
  
  METHODS
  Invoices detailing insurance information and charges incurred from 472 hospitalised diarrhoeal cases in one paediatric hospital in Ho Chi Minh City were retrieved. Hospital charges and the utilisation of elective services were analysed for patients utilising and not utilising FCCU6. Associations between socio-economic factors with non-utilisation of FCCU6 were evaluated.
  
  
  RESULTS
  Overall, 29% of patients were FCCU6 non-users. The FCCU6 non-users paid a median hospital charge of $29.13 (interquartile range, IQR: $18.57-46.24), consuming no more than 1.4% of a medium-income household's annual income. Seventy per cent of low-income FCCU6 non-users utilised less-expensive elective services, whereas only 43% of medium income patients and 21% of high-income patients did (P = 0.036). Patients from larger households and those with a parent working in government were more likely to use FCCU6.
  
  
  CONCLUSIONS
  The rate of FCCU6 non-usage in this study population was 29%. A significant proportion of those that did not use FCCU6 was from lower income households and may perceive a justifiable cost-benefit ratio when forgoing FCCU6. Although a single diarrhoeal hospitalisation is unlikely to induce a catastrophic expenditure, FCCU6 non-usage may disproportionately increase the risk of catastrophic expenditure for lower income households over multiple illnesses.
authors.affiliation: Novartis Vaccines Institute for Global Health, Siena, Italy.
authors.forename: Mae
authors.initials: M
authors.lastname: Shieh
authors.forename: Corinne
authors.initials: C
authors.lastname: Thompson
authors.forename: Vu Tra My
authors.initials: VT
authors.lastname: Phan
authors.forename: Thi Thuy Linh
authors.initials: TT
authors.lastname: Van
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tediosi
authors.forename: Laura
authors.initials: L
authors.lastname: Merson
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Farrar
authors.forename: Manh Tuan
authors.initials: MT
authors.lastname: Ha
authors.forename: Lu Viet
authors.initials: LV
authors.lastname: Ho
authors.forename: Thi Ngoc Tuyet
authors.initials: TN
authors.lastname: Pham
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D003967:Diarrhea / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006291:Health Policy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007223:Infant; D008297:Male; D062606:Tertiary Care Centers / Q000191:economics / Q000706:statistics & numerical data; D019472:Universal Health Insurance / Q000458:organization & administration / Q000706:statistics & numerical data*; D014744:Vietnam / Q000453:epidemiology
keywords: Vietnam; acute diarrhoea; child health; health insurance utilisation; hospital charges; out-of-pocket expenditures; social health insurance