title: Economic vulnerability of methadone maintenance patients: Implications for policies on co-payment services.
abstract: Co-payment for methadone maintenance treatment (MMT) services is a strategy to ensure the financial sustainability of the HIV/AIDS programs in Vietnam. In this study, we examined health services utilization and expenditure among MMT patients, and further explored factors associated with catastrophic health expenditure among affected households.
  
  
  
  A multi-site cross-sectional study was conducted among 1016 patients in two epicentres: Hanoi and Nam Dinh province in 2013.
  
  
  
  Overall, 8.2% and 28.7% respondents used inpatient and outpatient health care services in the past 12 months apart from receiving MMT. There were 12.8% respondents experiencing catastrophic health expenditure given MMT is provided free-of-charge, otherwise 63.5% patients would suffer from health care costs. MMT integrated with general health or HIV services may encourage health care services utilization of patients. Patients, who were single, lived in the rural, had inpatient care and reported problems in Mobility were more likely to experience catastrophic health expenditure than other patient groups.
  
  
  
  The health care costs are still financially burden to many drug users and remained over the course of MMT that implies the necessity of continuous supports from the program. Scaling-up and decentralizing integrated MMT clinics together with economic empowerments for treated drug users and their families should be prioritized in Vietnam.
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. Electronic address: bach@hmu.edu.vn.
authors.forename: Bach Xuan
authors.initials: BX
authors.lastname: Tran
authors.affiliation: Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Viet Nam.
authors.forename: Huong Thu Thi
authors.initials: HT
authors.lastname: Phan
authors.affiliation: Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam; School of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam.
authors.forename: Long Hoang
authors.initials: LH
authors.lastname: Nguyen
authors.affiliation: Institute for Global Health Innovation, Duy Tan University, Da Nang, Viet Nam.
authors.forename: Cuong Tat
authors.initials: CT
authors.lastname: Nguyen
authors.affiliation: Institute for Global Health Innovation, Duy Tan University, Da Nang, Viet Nam.
authors.forename: Anh Tuan Le
authors.initials: AT
authors.lastname: Nguyen
authors.affiliation: Foreign Trade University, Hanoi, Viet Nam; Center for AIDS Control, Hanoi Department of Health, Hanoi, Viet Nam.
authors.forename: Tuan Nhan
authors.initials: TN
authors.lastname: Le
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Carl A
authors.initials: CA
authors.lastname: Latkin
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000191:economics*; D003430:Cross-Sectional Studies; D016527:Drug Costs; D055030:Drug Users / Q000331:legislation & jurisprudence / Q000523:psychology; D005260:Female; D005102:Health Expenditures; D006295:Health Resources / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000331:legislation & jurisprudence; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000191:economics*; D058850:Opiate Substitution Treatment / Q000191:economics*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000191:economics* / Q000523:psychology / Q000534:rehabilitation*; D014744:Vietnam; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone
keywords: Catastrophic; Costs; Health services; Integrative services; Methadone; Vietnam