RESUMO
In recent years, many low- and middle-income countries are experiencing public health reforms, and Vietnam is one of those leading countries moving towards universal health coverage. Nevertheless, the government is currently facing challenges in sustaining health finance and reaching the entire population due to issues surrounding the design of the scheme and organisational practice. <BR><b>Objectives</b><BR> This paper has two objectives. The first objective is to summarise the history of the health insurance scheme and its design by collecting information from official documents in order to provide up-to-date information for a better understanding of the Vietnamese health system. The second objective is to review existing reports and related literature to identify the challenges and problems arising from the design of the health insurance system including premiums, benefit packages and payment rules, and organisational practices such as health service delivery.<BR><b>Method</b><BR> To collect information, decrees and laws as well as existing documents and reports by Vietnamese government agencies and related literature are thoroughly reviewed.<BR><b>Results</b><BR> We found that the government needs major revision of premiums and subsidies in terms of complexity of the design such as subdivided premiums for different statuses and large subsidies that could lead to unsustainable health finance. Also, hidden distorted incentives of health service providers such as unnecessary expensive technologically advanced medical treatment and inappropriate prescription of drugs are challenges. These embezzlements have increased both OOP payment and the financial burden on the health insurance budget.
RESUMO
<B>Objectives</B><BR>High adolescent fertility rates still persist in many developing countries. Adolescent childbearing often leads to negative outcomes including physical and mental disorders of mothers, a high incidence of infant death and household poverty. Obviously, it is important to explore the determinants of adolescent reproduction and its related behaviour to ensure its prevention. This study assesses the impact of the level of female autonomy and status of the community on adolescent childbearing, age of sexual debut and age of marriage.<BR><B>Methods</B><BR>This paper uses the pooled micro data from the Demographic and Health Survey Nicaragua 1998 and 2001. A logistic model is used to estimate the impact of the level of female autonomy and status of the community on adolescent childbearing, age of sexual debut and age of marriage. These variables are aggregated for each municipality using data on women aged over 20. Four female community autonomy variables are used. They are the percentage of women who have the final say on: own healthcare, making large household purchases, visit to family or relatives, and what food is to be cooked each day. Three variables of female status in the community are mean age at first marriage, mean age differences between spouses, and the percentage of those enrolled in secondary level education.<BR><B>Results</B><BR>Analysis proved that the level of autonomy and status of women in the community influence adolescent childbearing, age of sexual debut, and age of marriage. Particularly, the probability of younger sexual debut and younger marriage decreases when a community has a higher level of female autonomy and status.<BR><B>Conclusion</B><BR>The results indicate the importance of community intervention to strengthen female autonomy and promote female status in order to prevent adolescent childbearing.