Depression and associated factors among older people in Vietnam: Findings from a National Aging Survey.

BACKGROUND: Depression is one of the most common mental health disorders among older people. Depressive symptoms are often overlooked and untreated in primary care settings. This study aims to assess the prevalence of depressive symptoms and associated factors among older people in Vietnam. METHOD: The study analyzed data from the Vietnam National Aging Survey (VNAS) conducted in 2022 with a nationally representative sample of 3,006 older people aged 60 and over in 12 provinces. The 15-item Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms. Bivariate and multiple logistic regression analyses were used to explore the association between depressive symptoms and other related factors such as sociodemographic and economic characteristics, social support, health status, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) limitations, chronic diseases, cigarette smoking status, alcoholic drinking, and domestic violence. RESULTS: The prevalence of depressive symptoms among older people was 20.2%. The associated factors that increase the odds of having depression among older people were female gender (OR = 2.21, 95% CI 1.34-3.62), living in rural areas (OR = 1.83, 95% CI 1.15-2.89), the poorest quintile (OR = 2.26, 95% CI 1.39-3.66), self-rated poor health (OR = 11.68, 95% CI 4.96-27.49), ADL limitations (OR = 2.12, 95% CI 1.51-2.99), IADL limitation (OR = 1.61 95% CI 1.16-2.25), and experiencing domestic violence in the last 12 months (OR = 6.66, 95% CI 4.00-11.05). CONCLUSION: Depression symptoms were prevalent among older people in Vietnam. Depression screening for older people should be included in primary care settings for early identification and treatment of depression.

Unmet needs for care for activities of daily living among older adults with functional disabilities in Vietnam.

Background: Given its low-middle-income status, Vietnam is experiencing a rapidly aging population. Along with this demographic trend, the care needs of older adults, particularly those with functional disabilities, have become an emerging policy issue. Purpose: This study examined the prevalence of unmet needs for care in activities of daily living (ADLs) among Vietnamese older adults with functional disabilities. Methods: We used data from the Population Change and Family Planning Survey (PCS) in 2021, which was a nationally representative survey. Cross-tabulations and logistic regressions were applied to identify older adults' individual and household factors associated with their unmet care needs. Results: Overall, 4.80% of older adults with at least one functional disability needing care to perform one or more ADLs suffered from unmet needs, of whom 2.32% did not receive any care and 3.05% received insufficient assistance. Logistic regression results revealed that age, sex, place of residence, ethnicity, marital status, education levels, and self-rated health were significantly associated with unmet needs. The higher risk of having unmet needs is associated with those in middle age (70-79), men, rural residents, ethnic minorities, currently unmarried people, those with less than a primary educational level, and those with normal or poor self-rated health. Conclusion: Attention should be paid to vulnerable older adults, such as those living in rural areas with poor health status, in order to reduce their unmet needs for ADL assistance.

Patients' Satisfaction with Obstetrics-Gynecology, and Pediatric Healthcare Services in Vietnam: A Multicentre Cross-Sectional Study.

Purpose: Despite improvements in maternal and child health in Vietnam, sustained efforts are required to improve healthcare quality and resolve persistent disparities, highlighting the universal significance of customer satisfaction in healthcare. This study aims to assess patient satisfaction with healthcare services and associated factors at obstetrics-gynecology and pediatric hospitals across different geographical areas in Vietnam. Patients and Methods: A cross-sectional study was conducted in 2019 among 647 patients or caregivers of hospitalized children at three major obstetrics-gynecology and pediatric hospitals, representing different geographical areas in Northern Vietnam. A Ministry of Health-approved satisfaction instrument was utilized to assess patient satisfaction. The instrument included 31 items measuring five dimensions of perceived satisfaction. Exploratory factor analysis examined the construct validity of the satisfaction measurement, and multivariate linear regression determined the factors associated with patient satisfaction. Results: Among the 643 participants, 520 were female (89.87%), and nearly half were aged 18-29 years old (43.7%). Factor analysis revealed three dimensions: "Competency and Outcomes", "Accessibility and Procedures", and "Facilities and Equipment", with mean domain scores of 4.6 ± 0.43, 4.28 ± 0.67, and 4.53 ± 0.51, respectively. The proportion of participants completely satisfied with overall service quality was 48.52%, and expectation met was 34.53%. Multivariate linear regression indicated that patients from hospitals in the Red River Delta region had higher satisfaction scores than those in the Middle region across all domains (p<0.05). Higher health insurance coverage was associated with increased satisfaction, while education level, economic status, and ethnicity also influenced satisfaction. Conclusion: The study revealed moderate to high levels of satisfaction among patients at three major obstetrics-gynecology and pediatric hospitals in northern Vietnam. The findings may provide useful evidence for implementing hospital quality control in Vietnam, focusing on patient-centered goals.

Healthcare Services Utilisation and Financial Burden among Vietnamese Older People and Their Households.

BACKGROUND: This research examined differences in the utilisation of healthcare services and financial burden between and within insured and uninsured older persons and their households under the social health insurance scheme in Vietnam. METHODS: We used nationally representative data from the Vietnam Household Living Standard Survey (VHLSS) conducted in 2014. We applied the World Health Organization (WHO)'s financial indicators in healthcare to provide cross-tabulations and comparisons for insured and uninsured older persons along with their individual and household characteristics (such as age groups, gender, ethnicity, per-capita household expenditure quintiles, and place of residence). RESULTS: We found that social health insurance was beneficial to the insured in comparison with the uninsured in terms of utilization of healthcare services and financial burden. However, between and within these two groups, more vulnerable groups (i.e., ethnic minorities and rural persons) had lower utilization rates and higher rates of catastrophic spending than the better groups (i.e., Kinh and urban persons). CONCLUSION: Given the rapidly ageing population under low middle-income status and the "double burden of diseases", this paper suggested that Vietnam reform the healthcare system and social health insurance so as to provide more equitable utilisation and financial protection to all older persons, including improving the quality of healthcare at the grassroots level and reducing the burden on the provincial/central health level; improving human resources for the grassroots healthcare facilities; encroaching public-private partnerships (PPPs) in the healthcare service provision; and developing a nationwide family doctor network.

Factors associated with receipt of informal care among the Vietnamese older persons: Evidence from a national survey.

Background: The rapidly growing older population in Vietnam poses an increasing need for care among the older persons, who have mainly relied on informal care at homes and communities. This study examined the Vietnamese older persons' individual and household factors determining their receipt of informal care. Methods: This study provided cross-tabulations and multivariable regression analyses to identify who provided assistance to the Vietnamese older people along with their individual and household characteristics. Data: The nationally representative survey on older persons, namely Vietnam Aging Survey (VNAS) in 2011 was used in this study. Results: We found that proportions of older persons having difficulty in activities of daily living (ADLs) were different in regard to their age, sex, marital status, health status, working status, and living arrangements. In care provision, gender differences were clear, in which females generally had significantly higher rates of providing care to older persons than their male counterparts. Conclusion: Care for older persons in Vietnam has been mainly provided by their families, and thus changes in socio-economic, demographic factors along with differences among generations in family values will be a key challenge to maintain such care arrangements.

Factors Influencing the Vietnamese Older Persons in Choosing Healthcare Facilities.

BACKGROUND: The rapidly growing aging population poses major challenges for health systems in Vietnam. This study was therefore aimed to examine factors influencing the choices of healthcare facilities among older patients in Vietnam, using a national survey on older people. METHODS: We applied multinomial logistic regression models based on Andersen's Behavioral Model with various predisposing factors, enabling factors and healthcare-needs factors associated with different types of healthcare facilities where older patients utilized services. DATA: We used data from the Vietnam Aging Survey (VNAS) in 2011. This was the first-ever nationally representative survey on older persons in Vietnam. RESULTS: Among those who used healthcare services, 15.1% visited central hospitals; 23.6% visited provincial hospitals; 28.0% visited district hospitals; 8.8% visited commune heath centres; 18.3% visited private hospitals/clinics; and 6.2% visited other facilities. The results showed that "having to pay cost" and "having sufficient income" were strong predictors for using commune health centres, district hospitals, and private facilities, while "having health insurance" was not a significant predictor for using these facilities. Also, we showed that apart from enabling factors (such as age, gender, educational levels, employment status, living regionand place of residence), predisposing factor (such as health insurance, perceived sufficient income, household wealth and having to pay medical cost) as well as need factors (such as self-rated health and chronic disease) were also associated with the choice of healthcare facilities. CONCLUSIONS: Based on the findings, we discussed the implications of the results for organizing healthcare finance and delivery to achieve efficiency and equity for older people in Vietnam.

Empirical analysis on the illicit trade of cigarettes in Vietnam.

BACKGROUND: This paper examined how a higher tax on tobacco would affect illicit trade in Vietnam. METHODOLOGY AND DATA: This paper used the gap method to estimate the gap between cigarette domestically tax-paid sales and domestic consumption. Data were from the tax-paid sales by the Vietnam Steering Committee on Smoking and Health (VINACOSH), the Vietnam Tobacco Association, the General Tax Department, as well as two rounds of the Global Adult Tobacco Survey in 2010 and 2015. KEY RESULTS: The results indicated that Vietnam had a negative volume of illicit trade, either a result of under-reporting of tobacco use or due to net smuggling of tax-paid cigarettes out of the country. Furthermore, the trend showed an increased negative volume over time, which indicated that increases in tobacco taxes in the interleading years did not result in an increase in illicit trade in tobaccos in Vietnam. CONCLUSIONS: Vietnam's low prices on domestic cigarettes created favourable conditions for cigarette smugglers and provided easy access to illicit cigarettes for the Vietnamese people, but the absence of a relationship between tax changes and smuggling suggested that potential increases in the excise tax should not be discouraged by the threat of an increase in illicit trade. The government should increase taxes on cigarettes to raise domestic cigarette prices and take strong policy measures to create a more transparent social environment, therefore effectively reducing the prevalence of illicit cigarettes in Vietnam.

The evolution of social health insurance in Vietnam and its role towards achieving universal health coverage.

Our research examines the development of social health insurance (SHI) in Vietnam between 1992 and 2016 and SHI's role as a financial mechanism towards achieving universal health coverage (UHC). We reviewed and analysed legislation from the Government of Vietnam (GoV) and performance data from the GoV and the World Bank. Stages of development were identified from legislative change leading to change in SHI functioning as a public financing mechanism: revenue collection, pooling of risk, and purchasing. Movement towards UHC was assessed relative to: population coverage, benefit coverage, and financial protection. Vietnam has implemented SHI through five stages: Stage I (1992-1998), Stage II (1998-2005), Stage III (2005-2008), Stage IV (2008-2014), and Stage V (2014 onwards). Coverage has widened from a compulsory scheme for civil servants and pensioners and a voluntary scheme for others, to a scheme that targets the entire population. However, UHC has not been achieved with 19% of the population uninsured in 2016 and high out-of-pocket payments. The benefit package includes a wide range of services and many expensive medications and considered to be generous. It is recommended that Vietnam focus on improving population coverage rather than further expanding the benefit package to achieve UHC.

Decomposing gender inequality in functional disability among older people in Vietnam.

OBJECTIVES: This study compared functional disability in older men and women, and examined the extent to which social determinants contribute to the difference in functional disability between Vietnamese older men and women. METHODS: A nationally representative sample of persons aged 60 and older in Vietnam, taken from the 2011 Vietnam Aging Survey, was analyzed (N = 2,693, consisting of 1,622 women and 1,071 men). Ordinary least squares regression (OLS) was used to identify factors associated with functional disability in men and women, while Oaxaca-Blinder decomposition for linear models was applied to examine how much of gender inequality in functional disability was attributed by the distribution of the social determinants. RESULTS: The OLS results showed that functional disability score for women was significantly higher than that for men, and that men and women shared similarity in factors associated with functional disability (e.g., age, educational level, employment status, and perceived sufficiency of income). The decomposition results showed that the distribution of the social determinants explained about 54 per cent of gender inequality in functional disability; among the determinants, age, employment status, and educational level were the major drivers. Approximately 46 per cent of the inequality was explained by unobserved factors. CONCLUSION: The findings of this study highlight the need for policy to mitigate the social determinants (e.g., education and employment) that contribute to gender inequality in functional disability.

Productive activities of the older people in Vietnam.

Productive activities are crucial factors leading to an "active aging" population. With the case of Vietnam, this paper aimed to explore the productive activities among Vietnamese older people by using data from the Vietnam Aging Survey (VNAS), which was conducted in 2011 as the first-ever nationally representative survey on persons aged 50 and over in Vietnam and contained 2789 older people (those aged 60 and over) representing all older people living in 6 ecological regions and urban and rural areas in Vietnam. Productive activities included working and/or taking care of any (great)grandchild(ren) in the past 12 months prior to the survey. Using paired t-tests and probit models, we compared the differences in these productive activities among older people in terms of sex and living area. The results from various t-tests showed that educational attainment, health status and poverty status were key factors differentiating older men and women and rural and urban older people in these productive activities. For the probit estimations in terms of both gender and living location, the results indicated that age, education, health status and supportive children were determinants of working decision, while age, marital status and size of household were consistently important factors of taking care of (great)grandchildren. The paper also discussed policy implications for socio-economic and health protection in promoting older people's productive activities as well as protecting them from a variety of risks and vulnerabilities.

Determinants and impacts of international remittances on household welfare in Vietnam.

Remittances can potentially help to promote economic development by providing a mechanism to share risks, reduce poverty and improve equality. However, from the viewpoint of economic theory the overall impacts of remittances are uncertain, as different mechanisms lead to opposite impacts. Since the 1990s Vietnam has experienced a dramatic growth in remittance flows from abroad. Vietnam is a unique case for study, as economic motives historically played a smaller role in outward migration than in other countries. Fortunately, household survey data are available for this time period, allowing for a detailed analysis of the impacts of international remittances on Vietnam. Specifically, we examine the characteristics of recipients and the impacts of international remittances on economic inequality and poverty. We conclude that international remittances are helping to improve equality. For this reason, new development policies must also account for their potential impacts on remittance flows.