Access and payment for health care: the poor of Northern Vietnam.

In common with many developing countries, Vietnam has begun to introduce user fees at community and district level. This is part response to the transformation of the economy, economic recession, and the growing acceptability of alternative forms of health finance. This article examines the impact of these charges on the rural poor. Results from a 1995 survey in North Vietnam suggest that the poor generally delay treatment, make less use of government health facilities, and pay more for each episode of illness than the rich. There is evidence that the poor are forced to reduce consumption of essential goods or to borrow to meet these charges. A significant minority are deterred from using facilities. The current system of exemptions fails to provide adequate protection to the poor and a completely new system is required. The results suggest that it is the poor in poorer communes that are most affected by high user fees and it is to these areas that any assistance from government or donors should be targeted.

Early childhood survivorship in Vietnam.

The effects on early childhood mortality of birth order, age of the mother at the time of the child's birth, mother's education, as well as infant mortality risk in the province, urban/rural residence, the presence of schools and other facilities and health care services, were examined using data from the 1988 Vietnam Demographic and Health Survey and the 1990 Study of Accessibility of Contraceptives in Vietnam. A total of 4137 urban and rural children born between 1983 and 1988 to the 4172 women interviewed in the Demographic and Health Survey were included in the hazard model analysis of maternal and child characteristics. However, since the Accessibility of Contraceptives Study included only rural respondents, the hazard model analysis of community development characteristics and health services effects on early childhood mortality was based on a subsample of 3314 rural children. Rural children in birth orders five and higher had the greatest risk of early childhood death, birth order one an intermediate risk and orders 2-4 the lowest risk of early childhood death. Rural children residing in communes with fewer than 10,000 inhabitants were at significantly greater risk of early childhood death than children from larger communes. Neither age nor education of the mother nor gender of the child, had a significant impact on early childhood survivorship independent of other variables. Risk of infant mortality in the child's province was of borderline significance.

PIP: The authors examined the effects of the following factors upon early childhood mortality: birth order, mother's age at the time of the child's birth, mother's education, infant mortality risk in the province, urban/rural residence, and the presence of schools and other facilities and health care services. Data were used in a hazard model analysis of maternal and child characteristics for 4137 urban and rural children born between 1983 and 1988 whose 4172 mothers were interviewed in the 1988 Vietnam Demographic and Health Survey. Data were also used for a subsample of 3314 rural children from the 1990 Study of Accessibility of Contraceptives in Vietnam. Analysis found that rural children of birth orders five and higher had the greatest risk of early childhood death. Birth order one held an intermediate risk, while orders 2-4 held the lowest risk. Rural children residing in communes with less than 10,000 inhabitants were at significantly greater risk of early childhood death than children from larger communes. Neither mother's age nor education, nor gender of the child, had a significant impact upon early childhood survivorship independent of other variables. The risk of infant mortality in the child's province was of marginal significance.