Willingness to use and pay for options of care for community-dwelling older people in rural Vietnam.

BACKGROUND: The proportion of people in Vietnam who are 60 years and over has increased rapidly. The emigration of young people and impact of other socioeconomic changes leave more elderly on their own and with less family support. This study assesses the willingness to use and pay for different models of care for community-dwelling elderly in rural Vietnam. METHODS: In 2007, people aged 60 and older and their family representatives, living in 2,240 households, were randomly selected from the FilaBavi Demographic Surveillance Site. They were interviewed using structured questionnaires to assess dependence in activities of daily living (ADLs), willingness to use and to pay for day care centres, mobile care teams, and nursing centres. Respondent socioeconomic characteristics were extracted from the FilaBavi repeated census. Percentages of those willing to use models and the average amount (with 95% confidence intervals) they are willing to pay were estimated. Multivariate analyses were performed to measure the relationship of willingness to use services with ADL index and socioeconomic factors. Four focus group discussions were conducted to explore people's perspectives on the use of services. The first discussion group was with the elderly. The second discussion group was with their household members. Two other discussion groups included community association representatives, one at the communal level and another at the village level. RESULTS: Use of mobile team care is the most requested service. The fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than do the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require that services be free-of-charge is two to three times higher than the proportion willing to pay full cost. Households are willing to pay more than the elderly for day care and nursing centres. The elderly are more willing to pay for mobile teams than are their households. Age group, sex, literacy, marital status, living arrangement, living area, working status, poverty, household wealth and dependence in ADLs are factors related to willingness to use services. CONCLUSIONS: Community-centric elderly care will be used and partly paid for by individuals if it is provided by the government or associations. Capacity building for health professional networks and informal caregivers is essential for developing formal care models. Additional support is needed for the most vulnerable elderly to access services.

Creation of postgraduate training programs for family medicine in Vietnam.

BACKGROUND AND OBJECTIVES: The Vietnam Family Medicine Development Project has successfully created postgraduate training programs for family medicine in Vietnam. This paper's objective is to report on the project's progress and provide initial evaluation results. METHODS: A training network of medical schools in Vietnam partnered with family medicine departments in the United States to accomplish the goal of establishing family medicine as a specialty in Vietnam with assistance from the Ministry of Health. Together they created a curriculum and ambulatory training sites. Faculty development was accomplished, and training programs were implemented. RESULTS: A preliminary assessment of some of the graduates demonstrates that family physicians in Vietnam provide enhanced primary care with better patient satisfaction. A more-complete evaluation is underway. CONCLUSIONS: Initial establishment of the specialty of family medicine in Vietnam has been successful. Ongoing support for the development of this new primary care specialty has been garnered in each of the medical schools and at the ministerial level throughout the country.