Challenges in moving toward universal health coverage: rising cost of outpatient care among Vietnam's insured rural residents, 2006-2018.

OBJECTIVES: The aim of this study was to assess temporal trends in out-of-pocket (OOP) expenditures per outpatient contact by the insured residents in rural Vietnam. STUDY DESIGN: This was a repeated cross-sectional study. METHODS: Seven biennial waves from the Vietnam's Household Living Standard Survey covering the period 2006-2018 and a two-part model were used to assess temporal trends in OOP expenditures and its variations across various health facilities while controlling for a wide array of individual- and household-specific characteristics. RESULTS: The pattern of health facility utilization shifted steadily from commune health centers toward higher level government hospitals and private health facilities between 2006 and 2018. The regression results indicated an upward trend in the amount of OOP expenditures, with the amount of OOP expenditures incurred per outpatient contact being 40.3% higher in 2010-2012 than in 2006-2008 and by as much as 155.5% higher in 2018. These high-cost pressures were attenuated by 63%-65% when accounting for the types of health facility contacted. The cost inflation was more pronounced for care sought at higher level government hospitals and private hospitals than at other health facilities. CONCLUSION: The cost of accessing outpatient care rose sharply between 2006 and 2018, particularly for visits involving higher level government hospitals and private hospitals. These findings suggest that beside expanding the coverage over the transition path to universal coverage, efforts should be directed at reforming Vietnam's hospital-centric and fragmented delivery system as a way of containing costs and ensuring financial sustainability of social health insurance system.

RETRACTED: 5G Technology and induction of coronavirus in skin cells.

This article has been retracted at the request of the Editor. After a thorough investigation the Editor-in-Chief has retracted this article as it showed evidence of substantial manipulation of the peer review.

RETRACTED: 5G Technology and induction of coronavirus in skin cells.

Ahead of Print article withdrawn by publisher.

Correlates of body mass index among primary school children in Ho Chi Minh City, Vietnam.

OBJECTIVES: To document the prevalence of overweight and obesity and examine associated risk factors. STUDY DESIGN: A cross-sectional survey was conducted in 16 primary public schools in eight districts of Ho Chi Minh City in 2016. A multistage clustering sampling method was used to collect a sample of 1806 pupils attending the first, second, and third grades (7-9 years). METHODS: Age- and sex-adjusted body mass index (BMI) status was defined using International Obesity Taskforce cut-offs. Ordered probit regression models were used to assess the association between child BMI and its socio-economic and demographic risk factors. The model was estimated separately for boys and girls to assess the extent to which the socio-economic gradients in BMI vary by gender. RESULTS: The prevalence of obesity among boys was twice the rate for girls (24.7 vs 12.3%). The prevalence of overweight and obesity were also higher among pupils attending schools located in urban districts than in semi-rural districts. Gender, household wealth, the frequency of having breakfast at home, parental body weight, and school location were strong predictors of child BMI status. The protective effect of having breakfast more frequently at home against the risk of overweight/obesity was more pronounced in girls than in boys. Father's body weight and child BMI were more strongly associated with boys from poorer households than boys from wealthier households, while the differences were not significant for girls. CONCLUSIONS: The high prevalence of childhood overweight and obesity indicates an urgent need for more gender-specific, effective intervention, and prevention programs.

Severe injuries and household catastrophic health expenditure in Vietnam: findings from the Household Living Standard Survey 2014.

OBJECTIVES: To assess the extent that the presence of severe injuries among rural and urban household members is associated with household catastrophic expenditure. STUDY DESIGN: Vietnam's Household Living Standard Survey of 2014 was used for this study. METHODS: A two-level (household and community) logistic regression analysis was used to identify factors associated with catastrophic health expenditure. RESULTS: The incidence of catastrophic health expenditure was significantly higher in rural areas (3.1-11.7%) than in urban areas (1.4-6.1%). Households with members with severe injuries were significantly more likely to incur catastrophic health expenditure than those without severe injuries, and the increase was more pronounced for the rural poor and near poor (5.5-8.7 times) than for the rural rich (1.5-2.5 times). Having at least one inpatient contact at a higher level public hospital increased the risk of catastrophic health expenditure significantly for both rural and urban residents, and the increase was significantly greater among the rural residents than the urban residents. Having more household members with health insurance had little effect on the incidence of catastrophic health expenditure faced by urban residents, while it increased the incidence of catastrophic health expenditure faced by rural residents. CONCLUSION: The presence of severe injuries among household members was strongly associated with catastrophic health expenditure. To protect households against the financial consequences of severe injuries, efforts should be directed at injury prevention and strengthening the quality of primary and trauma care at the lower level public health facilities as well as extending the breadth and depths of insurance coverage.

Differences in the management of hypertension, diabetes mellitus and dyslipidemia between obesity classes.

We did not find any paper that assessed clinical inertia in obese patients. Therefore, no paper has compared the clinical inertia rates between morbidly and nonmorbidly obese patients. A cross-sectional observational study was carried out. We analysed 8687 obese patients ⩾40 years of age who attended their health-care center for a checkup as part of a preventive program. The outcome was morbid obesity. Secondary variables were as follows: failure in the management of high blood pressure (HBP), high blood cholesterol (HBC) and high fasting blood glucose (HFBG); gender; personal history of hypertension, dyslipidemia, diabetes, smoking and cardiovascular disease; and age (years). We analysed the association between failures and morbid obesity by calculating the adjusted odds ratio (OR). Of 8687 obese patients, 421 had morbid obesity (4.8%, 95% confidence interval (CI): 4.4-5.3%). The prevalence rates for failures were as follows: HBP, 34.7%; HBC, 35.2%; and HFBG, 12.4%. Associated factors with morbid obesity related with failures were as follows: failure in the management of HBP (OR=1.42, 95% CI: 1.15-1.74, P=0.001); failure in the management of HBC (OR=0.73, 95% CI: 0.58-0.91, P=0.004); and failure in the management of HFBG (OR=2.24, 95% CI: 1.66-3.03, P<0.001). Morbidly obese patients faced worse management for HBP and HFBG, and better management for HBC. It would be interesting to integrate alarm systems to avoid this problem.

A confirmatory factor analysis of the WISC-III in a clinical sample with cross-validation in the standardization sample.

Maximum likelihood confirmatory factor analysis was applied to the Wechsler Intelligence Scale for Children-Third Edition (WISC-III; Wechsler, 1991) data of a mixed clinical sample of 318 children. Analyses were designed to determine which of nine hypothesized oblique factor solutions could best explain intelligence as measured by the WISC-III in the clinical sample. Competing latent variable models were identified in previous studies, and results in the clinical sample were cross-validated by testing all models in the WISC-III standardization sample (n = 2200). Findings in both the clinical and standardization samples supported a five-factor model including Verbal Comprehension, Constructional Praxis, Visual Reasoning, Freedom from Distractibility, and Processing Speed factors. The Visual Reasoning factor was defined primarily by Picture Arrangement, whereas Mazes did not appear to improve model fit. Potential opportunities and pitfalls with regard to the interpretation of the proposed Visual Reasoning factor are discussed.

The class analysis of poverty: is the underclass living off the socially available surplus?

In a recent article Erik Olin Wright argues that the U.S. underclass is a drain on the socially available surplus and thus a hindrance to capital accumulation. Wright's argument is not supported by available evidence from the United States, Canada, and the United Kingdom on the state's distributive activities. This evidence suggests that the social welfare necessary to sustain the underclass is provided by transfers from wage and salary earners rather than from profit.

Primary health care, community participation and community-financing: experiences of two middle hill villages in Nepal.

Although community involvement in health related activities is generally acknowledged by international and national health planners to be the key to the successful organization of primary health care, comparatively little is known about its potential and limitations. Drawing on the experiences of two middle hill villages in Nepal, this paper reports on research undertaken to compare and contrast the scope and extent of community participation in the delivery of primary health care in a community run and financed health post and a state run and financed health post. Unlike many other health posts in Nepal these facilities do provide effective curative services, and neither of them suffer from chronic shortage of drugs. However, community-financing did not appear to widen the scope and the extent of participation. Villagers in both communities relied on the health post for the treatment of less than one-third of symptoms, and despite the planners' intentions, community involvement outside participation in benefits was found to be very limited.

PIP: During the summer of 1992, data were gathered through household and personal interviews in two isolated villages in western Nepal to compare a state- and a community-sponsored health center. The Ghandruk Community Health Centre was established in 1987 by a local nongovernmental organization (NGOs) and the Sikles health post was established by the Indian government in the mid-1950s. A comparison of the health-seeking behavior in each village showed that both health centers accounted for only about 30% of treatment, that 40% of illnesses were self-treated, and that 26% of illness in Ghandruk and 35% in the poorer Sikles remained untreated. In each village, more than 90% of the sample was unaware of the existence of a health committee and the health committees were afforded very low status compared to other committees (such as the forest committee). Health committee members were more active in Sikles despite the fact that the health post was controlled by district/regional health authorities. Health workers were more readily identified than members of the health committees but they performed only a few of their educational and health promotional tasks. Village health workers appeared to be inactive, and none of the trained traditional birth attendants were practicing. While the two villages showed no differences in participation in the delivery and use of health services, villagers in Ghandruk have been active in health-related activities such as the construction of private latrines, the development of a water supply, and regular clean-up campaigns. In Sikles, where such interventions have yet to be accomplished, the morbidity rate in the sample population was 81%, compared with 23.9% for Ghandruk. These results lead to the following observations: 1) the applicability of a participatory approach to development in rural Nepal is questionable from a cross-cultural perspective, and 2) the existence of socioeconomic and cultural hierarchies in the villages combined with male domination of the health committees prevents health committees from representing the needs of the entire community. In conclusion, community financing did not appear to increase community participation in the delivery and use of health services or to result in greater equity in health care. Rather than leading to abandonment of this financing option, however, these results should help lead to the creation of a proper balance between the role of government, NGOs, and community self-help in the delivery of health care.

The Canadian health care system as a managed care model for the United States.

After discussing the evolution of the Canadian health care system and its current cost trends, the authors address the degree to which the Canadian system provides direction for reform in the United States. Accessibility, quality, and cultural acceptability provide the focus of their approach.

An economist's brief guide to the recent debate on the Canadian health care system.

The purported advantages of the Canadian system of health insurance over the U.S. health care system have recently been questioned by a number of economists. These criticisms have in turn engendered a response by other economists who believe that the evidence supports the cost and coverage advantages of the Canadian system. The authors provide an overview of this recent debate.

Further refinements of Canadian/U.S. health cost containment measures.

Critics of the Canadian health care system have argued that the lower health care share of gross national product (GNP) in Canada relative to the United States is more likely to be associated with a relatively more rapid growth in GNP in Canada than with the ability of the Canadian single-payer system to contain costs. In this article the authors use both the level and the average annual growth rate of health care's share of GNP to provide an assessment of cost containment for the United States and Canada. They conclude that the suggestion that the success of the Canadian system has been an illusion created by its more rapid growth in GNP is not supported once the appropriate adjustments are made to the data.

Is the Canadian health care system more effective at expenditure control than previously thought? A reply to Peter Coyte.

In an article published by the Journal of Public Health Policy (Summer 1990), Peter C. Coyte argues that it is not empirically valid to say that the introduction of universal medical insurance in Canada successfully contained the growth in the share of society's resources devoted to the health care industry. During the period under consideration, both Canada and the United States witnessed several major policy changes in the provision and regulation of health services. Coyte's decision to apply a simple time trend to the data assumes away these changes, especially the introduction of universal medical insurance in Canada in 1971, whose influence on health expenditures is itself the primary subject of inquiry of this paper. We conclude that both the unadjusted and the adjusted data suggest that the Canadian universal health system has been a resounding success economically, once the appropriate periodization is applied to the data, reflecting the institutional and policy changes that took place. Finally, we propose suggestions for future research with respect to measuring resource usage in the Canadian and U.S. health care systems.

[Synovectomies of the knee. Apropos of 47 cases tuberculous synovitis]. / Les synovectomies du genou. A propos de 47 cas de synovites tuberculeuses

UNLABELLED: The authors carried out synovectomy of the knee in 70 cases, including 47 for tuberculous synovitis, with follow up periods of 2 years and half to 18 years. The subjects included: -30 children from 2 to 15 years; -17 adults from 16 to 50 years, with 3 cases of more than 50 years. RESULTS: Very good: greater or equal to 110 degrees in 2 cases; -Good: greater or equal to 90 degrees in 26 cases; -Average: greater or equal to 45 to 90 degrees in 11 cases; -Poor: less than 45 degrees in 8 cases. The authors believe that synovectomy in tuberculous synovitis of the knee without an osteocartilagenous lesion, or with slight lesions of the joint is more efficacious than medical treatment alone and may shorten the duration of treatment.