Preterm birth in Vietnam : direct medical cost assessment and the investigation of parents' experiences and satisfaction with health care services

Preterm birth remains a critical public health challenge and the leading cause of neonatal death in Vietnam. The aim of this thesis was to assess the financial impact of premature deliveries as well as parental experiences and satisfaction with preterm health care services in Vietnam. A mixed methods approach was used to address the main objectives of the study.
Our results suggest that preterm births create a considerable burden to families as well as the health system in Vietnam. Out-of-pocket expenditure was generally limited for parents who followed national care seeking guidelines. Parents who bypassed lower-level facilities without referral authorization faced out-of-pocket expenditure about six times higher than those of infants who had a proper transfer. Both premature birth and hospital transfers were caused a major psychological burden and stress for parents. The primary reasons for decision to transfer preterm infants to the national hospital were acute illness, positive perceptions of the quality of care of the national hospital and advice of other parents. Longer length of stay and worsening infant health status were the main factors resulting in lower parental satisfaction with the quality of care provided. Reducing the impact of preterm births likely requires a close cooperation between health professionals and infants’ families