Assessing the effect of household survey designs on the accuracy of out-of-pocket health expenditures measurement in Vietnam

Out-of-pocket payments (OOPs) are direct payments that patients or customers pay to healthcare providers when receiving health services, excluding any pre-payments or reimbursement by health insurance.
In several low-and-middle-income countries (LMICs), OOPs contribute a substantial proportion of the total health expenditures (40-50%) due to the relative lack of prepayment mechanisms. These expenditures are a significant burden on household resources. Therefore, measuring OOPs is important for tracking financial risk protection in health and monitoring the countries' progress in universal health coverage.
Household surveys are the primary source of data for estimating the household OOPs in most LMICs due to the absence of routine and transactional medical records. In these surveys, there are substantial variations in survey designs such as the choice of recall period and the mode of data collection, which hinder the effort of producing internationally comparable data on health expenditures. The lack of information on the utilization of services that are linked to diseases in these surveys also leads to concerns about the reliability of estimating household OOPs by diseases for resource allocation on health interventions and health financing programs.
The aims of this Ph.D. thesis are (i) to assess the effect of the recall period on the accuracy of out-of-pocket measurement for inpatient services using provider data as the gold standard in Vietnam; (ii) to compare a face-to-face survey with a mobile-phone survey in measuring out-of-pocket health expenditures estimated in Vietnam; (iii) to assess the validity of diseases-specific OOPs estimates related to hospital services obtained from a households’ survey in Vietnam comparing them to those reported by health care providers.
My work has produced evidence to suggest an improved health expenditure tool using existing instruments.