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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., (Copyright © 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

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., (Copyright © 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)