Temporal trends in the incidence of catastrophic health expenditure and the financial protection of social health insurance schemes in Vietnam: Findings from the National Living Standard Survey 2006–2020

OBJECTIVES: To assess temporal trends in the incidence of catastrophic health expenditure (CHE) and the financial protection provided by Vietnam's social health insurance (SHI) among rural and urban households from 2006 to 2020. STUDY DESIGN: Repeated cross-sectional study. METHODS: Eight biennial waves from the Vietnam Household Living Standards Survey (2006-2020) were analyzed using multivariate logistic regression models to assess temporal trends in CHE incidence and the financial protection offered by SHI. RESULTS: Adjusted time trend results showed a steep decline in CHE incidence in rural areas from 2006 to 2016 and in urban areas from 2006 to 2012, with little change thereafter. While higher insurance coverage among household members was associated with a reduced risk of CHE among both rural and urban households in 2006-2010, this association was no longer statistically significant for rural households during 2012-2014 or for urban households during 2012-2014 and 2016-2020. In contrast, higher insurance coverage was significantly associated with increased odds of CHE among rural households during 2016-2020. Seeking inpatient (outpatient) care was associated with odds of CHE that were 3.8-4.6 (1.4-1.5) times higher at district hospitals, 12.2-15.1 (2.2-3.0) times higher at provincial hospitals, and 34.0-38.2 (3.4-5.4) times higher at central hospitals. CONCLUSIONS: The declining financial protection provided by SHI, combined with steep gradients in CHE incidence across health facility levels, underscores the need to reform Vietnam's hospital-centric delivery system, address cost pressures at higher-level facilities, and strengthen financial protections for vulnerable groups.