1. Association Between User Fees and Dropout from Methadone Maintenance Therapy: Results of a Cohort Study in Vietnam
- Author
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Hoa Mai Do, Anh Thuy Duong, Kieu Huu Hanh, Benjamin Johns, Le Bao Chau, Long Hoang Nguyen, and Pham Duc Manh
- Subjects
medicine.medical_specialty ,catastrophic expenditures ,methadone maintenance therapy ,030508 substance abuse ,Health Informatics ,user fees ,methadone ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,mental disorders ,medicine ,030212 general & internal medicine ,Dropout (neural networks) ,health care economics and organizations ,lcsh:R5-920 ,business.industry ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,vietnam ,Methadone maintenance therapy ,Family medicine ,0305 other medical science ,business ,lcsh:Medicine (General) ,Methadone ,medicine.drug ,Cohort study - Abstract
—Vietnam launched methadone maintenance therapy (MMT) in 2008 with donor funding. To expand and ensure sustainability of the program, Vietnam shifted the responsibility for financing portions of MMT to provinces and, in 2015, some provinces started collecting user fees for MMT. This study assesses the association between user fees and patient dropout using a one-year observational cohort of 1,021 MMT patients in which three of seven provinces included in the study implemented user fees. We also estimate the catastrophic payments—payments of 40% or more of nonsubsistence expenditures—associated with MMT. Box-Cox proportional hazard models were used to assess the association between user fees and patient dropout. About 85% of the cohort was actively on MMT at the end of the observation period. Of those who stopped MMT care, about 8% dropped out, 3.5% were incarcerated, 1.5% died, and 2% stopped for other reasons. The dropout hazard ratio for paying user fees compared to not paying user fees ranged from 0.70 (unadjusted, p = 0.26) to 0.29 (adjusted, p = 0.33). However, 29% of patients in provinces implementing user fees incurred catastrophic payments for MMT associated user fees and transportation, compared with 11% of patients in provinces not implementing user fees (p < 0.001). In one year of follow-up, we do not find evidence that user fees increased dropout from MMT. However, catastrophic payment rates remain a concern. This study represents an example of one type of monitoring of financial transitions; further and longer-term evaluation of user fees is needed.
- Published
- 2018