Daovieng Douangvichit

BACKGROUND: Delivery by a skilled birth attendant (SBA) in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs) in Lao PDR. METHODS: A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. RESULTS: Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD) than for vaginal delivery (59 USD). After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. CONCLUSIONS: Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family incomes were able to pay for more non-medical care expenses. The effect of health insurance on service utilization was noted by women and SBAs. To achieve the goal of utilizing delivery care in the hospitals, coverage of health insurance needs to be expanded.

Objectives: This study aims to investigate the relationship between exposure to heavy drinkers and subjective well-being and health-related quality of life in Lao PDR and Thailand. Methods: The national surveys were undertaken in Lao PDR (n=1,212) and Thailand (n=1,571). The questionnaire survey was used to assess the Personal Wellbeing Index (PWI), the European Quality of Life-5 Dimension (EQ-5D), and encounters with heavy drinkers in the respondents’ everyday lives. The association between exposure to heavy drinkers and PWI and EQ-5D utility scores was examined using multivariate analysis. Results: Respondents who were exposed to a larger number of heavy drinkers in their lives were more likely to experience reduced scores for the PWI in Lao PDR and Thailand. However, Thai respondents suffered most when they were exposed to heavy drinkers in their households, while Lao respondents experienced more negative effects from exposure to heavy drinkers outside the household. In addition, every heavy drinker outside the household that Lao respondents came into contact with was associated with reduced EQ-5D utility scores. Conclusions: Exposure to heavy drinkers has a significant negative impact on well-being among the population in both countries. Thus, the reduction in alcohol’s harm to others should be considered in order to promote the well-being of the population as a whole.

OBJECTIVE: To assess obstetric care and health system responsiveness for hospital-based delivery care in Lao PDR, and associated factors. MATERIAL AND METHOD: A cross-sectional study was conducted in two provincial hospitals in Lao PDR between June and October 2010. All delivered women were interviewed for their perception of health system responsiveness and their medical records were reviewed for the obstetric care they received. RESULTS: Five hundred eighty one women participated in this study. The mean scores of obstetric care and health system responsiveness were 19.5 +/- 2.5 and 31.6 +/- 1.5, respectively. The mean score of overall performance was 51.0 +/- 2.8. Of the two hospitals, designated as Hospital A and Hospital B, the health responsiveness was rated lower in women undergoing cesarean section and delivering in Hospital B. Male doctor or obstetrician or delivery in Hospital B was significantly associated with higher obstetric care and overall performance. CONCLUSION: Different health system responsiveness for the delivery care between the two hospitals was found. Strategies to improve obstetric care need to be discussed and studied.

INTRODUCTION AND AIMS: Previous studies have confirmed that the number of heavy drinkers in a household negatively correlates with the subjective well-being of individuals in the household. However, limited studies have investigated the experiences of alcohol's harm to others (HTO) and subjective well-being, particularly in low- and middle-income countries. The purpose of this study was to investigate the associations between experiences of HTO and subjective well-being in two selected low- and middle-income countries. DESIGN AND METHODS: We analysed population survey data on 1205 and 1491 individuals aged 18-64 years from Lao People's Democratic Republic (Lao PDR) and Thailand, respectively. The respondents' experiences of HTO and their subjective well-being were measured using face-to-face interviews. The association between experiencing HTO and subjective well-being was investigated using Tobit regression models. RESULTS: A significant association between experiencing HTO and subjective well-being was found in Thailand, but not in Lao PDR. Those who had ever experienced HTO had a 2.77-point lower score of subjective well-being than those who had never experienced HTO (95% confidence interval -4.67, -0.88; P-value <0.05) in Thailand. In Lao PDR, the physical harm dimension showed the strongest association with subjective well-being compared to other types of harm, while in Thailand, financial harm was the dimension most strongly associated with the outcome. DISCUSSION AND CONCLUSIONS: There was a significant association between HTO and subjective well-being, particularly physical harm in Lao PDR and financial harm in Thailand. The study suggests that services to mitigate the impacts of HTO on well-being should focus on physical harm in Lao PDR and financial harm in Thailand.

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