Summary of study participants.

To achieve the Sustainable Development Goal’s targets of universal health coverage (UHC) and poverty reduction, interventions are required that strengthen and harmonize both UHC and social protection. Vietnam is committed to achieving financial protection and over 90% of the general population has enrolled in its social health insurance (SHI) scheme. However, an estimated 63% of tuberculosis (TB)-affected households in Vietnam still face catastrophic costs and little is known about the optimal strategies to mitigate the costs of TB care for vulnerable families. This study assessed the acceptability of a social protection package containing cash transfers and SHI using individual interviews (n = 19) and focus group discussions (n = 3 groups). Interviews were analyzed through framework analysis. The study’s main finding indicated that both conditional and unconditional cash transfers paired with SHI were acceptable, across six dimensions of acceptability. Cash transfers were considered beneficial for mitigating out-of-pocket expenditure, increasing TB treatment adherence, and improving mental health and general well-being, but the value provided was inadequate to fully alleviate the economic burden of the illness. The conditionality of the cash transfers was not viewed by participants as inappropriate, but it increased the workload of the TB program, which brought into question the feasibility of scale-up. SHI was viewed as a necessity by almost all participants, but people with TB questioned the quality of care received when utilizing it for auxiliary TB services. Access to multiple sources of social protection was deemed necessary to fully offset the costs of TB care. Additional research is needed to assess the impact of cash transfer interventions on health and economic outcomes in order to create an enabling policy environment for scale-up.

为实现可持续发展目标（Sustainable Development Goal）中的全民健康覆盖（Universal Health Coverage, UHC）与减贫目标，需出台强化并协同全民健康覆盖与社会保护体系的干预举措。越南致力于实现医疗财务保障，目前超90%的普通民众已加入其社会健康保险（Social Health Insurance, SHI）计划。然而，据估算越南仍有63%的结核病（Tuberculosis, TB）受累家庭面临灾难性医疗支出，且目前针对脆弱家庭减轻结核病诊疗费用的最优策略仍知之甚少。

本研究通过个人访谈（n=19）与焦点小组讨论（n=3组），评估了包含现金转移支付与社会健康保险的社会保护套餐的可接受性。研究采用框架分析法对访谈资料进行分析。主要研究结果显示，附条件与无条件现金转移支付搭配社会健康保险的方案，在六项可接受性维度上均具有良好的接受度。现金转移支付被认为有助于降低自付费用、提升结核病治疗依从性，并改善心理健康与整体福祉，但当前的支付额度不足以完全抵消疾病带来的经济负担。参与者并未认为现金转移支付的附条件要求存在不当之处，但该要求增加了结核病防控项目的工作量，这使得规模化推广的可行性受到质疑。

几乎所有参与者均认为社会健康保险是必要保障，但结核病患者在使用其覆盖结核病辅助诊疗服务时，对所获得的医疗服务质量提出了质疑。研究认为，需多渠道获取社会保护资源，才能完全抵消结核病诊疗的相关费用。此外，还需开展更多研究以评估现金转移支付干预措施对健康与经济结局的影响，从而为规模化推广营造有利的政策环境。