Road traffic injury (RTI) accounts for a substantial and increasing burden of mortality, morbidity, and health care costs in developing nations. Globally, road traffic is responsible for 1.3 million fatal and 78 million nonfatal injuries each year (WHO 2013a; World Bank and IHME 2014). In the Western Pacific, RTI is the leading cause of mortality for people ages 15–49 years (WHO 2013b). Direct economic costs are estimated to exceed US$500 billion worldwide and are anticipated to grow in tandem with motorization of the developing world (WHO 2004; World Bank and IHME 2014). The potentially substantial out-of-pocket (OOP) medical costs associated with traffic injury may result in catastrophic expenditures (expenditures that crowd out a significant portion of household expenditures) and subsequent impoverishment (Wagstaff 2010).
In response to the growing burden of traffic injury, the government of Vietnam passed comprehensive legislation mandating the use of motorcycle helmets in 2007. This legislation extended the mandatory use of helmets to all riders on all roads, substantially increased penalties for failure to wear a helmet, and provided for increased enforcement (Passmore, Nguyen, and others 2010). As a result, helmet use increased from 30 percent to 93 percent of riders within months (Hung, Stevenson, and Ivers 2006; Nguyen, Passmore, and others 2013). Studies in other settings have examined the influence of helmet use policies on aggregate health, but the distribution of benefits and equity improvements resulting from such regulatory changes remains understudied and uncertain (Ngo and others 2012; Passmore, Tu, and others 2010).
Traffic injury can lead to substantial and potentially impoverishing health expenditures (Wagstaff 2010). Legislation mandating helmet use is one non–health sector policy that may protect individuals against this financial risk. In nations with universal health coverage, helmet regulation may also reduce government spending for traffic injuries and thus free up health spending for other conditions. Defining the magnitude of the health and financial benefits attributable to Vietnam’s comprehensive helmet policy might bolster the case for a similar policy in neighboring countries (for example, Cambodia) and in other low-and-middle-income countries.
Extended cost-effectiveness analysis (ECEA) incorporates the dimensions of equity and financial risk protection into economic evaluations (Verguet, Laxminarayan, and Jamison 2014; Verguet and others 2013, 2015). In this chapter, a simulation model is used to perform an ECEA examining the influence that Vietnam’s 2007 helmet legislation has had in four areas:
Road traffic deaths and nonfatal injuries
Individuals’ direct costs of acute care treatment for motorcycle injuries
Individuals’ income losses from missed work
Individuals’ financial risk.
© 2017 International Bank for Reconstruction and Development / The World Bank.