Background. In recent years, health insurance (HI) has been chosen by many low- and middle-income countries to obtain an important health policy target—universal health coverage. Vietnam has recently introduced the Revised Health Insurance Law, and the effects of the voluntary health insurance (VHI) and heavily subsidised health insurance (HSHI) programmes have not yet been analysed. Therefore, this study is aimed at examining the impact of these HI programmes on the utilisation of health care services and out-of-pocket health expenditure (OOP) in general and across different health care providers in particular. Methods. Using the two waves of Vietnam Household Living Standard Surveys 2014 and 2016 and the difference-in-difference method, the impacts of VHI and HSHI on health care utilisation and OOP in Vietnam were estimated. Results. For both the VHI and HSHI groups, we found that HI increased the probability of seeking outpatient care, the mean number of outpatient visits, the total number of visits, and the mean number of visits at the district level of health care providers in the last 12 months. However, there was no evidence that the HSHI programmes increased the mean number of inpatient visits and the number of visits at the provincial hospital. We also found that while the VHI programme reduced OOP for both outpatient and inpatient care, the HSHI scheme did not result in a reduction in OOP for hospitalisation, although HI lowered the total OOP. Similarly, we found that for both groups, HI reduced OOP when the insured visited district and provincial hospitals. However, the statistically significant impact was not demonstrated when the enrolees of HSHI programmes visited provincial hospitals. Conclusion. The study offers evidence that the Vietnamese HI scheme increased health care service utilisation and decreased OOP for the participants of the VHI and HSHI programmes. Therefore, the government should continue to consider improving the HI system as a strategy to achieve universal health coverage.

This study aims at determining if organic tea farming results in higher net income than conventional tea farming in the mountainous areas of Northern Vietnam. Our sample includes 226 traditional and 319 organic tea-producing households in the provinces of Thai Nguyen, Phu Tho, Ha Giang, and Lai Chau. Using a propensity score matching approach, the study finds that the adoption of organic tea production had a positive impact on households’ farm income in the study area. Using different matching algorithms, organic tea adopters earned higher income than did non-adopters, from 1038.8 to 1059.0 thousand Vietnamese Dong (VND) per hectare of cultivation plot. To increase conversion to organic tea farming amongst smallholder farmers, the government and other stakeholders should aim to provide better extension services, which incorporate relevant training to farmers and better access to information on organic tea production, as well as encouraging the commercialization of organic fertilizers. Simultaneously, the Vietnamese government should introduce mechanisms to coordinate production activities and deliver tea products to processing and/or marketing facilities.

Background: The Government of Vietnam has set the goal of achieving universal health coverage (UHC) by 2025. Health insurance (HI) is being considered a tool to achieve this goal. However, out-of-pocket spending and catastrophic health expenditure (CHE) remain high. Research evidence on how to reduce these expenditures to achieve UHC is essential. Therefore, this study examines the determinants of CHE, especially the HI factor. Method: To identify HI participation status and other factors associated with CHE, we use logistic regression on a dataset from the 2016 Vietnam Household Living Standards Survey. Results: The study finds that HI is a protective factor against CHE, although this result is not always statistically significant across different subsamples. Moreover, the household head's age and employment status, household size, share of the elderly above 60 years, income, illness status, healthcare utilisation, availability of hospitals, commune health stations with medical doctors and place of residence all correlate with household CHE. Conclusion: Although there has been a rise in HI coverage, the financial protection capacity of HI schemes in Vietnam remains inadequate, particularly for households living in rural areas. Further investigations of the causal effect of HI, other health system factors and CHE in rural settings are necessary to reduce the incidence of CHE. Additionally, policies aimed at groups vulnerable to CHE, such as those

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ObjectivesThe study aims to evaluate the impact of the Revised Health Insurance Law 2014 on the utilisation of outpatient and inpatient care services, healthcare services utilisation at different levels of providers, types of providers and types of visits across different entitlement groups.Design/settingSecondary data from two waves of the Vietnam Household Living Standard Survey (VHLSS) 2016, VHLSS 2014 were used. A cross-sectional study applying propensity score matching was conducted.ParticipantsA total of 4900 individuals who reported using healthcare services are analysed.Outcomes measureNumbers of outpatient and inpatient visits, frequency of healthcare service utilisation at commune health stations, district hospitals, provincial hospitals, public and private health facilities, number of visits at health facility for medical treatment and health checks per year.ResultsThe result indicates that health insurance (HI) policy increased the number of outpatient visits for the enrolled between 0.87 and 1.29. The greatest impact was found on participants of heavily subsidised health insurance (HSHI) programmes with 1.29 visits per person per year. Similarly, an increase between 0.08 and 0.16 in the number of inpatient admissions was because of participation in HI. With regard to type of healthcare providers, the study found that participation in HI has the most effect on the use of healthcare services at district hospitals. However, the study demonstrated that the impacts of HI on the increase in the frequency of visiting commune health stations, number of visits at the provincial hospital for HSHI groups, and number of visits at health facilities for health check and consultation were sensitive to unobserved characteristics.ConclusionOur findings imply that policy-makers in Vietnam could continue expanding health insurance coverage to increase access to healthcare services for citizens, especially vulnerable groups. In addition, the government should draw more attention to primary healthcare level.