Analysis on demand‐ and supply‐side responses during the expansion of health insurance coverage in Vietnam: Challenges and policy implications toward universal health coverage

Matsushima, Midori; Yamada, Hiroyuki; Shimamura, Yasuharu

doi:10.1111/rode.12627

Cited by 14 publications

(15 citation statements)

References 22 publications

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“…Several countries established health insurance as one of the mechanisms for attaining UHC (Buttorff et al, 2015;Fang et al, 2019;Matsushima et al, 2020). However, the effectiveness of the insurance in increasing proper healthcare access for all depends on the behavior responses and health expenditure implications of different subsections of the targeted populations (Kraft and VD Schulenburg, 1986).…”

Section: Introductionmentioning

confidence: 99%

Health Insurance and Out-Of-Pocket Expenditure on Health and Medicine: Heterogeneities along Income

2021

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Background: Achieving universal health coverage is an important objective enshrined in the 2015 global Sustainable Development Goals. However, the rising cost of healthcare remains an obstacle to the attainment of the universal health coverage. Health insurance is considered an option to reduce out-of-pocket (OOP) expenditure on health and medicine. Nevertheless, the relationship between insurance and the OOP along welfare distributions is not well understood. This study investigates the heterogeneous association between health insurance and OOP expenditure on health and medicine, along income, using data from the Kingdom of Saudi Arabia.Methods: This study used data of 8655 individuals drawn from the Saudi Family Health Survey conducted in 2018. The study adopts Tobit models to account for possible corner solution due to individuals with zero expenditure on health. We minimize the confounding effects of non-random selection into the insurance program by estimating the Tobit equations on a sample weighted by inverse propensity scores of insurance participation. In addition, we test whether the health insurance differently relates to OOP on health and medicine amongst people with access to free medical care as opposed to those without this privilege. The study estimates separate models for OOP expenditure on health and on medicines.Results: Health insurance reduces OOP expenditure on health by 2.0% and OOP expenditure on medicine by 2.4% amongst the general population while increasing the OOP expenditure on health by 0.2% and OOP expenditure on medicine by 0.2%, once income of the insured rises. The relationship between the insurance and OOP expenditure is robust only amongst the citizens, a sub-sample that also has access to free public healthcare. Specifically, the insurance reduces OOP expenditure on health by 3.6% and OOP on medicine by 5.2% and increases OOP expenditure on health by 0.4% and OOP expenditure on medicine by 0.5% once income of the insured increases amongst Saudi citizens. In addition, targeting medicines can lead to greater changes in OOP. The relationship between insurance and OOP is stronger for medicine relative to that observed on health expenditure.Conclusion: Our findings suggest that insurance induces different effects along the income spectrum. Hence, policy needs to be aware of the possible welfare distribution impacts of upscaling or downscaling the coverage of insurance amongst the populations, while pursuing universal healthcare coverage.

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Section: Introductionmentioning

confidence: 99%

Health Insurance and Out-Of-Pocket Expenditure on Health and Medicine: Heterogeneities along Income

2021

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“…Therefore, the findings from these nationally representative data can be generalised to the whole population. Furthermore, regarding the health financing system, Vietnam and several LMIC share the same characteristics [ 34 ]. Hence, studying the performance of the HI scheme in terms of increasing access to health care services and reducing OOP can offer valuable experience to LMIC of moving toward UHC.…”

Section: Introductionmentioning

confidence: 99%

Impact of Health Insurance on Health Care Utilisation and Out-of-Pocket Health Expenditure in Vietnam

Thuong

Huy

Tài

et al. 2020

BioMed Research International

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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.

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“…Spending is higher than the average spending on health insurance for countries in the Easy Asia and Pacific region (excluding high income) (Figure 2). At the same time, the high level of spending by the poorest households can lead to financial disasters for households (Matsushima et al, 2020). According to the Vietnam Government Spending Survey, 2.5% of households, or about 2 million people, remain below the poverty line due to catastrophic health spending (Asia & The Pacific Policy Society, 2019).…”

Section: Resultsmentioning

confidence: 99%

Investigation of Possible Organizational Changes to the Health Insurance System in Vietnam

Doan

Dukhno²

2021

International Scientific Conference „Contemporary Issues in Business, Management and Economics Engineering"

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Purpose – to identify the prerequisites for organizational changes of the emerging health insurance system in Vietnam. Research methodology - comparative analysis, statistical analysis, case study. Findings – the obligatory health insurance in Vietnam performs its functions only partially. There is still high level of out-of-pocket spending on medical services. First we identified one of the most important challenges to the health insurance system in Vietnam, namely, the population aging. Secondly, we identified and analyzed and the prerequisites (the pre-existing conditions), which can become the basis for the reorganization of the existing health insurance system without major reforms: (1) the cultural values of Asian society, which allow to build a community-based type model of living for the elderly on the basis of “equal with equal”; (2) technological advances in medicine that extend the healthy life of the elderly, (3) trust in traditional medicine, which allows widen the coverage of the poorest “elderly households”. Practical implications - the results of the study require attention from the government and insurance providers when rethinking of organizing process for mandatory medical insurance. Originality/Value – we have identified the ways of possible organizational changes for the health insurance system, making the most of the existing prerequisites. This can help to get closer to the goal of full coverage with health insurance services while achieving a positive social effect. The identified internal reserves make it possible to imple- ment organizational changes without major reforms of the established health insurance system. No studies have been conducted in this perspective.

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Analysis on demand‐ and supply‐side responses during the expansion of health insurance coverage in Vietnam: Challenges and policy implications toward universal health coverage

Cited by 14 publications

References 22 publications

Health Insurance and Out-Of-Pocket Expenditure on Health and Medicine: Heterogeneities along Income

Health Insurance and Out-Of-Pocket Expenditure on Health and Medicine: Heterogeneities along Income

Impact of Health Insurance on Health Care Utilisation and Out-of-Pocket Health Expenditure in Vietnam

Investigation of Possible Organizational Changes to the Health Insurance System in Vietnam

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