Good budget or good care: The dilemma of social health insurance in Vietnam

Abstract

Objective: 2014 marked a rising public commitment to universal health coverage in Vietnam to eliminate the financial burden for patients, but there are lots of hindrances. It is evident that patients met difficulties to validate their insurances, so health insurance does not significantly address out-of-pocket payments issues. Furthermore, the unequal geographical distribution of hospitals in Vietnam has created an inequality between non-residing patients and residing patients; the former usually pay more. This calls into question how the validity of healthcare insurance and patient’s residence could be related to patient’s financial status and their satisfaction with health insurance. Methods: Bayesian regression models are employed to analyze a data set of 1042 inpatients in hospitals of all levels in Northern Vietnam. Result: The results show that living in the same region as the hospital and having valid insurance is negatively correlated with the impoverishing risk. Regarding patients’ satisfaction with health insurance, it is negatively correlated with having a residence in the same region as the hospital but positively correlated with higher socioeconomic status and insurance validity. Finally, on average, the satisfaction of patients who have already recovered from the illness and those who quit early is lower than that of patients who needed follow-up in medical care or stop in the middle. Conclusion: This article suggests that policymakers consider addressing the unequal geographical distribution of hospitals and healthcare quality to help patients avoid going to hospitals outside their regions, which may generate a financial burden for patients and lower their satisfaction with health insurance.

Fragmented understanding: exploring the practice and meaning of informed consent in clinical trials in Ho Chi Minh City, Vietnam

“…Limited access to treatment due to financial difficulties was also the most mentioned motivation for clinial trial participation in this context. In Vietnam, although social health insurance exists with the aim to enhance the accessibility to healthcare for people living in poverty, informal workers face significant barriers to healthcare access due to the poor quality of primary healthcare services offered to insured patients and complex paperwork and referral procedures [ 28 , 50 ]. Lack of support from the social security system, poverty and unequal access to quality healthcare services may result in clinical trial participation being the only feasible choice for participants to receive treatment.…”

“…As of 2020, the social health insurance covers 90.85% of the population. 3 However, out-of-pocket expenditure for health care remains high [ 28 ]. According to a human development report in 2020, although 95% of the Vietnamese population was literate, the mean years of schooling for the total population was only 8.3 years.…”

The heterogeneity of public preferences for the first healthcare visit: A discrete choice experiment in the context of Vietnam

“…However, the unequal geographical distribution of hospitals in the country has created inequality. Policymakers should therefore address this problem to prevent patients from seeking services from high‐level hospitals located outside their places of residence, which may cause them financial burdens and diminish their satisfaction with health insurance 55 …”

“…Policymakers should therefore address this problem to prevent patients from seeking services from high-level hospitals located outside their places of residence, which may cause them financial burdens and diminish their satisfaction with health insurance. 55 The respondents valued personal connection in class 1 under both minor and severe symptom scenarios, with a particular preference for acquaintance with medical staff. In class 3 under the severe symptom scenario, direct personal connection had a minor impact on the choice of healthcare facility.…”

Envelope culture in the healthcare system: happy poison for the vulnerable

“…For patients not residing in the same regions with the hospitals, their daily costs will be much higher than those living in the same areas as the hospitals. Nguyen (32) estimated that non-residing patients have to pay about 15 million Vietnam Dong (approximately 750 USD) more than residing patients, leading to a higher risk of destitution for non-residing patients (33). For this reason, we expected that the alleviation effect of thank-you money on patients' destitution risk would be stronger among those spending higher daily costs.…”