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

Abstract

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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“… 31 Meanwhile, the economic effect of health insurance was found to vary across different schemes. 32 In detail, while the voluntary scheme reduced OOP payment significantly and the health insurance programs reduced the aggregate OOP payment, the heavily subsidized health insurance schemes (for the poor and near-poor people) did not decrease the amount of OOP payment. In a study of insurance programs across the world, Lofgren et al, 33 reviewing 8755 abstracts and 118 articles about public health insurance in low- and middle-income countries, find a mixed effect of increasing insurance coverage, even though it tends to improve financial protection and health condition as well as access to health services.…”

“…First, patient’s opinions about health insurance could change due to patients’ socioeconomic status. As Thuong et al 32 suggested, the financial effect of health insurance in Vietnam varies across schemes. The heavily subsidized programs (for the poor, near-poor, and disadvantaged groups) do not reduce the OOP payment.…”