How public health insurance expansion affects healthcare utilizations in middle and low-income households: an observational study from national cross-section surveys in Vietnam
Open Access
- 31 March 2023
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Public Health
- Vol. 23 (1), 1-15
- https://doi.org/10.1186/s12889-023-15500-6
Abstract
Public health insurance (PHI) has been implemented with different levels of participation in many countries, from voluntary to mandatory. In Vietnam, a law amendment made PHI compulsory nationwide in 2015 with a tolerance phase allowing people a flexible time to enroll. This study aims to examine mechanisms under which the amendment affected the enrollment, healthcare utilization, and out-of-pocket (OOP) expenditures by middle- and low-income households in this transitioning process. Using the biennial Vietnam Household Living Standard Surveys, the study applied the doubly robust difference-in-differences approach to compare outcomes in the post-amendment period from the 2016 survey with those in the pre-amendment period from the 2014 survey. The approach inheriting advantages from its predecessors, i.e., the difference-in-differences and the augmented inverse-probability weighting methods, can mitigate possible biases in policy evaluations due to the changes within the group and between groups over time in the cross-section observational study. The results showed health insurance expansion with extensive subsidies in premiums and medical coverage for persons other than the full-time employed, young children or elderly members in the family, significantly increased enrollments in the middle- and low-income groups by 9% and 8%, respectively. The number of visits for PHI-eligible services also increased, approximately 0.5 more visit per person in the middle-income and 1 more visit per person in the low-income. The amendment, however, so far did not show any significant effect on reducing OOP payments, neither for the low nor the middle-income groups. To further expand PHI coverage and financial protections, policymakers should focus on improving public health facilities, contracting PHI to more accredited private health providers, and motivating the high-income group’s enrollments.This publication has 28 references indexed in Scilit:
- The impact of health insurance for children under age 6 in Vietnam: A regression discontinuity approachSocial Science & Medicine (1982), 2015
- Vietnam’s Health Care System Emphasizes Prevention And Pursues Universal CoverageHealth Affairs, 2014
- Using propensity scores in difference-in-differences models to estimate the effects of a policy changeHealth Services and Outcomes Research Methodology, 2014
- Heterogeneity in the effect of public health insurance on catastrophic out-of-pocket health expenditures: the case of MexicoHealth Policy and Planning, 2014
- Adverse selection in a community-based health insurance scheme in rural Africa: Implications for introducing targeted subsidiesBMC Health Services Research, 2012
- The effects of free government health insurance among small children—evidence from the free care for children under six policy in VietnamThe International Journal of Health Planning and Management, 2012
- THE IMPACT OF VOLUNTARY HEALTH INSURANCE ON HEALTH CARE UTILIZATION AND OUT‐OF‐POCKET PAYMENTS: NEW EVIDENCE FOR VIETNAMHealth Economics, 2011
- Social health insurance reexaminedHealth Economics, 2009
- Can insurance increase financial risk?: The curious case of health insurance in ChinaJournal of Health Economics, 2008
- VIOLATING IGNORABILITY OF TREATMENT BY CONTROLLING FOR TOO MANY FACTORSEconometric Theory, 2005