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Researches Health financing
An evaluation of health insurance policy and its implementation in Vietnam

An evaluation of health insurance policy and its implementation in Vietnam

 

Tran Van Tien and colleagues


Place of Publication: Ministry of Health

Year of Publication: 2007

 

Introduction

After more than 14 years since the first launch of the health insurance policy, its legal foundation has been made up by o­nly government decrees. Evaluating the health insurance policy, its implementation and results is o­ne of crucial steps in developing the health insurance law, improving policy and creating a stronger legal base for health insurance in .

Study methods

Various research methods were used, including review of legal documents o­n health insurance; descriptive statistics and secondary data analysis with data and information from health insurance agencies and health facilities at 7 provinces/cities; and qualitative techniques: exploring opinions and perception o­n the health insurance policy and its implementation from health insurance fund management agencies, health service providers, health management facilities, health service users, and private enterprise managers.

 

Main findings

Coverage: Most health insurance benificiaries were the poor or those under other social welfare criteria. The premium was paid by government. Voluntary health insurance schemes covered a small part of the population and experienced financial unsustainability. Inadequacy in the current legal framework and weak implementation worsened the problem of adverse selection in health insurance participation in the voluntary schemes and the private sector, raising the risk of unbalancing health insurance fund.

Health insurance premium: The average health insurance premium as currently regulated was much lower than the actual healthcare cost.

Payment mechanism: Fee for service with fixed payment ceiling was the most popular payment mechanism. Although it was a fee for service scheme, the providers were not satisfied because the payment ceiling covered o­nly up to 90% of the healthcare costs. The low ceiling due to low premium and out-of-date user fee frame negatively affected patients’ benefits and cost recovery of hospitals. Co-payment without fixed ceiling was applied to those who were not entitled to favorable terms (which were applied to priority groups o­nly) when using high-tech services, limting insured patients’ access to healthcare services.

Benefit package: Though the current benefit package as regulated was comprehensive, there were still important factors that limited benefits of the insured such as accessibility to health care service in the rural and mountainous areas and payment ceiling in the context of low premium. Policies o­n allocation and spending of user fee and health insurance revenue, drug management, drug price, and hospital autonomy alsohad negative impacts o­n the insured patients.

Financial sustanability:Risk factors such as adverse selection, low premium, ineffective healthcare cost control, unprofessional organization of health insurance implementation contributed to financial unbalance of the compulsory health insurance fund, especially the voluntary insurance fund. If health insurance policy is not adjusted in due time, a serious deficit of the health insurance fund would be inevitable.

20/03/2009
 
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