BRINGING HEALTH CARE TO THE VULNERABLE: DEVELOPMENT OF EQUITABLE AND SUSTAINABLE RURAL HEALTH INSURANCE IN VIETNAM: END-TERM RESULT EVALUATION (2010)
Lê Quang Cường, Nguyễn Khánh Phương, Hoàng Thị Phượng, Nguyễn Thị Thủy, Vương Lan Mai
Place of publication: Health Strategy and Policy Institute
Year of publication: 2009
The Vietnam’s health system is oriented as a health insurance based system with the aim of enabling people to access to quality health care services when needed and at the same time create equity in health financing contribution. The Health Insurance Law has identified the goal of universal health insurance by 2014. With more than 70% of population living in rural areas, the expansion of health insurance (HI) in rural areas is key to reach to goal of universal health insurance. The project titled “Bringing health care to the vulnerable: Development of equitable and sustainable rural health insurance in Vietnam” is implemented to provide evidence for developing HI policies for rural areas. Within this project, a number of interventions have been piloted in two districts of Hai Duong and Bac Giang provinces in 18 months. These interventions need evaluation to serve as grounds for making recommendations and providing information for policies makers in developing health insurance policies for rural areas.
To evaluate impacts of intervention package on health insurance development in rural areas Methods
The study employs pre- and post- comparison with case-control. Similar to the baseline survey in 2006, post-intervention evaluation is conducted in 4 districts of Hai Duong and Bac Giang, including Nam Sach, Chi Linh, Yen Dung and Viet Yen. Nam Sach and Yen Dung are the two intervention districts. Survey is carried out from 1st Nov to 15th Dec 2008, consisting of household survey, in-depth interviews with stakeholders, group discussion with representatives from sectors and people in the community. In total there are 2,397 households interviewed with structured questionnaires, 40 group discussions and 12 in-depth interviews.
The evaluation reported key findings as follows:
• HI coverage in 2008 increases by nearly 60% in surveyed locations, mainly due to expansion of compulsory participants.
• The percentage of people participating in voluntary health insurance is generally very low in all districts (6-7%). Expanding voluntary HI is a great challenge, especially in the context of many policy changes.
• Communication interventions are effective in raising awareness and knowledge of health insurance among target populations.
• However rural people have more difficulties in participating in voluntary HI due to increase in premium level carrying value.
• Adverse selection in voluntary HI tend to increase.
• HI card holders use more both in- and outpatient services than HI non-card holders. However it is difficult to assess the HI impact on medical service utilization due to adverse selection factor.
• HI helps to reduce outpatient medical care expenditures but no clear impact on inpatient medical care expenses.
• In general, the average medical care costs and cost burden on households in 2008 increase over 2006.
Based on study results, recommendations are made as follows:
• It is needed to strengthen government subsidy policies for people to take part in voluntary health insurance.
• It is necessary to actively apply measures to control the increase of medical care expenditures.
In parallel with expanding HI coverage, special attention should be paid to protect health insured from the burden of medical care expenditures.