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Researches Health financing
Current situation of health insurance, healthcare utilization, and health expenditures in Hai Duong and Bac Giang provinces - Findings from a baseline survey

Current situation of health insurance, healthcare utilization, and health expenditures in Hai Duong and Bac Giang provinces - Findings from a baseline survey

 

Dam Viet Cuong and colleagues

 

Introduction

Development of health insurance is a top priority in ’s health policy agenda. The project “ Bringing health care to the vulnerable: Development of equitable and sustainable rural health insurance in China and Vietnam” funded by EC is aimed to provide scientific evidence for developing and implementing health insurance policy in rural areas though an intervention approach. A baseline survey was conducted to provide information and data for intervention design and before-and-after evaluation. This report provides main findings from healthcare facility and household surveys.

 

Methods

The baseline survey was implemented in two Northern provinces, namely, Hai Duong and Bac Giang in 2006. Four districts were selected from the two provinces o­n the ground that two districts within each province had similar socioeconomic status and they all currently had voluntary health insurance schemes. The selected districts were Nam Sach and Chi Linh in Hai Duong province and Yen Dung and Viet Yen in Bac Giang province. A total of 8,983 individuals from 2,394households were interviewed. In addition to the household survey, information collection forms were sent to health insurance agencies and hospitals in each district to obtain information o­n health insurance coverage, revenue, utilization and expenditures for healthcare among health insurance members.

 

Main findings

In the studied areas, 40-50% of the population were covered by health insurance (HI). The majority of voluntary health insurance (VHI) enrollees were school children. Seventy percent of farmers were not covered by HI. Though the poor accounted for a high proportion of all HI enrollees, 20-30% of the poor still did not have health insurance. There was indication of adverse selection among VHI enrollees who were members of mass organizations and occupational associations. Awareness and understanding of HIamong the studied population were limited. Financial difficulty was the main reason for not joining VHI scheme. The proportion of people who did not seek healthcare services was low but the rate of self treatment was high (especially in Hai duong). HI card holders used health services more frequently than the uninsured. Utilization of healthcare services among the poor in 2006 increased compared to that of 2005. Satisfaction with healthcare services among HI patients was lower than that of cash-paying patients. Patients were least satisfied with healthcare facility conditions and staff’s attitude. HI reduced healthcare costs significantly for both inpatient and outpatient. However, HI patients still had to pay a considerable amount for healthcare.

 

Conclusion

HI schemes need to be adjusted so that the HI’s goal of equity and sustainability could be achieved. Intervention design should focus o­n the following areas: improving people’s awareness and knowledge o­n HI, strengthening management capacity of HI agencies, improving quality of care, better controlling healthcare costs, andstrengthening the realization of “pro-poor” policies.

20/03/2009
 
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