Development of equitable and sustainable health insurance in rural Vietnam (RHINCAV) – Findings from a qualitative research
Development of equitable and sustainable health insurance in rural (RHINCAV) – Findings from a qualitative research
Đam Viet Cuong and colleagues
Place of publication: Health Strategy and Policy Institute
Year of Publication: 2007
To explore the perceptions of different stakeholders on health insurance (HI); To learn people’s knowledge on existing HI schemes; To analyze people’s likelihood of participating in HI schemes; And to propose recommendations for developing appropriate intervention packages.
In-depth interview and focus group discussion were employed. Data were coded for analysis. Study subjects: Local authorities, representatives from the health sector, Vietnam Social Security Agency (VSSA), social organizations and agencies, and insured and non-insured people.
(1) Most respondents had good understanding of the meaning and purpose of HI. Perception on HI by different study subjects were however quite different.
(2) There existed differences in terms of knowledge on existing HI schemes among different target groups. Compulsory HI groups had adequate knowledge while the other groups understood less.
(3) Except members of the compulsory group, most respondents in the target groupswere not satisfied with the existing HI schemes due to high premium, delay in insurance card delivery, incorrect information on the insurance card, inadequate information on insurance policies, and lack of a feedback mechanism. Most respondents were unsatisfied with some aspects of the services such as long waiting time, complicated procedure, low quality, limited benefits, and improper attitudes among healthcare providers.
(4) People were unwilling to buy HI due to limited prescription drugs and lack of lab tests at healthcare facilities.
(5) Many people used HI cards only for inpatient care. Use of different types of health care providers depended on the severity of health problems. People often went to private drug sellers or private practitioners to buy drugs and self-treated at home for common health problems such as cough, flu, headache, and fever. Going to private drug sellers was the most common care-seeking behavior among both the insured and uninsured.
(6) Both HI agencies and health facilities faced difficulties in implementing HI policy. These difficulties included inadequately trained communication staff, lack of budget for communication activities, understaffing at district hospitals, lack of mechanisms for monitoring and supervision. Healthcare facilities faced problemsrelated to net benefit payment for services (regulated by VSSA), risk of overspending, patient overload, irrelevant payment packages, delayed and inadequate reimbursement, lack of qualified health staff (especially at district hospitals), inadequate equipment, and poor infrastructure.
(7) People expected improvements in information dissemination, administrative reform, financial subsidies for policy holders of the voluntary scheme, better quality of healthcare services, more investment in infrastructure and equipment for commune health stations, and periodic health checks for people at local healthcare facilities.
(1) Information on HI was inadequately communicated.
(2) Due to this lack of information, understanding of HI among stakeholders and other target groups was still limited.
(3) Management capacity of Vietnam Social Security Agency staff at different levels was still weak and needs to be strengthened.
(4) Quality of healthcare services provided to insured patients was still low due to limited benefit packages.
(5) People’s willingness to join HI schemes remained low.
The strategy for expanding coverage and utilization of HI should include two main areas: 1) enhance information, education and communication activities to improve people’s awareness and understanding of HI; Improve management capacity of HI staff for more effective implementation of HI policy; 2) Improve the quality of healthcare services at different levels of the health system, especially at the commune and district levels to improve access to healthcare.