Influence of the Fund of health care for

poor people o­n poor households

in Hai Duong and BacGiangprovinces

Agency of implementation: Health strategy and policy institute

Project manager:Dr Dam Viet Cuong

Project secretaries:Tran Thi Mai Oanh

Nguyen Khanh Phuong

Economics specialist:Henrik Axelson

Research group:Tran Thi Mai Oanh

Nguyen Khanh Phuong

Duong Huy Luong

Khuong Anh Tuan

Nguyen Thi Thuy

Tuong Duy Trinh

Trinh Thuy Hang

Introduction: o­ne of the priorities of Vietnamese government is to maintain equity in health care. Many studies have shown clear evidence that poverty is an obstacle in the use of health services in Vietnam. The Fund of health care for poor people was established in October 2002 with the aim to ensure that poor people can get free health care at public health services. The Ministry of Health has evaluated the preliminary operation of the Fund in 2004 including coverage, expenses of the Fund and other aspects, especially management. However, there have been no study to give a comprehensive evaluation of the effectiveness of the Fund, especially from beneficiaries' point of view. Therefore, this research was conducted in order to evaluate the effectiveness of the Fund of health care for poor people through such indicators as health services use, the obstacles in that use and the influence of the fund o­n reducing the financial burden for poor people.

Methods of study: The data were collected in Hai Duong and Bac Giang provinces in the North of Vietnam between November 2004 and January 2005 through household surveys (800 households), group discussion and in-depth interview.

Main findings: In general, the Fund has been appreciated by poor people (beneficiaries) in the localities. The research findings have revealed some positive effects. Firstly, the coverage of the Fund is very high (100% in Bac Giang and 86% in Hai Duong), the process of determining the target subjects has been carried out fairly objectively and effectively. Secondly, household survey results have showed an increasing tendency in the use of health services after the implementation of the Fund, especially for in-patient treatment. Thirdly, there has been a significant increase in the selection of commune health station as the first place of health care by the beneficiaries. Fourthly, the burden of health care expenses for poor households decreased significantly compared to that before the implementation of the Fund. The proportion of annual expenses for health in the total annual household expensesreduced from 6,9% to 5,5%. The proportion of annual expenses for health in the total annual household expenses not including expenses for food reduced from 23,3% to 11%. Finally, although the average expenses for o­ne case of inpatient and outpatient are still high, there was a significant reduction in the expenses of poor patients with health insurance cards/medical cards for poor people when compared to those without the cards.

The research also discovered some limitations in the preliminary implementation of the Fund. Firstly, the capacity of the Fund management of province and lower levels is still weak in both researched provinces. Secondly, because of the lack of human resources, the management and supervision was not systematic. Thirdly, the intersector co-operation was not effective. Fourthly, in some places the process of determining poor people was not conducted at the commune level and some people who are entitled to benefit from the Fund cannot get the cards. Fifthly, the increase in health care use was not met by the increase in the investment for health care units and human resources. Sixthly, poor people's satisfaction with health services provided including inpatient and outpatient treatment is still low. Seventhly, poor people's awareness of the Fund is very limited. The main reason of this weak awareness is insufficient information communication to community leaders and poor people. Eighthly, a significant proportion of beneficiaries did not use health care/health insurance cards for the poor when coming to public health services. The main reason is the lack of knowledge about the use and the usefulness of the cards. Finally, poor patients, the beneficiaries of the Fund, still have to face the burden of expenses for medicine outside health services and indirect expenses for travelling, food and opportunities.