Venue: The Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0120

 

Presentation

Exploring the Changes in Out-of-pocket Payments on Health Care in Vietnam: 1992-2002

Authors: Kakoli Roy, Centers for Disease Control and Prevention; Anoshua Chaudhuri, San Francisco State University

Presenter: Anoshua Chaudhuri (San Francisco State University)

Discussant: Mohammad Hajizadeh (University of Queensland)

Session: International Financing Experiences

Room: Classroom F

When: Wednesday 8:30 a.m. - 10 a.m.

Background: Post independence, Vietnam experienced a gradual breakdown in its well-organized public health infrastructure. Economic reforms initiated in the late 1980s and early 1990s introduced rapid privatization, an increase in user fees for both public and private health facilities, and subsequently, health insurance.

Objective: To examine the relationship between out-of-pocket (OOP) health expenditures and ability to pay (ATP) among Vietnamese households during 1992–2002.

Data: The data are drawn from 1992–93 and 1997–98 Vietnam Living Standard Survey (VLSS) and 2002 Vietnam Household and Living Standards Survey (VHLSS).

Methods: We use a probit model to estimate the probability that an individual will seek treatment. Then, using ordinary least-squares and fixed effects models, we estimate the relationship between household consumption (proxy for ATP) and individual OOP payments for healthcare, as well as the relationship between consumption and OOP share in consumption. Based on the analysis, we estimate the predicted share of individual OOP health payments according to consumption quintiles and selected socioeconomic characteristics.

Results: Our results indicate that utilization (payments) increased with increasing ATP, but the consequent financial burden (payment share) decreased with increasing ATP, indicating a regressive system during the first two periods. However, share of payments increased with ATP, indicating a decrease in regressivity in payments during 2002. When comparing across years, we find horizontal inequities in all the years with some improvements by 2002.

Conclusion: That OOP payment share declines with increasing ATP might be because the rich could avail of health insurance more than those at lower incomes. As a consequence, the wealthy are able to use the healthcare system more effectively without paying a high OOP payment. In contrast, the poor either incur higher OOP payments or are discouraged from seeking treatments until their ailment becomes serious. This inequality becomes exacerbated in 1998 when insurance take-up rates were not high, but the impact of privatization and deregulation was already occurring. By 2002, insurance take-up rates were much higher, and poverty alleviation policies (e.g., free health insurance and health fund membership targeted for the poor) were instituted, which may have resulted in a less regressive system.