Determinants of household healthcare expenditure an analysis in vietnam by using of VHLSS 2006

Determinants of hon.sehold health care expenditure.- An ariiilysis iii Vietiiiim u.sing of VHLSS 20111› UNIVEHSI"I“Y OF ECONOMICS HG €.“ III MINH CITY Y'lE I“NAM riiE HA €iUE THE NEJ“HERLANDS VIETNAM - NETHERLANDS PR GCRAMMF FOR M.A IN DEVELOPMENT ECONOMICS DETERMINANTS OF HOUSEHOLD HEALTHCARE EXPENDITURE: AN ANALYSIS IN VIETNAM BY USING OF VHLSS 2006 LF PHUONG THAO MASTER OF ARTS IN DEVELOPMENT ECONOMICS HO CHI MINH CITY, NOVEMBER 2011 Class 13 ' Determinants of household health care expenditure.• An analysis in Vietnam using of VHLSS 2006 UNIVERSITY OF ECONOMICS HO CHI MINH CITY VIETNAM INSTITUTE OF SOCIAL STUDIES THE HAGUE THE NETHERLANDS VIETNAM - NETHERLANDS PROGRAMME FOR M.A IN DEVELOPMENT ECONOMICS DETERMINANTS OF HOUSEH OLD HEALTHCARE EXPENDITURE: AN ANALYSIS IN VIETNAM BY USING OF VHLSS 2006 “ A thesis submitted in partial fulfilment of the requirements for the degree of MASTER OF ARTS IN DEVELOPMENT ECONOMICS By LE PHUONG THAO Academic Supervisor: DR LE THI THANH LOAN HO CHI MINH CITY, NOVEMBER 2011 VNP Class 13 Determinants of household health care expendimre.- An analysis in Vietnam using of VHLSS› 2006 ACKNOWLEDGEMENTS Foremost, I would like to express my gratitude to all those who gave me the possibility to complete this thesis I would like to express my deep and sincere gratitude to my advisor Prof Le Thi Thanh Loan for the continuous support of my study and research, for her patience, motivation, enthusiasm, and immense knowledge Her guidance helped me in all the time of research and writing of this thesis And my sincere thanks also go to Associate Professor Dr Nguyen Trong Hoai, Co- Director of Vietnam - The Netherlands Program for M.A in Development Economics, who has always given me his encouragements and kindly during the course of my study and thesis research I wish to thank my close friend, Pham Tien Thang, who supported me in finding working papers for references Lastly, I owe my loving thanks to my parents and my husband Without their encouragement and understanding, it would have been impossible for me to finish this work Class 13 Determinants of household health care expenditure.• An analysis in Vietnam using of VHLSS 2006 DECLARATION I declare that “Detcrminiiiits of household healthcare expenditure.- Ari nniifysis iii Uiefnizm asing of VHLSS 2006” is my own work, that it has not been submitted to any degree or examination at any other universities, and that all the sources used or quoted are indicated and acknowledged by complete references Ho Chi Minh City, November 2011 LE PHUONG THAO VN P Class 13 The main purpose of this study is to identify the determinants of household healthcare expenditure in Vietnam The main source data for the analysis are from Vietnam Household Living Standard Survey 2006 (VHLSS 2006) The analysis uses statistic analysis and Ordinary Least Squares (OLS) estimates to find out the determinants of healthcare expenditure First, statistic analysis gives us an overview of household healthcare expenditure situation in Vietnam Second, we estimate the parameters of household healthcare expenditure model by using the Ordinary Least Squares (OLS) estimates The statistic results indicate that in the total of household expenditure, the household healthcare expenditure made up only 6.37% and in total of household healthcare expenditure, 72.530 is used in paying user fees at health facilities (health expenditure for having treatment) The results also present that household healthcare expenditures differ by expenditure quintiles, health status, health insurance status, education of household head, gender of house head and ect, The regression results bring out some findings First, household healthcare expenditures and household income (that household expenditure is a proxy) have significant relationship Second, important determinants of household healthcare expenditure were household expenditure, household size, health status and health insurance The age and education of household head are also important, but their effects on household healthcare are small Moreover, there were statistically significant differences in household healthcare expenditure across regions Key words: households; healthcare expenditure, household expenditures, Vietnam VNP Class 13 Determinants of household health care expenditure.• An analysts in Vietnam using of VHLSS 2006 TABLE OF CONTENTS TABLE OF CONTENTS • Page ACKNOWLEGEMENTS DECLARATION ABSTRACT LIST OF TABLES LIST OF FIGURES LIST OF 10 APENDIXS 11 CHAPTER INTRODUCTION 11 1.1 Problem statements 14 1.2 Objectives of the study 15 1.3 Research questions 17 CHAPTER LITERATURE REVIEW 17 2.1 Definitions 17 2.1.1 Healthcare 18 2.1.2 Household Healthcare expenditure 2.2 Theoretical framework for Household Healthcare 18 Expenditure Function 18 2.2.1 Households and utilization of healthcare 2.2.2 22 2.3 VNP Household characteristics and household healthcare 20 expenditure Community characteristics and household healthcare 22 expenditure 23 An overview of the Empirical studies relates to household healthcare expenditure Class 13 Determinants of household health care expenditure.• An analysis iii Vietnam using of VIIL$$ 2006 CHAPTER 35 METHODOLOGY AND DATA SET 3.1 Econometric Model of the study 35 3.2 Data set 38 3.2.1 Data Source 38 3.2.2 Some definitions of VHLSS 2006 39 40 3.3 Methodology 3.3.1 Descriptive statistics 41 3.3.2 Estimation strategy 41 CHAPTER 4.1 RESEARCH FINDINGS FOR HOUSEHOLD HEALTHCARE EXPENDITURES IN VIETNAM Overview household healthcare expenditure in Vietnam 4.1.1 Healthcare expenditure and household expenditure structure in Vietnam 4.1.2 Household characteristics and healthcare expenditure 4.1.3 Community characteristics and healthcare expenditure 4.2 Estimated results and Explanation CHAPTER CONCLUSIONS AND RECOMMENDATIONS 5.1 Conclusions 5.2 Policy recommendations REFERENCES VNP Class 13 43 43 43 46 54 56 67 67 68 71 Determinants of household health care expenditure.• An analysis in Vietnam using of VHLSS 2tI#6 LIST OF TABLES LIST OF TABLES - Page Table 4.1 Household characteristics 46 Table 4.2 Income and household healthcare expenditure 48 Table 4.3 Healthcare expenditure by Education of head of household 49 Table 4.4 Healthcare expenditure by gender of head of household 50 Table 4.5 Healthcare expenditure by age of head of household 51 Table 4.6 Healthcare expenditure by health status 52 Table 4.7 Healthcare expenditure by Insurance 52 Table 4.8 Healthcare expenditure by household size 53 Table 4.9 Community characteristics 54 Table 4.10 Healthcare expenditure by urban/rural 55 Table 11 Healthcare expenditure by regions 55 Variables — their definitions and expected signs 56 Table 4.12 Table 4.13 Regression results of the determinants of household healthcare expenditures Regression results of the determinants of household Table 4.14 healthcare expenditures with significant variables 59 64 LIST OF FIGURES LIST OF FIGURES Figure 4.1 Page Structure of sources of health expenditures in Viet Nam, 43 2006 Figure 4.2 Household expenditure structure in year 2006 44 Figure 4.3 Household Healthcare expenditure structure in year 2006 45 V.NP Class 13 Determinants of household health care expenditure.- An analysis in Vietnam using of 'HLSS 2006 APPENDIXS LIST OF APPENDIXS Appendix Inter-correlation matrix of all the independent variables Correlation between household expenditures on Appendix healthcare and independent variables Appendix Checking for Multicollinearity Appendix Appendix Page 75 76 77 Regression of the model with dependent variable is Household per capita healthcare expenditure The best model: Regression of the model with dependent variable is Household per capita healthcare expenditure Class 13 78 79 Determinants of household health care expenditure.• An analysis in Vietnam using of VHLSS 2006 regression results of these variables are not different from the results in Table 13 so that we can explain similar before Beside, we also regress the model with dependent variable is household per capita healthcare expenditure (HHEXP PC) The regression results are given in Appendix and Appendix 5, the results also depict that household expenditure and ' health status had most impact on household healthcare expenditure And insurance status, education of household head and regions are significant impact on household healthcare expenditure We can see that the results are not different from the regression results with dependent variable is household healthcare expenditure Briefly, household healthcare expenditure is a function of many household characteristics and community characteristics variables The robust estimates of OLS regression equations of some major household characteristics and community characteristics variables that may effect on healthcare expenditure lead us to the following conclusions: • Household healthcare expenditures are highly elastic to household expenditures as a proxy of household income • Household expenditure, household size, health status and insurance status are major determinants of household healthcare expenditure • Age of household head and education level of household head are also important factors, but their effects on household healthcare are small • In general, gender is considered as a significant determinant of household healthcare expenditure However, in this case, it is not true The results show VNP Class 13 that gender has not any clear and meaningful pattern in the influence on household healthcare expenditure • Area of resident variable (urban/rural) presented a surprise result that household healthcare expenditure of rural household is higher than which of urban household • The region variables are also important determinant of household expenditures on healthcare There were statistically significant differences in household hc•althcare expenditure across regions (except in the case of North East region) Some of these results and their implications are discussed in Chapter VNP Class 13 Determinants of household hPalth care RXR•nditure.• An analysis in Vietnam using of VHLSS 2006 Chapter 5: Conclusions and Recommendations In this chapter, the main findings and results in the thesis will be summarized - in order to give some conclusions Based on these conclusions, the thesis will suggested some policy recommendations • 5.1Conclusions: Conclusions from the results of the analysis were as follows: J’he descriptive analysis for household healthcare expenditures presented several important findings First, in total national healthcare expenditures, household healthcare expenditures made up 63% This rate is high and it means that healthcare expenditures are burden of households, especially poor households Second, in total household expenditures, spending for healthcare made up only 6.37% while spending for food and drink made up to 52.76% This implied that the living standard of households was still low Third, in total of household healthcare expenditures, payment of medicines in self-treatment was still high, it accounted for around 22.39% Forth, the average household healthcare expenditures in 2006 was 1,344.5 l thousand VND and there were 20.25 percent of 9189 households that had member got illness/injury in the last week The inequity in healthcare expenditure among households had different characteristics on region, area of residence, income, • education levels and age of household head groups In the model for estimating the determinants of household healthcare in Vietnam, there are some important findings The factors that influenced household healthcare expenditures were regions, area of residence and some household’s characteristics as household size, household income, health status, education of 67/79 Class 13 household head, age of household head and health insurance coverage Healthcare expenditure was higher in the households with characteristics as follows; higher expenditure quintile, larger household size, the household head was older, lower education level of household head, less health insurance coverage, had member that get illness/injury and living in Mekong river Delta (compared with other regions) Household healthcare expenditures were highly elastic to household expenditures Household per capita expenditure measured the living standard that is a key determinant of household healthcare expenditure Therefore, household healthcare expenditures vary across expenditure quintiles The households in higher expenditure quintile spend more for health care than the lower while the lower is more likely to get sick Besides, health insurance was also an important determinant of household healthcare Health insurance had negative relatively to household healthcare expenditure It help to reduce household out-pocket healthcare expenditures 5.2Policy recommendations: In order to improve the quality of health care and reduce healthcare expenditures for households, especially for poor households, households in diff icultly regions (North West, North East ); the government should focus more on some problems and policies as below: First, the Government needs to continue increasing state budget spending for healthcare and using it more effectively to ease the cost burden of households on healthcare„ The health care system in rural areas and difficult regions also should be invested "Fhe government should equip commune health centers with health care equipments and support the health care facilities in training professional staff And VNP Determinants of household health care expenditure.• An analysis iii Vietnam using of VHLSS 2006 by implementing these policies, the overload problem in high level hospitals will be also solved Second, to reduce household out-of-pocket healthcare expenditures, especially for poor, near-poor households, we need have more financial assistance policies for healthcai e for the poor and other social welfare target groups The forms of prepayment for all groups in society, especially in the form of health insurance should be more diversify The procurement of health insurance for the poor, near-poor and other social welfare target groups also need to be supported (Example now, Ho Chi Minh city issues free health insurance cards to poor households that have income per capita less or equal million VND/ year, and support 50% fee for buying health insurance cards if households have income per capita from to 10 million VND /year) Health insurance level needs to increase to ensure covering rising cost of services Besides, the new voluntary health insurance program should be extended because it can help the poor, near-poor households and for all households to reduce burden of healthcare expenditure Third, the high rate of self — treatment expenditure indicates that there were inefficient health seeking and utilization behavior of households Self-medication and self — treatment are very dangerous for the health so that we need to popularize the significance of safe drug usage, especially in difficult regions where the health care information Therefore, the government should restrict self-medication and sales of prescription drugs without a prescription 5.3 Suggestions for further study The thesis also have some limitations and because we lack the information on health such as the information of and price of medical care, the thesis is still not a Class 13 Determinants of household health care expenditure.• An analysis in Vietnam using of VHLSS 2006 comprehensive analysis of determinants of health care expenditure And extent the model with some other household characteristics, community characteristics that may effect on household healthcare expenditure in Vietnam as number of inpatient visits, outpatient visits, over-counter visits for self-treatment, number of children, and number ‹›f elderly persons in household, ethnic status, distance to nearest healthcare facility „ A further study of the determinants of household healthcare expenditure should be done in order to follow-up and monitor the impact of changes in population, and socio-economics due to the development of the country VN P 7(l/79 Class 13 REFERENCES Bolin K, Jacobson L, Lindgren B, 1999, The family' as the health producer — lI'/ter spouses are Nash-bargainers, Studies in Health Economics 30, Department of Community Medicine, Lund University, Lund Becker €i, 1964, Human capital, New York: Columbia University Press Behrnian J R, Pollak R A, Taubman P, 1982, Parental preferences and provision for progeny, Journal of Political Economy, 90(1), 52-73 Blanchard Janice C., 2005, "Discrimination and Health Care Utilization", Published 2006 by the RAND Corporation Catharina Hjortsberg, 2000, Determinants Of Expenditure -The case ofZambia Household Health Care Chiappori, D A, 1988, Rational Household labour supply', Econometrica, 56(1), 63-89 Currie Gruber J, 1996, “ e‹z/I/i insurance eligibility, utilization of medical 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Vlces in Nigeria , A multivariate nested logit model" African Development Bank: 396424 Jacobson L, 1999, The family as producer of health, -An extended Grossman model, Departments of community medicine and economics, Lund University, Malmo/Lund, Sweden Kooreman P, 1990, Househld Labor force participation as a cooperative game An empi ircal model, Journal of Human Resources 24(4), 584-98 • Le Grand J,l982, The strategy of equality Redistribution and the social services, Allen and Unwin, London Lundberg S, Pollak A, 1996, Bargaining and Distribution in Marriage, Journal of Econ‹›mic Perspectives, 10:139-158 • Lindelow M., 2004, "Health care decisions as a family matter Intrahousehold education externalities and the utilization of health services", World Bank Policy Research Working PaperSeries: 3324 72/79 Class 13 Determinants of household health care expenditure.• An analysis in Vietnam using of VHLSS 2006 Muurinen J M, 1982, Demand for health A generalised Grossman model, Journal of Economics 1, 5-28 McElro.y M B, 1990, The Empirical content of Nash-bargained household behavior’, Journal ‹›f Human Resources 25(4), 559-50 Manser M, Brown, l980,Marriage and household decision making A bargaining analysis, International Economic Review, 21(1), 31-44 Margherita and Theodore, 2002, The regional impact of health care expenditure the case ofItaly, Applied Economics, 14, 1829± 1836 Ministry of Health Vietnam, 2008, "Joint annual Health review 2008 - Health Financing in Viet Nam “,Hanoi, November, 2008 Maathai K Mathiyazhagan, 2003, "Rural Household Characteristics and Health Expenditure in India An Analysis“, Journal of Social and Economic Development Vol No January - June 2003 Makinen M, Waters H, Rauch M, Almaganbetova N, Birtran R, Gilson L, Mclntyre D, Pannorunothai S, Prieto A.L, Ubilla G, Ram S., 2000, "Inequalities in health care use and expenditures Empirical data from eight developing countries and countries in transition", Bulletin of the World Health Organization 78(l): 55-65 Ngh) dJnh 299-HDBT, 1992, "Ban hanh diéu IQ ban hiém y té", cua Hoi dong bo truéing ban hanh 15/08/1992 Pravin K Trivedi, 2002, Patterns of Health Care Utilization in Vietnam Analysis of1997-98 Vietnam Living Standards Survey Data Parker S W, Wong R, 1997, House/io/d income ‹izid /ie‹z/th care expenditures in Mexico, Health Policy 40, 237-255 Quyet djnh ski 139/2002/QD-TTg, 2002, " Ué viec khém chu:a benh cho ngircti nghéo", cfia Thii tuéng chinh phu ban hanh ng:iy 15/10/2002 Class 13 Determinants of household health care expenditure.- An analysis in Vietnam using of VHLSS 2006 Reinhardt U.E, 2000, ”Health care for the aging baby boom Lessons from abroad", Journal of Economic Perspectives 14(2): 71-83 Samuelson, P, 1956, Social indifference curves Quarterly Journal of Economics, 70, 1-22 , Seri B and Himanshu ,2007, Determinants of Household Health Expenditure Case of Urban Orissa, NOT Paper No 6489, posted 31 December 2007 / 21:08; Online at http://mpra.ub.uni-muenchen.de/6489/ Sommer A.S, 2006-2007, "Access to health insurance, barriers to care, and service use among adults with disabilities”, Inquiry 43(4): 393-405 Thomas, D, 1990, “Intra Household Resource allocation approach”, Journal of Human Resources, 25(4), 635-664 • , an inferential Wagstaff A, 1986, The demand for health Some new empirical evidence, Journal of Health Economics 5, 195-233 World Bank, 1993, "Investing in Health Washington D.C.: Oxford University Press - World Development Report", Woottipong Satayavongthip, 2001, "Determinants of and inequity in household expenditure on health care in Thailand' Thesis was submitted to the Faculty of Graduate Studies, Mahidol University for the degree of Doctor of Philosophy (Demography) World Bank, 2001, "Attacking povertyWashington D.C.: Oxford University Press VNP World Development Report", 74/79 Class 13 Determinants of household health care expenditure.• An analysis in Vietnam using of VHLSS 2006 Appendix 1: Inter-Correlation matrix of all the independent variables Variables EXPEND INS SEX EDU HESTA AGEhh EXPEND 1.0000 INS 0.0208 1.0000 SEX 0.0109 -0.0103 1.0000 EDU 0.1638 0.0218 0.0393 1.0000 HESTA 0.0235 0.0372 -0.0177 -0.0521 1.0000 AGEl L 0.1210 -0.0356 -0.0703 -0.0388 0.0747 1.0000 HHSIZE -0.2046 0.0509 0.0381 -0.0099 -0 1159 -0.3104 Class 13 HHSIZE 1.0000 Determinants of household health care expenditure.- An analysis in Vietnam using of VHLSS 2006 Appendix 2: Correlation between Household healthcare expenditure and Independent variables , Variables HHEXP EXPEND INS SEX EDU HESTA AGEhh HHEXP 1.0000 EXPEND 0.2871 1.0000 INs -0.0246 0.0208 1.0000 SEX -0.0073 0.0109 -0.0103 1.0000 EDU 0.0249 0.1638 0.0218 0.0393 1.0000 HESTA 0.0715 0.0235 0.0372 -0.0177 -0.0521 1.0000 AGELL 0.0325 0.1210 -0.0356 -0.0703 -0.0388 0.0747 1.0000 HHSIZE 0.0514 -0.2046 0.0509 0.0381 -0.0099 -0.1159 -0.3104 Class 13 HHSIZE 1.0000 Determiniints of household health care expenditure.• An analysis in Vietnam using of VHLSS 2006 Appendix 3: Checking for Multicollinearity Variables VIF 1/VIF EXPEND 1.61 0.619904 EDU 1.20 0.831212 HHSIZE 1.16 0.860187 AGE 1.07 0.935559 SEX 1.00 0.995357 HESTA 1.03 0.974956 INs 1.05 0.952736 AREA 1.33 0.752099 Red River Delta 6.90 0.144873 Mekong River Delta 6.63 150822 South East 5.82 171746 North central 4.79 0.208566 North East 4.32 0.231614 Central Coast 3.64 0.274394 Central Highlands 2.88 0.347719 Mean VIF VNP 2.96 Class 13 Appendix 4: Regression of the model with dependent variable is Household per capita healthcare expenditure Dependent variable: LN (HHEXP_PC) Explanatory Variables Coef Std Err Household’ characteristics: 1.027886 0.03255 12 -0.0083092 0.0022934 -0.1004739 0.0324439 0.002** -0.0237285 0.0315362 0.452 AGEhh 0.0039667 0.0007744 HESTA 0.6250354 0.0373241 HHSIZE -0.0073179 0.0106489 AREA -0 197538 0.0414647 Red River Delta 0.1981882 0.0826514 0.017 North East 0.2132056 0.0877627 0.015 North cential -0.0751996 0.0846044 0.374 Central Coast 0.1960487 0.0893739 0.028 Central Highlands 0.3264841 0.0963288 South East 0.2928127 0.0891608 0.001 * Mekong River Delta 0.3780431 0.081759 0.000* -4.18889 0.2768638 0.000 LN (EXPEND) EDU SEX 0.492 Communities’ characteristics: • Constant Number of obs - 8789, F( 15, 8773) = 135.10, Prob > F - 0.0000, R-squared 0.23 * signifi‹!ant at the percent, ** significant at the percent,‘ ***.’ significant at the 10 percent, Omitted region is Northwest VNP Class J Appendix 5: The best model: Regression of the model with dependent variable is Household per capita healthcare expenditure Dependent variable: LN (HHEXP_PC) Explanatory Variables Coef Std Err Household’ characteristics: LN (EXPEND) 0.9699452 0.0295856 EDU -0.008251 0.0023024 -0.1080591 0.322785 AGEhh 0.0040379 0.0007557 HESTA 0.6280211 0.374743 Red River Delta 0.2685221 0.0513898 North central 0.2791466 0.0610435 Central Coast 0.2437715 0.622788 Central Highlands 0.3610007 0.728343 South East 0.3194286 0.062093 Mekong River Delta 0.4474105 0.0508001 Constant -3.855089 0.2381539 Communities’ characteristics: 0.000* N×mber of obs - 8789; F( 11, 8777) -177.48, Prob » F - 0.0000; R-squared - 0.2271 *.’ signifu.-ant at the percent,’ **.‘ significant at the percent,‘ *** significant at the 10 percent ', VNP Class 13 ... 13 Determinants of household health care expenditure. - An analysis in Vietnam using of VHLSS 2006 However, the influence of education on healthcare expenditure gives an interesting finding: ? ?healthcare. .. expenditure. - An analysis in Vietnam using of VHLSS 2006 Figure 4.1 depicts the structure of health expenditure in Viet Nam by source and financing mechanism in 2006 The figure indicates that in Vietnam, ... NETHERLANDS VIETNAM - NETHERLANDS PROGRAMME FOR M.A IN DEVELOPMENT ECONOMICS DETERMINANTS OF HOUSEH OLD HEALTHCARE EXPENDITURE: AN ANALYSIS IN VIETNAM BY USING OF VHLSS 2006 “ A thesis submitted in