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UNIVERSITY OF ECONOMICS ERASMUS UNVERSITY ROTTERDAM HO CHI MINH CITY INSTITUTE OF SOCIAL STUDIES VIETNAM THE NETHERLANDS VIETNAM NETHERLANDS PROGRAMME FOR M A IN DEVELOPMENT ECONOMICS THE IMPACT OF HE[.]
UNIVERSITY OF ECONOMICS ERASMUS UNVERSITY ROTTERDAM HO CHI MINH CITY INSTITUTE OF SOCIAL STUDIES VIETNAM THE NETHERLANDS VIETNAM - NETHERLANDS PROGRAMME FOR M.A IN DEVELOPMENT ECONOMICS THE IMPACT OF HEALTH INSURANCE ON OUT-OF-POCKET PAYMENTS IN THE MEKONG RIVER DELTA BY TA THI HONG NGOC MASTER OF ARTS IN DEVELOPMENT ECONOMICS HO CHI MINH CITY - DECEMBER, 2017 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com UNIVERSITY OF ECONOMICS INSTITUTE OF SOCIAL STUDIES HO CHI MINH CITY THE HAGUE VIETNAM THE NETHERLANDS VIETNAM - NETHERLANDS PROGRAMME FOR M.A IN DEVELOPMENT ECONOMICS THE IMPACT OF HEALTH INSURANCE ON OUT-OF-POCKET PAYMENTS IN THE MEKONG RIVER DELTA A thesis submitted in partial fulfilment of the requirements for the degree of MASTER OF ARTS IN DEVELOPMENT ECONOMICS By TA THI HONG NGOC Academic Supervisor: DR TU VAN BINH HO CHI MINH CITY - DECEMBER, 2017 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com DECLARATION “I certify that this material is my own work, containing my independent research results, have not been published I assure that all sources of information in the thesis, including data sets, are clearly acknowledged I pledge to take responsibility for my research.” Signature Ta Thi Hong Ngoc Date: December, 2017 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com ACKNOWLEDGEMENT Firstly, I would like to express my appreciation to my supervisor Dr Tu Van Binh who provided me motivation, patience, and knowledge to complete my thesis I am very grateful for his sympathy and his kind encouragement to me last year when my mother was deeply sick His friendly guidance in all the time of research helped me overcome a hard time of writing this thesis Besides my supervisor, I am grateful to Dr Truong Dang Thuy and Dr Pham Khanh Nam who have provided the theoretical background and econometrics methodology, which strongly supported my thesis My sincere thanks to tutor Nguyen Van Dung who support me data and kindly encourage me during my thesis I would thank all lecturers, administrators and my VNP 22 classmate in the Vietnam – The Netherlands Program for giving me a loyal sympathy, for the memorable moments we were working together before deadlines of assignments and exams during the course Finally, I would like to give a special thanks to my family who has encouraged me not only in thesis period but also in my life LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com ABSTRACT The study uses the Vietnam Household Living Standard Survey in the year of 2012 and 2014 in 13 provinces in the Mekong River Delta (MRD) to evaluate the impact of health insurance on out-of-pocket payments in the MRD Three models including Pool OLS, Random Effects and Fixed Effects are applied and the regression result shows that health insurance is statistically significant and has the negative relationship with out-of-pocket expenses per visit to outpatient service and inpatient service The study indicates that health insurance has a positive impact on reducing out-of-pocket expenses, meaning that people who have health insurance spend less than those who not have health insurance Heath insurance benefits the society by reducing the monetary cost of using the health services and therefore is potentially advantageous for poor and underprivileged people in approaching healthcare resources The policy implication insists that it is essential to increase health insurance coverage, especially for the poor and near poor In addition, policy makers could consider reducing or eliminating co-payments for the poor and policy beneficiaries such as ethnic minorities in the MRD Moreover, the authority needs to concern about awareness raising in the health insurance of people living in this area Key words: Health Insurance, Out-of-pocket expenses, Mekong River Delta JEL Classification: I13 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com TABLE OF CONTENTS DECLARATION i ACKNOWLEDGEMENT ii ABSTRACT iii TABLE OF CONTENTS iv LIST OF TABLES vi LIST OF FIGURES vii LIST OF ACRONYMS viii CHAPTER 1: INTRODUCTION 1.1 The practical problem 1.2 The research problem 1.3 Research Objectives 1.4 Contribution of the Study 1.5 Organization of the Study CHAPTER 2: LITERATURE REVIEW 2.1 Core concepts 2.1.1 Health insurance 2.1.2 Out-of-pocket payments 2.2 Theoretical background 2.3 Empirical studies about the impact of health insurance on out-of-pocket payments 2.3.1 Out-of-pocket payments definition and measurements 2.3.2 Estimation method 2.3.3 Control variables 10 2.3.4 Results 10 CHAPTER 3: RESEARCH METHODOLOGY AND DATA 13 3.1 Analytical framework 13 3.2 Research Methodology 13 3.2.1 Fixed Effects Estimation 14 3.2.2 Fixed Effects with Unbalanced Panels 15 3.2.3 Random Effects Models 15 3.2.4 Random Effects or Fixed Effects 16 iv LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 3.3 Model specification 17 3.4 Data 19 CHAPTER 4: FINDINGS AND DISCUSSION 21 4.1 Overview of the research topic 21 4.1.1 Background of health insurance in Vietnam and the MRD 21 4.1.2 Overview of out-of-pocket health expenditure in Vietnam 24 4.2 Descriptive statistics 26 4.3 Estimation results 33 CHAPTER 5: CONCLUSION AND POLICY IMPLICATIONS 40 5.1 Conclusion 40 5.2 Policy Implications 40 5.3 Limitation 41 REFERENCES 42 v LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com LIST OF TABLES Table 1: Variable description and sources 18 Table 1: Descriptive statistics 26 Table 2: The correlation coefficient between the variables 27 Table 3: Number of observations and proportion of people having health insurance28 Table 4: Proportion of people having health insurance in 13 provinces in the MRD29 Table 5: Statistical coverage of health insurance by age 30 Table 6: Statistics on the share of health insurance participation by gender 30 Table 7: Statistics on the share of health insurance participation by marital status 31 Table 8: Statistics on health insurance participation by ethnics 31 Table 9: Statistics on health insurance coverage by level of education 32 Table 10: Statistics on health insurance coverage by rural, urban area 33 Table 11: The panel data regression result with Out-of-pocket expenses per visit to outpatient service (OOV) 34 Table 12: The panel data regression result with Out-of-pocket expenses per visit to inpatient service (OIV) 37 vi LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com LIST OF FIGURES Figure Analytical framework 13 vii LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com LIST OF ACRONYMS 2SLS Two-Stage Least Squares DID Difference-in-Difference FE Fixed Effects GLS Generalized Least Squares GSO General Statistics Office HI Health Insurance IV Instrumental Variables MRD Mekong River Delta OIV Out-of-pocket expenses per visit to inpatient service OLS Ordinary Least Squares OOP Out-of-pocket payments OOV Out-of-pocket expenses per visit to outpatient POLS Pooled Ordinary Least Squares PSM Propensity Score Matching RE Random Effects VHLSS Vietnam Household Living Standard Survey WHO World Health Organization viii LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com ... about the impact of health insurance on out -of- pocket payments 2.3.1 Out -of- pocket payments definition and measurements Out -of- pocket payments have been used as the main variable in a number of. .. Health insurance 2.1.2 Out -of- pocket payments 2.2 Theoretical background 2.3 Empirical studies about the impact of health insurance on out -of- pocket payments 2.3.1 Out -of- pocket payments definition... The study uses the Vietnam Household Living Standard Survey in the year of 2012 and 2014 in 13 provinces in the Mekong River Delta (MRD) to evaluate the impact of health insurance on out -of- pocket