Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.

Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.Impact of health insurance in Vietnam on healthcare utilization, selfreported health, and financial choices.

MINISTRY OF EDUCATION AND TRAINING UNIVERSITY OF ECONOMICS HO CHI MINH CITY IMPACTS OF HEALTH INSURANCE IN VIETNAM ON HEALTHCARE UTILIZATION, SELF-REPORTED HEALTH, AND FINANCIAL CHOICES DOCTORAL THESIS IN ECONOMICS Ho Chi Minh City, 2022 MINISTRY OF EDUCATION AND TRAINING UNIVERSITY OF ECONOMICS HO CHI MINH CITY IMPACTS OF HEALTH INSURANCE IN VIETNAM ON HEALTHCARE UTILIZATION, SELF-REPORTED HEALTH, AND FINANCIAL CHOICES DOCTORAL THESIS IN ECONOMICS Major: Economic development Code: 9310105 Academic advisors: Dr Le Thanh Loan Assoc Prof Dr Pham Khanh Nam Ho Chi Minh City, 2022 i Declaration I hereby declare that this thesis is entirely my own work, with the exception of quotations and citations, which have been appropriately acknowledged This thesis has not been submitted to any other academic or non-academic institution for any degree or certification Ho Chi Minh City, December 2022 Truong Anh Tuan ii Table of Contents DECLARATION I TABLE OF CONTENTS II ABBREVIATIONS VI LIST OF TABLES VII LIST OF FIGURES VIII CHAPTER 1: INTRODUCTION BACKGROUND HEALTH INSURANCE AND HEALTHCARE SCHEME IN VIETNAM 1.2.1 Development of health insurance in Vietnam 1.2.2 Healthcare scheme in Vietnam OBJECTIVES OF THESIS 11 RESEARCH QUESTIONS 12 SCOPE OF THE THESIS 12 STRUCTURE OF THE THESIS .13 CHAPTER 2: THEORY AND LITERATURE REVIEW 16 THEORETICAL BACKGROUNDS 16 2.1.1 Model of demand for health 16 2.1.2 The behavioral model of health services utilization 19 2.1.3 Moral hazard 21 2.1.4 Moral hazard and Cost-sharing 22 2.1.5 Literature relevant to the heterogeneous impact of health insurance coverage on healthcare utilization 24 2.1.6 Theory of precautionary savings 26 CONCEPTUAL FRAMEWORK .28 PROGRAM EVALUATIONS .30 2.3.1 Program impact measures .30 iii 2.3.2 Program impact evaluation methods 31 EMPIRICAL LITERATURE REVIEW AND RESEARCH GAPS 39 2.4.1 Review of key findings .40 2.4.2 Review of methodologies 46 JUSTIFICATION OF ANALYTICAL METHODOLOGIES 50 CHAPTER 3: IMPACTS OF HEALTH INSURANCE ON HEALTHCARE UTILIZATION AND OUT-OF-POCKET EXPENDITURES 53 INTRODUCTION 53 CONCEPTUAL FRAMEWORK .56 METHODS 57 3.3.1 Model specification 57 3.3.2 Data and variables 60 RESULTS 64 3.4.1 Impacts of the health insurance program for the elderly on the probability of being insured 64 3.4.2 Impacts of health insurance on healthcare utilization outcomes 67 MODEL SIGNIFICANCE TESTING .68 3.5.1 Validity of RDD .68 3.5.2 Robustness checks 72 DISCUSSION .74 CONCLUSION 76 CHAPTER 4: IMPACTS OF HEALTH INSURANCE ON HOUSEHOLDS’ FINANCIAL CHOICES: EVIDENCE FROM VIETNAM .78 INTRODUCTION 78 DATA AND VARIABLES 82 4.2.1 Data source 82 4.2.2 Variable definitions and descriptive statistics 83 CONCEPTUAL FRAMEWORK .89 iv RESEARCH HYPOTHESES AND METHODS 90 4.4.1 Research hypotheses 90 4.4.2 Research methods 92 RESULTS 96 4.5.1 Impacts of covariates .96 4.5.2 Impact of health insurance on financial choices 98 4.5.3 Correlations between the error terms 102 ROBUSTNESS CHECKS 103 CONCLUSION 106 CHAPTER 5: IMPACTS OF CO-PAYMENTS ON SELF-REPORTED HEALTH AMONG THE HEALTH INSURANCE INSURED IN RURAL VIETNAM .108 INTRODUCTION 108 CONCEPTUAL FRAMEWORK AND HYPOTHESIS 112 METHODS 113 DATA AND VARIABLES 117 5.4.1 Data source 117 5.4.2 Treatment and outcome variables 117 5.4.3 Covariates 118 RESULTS 120 5.5.1 Propensity score estimation 120 5.5.2 Covariate balance check 121 5.5.3 The impact of co-payment exemption on self-reported health 125 5.5.4 Heterogeneous impacts 126 5.5.5 Sensitive test for hidden bias 128 DISCUSSION 129 CONCLUSION 132 CHAPTER 6: CONCLUSIONS 133 v KEY FINDINGS .133 6.1.1 The impacts of health insurance on healthcare utilization and out-ofpocket expenditures 133 6.1.2 The impact of health insurance on households’ financial choices .134 6.1.3 The impacts of co-payments on self-reported health 134 CONTRIBUTIONS OF THE THESIS 134 POLICY IMPLICATIONS OF THE THESIS FINDINGS 136 LIMITATIONS AND AREAS FOR FUTURE RESEARCH 138 LIST OF THE AUTHOR'S PUBLICATIONS 141 REFERENCES 142 APPENDICES .163 vi Abbreviations ATE: Average Treatment Effect ATT: Average Treatment Effect of the Treated BMI: Body Mass Index DID: Difference–in–Differences ITT: Intention-to-treat effect IV: Instrumental variable LATE: Local average treatment effect LMICs: Low- and middle-income countries OLS: Ordinary least squares PSM: Propensity score matching RCTs: Randomized controlled trials RD: Regression discontinuity RDD: Regression discontinuity design TVSEP: Thailand-Vietnam Socioeconomic Panel UHC: Universal health coverage US: United States VHLSS: Vietnam Household Living Standard Survey VSS: Vietnam Social Security Agency 2SLS: Two-stage least squares vii List of tables Table 1.1: Health insurance reform in Vietnam Table 2.1: Overview of econometric methods for program impact evaluation 38 Table 3.1: Descriptive statistics of control variables 61 Table 3.2: Descriptive statistics of outcome variables 63 Table 3.3: Impact of the health insurance program for the elderly on the probability of being insured 65 Table 3.4: Regression model for the probability of being insured when reaching 80 years old, using pre-policy data 67 Table 3.5: Impacts of health insurance on healthcare utilization outcomes .68 Table 3.6: RD estimates of covariates 72 Table 3.7: Robustness checks with different bandwidths 73 Table 3.8: Intention-to-treat effects 74 Table 4.1: Definitions of dependent variables 85 Table 4.2: Definitions of control variables .86 Table 4.3: Descriptive statistics of variables (mean, standard deviation) .88 Table 4.4: Pairwise tetrachoric correlations between dependent variables 89 Table 4.5: Univariate probit coefficients 99 Table 4.6: Multivariate probit coefficients .100 Table 4.7: Correlation between error terms in multivariate probit regressions 103 Table 4.8: IV random-effects two-stage least-squares regressions 104 Table 4.9: Bivariate probit models 105 Table 5.1: Variable definitions and descriptive statistics .119 Table 5.2: Covariate balance check and bias reduction 123 Table 5.3: Statistical tests pre-matching and post-matching 125 Table 5.4: Impact of co-payment exemption on self-reported health .126 Table 5.5: Heterogeneous effects of co-payment exemption on self-reported health 127 Table 5.6: Mantel-Haenszel test 129 viii List of figures Figure 1.1 Organisational chart of the Vietnamese healthcare system .9 Figure 1.2: Payment mechanism in health insurance 10 Figure 2.1: Andersen’s Behavioral Model of Healthcare Utilization .20 Figure 2.2 Conventional ex-post moral hazard effect .23 Figure 2.3: Conceptual framework for the thesis 29 Figure 3.1: Conceptual framework for the impacts of health insurance on healthcare utilization and out-of-pocket expenditures .57 Figure 3.2 Insurance coverage, aged 70 – 89 years old 65 Figure 3.3 Histogram of age around the cutoff point (960 months) 70 Figure 3.4 Estimated density of age around the cutoff point (960 months) .70 Figure 3.5 RD plots of covariates .71 Figure 4.1 Map of Vietnam's surveyed provinces 84 Figure 4.2: Conceptual framework for the impacts of health insurance on financial choices .90 Figure 5.1: Conceptual framework for the impact of co-payment on self-reported health .113 Figure 5.2: Histogram of propensity score distribution for treated and control individuals .121 Figure 5.3: Standardised percent bias of covariates prior and post matching 122 Figure 5.4: The density distribution of propensity scores before and after the PSM for treated and control groups 125 187 saving healthInsu risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks1 economicshocks1 crimeshocks1 yeardum2 yeardum3 _cons 6480766 0336084 0784714 -.0034094 0000168 0720663 0913686 0162115 -.0017452 -.0151 0001972 0345428 010162 -.042397 -.142703 -.1034756 -.0940044 -.1601556 4259756 -.1570926 -.80455 1230704 0073534 079328 0115923 0000997 0784833 0940394 0055274 0178346 0114941 0002785 0072602 0136993 0168699 0375438 0604442 0343569 0496885 054728 0596364 3109542 5.27 4.57 0.99 -0.29 0.17 0.92 0.97 2.93 -0.10 -1.31 0.71 4.76 0.74 -2.51 -3.80 -1.71 -2.74 -3.22 7.78 -2.63 -2.59 0.000 0.000 0.323 0.769 0.866 0.358 0.331 0.003 0.922 0.189 0.479 0.000 0.458 0.012 0.000 0.087 0.006 0.001 0.000 0.008 0.010 4068632 019196 -.0770086 -.0261298 -.0001785 -.0817582 -.0929453 005378 -.0367005 -.0376279 -.0003486 020313 -.0166881 -.0754614 -.2162875 -.2219442 -.1613426 -.2575432 3187107 -.2739777 -1.414009 8892901 0480207 2339514 0193111 0002122 2258908 2756824 027045 03321 007428 000743 0487726 0370122 -.0093327 -.0691185 0149929 -.0266662 -.0627679 5332404 -.0402075 -.1950911 invest healthInsu risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks1 economicshocks1 crimeshocks1 yeardum2 yeardum3 _cons 2191323 018223 0701008 0170603 -.0002034 -.0034334 1782384 013554 -.0270259 0286718 -.000461 0403131 0652832 0080571 0816817 0997685 0352087 069966 2255189 804437 -1.673672 1177544 0071841 0770015 0105412 0000921 0696671 0783532 0052807 0169501 0108892 0002728 0080165 0133205 0159001 0345266 0645936 0357526 0509814 0459404 0539739 2839805 1.86 2.54 0.91 1.62 -2.21 -0.05 2.27 2.57 -1.59 2.63 -1.69 5.03 4.90 0.51 2.37 1.54 0.98 1.37 4.91 14.90 -5.89 0.063 0.011 0.363 0.106 0.027 0.961 0.023 0.010 0.111 0.008 0.091 0.000 0.000 0.612 0.018 0.122 0.325 0.170 0.000 0.000 0.000 -.0116621 0041424 -.0808193 -.0036001 -.0003839 -.1399783 0246688 0032041 -.0602475 0073294 -.0009957 024601 0391755 -.0231065 0140107 -.0268326 -.0348651 -.0299557 1354773 6986501 -2.230264 4499267 0323037 221021 0377206 -.0000229 1331116 3318079 0239039 0061958 0500142 0000737 0560252 091391 0392207 1493526 2263696 1052824 1698878 3155604 9102239 -1.117081 188 credit healthInsu risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks1 economicshocks1 crimeshocks1 yeardum2 yeardum3 _cons -.6149693 0202 -.2188782 0134706 -.0003518 0956763 -.1149902 0009448 1394177 0712016 -.0001586 -.0055066 0729988 0678441 2245585 -.063625 202318 1994007 -.1380092 0235585 2816419 1759865 0074589 089673 0141642 0001215 0886133 100521 0061256 0209725 0124613 0002851 0054434 0148684 0184339 0430423 0717946 0398545 0546895 0454281 0610434 3971054 -3.49 2.71 -2.44 0.95 -2.89 1.08 -1.14 0.15 6.65 5.71 -0.56 -1.01 4.91 3.68 5.22 -0.89 5.08 3.65 -3.04 0.39 0.71 0.000 0.007 0.015 0.342 0.004 0.280 0.253 0.877 0.000 0.000 0.578 0.312 0.000 0.000 0.000 0.376 0.000 0.000 0.002 0.700 0.478 -.9598965 0055809 -.394634 -.0142907 -.00059 -.0780026 -.3120077 -.0110611 0983125 0467779 -.0007173 -.0161756 0438573 0317144 1401972 -.2043399 1242047 0922113 -.2270467 -.0960843 -.4966703 -.270042 0348191 -.0431224 0412319 -.0001136 2693552 0820272 0129508 180523 0956253 0004001 0051623 1021403 1039738 3089198 07709 2804313 3065901 -.0489717 1432014 1.059954 healthInsu CoverRate risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks1 economicshocks1 crimeshocks1 yeardum2 yeardum3 _cons 2.616578 0262176 1801188 0121976 -.0002316 -.0102722 7948755 0327817 -.0578117 0487436 0009074 0019684 0726087 0435374 -.137622 -.0933534 -.027406 03394 -.2513871 -.0572062 -2.46876 208601 009237 0800012 0136186 0001139 0837617 0970898 0075257 0199172 0134684 0004567 006546 0144763 0211766 0402539 0675023 0409473 0626616 0565031 066302 365516 12.54 2.84 2.25 0.90 -2.03 -0.12 8.19 4.36 -2.90 3.62 1.99 0.30 5.02 2.06 -3.42 -1.38 -0.67 0.54 -4.45 -0.86 -6.75 0.000 0.005 0.024 0.370 0.042 0.902 0.000 0.000 0.004 0.000 0.047 0.764 0.000 0.040 0.001 0.167 0.503 0.588 0.000 0.388 0.000 2.207728 0081135 0233193 -.0144943 -.0004548 -.1744422 6045829 0180315 -.0968488 022346 0000124 -.0108614 0442357 002032 -.2165181 -.2256554 -.1076612 -.0888745 -.3621312 -.1871558 -3.185158 3.025429 0443218 3369183 0388895 -8.38e-06 1538977 9851681 0475318 -.0187746 0751411 0018025 0147982 1009817 0850428 -.0587258 0389487 0528492 1567545 -.1406431 0727434 -1.752362 189 /atrho21 1345311 0343363 3.92 0.000 0672332 201829 /atrho31 1417295 0248079 5.71 0.000 0931068 1903521 /atrho41 0510572 0330341 1.55 0.122 -.0136885 1158029 /atrho51 0551423 1302463 0.42 0.672 -.2001357 3104203 /atrho32 0862124 0264834 3.26 0.001 0343058 138119 /atrho42 -.2926651 0279444 -10.47 0.000 -.3474351 -.2378951 /atrho52 -.2294435 0813632 -2.82 0.005 -.3889125 -.0699745 /atrho43 0518758 0303538 1.71 0.087 -.0076165 1113681 /atrho53 -.0414297 0728427 -0.57 0.570 -.1841988 1013394 /atrho54 3622673 1241833 2.92 0.004 1188724 6056622 rho21 1337253 0337223 3.97 0.000 0671321 1991324 rho31 140788 0243162 5.79 0.000 0928387 1880859 rho41 0510129 0329482 1.55 0.122 -.0136876 115288 rho51 0550865 129851 0.42 0.671 -.1975057 3008194 rho32 0859994 0262876 3.27 0.001 0342923 1372473 rho42 -.2845859 0256812 -11.08 0.000 -.3340989 -.2335066 rho52 -.2255002 0772259 -2.92 0.004 -.3704224 -.0698605 rho43 0518293 0302722 1.71 0.087 -.0076164 1109099 rho53 -.041406 0727178 -0.57 0.569 -.1821435 1009939 rho54 3472096 1092125 3.18 0.001 1183157 5410664 Likelihood ratio test of rho21 = rho31 = rho41 = rho51 = rho32 = rho42 = rho52 = rho43 = rh > o53 = rho54 = 0: chi2(10) = 253.929 Prob > chi2 = 0.0000 190 Appendix 13: STATA output for estimation results of Table 4.8 > > > > quietly xtivreg PrivInsu risk gender age agesq marital ethnic edu health hhsiz e asset remit SocialMember wage_employ naturalshocks socialshocks economicshock s crimeshocks ( healthInsu = CoverRate risk gender age agesq marital ethnic ed u health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks economicshocks crimeshocks), first vce(cl subdistr) quietly eststo e > > > > quietly xtivreg saving risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks economicshocks crimeshocks ( healthInsu = CoverRate risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks e conomicshocks crimeshocks), first vce(cl subdistr) quietly eststo f > > > > quietly xtivreg invest risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks economicshocks crimeshocks ( healthInsu = CoverRate risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks e conomicshocks crimeshocks), first vce(cl subdistr) quietly eststo g > > > > quietly xtivreg credit risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks economicshocks crimeshocks ( healthInsu = CoverRate risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks e conomicshocks crimeshocks), first vce(cl subdistr) quietly eststo h 191 esttab e f g h, wide star(* 0.1 ** 0.05 *** 0.01) cells(b(star fmt(4)) se(par f > mt(4))) (1) PrivInsu b/se healthInsu risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalsho~s socialshoc~1 economicsh~1 crimeshocks1 _cons N -0.0200 (0.0529) 0.0153*** (0.0021) 0.0015 (0.0287) 0.0128*** (0.0045) -0.0002*** (0.0000) 0.0725*** (0.0275) 0.1461*** (0.0441) 0.0107*** (0.0033) -0.0135** (0.0064) 0.0348*** (0.0036) 0.0001** (0.0000) 0.0005 (0.0017) 0.0098** (0.0048) 0.0129** (0.0065) -0.0012 (0.0131) -0.0251 (0.0219) -0.0245** (0.0118) -0.0092 (0.0161) -0.0735 (0.1259) 5701 (2) saving b/se 0.1014* (0.0544) 0.0127*** (0.0027) 0.0383 (0.0296) -0.0011 (0.0040) -0.0000 (0.0000) 0.0163 (0.0288) 0.1086*** (0.0355) 0.0068*** (0.0023) 0.0002 (0.0064) 0.0092** (0.0039) 0.0001 (0.0001) 0.0086*** (0.0024) -0.0017 (0.0051) -0.0120* (0.0063) -0.0502*** (0.0140) -0.0268 (0.0222) -0.0200 (0.0123) -0.0217 (0.0179) 0.1702 (0.1063) 5701 (3) invest b/se 0.4245*** (0.0580) 0.0066** (0.0028) 0.0122 (0.0277) 0.0109*** (0.0038) -0.0001*** (0.0000) -0.0076 (0.0273) -0.1015*** (0.0351) 0.0032 (0.0021) 0.0049 (0.0067) -0.0119*** (0.0041) -0.0002*** (0.0001) 0.0133*** (0.0047) 0.0169*** (0.0053) 0.0078 (0.0061) 0.0272** (0.0131) 0.0131 (0.0246) -0.0078 (0.0132) 0.0282 (0.0196) -0.0828 (0.1030) 5701 (4) credit b/se -0.1500*** (0.0526) 0.0032 (0.0022) -0.0546* (0.0283) 0.0073* (0.0043) -0.0001*** (0.0000) 0.0244 (0.0281) -0.0611** (0.0286) 0.0007 (0.0021) 0.0313*** (0.0050) 0.0179*** (0.0033) 0.0000 (0.0001) -0.0015 (0.0014) 0.0252*** (0.0043) 0.0170*** (0.0054) 0.0595*** (0.0126) -0.0203 (0.0201) 0.0554*** (0.0114) 0.0395*** (0.0144) 0.5726*** (0.1143) 5701 192 Appendix 14: STATA output for estimation results of Table 4.9 > > > > quietly biprobit ( PrivInsu healthInsu risk gender age agesq marital ethnic ed u health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks economicshocks crimeshocks i.year) ( healthInsu CoverRate risk gender age age sq marital ethnic edu health hhsize asset remit SocialMember wage_employ natura lshocks socialshocks economicshocks crimeshocks i.year), vce(cl subdistr) quietly eststo a > > > > quietly biprobit ( saving healthInsu risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks e conomicshocks crimeshocks i.year) ( healthInsu CoverRate risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturals hocks socialshocks economicshocks crimeshocks i.year), vce(cl subdistr) quietly eststo b > > > > quietly biprobit ( invest healthInsu risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks e conomicshocks crimeshocks i.year) ( healthInsu CoverRate risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturals hocks socialshocks economicshocks crimeshocks i.year), vce(cl subdistr) quietly eststo c > > > > quietly biprobit ( credit healthInsu risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalshocks socialshocks e conomicshocks crimeshocks i.year) ( healthInsu CoverRate risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturals hocks socialshocks economicshocks crimeshocks i.year), vce(cl subdistr) quietly eststo d 193 esttab a b c d, scalars( rho) wide star(* 0.1 ** 0.05 *** 0.01) cells(b(star f > mt(4)) se(par fmt(4))) (1) PrivInsu b/se main healthInsu risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalsho~s socialshoc~1 economicsh~1 crimeshocks1 2013.year 2016.year 2017.year _cons 0.2917 (0.2374) 0.0560*** (0.0071) -0.0197 (0.0874) 0.0390*** (0.0145) -0.0005*** (0.0001) 0.1781** (0.0839) 0.2268 (0.1502) 0.0311*** (0.0099) -0.0401** (0.0188) 0.0859*** (0.0121) 0.0192* (0.0114) 0.0014 (0.0064) 0.0363** (0.0161) 0.0289 (0.0217) -0.0073 (0.0406) -0.1527** (0.0674) -0.0929** (0.0400) -0.0499 (0.0525) 0.0000 (.) 0.1565*** (0.0413) -0.0992 (0.0666) -1.7450*** (0.3849) (2) saving b/se 0.6779*** (0.1271) 0.0333*** (0.0074) 0.0774 (0.0788) -0.0033 (0.0116) 0.0000 (0.0001) 0.0686 (0.0779) 0.0816 (0.0944) 0.0157*** (0.0056) -0.0010 (0.0178) -0.0159 (0.0115) 0.0002 (0.0003) 0.0347*** (0.0075) 0.0099 (0.0138) -0.0431*** (0.0167) -0.1412*** (0.0374) -0.1013* (0.0602) -0.0923*** (0.0343) -0.1606*** (0.0498) 0.0000 (.) 0.4283*** (0.0546) -0.1632*** (0.0599) -0.8050*** (0.3117) (3) invest b/se 0.2483** (0.1216) 0.0177** (0.0072) 0.0669 (0.0766) 0.0166 (0.0106) -0.0002** (0.0001) -0.0030 (0.0694) 0.1671** (0.0810) 0.0131** (0.0053) -0.0264 (0.0170) 0.0281*** (0.0109) -0.0005 (0.0003) 0.0406*** (0.0080) 0.0647*** (0.0135) 0.0075 (0.0159) 0.0833** (0.0344) 0.0993 (0.0648) 0.0340 (0.0357) 0.0702 (0.0510) 0.0000 (.) 0.2273*** (0.0460) 0.7990*** (0.0540) -1.6582*** (0.2848) (4) credit b/se -0.6698*** (0.1876) 0.0201*** (0.0074) -0.2169** (0.0902) 0.0143 (0.0142) -0.0004*** (0.0001) 0.0965 (0.0890) -0.0961 (0.1034) 0.0010 (0.0061) 0.1373*** (0.0215) 0.0721*** (0.0125) -0.0001 (0.0003) -0.0059 (0.0055) 0.0742*** (0.0149) 0.0687*** (0.0186) 0.2202*** (0.0436) -0.0601 (0.0712) 0.2013*** (0.0396) 0.2023*** (0.0544) 0.0000 (.) -0.1334*** (0.0454) 0.0383 (0.0621) 0.2629 (0.3987) 194 healthInsu CoverRate risk gender age agesq marital ethnic edu health hhsize asset remit SocialMember wage_employ naturalsho~s socialshoc~1 economicsh~1 crimeshocks1 2013.year 2016.year 2017.year _cons athrho _cons N rho 2.6282*** (0.2090) 0.0273*** (0.0092) 0.1814** (0.0794) 0.0118 (0.0136) -0.0002** (0.0001) -0.0070 (0.0839) 0.7944*** (0.0971) 0.0325*** (0.0074) -0.0579*** (0.0199) 0.0503*** (0.0133) 0.0009* (0.0005) 0.0031 (0.0071) 0.0719*** (0.0145) 0.0459** (0.0213) -0.1360*** (0.0400) -0.0955 (0.0676) -0.0267 (0.0407) 0.0350 (0.0620) 0.0000 (.) -0.2571*** (0.0569) -0.0558 (0.0671) -2.4773*** (0.3641) 2.6251*** (0.2105) 0.0270*** (0.0092) 0.1803** (0.0793) 0.0112 (0.0135) -0.0002** (0.0001) -0.0124 (0.0835) 0.7921*** (0.0978) 0.0334*** (0.0076) -0.0584*** (0.0200) 0.0500*** (0.0134) 0.0009* (0.0005) 0.0030 (0.0070) 0.0728*** (0.0145) 0.0462** (0.0214) -0.1358*** (0.0404) -0.0926 (0.0670) -0.0272 (0.0408) 0.0366 (0.0625) 0.0000 (.) -0.2571*** (0.0567) -0.0568 (0.0670) -2.4576*** (0.3614) 2.6275*** (0.2096) 0.0274*** (0.0092) 0.1838** (0.0793) 0.0117 (0.0135) -0.0002** (0.0001) -0.0118 (0.0838) 0.7942*** (0.0970) 0.0329*** (0.0075) -0.0579*** (0.0199) 0.0506*** (0.0133) 0.0009* (0.0005) 0.0031 (0.0071) 0.0724*** (0.0146) 0.0460** (0.0213) -0.1369*** (0.0400) -0.0943 (0.0674) -0.0274 (0.0407) 0.0357 (0.0621) 0.0000 (.) -0.2576*** (0.0570) -0.0568 (0.0671) -2.4756*** (0.3630) 2.6007*** (0.2128) 0.0265*** (0.0092) 0.1853** (0.0796) 0.0126 (0.0137) -0.0002** (0.0001) -0.0126 (0.0831) 0.8015*** (0.0971) 0.0327*** (0.0076) -0.0582*** (0.0199) 0.0494*** (0.0134) 0.0009** (0.0004) 0.0022 (0.0066) 0.0720*** (0.0144) 0.0436** (0.0210) -0.1382*** (0.0401) -0.0930 (0.0670) -0.0277 (0.0406) 0.0301 (0.0624) 0.0000 (.) -0.2494*** (0.0569) -0.0547 (0.0669) -2.4838*** (0.3680) 0.0566 (0.1475) -0.2504*** (0.0843) -0.0611 (0.0745) 0.4023*** (0.1369) 5701 0.0565 5701 -0.245 5701 -0.0610 5701 0.382 195 Appendix 15: STATA output for estimation results of Table 5.1 format Health CopayExemption Age Male NoSchool Primary Secondary HighSchool Marital Ethnicity Social_group NormalBMI Free > card HHsize Income Difficulty MemberHealth Hatinh TT_Hue DakLak %9.4f labsumm Health CopayExemption Age Male NoSchool Primary Secondary HighSchool Marital Ethnicity Social_group NormalBMI Fre > ecard HHsize Income Difficulty MemberHealth Hatinh TT_Hue DakLak, format Variable | Obs Mean Std Dev Min Max -+ -Health: Self-reported health status (1 if healthy, if manage or sick) | 2968 0.5856 0.4927 0.0000 1.0000 CopayExemption (1 if yes, if no) | 2968 0.1493 0.3564 0.0000 1.0000 Age (Years) | 2968 35.7689 19.6808 0.0000 97.0000 Male (1 if yes, if no) | 2968 0.4811 0.4997 0.0000 1.0000 No school (1 if yes, if others) | 2968 0.0708 0.2565 0.0000 1.0000 Primary school (1 if yes, if others) | 2968 0.2032 0.4024 0.0000 1.0000 Secondary school (1 if yes, if others) | 2968 0.3575 0.4793 0.0000 1.0000 High school or above (1 if yes, if others) | 2968 0.3686 0.4825 0.0000 1.0000 Marital (1 if married, if others) | 2968 0.5098 0.5000 0.0000 1.0000 Ethnicity (1 if Kinh group, if others) | 2968 0.9191 0.2727 0.0000 1.0000 Social_group: Socio-political organization member (1 if yes, if no) | 2968 0.5866 0.4925 0.0000 1.0000 NormalBMI: Normal Body Mass Index (1 if >=18.5 and ecard HHsize Income Difficulty MemberHealth Hatinh TT_Hue DakLak if CopayExemption==1 , format Variable | Obs Mean Std Dev Min Max -+ -Health: Self-reported health status (1 if healthy, if manage or sick) | 443 0.7223 0.4483 0.0000 1.0000 CopayExemption (1 if yes, if no) | 443 1.0000 0.0000 1.0000 1.0000 Age (Years) | 443 32.8217 18.6175 0.0000 84.0000 Male (1 if yes, if no) | 443 0.4763 0.5000 0.0000 1.0000 No school (1 if yes, if others) | 443 0.0587 0.2353 0.0000 1.0000 Primary school (1 if yes, if others) | 443 0.1603 0.3673 0.0000 1.0000 Secondary school (1 if yes, if others) | 443 0.3679 0.4828 0.0000 1.0000 High school or above (1 if yes, if others) | 443 0.4131 0.4929 0.0000 1.0000 Marital (1 if married, if others) | 443 0.4492 0.4980 0.0000 1.0000 Ethnicity (1 if Kinh group, if others) | 443 0.9007 0.2994 0.0000 1.0000 Social_group: Socio-political organization member (1 if yes, if no) | 443 0.5102 0.5005 0.0000 1.0000 NormalBMI: Normal Body Mass Index (1 if >=18.5 and eecard HHsize Income Difficulty MemberHealth Hatinh TT_Hue DakLak if CopayExemption ==0, format Variable | Obs Mean Std Dev Min Max -+ -Health: Self-reported health status (1 if healthy, if manage or sick) | 2525 0.5616 0.4963 0.0000 1.0000 CopayExemption (1 if yes, if no) | 2525 0.0000 0.0000 0.0000 0.0000 Age (Years) | 2525 36.28594 19.81991 97 Male (1 if yes, if no) | 2525 0.4820 0.4998 0.0000 1.0000 No school (1 if yes, if others) | 2525 0.0729 0.2600 0.0000 1.0000 Primary school (1 if yes, if others) | 2525 0.2107 0.4079 0.0000 1.0000 Secondary school (1 if yes, if others) | 2525 0.3556 0.4788 0.0000 1.0000 High school or above (1 if yes, if others) | 2525 0.3608 0.4803 0.0000 1.0000 Marital (1 if married, if others) | 2525 0.5204 0.4997 0.0000 1.0000 Ethnicity (1 if Kinh group, if others) | 2525 0.9224 0.2676 0.0000 1.0000 Social_group: Socio-political organization member (1 if yes, if no) | 2525 0.6000 0.4900 0.0000 1.0000 NormalBMI: Normal Body Mass Index (1 if >=18.5 and alBMI Freecard HHsize Income Difficulty MemberHealth Hatinh TT_Hue DakLak, both graph Variable Unmatched Matched Age Male NoSchool Primary Secondary HighSchool Marital Ethnicity Social_group NormalBMI Freecard HHsize Income Difficulty MemberHealth Hatinh TT_Hue DakLak Mean Treated Control %bias %reduct |bias| U M 32.822 32.822 36.286 32.682 -18.0 0.7 96.0 -3.42 0.11 0.001 0.911 0.88 0.98 U M 4763 4763 48198 52596 -1.1 -9.9 -774.0 -0.22 -1.48 0.825 0.140 U M 05869 05869 07287 07223 -5.7 -5.5 4.5 -1.07 -0.81 0.283 0.416 U M 16027 16027 21069 15801 -13.0 0.6 95.5 -2.43 0.09 0.015 0.927 U M 36795 36795 35564 36569 2.6 0.5 81.7 0.50 0.07 0.618 0.945 U M 41309 41309 36079 40406 10.7 1.9 82.7 2.11 0.27 0.035 0.785 U M 44921 44921 5204 4447 -14.3 0.9 93.7 -2.77 0.13 0.006 0.893 U M 90068 90068 92238 90293 -7.6 -0.8 89.6 -1.55 -0.11 0.122 0.910 U M 51016 51016 5237 -18.1 -2.7 84.9 -3.55 -0.40 0.000 0.687 U M 56659 56659 57822 56885 -2.3 -0.5 80.6 -0.46 -0.07 0.648 0.946 U M 06321 06321 05743 04966 2.4 5.7 -134.3 0.48 0.87 0.632 0.383 U M 5.3138 5.3138 5.217 5.2596 5.1 2.9 44.0 1.13 0.43 0.260 0.668 1.93* 1.99* U M 41.198 41.198 35.594 37.114 12.5 9.1 27.1 2.58 1.24 0.010 0.214 1.39* 0.96 U M 09255 09255 08119 11512 4.0 -8.0 -98.7 0.80 -1.10 0.424 0.271 U M 1.2438 1.2438 1.0986 1.1896 11.4 4.2 62.7 2.47 0.62 0.013 0.535 U M 26411 26411 30733 29345 -9.6 -6.5 32.1 -1.83 -0.97 0.067 0.331 U M 27765 27765 47644 24153 -41.9 7.6 81.8 -7.84 1.23 0.000 0.221 U M 45824 45824 21624 46501 52.9 -1.5 97.2 11.03 -0.20 0.000 0.840 t t-test p>|t| V(T)/ V(C) 1.82* 1.66* * if variance ratio outside [0.83; 1.21] for U and [0.83; 1.21] for M Sample Ps R2 LR chi2 p>chi2 Unmatched Matched 0.058 0.008 145.05 10.28 0.000 0.852 * if B>25%, R outside [0.5; 2] MeanBias 13.0 3.9 MedBias 10.2 2.8 B 64.8* 21.6 R 0.95 1.02 %Var 75 50 198 Appendix 17: STATA output for estimation results of Table 5.4 bootstrap r(att), reps(200):psmatch2 CopayExemption , pscore(score) outcome( Heal > th ) caliper(.13492327) noreplacement (running psmatch2 on estimation sample) Bootstrap replications (200) Bootstrap results command: _bs_1: _bs_1 50 100 150 200 Number of obs Replications = = 2,968 200 psmatch2 CopayExemption, pscore(score) outcome( Health ) caliper(.13492327) noreplacement r(att) Observed Coef Bootstrap Std Err .1444695 0313866 z 4.60 Normal-based [95% Conf Interval] P>|z| 0.000 082953 2059861 bootstrap r(att), reps(200):psmatch2 CopayExemption , pscore(score) outcome( H > ealth ) n(5) caliper(.13492327) (running psmatch2 on estimation sample) Bootstrap replications (200) Bootstrap results command: _bs_1: _bs_1 50 100 150 200 Number of obs Replications = = 2,968 200 psmatch2 CopayExemption, pscore(score) outcome( Health ) n(5) caliper(.13492327) r(att) Observed Coef Bootstrap Std Err .1282167 0266627 z 4.81 P>|z| Normal-based [95% Conf Interval] 0.000 0759588 1804747 199 bootstrap r(att), reps(200):psmatch2 CopayExemption , pscore(score) outcome( H > ealth ) radius caliper(.13492327) noreplacement (running psmatch2 on estimation sample) Bootstrap replications (200) Bootstrap results command: _bs_1: 50 100 150 200 Number of obs Replications = = 2,968 200 psmatch2 CopayExemption, pscore(score) outcome( Health ) radius caliper(.13492327) noreplacement r(att) _bs_1 Observed Coef Bootstrap Std Err .1423518 0233369 z 6.10 P>|z| Normal-based [95% Conf Interval] 0.000 0966122 1880913 bootstrap r(att), reps(200): psmatch2 CopayExemption , pscore(score) outcome( > Health ) kernel k(normal) bw(0.05) (running psmatch2 on estimation sample) Bootstrap replications (200) Bootstrap results command: _bs_1: _bs_1 50 100 150 200 Number of obs Replications = = 2,968 200 psmatch2 CopayExemption, pscore(score) outcome( Health ) kernel k(normal) bw(0.05) r(att) Observed Coef Bootstrap Std Err .1286668 0225731 z 5.70 P>|z| Normal-based [95% Conf Interval] 0.000 0844244 1729092 200 Bootstrapping of standard errors command: atts Health CopayExemption Age Male Primary Secondary HighSchool M > arital Ethnicity Social_group NormalBMI Freecard HHsize Income Difficulty Memb > erHealth TT_Hue DakLak , pscore(score) blockid(5) statistic: atts = r(atts) note: label truncated to 80 characters Bootstrap statistics Variable Reps atts Note: N P BC 200 Number of obs Replications Observed Bias 1607635 -.0035945 = = 2968 200 Std Err [95% Conf Interval] 0232911 1148344 1146737 1201664 = normal = percentile = bias-corrected ATT estimation with the Stratification method Bootstrapped standard errors n treat n contr ATT Std Err t 443 2525 0.161 0.023 6.902 2066925 2044037 2099176 (N) (P) (BC) 201 Appendix 18: STATA output for estimation results of Table 5.6 mhbounds Health ,gamma(1 (0.1) 2) Mantel-Haenszel (1959) bounds for variable Health Gamma Q_mh+ Q_mhp_mh+ p_mh 4.43527 4.43527 4.6e-06 4.6e-06 1.1 3.76277 5.11598 000084 1.6e-07 1.2 3.14892 5.73835 000819 4.8e-09 1.3 2.58592 6.31392 004856 1.4e-10 1.4 2.06585 6.8497 019421 3.7e-12 1.5 1.5825 7.3512 056768 9.8e-14 1.6 1.13091 7.82287 129046 2.6e-15 1.7 707057 8.26835 239765 1.1e-16 1.8 307634 8.69062 37918 1.9 -.07011 9.0922 527947 28489 9.47521 387864 Gamma Q_mh+ Q_mhp_mh+ p_mh- : : : : : odds of differential assignment due to unobserved factors Mantel-Haenszel statistic (assumption: overestimation of treatment effect) Mantel-Haenszel statistic (assumption: underestimation of treatment effect) significance level (assumption: overestimation of treatment effect) significance level (assumption: underestimation of treatment effect) ... of health insurance on other financial services in Vietnamese households Health insurance and healthcare scheme in Vietnam 1.2.1 Development of health insurance in Vietnam Vietnamese health insurance. ..MINISTRY OF EDUCATION AND TRAINING UNIVERSITY OF ECONOMICS HO CHI MINH CITY IMPACTS OF HEALTH INSURANCE IN VIETNAM ON HEALTHCARE UTILIZATION, SELF-REPORTED HEALTH, AND FINANCIAL CHOICES.. . beneficiaries'' healthcare behaviors This thesis examines the impacts of health insurance in Vietnam on a range of healthcare behaviors, including healthcare usage, out -of- pocket spending, financial decisions,