The impact of non profit health insurance on treatment seeking behavior the case of vietnam(vhlss 2006

NATIONAL ECONOMICS UNIVERSITY HANOI INSTITUTE OF SOCIAL STUDIES THE HAGUE VIETNAM-NEITHERLANDS CENTER FOR DEVELOPMENT ECONOMICS AND PUBLIC POLICY The impact of non-profit health insurance on treatment seeking behavior: The case of vietnam (VHLSS 2006) A thesis presented by LE TUAN SANG In partial Fulfillment of the Requirement for Obtaining the Degree of Master of Arts in Development Economics Supervisor: Prof Ardeshir Sepehri, PhD ii HANOI 2011 DECLARATION I hereby certify that this thesis has used materials that has been accepted or with out copied of any other degrees or diplomas at any other academic institutions By learning and my knowledge, the thesis contains no sources and materials previously published or written by other persons, except the references listed Hanoi, June 2011 Le Tuan Sang ACKNOWLEDGEMENT By completing the thesis, I would like to express my gratitude to people who gave me a great support and assistance to complete this thesis First of all, I would sincerely express to thanks my suppervisor, Prof Dr Ardeshir Sepehri for his support, guidance and comments to allow my thesis to be completed I would specially thanks to Prof Vu Thieu, Dr Nguyen T.T Mai and Dr Giang Thanh Long for their encouragement, comments and patience during the long course of my thesis preparation Sincere thanks to all my friends for their time and guidance in the course of my econometrical estimation and interpretation of Probit regression results Finally, I would sincerely express to thanks my family and specially from my wife who gave me an encouragement and a contritbution of finance during my study Le Tuan Sang June 2011 ABSTRACT In Vietnam, there are some studies on health care services and it gives out some significant ruslts of influence on policy makers However, these studies still have some limitations due to data as well as information updates By using very rich date set from the Vietnam Household Living Standards Surveys 2006 (VHLSS 2006), the thesis has explicitly estimated the effect of health insurance on utilization of all types of health care services and providing detailed information on both of individual health and household status and the type of provider sought covering all provinces Beside, the thesis also estimated the impact of health insurance on health care utilization by the poor In addtion, by the stusdy period covered 12 months, the thesis is better capture seasonal effects as well as other time- related dimensions of health treatment behaviors within a year Findings of the thesis has been suggested that individuals are propensity to visiting or admission to health facilitaties, specially for public health facilitation and the insured is no effect on the frequency of outpatient visit to public providers Deeply, the result of thesis showed that the groups of health insurance/free health card for the poor and children under YOs is commune clinics and the group of compulsory health insurance mainly visited public polyclinics, district hospital or higher level of public health facilities TABLE OF CONTENTS DECLARATION ACKNOWLEDGEMENT .3 ABSTRACT LIST OF ABBREVIATIONS .7 LIST OF TABLES LIST OF FIGURES .9 CHAPTER I 10 Introduction: 10 Research questions 13 Objectives and scope of the study: 13 Data and Methodology: 14 Structure of the thesis 15 CHAPTER II: LITERATURE REVIEW 16 Literature review in general 16 Studies of utilization on healthcare in Vietnam 18 CHAPTER III: HEALTH CARE SYSTEM AND HEALTH UTILIZATION IN VIETNAM .21 Introduction of healthcare system in Vietnam 21 1.1 Public health care system 21 1.2 Private health care system 22 Health care utilization 24 2.1 No treatment and self-medication 24 2.2 Inpatient services 25 2.3 Outpatient services utilization 26 2.4 The schemes of health insurance in Vietnam 27 2.5 Heath care for the poor 28 CHAPTER IV: METHODOLOGY AND EMPIRICAL RESULT .30 Methodology and data 30 1.1 Methodology 30 1.1.1 Logit model 30 1.1.2 Count regression models 31 1.2 Model selection .33 1.3 Data 33 Variable description 34 Descriptive analysis .72 Econometric results .76 CHAPTER V: FINDINGS AND POLICY IMPLICATIONS .83 CHAPTER VI: CONCLUSION 84 REFERENCES 87 LIST OF ABBREVIATIONS CHI : Compulsory Health Insurance CHS : Commune Health Station DHO : District Health Office DPC : District People’s Committee GSO : General Statistics Office HCFP : Health Care Fund for the Poor JHUES : Healthcare Utilization and Expenditure Survey JHUES : Jordan Healthcare Utilization and Expenditure Survey MOH : Ministry of Heath OOP : out-of-pocket PHD : Provincial Health Department PPC : Provincial People’s Committee VHI : Voluntary Health Insurance VHLSS : Vietnam Household Living Standards Surveys LIST OF TABLES Table 1: Health insurance coverage by expenditure quintiles 35 Table 2: The use of outpatient care across providers by the insurance status and the type of insurance .36 Table 3: Decomposition of utilization by health facilities, inpatients 37 Table 4: Number of outpatient contacts per person 38 Table 5: Number of inpatient contacts per person 39 Table 6: Probability of health facilities contacts in general Odd ratio 40 Table 7: The results for contacts and frequency of outpatient contacts at the commune health centres .48 Table 8: Probability of out-patient contacts and Frequencies of contacts: public polyclinics/hospitals 56 Table 9: Probability of out-patient contacts and Frequency of contacts: Private clinics/hospitals 61 Table 10: Probability of in-patient contacts and frequency of contacts: public polyclinics/hospitals .66 10 LIST OF FIGURES Firgue 1: Distribution of inpaatient contacts across healthfacilities by rural and urban population 25 Figure 2: Health insurance coverage by expenditure quintiles 72 Figure3: Percentage of health contacts of different groups of health insurances .73 ... afore-mentioned studies, the thesis examines the impact of Vietnamese health insurance on treatment seeking behaviors of the insured, with a further focus on those of the insured under the health insurance. .. information on health insurance and a discriptive analysis of data (ii) It presents empirical analysis of the impact of health insurance schemes, with focus on the health insurance for the poor, on the. .. Beside, the thesis also estimated the impact of health insurance on health care utilization by the poor In addtion, by the stusdy period covered 12 months, the thesis is better capture seasonal