Factors Impact on Revenues of the Health Insurance Fund in Vietnam

1 INTRODUCTION revenues also increased rapidly, thus the burden on the state budget reduces Rationale of the Study significantly In particular, the poor, those who are living in remote and isolated areas Social insurance and health insurance are great social policies of our Party and have opportunities to get health care through health insurance with the great help from Government These kinds of insurance are always main factors in the social security the Government However, the deployment process of health insurance policies in system of each country, especially today when the Earth's climate is changing rapidly our country has always faced difficulties and challenges Among these difficulties, in a negative direction and aging speed of population is happening rapidly In our fiscal health insurance, health insurance revenues and expenditures to ensure the country, after the economy has transfered to the market economy, the Party and State health insurance fund balances to emerging issues is always the toughest issue This is have had clear views and policies relating to medical field under the spirit of the because, collecting money cannot cover costs, which leads to imbalance in the health Party's Sixth Congress: "State and citizens are working together "[31] From this point insurance fund Meanwhile, health insurance is the main and important financial of view, health insurance policies were launched and gradually were developed until source for each country to cover the costs of medical care for people when they are today At the VIII Congress of the Party, opinion relating to developing health sick, which makes social security sustainable insurance was included in the Resolution orientation for the first time Accordingly, So how can we balance the income - cost health insurance fund in Vietnam? This "investment for the State is increased, and other funding sources such as health is a tough, the difficult problem, because it is a broad "economics - society" matter insurance are created more for health insurance to develop" [32 ] After that, the Only one left-hand sided issue of this equation (revenue MI) also has a lot of issues Congress IX stated that: "Implementing social justice in health care, and try to needed to be resolved, such as; health insurance revenues, organizing the collection, universalize health insurance in the future" [33] In the Congress X and XI, the managing and collecting health insurance opinion of the Party and the State about developing universal health insurance has From this reality, the author does not have the ambition to find an absolute shown more clearly under the spirit: "Building a diversity social security system, solution for this precise big problem, but the author expected to find a part of the strongly develop social insurance system, health insurance and try to develop universal solution and decided to choose the research title: "The factors impact to the revenues health insurance for the whole citizens "[34,35] Realizing these views and of the health insurance fund in Vietnam" for this dissertation in economics orientations, we have institutionalized health insurance policies with a series of legal Purpose of the Study documents and started with the Decree 299 / HĐBT in 1992, the Decree 58/1998 / - To systematize the basic theoretical issues relating to revenue, revenue ND-CP of 1998, the Decree 63/2005 / ND-CP in 2005 and the most important was the Health insurance Policies adopted by the National Assembly on 14.11.2008 and was come into effect from the date 01/7/2009 Since health insurance was applied in our country so far, its impact on life society economy has been great Specifically, thanks to the policy, the number of insured people increased rapidly over the years, there have been nearly 70% of the population benefited from health insurance Accordingly, health insurance fund development and factors that impact the health insurance fund revenues - Analysis of the current situation and the factors impacting to health insurance revenue in Vietnam Thereby, the dissertation clarifies the factors that mainly impact revenues of the health insurance fund - Recommend perspectives, orientation, solutions to develop the health insurance fund revenue in Vietnam 3 Objects and Scope of the Study provinces and cities nationwide and staff collecting insurance and the Vietnamese - Research Objects: Factors affecting to health insurance fund revenues social Insurance board of examination; The author randomly chooses 60 employers - Scope of the study: selected from enterprises in Hanoi; Intentionally selects 200 employees who were + Space: Revenues and factors affecting to the health insurance fund revenue in insured in Da Nang; 110 people in Hanoi who are not insured are purposely choosen Vietnam (including compulsory health insurance and voluntary health insurance) The total surveys collected for primary information are 770 questionnaires + About Time: The dissertation focuses on studying real situation of income and The survey results are: the author collected 394 questionnaires from revenue the factors affecting to health insurance fund revenue in Vietnam Especially since the managers, social workers who check social insurance from the entire 63 provinces health insurance policies went into implementation from 2010 to 2014 with and cities across the country, 52 questionnaire from enterprises, 196 comparative analysis with the operation period of health insurance activities since its questionnaires from insured people and 103 questionnaires from people without founding in 1992 up to now Thereby, the dissertation proposes solutions to develop valid health insurance coverage the health insurance fund revenues, contributing to balance the health insurance fund From the information in the questionnaires, the primary data are processed Research Method through SPSS software to analyze, synthetic and clarify the factors affecting to health Descriptive cross-sectional research method is employed with combination of insurance fund revenues Integrated approaches to analysis mainly used are qualitative and quantitative methods The dissertation uses some common techniques disaggregated statistics and indicators in combination with the comparative method, such as collecting information, statistics and synthesize to analyse revenues and factors that impact health insurance fund revenues The dissertation uses the methodology of dialectical materialism and historical materialism to further clarify and systematize the basic theoretical issues about health insurance, health insurance fund revenues Method to collect information: Information is gathered from secondary data including statistical yearbook of the General Statistics Office of Vietnam (GSO), the survey data about Vietnam Household Living Standard (VHLSS in 2010 and 2012) of the GSO with technical assistance from World Bank From the annual report on the collection of social insurance Vietnam, the data collected from the related ministries and agencies such as the Ministry of Labour, Invalids and Social Affairs, Ministry of Health, Ministry of Finance Information sources gathered from the primary data are the direct survey and interview from insured subjects through the questionnaire including: Intentional survey collected from 400 managers, inspectors of the Social Insurance from all 63 with reference to clarify the contents to be analyzed Methods to analysis and synthesis: On the basis of accumulated knowledge about health insurance, health insurance financing combined with consulting materials both inside and abroad in this field, the author analyzes, synthesizes and systematizes indepth the basic theoretical issues about health insurance, collected money and revenues of the health insurance fund as well as the factors affecting the revenue Statistical Methods: The dissertation uses synthetic statistics methods such as statistical disaggregation method, indices, reference on the collection situation, the factors affecting the health insurance fund revenues Then it proposes suitable solutions for the development of the health insurance fund revenue in Vietnam to operate safely, sustainably health insurance fund Research Overview about revenues and the factors affecting to the revenues of the health insurance fund 5.1 Studies in the world Diamond;P, 1992, Organizing the Health Insurance Market, Econometrica, 60 (6), 1233 - 1254 [77] Joint NGO Briefing Paper, May 2008: "Health Insurance in low - income countries" [68] 6 Phạm Thị Thu Hường (2013) " Voluntary health insurance in the province of Vinh Phuc - problems and solutions ", Economic Dissertation [47] Research of the American Medical Association (2005) "Expanding US health Dr Đỗ Văn Sinh (2011) “Scientific evaluation schemes to evaluate operation insurance: AMA proposal for reform", "Mở rộng bảo hiểm y tế Mỹ - dự án cải cách of social security funds, health insurance, forecast balance calculations social security AMA" [66] funds, health insurance until 2020 and vision to 2030” [34] Carrin G (2002) "Social health insurance in developing countries: A continuing challenge" [74] Dey, M.S and Flinn, C.J., 2005, An Equilibrium Model of Health Insurance Provision and Wage Determination, Econometrica, 73 (2), 571 - 627 [76] Borrell, C., Fernandez, E., Schiaffino, A., B enach, J., Rajmil, L., Villalbi, J.R 5.3 Issues needed for further study Theoretical Gaps: the concepts of the health insurance fund revenues, distinguishing revenue collection activities with health insurance, evaluation indicator system assessing the growth of the revenue, the factors affecting the revenues of the health insurance fund and Segura, A., 2001, Social class inequalities in the use of and access to health Gaps in research methodology: Since most of the factors affecting the health services in Catalonia, Spain: what is the influence of supplemental private health insurance fund's revenues are qualitative factors, and there are only few quantitative insurance?, International Journal for quality in Healthcare, 13 (2), 117 – 125 [72] indicators are: The number of objects and structure of object insured health insurance Euson T, San PB Health clarges and exemptions in Vietnam Bamako Initiontive Operations Research Programme Paper No 1, 1996, UNICEF New York [81] Hiroi Yoshinnosi (professor, Univercity ChiPa) “Social security, medical insurance in Japan and suggestions to apply in Vietnam” [35] 5.2 Studies in Vietnam Lê Minh Phiêu (2010): " Reorganization of Vietnamese health insurance system " – Montesquieu University - France [41] premiums Therefore, the dissertation uses survey methods using questionnaires with respondents are: health insurance managers, different stakeholders to collect the primary data Then the author uses the method to synthesize, analysize data sources to assess the impact of each factor to the health insurance fund revenues Gaps in practice: The dissertation conductes a comprehensive, detailed and objective analysis factors affecting the revenues of the health insurance fund in Vietnam Analysis of factors affecting to health insurance fund revenues in Vietnam to be Ass.Prof Dr Phạm Tất Dong Dr Đàm Viết Cương (9/2002) "User fees, studied from the perspective of management and policy makers as well as policy health insurance and the use of health services" in the health cooperation program implementation Therefore, solutions and recommendations of the dissertation are to Vietnam - Sweden [46] purify the policy and it is expected that these policies will quickly come to real life Dr Trần Văn Tiến (2002) in the book " User fees, health insurance and the New Contributions of the Study use of health services, also has a journal titled "The draft of the roadmap towards - New academic, theoretical contributions: universal health insurance " [65] + The dissertation studies and puts forward the concepts of the health insurance Phạm Lương Sơn (2012): "Study drug bidding situation for the base health insurance and treatment in Vietnam " – Economic Dissertation [44] Dr Lê Duy Đồng Dr Bùi Sỹ Lợi (2001) published the book " Orientations policy on social development and social development management period 2011 - 2020" [38] fund revenues, distinguishing revenue to processing, health insurance collecting mechanism + Identifies factors that affect to the income of the health insurance fund, explains and clarifies contents of each factor 7 CHAPTER + Proposes indicators to assess the development of the health insurance fund revenues RATIONALE AND PRACTICES OF FACTORS IMPACTING TO REVENUES OF THE HEALTH INSURANCE FUND - New findings drawn from the research findings: + Analysis and clarify the status of revenue collection and the health insurance fund in Vietnam (2010-2014) 1.1 Background of health insurance 1.1.1 The concept and characteristics of health insurance + Clearly identifies factors affecting to the health insurance fund revenue in 1.2.1.1 Concepts Vietnam, including policies and laws on health insurance; objects and structure of Health insurance is a policy of the State Social security, with community, risk- participants; the rate and method of collecting health insurance; Working mechanisms sharing characteristics, based on the contributions of those who participated in the and organization of the collection; the propagation and dissemination of policies and fund, with the support and patronage of the State for the purpose of paying the cost of legislation; the monitoring and inspection of the implementation of health insurance medical care for members in the community when they are sick, get diseases It runs and the coordination between the authorities involved in health insurance with non profit + Proposes some solutions to develope the health insurance fund revenues; including measuring policies and implementing health insurance policies in Vietnam Conclusion Besides the introduction, conclusion, list of references, appendices The thesis is structured into three chapters: Chapter 1: Rationale and practice on the factors affecting the revenues of the health insurance fund Chapter 2: Analysis of the factors affecting the revenues of the health insurance fund in Vietnam Chapter 3: The views, orientation and development solutions revenues of the health insurance fund in Vietnam 1.1.1.2 Characteristics of health insurance Health insurance is an objective, diversified and complex need of a society; Health insurance is a social policy lying in a system of social security policies of each country Sharing financial calculation, risk sharing important contents are always the nature of health insurance Health insurance involves a lot of parties, depending on the types of health insurance 1.1.1.3 Features of health insurance Firstly, health insurance is a social policy with broad, diversed object with great coverage; therefore, it should be legalized Secondly, health insurance operates with non profit Thirdly, health insurance always reflects economical, social, humanitarian and noble humanity Fourthly, the financial resources meeting the needs in health insurance policies always encounter complex difficulties because eligible subjects for health insurance are extensive Fifthly, the development of policies and institutions implementing of health insurance policies in different countries are different 9 1.1.2 The role of health insurance 1.1.2.1 Protecting financial situation for participants 10 1.2.2.3 Assessment indicators for the development of the health insurance fund revenues 1.2.2.2 Covering health care for the entire population The number of insured employees relating working (1) 1.1.2.3 Reducing budget burden for the State Number of agencies taking part in insurance as a must (2) 1.1.2.4 Ensuring main responsibilities in the system of social security policies Amount of receivable insurance (3) 1.1.3 Main activities of health insurance The number of insured employees relating working(L) (4) 1.1.3.1 Disseminating policy relating health insurance legislation The number of agencies taking part in insurance (D) (5) 1.1.3.2 Allocating health insurance cards Real amount of money collected from insurance (T) (6) 1.1.3.3 Operating income - expenditure and investment of the health insurance fund The growth rate of insured employees relating to working ( t L ) 1.1.3.4 Coorperating in organizing health insurance The growth rate of agencies taking part in insurance ( t D ) 1.2 The health insurance fund and health insurance fund revenues The growth rate of revenues from health insurance ( t T ) 1.2.1 The health insurance fund 10 The average of health insurance contribution per employee relating to The health insurance fund is an independent financial fund, working outside the state budget The formation, existence and development of the health insurance fund always has its own purpose and subject: 1.2.2 The revenues of the health insurance fund 1.2.2.1 Concept The revenues of the health insurance fund are the contributions of the stakeholders, revenues from operating activities and other sources to mainly cover working ( M ) 11 The growth rate of health insurance contributions for workers relating to working ( t M ) 12 Number of insured employees without labour relation ( C N ) (12) 13 Revenue from the health insurance from employees without labor relations ( TN ) (13) 14 The growth rate of the insured employees without labour relation ( TCN ) health care costs for participants when they get sick or have diseases as prescribed 15 The growth rate of revenues from employees without labour relation ( t TN ) legally and carried out by the health insurance agency 16 Mức đóng góp BHYT bình qn người chưa có quan hệ lao động 1.2.2.2 The need of developing health insurance fund revenues Developing revenues for the health insurance fund also means to increase the number of participants and potential contribution of subjects and object groups This năm ( M N ) 17 The average contribution level of health insurance from those who not have health insurance ( TMN ) most critical issue not only relates to health insurance agency but also relates to all 18 Number of people participating health insurance ( D Y ) levels and sectors 19 Proportion of population with health insurance ( TD ) 20 Annual total income in health insurance ( TY ) 21 The growth rate of insured people in general ( t D ) 11 12 22 The growth rate of insurance revenue in general ( t TY ) 1.4.1.3 In Korea 23 The annual health insurance contribution rate per insured person ( M D ): 1.4.1.4 In Thai land 24 The general growth rate of insurance contributions ( t MY ): 1.4.1.5 In Taiwan 25 Interest received from investing activities of idle health insurance fund ( LY ) (25) 1.4.2 Health insurance fund sources in Vietnam 1.4.2.1 Appearance and development 26 Profitability rate from investment activities ( Te ) In addition, in view of the fund management, the development of the health insurance fund revenue must also put in balance relationship between income and expenses It also needs considering: Total expenditure Total annual revenue from health insurance = KCB for the insured a/ 1992 – 2008 period b/ 2009 - 2014 period 1.4.2.2 Organization Management of Vietnam Health Insurance Administration + expenses in during the year + Annual Preventive the year 1.3 Factors impact on revenues of the health insurance fund 1.3.1 Legal policies on health insurance 1.3.2 Social and economic conditions 1.3.3 The awareness of the people about popular propaganda policy on health insurance policies 1.3.4 Quality health care for those participating health insurance 1.3.5 Organizatiing to collect health insurance 1.3.6 Inspection, testing and monitoring 1.3.7 Participants and organization of the insured people 1.3.8 Health insurance premiums 1.4 Revenues and development of the health insurance fund revenues in some countries in the world and lessons for Vietnam BHXH Huyện Chi trả cho đại lý 1.4.1 Revenues and developing health insurance fund revenues in some countries in the world 1.4.1.1 In the Federal Republic of Germany 1.4.1.2 In Japan Hình 1.1: The organization system of Vietnam Social Insurance 13 14 1.4.2.3 The coverage rate of health insurance in Vietnam CHAPTER The government set a target of 2020, the coverage rate is minimum 80% ANALYSIS ON FACTORS AFFECTING TO THE REVENUES Table 1.1: Number of participants by health insurance type Number of health Year insurance participants Health insurance compulsary voluntary participation participation OF HEALTH INSURANCE FUND IN VIETNAM Health insurance 2.1 Current status of the revenues and collected revenues of Vietnam health insurance People Growth People Growth People Growth 2.1.1 Sources of health insurance revenues and results (million) rate (%) (million) rate (%) (million) rate (%) Sources of health insurance fund include: 2010 50.184 - 46.024 - 4.159 - 2011 52.094 1,038 47.110 1,024 4.987 1,199 Profits from investment activities of the health insurance fund 2012 58.977 1,132 53.494 1,136 5.483 1,099 Sponsorship, donation from domestic and oversea organizations and 2013 63.018 1,069 55.950 1,046 7.068 1,289 2014 64.608 1,025 57.039 1,019 7.568 1,071 Fund collected under the Health Insurance Law; individuals Other legal sources "(Act 33 - Law of Health Insurance) Source: Vietnam Health Insurance [4] Table 2.1: The results of health insurance (2010-2014) 1.4.2.4 Lessons for Vietnam Total income of compulsory collected Voluntary collected Firstly, health insurance policy needs to be organized appropriately according to health insurance health insurance health insurance each economic - social development period of the country Year Secondly, voluntary health insurance is a coming step to progress to universal health insurance Thirdly, the State should always support the health insurance fund 2010 Fourthly, the determination of health insurance premiums should have specific regulations for each type of health insurance 2011 Fifthly, the State management issues for health insurance should be determined Sixthly, social health insurance is necessarily sponsored by the State 2012 amount Growth amount growth amount growth (billion Rate ( %) (billion rate (%) (billion rate (%) VND) VND) 23.305,2 21.759,3 VND) 1.545,9 31.829,4 136,6 29.724,2 136,6 2.105,1 136,2 40.176,9 126,2 37.758,3 127,0 2.417,6 114,8 48.433,8 120,6 44.685,1 118,3 3.748,7 155,1 55.026,0 113,6 51.027,3 114,2 3.998,7 106,7 Sevenly, the State needs to accelerate the complete health care market 2013 2014 Source: Vietnam Social Insurance [4] 15 16 2.2 Analysis of factors affecting the income of the health insurance fund in Rate of health insurance Vietnam Health insurance rate is regulated in Act 13 of the Law on Health Insurance Year Table 2.2: The average fee of health insurance (2010-2014) 2.2.1 Health insurance policy General insurance 2.2.2 Social and Economic conditions Compulsory health Voluntary health insurance insurance Table 3.4: The relationship between economic growth - income and health Average Growth Average Growth Average Growth rate per rate (%) rate per rate (%) rate per rate (%) person person person (VND) (VND) (VND) - 473.029 - insurance rate (2010-2014) Indicator Unit 466.105 2011 571.621 131,3 612.104 120,8 526.290 136,2 2012 692.689 113,2 712.422 124,6 483.524 91,9 2013 768.790 111,0 812.456 114,0 535.530 110,8 rate/person 2014 859.781 111,8 895.215 110,2 571.244 106,7 386.488 - Average income/person/month Source: Vietnam Social Insurance [4] Income growth rate The average health insurance The growth rate of health insurance 2.1.3 Organisating the collection of health insurance The average growth rate of prices 2.1.4 The revenue and expenditure balance sheet of the health insurance fund of medical services Table 2.3: Surplus income - cost health insurance fund (2010-2014) Unit: billion 2011 2012 2013 6.78 5.96 5.25 5.42 1,000 VND 1,150 1,179 1,196 1,294 1,464 Income% - 2.6 1,000 VND 466.1 612.1 692.6 768.7 859.7 - 31.5 13.4 10.8 11.9 - 14.7 17.6 19.6 22.4 Economic growth rate 2010 Year 2010 Health insurance Total expenses Revenues - expenses Gross insurance differences 4=2–3 2010 23.305 18.895 4.410 2011 31.829 24.753 7.076 2012 40.176 33.419 6.757 2013 48.434 39.060 9.374 2014 55.026 45.550 9.476 Note: The data does not include hedge and management funds Source: Vietnam Social Insurance [4] Premiums % services% 1.8 7.2 2014 5.65 % 14.8 Source: GSO - Vietnam Social Insurance [46] The dissertation applies the following research models: a) Model 1: the probability of participating voluntary health insurance Accreditation results multicollinearity provides the following results: Variable | VIF / VIF + primary |0.130580 7.66 Secondary|0.170446 5.87 Highschool| 5:39 0.185368 quintiles_5 |0.271461 3.68 Quintiles_4| 3:44 0.290361 17 18 quintiles_3 | 3:21 0.311263 (margin) of going to health care center or not to the probability of their choice in quintiles_2 |0.361636 2.77 buying voluntary medical insurance, about 38% of people who go to health care Reg8_8|0.608112 1.64 center compared with 32% of people not From the regression results in table Reg8_7| 1:54 0.648215 and figure 1, it is implied that those who go to health care center for health reg8_5 | 1:42 0.704634 reg8_4 | 1:38 0.726024 reg8_2 | 1:35 0.738252 reg8_6 | 1:24 0.807133 urban | 1:16 0.860509 visited | 1:15 0.872969 treatment should be encouraged and propagated to purchase voluntary health insurance To reinforce this claim, column line shows that people spending on health insurance will spend about 24% higher in health insurance than those who not when other elements unchanged The study took the first quintile of income (or low income groups) as a standard reg8_3 | 1:10 0.907788 for comparison Probability of purchasing voluntary health insurance rose steadily year_1 | 1:09 0.915149 according to income level This means that the higher income families have, the more business | 1:09 0.920389 they will be able to participate in voluntary medical insurance Specifically, the high hhsize | 1:08 0.927807 income group will have a double probability of participating health insurance than female | 1:01 0.993172 poor groups Thus, to facilitate and increase revenue for voluntary health insurance, - + we should focus on the target groups at the upper and middle class Mean VIF | 2:41 Next, the ethnic minorities have a lower probability of voluntary insurance than This result shows that the model has no multicollinearity phenomenon and it is the Kinh and Hoa groups This is largely because they are poor or vulnarable groups in estimated that the model's variables are statistically significant at 1% (excluding a the society, along with they are issued health insurance cards for free and they often coefficient) That R-squared result of the Logit model is low (6%) is consistent with live in rural and mountainous areas The table statistics show that the number of the characteristics of this model form R-squared of the regression model OLS at people participating in voluntary medical insurance in rural areas is 2/3 times higher 18.5% due to the studies using independent variables are qualitative variables while than those in urban, but the ability to participate is lower, 0.39 compared to 0.32 the dependent variable is the dependent variable for the purpose of comparing the respectively (Figure 3.9) In fact, the difference is negligible so we should focus on difference of the group rather than the beat General price Such results will provide encouraging both rural and urban people to participate in voluntary health insurance higher recommendation because the health insurance policy is a broadly covered What is noteworthy here is that spending on health insurance in urban and rural areas policy for the entire population rather than policies focusing on a specific target is not statistically significant, we expected that people living in urban areas will spend group more on health insurance; however, this expectation has not been demonstrated This The group seeking treatment at health units will have a higher probability of buying medical insurance than those who don’t go to medical units for treatment (first row, column 1) More specifically, Figure 3.8 shows the marginal influence could be a negative signal to those livng in rural areas, because they have to spend for health insurance as much as people living in urban areas 19 20 Table 2.5: Calculation of the factors affecting health insurance revenue in Vietnam 2.2.3 The propagation of policy and legislation under the two types of subjects: compulsory subjects and voluntary subjects 2.2.4 Quality of heath treatment under health care insurance 2.2.5 Participation procedure, charging and expenditure of health insurance for medical expenses 2.2.6 Inspecting, checking and monitoring health insurance Type of health 2.2.7 Participants, structure and participants and the premium of health insurance Health insurance Number of premiums average participants in (1,000 VND / medical insurance person) (million) (billion) (billion) (billion) insurance To see the impact of theses quantitative factors to the health insurance fund revenues of Vietnam, the writer used composite index method in statistical and secondary data sources of the Vietnam social insurance agency for analysis, namely: - If the symbol of participants in 2013 and 2014 are and - If the symbol of health insurance premiums in 2013 and 2014 are then a composite index system with factors will be set up as follow: Compulsory health insurance Voluntary health and insurance General 812.4 895.2 55.9 57.0 45413.2 51026.4 46306.8 535,5 571,2 7,0 7,5 3.748,5 4.284,0 4.016,2 781,59 857,53 62,9 64,5 49.161,7 55.310,4 50.323,0 Source: The author’s investigation documents a) the relative number: 2.3 General assessment of revenues development and other factors affecting the income of health insurance in Vietnam 2.3.1 Achievements Firstly, revenue is increasingly expanding and relatively stable, because subjects ( 1) b) the absolute number: (2) (3) participating health insurance is rapidly growing, especially in this kind of voluntary health insurance Secondly, health insurance has the most powerful and largest to the income of health insurance fund in both relative and absolute numbers Thirdly, due to economic and social conditions are stable, despite the economic crisis, the pace of economic growth remained relatively high compared with other countries in the region and around world Fourthly, all of these factors, either qualitative or quantitative, more or less impact on the health insurance fund revenues, but their aggregate impact is important Fifthly, in the recent stage of implementing the Health insurance Law, annual revenues are rising, therefore, basically balance income - cost is ensured 21 22 Difference between revenue - expenses of the previous years is always higher than CHAPTER the following years 2.3.2.Limitation and the cause Firstly, the views and perceptions about health insurance are not really sufficient Secondly, the propulgation of laws and policy documents guiding the implementation has been slow compared to the proposed schedule Thirdly, statistical indicator system serves revenue management has not yet been complemented and quotas of receivables has not been assigned Fourthly, quality of health treatment and health insurance is still weak, which leads to the fact that a majority of people not want to participate Fifthly, in recent time, management subject participating compulsary health insurance is not strick Sixthly, the procedures for registration of voluntary health insurance are inadequate Seventhly, investment of idle funds from health insurance has not yet been realized PERCEPTION, ORIENTATION AND SOLUTIONS FOR DEVELOPMENT FUND REVENUES OF HEALTH INSURANCE IN VIETNAM 3.1 Perception and orientation for development of health insurance fund in Vietnam 3.1.1 Perception Firstly, the health insurance fund's revenues must always be the goal of growth and development Secondly, all related levels and relevant departments must be responsible for directing and guiding people to participate under the health insurance law Thridly, developing health insurance fund's revenues must tie to economic social conditions of the country in each period Fourthly, developing health insurance fund must be linked to income nourishing source of revenue for the health insurance fund Fifthly, the health insurance fund revenue must be managed under law and inspection and supervision of revenues must be strengthened Sixthly, policies of the Party and the State must always be advocated thoroughly in the process of developing revenue sources 3.1.2 Orientation and objectives to develop Vietnam health insurance fund revenues 3.1.3.1 Orientation - Increasing revenue for the health insurance fund based on contributions from the community - Health insurance premiums must be adjusted in accordance with the Health insurance Law in period - Managing closely the health insurance fund, preventing revenue loss, and abuse against the health insurance fund - Exploitating other financial resources to contribute to the development of health insurance fund 3.1.3.2 Goals of developing resource for insurance fund - Overall objective: Mobilizing all resources for a full health insurance premium, 23 and legally for forming the health insurance fund Ensuring a stable and sustainable development for health insurance fund, and balancing the revenue - expenses Gradually decreasing the support from the State B, Specific goals: - Collecting accuratedly and fully and timely health insurance fee - Closely managing the participants, especially people in regional non-state enterprises, preventing health insurance fund losses; - Strengthening sanctions for violations of insurance law, such as evasion, arrears, escape fees to develop revenue for sustainable health insurance fund 3.2 Solutions to develop revenues of the health insurance fund in Vietnam 3.2.1 Further concretizing and improving the health insurance policies and legislation system 3.2.2 Strengthening and spreading propaganda developments policy on health insurance legislation 3.2.3 Closely managing the insured subjects, especially those relating to working 24 CONCLUSION The dissertation "The factors affecting the health insurance fund revenues in Vietnam" has contributed as follow: / Systematizating the theoretical issues about health insurance and health insurance fund revenues including: Concepts, classification and the role of health insurance; Revenues of the health insurance fund, to distinguish the collection of revenues; factors affecting the health insurance fund revenues In particular, the dissertation has researched and proposed a system of statistical indicators assessing the development of health insurance fund revenues Showing expericen in developing health insurance fund revenues in several countries around the world, from which it draws some lessons for Vietnam / Analyzing and assessing the current status of health insurance revenues in the 2010 - 2014 period; factors affecting the revenue of the health insurance fund in Vietnam in recent years Through analysis, the dissertation clarified the obtained results, as well as limited problems in collecting and developing health insurance fund revenues, as well as limited reasons / Recommending perspective system and solutions to develop health insurance 3.2.4 Raising the quality of health care treatment of health insurance 3.2.5 Renewing the collection and management of the health insurance fund revenues 3.2.6 Investing effectively reserve funds and the amount of idle money in the fund revenue in Vietnam Although there are certain theoretical contributions as well as collections and analysis of actual development of the health insurance fund revenue in Vietnam are health insurance provided through secondary sources and primary with an aim to clarify the factors that 3.2.7 affect revenue, the sample size of the survey is still not high, so the results analysis Promoting the application of information technology and gradually modernizing information technology in health insurance management and evaluation is still more or less limited As a policy of the Party and the State, a 3.2.8 Concretizing functions, tasks and issues related to health insurance agents pillar in the social security policies system, health insurance, the revenue and the 3.2.9 Strengthening inspection, inspection and strictly handle individuals and factors that impact the health insurance fund revenues need to be further studied If the organizations that commit violations of insurance law 3.3 Recommendations 3.3.1 For the Congress income of the health insurance fund sustainably develops, the goal of universal health insurance in our country will become a reality The solutions and recommendations to develop health insurance fund revenues 3.3.2 For the Government in Vietnam as well as the content is presented in the dissertation certainly has not yet 3.3.3 For Ministry of Health completed and there are many shortcomings; therefore, the author would like to 3.3.4 For Vietnam Social Insurance receive additional comments, contributions from economists, of all interested people 3.3.5 For the Party committees and governments to further complete the disseration