Effects of demand side health financing programs in developing countries - Evidence from Vietnam

This dissertation consists of three papers which address different demand-side targeted health financing programs in Vietnam. Each chapter uses one or several of the four recent surveys: the Vietnam National Health Survey 2001/02 and the three rounds of the Vietnam Household Living Standard Surveys 2002-04-06.;In the first chapter, I measure the early (as of 2004) and later (as of 2006) impact of the Health Care Fund for the Poor Program, which came into effect in 2003. I employ a difference-in-differences approach to assess the program's intention to treat effect, and I use the program's rule to instrument for insurance status to evaluate the effect of obtaining insurance from the program. To address the potential measurement error of the officially designated eligibility status, I estimate this variable using household ownership of assets and other characteristics. The evaluation among adults ages 20-60 in the informal sector reveals a large increase in the utilization of covered public services and a decrease in the utilization of uncovered private services. However, the program also increased out-of-pocket expenditure on health services.;Applying the conceptual framework and methodology from the first chapter, the second chapter evaluates the 2004 Policy on Free Health Care for Children under Six. To build on the knowledge gained from the first chapter, I exclude children from households eligible for the Health Care Fund for the Poor Program using an eligibility status estimated from the data. I found a significant increase in inpatient care at the secondary, district hospitals among all children ages 0-5 and a reduction of 1.7-2 sick days among children ages 4-5.;The last chapter estimates the demand for health insurance among students ages 6-20. My analysis reveals that the level of premium and availability of insurance are explained more by the provincial fixed effects than commune socio-economic factors. Conditioned on having access to insurance, demand increases with expected benefits as measured by proximity to and quality of tertiary hospital. There is a strong socio-economic gradient both at the household and commune levels, with wealthier, higher educated households in better off communes significantly more likely to purchase insurance for their kids.