Impact of health insurance on health care utilization in Vietnam

Background. Economic and social reforms in Vietnam had huge impact on its health care system, resulting in higher private health expenditure and lower consumption of essential services among high need groups. A health insurance system of mandatory and voluntary schemes was introduced in 1992.;Objectives. The current study aimed at investigating the impact of health insurance programs on health care utilization in terms of curative outpatient care utilization, preference of public provider for curative outpatient care and preventive care utilization.;Methods. Data from the Vietnam National Health Survey (VNHS) conducted in 2002 were used in the study, including a total of 36,000 households and 158,019 individuals. Analyses were carried out separately on the two subpopulations eligible for compulsory and voluntary insurance programs. A bivariate probit estimation procedure was used to identify and correct for selection bias. A robust estimation method was integrated into the analyses to correct for heteroskedasticity.;Results. Individuals with health insurance were found more likely to use both curative and preventive care. The magnitude of the impact was the greatest among individuals from the poorest families and smallest among individuals from the richest families. Enrollees with the compulsory scheme were more likely to use public care provider when ill. Such preference was no seen among enrollees with the voluntary scheme, who used public or private providers with equal likeliness.;Conclusions. Health insurance programs in Vietnam achieved its expected goal in increasing health service utilization on a national level. Moreover, the programs enhanced social welfare and equity by creating a differential positive impact that was the greatest among the poorest and smallest among the richest in using preventive services. Preference to public providers over private ones were identified among enrollees of the compulsory program but absent among enrollees of the voluntary program. This most likely stemmed from differences in benefits packages by the two programs and suggested needs for strengthening of the primary care infrastructure, an upgrade of benefits package in the voluntary scheme and an expansion and more regulation of private sector in health care.