Two Essays on Health Care in Vietnam

This dissertation consists of two papers that investigate aspects of health care in Vietnam. The first paper evaluates the effects of the Free Health Care Card program for children under six on health care utilization, out-of-pocket spending, and self-reported health outcomes. The second paper studies the determinants and the overall impact of informal payment.;First introduced in 2005, the free health care for children program provides free health care for all children under six regardless of their families' income and location. I use two research designs: difference-in-differences and regression discontinuity design to evaluate the effects of the program. While the DID estimator represents the differences between the pre-post, within-subjects differences of the treatment and control groups, the fuzzy RD design estimates the Local Average Treatment Effect (LATE). The data is culled from the Vietnam Household Living Standard Survey 2002-2008. In the difference-in-differences design, children age 6-10 group is the control group and children age 0-5 is the treatment group. I find that health insurance is associated with a 20% increase in the probability of an outpatient visit for all children and a 56% increase in the probability of an inpatient visit for children aged 0-2. Insurance is also associated with a 69% reduction in inpatient out-of-pocket spending for children age 3-5 and a 30% reduction in number of sick days. Nevertheless, health insurance is not associated with a reduction in out-of-pocket spending for outpatient visits for children.;The fuzzy regression discontinuity design takes advantage of the fact that children become ineligible for the under-six program when they turn 6 years old. As a result, children slightly younger than 72 months are entitled to free health care while those slightly older than 72 months are not. The fuzzy regression discontinuity results are consistent with the difference-in-differences results. Children under six are approximately 21 percentage points more likely to have health insurance compared to children just over six years old. Children under six are also more likely to visit outpatient facilities than their over six counterparts. In addition, children under six have lower out-of-pocket spending for both inpatient and outpatient visits. Thus, the RD results can be explained in the local of age six, i.e. children of the age just under six (e.g. age 5) versus children of the age just over six (e.g. age 7). These results illustrate the importance of expanding the range of benefits as well as the need to tailor public health programs to specific groups. The government may increase subsidies for children in poor families while reducing support for children from better-off families.;The second paper investigates the determinants and impacts of informal payments in the health care sector in Vietnam. Outpatient patients at private facilities are less likely to make informal payment compared to those at public facilities. Inpatient patients who show higher willingness to pay with the use of on-demand health care services are 52 percentage points more likely to pay informally, and when they do, they pay 177 percent higher amounts compared to patients who do not use on-demand services. Patients who endure a need for serious medical care such as an accident or a maternal visit are more likely to make informal payments compared to those with chronic conditions. Inpatient patients who use central hospitals are 26 percentage points more likely to pay informally compared to patients at district hospitals, and they also pay 180 percent higher amounts. Using the Altonji et al method, I find that informal payment is associated with a reduction in the number of sick days. Patients who pay informally are more likely to stay longer at an inpatient facility, which is a sign of better quality in the context of a developing country.;The findings from this dissertation are potentially of interest to other middle and low income countries who are considering health insurance reform. The dissertation also highlights a possible venue for researchers interested in the long-term consequences of health insurance expansion and informal payment on health outcomes.