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People's willingness to pay for health insurance in rural Vietnam
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.ORCID iD: 0000-0002-5348-7698
Institute of Health Economics, Edmonton, Canada.
Dept. of Health Economics, Faculty of Public Health, Hanoi Medical University, Vietnam.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
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2008 (English)In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, Vol. 6, 16- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The inequity caused by health financing in Vietnam, which mainly relies on out-of-pocket payments, has put pre-payment reform high on the political agenda. This paper reports on a study of the willingness to pay for health insurance among a rural population in northern Vietnam, exploring whether the Vietnamese are willing to pay enough to sufficiently finance a health insurance system.

METHODS: Using the Epidemiological Field Laboratory for Health Systems Research in the Bavi district (FilaBavi), 2070 households were randomly selected for the study. Existing FilaBavi interviewers were trained especially for this study. The interview questionnaire was developed through a pilot study followed by focus group discussions among interviewers. Determinants of households' willingness to pay were studied through interval regression by which problems such as zero answers, skewness, outliers and the heaping effect may be solved.

RESULTS: Households' average willingness to pay (WTP) is higher than their costs for public health care and self-treatment. For 70-80% of the respondents, average WTP is also sufficient to pay the lower range of premiums in existing health insurance programmes. However, the average WTP would only be sufficient to finance about half of total household public, as well as private, health care costs. Variables that reflect income, health care need, age and educational level were significant determinants of households' willingness to pay. Contrary to expectations, age was negatively related to willingness to pay.

CONCLUSION: Since WTP is sufficient to cover household costs for public health care, it depends to what extent households would substitute private for public care and increase utilization as to whether WTP would also be sufficient enough to finance health insurance. This study highlights potential for public information schemes that may change the negative attitude towards health insurance, which this study has uncovered. A key task for policy makers is to win the trust of the population in relation to a health insurance system, particularly among the old and those with relatively low education.

Place, publisher, year, edition, pages
BioMed Central, 2008. Vol. 6, 16- p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-10325DOI: 10.1186/1478-7547-6-16PubMedID: 18691440OAI: oai:DiVA.org:umu-10325DiVA: diva2:149996
Available from: 2008-08-13 Created: 2008-08-13 Last updated: 2015-04-29Bibliographically approved
In thesis
1. The injury poverty trap in rural Vietnam: causes, consequences and possible solutions
Open this publication in new window or tab >>The injury poverty trap in rural Vietnam: causes, consequences and possible solutions
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The focus of this study is the vicious circle of poverty and ill-health. The case is injuries but it could have been any lasting and severe disease. Poverty and health have very close links to economic development and to how health care is financed. Out-of-pocket payment seems to increase the risk of poverty while prepaid health care reduces it. The overall objective is to investigate the “injury poverty trap” and suggest possible solutions for it. A cohort of 23,807 people living in 5,801 households in Bavi district of Vietnam was followed from 1999 to 2003 to investigate income losses caused by non-fatal unintentional injuries in 2000 as well as the relationships between social position in 1999 and those injuries. For the possible solutions, a survey in 2064 household was performed to elicit people’s preferences and willingness to pay for different health care financing options. The results showed that unintentional injuries imposed a large economic burden on society, especially on the victims. By two pathways – treatment costs and income losses – unintentional injury increased the risk of being poor. The losses for non-poor and poor injured households were about 15 and 11 months of income of an average person in the non-poor and poor group, respectively. Furthermore, poverty was shown to be a probable cause of non-fatal unintentional injuries. Specifically, poverty led to home injuries among children and the elderly, and adults 15 – 49 years of age were particularly at risk in the workplace. The middle-income group was at greatest risk for traffic injuries, probably due to the unsafe use of bicycles or motorbikes. About half of the population preferred to keep an out-of-pocket system and the other half preferred health insurance. People’s willingness to pay suggested that a community-based health insurance scheme would be feasible. However, improvements in the existing health insurance systems are imperative to attract people to participate in these or any alternative health insurance schemes, since the limitations of the existing systems were generalized to health insurance as a whole. A successful solution should follow two tracks: prepayment of health care and some insurance based compensation of income losses during the illness period. If the risk of catastrophic illness is more evenly spread across the society, it would increase the general welfare even if no more resources are provided.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin, 2005. 182 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 990
Keyword
unintentional injury, poverty, out-of-pocket payment, health insurance, Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-627 (URN)91-7305-958-7 (ISBN)
Public defence
2005-12-09, 09:00 (English)
Supervisors
Available from: 2005-11-16 Created: 2005-11-16 Last updated: 2010-01-29Bibliographically approved
2. Catastrophic health expenditure in Vietnam: studies of problems and solutions
Open this publication in new window or tab >>Catastrophic health expenditure in Vietnam: studies of problems and solutions
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In Vietnam, problems of high out-of-pocket payments for health, leading to catastrophic health expenditure and resulting impoverishment for vulnerable groups, has been at focus in the past decades. Since the beginning of the 1990’s, the Vietnamese government has launched a series of social health insurance reforms to increase prepayment in the health sector and thereby better protect the population from the financial consequences of health problems.

Objective: The objective of this thesis is to contribute to the discussion in Vietnam on how large the problems of catastrophic health expenditure are in the population as a whole and in a special subgroup; the elderly households, and to assess important aspects on health insurance as a means to reduce the problems.

Methods: Catastrophic health expenditure has been estimated, using an established and common method, from two different data sources; the Epidemiological Field Laboratory for Health Systems Research (FilaBavi) in the Bavi district, and Vietnam Household Living Standards Survey (VHLSS) 2010. Results from two cross-sectional analyses and a panel study have been compared, to gain information on whether the estimates of catastrophic health spending may be overestimated when using cross-sectional data. Then, the size of the problem for one group, the elderly households; hypothesized to be particularly vulnerable in this context, has been estimated. The question of to what extent a health insurance reform; the Health Care Funds for the Poor (HCFP), has offered protection for the insured against health spending is being assessed in another study over the period 2001 – 2007, using propensity score matching. The value that households attach to health insurance has also been explored through a willingness to pay (WTP) study.

Results: Comparing results from two cross-sectional studies with a panel study over a full year in which the respondents were interviewed once every month, the estimates of catastrophic spending vary largely. The monthly estimates in the panels study are half as large as the cross-sectional estimates; the latter also having a recall period of one month. Among the elderly households, catastrophic health spending and impoverishment are found to be problems three times as large as for the whole population. However, household health care expenditure as a percentage of total household expenditure was affected by the HCFP, and significantly reduced for the insured. In the study of household WTP for health insurance, it was iiifound that households attach a low value to this insurance form; WTP being only half of household health expenditure.

Conclusions: Cross-sectional studies of catastrophic spending with a monthly recall period are likely to be affected by recall bias leading to overestimations through respondents including expenditure in the period preceding the recall period. However, such problems should not deter researchers form studying this phenomenon. If using the same method, estimates of catastrophic spending and impoverishment can be compared between different groups – as for the elderly households – and over time; e.g. studying the protective capacity of health insurance. It should be used more, not less. The VHLSS rounds offer the Vietnamese a possibility to regularly study this. The HCFP were found to be partly protective but important problems remain to be solved, e.g. the fact that people are reluctant to use their health insurance because of e.g. quality problems and possible discrimination of the insured. The findings of a low WTP for health insurance may be another reflection of this.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 121 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1673
Keyword
Catastrophic health expenditure, impoverishment, elderly, health insurance, Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-93259 (URN)978-91-7601-129-4 (ISBN)
Public defence
2014-10-10, Sal B, Rosa salen, 9 tr, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2014-09-19 Created: 2014-09-15 Last updated: 2015-04-29Bibliographically approved

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Löfgren, CurtEmmelin, AndersLindholm, Lars

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