Umeå University's logo

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.

User fees at public health care facilities and out-of-pocket payments for health care services are major health financing problems in Vietnam. In 2002, the Government launched the Health Care Funds for the Poor (HCFP) policy which offered free public health care services to help the poor access public health services and reduce their health care expenditure (HCE). This paper is an assessment of the implementation of the HCFP in a rural district of Vietnam. The impacts of HCFP on household HCE as a percentage of total expenditure and health care utilization were assessed by a double-difference propensity score matching method using panel data of 10,711 households in 2001, 2003, 2005 and 2007. The results showed that the HCFP significantly reduced the HCE as a percentage of total expenditure and increased the use of the local public health care among the poor. However, the impacts of HCFP on the use of the higher levels of public health care and the use of go-to-pharmacies were not significant. In conclusion, this assessment indicates that the HCFP has met its objectives by reducing HCE for the poor and increasing their use of the local public health care services. However, further efforts are needed to help them access higher levels of public health care. Pharmacists should be better regulated and incorporated with primary health care to improve efficiency of the system.

Objective: To describe the proportion of the households that experienced catastrophic health expenditure and to compare the magnitude of catastrophic health expenditure that is estimated from three different data sets in Vietnam.

Methods: The study we are comparing with is based on data from the Vietnam Living Standard Survey (VLSS) 1997/98. We have used data from the 2001 re-survey. The FilaBavi sample consists of 11,089 households. We have also conducted a special survey from July 2001 to June 2002. The sample is smaller, 629 households, but they have been followed for an entire year with monthly interviews. For VLSS and FilaBavi, re-census survey households were interviewed once with a recall period of one month.

Findings: In the VLSS data and in the FilaBavi re-census survey it was found that 9%-10% of the households experienced catastrophic healthcare spending. But, only 5% (average per month) and 1% (for the whole year) of the households in the special survey report catastrophic spending.

Conclusions: We suggest that the major reason for the difference in the estimates is the different data collection methods. When doing a cross sectional study with a relatively short recall period there is a risk that households will tend to overestimate non-recurrent large expenditures as that for health.