Out-of-Pocket Health Expenditures Among Insured and Uninsured Patients in Vietnam

Abstract

Out-of-pocket expenditure/payment (OOP) is one of the indicators measuring the achievement of Universal Health Coverage. This article aimed to compare OOP among the insured and uninsured for their outpatient and inpatient health care services. The data of 6710 individuals using outpatient care and 924 individuals using inpatient care at 78 district hospitals and 246 commune health centers in 6 provinces from the World Bank survey, "The 2015 Vietnam District and Commune Health Facility," were used for analysis. In the ordinary least square model, the estimated coefficient of the insurance status variable suggested that insurance reduced OOP by 31.1% for outpatient care and 31.5% for inpatient care of the insured as compared with the uninsured (P <0.001). For outpatient care, insurance reduced OOP more for those enrollees using commune health centers than those using district health facilities, 42.3% and 20.2%, respectively. For inpatient care at district health facilities, insurance reduced OOP by 34.9% as compared with the uninsured (P <0.001). The study suggested that more active solutions should be created to promote the universal health insurance in Vietnam.

Impact of Public Health Insurance on Out-of-Pocket Health Expenditures of the Near-Poor in Vietnam

“…12 The same conclusion was made about the substantial reduction of the poor's OOP spending for health. 13 This finding was recently reported in the studies conducted in countries such as Vietnam, India and Thailand [14][15][16][17] where significantly lower OOP expenditures occurred among insured individuals more than the uninsured for outpatient healthcare services used. Also, most of the literature in these studied above mentioned that the type of out-patient visits at private or public health facilities was a determinant of financial burden on house-holds expenditure.…”

“…This finding was consistent with other studies. 8,14,21,24 The Heckman model also indicated that those residing in urban areas had lower health care payments than those residing in rural areas. This finding was similarly to other studies reporting no significant association between urban residence and private health payments.…”

“…Yet these studies showed that the health status or expenses on diagnostics were as a contribute factor in high OOP spending and frequent result from out-patient care. [14][15][16] This study aimed to describe the OOP payments concerning outpatient healthcare services of the near-poor and to identify the impact of public health insurance on the private spending of this target group in Cao Lanh District, Dong Thap Province, Vietnam.…”

Pooling financial resources for universal health coverage: options for reform

“…[14][15][16] Gaps in automatic or compulsory coverage mean that population groups who are not covered are likely to have higher out-of-pocket expenditure, with the ensuing financial burden resulting in lower use of services. 12,17 In summary, merely introducing compulsory or automatic coverage can be both unfeasible and insufficient on its own, as it needs to be accompanied by subsidies for those who cannot contribute, as discussed below.…”

The COVID-19 global pandemic: a review of the Vietnamese Government response

“…Total health expenditure was estimated at approximately 6.6% of the total GDPand up to 31.3% of health care costs are out-of-pocket. [13][14][15] Vietnam is one of the five countries including Japan, the Republic of Korea, Thailand and the United States of America (USA) where COVID-19 cases were first confirmed outside of China; however, Vietnam was fast to implement impressive and effective control measures against COVID-19. 16 The first two cases in Vietnam were identified on 23 rd January.…”