Impacts of health insurance in Vietnam on healthcare utilization, self-reported health, and financial choices

Abstract

As in many other low- and middle-income countries, Vietnam is implementing a social health insurance program as one method of reaching universal health coverage. In addition to serving as a health financing mechanism for universal health coverage, this program undoubtedly impacts the beneficiaries' healthcare behaviors. This thesis examines the impacts of health insurance in Vietnam on a range of healthcare behaviors, including healthcare usage, out-of-pocket spending, financial decisions, and self-reported health. Based on a conceptual framework derived from the theoretical literature, the present thesis includes three sub-studies in the form of three essays to investigate the impacts of health insurance on healthcare utilization, out-ofpocket expenditure, and households' financial choices; and the effect of the copayment scheme on self-reported health. A regression discontinuity design was used to study the effects of healthcare use and out-of-pocket spending with data from the Vietnam Household Living Standard Survey. Impacts on households' financial choices and self-reported health were investigated using data from the Thailand-Vietnam Socio-economic Panel surveys. A recursive multivariate probit model was used to examine the effects of health insurance on households' financial choices, while propensity score matching was employed to analyze how the removal of co-payments affected patients' assessments of their own health. The results of the first sub-study demonstrated that insurance helps individuals reduce the expenditures per outpatient visit but has no effect on the outcomes, including the likelihood of an outpatient visit, the probability of an inpatient visit, the number of outpatient visits, the number of inpatient visits, and the expenditures per inpatient visit. The second sub-study revealed that, although health insurance has no influence on private insurance, it has positive effects on savings and investment and a negative impact on credit choice. The third sub-study discovered that co-payment exemption has a favorable impact on the self-reported health of the insured. In addition, the exemption for co-payments has varied effects across income levels and locations.