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Catastrophic health expenditure and impoverishment in Vietnam: Evidence from national Household Living Standards Surveys 2008–2018

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  • Thuong, Nguyen Thi Thu

Abstract

One of the strategic objectives of the Vietnamese government in achieving universal health coverage (UHC) is to develop a sustainable, equitable, and effective health financing system. This study aimed to examine the incidence and intensity of catastrophic health expenditure (CHE) and impoverishment in Vietnam at different thresholds of expenditure. The data were obtained from six national representative Household Living Standards Surveys from 2008 to 2018. We found that the incidence and intensity of CHE declined significantly over study years. Additionally, we found a substantial reduction in the incidence and intensity of medical impoverishment in Vietnam. The increase in the poverty gap in 2012 and 2014 was because non-poor households became poor after out-of-pocket (OOP) health payments. However, the rise in poverty gaps in 2008, 2010, 2016 and 2018 was attributable to the worsening state of existing poor households after healthcare payments. In addition, we found that the CHE rate and impoverishment were more concentrated in the poor quintile groups. Furthermore, we found that the Red River Delta had the highest CHE rate, whereas the Northern Midland region experienced the strongest poverty impact of OOP payments. Generally, in Vietnam, the health financing system has had no considerable success in reducing inequality across quintiles and regions. Finally, our findings revealed that health insurance showed positive impacts on households’ financial protection against CHE and impoverishment, after enacting both the first Health Insurance Law in 2009 and the Revised Health Insurance Law in 2015. The results suggest that the health insurance scheme should be reviewed to continue reducing CHE and impoverishment, promoting equity and enhancing the performance of the health financing system in Vietnam.

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  • Thuong, Nguyen Thi Thu, 2021. "Catastrophic health expenditure and impoverishment in Vietnam: Evidence from national Household Living Standards Surveys 2008–2018," Economic Analysis and Policy, Elsevier, vol. 72(C), pages 668-684.
    • Handle: RePEc:eee:ecanpo:v:72:y:2021:i:c:p:668-684
    DOI: 10.1016/j.eap.2021.10.009
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    2. He, Wen, 2023. "Social medical insurance integration and health care disparities in China: Evidence from an administrative claim dataset," Economic Analysis and Policy, Elsevier, vol. 79(C), pages 20-39.

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    More about this item

    Keywords

    Vietnam; Catastrophic health expenditure; Poverty; Equity; Health insurance;
    All these keywords.

    JEL classification:

    • D31 - Microeconomics - - Distribution - - - Personal Income and Wealth Distribution
    • D63 - Microeconomics - - Welfare Economics - - - Equity, Justice, Inequality, and Other Normative Criteria and Measurement
    • I32 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Measurement and Analysis of Poverty
    • G52 - Financial Economics - - Household Finance - - - Insurance
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality

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