IDEAS home Printed from https://ideas.repec.org/a/kap/ijhcfe/v23y2023i2d10.1007_s10754-022-09330-z.html
   My bibliography  Save this article

Trends in out-of-pocket expenditure on facility-based delivery and financial protection of health insurance: findings from Vietnam’s Household Living Standard Survey 2006–2018

Author

Listed:
  • Phuong Hung Vu

    (National Economics University)

  • Ardeshir Sepehri

    (University of Manitoba)

  • Linh Thi Thuy Tran

    (Thang Long University)

Abstract

Much of the existing empirical literature on the association between health insurance and out-of-pocket (OOP) expenditures on facility-based delivery in low- and middle-income countries is cross sectional in nature. Comparatively little is known about the dynamic shifts in OOP expenditures and the health insurance nexus. Using seven biennial waves of Vietnam’s Household Living Standard Survey covering the period 2006–2018 and a generalized linear model this study examines trends in OOP expenditures on facility-based delivery and financial protection afforded by Vietnam’s social health insurance system. Over the period under consideration, the pattern of health facility utilization among the insured shifted steadily from commune health centers towards higher-level government hospitals. Real OOP for delivery was 52.7% higher in 2018 than in 2006–2008 and insurance reduced OOP expenditures by 28.5%. Compared to district hospitals, giving birth at higher-level government hospitals increased OOP expenditures by 72.3% while giving birth at commune health centers reduced OOP expenditures by 55.7%. Additional analysis involving interactions between insurance status, types of public health facility and year dummies suggested a drop in financial protection of insurance, from 48% to 26.9% among women delivering at district hospitals and from 31.2 to 18.7% among those delivering at higher-level government hospitals. The modest financial protection of health insurance and its declining trend calls for policy measures that would strengthen the quality of maternal care at primary care institutions, strengthen financial protection and curb the provision of two-tiered clinical services and charges.

Suggested Citation

  • Phuong Hung Vu & Ardeshir Sepehri & Linh Thi Thuy Tran, 2023. "Trends in out-of-pocket expenditure on facility-based delivery and financial protection of health insurance: findings from Vietnam’s Household Living Standard Survey 2006–2018," International Journal of Health Economics and Management, Springer, vol. 23(2), pages 237-254, June.
    • Handle: RePEc:kap:ijhcfe:v:23:y:2023:i:2:d:10.1007_s10754-022-09330-z
    DOI: 10.1007/s10754-022-09330-z
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10754-022-09330-z
    File Function: Abstract
    Download Restriction: Access to full text is restricted to subscribers.
    File URL: https://libkey.io/10.1007/s10754-022-09330-z?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Agar Brugiavini & Noemi Pace, 2016. "Extending health insurance in Ghana: effects of the National Health Insurance Scheme on maternity care," Health Economics Review, Springer, vol. 6(1), pages 1-10, December.
    2. Karen Eggleston & Li Ling & Meng Qingyue & Magnus Lindelow & Adam Wagstaff, 2008. "Health service delivery in China: a literature review," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 149-165, February.
    3. Srinivas Goli & Moradhvaj & Anu Rammohan & Shruti & Jalandhar Pradhan, 2016. "High Spending on Maternity Care in India: What Are the Factors Explaining It?," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-17, June.
    4. Storeng, Katerini Tagmatarchi & Baggaley, Rebecca F. & Ganaba, Rasmané & Ouattara, Fatoumata & Akoum, Mélanie S. & Filippi, Véronique, 2008. "Paying the price: The cost and consequences of emergency obstetric care in Burkina Faso," Social Science & Medicine, Elsevier, vol. 66(3), pages 545-557, February.
    5. Federico Belotti & Partha Deb & Willard G. Manning & Edward C. Norton, 2015. "twopm: Two-part models," Stata Journal, StataCorp LLC, vol. 15(1), pages 3-20, March.
    6. Jacky Mathonnat & Martine Audibert & Salam Belem, 2020. "Analyzing the Financial Sustainability of User Fee Removal Policies: A Rapid First Assessment Methodology with a Practical Application for Burkina Faso," Applied Health Economics and Health Policy, Springer, vol. 18(6), pages 767-780, December.
    7. Sepehri, Ardeshir & Sarma, Sisira & Oguzoglu, Umut, 2011. "Does the financial protection of health insurance vary across providers? Vietnam's experience," Social Science & Medicine, Elsevier, vol. 73(4), pages 559-567, August.
    8. Sebastian Bauhoff & David R. Hotchkiss & Owen Smith, 2011. "The impact of medical insurance for the poor in Georgia: a regression discontinuity approach," Health Economics, John Wiley & Sons, Ltd., vol. 20(11), pages 1362-1378, November.
    9. Nguyen, K.T. & Khuat, O.T.H. & Ma, S. & Pham, D.C. & Khuat, G.T.H. & Ruger, J.P., 2012. "Impact of health insurance on health care treatment and cost in Vietnam: A health capability approach to financial protection," American Journal of Public Health, American Public Health Association, vol. 102(8), pages 1450-1461.
    10. Ajay Tandon & Aparnaa Somanathan & Huong Lan Dao & Kari L. Hurt & Hernan L. Fuenzalida-Puelma, 2014. "Moving toward Universal Coverage of Social Health Insurance in Vietnam : Assessment and Options," World Bank Publications - Books, The World Bank Group, number 18885.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Nshakira-Rukundo, Emmanuel & Mussa, Essa Chanie & Gerber, Nicolas & von Braun, Joachim, 2020. "Impact of voluntary community-based health insurance on child stunting: Evidence from rural Uganda," Social Science & Medicine, Elsevier, vol. 245(C).
    2. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    3. Lin, Lin & Zai, Xianhua, 2022. "The Power of Public Insurance With Limited Benefits: Evidence from China's New Cooperative Medical Scheme," GLO Discussion Paper Series 1180, Global Labor Organization (GLO).
    4. repec:dem:wpaper:wp-2022-025 is not listed on IDEAS
    5. Ali, Shehzad & Cookson, Richard & Dusheiko, Mark, 2017. "Addressing care-seeking as well as insurance-seeking selection biases in estimating the impact of health insurance on out-of-pocket expenditure," Social Science & Medicine, Elsevier, vol. 177(C), pages 127-140.
    6. 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.
    7. Currie, Janet & Lin, Wanchuan & Zhang, Wei, 2011. "Patient knowledge and antibiotic abuse: Evidence from an audit study in China," Journal of Health Economics, Elsevier, vol. 30(5), pages 933-949.
    8. Yamei Bai & Aaron Yao & Yulei Song & Guihua Xu, 2018. "Redesigning the patient classification system in China: A pilot study," Nursing & Health Sciences, John Wiley & Sons, vol. 20(2), pages 181-186, June.
    9. Pan, Jay & Qin, Xuezheng & Li, Qian & Messina, Joseph P. & Delamater, Paul L., 2015. "Does hospital competition improve health care delivery in China?," China Economic Review, Elsevier, vol. 33(C), pages 179-199.
    10. Cheung, Diana & Padieu, Ysaline, 2015. "Heterogeneity of the Effects of Health Insurance on Household Savings: Evidence from Rural China," World Development, Elsevier, vol. 66(C), pages 84-103.
    11. Michael Essman & Lindsey Smith Taillie & Tamryn Frank & Shu Wen Ng & Barry M Popkin & Elizabeth C Swart, 2021. "Taxed and untaxed beverage intake by South African young adults after a national sugar-sweetened beverage tax: A before-and-after study," PLOS Medicine, Public Library of Science, vol. 18(5), pages 1-17, May.
    12. Phuong Huu Khiem & Yu-Chen Kuo, 2022. "Health insurance reform impact on children’s educational attainment: evidence from Vietnam," Review of Economics of the Household, Springer, vol. 20(4), pages 1255-1285, December.
    13. Schoeni, Robert F. & Cho, Tsai-Chin & Choi, HwaJung, 2022. "Close enough? Adult child-to-parent caregiving and residential proximity," Social Science & Medicine, Elsevier, vol. 292(C).
    14. Neelsen, Sven & Limwattananon, Supon & O'Donnell, Owen & van Doorslaer, Eddy, 2019. "Universal health coverage: A (social insurance) job half done?," World Development, Elsevier, vol. 113(C), pages 246-258.
    15. Anshul Kastor & Sanjay K Mohanty, 2018. "Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing?," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-18, May.
    16. Rize Jing & Tingting Xu & Xiaozhen Lai & Elham Mahmoudi & Hai Fang, 2019. "Technical Efficiency of Public and Private Hospitals in Beijing, China: A Comparative Study," IJERPH, MDPI, vol. 17(1), pages 1-18, December.
    17. Qian Long & Weixi Jiang & Di Dong & Jiaying Chen & Li Xiang & Qiang Li & Fei Huang & Henry Lucas & Shenglan Tang, 2020. "A New Financing Model for Tuberculosis (TB) Care in China: Challenges of Policy Development and Lessons Learned from the Implementation," IJERPH, MDPI, vol. 17(4), pages 1-11, February.
    18. Li Zhang & Qian Zhang & Xinru Li & Weiya Shao & Jingyu Ma & Ruijie Zhang & Angdi Zhou & Jinghua Li, 2022. "The effect of patient perceived involvement on patient loyalty in primary care: The mediating role of patient satisfaction and the moderating role of the family doctor contract service," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(2), pages 734-754, March.
    19. Ermagun, Alireza & Stathopoulos, Amanda, 2018. "To bid or not to bid: An empirical study of the supply determinants of crowd-shipping," Transportation Research Part A: Policy and Practice, Elsevier, vol. 116(C), pages 468-483.
    20. Melberg, Andrea & Diallo, Abdoulaye Hama & Storeng, Katerini T. & Tylleskär, Thorkild & Moland, Karen Marie, 2018. "Policy, paperwork and ‘postographs’: Global indicators and maternity care documentation in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 215(C), pages 28-35.
    21. Caballer-Tarazona, Vicent & Guadalajara-Olmeda, Natividad & Vivas-Consuelo, David, 2019. "Predicting healthcare expenditure by multimorbidity groups," Health Policy, Elsevier, vol. 123(4), pages 427-434.

    More about this item

    Keywords

    Facility-based delivery; Out-of-pocket expenditure; Health insurance; Vietnam;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:kap:ijhcfe:v:23:y:2023:i:2:d:10.1007_s10754-022-09330-z. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.